Blastomycosis history and symptoms
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: ; Vidit Bhargava, M.B.B.S [2] Aditya Ganti M.B.B.S. [3]
Symptoms
Clinical manifestations of Blastomycosis range from subclinical infection to fatal disseminated disease. Symptoms can be discussed under pulmonary and extra-pulmonary presentations.
Pulmunory Blastomycosis
Presents clinically as acute and chronic.
Acute
- The symptoms mimic with acute bacterial pneumonia presentation
- Presents with fever, chills, productive cough, with or without hemoptysis.
- Often self limited
Chronic
- Symptoms last for more that 2 months
- Presents with weight loss, fever, night sweats, cough with sputum, and chest pain
- This presentation can be confused with pulmonary tuberculosis, malignancy of lung
- ARDS can develop as a result of endobronchial spread of infection which is dreadful complication with high mortality rate.
Extra-Pulmonary blastomycosis
The most common extra pulmonary sites involved in blastomycosis are skin, bone, CNS.
Cutaneous blastomycosis
The cutaneous manifestations of blastomycosis come in two forms, verrucous and ulcerative.
| Verrucous | Ulcerative | |
|---|---|---|
| Location | Above the subcutaneous abscess | Drainout from subcutaneous abscess through skin |
| Morphology | Irregularly shaped lesions with raised and crusted borders | Heaped up borders with or without exudative base |
| Microscopic
findings |
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- A flu like illness with fever, chills, myalgia, headache, and a nonproductive cough which resolves within days.
- An acute illness resembling bacterial pneumonia, with symptoms of high fever, chills, a productive cough, and pleuritis.
- A chronic illness that mimics tuberculosis, other fungal infections or lung cancer, with symptoms of low-grade fever, a productive cough, night sweats, hemoptysis and weight loss.
- A fast, progressive, and severe disease that manifests as Acute respiratory distress syndomeARDS, with fever, shortness of breath, tachypnea, hypoxemia, and diffuse pulmonary infiltrates.
- Skin lesions, usually asymptomatic, appear as ulcerated lesions with small pustules at the margins or they can be verrucous with irregular margins, and color ranging from gray to violet. Skin lesions are usually a result of hematogenous spread but sometimes they can be inoculated directly due to animal bite (pet dogs).
- Bone lesions can lead to osteomyelitis, which can damage underlying bone and overlying skin leading to discharging sinuses. It presents with fever, bone pain, etc. Acute or chronic arthritis can develop due to underlying osteomyelitis.
- Prostatitis in men may be asymptomatic e or may cause pain on urinating, in women genito-urinary system involvement can lead to tubo-ovarian abscess or endometritis.
- Laryngeal involvement causes hoarseness.
- CNS(central nervous system) involvement can lead to meningtis, abscess, which can lead to focal neurological deficit's.
- Blastomycosis can include almost any other site such as liver, spleen, breast, lymph nodes etc.[1]