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]
Overview
Patients with blastomycosis may present with any of several patterns of illness from a flu like illness which resolves within days to asymptomatic presentation (30-50%). Because of the brief and self-limited nature of these symptoms, blastomycosis may go un-diagnosed. Alternatively, patients may present with an acute illness mimicking bacterial pneumonia, with high fever, chills, a productive cough, and pleuritic chest pain which in most cases gets treated with antibiotics. ARDS is the most feared complication of the chronic blastomycosis. Dissemination through blood or lymph can result in extra pulmonary blastomycosis, which commonly involves skin, bone, genitourinary system and central nervous system.
History
The significant information that needs to focused in the history of the patient includes
- Any history of travel to the endemic areas
- Any ill contact with similar complaints
Symptoms
Clinical manifestations of Blastomycosis range from subclinical infection to fatal disseminated disease. Symptoms are based on the involvement of organ systems:
Pulmonary Blastomycosis
Presents clinically as acute and chronic. The symptoms often mimic with bacterial pneumonia presentation. Most common symptoms include : [1]
- Fever with chills
- Productive cough
- Hemoptysis.
- Weight loss
- Night sweats
- chest pain
- ARDS can develop as a result of endo-bronchial 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, genitourinary and CNS.
Cutaneous blastomycosis
- The cutaneous manifestations of blastomycosis comes in two forms verrucous and ulcerative.[3]
- Cutaneous blastomycosis is often confused with basal cell or squamous cell carcinomas or pyoderma gangrenosum.
| Verrucous | Ulcerative | |
|---|---|---|
| Location | Above the subcutaneous abscess | Drain-out from subcutaneous abscess through skin |
| Morphology | Irregularly shaped lesions with raised and crusted borders | Heaped up borders with or without exudative base |
| Microscopic
findings |
| |
Oseous blastomycosis
- About 25% of the blastomycosis involve bone.
- Osteomyelitis is the most common presentation of oseous blastomycosis.[4]
- Most commonly involved bones include vertebrae, ribs, skull and long bones.[5]
- Infection can spread from the involved bone to surrounding joints (purulent arthritis) or soft tissue (subcutaneous abscess with draining sinus which can lead to the formation of an ulcer.[5]
- The most common complication of vertebral osteomyelitis is extension of infection from the spine, resulting para-vertebral or psoas abscess.
Genito-urinary
- About 10 % of the blastomycosis involves genitourinary system.
- In men the most commonly involved organs include prostate, testicles and epididymis.
- Epididymo-orchitis causes swelling and pain, and prostatitis is associated with dysuria and symptoms of obstruction.
- Involvement of female genitourinary system is rare but if involved it causes endometrial infection or tubo-ovarian abscess.
Central nervous system
- About 5-10 % of blastomycosis involve CNS.
- It presents as meningitis or mass lesion.[6]
- CSF analysis of WBC reveals neutrophilic predominance.[7]
- Laryngeal involvement causes hoarseness.
Other sites of disease
Blastomycosis can disseminate almost to any other site such as liver, spleen, breast, lymph nodes etc.[8]
References
- ↑ Smith JA, Gauthier G (2015). "New Developments in Blastomycosis". Semin Respir Crit Care Med. 36 (5): 715–28. doi:10.1055/s-0035-1562898. PMID 26398538.
- ↑ Smith, Jeannina; Gauthier, Greg (2015). "New Developments in Blastomycosis". Seminars in Respiratory and Critical Care Medicine. 36 (05): 715–728. doi:10.1055/s-0035-1562898. ISSN 1069-3424.
- ↑ Kauffman, Carol (2011). Essentials of clinical mycology. New York: Springer. ISBN 978-1-4419-6639-1.
- ↑ CARNESALE PL, STEGMAN KF (1956). "Blastomycosis of bone; report of four cases". Ann. Surg. 144 (2): 252–7. PMC 1465309. PMID 13355200.
- ↑ 5.0 5.1 Sanders, Louis L. (1967). "Blastomycosis arthritis". Arthritis & Rheumatism. 10 (2): 91–98. doi:10.1002/art.1780100203. ISSN 0004-3591.
- ↑ Bariola, J. Ryan; Perry, Paul; Pappas, Peter G.; Proia, Laurie; Shealey, Wesley; Wright, Patty W.; Sizemore, James M.; Robinson, Matthew; Bradsher, Robert W. (2010). "Blastomycosis of the Central Nervous System: A Multicenter Review of Diagnosis and Treatment in the Modern Era". Clinical Infectious Diseases. 50 (6): 797–804. doi:10.1086/650579. ISSN 1058-4838.
- ↑ Harley WB, Lomis M, Haas DW (1994). "Marked polymorphonuclear pleocytosis due to blastomycotic meningitis: case report and review". Clin. Infect. Dis. 18 (5): 816–8. PMID 8075280.
- ↑ Saccente, M.; Woods, GL. "Clinical and laboratory update on blastomycosis". Clin Microbiol Rev. 23 (2): 367–81. doi:10.1128/CMR.00056-09. PMID 20375357.