Blastomycosis-blastomycosis symptoms-blastomycosis treatment-blastomycosis diagnosis

Blastomycosis-blastomycosis symptoms-blastomycosis treatment-blastomycosis diagnosis

Blastomycosis-blastomycosis symptoms-blastomycosis treatment-blastomycosis diagnosis-blastomycosis is a lung disease caused by the inhalation of spores of the dimorphic fungus Blastomyces dermatitidis; Occasionally, these fungi are disseminated hematogenously and cause extrapulmonary disease. Symptoms are secondary to the development of pneumonia or spread to various organs, most often to the skin. Diagnosis is based on clinical evaluation or chest radiography is confirmed by the identification of the fungus in laboratory tests. The treatment consists of itraconazole, fluconazole or amphotericin B.

See also Review on fungal infections and Practice guidelines for the management of patients with blastomycosis of the Infectious Diseases Society of America).

In North America, the endemic area of ​​blastomycosis includes

• watersheds of the Ohio and Mississippi Rivers (extended to the central states adjacent to the Atlantic Ocean and southeastern)
• Central Northwest
• North of New York
• Southern Canada

Rarely, the infection appears in the Middle East and in Africa.

Immunocompetent individuals can get the infection. Although blastomycosis may be more frequent and severe in immunodeficient patients, it is an opportunistic infection less common than histoplasmosis or coccidioidomycosis.

B. dermatitidis proliferates as a mold at room temperature in soil enriched with animal droppings and inorganic material wet and decomposing acid, often near rivers.

In the lungs, the inhaled spores become large (15 to 20 μm) and invasive yeasts, which form characteristic broad-based buds.

Once in the lungs, the infection can

• Stay localized
• Disseminate by the hematogenous route

The hematogenous spread causes localized infections in The various part organs, such as the skin, prostate, epididymides, testes, kidneys, vertebrae, ends of long bones, subcutaneous tissues, brain, buccal or nasal mucosa, the thyroid, the lymph nodes, and the bone marrow.

Blastomycosis-blastomycosis symptoms-blastomycosis treatment-blastomycosis diagnosis

Blastomycosis symptoms

It is possible that the lung infection does not cause symptoms. Symptoms may occur if the infection spreads. Symptoms may include:

• Joint pain
• Chest pain
• Cough (can produce a brown or bloody mucus)
• Fatigue
• Fever and night sweats
• Discomfort, discomfort or feeling of general indisposition (discomfort)
• Muscle pain
• Unintentional weight loss
• Most people developed skin symptoms when the infection spreads in their body. It is possible that papules, pustules or nodules appear in exposed areas of the body.

Blastomycosis-blastomycosis symptoms-blastomycosis treatment-blastomycosis diagnosis

The pustules:

• They may look like warts or ulcers
• They are usually painless
• They vary in color between gray and violet
• They can appear in the nose or mouth
• They bleed easily and form ulcers

Pulmonary

Pulmonary blastomycosis can be asymptomatic or cause a severe self-limiting disease that usually goes unnoticed. It can also manifest itself insidiously and become a chronic and progressive infection. Its symptoms include productive or dry metallic cough, chest pain, dyspnea, fever, chills, and profuse sweating.

Sometimes a pleural effusion appears. Some patients have rapidly progressive infections and can develop a syndrome of acute respiratory distress.

Blastomycosis-blastomycosis symptoms-blastomycosis treatment-blastomycosis diagnosis

Extrapulmonary

In generalized extrapulmonary blastomycosis, the symptoms depend on the compromised organ.

Cutaneous lesions are, by far, the most frequent site of dissemination; they can be solitary or multiple and associate or not with evident pulmonary involvement. Papules or papulopustules are usually identified on the exposed surfaces, which spread slowly. In the fronts of advance form painless abscesses, that can be from punctiform until of 1 mm of diameter. Irregular wart-like papillae can form on surfaces. Sometimes blisters develop. As the lesions enlarge, the centers heal and atrophic scars form. At its maximum development, an individual lesion presents as an elevated warty patch, generally ≥ 2 cm wide, with a well-defined edge of violet-red covered with abscesses. The lesion may ulcerate if a bacterial superinfection develops.

When bone lesions develop, the overlying areas are usually swollen, hot, and hypersensitive to palpation.

Genital lesions cause painful epididymal swelling, deep perineal discomfort or prostatic pain during the digital rectal examination.

CNS involvement may manifest as brain abscess, epidural abscess, or meningitis.

Blastomycosis-blastomycosis symptoms-blastomycosis treatment-blastomycosis diagnosis

Causes

You can get blastomycosis from contact with moist soil, most commonly where there are leaves and decaying vegetation. The fungus enters the body through the lungs, where the infection begins. Subsequently, the fungus spreads to other parts of the body. The disease can affect the skin, bones and joints, and other areas.

It is rare to get blastomycosis. It is found in the central and southeastern states of the United States and in Canada, India, Israel, Saudi Arabia and Africa.

The key risk factor for this disease is in contact with infected soil. It almost always affects people with weakened immune systems, such as those who have HIV / AIDS or have had an organ transplant. It can also infect healthy people.

Blastomycosis-blastomycosis symptoms-blastomycosis treatment-blastomycosis diagnosis

Blastomycosis diagnosis

• Crops and stains for fungi
• Blastomyces antigen in urine

If blastomycosis is suspected, a chest x-ray should be obtained. , where localized or diffuse infiltrates are identified that sometimes constitute patchy bronchopneumonia that extends towards the periphery from the hilum. These findings should be distinguished from other causes of pneumonia (eg, other mycoses, tuberculosis, tumors).

The skin lesions can be confused with those of sporotrichosis, tuberculosis, iodism or basal cell carcinoma. Genital involvement can simulate that of tuberculosis.

Cultures of the infected material must be obtained, which allow arriving at a diagnosis of certainty when they are positive. Because Blastomyces culture can pose a serious biological risk to laboratory personnel, it must be notified of the suspected diagnosis. The characteristic appearance of the microorganism, observed during the microscopic examination of the tissues or sputum, also usually makes it possible to arrive at the diagnosis.

Serological tests are not sensitive, but they are useful if their results are positive.

An antigen test in urine is useful, but cross-reactivity with Histoplasma is high.

Blastomycosis-blastomycosis symptoms-blastomycosis treatment-blastomycosis diagnosis

Blastomycosis treatment

• In the presence of mild or moderate disease, itraconazole
• In the presence of a serious infection that threatens the patient's life, amphotericin B

(See also Antifungal medications).

Untreated blastomycosis usually advances slowly and rarely causes the death of the patient.

The treatment of blastomycosis depends on the severity of the infection.

In mild or moderate disease, 200 mg of itraconazole should be administered orally three times a day for 3 days, followed by 200 mg orally once or twice a day for 6 to 12 months. Fluconazole appears to be less effective, but administration of between 400 and 800 mg orally once daily may be attempted in patients with mild disease who can not tolerate itraconazole.

In the presence of a severe infection that threatens the patient's life, amphotericin B IV is usually effective. The guidelines of the Infectious Diseases Society of America recommend a lipid formulation of amphotericin B at a dose of 3 to 5 mg/kg once / day or amphotericin B deoxycholate 0.7 to 1 mg/kg once / day for 1 to 2 weeks or until you notice an improvement.

The therapy is changed to oral itraconazole once the patients improve; the dose is 200 mg 3 times a day for 3 days, then 200 mg twice a day for ≥ 12 months.

Patients with CNS blastomycosis, pregnant and immunocompromised patients should be treated with intravenous amphotericin B (preferably liposomal amphotericin B), using the same dose scheme as for the life-threatening infection.

Voriconazole, isavuconazole, and posaconazole are active against B. dermatitidis, but clinical data are limited and their role in this infection has not yet been determined with precision.

Blastomycosis-blastomycosis symptoms-blastomycosis treatment-blastomycosis diagnosis

Expectations (prognosis)

People with minor skin ulcerations (lesions) and relatively mild lung infections generally recover completely. If the infection is not treated, it can cause death.

Pathogeny:

Clinical (symptomatology): Approximately half of the infections can be asymptomatic; however, the infection can lead to serious and fatal diseases, often due to respiratory failure (pneumonia is the most frequent manifestation). Disseminated infection can affect any organ, often includes skin abscesses and osteomyelitis, and is often accompanied by fever, weight loss, and night sweats.

Possible complications


Complications from blastomycosis may include:

Large ulcers with pus (abscesses)

• Skin lesions that can heal and lose skin color (pigment)
• The reappearance of the infection (relapse or recurrence of the disease)
• Side effects of medications such as amphotericin B
• When to contact a medical professional
• Check with your provider if you have symptoms of blastomycosis.

Blastomycosis-blastomycosis symptoms-blastomycosis treatment-blastomycosis diagnosis

Prevention

Avoiding travel to areas where the infection is known to occur can help prevent exposure to the fungus, but this may not always be possible.

Alternative names

North American blastomycosis; Gilchrist's disease
Key concepts

The inhalation of spores of the dimorphic fungus Blastomyces can cause lung disease and, less frequently, disseminated infection (particularly in the skin).

In North America, blastomycosis is endemic in the regions surrounding the Great Lakes and the valleys of Ohio and the Mississippi River (which extend into the states in the Mid-Atlantic and Southeast).

Diagnose using cultures of infected material; Serological testing is specific but not very sensitive.

In the presence of mild or moderate disease, use itraconazole

In severe cases, use amphotericin B

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