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Blastomycosis

Synonyms of Blastomycosis

  • Gilchrist's Disease
  • North American Blastomycosis

Disorder Subdivisions

  • No subdivisions found.

General Discussion

Blastomycosis is a rare infectious multisystem disease that is caused by the fungus Blastomyces dermatitidis. The symptoms vary greatly according the affected organ system. It is characterized by fever, chills, cough, and/or difficulty breathing (dyspnea). In the chronic phase of the disease, the lungs and skin are most frequently affected. The genitourinary tract and bones may also be involved.

Symptoms

Blastomycosis is an infectious disease characterized by fever, chills, headaches, chest pain, weight loss, night sweats, cough, and/or difficulty breathing (dyspnea). Some affected individuals do not experience these symptoms although they are actively infected (asymptomatic). Muscle and joint pain may occur during the acute stage which typically lasts less than three weeks. The disease may resolve on its own or persist into the chronic form of the infection. Chronic Blastomycosis, which lasts more than three weeks, may affect the lungs, skin, bones, joints, genitourinary tract, and/or central nervous system.

Involvement of the skin is very common in individuals with Blastomycosis. Wart-like (verrucous) and small raised pus-filled (papulopustular) lesions are common. They may be violet colored and have very small abscesses around the borders of the lesions. Nodular lesions may be present under the skin (subcutaneous) and are usually accompanied by active fungal infection of the lungs.

When Blastomycosis affects the lungs, which are common sites of fungal involvement, it usually takes the form of chronic pneumonia. Symptoms may include a cough ccompanied by thick sputum, chest pain, difficulty breathing, and/or rapid heartbeat. In some severe cases of Blastomycosis, Respiratory Distress Syndrome may develop, characterized by excessive deep and rapid breathing (hyperventilation) and insufficient levels of oxygen in the circulating blood (hypoxemia). Affected individuals typically require mechanical ventilation to assist breathing. (For more information on this disorder, choose "Respiratory Distress" as your search term in the Rare Disease Database.)

Blastomycosis may also affect the bones and cause lesions that destroy bone tissue (osteolytic). The ribs, vertebrae of the spine, and the long bones of the arms and legs are most frequently involved. In many cases these lesions are painless but may develop an overlying abscess.

Involvement of the urogenital tract is common in males with Blastomycosis. In about 30 percent of cases, the prostate gland and the tubes that carry sperm from the testes (epididymis) are infected by the fungus. Symptoms may include inflammation, swelling, and/or pain in the groin. Involvement of the central nervous system, liver, spleen, gastrointestinal tract, thyroid, adrenal glands, and other organs has also been reported in chronic cases of Blastomycosis.

Causes

Blastomycosis is a rare infectious disease caused by the fungus Blastomyces dermatitidis. This fungus grows and is inhaled through mold spores. In the body the fungus converts to yeasts and invades the lungs. It travels throughout the body through the blood. Blastomycosis usually affects people with a compromised immune system.

Affected Populations

Blastomycosis affects males and females in equal numbers. The organism that causes this disease (Blastomyces dermatitidis) is most common (endemic) in the south central and southeastern portions of the United States. It may also be found around the perimeter of the Great Lakes, and along the St. Lawrence River in Canada. Blastomycosis has also been reported in Mexico, the Middle East, Africa, India, and South and Central America.

The natural habitat of this fungus is unclear but it is suspected to come from the soil. Farmers, construction workers, and others who work with soil appear to be at increased risk for Blastomycosis. Also at increased risk for severe chronic Blastomycosis are individuals who have a compromised immune system such as people with Acquired Immunodeficiency Syndrome (AIDS), these taking medications that suppress the immune system, and the elderly.

Related Disorders

Symptoms of the following disorders can be similar to those of Blastomycosis. Comparisons may be useful for a differential diagnosis:

Paracoccidioidomycosis (PCM) is a chronic infectious tropical disease caused by the fungus Paracoccidioides brasiliensis. The initial infection usually occurs in the lungs, but may also spread to the skin, mucous membranes, and other parts of the body. The symptoms generally develop about five years after the initial exposure to the fungus and vary according to the area of the body that is infected. In Mucocutaneous Paracoccidioidomycosis, ulcers appear on the mucous membranes, especially those of the mouth and nose. When the lungs are affected, symptoms may include cough, difficulty breathing (dyspnea), fatigue, and/or chest pain. (For more information on this disorder, choose "Paracoccidioidomycosis" as your search term in the Rare Disease Database.)

Tuberculosis is a bacterial disease caused by Mycobacterium tuberculosis or Mycobacterium bovis. It is characterized by an initial period without symptoms. Pneumonia may be the first symptom in some people with Tuberculosis. Other symptoms may include coughing, weight loss, night sweats, fever, and/or fatigue. Chest x-rays typically reveal cavities in the lungs caused by chronic infection. The major symptom at this stage is coughing and the production of phlegm. (For more information on this disorder, choose "Tuberculosis" as your search term in the Rare Disease Database.)

Nocardiosis is a rare infectious disease caused by the bacteria Nocardia asteroides and is characterized by acute inflammation of the lungs (pneumonia) and abscesses in the lungs. Symptoms include the profound loss of appetite (anorexia), generalized weakness, cough, and/or chest pain. Some affected individuals may also have abscesses in the brain, kidneys, intestines, and/or other organs of the body. Symptoms associated with brain abscesses may include severe headaches and other neurological difficulties. (For more information on this disorder, choose "Nocardiosis" as your search term in the Rare Disease Database.)

Toxoplasmosis is an infectious disorder that is caused by a parasite (Toxoplasma gondii) that is found in the feces of cats. This infection is found worldwide and may be either acquired or transmitted to a fetus from an infected mother. When the disorder is acquired, the symptoms are similar to mononucleosis or involve lesions of the lungs, liver, heart, skin, muscle, brain, and spinal cord membranes. Lesions are often accompanied by inflammation and in some cases hepatitis. Acute cases are often characterized by rash, high fever, chills, and fatigue. To avoid this disease, pregnant women and people with an impaired immune system should wear a protective mask when emptying litter boxes containing cat feces. The prognosis for the acquired forms of Toxoplasmosis is usually good with treatment, and complications are uncommon. Without treatment this disorder may persist for many months. (For more information on this disorder, choose "Toxoplasmosis" as your search term in the Rare Disease Database.)

Standard Therapies

Diagnosis
The diagnosis of Blastomycosis is confirmed by clinical evaluation that includes chest X-ray studies which may reveal findings that are consistent with fungal pneumonia (i.e., consolidation or cavitation). The direct microscopic examination of infected material (i.e., pus, sputum, or urine) is also performed. The tissue samples are prepared with potassium hydroxide which makes the yeast cells easily visible. Growing tissue samples and then isolating Blastomyces dermatitidis from the culture also confirms the diagnosis of Blastomycosis. Skin testing and blood tests are not helpful in the diagnosing of Blastomycosis.

Pulmonary Blastomycosis may be mistaken for a malignancy such as lung cancer. Examination of the throat with a special instrument (bronchoscopy) may be required to confirm the diagnosis of Blastomycosis. Cutaneous Blastomycosis of the skin may also resemble certain forms of skin cancer.

Treatment
The treatment of choice for both acute and chronic forms of Blastomycosis, especially those involving the central nervous system, is the oral administration of the antibiotic drug amphotericin B. If the disease is mild to moderate, then ketoconazole may be the drug of choice. Prolonged therapy may be necessary in some cases and relapses may occur. When the central nervous system is involved, the drug amphotericin B is usually administered. Affected individuals who cannot tolerate amphotericin B may be treated with hydroxystilbamidine isethionate. This drug is difficult to administer and may have various side effects. Other treatment is symptomatic and supportive. Other newer antifungal drugs such as fluconazole and itraconazole appear to be effective for the treatment of mild or moderate cases.

Investigational Therapies

Research on infectious diseases is underway throughout the world. For more information, contact the World Health Organization (WHO) and/or the Centers for Disease Control listed in the Resources section of this report.

Information on current clinical trials is posted on the Internet at www.clinicaltrials.gov. All studies receiving U.S. Government funding, and some supported by private industry, are posted on this government web site.

For information about clinical trials being conducted at the NIH Clinical Center in Bethesda, MD, contact the NIH Patient Recruitment Office:

Tollfree: (800) 411-1222
TTY: (866) 411-1010
Email: prpl@cc.nih.gov

For information about clinical trials sponsored by private sources, contact:
www.centerwatch.com

Blastomycosis Resources

Organizations:

References

TEXTBOOK
Cecil Textbook of Medicine, 20th Ed.: J. Claude Bennett and Fred Plum, Editors; W.B. Saunders Co., 1996. Pp. 1821-22.

Harrison's Principles of Internal Medicine, 14th Ed.: Kurt J. Isselbacher, M.D. et al., Editors; McGraw-Hill, Inc., 1998. Pp. 1152-53.

Internal Medicine, 4th Ed.: Jay H. Stein, Editor-In-Chief; Mosby-Year Book, Inc., 1994. P. 2223.

The Merck Manual, 17th Ed.: Robert Berkow and Mark Beers, Editors; Merck Research Laboratories; 1999. Pp. 1216-17.

Nelson Textbook of Pediatrics, 15th Ed.: Richard E. Behrman, Editor; W.B. Saunders Company, 1996. P. 946.

Pulmonary Diseases and Disorders, 2nd Ed.: Alfred P. Fishman, Editor; McGraw-Hill Book Company, 1988. P. 1390.

Infectious Diseases: Sherwood L. Gorbach, John G. Bartlett, and Neil R. Blacklow, Editors; W.B. Saunders Company, 1992. Pp. 449 & 1928-30.

Mandell, Douglas and Bennett's Principles and Practice of Infectious Diseases, 4th Ed.: Gerald L. Mandell, M.D. et al., Editors; Churchill Livingstone Inc., 1995. P. 1123.

Textbook of Dermatology, 5th Ed.: R.H. Champion, J.L. Burton, and F.J.G. Ebling, Editors; Blackwell Scientific Publications, 1992. Pp. 1195-97.

ARTICLE
North American Blastomycosis. J. Weingardt et al.; Am Fam Physician (Apr 1991; 43(4)). Pp. 1245-48.

Itraconzole Therapy for Blastomycosis and Histoplasmosis. NIAID Mycoses Study Group. W.E. Dismukes et al.; Am J Med (Nov 1992; 93(5)). Pp. 489-97.

Case Report: Treatment of Blastomycosis with Gluconazole Fluconazole. G.J. Pearson et al.; Am J Med Sci (May 1992; 393(5)). Pp. 313-15.

Hyperendemic Urban Blastomycosis. A.C. Manetti; Am J Public Health (May 1991; 81(5)). Pp. 633-36.

Blastomycosis in Patients with the Acquired Immunodeficiency Syndrome. P.G. Pappas et al.; Ann Intern Med (May 1992; 116(10)). Pp. 847-53.

Systemic Fungal Infections: An Overview. G. Medoff et al.; Hosp Pract (Feb 1991; 26(2)). Pp. 41-52.

Blastomycosis in Immunocompromised Patients. P.G. Pappas et al.; Medicine (Sep 1993; 72(5)). Pp. 311-25.

Tropical Mycoses. M.A. Bayles; Chemotherapy (1992; 38(Suppl 1)). Pp. 27-34.

Blastomycosis. R.W. Bradsher; Clin Infect Dis (Mar 1992; 14 Suppl 1)). Pp. S82-90.

A Clinician's View of Blastomycosis. R.W. Bradsher; Curr Trop Med Mycol (1993; 5). Pp. 181-200.

Cutaneous Blastomycosis. M.G. Mercurio et al.; Cutis (Dec 1992; 50(6)). Pp. 422-24.

Current Therapy of Major Fungal Diseases of the Lung. P. Johnson et al.; Infect Dis Clin North Am (Sep 1994; 5(3)). Pp. 635-45.

Clinical Presentation, Radiograhic Findings and Diagnostic Methods of Pulmonary Blastomycosis: A Review of 100 Consecutive Cases. R. G. Patel et al.; South Med J (Mar 1999; 92(3)). Pp. 289-95.

FROM THE INTERNET
http://www.cdc.gov/ncidod/dbmd/diseaseinfo/blastomycosis_t.htm

The information in NORD’s Rare Disease Database is for educational purposes only. It should never be used for diagnostic or treatment purposes. If you have questions regarding a medical condition, always seek the advice of your physician or other qualified health professional. NORD’s reports provide a brief overview of rare diseases. For more specific information, we encourage you to contact your personal physician or the agencies listed as “Resources” on this report.

Report last updated: 2009/04/08 00:00:00 GMT+0

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