Blastomycosis

Blastomycosis is an endemic fungal infection predominantly seen in the south central and mid-western United States and portions of Canada. The disorder is caused by Blastomyces dermatitidis, a dimorphic organism usually acquired through inhalation of aerosolized conidia. Most acutely infected patients are asymptomatic or develop a self-limited respiratory illness. Chronic pneumonia is the dominant clinical manifestation of blastomycosis, although extrapulmonary disease is common, usually involving skin and subcutaneous tissue, bones and joints, the prostate gland, and the central nervous system (CNS). Chronic blastomycosis should always be treated with systemic antifungal therapy, and oral itraconazole is the drug of choice for mild to moderate forms of the disease. Severe manifestations, including adult respiratory distress syndrome, CNS involvement, and disease in severely immunocompromised hosts require primary therapy with an amphotericin B formulation. There are no routine measures to prevent blastomycosis, although there is promising experimental data involving the use of a live, attenuated vaccine.

KEYWORDS

Blastomycocis - fungal pneumonia - chronic pneumonia

REFERENCES

• 1 Kwon-Chung KJ, Bennett JE Blastomycosis. In: Medical Mycology . Philadelphia; Lea & Febiger 1992: 248-279
• 2 Furcolow M L, Busey J F, Menges R W, Chick E W. Prevalence and incidence studies of human and canine blastomycosis.  Am J Epidemiol. 1970;  92 121-131
• 3 Busey J F. Blastomycosis: a review of 198 collected cases in Veterans Administration hospitals.  Am Rev Respir Dis. 1964;  89 659-672
• 4 Furcolow M L, Chick E W, Busey J F, Menges R W. Prevalence and incidence studies of human and canine blastomycosis.  Am Rev Respir Dis. 1970;  102 60-67
• 5 Crampton T L, Light R B, Berg G M et al.. Epidemiology and clinical spectrum of blastomycosis diagnosed at Manitoba hospitals.  Clin Infect Dis. 2002;  34 1310-1316
• 6 De Groote M A, Bjerke R, Smith H, Rhodes III L V. Expanding epidemiology of blastomycosis: clinical features and investigation of 2 cases in Colorado.  Clin Infect Dis. 2000;  30 582-584
• 7 Gilchrist T C. Protozoan dermatitidis.  J Cutan Genitourin Dis. 1894;  12 496
• 8 Gilchrist T C, Stokes W R. A case of pseudolupus caused by Blastomyces .  J Exp Med. 1898;  3 53-78
• 9 Schwarz J, Baum G L. Blastomycosis.  Am J Clin Pathol. 1951;  21 999-1029
• 10 Klein B S, Vergeront J M, Weeks R J et al.. Isolation of Blastomyces dermatitidis in soil associated with a large outbreak of blastomycosis in Wisconsin.  N Engl J Med. 1986;  314 529-534
• 11 Baumgardner D J, Paretsky D P. The in vitro isolation of Blastomyces dermatitidis from a woodpile in north central Wisconsin, USA.  Med Mycol. 1999;  37 163-168
• 12 Centers for Disease Control and Prevention . Blastomycosis-Wisconsin, 1986-1995.  MMWR Morb Mortal Wkly Rep. 1996;  45 601-603
• 13 Vasquez J E, Mehta J B, Agrawal R, Sarubbi F A. Blastomycosis in northeast Tennessee.  Chest. 1998;  114 436-443
• 14 Bradsher R W, Chapman S W, Pappas P G. Blastomycosis.  Infect Dis Clin North Am. 2003;  17 21-40
• 15 Bernstein S, Richardson S. Inoculation blastomycosis.  Can Med Assoc J. 2001;  164 1664-1665
• 16 Larson D M, Eckman M R, Alber R L, Goldschmidt V G. Primary cutaneous (inoculation) blastomycosis: an occupational hazard to pathologists.  Am J Clin Pathol. 1983;  79 253-255
• 17 Gnann J W, Bressler G S, Bodet C A, Avent C K. Human blastomycosis after a dog bite.  Ann Intern Med. 1983;  98 48-49
• 18 Craig M W, Davey W N, Green R A. Conjugal blastomycosis.  Am Rev Respir Dis. 1970;  102 86-90
• 19 Watts E A, Gard P D, Tuthill S W. First reported case of intrauterine transmission of blastomycosis.  Pediatr Infect Dis. 1983;  2 308-310
• 20 Schutze G E, Hickerson S L, Fortin E M et al.. Blastomycosis in children.  Clin Infect Dis. 1996;  22 496-502
• 21 Hansen J E, Simmons D H. An urban epidemic of North American blastomycosis.  Am Rev Respir Dis. 1977;  115 1063-1066
• 22 Tosh F E, Hammerman K J, Weeks R J, Sarosi G A. A common source of epidemic of North American blastomycosis.  Am Rev Respir Dis. 1974;  109 525-529
• 23 Smith Jr J G, Harris J S, Conant N F, Smith D T. An epidemic of North American blastomycosis.  JAMA. 1955;  158 641-645
• 24 Klein B S, Vergeront J M, Disalvo A F, Kaufman L, Davis J. Two outbreaks of blastomycosis along rivers in Wisconsin.  Am Rev Respir Dis. 1987;  136 1333-1338
• 25 Armstrong C W, Jenkins S R, Kaufman L, Kerkering T M, Rouse B S, Miller G B. Common-source outbreak of blastomycosis in hunters and their dogs.  J Infect Dis. 1987;  155 568-570
• 26 Vaaler A D, Bradsher R W, Davies S F. Evidence of subclinical blastomycosis in forestry workers in northern Minnesota and northern Wisconsin.  Am J Med. 1990;  89 470-476
• 27 Sarosi G A, Davies S F. Blastomycosis.  Am Rev Respir Dis. 1979;  120 911-938
• 28 Bradsher R W, Martin M R, Wilkes T D, Waltman C, Bolyard K. Unusual manifestations of blastolycosis: ten case summaries.  Infect Med. 1990;  7 10-19
• 29 Baum G L, Lerner P I. Primary pulmonary blastomycosis: a laboratory-acquired infection.  Ann Intern Med. 1970;  73 263-265
• 30 Sarosi G A, Davies S F, Phillips J R. Self-limited blastomycosis: a report of 39 cases.  Semin Respir Infect. 1986;  1 40-44
• 31 Recht L D, Phillips J R, Eckman M R, Sarosi G A. Self-limited blastomycosis: a report of thirteen cases.  Am Rev Respir Dis. 1979;  120 1109-1112
• 32 Sarosi G A, Hammerman K J, Tosh F E, Kronenberg R S. Clinical features of acute pulmonary blastomycosis.  N Engl J Med. 1974;  290 540-543
• 33 Abernathy R S. Clinical manifestations of pulmonary blastomycosis.  Ann Intern Med. 1959;  51 707-727
• 34 Brown L R, Swensen S J, Van Scoy R E, Prakash U BS, Coles D T, Colby T V. Roentgenologic features of pulmonary blastomycosis.  Mayo Clin Proc. 1991;  66 29-38
• 35 Patel R G, Patel B, Petrini M F, Carter R R, Griffith J. Clinical presentation, radiographic findings, and diagnostic methods of pulmonary blastomycosis: a review of 100 consecutive cases.  South Med J. 1999;  92 289-295
• 36 Rabinowitz J G, Busch J, Buttram W R. Pulmonary manifestations of blastomycosis.  Radiology. 1976;  120 25-32
• 37 Kinasewitz G T, Penn R L, George R B. The spectrum and significance of pleural disease in blastomycosis.  Chest. 1984;  86 580-584
• 38 Evans M E, Haynes J B, Atkinson J B, Delvaux T C, Kaiser A B. Blastomyces dermatitidis and the adult respiratory distress syndrome: case reports and review of the literature.  Am Rev Respir Dis. 1982;  126 1099-1102
• 39 Griffith J E, Campbell G D. Acute military blastomycosis presenting as fulminating respiratory failure.  Chest. 1979;  75 630-632
• 40 Meyer K C, McManus E J, Make D G. Overwhelming pulmonary blastomycosis associated with the adult respiratory distress syndrome.  N Engl J Med. 1993;  329 1231-1236
• 41 Lockridge R S, Glauser F L. Adult respiratory distress syndrome secondary to diffuse pulmonary blastomycosis.  South Med J. 1979;  72 235-236
• 42 Mundey K, Varkey B, VanRuiswyk J, Yang F, Schapira R M. Acute respiratory distress syndrome from blastomycosis: a case report.  WMJ. 2001;  100 40-42
• 43 Lemos L B, Baliga M, Guo M. Acute respiratory distress syndrome and blastomycosis: presentation of nine cases and review of the literature.  Ann Diagn Pathol. 2001;  5 1-9
• 44 Stelling C B, Woodring J H, Rehn S R, Hopper D W, Noble R C. Miliary pulmonary blastomycosis.  Radiology. 1984;  150 7-13
• 45 Renston J P, Morgan J, DiMarco A F. Disseminated military blastomycosis leading to acute respiratory failure in an urban setting.  Chest. 1992;  101 1463-1465
• 46 Isotalo P A, Ford J C, Veinot J P. Miliary blastomycosis developing in an immunocompromised host with chronic lymphocytic leukaemia.  Pathol. 2002;  34 293-295
• 47 Chapman S W. Blastomyces dermatitidis . In: Mandell GL, Bennett JE, Dolin R Principles and Practice of Infectious Diseases. New York; Churchill Livingstone 2000: 2733-2746
• 48 Schwarz J, Salfelder K. Blastomycosis: a review of 152 cases.  Curr Top Pathol. 1977;  65 165-200
• 49 Pappas P G, Dismukes W E. Blastomycosis: Gilchrist's disease revisited.  Curr Clin Top Infect Dis. 2002;  22 61-77
• 50 Bayer A S, Scott V J, Guze L B. Fungal arthritis, IV: Blastomycotic arthritis.  Semin Arthritis Rheum. 1979;  9 145-151
• 51 Saccente M, Abernathy R S, Pappas P G, Shah H R, Bradsher R W. Vertebral blastomycosis with paravertebral abscess: report of eight cases and review of the literature.  Clin Infect Dis. 1998;  26 413-418
• 52 Eikenberg H U, Amin H U, Lich R. Blastomycosis of the genitourinary tract.  J Urol. 1975;  113 650-652
• 53 Beuchner H A, Clawson C M. Blastomycosis of the central nervous system.  Am Rev Respir Dis. 1966;  95 820-826
• 54 Gonyea E F. The spectrum of primary blastomycetic meningitis: a review of central nervous system blastomycosis.  Ann Neurol. 1978;  3 26-39
• 55 Friedman J A, Wijdicks E FM, Fulgham J R, Wright A J. Meningoencephalitis due to Blastomyces dermatitidis: case report and literature review.  Mayo Clin Proc. 2000;  75 403-408
• 56 Roos K L, Bryan J P, Maggio W W, Jane J A, Scheld W M. Intracranial blastomycoma.  Medicine (Baltimore). 1987;  66 224-235
• 57 Harley W B, Lomis M, Haas D W. Marked polymorphonuclear pleocytosis due to blastomycotic meningitis: case report and review.  Clin Infect Dis. 1994;  18 816-818
• 58 Ebeo C T, Olive K, Byrd R P, Mirle G, Roy T M, Mehta J B. Blastomycosis of the vocal folds with life-threatening upper airway obstruction: a case report.  Ear Nose Throat J. 2002;  81 852-855
• 59 Lopez R, Mason J O, Parker J S, Pappas P G. Intraocular blastomycosis: case report and review.  Clin Infect Dis. 1994;  18 805-807
• 60 Pappas P G, Pottage J C, Powderly W G et al.. Blastomycosis in patients with acquired immunodeficiency syndrome.  Ann Intern Med. 1992;  116 847-853
• 61 Laskey W K, Sarosi G A. Blastomycosis in children.  Pediatrics. 1980;  65 111-114
• 62 Palmer P E, McFadden S W. Blastomycosis: report of an unusual case.  N Engl J Med. 1976;  279 979-983
• 63 Cummins R E, Romero R C, Mancini A J. Disseminated North American blastomycosis in an adolescent male: a delay in diagnosis.  Pediatrics. 1998;  102 977-979
• 64 Pappas P G, Threlkeld M G, Bedsole G D, Cleveland K O, Gelfand M S, Dismukes W E. Blastomycosis in immunocompromised patients.  Medicine. 1993;  72 311-325
• 65 Pappas P G. Blastomycosis in immunocompromised patients.  Semin Respir Infect. 1997;  12 243-251
• 66 Srinath L, Ahkee S, Huang A, Raff M J, Ramirez A. Acute military blastomycosis in an AIDS patient.  J Kentuk Med Assoc. 1994;  92 450-452
• 67 Harding C V. Blastomycosis and opportunistic infections in patients with acquired immunodeficiency syndrome: an autopsy study.  Arch Pathol Lab Med. 1991;  115 1133-1136
• 68 Nelson M R, Barton S E, Hawkins D A, Gazzard B G. Blastomycosis in an HIV positive male in the UK.  Int J STD AIDS. 1993;  4 176-177
• 69 Tan G, Kaufman L, Peterson E M, de la Maza L M. Disseminated atypical blastomycosis in two patients with AIDS.  Clin Infect Dis. 1993;  16 107-111
• 70 Herd A M, Greenfield S B, Thompson W S, Brunham R C. Miliary blastomycosis and HIV infection.  Can Med Assoc J. 1990;  143 1329-1330
• 71 Pradinaud R, Sainte-Marie D, Clity E. Premier cas guyanais de blastomycose avec intense focalisation nasale chez une patiente infectee par le V.I.H  Nouv Dermatol. 1991;  10 480-482
• 72 Witzig R S, Hoadley D J, Greer D L, Abriola K P, Hernandez R L. Blastomycosis and human immunodeficiency virus: three new cases and review.  South Med J. 1994;  87 715-719
• 73 Kitchen L W, Clark R A, Hoadley D J, Wisniewski T L, Janney F A, Greer D L. Concurrent pulmonary Blastomyces dermatitidis and Mycobacterium tuberculosis infection in an HIV-1 seropositive man.  J Infect Dis. 1989;  160 911-912
• 74 Cohen L M, Golitz L E, Wilson M L. Widespread papules and nodules in a Ugandan man with acquired immunodeficiency syndrome.  Arch Dermatol. 1996;  132 821-826
• 75 Klein B S, Kuritsky J N, Chappell W A et al.. Comparison of enzyme immunoassay, immunodiffusion, and complement fixation in detecting antibody to the A antigen in Blastomyces dermatitidis .  Am Rev Respir Dis. 1986;  133 144-148
• 76 Lo C Y, Notenboom R H. A new enzyme immunoassay specific for blastomycosis.  Am Rev Respir Dis. 1990;  141 84-88
• 77 Chapman S E, Bradsher R W, Campbell G D, Pappas P G, Kauffman C A. Practice guidelines for the management of patients with blastomycosis.  Clin Infect Dis. 2000;  30 679-683
• 78 National Institute of Allergy and Infectious Diseases Mycoses Study Group . Treatment of blastomycosis and histoplasmosis with ketoconazole: results of a prospective randomized clinical trial.  Ann Intern Med. 1985;  103 861-872
• 79 Bradsher R W, Rice D C, Abernathy R S. Ketoconazole therapy for endemic blastomycosis.  Ann Intern Med. 1985;  103 872-879
• 80 Dismukes W E, Bradsher R W, Cloud G C et al.. Itraconazole therapy for blastomycosis and histoplasmosis.  Am J Med. 1992;  93 489-497
• 81 Bradsher R W. Blastomycosis.  Clin Infect Dis. 1992;  14(suppl 1) S82-S90
• 82 Pitrak D L, Andersen B R. Cerebral blastomycoma after ketoconazole therapy for respiratory tract blastomycosis.  Am J Med. 1989;  86 713-714
• 83 Yancey R W, Perlino C A, Kaufman L. Asymptomatic blastomycosis of the central nervous system with progression in patients given ketoconazole therapy: a report of two cases.  J Infect Dis. 1991;  164 807-810
• 84 Cook P P. Amphotericin B lipid complex for the treatment of recurrent blastomycosis of the brain in a patient previously treated with itraconazole.  South Med J. 2001;  94 548-549
• 85 Pappas P G, Bradsher R W, Chapman S W et al.. and the National Institute of Allergy and Infectious Diseases Mycoses Study Group . Treatment of blastomycosis with fluconazole: a pilot study.  Clin Infect Dis. 1995;  20 267-271
• 86 Pappas P G, Bradsher R W, Kauffman C A et al.. and the National Institute of Allergy and Infectious Diseases Mycoses Study Group . Treatment of blastomycosis with higher doses of fluconazole.  Clin Infect Dis. 1997;  25 200-205
• 87 Sugar A M, Liu X P. Efficacy of voriconazole in treatment of murine pulmonary blastomycosis.  Antimicrob Agents Chemother. 2001;  45 601-604
• 88 Hoffman H L, Ernst E J, Klepser M E. Novel triazole antifungal agents.  Expert Opin Investig Drugs. 2000;  9 593-605
• 89 Ernst E J. Investigational antifungal agents.  Pharmacotherapy. 2001;  21(8 pt 2) 165S-174S
• 90 Perfect J R, Marr K A, Walsh T J et al.. Voriconazole treatment for less-common, emerging, or refractory fungal infections.  Clin Infect Dis. 2003;  36 1122-1131
• 91 Lockwood W R, Allison Jr F, Batson B E, Busey J F. The treatment of North American blastomycosis: ten years experience.  Am Rev Respir Dis. 1969;  100 314-320
• 92 Busey J F. Blastomycosis: a comparative study of 2-hydroxystilbamidine and amphotericin B therapy.  Am Rev Respir Dis. 1972;  105 812-818
• 93 Wuthrich M, Filutowicz I, Klein B S. Mutation of the WI-1 gene yields an attenuated Blastomyces dermatitidis strain that induces host resistance.  J Clin Invest. 2000;  106 1381-1389