RESUMEN
Blastomycoses dermatitidis is a dimorphic fungus that can cause disseminated blastomycosis with varying clinical manifestations and multiorgan involvement. While blastomycosis commonly causes pulmonary disease, extrapulmonary spread can result in skin, bone, and central nervous system involvement. Cutaneous blastomycosis can present as pustular lesions that evolve into ulcerative or verrucous plaques. We present a case of disseminated blastomycosis in an immunocompetent patient with both pulmonary and cutaneous features. The patient developed hypoxic respiratory failure and was subsequently diagnosed with disseminated blastomycosis after undergoing bronchoscopy with bronchial washing. He was found to have ulcerative nasal lesions as part of his disseminated disease. He was successfully treated with amphotericin B and ultimately discharged from the hospital.
Asunto(s)
Blastomicosis , Inmunocompetencia , Humanos , Blastomicosis/diagnóstico , Blastomicosis/tratamiento farmacológico , Masculino , Antifúngicos/uso terapéutico , Anfotericina B/uso terapéutico , Anfotericina B/administración & dosificación , Persona de Mediana Edad , Blastomyces/aislamiento & purificaciónRESUMEN
INTRODUCTION: Blastomycosis is a fungal infection caused by Blastomyces dermatitidis that is hyperendemic in Wisconsin. It commonly presents as a pulmonary infection and frequently disseminates to the skin. Studies evaluating the presentation and diagnosis of blastomycosis with skin as a presenting sign have not been thoroughly evaluated, and understanding the most accurate way to diagnose this infection is important for earlier therapeutic intervention. METHODS: This is a retrospective chart review study of a single institution. Subjects were identified through a search of ICD-9 (International Classification of Diseases, Ninth Revision) and ICD-10 (International Classification of Diseases, Tenth Revision) codes for blastomycosis in the clinical record and pathology database. Patients were included if diagnosed with cutaneous blastomycosis infection or involvement of the skin from systemic infection from January 1, 2009, to June 1, 2021. RESULTS: Twenty patients with a diagnosis of cutaneous involvement of blastomycosis were identified; 65% (n = 13) were male. Median age of diagnosis was 55.5 years. Fifty-five percent of patients were White, 35% were Black or African American. In addition to residence in an endemic area, 50% (n = 10) had exposure risk factors. Fifty percent of patients (n = 10) initially presented with a skin concerns; 65% (n = 13) had extracutaneous involvement. Diagnosis was made by histopathology alone in 55% (n = 11), culture plus histopathology in 35% (n = 7), and culture alone in 5% (n = 1) of cases. CONCLUSIONS: Our study highlighted similarities to those previously performed. Half of the patients (n = 10) who had cutaneous involvement of blastomycosis did not demonstrate clinically significant pulmonary involvement. Histopathology and culture remain critical in diagnosing cutaneous blastomycosis.
Asunto(s)
Blastomicosis , Humanos , Wisconsin/epidemiología , Blastomicosis/diagnóstico , Blastomicosis/epidemiología , Masculino , Femenino , Estudios Retrospectivos , Persona de Mediana Edad , Adulto , Anciano , Factores de Riesgo , Blastomyces/aislamiento & purificaciónAsunto(s)
Blastomicosis/microbiología , Abdomen/diagnóstico por imagen , Adulto , Dolor de Espalda/etiología , Blastomyces/aislamiento & purificación , Blastomicosis/diagnóstico , Fiebre , Humanos , Pulmón/diagnóstico por imagen , Pulmón/patología , Masculino , Pelvis/diagnóstico por imagen , RecurrenciaRESUMEN
Blastomyces is a fungus found in the soil of regions of North America including the Mississippi and Ohio River Valleys. It can be inhaled into the lungs and cause pneumonia and disseminated disease. Although blastomycosis is not widely reported in the sickle cell literature, sickle cell patients may be at increased risk of complications from blastomycosis pneumonia due to their immune compromise and risk of developing acute chest syndrome. We describe the case of a 13-year-old female with homozygous sickle cell disease who presented with pneumonia and acute chest syndrome and was found to have pulmonary blastomycosis.
Asunto(s)
Síndrome Torácico Agudo/patología , Anemia de Células Falciformes/fisiopatología , Blastomyces/aislamiento & purificación , Blastomicosis/complicaciones , Enfermedades Pulmonares Fúngicas/complicaciones , Neumonía/complicaciones , Síndrome Torácico Agudo/etiología , Adolescente , Blastomicosis/microbiología , Femenino , Humanos , Enfermedades Pulmonares Fúngicas/microbiología , Neumonía/microbiología , PronósticoRESUMEN
Blastomycosis is a prominent fungal disease in the United States. Vitamin D status has been found to be altered in critical illness and various infectious diseases. The objectives of this study were to compare serum 25-hydroxyvitamin D (25[OH]D) concentrations in dogs with blastomycosis and healthy controls, to assess the change in serum 25(OH)D concentrations in dogs with blastomycosis after 30 days of treatment, and to determine if baseline serum 25(OH)D concentrations in dogs with blastomycosis were associated with in-hospital, 30-day, or end-of-study mortality. In this prospective cohort study, 19 dogs newly diagnosed with blastomycosis had serum 25(OH)D concentrations measured with a commercially available validated radioimmunoassay at the time of diagnosis and 30 days after start of treatment. These values were compared to 24 healthy control dogs. Serum 25(OH)D concentrations at the time of diagnosis were lower in dogs with blastomycosis (median, 203 nmol/L; range, 31-590 nmol/L) than in clinically healthy control dogs (259.5 nmol/L, 97-829 nmol/L; P = 0.01). Despite clinical improvement, there was no significant change in serum 25(OH)D concentrations from baseline to 30-day follow-up. Dogs with baseline serum 25(OH)D concentrations <180.5nmol/L had a greater odds of death during hospitalization (odds ratio [OR], 15.0; 95% confidence interval [CI], 1.4-191.3; P = 0.04) and at 30 days follow-up (OR, 30.0; 95% CI, 2.5-366.7; P = 0.006). These findings highlight the need for further studies evaluating the prognostic value of vitamin D status in dogs with blastomycosis at diagnosis and throughout treatment and remission.
Asunto(s)
Antifúngicos/uso terapéutico , Blastomicosis/veterinaria , Enfermedades de los Perros/sangre , Vitamina D/análogos & derivados , Animales , Blastomyces/aislamiento & purificación , Blastomicosis/sangre , Blastomicosis/tratamiento farmacológico , Blastomicosis/mortalidad , Estudios de Cohortes , Enfermedades de los Perros/tratamiento farmacológico , Enfermedades de los Perros/mortalidad , Perros , Femenino , Masculino , Estudios Prospectivos , Vitamina D/sangreAsunto(s)
Absceso/cirugía , Anfotericina B/administración & dosificación , Antifúngicos/uso terapéutico , Blastomyces/aislamiento & purificación , Blastomicosis/complicaciones , Blastomicosis/tratamiento farmacológico , Drenaje , Escápula/diagnóstico por imagen , Absceso/microbiología , Adulto , Anfotericina B/uso terapéutico , Blastomicosis/diagnóstico , Lavado Broncoalveolar , Humanos , Masculino , Escápula/patología , Resultado del TratamientoRESUMEN
BACKGROUND: Blastomycosis, an endemic mycosis of immunocompetent individuals, is typically seen after exposure to waterways within rural wooded regions. It is not considered a disease of urban environments. Infection can be solely pneumonic or disseminate to skin, bone or central nervous system. Unknown factors influence disease acquisition and severity in children. METHODS: We analyzed acquisition risks and disease characteristics of blastomycosis in children seen at a tertiary care center from 1998 to 2018 to identify potential exposure sources, measure disease severity and assess the effect of race upon disease severity. RESULTS: Of 64 infected children, mean age was 12.9 years, with median time to diagnosis 38.5 days. About 72% were male, 38% resided in urban counties and 50% had typical environmental exposure. Isolated pulmonary infection occurred in 33 (52%). The remainder had evidence of dissemination to skin (N = 13), bone (N = 16; 7 clinically silent) and cranium (N = 7; 3 clinically silent). Infection was moderate/severe in 19 (30%). Two children (3%) died. About 79% of children with moderate/severe disease (P = 0.008) and 71% of urban children (P = 0.007) lacked typical environmental exposure. Comparing children from urban counties to other residences, 63% versus 5% were black (P < 0.001) and 71% versus 35% developed extrapulmonary dissemination (P = 0.006). Moderate/severe disease was seen in 7/17 (42%) black children but only 12/47 (26%) children of other races (P = 0.23). CONCLUSIONS: Blastomycosis, can be endemic in urban children in the absence of typical exposure history, have frequent, sometimes clinically silent, extrapulmonary dissemination and possibly produces more severe disease in black children.
Asunto(s)
Blastomyces/genética , Blastomicosis/microbiología , Gravedad del Paciente , Población Urbana/estadística & datos numéricos , Adolescente , Negro o Afroamericano/estadística & datos numéricos , Blastomyces/aislamiento & purificación , Blastomicosis/diagnóstico , Blastomicosis/etnología , Niño , Preescolar , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Estudios Retrospectivos , Factores de Riesgo , Centros de Atención Terciaria/estadística & datos numéricos , WisconsinRESUMEN
A previously healthy 15-year-old boy from a rural county in the southeastern United States was evaluated in the emergency department with fever and worsening toe pain in the absence of trauma. He initially presented to his primary care physician 4 weeks before with upper respiratory symptoms and was treated with corticosteroids for presumed reactive airway disease. His respiratory symptoms resolved. One week after this presentation, he developed fever and right great toe pain and presented to an outside hospital. Inflammatory markers were elevated. MRI confirmed a diagnosis of osteomyelitis with associated periosteal abscess. He was treated with intravenous antibiotics and drainage of the abscess. Ten days after his discharge from the outside hospital, he developed fever and had increasing drainage of the toe and pain refractory to oral pain medications. He presented to our facility for further evaluation. Repeat MRI and inflammatory markers corroborated his worsening disease, and he was admitted to the hospital for intravenous antibiotics and underwent serial surgical debridement. He developed painful subcutaneous nodules on his lower extremities and was found to have lung abnormalities on chest radiograph. A multispecialty team collaborated in the management of this patient and unveiled a surprising diagnosis.
Asunto(s)
Absceso/microbiología , Blastomicosis/diagnóstico , Fiebre/microbiología , Hallux , Osteomielitis/microbiología , Dolor Intratable/etiología , Enfermedades de los Trabajadores Agrícolas/microbiología , Amputación Quirúrgica , Antibacterianos/uso terapéutico , Antifúngicos/uso terapéutico , Blastomyces/aislamiento & purificación , Blastomicosis/complicaciones , Daptomicina/uso terapéutico , Progresión de la Enfermedad , Hallux/cirugía , Humanos , Itraconazol/uso terapéutico , MasculinoAsunto(s)
Blastomyces/aislamiento & purificación , Blastomicosis/microbiología , Infecciones por Citomegalovirus/virología , Citomegalovirus/aislamiento & purificación , Esofagitis , Herpes Simple/virología , Huésped Inmunocomprometido , Infecciones Oportunistas , Simplexvirus/aislamiento & purificación , Anciano , Biopsia , Blastomyces/inmunología , Blastomicosis/diagnóstico , Blastomicosis/inmunología , Coinfección , Citomegalovirus/inmunología , Infecciones por Citomegalovirus/diagnóstico , Infecciones por Citomegalovirus/inmunología , Endoscopía del Sistema Digestivo , Esofagitis/diagnóstico , Esofagitis/inmunología , Esofagitis/microbiología , Esofagitis/virología , Herpes Simple/diagnóstico , Herpes Simple/inmunología , Humanos , Inmunosupresores/efectos adversos , Trasplante de Riñón/efectos adversos , Masculino , Infecciones Oportunistas/diagnóstico , Infecciones Oportunistas/inmunología , Infecciones Oportunistas/microbiología , Infecciones Oportunistas/virología , Simplexvirus/inmunologíaAsunto(s)
Blastomicosis/diagnóstico , Enfermedades Óseas/diagnóstico , Enfermedades Óseas/tratamiento farmacológico , Adulto , Biopsia , Blastomyces/aislamiento & purificación , Blastomicosis/tratamiento farmacológico , Blastomicosis/cirugía , Enfermedades Óseas/cirugía , Neoplasias Óseas/diagnóstico , Diagnóstico Diferencial , Humanos , Ilion/microbiología , Ilion/patología , Itraconazol/uso terapéutico , Imagen por Resonancia Magnética , Masculino , Tomografía Computarizada por Rayos XRESUMEN
CASE: We describe a case of biopsy-proven blastomycosis in a patient residing in Upstate New York with osseous and skin lesions and no pulmonary or constitutional symptoms. The patient had a rapid resolution of symptoms after the initiation of antifungal treatment, followed by curettage and cementation of her distal femoral lesion. CONCLUSIONS: Orthopaedic surgeons should be aware of the presence of blastomycosis in nonendemic areas, especially since bone involvement may be the predominant manifestation. Tissue should be submitted for both histologic and microbiologic analysis. Antifungal therapy and surgical management if needed can result in a good outcome.
Asunto(s)
Blastomicosis/diagnóstico , Enfermedades Óseas/diagnóstico , Enfermedades Óseas/microbiología , Blastomyces/aislamiento & purificación , Blastomicosis/terapia , Enfermedades Óseas/terapia , Femenino , Humanos , Persona de Mediana EdadAsunto(s)
Blastomicosis/diagnóstico por imagen , Ganglios Linfáticos/diagnóstico por imagen , Linfadenopatía/diagnóstico por imagen , Sarcoidosis/diagnóstico , Infecciones de los Tejidos Blandos/diagnóstico , Nódulo Pulmonar Solitario/diagnóstico por imagen , Enfermedad Aguda , Adulto , Antifúngicos/uso terapéutico , Blastomyces/genética , Blastomyces/aislamiento & purificación , Blastomicosis/tratamiento farmacológico , Blastomicosis/patología , Broncoscopía , California , ADN de Hongos/genética , Diagnóstico Diferencial , Biopsia por Aspiración con Aguja Fina Guiada por Ultrasonido Endoscópico , Femenino , Fiebre , Humanos , India/etnología , Itraconazol/uso terapéutico , Ganglios Linfáticos/patología , Linfadenopatía/patología , Ohio , Análisis de Secuencia de ADN , Infecciones de los Tejidos Blandos/tratamiento farmacológico , Nódulo Pulmonar Solitario/tratamiento farmacológico , TexasRESUMEN
Background: Dimorphic fungi may cause infections and symptoms similar to tuberculosis (TB), in humans and animals. Such infections, individually or concurrently with TB, have been identified in cattle in Kenya, raising the possibility of infections in other animals, including humans. The study aimed to identify and quantify dimorphic fungi co-infection in persons with TB. Methods: Smear-positive sputum samples, 400, were obtained from TB clinics between October 2016 and November 2017. The samples were examined microscopically for yeast fungi, cultured for isolation of yeast, conversion to molds, and conversion from molds to yeasts. The isolates were characterized morphologically. Results: Blastopores, with morphological characteristics of Paracoccidiodes and Blastomyces, were observed in 37 smears of the sputum samples. Similar yeast cells were observed in smears of the sputum cultures. The yeast cultures were converted to molds on incubation at room temperature and back to yeasts on incubation at 37°C. Conclusion: Dimorphic fungi, morphologically identified as Paracoccidiodes and Blastomyces, concomitantly infect a proportion of TB patients in the study area. It is recommended that routine diagnosis for TB should consider infection or co-infection by dimorphic fungi for institution of appropriate treatment.
Asunto(s)
Coinfección/microbiología , Hongos/aislamiento & purificación , Esputo/microbiología , Tuberculosis/microbiología , Animales , Blastomyces/aislamiento & purificación , Bovinos , Coinfección/epidemiología , Hongos/clasificación , Hongos/patogenicidad , Humanos , Kenia/epidemiología , Mycobacterium tuberculosis/aislamiento & purificación , Paracoccidioides/aislamiento & purificación , Tuberculosis/epidemiología , Tuberculosis/transmisiónRESUMEN
A 9 yr old female spayed Labrador retriever presented for progressive dyspnea. Inspiratory stridor and inspiratory and expiratory dyspnea were present, consistent with an upper airway obstruction. A laryngeal exam revealed severe thickening of the arytenoid cartilages and masses associated with the arytenoids. A tracheostomy tube was placed, and the masses were biopsied. Histopathology showed pyogranulomatous inflammation secondary to Blastomyces dermatitidis. The dog was initially treated with amphotericin B and terbinafine in the hospital until the airway obstruction resolved and the tracheostomy tube could be removed. The dog experienced complete recovery after long-term treatment with itraconazole and terbinafine. This is the first report of laryngeal obstruction secondary to primary laryngeal blastomycosis in a dog. Blastomycosis should be considered for cases of obstructive laryngeal disease, and a good outcome can be achieved with antifungal treatment.
Asunto(s)
Obstrucción de las Vías Aéreas/veterinaria , Blastomyces/aislamiento & purificación , Blastomicosis/veterinaria , Enfermedades de los Perros/diagnóstico , Enfermedades de la Laringe/veterinaria , Obstrucción de las Vías Aéreas/etiología , Anfotericina B/administración & dosificación , Anfotericina B/uso terapéutico , Animales , Antifúngicos/administración & dosificación , Antifúngicos/uso terapéutico , Blastomicosis/complicaciones , Blastomicosis/diagnóstico , Diagnóstico Diferencial , Enfermedades de los Perros/tratamiento farmacológico , Perros , Femenino , Enfermedades de la Laringe/complicaciones , Enfermedades de la Laringe/diagnóstico , Linaje , Terbinafina/administración & dosificación , Terbinafina/uso terapéutico , Traqueostomía/veterinariaRESUMEN
Drug pharmacokinetics may be significantly altered in patients receiving extracorporeal membrane oxygenation (ECMO). Ensuring the optimized effective dosing of antimicrobials on ECMO remains a challenge. To date, limited data are available regarding the optimal use of amphotericin and triazoles during ECMO. We report a case of altered pharmacokinetics, insufficient liposomal amphotericin B and isavuconazole levels, and the need for escalated doses during ECMO in a patient with severe acute respiratory distress syndrome secondary to pulmonary blastomycosis. A 2-fold increase in the standard total daily dose of both drugs was necessary to overcome low serum concentrations thought to be secondary to drug loss from ECMO circuit sequestration. These findings have important implications for optimizing antimicrobial therapy in patients receiving ECMO to maximize therapeutic efficacy. The use of therapeutic drug monitoring for patients receiving antimicrobial therapy with concurrent ECMO may facilitate appropriate drug dosing to achieve adequate serum concentrations and optimize favorable patient outcomes. Further studies exploring antimicrobial pharmacokinetics during ECMO are needed to inform dosing recommendations in critically ill patients.
Asunto(s)
Anfotericina B/uso terapéutico , Antifúngicos/uso terapéutico , Blastomicosis/terapia , Oxigenación por Membrana Extracorpórea , Adulto , Anfotericina B/administración & dosificación , Anfotericina B/farmacocinética , Antifúngicos/administración & dosificación , Antifúngicos/farmacocinética , Blastomyces/aislamiento & purificación , Blastomicosis/sangre , Blastomicosis/complicaciones , Tos/etiología , Disnea/etiología , Fiebre/etiología , Humanos , MasculinoRESUMEN
Chronic pulmonary blastomycosis is often misdiagnosed and treated as tuberculosis in disease-endemic and non-disease-endemic areas. We report the case of a 32-year-old man who after visiting Chicago, Illinois, USA, returned to India and received treatment for tuberculosis for 12 months before receiving the correct diagnosis of blastomycosis.
Asunto(s)
Blastomyces/aislamiento & purificación , Blastomicosis/diagnóstico , Enfermedades Pulmonares Fúngicas/diagnóstico , Adulto , Antifúngicos/uso terapéutico , Blastomicosis/tratamiento farmacológico , Blastomicosis/microbiología , Chicago , Diagnóstico Diferencial , Errores Diagnósticos , Humanos , India , Enfermedades Pulmonares Fúngicas/tratamiento farmacológico , Enfermedades Pulmonares Fúngicas/microbiología , Masculino , Viaje , Tuberculosis Pulmonar/diagnósticoRESUMEN
Talaromyces marneffei is a fungal opportunistic infection usually seen in immunocompromised patients from eastern countries. In the US when examining HIV-patients for suspected fungal infections, laboratory serological tests guide therapy until cultures are available. We present the case of a 35-year-old HIV patient originally from Thailand in which urine lab results were positive for Blastomyces and Histoplasma antigen, but biopsy showed T. marneffei. Concomitantly the patient presented with hyponatremia which was deemed to be from SIADH. We present the first case of a patient with T. marneffei cross reactivity with Blastomyces, Histoplasma and SIADH due to pulmonary disease.