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2.
BMJ Case Rep ; 12(7)2019 Jul 18.
Artigo em Inglês | MEDLINE | ID: mdl-31324667

RESUMO

A 43-year-old man with history of non-Hodgkins' lymphoma presented with unilateral eye swelling, pain and vision deficits which had been progressive over 2 months. Symptoms followed a presumed bacterial pneumonia 4 months prior. Imaging demonstrated retro-orbital soft tissue swelling with bony erosion concerning for a mass; surgical decompression was performed with histology confirming disseminated Blastomyces dermatitidis Symptoms responded rapidly to antifungal therapy with amphotericin followed by itraconazole. Orbital dissemination of blastomycosis is extremely rare; accurate diagnosis requires tissue biopsy to facilitate timely targeted therapy and minimise morbidity.


Assuntos
Blastomicose/diagnóstico por imagem , Pneumopatias Fúngicas/diagnóstico por imagem , Celulite Orbitária/diagnóstico por imagem , Adulto , Antifúngicos/uso terapêutico , Blastomyces , Blastomicose/terapia , Descompressão Cirúrgica , Dor Ocular/etiologia , Humanos , Masculino , Nervo Óptico , Órbita/cirurgia , Celulite Orbitária/terapia , Coxa da Perna , Tomografia Computadorizada por Raios X , Transtornos da Visão/etiologia
3.
Am J Health Syst Pharm ; 76(11): 810-813, 2019 May 17.
Artigo em Inglês | MEDLINE | ID: mdl-30994894

RESUMO

PURPOSE: We describe the use of liposomal amphotericin B and amphotericin B deoxycholate in a critically ill patient with pulmonary blastomycosis receiving both venovenous extracorporeal membrane oxygenation (ECMO) and continuous renal replacement therapy (CRRT). SUMMARY: A 50-year-old African American man presented for dyspnea and cough and was noted to have blastomycosis on bronchoscopy. He developed respiratory failure and acute kidney injury, requiring mechanical ventilation, ECMO, and CRRT. After 4 days of liposomal amphotericin, the transmembrane pressure gradient on the membrane oxygenator increased dramatically without visualization of a clot, requiring a circuit exchange. A trough amphotericin B level taken the day before the exchange was undetectable for amphotericin B. After the circuit exchange, the patient was switched to amphotericin B deoxycholate. A subsequent trough level was 3.8 µg/mL. The patient improved and was able to be decannulated. However, he did require tracheostomy and long-term hemodialysis. CONCLUSION: In our case we believe that liposomal amphotericin B was significantly removed by ECMO and was responsible for the failure of the ECMO circuit. We would suggest amphotericin B deoxycholate be used in such patients preferentially and that serum levels of the drug be assessed when possible.


Assuntos
Anfotericina B/farmacologia , Blastomicose/terapia , Terapia de Substituição Renal Contínua , Ácido Desoxicólico/farmacologia , Oxigenação por Membrana Extracorpórea/instrumentação , Lesão Renal Aguda/etiologia , Lesão Renal Aguda/terapia , Anfotericina B/química , Anfotericina B/uso terapêutico , Área Sob a Curva , Blastomicose/sangue , Blastomicose/complicações , Terapia Combinada/métodos , Estado Terminal/terapia , Ácido Desoxicólico/uso terapêutico , Combinação de Medicamentos , Substituição de Medicamentos , Falha de Equipamento , Humanos , Masculino , Pessoa de Meia-Idade , Oxigenadores de Membrana/efeitos adversos , Insuficiência Respiratória/etiologia , Insuficiência Respiratória/terapia , Resultado do Tratamento
4.
Cutis ; 104(6): E18-E21, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31939939

RESUMO

Blastomycosis is a subacute or chronic deep mycosis caused by a dimorphic fungus, Blastomyces dermatitidis, that generally produces a pulmonary form of the disease and, to a lesser extent, extrapulmonary forms, such as cutaneous, osteoarticular, and genitourinary. Both immunocompetent and immunocompromised individuals can be infected, but more severe disease occurs in the immunocompromised. Blastomycosis can be diagnosed by culture, direct visualization of the yeast in affected tissue, antigen testing, or a combination of these methods. Treatment course and duration depend on the severity of illness. For mild to moderate pulmonary disease, treatment is itraconazole. For severe blastomycosis, lipid-formulation amphotericin B is given, followed by itraconazole. We present an interesting case of cutaneous blastomycosis acquired in Atlanta, Georgia, that looks quite similar to other mycoses, such as coccidioidomycosis and sporotrichosis, and describe its distinguishing features.


Assuntos
Blastomicose/diagnóstico , Infecções por HIV/imunologia , Hospedeiro Imunocomprometido , Adulto , Blastomicose/terapia , Humanos , Masculino
5.
Clin Chest Med ; 38(3): 435-449, 2017 09.
Artigo em Inglês | MEDLINE | ID: mdl-28797487

RESUMO

The causal agents of blastomycosis, Blastomyces dermatitidis and Blastomyces gilchristii, belong to a group of thermally dimorphic fungi that can infect healthy and immunocompromised individuals. Following inhalation of mycelial fragments and spores into the lungs, Blastomyces spp convert into pathogenic yeast and evade host immune defenses to cause pneumonia and disseminated disease. The clinical spectrum of pulmonary blastomycosis is diverse. The diagnosis of blastomycosis requires a high degree of clinical suspicion and involves culture-based and non-culture-based fungal diagnostic tests. The site and severity of infection, and the presence of underlying immunosuppression or pregnancy, influence the selection of antifungal therapy.


Assuntos
Antifúngicos/uso terapêutico , Blastomicose/diagnóstico , Blastomicose/terapia , Blastomicose/patologia , Humanos
6.
J Hand Surg Am ; 42(11): 932.e1-932.e6, 2017 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-28666674

RESUMO

Isolated blastomycosis hand infections are extremely rare, and are often clinically unsuspected, leading to delays in clinical diagnosis. Conclusive diagnosis often necessitates fungal cultures and histopathological demonstration of budding yeasts in tissues. In this report, we describe the rare occurrence of isolated blastomycotic hand infection, without any other organ involvement, in a 42-year-old male patient. Analyzing tissue specimens with frozen section has been shown in the past to demonstrate granulomatous inflammation and yeast forms of the organism; however, as demonstrated in this patient, the presence of pseudoepitheliomatous cells may deceptively appear as malignant, causing substantial concern and anxiety. Definitive diagnosis often necessitates fungal culture and histopathological examination with special fungal stains including polymerase chain reaction for speciation.


Assuntos
Blastomicose/diagnóstico , Blastomicose/terapia , Imagem Multimodal/métodos , Osteomielite/diagnóstico , Osteomielite/terapia , Adulto , Antifúngicos/administração & dosagem , Biópsia por Agulha , Terapia Combinada , Drenagem/métodos , Edema/diagnóstico , Edema/etiologia , Articulações dos Dedos/diagnóstico por imagem , Articulações dos Dedos/fisiopatologia , Seguimentos , Mãos/fisiopatologia , Humanos , Imuno-Histoquímica , Imagem por Ressonância Magnética/métodos , Masculino , Osteomielite/microbiologia , Tomografia por Emissão de Pósitrons/métodos , Doenças Raras , Resultado do Tratamento
8.
JBJS Case Connect ; 6(3): e66, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-29252643

RESUMO

CASE: A thirty-eight-year-old male patient presented with fusiform swelling of the left ring finger after minor trauma. After medical evaluation by the emergency department, primary care service, and rheumatology service, he was referred to the orthopaedic service, where he underwent 2 surgical debridements. Cultures from the second surgery revealed a diagnosis of blastomycosis, and the patient was treated with intravenous amphotericin B followed by oral itraconazole. CONCLUSION: Our case report demonstrates a rare presentation and diagnosis of blastomycosis. Knowledge of atypical infections such as this can allow for earlier diagnosis and more appropriate treatment.


Assuntos
Blastomyces/isolamento & purificação , Blastomicose/diagnóstico por imagem , Infecções dos Tecidos Moles/microbiologia , Adulto , Blastomicose/microbiologia , Blastomicose/terapia , Humanos , Masculino
9.
Can J Anaesth ; 62(7): 807-15, 2015 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-25851019

RESUMO

PURPOSE: Blastomyces dermatitidis is a dimorphic fungus endemic to North America capable of causing fatal respiratory failure. Acute respiratory distress syndrome (ARDS) complicates up to 10% of pulmonary blastomycosis in hospitalized patients and carries a mortality of 50-90%. This report describes the clinical course of four consecutive patients with blastomycosis-related ARDS treated with venovenous extracorporeal membrane oxygenation (ECMO) during 2009-2014. CLINICAL FEATURES: Four adults were referred from northwestern Ontario, Canada with progressive respiratory illnesses. All patients developed diffuse bilateral opacities on chest radiography and required mechanical ventilation within 6-72 hr. Patients satisfied Berlin criteria for severe ARDS with trough PaO2/F i O2 ratios of 44-61 on positive end-expiratory pressure of 12-24 cm H2O. Wet mount microscopy from respiratory samples showed broad-based yeast consistent with B.dermatitidis. Despite lung protective ventilation strategies with maximal F i O2 (patients A-D), neuromuscular blockade (patients A-D), inhaled nitric oxide (patients A and D), and prone positioning (patient D), progressive hypoxemia resulted in initiation of venovenous ECMO by hours 24-90 of mechanical ventilation with subsequent de-escalation of ventilatory support. In all four cases, ECMO decannulation was performed (7-23 days), mechanical ventilation was withdrawn (18-52 days), and the patients survived to hospital discharge (31-87 days). CONCLUSION: This report describes the successful application of ECMO as rescue therapy in aid of four patients with refractory blastomycosis-associated ARDS. In addition to early appropriate antimicrobial therapy, transfer to an institution experienced with ECMO should be considered when caring for patients from endemic areas with rapidly progressive respiratory failure.


Assuntos
Blastomicose/terapia , Oxigenação por Membrana Extracorpórea/métodos , Síndrome do Desconforto Respiratório do Adulto/terapia , Insuficiência Respiratória/terapia , Adulto , Blastomicose/complicações , Feminino , Humanos , Masculino , Óxido Nítrico/administração & dosagem , Ontário , Respiração com Pressão Positiva , Decúbito Ventral , Respiração Artificial , Síndrome do Desconforto Respiratório do Adulto/microbiologia , Insuficiência Respiratória/microbiologia , Resultado do Tratamento , Adulto Jovem
11.
PLoS One ; 9(8): e105466, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-25126839

RESUMO

We used the State Inpatient Databases from the United States Agency for Healthcare Research and Quality to provide state-specific age-adjusted blastomycosis-associated hospitalization incidence throughout the entire United States. Among the 46 states studied, states within the Mississippi and Ohio River valleys had the highest age-adjusted hospitalization incidence. Specifically, Wisconsin had the highest age-adjusted hospitalization incidence (2.9 hospitalizations per 100,000 person-years). Trends were studied in the five highest hospitalization incidence states. From 2000 to 2011, blastomycosis-associated hospitalizations increased significantly in Illinois and Kentucky with an average annual increase of 4.4% and 8.4%, respectively. Trends varied significantly by state. Overall, 64% of blastomycosis-associated hospitalizations were among men and the median age at hospitalization was 53 years. This analysis provides a complete epidemiologic description of blastomycosis-associated hospitalizations throughout the endemic area in the United States.


Assuntos
Blastomicose/epidemiologia , Blastomicose/terapia , Feminino , Hospitalização/tendências , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estados Unidos/epidemiologia
12.
J Foot Ankle Surg ; 53(4): 472-9, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-24726794

RESUMO

Disseminated blastomycosis can be a devastating disease, affecting multiple organ systems, including the musculoskeletal system. Osteomyelitis from disseminated disease can be difficult to eradicate but is particularly important to successfully manage in the load-bearing bones of the lower extremity. We present a staged protocol for salvage of blastomycotic calcaneal osteomyelitis in the presence of disseminated disease.


Assuntos
Blastomicose/terapia , Calcâneo/microbiologia , Staphylococcus aureus Resistente à Meticilina , Osteomielite/terapia , Terapia de Salvação , Infecções Estafilocócicas/terapia , Adulto , Antifúngicos/uso terapêutico , Calcâneo/cirurgia , Humanos , Masculino , Procedimentos Cirúrgicos Reconstrutivos , Infecções Estafilocócicas/microbiologia
14.
Ital J Pediatr ; 38: 69, 2012 Dec 10.
Artigo em Inglês | MEDLINE | ID: mdl-23228191

RESUMO

BACKGROUND: Blastomycosis, caused by the thermally dimorphic fungus Blastomyces dermatitidis is a systemic pyogranulomatous infection, endemic in United States and Canada, with few reported cases in Africa and Asia. It is uncommon among children and adolescents, ranging from 3% to 10%. Clinical features vary from asymptomatic spontaneously healing pneumonia, through acute or chronic pneumonia, to a malignant appearing lung mass. Blastomycosis can originate a "metastatic disease" in the skin, bones, genitourinary tract and central nervous system. Bone is the third most common site of blastomycotic lesions, after lung and skin. Bones may be involved in 14-60% of cases of blastomycosis. Direct visualization of single broadbased budding yeast with specific stains in sputum or tissue samples at microscopy is the primary method for diagnosis, while culture is timeconsuming and other methods are unreliable. CASE PRESENTATION: We report a case of severe osteoarticular Blastomycosis occurring in a 3-years-old presented to our Emergency Department with pain and swelling of the left knee, successfully treated with surgical curettage and antifungal therapy. To our knowledge this is the first case reported in Europe. CONCLUSIONS: Blastomycosis represents a challenge for European physicians, and it should be included in the differential diagnosis of unexplained infections in patients coming from endemic areas.


Assuntos
Blastomyces/isolamento & purificação , Blastomicose/complicações , Blastomicose/diagnóstico , Emigrantes e Imigrantes , Osteoartrite do Joelho/diagnóstico , Osteoartrite do Joelho/microbiologia , Antifúngicos/uso terapêutico , Blastomicose/terapia , Pré-Escolar , Diagnóstico Diferencial , Drenagem , Gana , Humanos , Itália , Masculino , Osteoartrite do Joelho/terapia , Resultado do Tratamento
15.
Pediatr Dev Pathol ; 15(1): 71-5, 2012.
Artigo em Inglês | MEDLINE | ID: mdl-21815826

RESUMO

Intraoperative consultation via frozen section is an important part of modern day surgical pathology. Recognizing fungi in tissues on frozen and permanent sections is not always a simple task, and correctly identifying the agent can be a significant challenge, even for experienced microscopists. We present a case of a 17-year-old boy with chronic osteomyelitis involving the right proximal ulna. During an irrigation and debridement operation, a frozen section was sent to surgical pathology for evaluation. A limited patient history coupled with sparse organisms present in the frozen section led to the diagnosis of fungal osteomyelitis, favor Coccidioides . Follow-up permanent sections with special staining and successful fungal culture clarified the causal agent to be Blastomyces dermatitidis . The role of frozen sections is not to perfectly speciate the fungal pathogen but to describe the morphology and infectious process and provide a differential diagnosis of the candidate fungi. The importance of intraoperative culture in infectious cases cannot be understated, and it is the responsibility of pathologists to inform surgeons that tissue is needed for culture. A brief overview of Blastomyces , including histopathologic features and key microscopic differences from Coccidioides and Cryptococcus , is discussed.


Assuntos
Antifúngicos/uso terapêutico , Blastomicose/diagnóstico , Coccidioidomicose/diagnóstico , Criptococose/diagnóstico , Secções Congeladas , Osteomielite/diagnóstico , Adolescente , Algoritmos , Blastomyces/isolamento & purificação , Blastomicose/terapia , Quimioterapia Adjuvante , Doença Crônica , Coccidioides/isolamento & purificação , Cryptococcus/isolamento & purificação , Desbridamento , Diagnóstico Diferencial , Humanos , Período Intraoperatório , Itraconazol/uso terapêutico , Masculino , Osteomielite/microbiologia , Osteomielite/terapia , Resultado do Tratamento , Ulna/microbiologia , Ulna/patologia
16.
Rev. iberoam. micol ; 27(4): 210-212, oct.-dic. 2010. ilus
Artigo em Espanhol | IBECS | ID: ibc-82967

RESUMO

Antecedentes. La blastomicosis es una enfermedad infecciosa granulomatosa, causada por el hongo dimorfo Blastomyces dermatitidis. Predomina en Estados Unidos de América, y en México solo se han reportado 2 casos sistémicos importados. La forma primaria cutánea es la presentación clínica menos frecuente de la enfermedad y ocurre después de la inoculación del hongo por traumatismo. Objetivos. Se presenta el caso de un hombre de 54 años de edad, originario de Guadalajara, México, y residente en Chicago, Estados Unidos. Presentaba en la región frontal y surco nasogeniano derecho 2 nódulos verrugosos de 8mm de diámetro de 4 semanas de evolución. Métodos. Se realizó un estudio histopatológico (tinciones de hematoxilina-eosina, Gomori-Grocott y ácido peryódico de Schiff), además, estudio micológico (directo con KOH y cultivos en agar Sabouraud y micobiótico). Además, se realizaron otros estudios que descartaron afección sistémica. Resultados. La biopsia mostró una dermis con infiltrado inflamatorio compuesto por linfocitos, neutrófilos, histiocitos y células gigantes multinucleadas, y escasas levaduras monogemantes con base ancha y rodeadas por un halo. Al examen directo con KOH, se observaron levaduras monogemantes de 8 a 10mm de diámetro de B. dermatitidis. En el cultivo a 35°C creció una colonia blanca, plegada que, con el tiempo, se tornó amarillenta y cerebriforme. Resultados. Se indicó tratamiento con itraconazol a dosis de 200mg/d durante 2 meses con curación clínica y micológica. Conclusiones. El caso presentado podría ser el primero importado en México donde la blastomicosis se presenta solo con lesiones cutáneas y sin compromiso sistémico(AU)


Background. Blastomycosis is a granulomatous infectious disease. It is caused by the dimorphus fungus Blastomyces dermatitidis. It predominates in the United States of America, but in Mexico two systemic imported cases have been reported. Cutaneous primary blastomycosis is a rare clinical presentation, which occurs after traumatic inoculation of the fungus. Objectives. We present a case of a 54 year old male, born in Guadalajara, Mexico, and living in Chicago, USA, who had two verrucous nodules (8mm in diameter) on the forehead and right nasogenian fold, of 4 weeks progression. Methods. We made a histopathological study (hematoxylin and eosin, Gomori Groccot and periodic acid-Schiff stains) and mycology studies (direct microscopic examination, Sabouraud and mycobiotic agar cultures). Multiple studies were made with no evidence of systemic spread. Results. Biopsy showed a dermal inflammatory infiltrate made up of lymphocytes, neutrophils, histiocytes and multinucleated giant cells. A few large, haloed, broad-based budding yeasts were also observed. Direct examination with KOH revealed broad-based budding yeasts, 10ìm in diameter. Culture at 35°C yielded a white, pleated colony, which changed into a yellowish cerebriform. Multiple studies were made with no evidence of systemic spread. Results. Itraconazole 200mg qd PO was given over a 2 month period, with a complete clinical and mycological response. Conclusions. This is the first imported case in Mexico of blastomycosis with cutaneous lesions without systemic involvement(AU)


Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Blastomicose/diagnóstico , Blastomicose/terapia , Blastomyces/isolamento & purificação , Blastomyces/patogenicidade , Biópsia , Itraconazol/uso terapêutico , Microscopia , Micologia/métodos , Blastomicose/microbiologia , Blastomicose/fisiopatologia , Radiografia Torácica
19.
Clin Microbiol Rev ; 23(2): 367-81, 2010 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-20375357

RESUMO

Blastomycosis is endemic in regions of North America that border the Great Lakes and the St. Lawrence River, as well as in the Mississippi River and Ohio River basins. Men are affected more often than women and children because men are more likely to participate in activities that put them at risk for exposure to Blastomyces dermatitidis. Human infection occurs when soil containing microfoci of mycelia is disturbed and airborne conidia are inhaled. If natural defenses in the alveoli fail to contain the infection, lymphohematogenous dissemination ensues. Normal host responses generate a characteristic pyogranulomatous reaction. The most common sites of clinical disease are the lung and skin; osseous, genitourinary, and central nervous system manifestations follow in decreasing order of frequency. Blastomycosis is one of the great mimickers in medicine; verrucous cutaneous blastomycosis resembles malignancy, and mass-like lung opacities due to B. dermatitidis often are confused with cancer. Blastomycosis may be clinically indistinguishable from tuberculosis. Diagnosis is based on culture and direct visualization of round, multinucleated yeast forms that produce daughter cells from a single broad-based bud. Although a long course of amphotericin B is usually curative, itraconazole is also highly effective and is the mainstay of therapy for most patients with blastomycosis.


Assuntos
Blastomyces , Blastomicose/diagnóstico , Blastomicose/terapia , Feminino , Humanos , Masculino
20.
Am J Surg Pathol ; 34(2): 256-61, 2010 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-20090507

RESUMO

Blastomycosis, a worldwide disease caused by the inhalation of Blastomyces dermatitidis spores, can be diagnosed by microbiologic culture or morphologic identification in tissue or cytologic material. A retrospective review of cases diagnosed as blastomycosis in surgical pathology and cytopathology was undertaken at a University Medical Center to assess the diagnostic value of morphologic methods and their correlation with microbiologic cultures. Surgical pathology/cytology records were reviewed for the period between January 1998 and April 2007 and 53 cases diagnosed as blastomycosis were retrieved: 38 males, 15 females; age 14 to 77 years, median 48. Twenty-nine cases (54.7%) involved lung, 14 (26.4%) soft tissue/bone, 5 (9.4%) skin, 3 (5.6%) other sites, and 2 (3.7%) involved both lung and skin. Forty-six of the 53 patients (87%) had concomitant cultures: 31 (67.4%) were positive for blastomycosis, 11 (23.9%) negative and 4 (8.7%) showed other fungal organisms. A review of microbiology laboratory results for the same period identified a total of 39 patients who were diagnosed with blastomycosis based on isolation of B. dermatitidis. These included 31 cases (79.5%) that were also diagnosed on histology/cytology specimens, 4 (10.25%) that were not submitted to surgical pathology and 4 (10.25%) cases in which pathologic examination failed to identify Blastomyces. This study shows that blastomycosis encountered in surgical/cytopathology can be reliably diagnosed by morphologic examination allowing for prompt treatment. However, microbiologic cultures still play a major role in clinical management of patients suspected of infection because 10.25% were false negative on morphology in our study.


Assuntos
Blastomyces/isolamento & purificação , Blastomicose/diagnóstico , Adolescente , Adulto , Idoso , Blastomyces/citologia , Blastomyces/fisiologia , Blastomicose/terapia , Feminino , Humanos , Masculino , Técnicas Microbiológicas , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Estudos Retrospectivos , Adulto Jovem
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