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Seminars in Respiratory and Critical... Feb 2020Blastomycosis is a serious fungal disease of humans and other mammals caused by environmentally acquired infection with geographically restricted, thermally dimorphic... (Review)
Review
Blastomycosis is a serious fungal disease of humans and other mammals caused by environmentally acquired infection with geographically restricted, thermally dimorphic fungi belonging to the genus . The genetic and geographic diversity of these pathogens is greater than previously appreciated. In addition to and the cryptic species , which cause blastomycosis in mid-western and various eastern areas of North America, atypical blastomycosis is occasionally caused by in western parts of North America and in Africa. Blastomycosis is acquired by inhalation of the conidia that are produced in the mold phase; in the lungs, temperature-dependent transformation occurs to the yeast phase. In this form, the organism is phagocytized by macrophages and can spread hematogenously to various organs causing disseminated infection. Pulmonary disease is most common and varies from mild, self-limited infection to severe, potentially fatal adult respiratory distress syndrome. Disseminated infection is manifested primarily by skin lesions, but many other organs can be involved. Diagnosis is established by growth of the organism in culture; however, a tentative diagnosis can be made quickly by histopathological identification of the classic yeast form in tissues or by finding antigen in urine or serum. Blastomycosis is treated initially with amphotericin B when the disease is severe, involves the central nervous system, or the host is immunosuppressed. Itraconazole is recommended for primary therapy in mild-to-moderate infection and for step-down therapy after initial amphotericin B treatment. Voriconazole and posaconazole can be used for patients in whom itraconazole is not tolerated.
Topics: Amphotericin B; Antifungal Agents; Blastomyces; Blastomycosis; Humans; Immunocompromised Host; Itraconazole; Triazoles; Voriconazole
PubMed: 32000282
DOI: 10.1055/s-0039-3400281 -
Infectious Disease Clinics of North... Jun 2021Blastomycosis is the fungal disease caused by thermally dimorphic fungi in the genus Blastomyces, with B dermatitidis complex causing most cases. It is considered... (Review)
Review
Blastomycosis is the fungal disease caused by thermally dimorphic fungi in the genus Blastomyces, with B dermatitidis complex causing most cases. It is considered hyperendemic in areas adjacent to the Great Lakes and along the St. Lawrence, Mississippi, and Ohio rivers, but definitive geographic distribution of blastomycoses remains obscure. Clinical presentation is variable. Disseminated blastomycosis with extrapulmonary manifestations is more common in immunosuppressed individuals. Culture positivity is required for definitive diagnosis, but compatible histology is often sufficient for presumptive diagnosis and initiation of treatment. Treatment should be provided to all symptomatic cases to prevent progression or recurrence.
Topics: Amphotericin B; Antifungal Agents; Blastomyces; Blastomycosis; Endemic Diseases; Humans; Itraconazole
PubMed: 34016289
DOI: 10.1016/j.idc.2021.03.013 -
Journal of Investigative Medicine High... 2023Blastomycosis is a rare endemic fungal infection caused by the dimorphic fungus It is more likely to occur in persons living in areas of the United States and Canada,...
Blastomycosis is a rare endemic fungal infection caused by the dimorphic fungus It is more likely to occur in persons living in areas of the United States and Canada, which border the Ohio and Mississippi River Valleys and the Great Lakes region. Most infections are localized to the lungs, often presenting as acute or chronic pneumonia. Occasionally, patients progress to develop disseminated disease and extrapulmonary infections. Blastomycosis tends to be misdiagnosed initially at clinical evaluation as it is rare and may resemble other common conditions. We present a case of a 78-year-old immunosuppressed renal transplant patient who was suspected of having gout but eventually was diagnosed with an unusual presentation of septic arthritis of the ankle secondary to blastomycosis.
Topics: Humans; United States; Aged; Blastomyces; Blastomycosis; Kidney Transplantation; Pneumonia; Arthritis, Infectious
PubMed: 37032537
DOI: 10.1177/23247096231166674 -
Current Opinion in Microbiology Aug 2000An understanding of the molecular bases of pathogenicity in Blastomyces dermatitidis and related systemic dimorphic fungi has been limited until recent years. Yeast... (Review)
Review
An understanding of the molecular bases of pathogenicity in Blastomyces dermatitidis and related systemic dimorphic fungi has been limited until recent years. Yeast cells of B. dermatitidis display an adhesion promoting protein termed WI-1. Recent studies entailing homologous gene targeting and mutation of WI-1 have provided null mutants at this locus and demonstrated the crucial role of the WI-1 adhesin in pathogenesis of blastomycosis. Ongoing studies are pointing to a link between phase-specific expression of WI-1 and the observation that transition to yeast cells is essential for the acquisition of pathogenicity by B. dermatitidis. Recombinant attenuated yeast that lack WI-1 are serving as invaluable tools for induction of vaccine resistance and are pointing to new insights about adaptive immunity to B. dermatitidis.
Topics: Animals; Blastomyces; Blastomycosis; Cell Adhesion; Fungal Proteins; Fungal Vaccines; Glycoproteins; Humans; Mice; Virulence
PubMed: 10972490
DOI: 10.1016/s1369-5274(00)00100-4 -
Contributions To Microbiology 2000
Review
Topics: Blastomyces; Cysteine; Ecology; Genes, Fungal; HSP70 Heat-Shock Proteins; Histoplasma; Stearoyl-CoA Desaturase; Virulence
PubMed: 10863674
DOI: 10.1159/000060346 -
Journal of Clinical Microbiology Sep 2021Laboratory diagnosis of blastomycosis relies on a combination of methods, including antigen detection. We assessed the performance of analyte-specific reagents from...
Laboratory diagnosis of blastomycosis relies on a combination of methods, including antigen detection. We assessed the performance of analyte-specific reagents from Gotham Biotech (Portland, ME) for quantitative detection of Blastomyces dermatitidis galactomannan (GM) in urine using an enzyme immunoassay (EIA) compared to the quantitative EIA from MiraVista Diagnostics (Indianapolis, IN). Residual urine from 232 unique patients previously tested by the MiraVista assay was evaluated using the Gotham EIA, which showed 97.4% (74/76), 100% (156/156), and 99.1% (230/232) positive, negative, and overall agreement, respectively. Correlation between the quantitative B. dermatitidis antigen levels by the Gotham and MiraVista EIAs was low ( = 0.20). Medical records were available for 36 of the 232 patients, among whom four had confirmed blastomycosis and both the Gotham and MiraVista EIAs were positive. Nine of these patients had histoplasmosis, and the Gotham and MiraVista EIAs yielded negative results in 44.4% (4/9) and 22.2% (2/9) of cases, respectively. Both assays were negative in the remaining 23 patients. After laboratory implementation of the Gotham EIA, chart reviews were performed on the first 50 unique patients (51 samples) tested by the assay in our hospital. Among these, 3/50 (6%) samples were positive by the Gotham EIA, including two samples from a patient with culture-confirmed blastomycosis and one from a patient with histoplasmosis (also positive by the MiraVista EIA). All remaining patients were negative by the Gotham EIA and had alternative diagnoses. Our findings show comparable performance between the Gotham and MiraVista quantitative EIAs for detection of B. dermatitidis GM in urine.
Topics: Antigens, Fungal; Blastomyces; Blastomycosis; Humans; Immunoenzyme Techniques; Sensitivity and Specificity
PubMed: 34346719
DOI: 10.1128/JCM.01444-21 -
Mycopathologia Apr 1982
Review
Topics: Agglutination Tests; Antibodies, Monoclonal; Antigens, Fungal; Antimycin A; Blastomyces; Cell Wall; Complement Fixation Tests; Cytoplasm; Fungal Proteins; Glucans; Lipids; Lymphocyte Activation; Precipitin Tests; Skin Tests
PubMed: 7048101
DOI: 10.1007/BF00436581 -
Mycopathologia Oct 2019Blastomycosis is a systemic fungal disease of humans and other animals produced by the thermally dimorphic fungal organism, Blastomyces dermatitidis. Recent studies have...
Blastomycosis is a systemic fungal disease of humans and other animals produced by the thermally dimorphic fungal organism, Blastomyces dermatitidis. Recent studies have focused on the utilization of antibody and antigen detection in the development of immunoassays for the diagnosis of blastomycosis. This study was designed to evaluate four B. dermatitidis yeast lysate antigenic preparations from human isolates (591, 592, 597, 598) from an outbreak of blastomycosis in Eagle River, Wisconsin. The indirect enzyme-linked immunosorbent assay (ELISA) was used to compare these four antigens for their ability to detect antibodies in 28 serum specimens from immunized rabbits and in 18 sera from dogs with blastomycosis. This study also compared antibodies prepared from each of the four B. dermatitidis lysate antigens for their ability to detect antigen using the competitive enzyme-linked immunosorbent assay in 18 urine specimens from the same dogs as above with blastomycosis. All four reagents proved to be immunoreactive and were able to detect antibody in the rabbit and dog sera and antigen in each of the urine specimens with only slight variations in the mean absorbance values evidenced. Antibody detection, mean absorbance values with the four lysates, ranged from 1.522 (592 antigen) to 2.047 (597 antigen) in the rabbit sera and from 1.504 (591 antigen) to 1.878 (597 antigen) in the dog sera. Antigen detection, sensitivity values obtained with the antibodies prepared from the four lysates, ranged from 89% (598 serum) to 100% (591 and 592 serum specimens).
Topics: Animals; Antibodies, Fungal; Antigens, Fungal; Blastomyces; Blastomycosis; Disease Outbreaks; Dogs; Humans; Rabbits
PubMed: 31583528
DOI: 10.1007/s11046-019-00385-0 -
Ophthalmology Aug 1998The authors report the clinical, cytologic, and histopathologic findings of a unique presentation of concomitant unilateral endophthalmitis and orbital cellulitis... (Review)
Review
PURPOSE
The authors report the clinical, cytologic, and histopathologic findings of a unique presentation of concomitant unilateral endophthalmitis and orbital cellulitis secondary to Blastomyces dermatitidis.
DESIGN
Case report.
METHODS
A 29-year-old healthy woman with a history of pulmonary tuberculosis presented with a painful right eye and rapidly decreasing vision. Fundus examination showed a diffuse elevated choroidal lesion at the posterior pole. With an otherwise unremarkable systemic work-up, the patient was treated with systemic antibiotics and corticosteroids for a presumed diagnosis of choroidal tuberculous granuloma. After an initial response to the treatment, the patient's condition deteriorated rapidly with visual acuity decreasing from 20/25 to no light perception in 3 months. Ipsilateral proptosis developed with magnetic resonance imaging showing a poorly defined orbital mass. Surgical enucleation and an orbital biopsy were performed.
RESULTS
Histopathologic examination of the orbital specimen and an intact enucleated globe showed a diffuse necrotizing granulomatous process with the presence of numerous yeasts consistent with B. dermatitidis. This subsequently was confirmed by positive culture of B. dermatitidis from the orbital specimen.
CONCLUSIONS
This is a unique case of concurrent unilateral endophthalmitis and orbital cellulitis secondary to B. dermatitidis. Intraocular dissemination of blastomycosis should be suspected in the differential diagnosis of endophthalmitis in patients with previous or active pulmonary lesions of equivocal nature. Early diagnosis and prompt treatment with antifungal medications are essential.
Topics: Adult; Biopsy; Blastomyces; Blastomycosis; Cellulitis; Endophthalmitis; Eye Enucleation; Eye Infections, Fungal; Female; Fundus Oculi; Humans; Magnetic Resonance Imaging; Orbit; Orbital Diseases; Tuberculosis, Pulmonary
PubMed: 9709759
DOI: 10.1016/S0161-6420(98)98030-7 -
Transplant Infectious Disease : An... Aug 2014Blastomyces dermatitidis is a dimorphic fungus endemic to the midwestern, south-central, and southeastern United States known to cause disseminated infection in... (Review)
Review
Blastomyces dermatitidis is a dimorphic fungus endemic to the midwestern, south-central, and southeastern United States known to cause disseminated infection in immunocompromised individuals. We report a case of B. dermatitidis peritonitis in a renal allograft recipient with new-onset ascites and cytomegalovirus encephalitis. Peritoneal blastomycosis is a rare clinical entity and, to our knowledge, this patient represents the first known case of peritoneal blastomycosis in a solid organ transplant recipient. We review the clinical characteristics of B. dermatitidis peritonitis as well as the literature on fungal peritonitis with emphasis on dimorphic fungal pathogens. Clinical features suggestive of fungal peritonitis include new-onset ascites, abdominal pain, and fevers, especially with antecedent or concomitant pneumonia. A high index of clinical suspicion, along with the use of culture and non-culture diagnostics, is needed for early diagnosis and prompt initiation of therapy.
Topics: Aged; Amphotericin B; Antifungal Agents; Blastomyces; Blastomycosis; Humans; Kidney Transplantation; Male; Peritonitis
PubMed: 24862205
DOI: 10.1111/tid.12234