Blastomycosis: Difference between revisions
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* Southeast and Midwest US (Mississippi and Ohio River valleys) | * Southeast and Midwest US (Mississippi and Ohio River valleys) | ||
* Reportable disease | * Reportable disease | ||
* Systemic pyogranulomatous infection | |||
==Clinical Features== | ==Clinical Features== | ||
* Flu like symptoms: Fever, chills, cough, muscle aches, joint pain, chest pain | * Flu like symptoms: Fever, chills, cough, muscle aches, joint pain, chest pain | ||
* Pulmonary: most | * Up to 50% asymptomatic | ||
* Skin: | * Systemic: Weight loss, night sweats, chills | ||
* Bone | * Pulmonary: most common | ||
* Genitourinary: | ** Acute or chronic pneumonia | ||
* CNS | ** Diffuse pneumonitis, ARDS | ||
* Skin: | |||
** Verrucous lesion with irregular borders | |||
** Microabscess (cold), subcutaneous nodules | |||
** Ulcers that bleed easily and well-demarcated | |||
* Bone: Osteomyelitis, chronic draining sinus, paravertebral abscess | |||
* Genitourinary: Prostatitis, epididymoorchitis | |||
* CNS: Meningitis, epidural/intracranial abscess in immunocompromised | |||
* Can involve breast, adrenal, thyroid, eye, lymph node, liver, spleen | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
* Pneumonia | * Pneumonia | ||
* Malignancy | * Malignancy | ||
* Tuberculosis | * Tuberculosis | ||
* Histoplasmosis | |||
* Pyoderma gangrenosum | * Pyoderma gangrenosum | ||
* Keratoacanthoma | * Keratoacanthoma | ||
==Workup== | ==Workup== | ||
* Fungal culture (Blood, sputum, bone marrow, liver or skin) | * Fungal culture (Blood, sputum, bone marrow, liver or skin) : Broad based buds | ||
* Antigen test (Serum or urine) | * Antigen test (Serum or urine) | ||
* | * Histopathology | ||
* Serologic testing | |||
* HIV testing | |||
* CXR: Alveolar infiltrates +/- cavitation, mass lesions, miliary or reticulo- or fibronodular pattern, pleural effusions, upper lobe infiltrat | |||
* Chest CT: Nodules, consolidation +/- cavitation, tree-in-bud opacities, pleural effusion, lack hilar adenopathy | |||
* Xray of bone: Well-circumscribed osteolytic lesion | |||
** Xray vertebrae: Lytic lesion in anterior vertebral body and destruction of disc space | |||
* Bronchoscopy | |||
==Management== | ==Management== | ||
* Mild or moderate infections: Itraconazole | * ID consult | ||
* Severe infection: | * Mild or moderate infections: Itraconazole (200mg TID x 3 days then once or twice daily x 6-12 months) | ||
** Alternative: Fluconazole or ketoconozale (400-800mg/day) | |||
**Azoles embryotoxic and teratogenic, avoid in pregnancy | |||
* Severe infection: Amphotericin B (Lipid 3-5mg/kg IV daily or deoxycholate 0.7-1mg/kg IV daily) | |||
** All immunocompromised patient should receive amphotericin B | |||
** Lipid for all patients, except children | |||
** If CNS involvement, lipid for all patients | |||
==Disposition== | ==Disposition== | ||
* Subclinical disease: observation and no treatment | |||
* Patients with immunocompetence or progressive pulmonary or extrapulmonary symptoms need treatment and often admission | |||
* Some may need ICU | |||
==See Also== | ==See Also== | ||
==External Links== | ==External Links== | ||
* http://www.idsociety.org/uploadedFiles/IDSA/Guidelines-Patient_Care/PDF_Library/Blastomycosis.pdf | |||
==Sources== | ==Sources== | ||
<references/> | <references/> | ||
* http://www.cdc.gov/fungal/diseases/blastomycosis/information.html | * http://www.cdc.gov/fungal/diseases/blastomycosis/information.html | ||
**Bradsher RW, et al. Clinical manifestations and diagnosis of blastomycosis. In: Post T, ed. UpToDate. Waltham, Mass.: UpToDate; 2014. www.uptodate.com. Accessed December 43, 2014. | |||
** Chapman SW, et al. Clinical practice guidelines for the management of blastomycosis: 2008 update by the Infectious Diseases Society of America. CID. 2008; 40: 1801-1812. | |||
**Bradsher RW, et al. Treatment of blastomycosis. In: Post T, ed. UpToDate. Waltham, Mass.: UpToDate; 2014. www.uptodate.com. Accessed December 24, 2014. | |||
***Varkey B, et al. (2014, Jun 30).Blastomycosis. eMedicine. Retrieved 12/24/2014 from http://emedicine.medscape.com/article/296870-overview | |||
Revision as of 05:45, 25 December 2014
Background
- Fungus: Blastomyces dermatitidis
- Lives in moist soil, wooded areas
- Spores airborne
- Incubation: 3-6 weeks
- North, Central and South America
- Southeast and Midwest US (Mississippi and Ohio River valleys)
- Reportable disease
- Systemic pyogranulomatous infection
Clinical Features
- Flu like symptoms: Fever, chills, cough, muscle aches, joint pain, chest pain
- Up to 50% asymptomatic
- Systemic: Weight loss, night sweats, chills
- Pulmonary: most common
- Acute or chronic pneumonia
- Diffuse pneumonitis, ARDS
- Skin:
- Verrucous lesion with irregular borders
- Microabscess (cold), subcutaneous nodules
- Ulcers that bleed easily and well-demarcated
- Bone: Osteomyelitis, chronic draining sinus, paravertebral abscess
- Genitourinary: Prostatitis, epididymoorchitis
- CNS: Meningitis, epidural/intracranial abscess in immunocompromised
- Can involve breast, adrenal, thyroid, eye, lymph node, liver, spleen
Differential Diagnosis
- Pneumonia
- Malignancy
- Tuberculosis
- Histoplasmosis
- Pyoderma gangrenosum
- Keratoacanthoma
Workup
- Fungal culture (Blood, sputum, bone marrow, liver or skin) : Broad based buds
- Antigen test (Serum or urine)
- Histopathology
- Serologic testing
- HIV testing
- CXR: Alveolar infiltrates +/- cavitation, mass lesions, miliary or reticulo- or fibronodular pattern, pleural effusions, upper lobe infiltrat
- Chest CT: Nodules, consolidation +/- cavitation, tree-in-bud opacities, pleural effusion, lack hilar adenopathy
- Xray of bone: Well-circumscribed osteolytic lesion
- Xray vertebrae: Lytic lesion in anterior vertebral body and destruction of disc space
- Bronchoscopy
Management
- ID consult
- Mild or moderate infections: Itraconazole (200mg TID x 3 days then once or twice daily x 6-12 months)
- Alternative: Fluconazole or ketoconozale (400-800mg/day)
- Azoles embryotoxic and teratogenic, avoid in pregnancy
- Severe infection: Amphotericin B (Lipid 3-5mg/kg IV daily or deoxycholate 0.7-1mg/kg IV daily)
- All immunocompromised patient should receive amphotericin B
- Lipid for all patients, except children
- If CNS involvement, lipid for all patients
Disposition
- Subclinical disease: observation and no treatment
- Patients with immunocompetence or progressive pulmonary or extrapulmonary symptoms need treatment and often admission
- Some may need ICU
See Also
External Links
Sources
- http://www.cdc.gov/fungal/diseases/blastomycosis/information.html
- Bradsher RW, et al. Clinical manifestations and diagnosis of blastomycosis. In: Post T, ed. UpToDate. Waltham, Mass.: UpToDate; 2014. www.uptodate.com. Accessed December 43, 2014.
- Chapman SW, et al. Clinical practice guidelines for the management of blastomycosis: 2008 update by the Infectious Diseases Society of America. CID. 2008; 40: 1801-1812.
- Bradsher RW, et al. Treatment of blastomycosis. In: Post T, ed. UpToDate. Waltham, Mass.: UpToDate; 2014. www.uptodate.com. Accessed December 24, 2014.
- Varkey B, et al. (2014, Jun 30).Blastomycosis. eMedicine. Retrieved 12/24/2014 from http://emedicine.medscape.com/article/296870-overview