Blastomycosis: Difference between revisions
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==Background== | ==Background== | ||
* Fungus: Blastomyces dermatitidis | * [[Fungus]]: Blastomyces dermatitidis | ||
* Lives in moist soil, wooded areas | * Lives in moist soil, wooded areas | ||
* Spores airborne | * Spores airborne | ||
| Line 8: | Line 8: | ||
* Reportable disease | * Reportable disease | ||
* Systemic pyogranulomatous infection | * 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 | ||
| Line 23: | Line 24: | ||
* CNS: Meningitis, epidural/intracranial abscess in immunocompromised | * CNS: Meningitis, epidural/intracranial abscess in immunocompromised | ||
* Can involve breast, adrenal, thyroid, eye, lymph node, liver, spleen | * Can involve breast, adrenal, thyroid, eye, lymph node, liver, spleen | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
* Pneumonia | * Pneumonia | ||
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* Pyoderma gangrenosum | * Pyoderma gangrenosum | ||
* Keratoacanthoma | * Keratoacanthoma | ||
==Workup== | ==Workup== | ||
* Fungal culture (Blood, sputum, bone marrow, liver or skin) : Broad based buds | * Fungal culture (Blood, sputum, bone marrow, liver or skin) : Broad based buds | ||
| Line 41: | Line 44: | ||
** Xray vertebrae: Lytic lesion in anterior vertebral body and destruction of disc space | ** Xray vertebrae: Lytic lesion in anterior vertebral body and destruction of disc space | ||
* Bronchoscopy | * Bronchoscopy | ||
==Management== | ==Management== | ||
* ID consult | * ID consult | ||
| Line 50: | Line 54: | ||
** Lipid for all patients, except children | ** Lipid for all patients, except children | ||
** If CNS involvement, lipid for all patients | ** If CNS involvement, lipid for all patients | ||
==Disposition== | ==Disposition== | ||
* Subclinical disease: Observation and no treatment | * Subclinical disease: Observation and no treatment | ||
* Patients with immunocompetence or progressive pulmonary or extrapulmonary symptoms need treatment and often admission | * Patients with immunocompetence or progressive pulmonary or extrapulmonary symptoms need treatment and often admission | ||
* Some may need ICU | * Some may need ICU | ||
==See Also== | ==See Also== | ||
*[[Fungal infections]] | |||
==External Links== | ==External Links== | ||
* http://www.idsociety.org/uploadedFiles/IDSA/Guidelines-Patient_Care/PDF_Library/Blastomycosis.pdf | * http://www.idsociety.org/uploadedFiles/IDSA/Guidelines-Patient_Care/PDF_Library/Blastomycosis.pdf | ||
==Sources== | ==Sources== | ||
<references/> | <references/> | ||
Revision as of 03:29, 28 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