Self-limited blastomycosis: a report of 39 cases

We report 39 patients with pulmonary blastomycosis who were not treated with specific antifungal chemotherapy. Fourteen of these patients were recognized during an epidemic of blastomycosis in 1972 and did not have culturally proven disease. The remaining 25 patients were all proven instances of blastomycosis, 24 of whom had pulmonary disease only. Over a median observation period of 42 months (range: 12 to 168) one patient relapsed 52 months after the original diagnosis, while all of the others have remained clinically well. It is our belief that certain patients with blastomycosis limited to the lungs may safely be followed without specific antifungal chemotherapy until clearing occurs. These include patients with mild or no symptoms and those who have been more symptomatic but are already improving when the diagnosis is established. Worsening of the clinical picture, or evidence of extrapulmonary disease requires immediate antifungal chemotherapy.

Pulmonary phycomycosis without obvious predisposing factors. A case report

A previously healthy infant developed congestive cardiac failure and an acute respiratory tract infection and died 4 days after the onset of illness. Autopsy showed pulmonary phycomycosis. Published reports on cases of pulmonary phycomycosis in which no predisposing factor was known are reviewed.

Allergic bronchopulmonary stemphyliosis

A patient is described in whom a clinical picture resembling allergic bronchopulmonary aspergillosis was found to be caused by hypersensitivity to the fungus Stemphylium lanuginosum. Bronchopulmonary reactions to antigens other than Aspergillus may be more frequent than is currently believed.

Mouse model of pulmonary blastomycosis: utility, simplicity, and quantitative parameters

A murine model of pulmonary mycotic disease using Blastomyces dermatitidis is defined quantitatively. Intranasal inoculation with yeasts avoids delays in growing microconidia and can be performed with routine precautions without sophisticated biohazard facilities. The particles rapidly reach the bronchioles and alveoli, producing a progressive focal pneumonia, studied histologically. In vitro growth conditions are defined to titer inocula reproducibly with visual methods. Median survival can be titrated with the challenge inocula. Although initial postchallenge lung cultures are not always positive, replication eventually proceeds, at a rate defined for various challenge sizes, to a ceiling of 10(7) to 10(8) colony-forming units per g of tissue incompatible with life. Lung weight correlates closely with colony-forming units per g above a threshold. Lethality correlates with initial body weight and with age. During the course of infection, weight is an accurate predictor of mortality. Extrapulmonary dissemination occurs as a premortem event in protracted infections. A wide variation in fungal strain virulence is documented. Quantification of these features of the model makes it useful for study of host response or therapeutic intervention, because efficacy can be related to stage of disease and parasitic burden.

Sporotrichosis: an unusual disseminated cutaneous case and a fatal pulmonary case

Two unusual cases of sporotrichosis are presented. One patient had disseminated vesicular skin lesions which yielded Sporothrix schenckii on culture. The other, with extensive pulmonary sporotrichosis, continued to have sputum cultures positive for S schenckii during three years of intensive chemotherapy.

[Physiopathology and clinical aspects of respiratory tract infections. Review]

A topographical account is given of the (mostly viral) infections that strike the upper airways and the lung parenchyma sites caused by bacteria, Mycoplasma, Rickettsiae and fungi. The different features of the three main syndromes that ensue: obstructive and restrictive ventilatory insufficiency, and alveolo-capillary block, are examined. The need for care in the administration of antibiotics is stressed, since germ resistance must be restricted as far as possible. In the case of chronic forms of lung disease, careful clinical surveillance and active therapeutic management are mandatory to prevent the establishment of irreversible, incapacitating consequences.