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Gullapalli D, Raza A, Khan A, Ganti SS, Pervaiz A. Battling the breath-stealers: Blastomyces and Pseudomonas triggering acute respiratory distress syndrome (ARDS). Med Mycol Case Rep 2024; 45:100655. [PMID: 39005644 PMCID: PMC11245912 DOI: 10.1016/j.mmcr.2024.100655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 05/31/2024] [Accepted: 06/08/2024] [Indexed: 07/16/2024] Open
Abstract
Blastomycosis is an endemic disease in North America and commonly manifests with pulmonary symptoms. Blastomycosis should be consider when patients have persistent infiltrates on imaging in an endemic area. We present a case of a 46-year-old male who presented to the pulmonary clinic with fever, cough with production of yellowish-green sputum and culture of BAL-fluid showed growth of Pseudomonas spp. Antimicrobial therapy was started accordingly, but was not effective. A repeat bronchoscopy was performed and BAL-fluid culture was positive for Blastomyces dermatitidis and liposomal amphotericin B was initiated. Unfortunately, the patient died after withdrawing care.
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Affiliation(s)
- Dedeepya Gullapalli
- Appalachian Regional Healthcare Internal Medicine Residency Program, Harlan, 40831, KY, USA
| | - Ali Raza
- Appalachian Regional Healthcare Internal Medicine Residency Program, Whitesburg, 41858, KY, USA
| | - Amna Khan
- Appalachian Regional Healthcare Internal Medicine Residency Program, Harlan, 40831, KY, USA
| | - Subramanya Shyam Ganti
- Division of Pulmonary, Critical Care Medicine, Appalachian Regional Healthcare, Harlan, 40831, KY, USA
| | - Amina Pervaiz
- Division of Pulmonary, Critical Care and Sleep Medicine, Wayne State University School of Medicine, Detroit, 48201, MI, USA
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Kasule SN, Grant LM, Apolinario MA, Speiser LJ, Saling CF, Blair JE, Vikram HR. Endemic Fungal Infective Endocarditis Caused by Coccidioides, Blastomyces and Histoplasma Species in the United States. Cureus 2024; 16:e60285. [PMID: 38746483 PMCID: PMC11093152 DOI: 10.7759/cureus.60285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/14/2024] [Indexed: 05/16/2024] Open
Abstract
We describe a recent case of Coccidioides bioprosthetic aortic valve infective endocarditis successfully managed at our institution. This led us to perform a literature review of endemic fungal infective endocarditis in the United States caused by Coccidioides, Blastomyces, and Histoplasma. Symptoms preceded infective endocarditis diagnosis by several months. Patients with Coccidioides and Blastomyces infective endocarditis were younger with fewer comorbid conditions. Valvular involvement was relatively uncommon in Blastomyces infective endocarditis (27%). Fungemia was noted in patients with infective endocarditis due to Histoplasma (30%) and Coccidioides (18%). Mortality rates for infective endocarditis were high (Histoplasma, 46%; Coccidioides, 58%; Blastomyces, 80%); infective endocarditis was commonly diagnosed post-mortem (Coccidioides, 58%; Blastomyces, 89%). Most surviving patients with infective endocarditis (Histoplasma, 79%; Coccidioides, 80%) underwent valve surgery along with prolonged antifungal therapy. The two surviving patients with Blastomyces infective endocarditis received antifungal therapy without surgery.
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Granger D, Streck NT, Theel ES. Detection of Histoplasma capsulatum and Blastomyces dermatitidis antigens in serum using a single quantitative enzyme immunoassay. J Clin Microbiol 2024; 62:e0121323. [PMID: 38099670 PMCID: PMC10793276 DOI: 10.1128/jcm.01213-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 11/09/2023] [Indexed: 01/18/2024] Open
Abstract
Histoplasma and Blastomyces antigen detection assays are commonly used diagnostic tools. However, a high level of cross-reactivity between these antigens prevents definitive pathogen identification by these assays alone. Retrospective analysis of 3,529 patients with Histoplasma and Blastomyces antigen testing performed on the same serum sample yielded an overall percent agreement of 99.3% (3,506 of 3,529; kappa: 0.859) between the two assays, suggesting that use of a single assay to detect both antigens may be an alternative diagnostic approach. We assessed performance of the Gotham BioTech Blastomyces antigen (GBA) enzyme immunoassay (EIA) (Portland, Maine) for detection of Blastomyces and Histoplasma antigens in serum. Comparison to the MiraVista Diagnostics Blastomyces (MVB) EIA showed 100% positive (24 of 24), negative (57 of 57), and overall (81 of 81) percent agreement. Additionally, 171 sera were used to compare the GBA EIA to the MiraVista Diagnostics Histoplasma (MVH) EIA, which showed 91.3% (63 of 69), 98% (100 of 102), and 95.3% (163 of 171) positive, negative, and overall percent agreement, respectively. Among eight patients with discordant GBA/MVH EIA results, seven had additional fungal testing performed, and results suggested that the MVH and GBA results were inaccurate for two and five samples, respectively. Overall, this study suggests that the GBA EIA has a high level of agreement with both of the commonly used, individual Blastomyces and Histoplasma antigen EIAs. By taking advantage of the high level of cross-reactivity between Blastomyces and Histoplasma antigen EIAs, utilization of a single antigen detection assay for these fungi provides an opportunity to optimize test utilization and decrease patient cost while maintaining a high level of diagnostic accuracy.
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Affiliation(s)
- Dane Granger
- Division of Clinical Microbiology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Nicholas T. Streck
- Division of Clinical Microbiology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Elitza S. Theel
- Division of Clinical Microbiology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
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Vangara A, Gullapalli D, Depa JK, Kolagatla S, Ali M, Ganti SS. Beware of the Acute Respiratory Distress Syndrome in a Pulmonary Blastomycosis! J Investig Med High Impact Case Rep 2024; 12:23247096241233042. [PMID: 38375745 PMCID: PMC10880536 DOI: 10.1177/23247096241233042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 01/24/2024] [Accepted: 01/30/2024] [Indexed: 02/21/2024] Open
Abstract
Blastomyces dermatitidis is a dimorphic fungus that can range from mild to severe disease presentation, including the acute respiratory distress syndrome (ARDS) based on the individual's immunity. Acute respiratory distress syndrome is an uncommon presentation having an incidence of about 10% to 15% but has a high mortality exceeding 90%. This is a case of a 50-year-old female with past medical history of asthma and type 2 diabetes mellitus who presented to the pulmonology clinic with worsening dyspnea for the last 2 months. She also had a lesion in the left lower back, which was draining purulent fluid. Chest radiographs showed bilateral infiltrates and was started empirically on vancomycin and piperacillin-tazobactam. Bronchoalveolar lavage was done and the cultures grew B dermatitidis. The patient was moved to a higher level of care and given amphotericin B. Unfortunately, the patient experienced septic shock, which later deteriorated into cardiac arrest, ultimately leading to their passing. The importance of early diagnosis of blastomycosis and timely treatment has been emphasized in this case report.
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Affiliation(s)
- Avinash Vangara
- Internal Medicine Residency Program, Appalachian Regional Healthcare, Harlan, KY, USA
| | - Dedeepya Gullapalli
- Internal Medicine Residency Program, Appalachian Regional Healthcare, Harlan, KY, USA
| | - Jayaram Krishna Depa
- Internal Medicine Residency Program, Appalachian Regional Healthcare, Harlan, KY, USA
| | - Sandhya Kolagatla
- Internal Medicine Residency Program, Appalachian Regional Healthcare, Whitesburg, KY, USA
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Benedict K, Hennessee I, Gold JAW, Smith DJ, Williams S, Toda M. Blastomycosis-Associated Hospitalizations, United States, 2010-2020. J Fungi (Basel) 2023; 9:867. [PMID: 37754975 PMCID: PMC10532734 DOI: 10.3390/jof9090867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 08/18/2023] [Accepted: 08/19/2023] [Indexed: 09/28/2023] Open
Abstract
BACKGROUND Blastomycosis is an environmentally acquired fungal disease that can cause severe illness, with approximately 65% of reported cases requiring hospitalization. Recent trends in blastomycosis-associated hospitalizations in the United States have not been described. METHODS We analyzed hospital discharge data from the Healthcare Cost and Utilization Project (HCUP) National (Nationwide) Inpatient Sample. We calculated hospitalization rates per 100,000 population using U.S. census data and examined factors associated with in-hospital mortality. RESULTS An estimated 11,776 blastomycosis-associated hospitalizations occurred during 2010-2020 (average yearly rate 0.3 per 100,000 persons), with no apparent temporal trend. Rates were consistently highest among persons ≥65 years old and males. In-hospital death occurred in 7.9% and approximately doubled from 3.9% in 2010 to 8.5% in 2020. Older age, chronic obstructive pulmonary disease, and malignancy were associated with mortality. CONCLUSIONS Blastomycosis-associated hospitalizations can result in poor outcomes, underscoring the continued need for attention to early detection and treatment of blastomycosis and monitoring of disease trends.
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Affiliation(s)
- Kaitlin Benedict
- Mycotic Diseases Branch, Division of Foodborne, Waterborne and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA; (I.H.); (J.A.W.G.); (D.J.S.); (S.W.); (M.T.)
| | - Ian Hennessee
- Mycotic Diseases Branch, Division of Foodborne, Waterborne and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA; (I.H.); (J.A.W.G.); (D.J.S.); (S.W.); (M.T.)
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
| | - Jeremy A. W. Gold
- Mycotic Diseases Branch, Division of Foodborne, Waterborne and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA; (I.H.); (J.A.W.G.); (D.J.S.); (S.W.); (M.T.)
| | - Dallas J. Smith
- Mycotic Diseases Branch, Division of Foodborne, Waterborne and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA; (I.H.); (J.A.W.G.); (D.J.S.); (S.W.); (M.T.)
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
| | - Samantha Williams
- Mycotic Diseases Branch, Division of Foodborne, Waterborne and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA; (I.H.); (J.A.W.G.); (D.J.S.); (S.W.); (M.T.)
| | - Mitsuru Toda
- Mycotic Diseases Branch, Division of Foodborne, Waterborne and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA; (I.H.); (J.A.W.G.); (D.J.S.); (S.W.); (M.T.)
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Burton KA, Karulf M. Necrotizing Pneumonia Secondary to Pulmonary Blastomycosis: A Case Report. Cureus 2023; 15:e38846. [PMID: 37303385 PMCID: PMC10256257 DOI: 10.7759/cureus.38846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/10/2023] [Indexed: 06/13/2023] Open
Abstract
Necrotizing pneumonia is a rare but potentially life-threatening complication of pulmonary blastomycosis, a fungal infection caused by inhaling spores of the fungus Blastomyces dermatitidis. This case report describes a 56-year-old male who presented with worsening malaise, subjective fevers and chills, night sweats, and a productive cough. Further evaluation revealed a right upper lobe necrotizing pneumonia secondary to pulmonary blastomycosis.
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Affiliation(s)
- Kyle A Burton
- Internal Medicine, Michigan State University College of Human Medicine, Marquette, USA
| | - Matthew Karulf
- Pulmonology, Upper Peninsula Health Systems, Marquette, USA
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Varghese JA, Guhan S, Zheng L. Emerging Fungal Infections and Cutaneous Manifestations in Immunosuppressed Patients. CURRENT DERMATOLOGY REPORTS 2023. [DOI: 10.1007/s13671-023-00386-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023]
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Vaccines to Prevent Coccidioidomycosis: A Gene-Deletion Mutant of Coccidioides Posadasii as a Viable Candidate for Human Trials. J Fungi (Basel) 2022; 8:jof8080838. [PMID: 36012826 PMCID: PMC9410110 DOI: 10.3390/jof8080838] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 08/05/2022] [Accepted: 08/07/2022] [Indexed: 11/19/2022] Open
Abstract
Coccidioidomycosis is an endemic fungal infection that is reported in up to 20,000 persons per year and has an economic impact close to $1.5 billion. Natural infection virtually always confers protection from future exposure, and this suggests that a preventative vaccine strategy is likely to succeed. We here review progress toward that objective. There has been ongoing research to discover a coccidioidal vaccine over the past seven decades, including one phase III clinical trial, but for reasons of either efficacy or feasibility, a safe and effective vaccine has not yet been developed. This review first summarizes the past research to develop a coccidioidal vaccine. It then details the evidence that supports a live, gene-deletion vaccine candidate as suitable for further development as both a veterinary and a human clinical product. Finally, a plausible vaccine development plan is described which would be applicable to this vaccine candidate and also useful to other future candidates. The public health and economic impact of coccidioidomycosis fully justifies a public private partnership for vaccine development, and the development of a vaccine for this orphan disease will likely require some degree of public funding.
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Pullen MF, Alpern JD, Bahr NC. Blastomycosis-Some Progress but Still Much to Learn. J Fungi (Basel) 2022; 8:jof8080824. [PMID: 36012812 PMCID: PMC9410313 DOI: 10.3390/jof8080824] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 08/02/2022] [Accepted: 08/03/2022] [Indexed: 11/16/2022] Open
Abstract
Blastomycosis, caused by Blastomyces spp., is an endemic mycosis capable of causing significant disease throughout the body. Higher rates of infection are seen in the Mississippi and Ohio River valleys, the Great Lakes region of the United States and Canada, much of Africa, and, to a lesser extent, in India and the Middle East. Limited reporting inhibits our true understanding of the geographic distribution of blastomycosis. An estimated 50% of those infected remain asymptomatic. Of those who present with symptomatic disease, pulmonary involvement is most common, while the most common extrapulmonary sites are the skin, bones, genitourinary system, and central nervous system. Itraconazole is the standard therapy for mild-moderate disease. Data for other azoles are limited. Amphotericin is used for severe disease, and corticosteroids are occasionally used in severe disease, but evidence for this practice is limited. Despite increasing incidence and geographic reach in recent years, there are still significant knowledge gaps in our understanding of blastomycosis. Here, we provide an updated review of the epidemiology, clinical presentations, and diagnostic and therapeutic approaches for this infection. We also discuss areas needing further research.
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Affiliation(s)
- Matthew F. Pullen
- Division of Infectious Diseases and International Medicine, Department of Medicine, University of Minnesota, Minneapolis, MN 55455, USA
| | - Jonathan D. Alpern
- Division of Infectious Diseases, HealthPartners, Bloomington, MN 55425, USA
- Department of Medicine, University of Minnesota, Minneapolis, MN 55455, USA
| | - Nathan C. Bahr
- Division of Infectious Diseases, Department of Medicine, University of Kansas Medical Center, Kansas City, KS 66160, USA
- Correspondence:
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