1
|
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.
Collapse
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
| |
Collapse
|
2
|
A 37-Year-Old Man With Right Lung Consolidation. Chest 2023; 163:e111-e114. [PMID: 36894264 DOI: 10.1016/j.chest.2022.10.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 09/20/2022] [Accepted: 10/21/2022] [Indexed: 03/09/2023] Open
Abstract
CASE PRESENTATION A 37-year-old man attended a medical clinic at the confluence of the Appalachian and the St. Lawrence Valley after 2 weeks of coughing greenish sputum and progressive dyspnea on exertion. In addition, he reported fatigue, fevers, and chills. He had quit smoking a year earlier and was not a drug user. He recently had spent most of his free time outdoors, mountain biking, but had not travelled outside of Canada. Medical history was unremarkable. He did not take any medication. Upper airway samples taken for SARS-CoV-2 proved negative; he was prescribed cefprozil and doxycycline for presumed community-acquired pneumonia. He returned to the emergency room 1 week later with mild hypoxemia, persisting fever, and a chest radiography consistent with lobar pneumonia. The patient was admitted to his local community hospital, and broad-spectrum antibiotics were added to the regimen. Unfortunately, his condition deteriorated over the following week, and he experienced hypoxic respiratory failure for which he required mechanical ventilation before his transfer to our medical center.
Collapse
|
3
|
A Rare Case of MDA-5-Positive Amyopathic Dermatomyositis with Rapidly Progressive Interstitial Lung Disease Following COVID-19 mRNA Vaccination — a Case Report. SN COMPREHENSIVE CLINICAL MEDICINE 2022; 5:18. [PMCID: PMC9735185 DOI: 10.1007/s42399-022-01357-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 11/25/2022] [Indexed: 12/13/2022]
|
4
|
Imaging findings of pulmonary blastomycosis in pediatric patients. Pediatr Radiol 2022; 52:1974-1984. [PMID: 35687113 DOI: 10.1007/s00247-022-05402-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 03/29/2022] [Accepted: 05/14/2022] [Indexed: 10/18/2022]
Abstract
Blastomycosis is caused by Blastomyces dermatitidis, a thermally dimorphic fungus that lives in the form of spores in the soil in North America. The main mode of transmission is through the inhalation of these spores. Despite the importance of knowing the imaging characteristics of blastomycosis given the suggested high rates of dissemination in symptomatic children, a paucity of literature focuses on the imaging patterns of blastomycosis in the pediatric population. In this review, we describe the main imaging findings of pediatric pulmonary blastomycosis and briefly review extrapulmonary manifestations of the disease. Familiarity with these imaging manifestations is important to aid in rapid diagnosis.
Collapse
|
5
|
Canfield GS, Bock A, Mann S, Zimmer S, Somerset H, Franco-Paredes C, Wilson CC, Metter RB. A 31-year-old Micronesian Man With Shoulder Fungating Mass. Clin Infect Dis 2021; 70:973-975. [PMID: 32055859 DOI: 10.1093/cid/ciz591] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Gregory S Canfield
- Division of Infectious Diseases, University of Colorado School of Medicine, Denver
| | - Allison Bock
- Division of Internal Medicine, University of Colorado School of Medicine, Denver
| | - Sarah Mann
- Division of Infectious Diseases, University of Colorado School of Medicine, Denver
| | - Shanta Zimmer
- Division of Infectious Diseases, University of Colorado School of Medicine, Denver
| | - Hilary Somerset
- Division of Pathology, University of Colorado School of Medicine, Denver
| | | | - Cara C Wilson
- Division of Infectious Diseases, University of Colorado School of Medicine, Denver
| | - Robert B Metter
- Division of Hospital Medicine, University of Colorado School of Medicine, Denver
| |
Collapse
|
6
|
Abstract
OBJECTIVE The objective of our study was to characterize and update the radiologic patterns of pediatric pulmonary blastomycosis, and correlate the radiologic patterns with patient age. MATERIALS AND METHODS Patients 0-18 years old with pulmonary blastomycosis who underwent chest imaging from 2005 to 2016 were included in this study. The following data were collected: age, sex, clinical information, and imaging findings including presence of extrapulmonary involvement and scarring on follow-up examinations. Concordance between radiography and CT was analyzed. RESULTS Thirty-six patients (28 boys and eight girls) ranging in age from 3 months to 17 years (mean, 10.5 years) were identified. Consolidation was found in 94.4% of patients and was unilateral in 76.5% of cases and bilateral in 23.5%. Upper (70.6%) and middle (47.1%) lobes were more frequently involved. Air bronchograms were identified in 76.5% of patients with consolidations, masslike consolidation was found in 55.9%, cavitation in 38.2%, and bubbly pattern (i.e., multiple small cavities) in 32.4%. In all patients younger than 5 years, consolidations involved multiple lobes. In 67.6% of patients, consolidations were associated with the following additional pulmonary or pleural abnormalities: pulmonary nodules (50% of patients), diffuse patchy opacification (26.5%), reticulonodular pattern (41.2%), atelectasis (5.9%), pleural effusion (20.6%), and hilar lymphadenopathy (23.5%). Pulmonary scarring was found in 70.4% of patients. Five patients had extrapulmonary involvement. The concordance between radiography and CT was excellent for location and extension of consolidation and diagnosis of cavitation, bubbly pattern, and nodules. CONCLUSION The most common pattern of lung involvement from pulmonary blastomycosis in our series was a combination of consolidations with bilateral lung nodules and reticulonodular opacification.
Collapse
|
7
|
Patel RH, Pandya S, Nanjappa S, Greene JN. A Case of Refractory Pulmonary Coccidioidomycosis Successfully Treated with Posaconazole Therapy. JOURNAL OF FAMILY MEDICINE 2017; 4:1130. [PMID: 29938709 PMCID: PMC6010061 DOI: 10.26420/jfammed.2017.1130] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Coccidioidomycosis is an endemic fungal infection caused by the inhalation of the spores of Coccidioides species. Patients with underlying immunosuppressive illness can contract chronic or disseminated disease which requires prolonged systemic therapy. Pulmonary coccidioidomycosis remains as an illusory and abstruse disease, with increased prevalence that poses as a challenge for clinicians in developing an effective strategy for treatment. Here, we report successful treatment of a refractory case of chronic relapsing pulmonary coccidioidomycosis in a 50-year old woman with a thin-walled cavitary lung lesion who was ultimately treated with posaconazole.
Collapse
Affiliation(s)
- R H Patel
- Undergraduate Student, University of South Florida, USA
| | - S Pandya
- Chief Infectious Diseases Fellow, University of South Florida, Morsani College of Medicine, USA
| | - S Nanjappa
- Assistant Member, Department of Internal Hospital Medicine, H. Lee Moffitt Cancer Center and Research Institute, Department of Oncologic Sciences, University of South Florida, Morsani College of Medicine, USA
| | - J N Greene
- Chief, Infectious Diseases and Hospital Epidemiologist, H. Lee Moffitt Cancer Center and Research Institute, USA
| |
Collapse
|
8
|
A Case of Refractory Pulmonary Coccidioidomycosis Successfully Treated with Posaconazole Therapy. ACTA ACUST UNITED AC 2017. [PMID: 29938709 DOI: 10.14260/jemds/2017/1130] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Coccidioidomycosis is an endemic fungal infection caused by the inhalation of the spores of Coccidioides species. Patients with underlying immunosuppressive illness can contract chronic or disseminated disease which requires prolonged systemic therapy. Pulmonary coccidioidomycosis remains as an illusory and abstruse disease, with increased prevalence that poses as a challenge for clinicians in developing an effective strategy for treatment. Here, we report successful treatment of a refractory case of chronic relapsing pulmonary coccidioidomycosis in a 50-year old woman with a thin-walled cavitary lung lesion who was ultimately treated with posaconazole.
Collapse
|
9
|
Mansour MK, Ackman JB, Branda JA, Kradin RL. CASE RECORDS of the MASSACHUSETTS GENERAL HOSPITAL. Case 32-2015. A 57-Year-Old Man with Severe Pneumonia and Hypoxemic Respiratory Failure. N Engl J Med 2015; 373:1554-64. [PMID: 26465989 DOI: 10.1056/nejmcpc1503830] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
|
10
|
Gandhi V, Singh A, Woods GL, Epelbaum O. A 66-year-old woman with fever, cough, and a tongue lesion. Chest 2015; 147:e140-e147. [PMID: 25846538 DOI: 10.1378/chest.14-1858] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
A 66-year-old woman presented with acute onset of fever, chills, and productive cough associated with right-sided chest pain. During a recent hospitalization for dyspnea, she had been diagnosed with Coombs-positive autoimmune hemolytic anemia and had been taking a tapering dose of prednisone starting approximately 6 weeks prior to admission. In the interim, her dyspnea had resolved on treatment with steroids. At the time of presentation, her prednisone dose was 40 mg. Additional medical history included VTE, for which the patient was receiving anticoagulation therapy, and steroid-induced diabetes mellitus. Many years earlier, she had been treated for TB in her home country. The patient had immigrated to Queens, New York, from a Nepalese village 8 years prior. While still in Nepal, she had worked on a farm and had been in close proximity to cows. In Queens, she lived with her family in a house with a small garden but had no pets. Recent travel included a visit to Nepal 9 months ago and a trip to Syracuse, New York, one month prior to presentation. She was a never smoker and did not consume alcohol.
Collapse
Affiliation(s)
- Viral Gandhi
- Department of Internal Medicine, Elmhurst Hospital Center, Icahn School of Medicine at Mount Sinai, Elmhurst, NY.
| | - Amteshwar Singh
- Department of Internal Medicine, Johns Hopkins University-Sinai Hospital, Baltimore, MD
| | - Gail L Woods
- Division of Pediatric Pathology, Arkansas Children's Hospital, Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Oleg Epelbaum
- Division of Pulmonary and Critical Care Medicine, Elmhurst Hospital Center, Icahn School of Medicine at Mount Sinai, Elmhurst, NY
| |
Collapse
|
11
|
Putman MS, Shah NS, Husain AN, David MZ. Extrapulmonary intrathoracic blastomycosis: a case report and systematic literature review. JMM Case Rep 2015. [DOI: 10.1099/jmmcr.0.000022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
| | - Nirav S. Shah
- Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Aliya N. Husain
- Department of Pathology, University of Chicago, Chicago, IL, USA
| | | |
Collapse
|
12
|
Rapid progression of pulmonary blastomycosis in an untreated patient of chronic lymphocytic leukemia. Case Rep Med 2014; 2014:514382. [PMID: 24822069 PMCID: PMC4005070 DOI: 10.1155/2014/514382] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Revised: 03/01/2014] [Accepted: 03/17/2014] [Indexed: 11/18/2022] Open
Abstract
Chronic lymphocytic leukemia (CLL) is associated with a state of immunosuppression characterized by hypogammaglobulinemia as well as B and T lymphocyte dysfunction. Though opportunistic infections are common in CLL patients, particularly after treatment, reports of infections by endemic dimorphic fungi are very few. Here we report a case of pulmonary blastomycosis in a CLL patient who initially presented with an indolent pulmonary mass lesion. The pulmonary lesions progressed rapidly over a two-week period. The diagnosis was established by transbronchial lung biopsy. He was treated with Amphotericin B lipid complex followed by oral itraconazole and recovered uneventfully. This case illustrates the importance of a timely diagnosis and treatment. The presentation of blastomycosis in immunocompromised patients, diagnosis, and treatment are discussed.
Collapse
|
13
|
Jhun BW, Kim DM, Park JH, Yoo HS, Shim H, Kim JG, Han J, Kwon OJ. A Case of Pulmonary Blastomycosis Mimicking Pulmonary Tuberculosis. Tuberc Respir Dis (Seoul) 2012. [DOI: 10.4046/trd.2012.72.1.77] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Byung Woo Jhun
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Da Min Kim
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ji Hyeon Park
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hong Seok Yoo
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hunbo Shim
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jhin Gook Kim
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Joungho Han
- Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - O Jung Kwon
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| |
Collapse
|
14
|
Kanne JP, Yandow DR, Haemel AK, Meyer CA. Beyond Skin Deep: Thoracic Manifestations of Systemic Disorders Affecting the Skin. Radiographics 2011; 31:1651-68. [DOI: 10.1148/rg.316115516] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
15
|
Computed tomographic scan evaluation of pulmonary blastomycosis. CANADIAN JOURNAL OF INFECTIOUS DISEASES & MEDICAL MICROBIOLOGY 2011; 20:112-6. [PMID: 21119802 DOI: 10.1155/2009/763018] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Blastomycosis is an uncommon granulomatous pulmonary and extrapulmonary infectious disease caused by the thermally dimorphic fungus Blastomyces dermatitidis. Diagnosis may be delayed or difficult because of varied presentation. The characteristics of blastomycosis on computed tomographic (CT) scan of the chest are not well characterized. METHODS The images from 34 chest CT scans from patients with confirmed pulmonary blastomycosis were retrospectively reviewed. RESULTS The most common CT findings were air bronchograms in 22 patients (65%), consolidation in 21 patients (62%), nodules (smaller than 3 cm) in 21 patients (62%) and lymph node enlargement (mediastinal and hilar nodes combined) in 12 patients (35%). Only four patients (12%) had a miliary pattern. CONCLUSIONS A specific abnormality characteristic of pulmonary blastomycosis was not identified on CT scanning. The diagnosis can only be made in the context of a high index of clinical suspicion with histological or culture confirmation.
Collapse
|
16
|
Carlos WG, Rose AS, Wheat LJ, Norris S, Sarosi GA, Knox KS, Hage CA. Blastomycosis in indiana: digging up more cases. Chest 2010; 138:1377-82. [PMID: 20558552 DOI: 10.1378/chest.10-0627] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND The endemic region of blastomycosis historically has included the state of Indiana. However, few published reports of blastomycosis exist to substantiate this distinction. A surge of patients with blastomycosis in central Indiana (Indianapolis and surrounding counties) beginning in 2005 prompted us to review our local experience. We propose that this surge was related to major highway construction around Indianapolis. METHODS We reviewed all microbiologically confirmed cases from four hospitals serving central Indiana. Chart review was completed for adult patients, and data were collected on clinical presentations, methods of diagnosis, comorbidities, radiologic findings, treatment, and outcomes. We plotted patient residence addresses with sites of highway construction. RESULTS Fifty-nine patients were identified from laboratory results and physician referral. Interestingly, a surge of blastomycosis incidence occurred in 34 patients between 2005 and 2008 during which time major highway projects were under way around the Indianapolis metropolitan area. The majority of these patients presented acutely and with pulmonary involvement. Fungal culture and antigen testing were the most sensitive means to diagnosis. Antifungal therapy was highly effective. CONCLUSIONS This urban outbreak of blastomycosis in Indianapolis should prompt clinicians to consider blastomycosis in this highly endemic area of histoplasmosis.
Collapse
Affiliation(s)
- W Graham Carlos
- Pulmonary-Critical Care and Infectious Diseases, Roudebush VA Medical Center and Indiana University, Indianapolis, IN 46202, USA.
| | | | | | | | | | | | | |
Collapse
|
17
|
Gill RR, Matsusoka S, Hatabu H. Cavities in the lung in oncology patients: Imaging overview and differential diagnoses. APPLIED RADIOLOGY 2010. [DOI: 10.37549/ar1757] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Ritu R. Gill
- Brigham and Women’s Hospital
- Harvard Medical School
| | | | | |
Collapse
|
18
|
Fungal pneumonias. Infect Dis (Lond) 2010. [DOI: 10.1016/b978-0-323-04579-7.00031-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
|
19
|
Bruce Light R, Kralt D, Embil JM, Trepman E, Wiebe L, Limerick B, Sarsfield P, Hammond G, Macdonald K. Seasonal variations in the clinical presentation of pulmonary and extrapulmonary blastomycosis. Med Mycol 2009; 46:835-41. [PMID: 18651302 DOI: 10.1080/13693780802132763] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Blastomycosis is a granulomatous infection caused by the thermally dimorphic fungus, Blastomyces dermatitidis, for which seasonal variation has been proposed. We conducted a retrospective review of medical records of 324 patients with blastomycosis in Manitoba and northwestern Ontario. The average age of patients at the time of diagnosis was 39+/-20 (range, 0-85) years. Symptoms referable to blastomycosis were first noted in the autumn and winter (September to February) by 63% of the patients. The seasonal distribution of cases was different for localized pulmonary infection than the disseminated disease (P<0.0001). For localized lung disease, the peak incidence of symptom onset occurred in the autumn, and lowest incidence in the spring; one half (50%) of the patients with diffuse lung disease had onset of symptoms in the spring months and a few (11%) cases occurred during the summer. We noted a distinct seasonal variation in the clinical presentation of blastomycosis. The observed pattern suggests that summer environmental exposure and acquisition of the infection results in an early (1-6 months) localized pneumonia in the majority of cases, followed by later (4-9 months) reactivation or slow progression of asymptomatic infection resulting in isolated extrapulmonary or disseminated hematogenous disease in the minority.
Collapse
Affiliation(s)
- R Bruce Light
- Section of Infectious Diseases, Department of Medicine, University of Manitoba, Winnipeg
| | | | | | | | | | | | | | | | | |
Collapse
|
20
|
Norman D, Yoshikawa T. Fungal Infections. INFECTIOUS DISEASE IN THE AGING 2009. [PMCID: PMC7122029 DOI: 10.1007/978-1-60327-534-7_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Older adults are at increased risk of developing opportunistic fungal infections because organ transplantation, intensive cancer chemotherapy regimens, and anti-tumor necrosis factor agents are now used more commonly, and because admission to an intensive care unit, which carries many risk factors for fungal infection, has become commonplace in this group. Candida species are the most common cause of opportunistic fungal infections, and bloodstream infections are usually treated with fluconazole or an echinocandin antifungal agent. Invasive mold infections are mostly caused by Aspergillus species; in older adults, they cause primarily pulmonary and sinus infections, and they are associated with a high mortality rate. The endemic fungi, Histoplasma capsulatum, Coccidioides species, and Blastomyces dermatitidis, cause infection when the mold form is dispersed and inhaled from the environment in those specific areas of the country in which these organisms flourish. Amphotericin B is used for initial treatment of severe histoplasmosis, coccidioidomycosis, and blastomycosis; itraconazole is the therapy of choice for most mild to moderate infections due to these endemic mycoses.
Collapse
|
21
|
Kralt D, Light B, Cheang M, MacNair T, Wiebe L, Limerick B, Sarsfield P, Hammond G, MacDonald K, Trepman E, Embil JM. Clinical characteristics and outcomes in patients with pulmonary blastomycosis. Mycopathologia 2008; 167:115-24. [PMID: 18931937 DOI: 10.1007/s11046-008-9163-7] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2008] [Accepted: 10/02/2008] [Indexed: 12/22/2022]
Abstract
BACKGROUND Blastomycosis is an uncommon granulomatous infection caused by the thermally dimorphic fungus Blastomyces dermatitidis. The most frequent clinical infections involve the lung, skin, and bone. Pulmonary manifestations range from asymptomatic self-limited infection to severe diffuse pneumonia causing respiratory failure. OBJECTIVES To establish the clinical characteristics and outcomes of patients with pulmonary blastomycosis diagnosed at hospitals in Manitoba and northwestern Ontario, Canada. METHODS A retrospective review of medical records was done for 318 patients with blastomycosis in these regions. RESULTS The majority of patients were Caucasian (198 (62.5%) patients), male (193 (61%) patients), and residents of Ontario (209 (65.7%) patients). Most patients were treated in an inpatient hospital ward (266 (84%) patients) and survived (294 (92%) patients). Pulmonary involvement, either alone or associated with other sites, was present in 296 (93%) of the 318 patients; 22 (7%) patients had no evidence of pulmonary blastomycosis. The majority of patients had localized lung disease (1-3 quadrants on chest radiograph involved; 225 (82%) patients). Of 294 (92%) patients requiring hospitalization, 266 (90%) patients received all inpatient care on a general medical ward; 28 (10%) patients received some care in the intensive care unit (ICU). Factors associated with ICU admission included diffuse pulmonary disease (four quadrants involved on chest radiograph), diabetes, and prior use of antimicrobial therapy. Twenty-four (8%) patients died, and multivariate analysis showed that older age and Aboriginal ethnicity were the significant risk factors for death from blastomycosis. CONCLUSION Blastomycosis is a cause of serious, potentially life-threatening pulmonary infection in this geographic region.
Collapse
Affiliation(s)
- Doug Kralt
- Faculty of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
22
|
|
23
|
Chapman SW, Dismukes WE, Proia LA, Bradsher RW, Pappas PG, Threlkeld MG, Kauffman CA. Clinical practice guidelines for the management of blastomycosis: 2008 update by the Infectious Diseases Society of America. Clin Infect Dis 2008; 46:1801-12. [PMID: 18462107 DOI: 10.1086/588300] [Citation(s) in RCA: 366] [Impact Index Per Article: 22.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Evidence-based guidelines for the management of patients with blastomycosis were prepared by an Expert Panel of the Infectious Diseases Society of America. These updated guidelines replace the previous management guidelines published in the April 2000 issue of Clinical Infectious Diseases. The guidelines are intended for use by health care providers who care for patients who have blastomycosis. Since 2000, several new antifungal agents have become available, and blastomycosis has been noted more frequently among immunosuppressed patients. New information, based on publications between 2000 and 2006, is incorporated in this guideline document, and recommendations for treating children with blastomycosis have been noted.
Collapse
|
24
|
Abstract
A pulmonary cavity is a gas-filled area of the lung in the center of a nodule or area of consolidation and may be clinically observed by use of plain chest radiography or computed tomography. Cavities are present in a wide variety of infectious and noninfectious processes. This review discusses the differential diagnosis of pathological processes associated with lung cavities, focusing on infections associated with lung cavities. The goal is to provide the clinician and clinical microbiologist with an overview of the diseases most commonly associated with lung cavities, with attention to the epidemiology and clinical characteristics of the host.
Collapse
|
25
|
Abstract
Blastomycosis is caused by the inhalation of spores of the dimorphic fungus, Blastomyces dermatitidis. The reporting of this disease is not required by all states. The diagnosis is established by culture or by identification of broad budding yeast forms in tissue or cytology samples. A retrospective review of blastomycosis was conducted using surgical pathology and cytopathology records of a large community based general hospital, for the years 1982 to 2002; the autopsy records of a university referral center were searched for the years 1992 to 2004. Thirteen surgical/cytology cases were retrieved: 8 localized to the lung (group 1) and 5 with extrapulmonary presentation (group 2). Three of the former were clinically thought to be tumors. Broad-based budding yeast forms with thick cell walls were seen in all but 1 case and identified on conventional routinely stained preparations. Microbiologic culture was positive in 2 lung cases only, in 1 of which it was the sole means of diagnosis. Culture was negative for Blastomyces in the only extrapulmonary case for which a specimen was submitted. One patient in group 2 died, but had a coexistent disseminated gastric adenocarcinoma. No autopsy was performed. Three autopsies of blastomycosis were recovered (group 3). Two patients were on corticosteroids and 1 was diabetic. Premortem diagnoses were established only within a few days of death in 2 patients. Blastomycosis is seldom a fatal disease. Most patients are immune competent; immune compromise favors an aggressive course. Microbiologic culture and conventional morphologic assessment of routine samples have redundant utility in diagnosis.
Collapse
Affiliation(s)
- Jerome B Taxy
- Department of Pathology, Advocate Lutheran General Hospital, Park Ridge, IL, USA.
| |
Collapse
|
26
|
Abstract
The endemic mycoses are diverse group of fungi that share several characteristics. They are able to cause disease in healthy hosts, they each occupy a specific ecologic niche in the environment, and they exhibit temperature dimorphism, existing as molds in the environment at temperature of 25 degrees C to 30 degrees C, and as yeasts, or spherules in the case of coccidioidomycosis, at body temperatures. This article discusses histoplasmosis and blastomycosis. Sporotrichosis, which differs in that it is usually a localized lymphocutaneous infection, is included because it shares the characteristics of endemic mycoses.
Collapse
Affiliation(s)
- Carol A Kauffman
- University of Michigan Medical School, Ann Arbor, MI 48109, USA.
| |
Collapse
|
27
|
Chong S, Lee KS, Yi CA, Chung MJ, Kim TS, Han J. Pulmonary fungal infection: imaging findings in immunocompetent and immunocompromised patients. Eur J Radiol 2006; 59:371-83. [PMID: 16725293 DOI: 10.1016/j.ejrad.2006.04.017] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2006] [Revised: 04/10/2006] [Accepted: 04/10/2006] [Indexed: 11/18/2022]
Abstract
Histoplasmosis is the most common endemic mycosis in North America, and is followed by coccidioidomycosis and blastomycosis. Although the majority of these infections in immunocompetent persons are self-limited, some patients can develop severe pneumonitis or various forms of chronic pulmonary infection. Cryptococcoci, Aspergillus, Candidas, and Mucorals are ubiquitous organisms, which may affect immunocompromised patients. Specific imaging findings can be expected, depending on the organisms involved, underlying patients' conditions (immune status), and specific situations after immune depleting procedures.
Collapse
Affiliation(s)
- Semin Chong
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50, Ilwon-Dong, Kangnam-Ku, Seoul 135-710, Republic of Korea
| | | | | | | | | | | |
Collapse
|
28
|
|
29
|
Affiliation(s)
- Ahmed Masood
- Division of Pulmonary and Critical Care Medicine, University of Kentucky, Lexington, KY 40536-0298, USA
| | | |
Collapse
|
30
|
Chapman SW, Bradsher RW, Campbell GD, Pappas PG, Kauffman CA. Practice guidelines for the management of patients with blastomycosis. Infectious Diseases Society of America. Clin Infect Dis 2000; 30:679-83. [PMID: 10770729 DOI: 10.1086/313750] [Citation(s) in RCA: 168] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/1999] [Revised: 07/28/1999] [Indexed: 11/03/2022] Open
Abstract
Guidelines for the treatment of blastomycosis are presented; these guidelines are the consensus opinion of an expert panel representing the National Institute of Allergy and Infectious Diseases Mycoses Study Group and the Infectious Diseases Society of America. The clinical spectrum of blastomycosis is varied, including asymptomatic infection, acute or chronic pneumonia, and extrapulmonary disease. Most patients with blastomycosis will require therapy. Spontaneous cures may occur in some immunocompetent individuals with acute pulmonary blastomycosis. Thus, in a case of disease limited to the lungs, cure may have occurred before the diagnosis is made and without treatment; such a patient should be followed up closely for evidence of disease progression or dissemination. In contrast, all patients who are immunocompromised, have progressive pulmonary disease, or have extrapulmonary disease must be treated. Treatment options include amphotericin B, ketoconazole, itraconazole, and fluconazole. Amphotericin B is the treatment of choice for patients who are immunocompromised, have life-threatening or central nervous system (CNS) disease, or for whom azole treatment has failed. In addition, amphotericin B is the only drug approved for treating blastomycosis in pregnant women. The azoles are an equally effective and less toxic alternative to amphotericin B for treating immunocompetent patients with mild to moderate pulmonary or extrapulmonary disease, excluding CNS disease. Although there are no comparative trials, itraconazole appears more efficacious than either ketoconazole or fluconazole. Thus, itraconazole is the initial treatment of choice for nonlife-threatening non-CNS blastomycosis.
Collapse
Affiliation(s)
- S W Chapman
- Division of Infectious Diseases, University of Mississippi Medical Center, Jackson, MS 39216-4505, USA.
| | | | | | | | | |
Collapse
|
31
|
Rabatin JT, Utz JP. 55-year-old man with a lung lesion and hemidysesthesia. Mayo Clin Proc 1999; 74:515-8. [PMID: 10319085 DOI: 10.4065/74.5.515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- J T Rabatin
- Mayo Graduate School of Medicine, Mayo Clinic Rochester, MN 55905, USA
| | | |
Collapse
|
32
|
Affiliation(s)
- R Martínez Cruz
- Servicio de Neumología, Hospital Clínico San Carlos, Universidad Complutense, Madrid
| | | |
Collapse
|
33
|
Abstract
Blastomycosis is a relatively uncommon disease, even in its endemic region. The clinical course and symptoms are highly variable; patients may be asymptomatic or present with severe, fulminant disease. Antifungal agents are effective against pulmonary and disseminated disease, but relapses and reactivation can occur. The radiographic findings are nonspecific, and patients are often assumed to have bacterial pneumonia, malignancy, tuberculosis, or sarcoidosis before the correct diagnosis is made.
Collapse
Affiliation(s)
- R S Kuzo
- Department of Radiology, Medical College of Wisconsin, Milwaukee 53226-3512, USA
| | | |
Collapse
|
34
|
Winquist EW, Walmsley SL, Berinstein NL. Reactivation and dissemination of blastomycosis complicating Hodgkin's disease: a case report and review of the literature. Am J Hematol 1993; 43:129-32. [PMID: 8342540 DOI: 10.1002/ajh.2830430211] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Patients presenting with Hodgkin's disease (HD) may show lung involvement characterized by contiguous spread from ipsilateral hilar lymph nodes. Lung consolidation or noncontiguous pulmonary involvement makes an alternative diagnosis more likely. This report describes a patient with HD in whom concurrent pulmonary blastomycosis was recognized only after chemotherapy had started and dissemination had occurred. Although Blastomyces dermatitidis may behave as an opportunist pathogen, there are no previous reports of blastomycosis in patients with HD. Undiagnosed active opportunistic infection at the time of diagnosis of HD may complicate staging as well as treatment. Biopsy of lung lesions with stain and culture for opportunistic pathogens should be considered in patients with newly diagnosed HD disease and atypical patterns of lung involvement.
Collapse
Affiliation(s)
- E W Winquist
- Department of Medicine, University of Toronto, Toronto-Bayview Regional Cancer Centre, Ontario, Canada
| | | | | |
Collapse
|
35
|
Byrd RP, Fields CL, Dickerson JW, Skolnick JH, Roy TM. Upper lobe cystic lesions and cough in a young woman. Chest 1992; 102:261-2. [PMID: 1623763 DOI: 10.1378/chest.102.1.261] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Affiliation(s)
- R P Byrd
- Division of Respiratory and Environmental Medicine, University of Louisville School of Medicine 40292
| | | | | | | | | |
Collapse
|
36
|
|