Also called North American blastomycosis and Gilchrist's disease, blastomycosis is a fungal infection that usually affects the lungs and produces bronchopneumonia. During the chronic stage of illness, the disease may disseminate through the blood and cause skin disorders (most commonly), osteomyelitis, genitourinary (GU) disorders, and central nervous system (CNS) disorders (rarely). In contrast to other fungal diseases, it seldom acts as an opportunistic infection.
Blastomycosis is found in North America (where Blastomyces dermatitidis normally inhabits the soil). Sporadic cases have been reported in Africa.
The incubation period ranges from weeks to months. Untreated blastomycosis is slowly progressive and usually fatal, although spontaneous remission may occur. The mortality rate is 15% in appropriately treated cases.
Infection occurs by breathing in the spores that become airborne when contaminated soil or wood is disturbed. Humans and animals such as dogs, rats and cats may become infected. The disease is rarely transmitted from human-to-human or animal-to-human. Very rarely, infection via the skin may occur.
Symptoms and Signs
Accurate diagnosis of blastomycosis requires the following:
Other abnormal laboratory findings include an increased white blood cell count, an elevated erythrocyte sedimentation rate, slightly increased serum globulin levels, mild normochromic anemia and, with bone lesions, increased alkaline phosphatase levels.
Amphotericin B is used to treat all patients with rapidly progressive infections, severe illness, or meningitis. Itraconazole is used to treat patients with mild to moderately severe indolent non-meningeal blastomycosis, and ketoconazole is the alternative treatment.
Avoiding travel to areas where the infection is known to occur may help prevent exposure to the fungus, but this may not always be possible.
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