A Review of Blastomycosis in Indian Subcontinent

doi:10.34104/ejmhs.022.01007

Abstract

This study traces the earliest cases of blastomycosis reported from India. Four authentic cases of blastomycosis from India including one each from Arunachal Pradesh, Himachal Pradesh, Kerala, and one each from Bangladesh and Nepal, and five misdiagnosed cases have been reported in India after 2013. The clinical and diagnostic features of all cases are reviewed. The authentic cases from India originate from widespread locations in the country. The incidence of blastomycosis in dogs is known to be eight to ten times higher than that in humans. There is only one case of canine blastomycosis from India manifesting as a fatal pulmonary infection in a Mongrel dog. It is suggested additional canine cases should be looked for in different parts of India to facilitate the detection of endemic foci of B. dermatitidis for human and animal infections in the country. Mycological investigation of cases of pulmonary tuberculosis negative for culture and AFBs mear, and not responding to anti-tubercular therapy may reveal some cases of blastomycosis. A recently developed real-time PCR for identification of B. dermatitidis in culture and tissue may facilitate correct diagnosis of blastomycosis in suspected cases. Antigen testing in urine or serum is also recommended for diagnosing clinical infection and monitoring antifungal therapy in blastomycosis.

Highlights

Blastomycosis is a systemic mycosis caused by thermally dimorphic fungi, Blastomyces dermatitidis and B. gilchristii
Literature search revealed that the first report of Blastomyces dermatitidis infection from India was by Ganguli in 1925, described as a very common affliction prevalent in the rainy season, generally affecting t10-40% coolies working in the tea gardens of Duars situated at the foot of hills in east central Himalayas
From the lesions described as multiple warty ulcerated growths sometimes appearing granuloma to us and the detection of roundy east like cells scraping s of the lesions described, this report evidences a misdiagnosis of Blastomycosis as these are clinical and histological features of chromo blastomycosis

Summary

Introduction

Blastomycosis is a systemic mycosis caused by thermally dimorphic fungi, Blastomyces dermatitidis and B. gilchristii. Direct inoculation of the fungus is a rare means of infection (Sarcante and Woods, 2010; Benedict et al, 2012). The incubation period varies from 2 to 15 weeks, and the clinical spectrum ranges from asymptomatic to life-threatening infections involving acute respiratory distress syndrome or extra pulmonary dissemination (Sarcante and Woods, 2010) Most identified cases involve pulmonary infection that manifests to other causes of pneumonia (Benedict et al, 2012; Hayle et al, 2020; Schwartz et al, 2018). The clinical similarities between blastomycosis and other pulmonary infections often result in diagnostic delays and unnecessary empiric antimicrobial drug treatment for suspected bacterial pneumonia (Schwartz et al, 2018). Lawrence River, Canada, Europe, Central America, and India (Sarcante and Woods, 2010; Thompson et al, 2017)

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Discussion

Conclusion