Cases Of Blastomycosis Research Articles

A Rare Case of Cutaneous Blastomycosis of the Eyelid

A Rare Case of Cutaneous Blastomycosis of the Eyelid

Exome Sequencing of a Blastomycosis Case–Control Cohort From Manitoba and Northwestern Ontario, Canada

ABSTRACTBackgroundBlastomycosis is a pulmonary disease caused by Blastomyces spp., a group of pathogenic dimorphic fungi endemic to a number of geographic regions, specifically Manitoba and northwestern Ontario, Canada. Immunosuppression is a major risk factor affecting disease susceptibility, yet host immunity is not well understood. Genetic immunodeficiencies can also influence disease, with variants in IL6, GATA2 and VDBP shown to influence susceptibility. Additional genetic factors in disease susceptibility and severity remain undetected. Our study seeks to identify potential genetic risk factors in a blastomycosis case–control cohort from Manitoba and northwestern Ontario, Canada.MethodsExomes from 18 blastomycosis cases and 9 controls were sequenced, variants were identified and filtered for accuracy and quality. We performed candidate gene prioritisation and variant aggregation to identify genetic associations and explored the full exome dataset.ResultsNinety‐nine genetic variants in 42 candidate genes were identified in the exome dataset. No variants associated with susceptibility were identified in a single‐variant analysis although two non‐synonymous variants in TYK2 were enriched among cases suggesting a possible role in susceptibility. Gene‐based association analysis found variants in TLR1 enriched in controls (p = 0.024) suggesting a possible protective effect. Gene cluster analysis identified genetic variants in genes of chromatin remodelling, proteasome and intraflagellar transport significantly enriched in cases (false discovery rates < 14%).ConclusionsThe findings in this study show novel associations with blastomycosis susceptibility. A better understanding of host immunity and genetic predisposition to Blastomyces infection can help to inform clinical practice for improved outcomes.

Surveillance for Coccidioidomycosis, Histoplasmosis, and Blastomycosis During the COVID-19 Pandemic - United States, 2019-2021.

Coccidioidomycosis, histoplasmosis, and blastomycosis are lower respiratory tract fungal infections whose signs and symptoms can resemble those of other respiratory illnesses, including pneumonia caused by bacterial or viral etiologies; this overlap in clinical presentation might lead to missed or delayed diagnoses. The causative fungi live in the environment, often in soil or plant matter. To describe the epidemiologic characteristics of cases of coccidioidomycosis, histoplasmosis, and blastomycosis during the COVID-19 pandemic, CDC analyzed case surveillance data for 2019-2021. During this period, a total of 59,655 coccidioidomycosis cases, 3,595 histoplasmosis cases, and 719 blastomycosis cases were reported to CDC. In 2020, fewer cases of each disease occurred in spring compared with other seasons, and most cases occurred in fall; national seasonality is not typically observed, and cases were seasonally distributed more evenly in 2019 and 2021. Fewer cases coinciding with the start of the COVID-19 pandemic, along with an unusually high blastomycosis case fatality rate in 2021 (17% compared with more typical rates of 8%-10%), suggest that the pandemic might have affected patients' health care-seeking behavior, public health reporting practices, or clinical management of these diseases. Increased awareness and education are needed to encourage health care providers to consider fungal diseases and to identify pneumonia of fungal etiology. Standardized diagnostic guidance and informational resources for fungal testing could be incorporated into broader respiratory disease awareness and preparedness efforts to improve early diagnosis of coccidioidomycosis, histoplasmosis, and blastomycosis.

Detection of Blastomyces gilchristii via metagenomic sequencing in outbreak-associated soils.

Cases of blastomycosis, a serious fungal disease globally rare but endemic to North America, can appear both sporadically and in outbreaks. Tracing these outbreaks to their environment has traditionally used culturing and polymerase chain reaction. Here, we present our method for metagenomic detection of Blastomyces in a 2015 outbreak soil sample from central Wisconsin. By sequencing this sample to multiple depths, we simulated the minimum required depth to detect Blastomyces in this outbreak. Our methods and recommendations can be used to identify the sources of blastomycosis during outbreaks and to learn about the ecology of Blastomyces.

22-Year-Old with Invasive Mass of the Right Femur

Blastomyces dermatitidis is an endemic mycosis in certain regions of the United States of America and can cause disseminated infection in immunocompetent individuals. We present a case of osseous blastomycosis in a previously healthy 22-year-old male from Missouri, who developed sudden onset right knee pain in June 2019. Magnetic Resonance Imaging (MRI) demonstrated an enhancing mass that was concerning for osseous malignancy. Antigen and antibody testing for dimorphic fungi was confounding. He underwent debridement and surgical specimen cultures grew B. dermatitidis. He was treated initially with liposomal amphotericin B and transitioned to oral itraconazole to complete therapy. Blastomycosis of the bone can be mistaken for malignancy and should be included on a differential for these types of cases. Blastomycosis of the bone and joints can be successfully treated with surgical debridement and prolonged antifungal therapy.

The Billirud Mill Blastomycosis Outbreak: Comparison to Historical Controls.

A large outbreak of blastomycosis among paper mill workers in Escanaba, Michigan began with the first cases reported on February 28, 2023 and expanded to 120 cases. Analysis of baseline regional data and the data collected during this unprecedented outbreak provide insight on the outbreak's unique characteristics. The Michigan Disease Surveillance System provided descriptive and outcome data on blastomycosis cases in the Upper Peninsula from 2007 through 2022 and the 2023 outbreak. Baseline incidence for the region was estimated and outbreak cases were compared to historic controls using quantitative methods such as t-tests, chi-square, and Poisson and logistic regression. The Billirud blastomycosis outbreak has resulted in 28 confirmed and 92 probable cases. Blastomycosis incidence for the Upper Peninsula was 2.13 (95%CI: 1.75, 2.59) per 100,000 person-years with counties bordering Wisconsin having a higher incidence more than other counties (4.56, 95%CI: 3.48, 5.97; RR=3.46, 95%CI: 2.35, 5.11). Outbreak cases were significantly younger, more likely to be male, reported more respiratory symptoms, and had a shorter time from onset of illness to diagnosis. The Billirud paper mill blastomycosis outbreak is the largest reported to date, the first in an industrial facility, and the first to specifically involve Blastomyces gilchristii. Blastomyces species are endemic in regional forests, so other facilities handling forestry products may be at risk.

Morphological Diagnosis of Blastomycosis Clinically Presenting as Mycetoma in a Young Immunocompetent Indian Patient; A Diagnostic Dilemma.

Primary cutaneous blastomycosis is very rare in non-endemic regions like India. Only few cases have been reported from India. Herein, we are reporting a rare case of chronic cutaneous blastomycosis in a young immunocompetent male presenting as mycetoma with multiple discharging sinuses in the anterior abdominal wall with no significant travel history.

Risk of occupational infection in forensic workers: a review.

The occupational risk of infection in forensic workers is a cause for concern, furthermore in the current context of the coronavirus disease-19 (COVID-19) pandemic. In order to characterize this risk, we performed an extended review of the literature on occupational infections occurring in forensic workers. Seventeen articles were included. Direct contamination by aerosolization was the main mode of transmission reported, with 17 cases of tuberculosis. Indirect contamination was described as the mode of transmission in 10 cases (five cases of blastomycosis, two cases of tuberculosis, two Streptococcus pyogenes, and one case of human immunodeficiency virus). In all the other included cases, the mode of transmission was unknown. For two of them, the information provided was sufficient to link them to occupational exposure (one case of toxoplasmosis, one case of tuberculosis). For the remaining 10 cases, the link was uncertain (six cases of tuberculosis, three of hepatitis B, and one of COVID-19). Even if there is probably significant under-declaration, the number of infections linked to an occupational risk in forensic workers is not alarming, thanks to effective preventive measures.

Cutaneous Blastomycosis Presenting as a Nonhealing Wound in the Northeast United States: A Case Report.

Primary cutaneous blastomycosis is a rare presentation of infection caused by direct inoculation of a wound. We present a 61-year-old male with an extensive history of wound dehiscence and wound care noncompliance after a bite from a brown recluse spider on the left thigh while on vacation in Cape Cod in September of 2020. After antibiotic therapy and culture, treatment involved debridement, split thickness skin grafting, strict wound vacuum-assisted closure care, and oral itraconazole. This brief demonstrates a case of blastomycosis arising from trauma in a non-endemic region for infection and serves as an example of successful management of the longstanding wound.

BLAST VS MASS: USE OF FLEXIBLE BRONCHOSCOPY AND ENDOBRONCHIAL ULTRASOUND IN THE MEDICAL ICU

BLAST VS MASS: USE OF FLEXIBLE BRONCHOSCOPY AND ENDOBRONCHIAL ULTRASOUND IN THE MEDICAL ICU

Molecular Epidemiology of Blastomyces gilchristii Clusters, Minnesota, USA.

We characterized 2 clusters of blastomycosis cases in Minnesota, USA, using whole-genome sequencing and single-nucleotide polymorphism analyses. Blastomyces gilchristii was confirmed as the cause of infection. Genomic analyses corresponded with epidemiologic findings for cases of B. gilchristii infections, demonstrating the utility of genomic methods for future blastomycosis outbreak investigations.

Surveillance for Coccidioidomycosis, Histoplasmosis, and Blastomycosis - United States, 2019.

Problem/ConditionCoccidioidomycosis, histoplasmosis, and blastomycosis are underdiagnosed fungal diseases that often mimic bacterial or viral pneumonia and can cause disseminated disease and death. These diseases are caused by inhalation of fungal spores that have distinct geographic niches in the environment (e.g., soil or dust), and distribution is highly susceptible to climate changes such as expanding arid regions for coccidioidomycosis, the northward expansion of histoplasmosis, and areas like New York reporting cases of blastomycosis previously thought to be nonendemic. The national incidence of coccidioidomycosis, histoplasmosis, and blastomycosis is poorly characterized.Reporting Period2019.Description of SystemThe National Notifiable Diseases Surveillance System (NNDSS) tracks cases of coccidioidomycosis, a nationally notifiable condition reported to CDC by 26 states and the District of Columbia. Neither histoplasmosis nor blastomycosis is a nationally notifiable condition; however, histoplasmosis is voluntarily reported in 13 states and blastomycosis in five states. Health departments classify cases based on the definitions established by the Council of State and Territorial Epidemiologists.ResultsIn 2019, a total of 20,061 confirmed coccidioidomycosis, 1,124 confirmed and probable histoplasmosis, and 240 confirmed and probable blastomycosis cases were reported to CDC. Arizona and California reported 97% of coccidioidomycosis cases, and Minnesota and Wisconsin reported 75% of blastomycosis cases. Illinois reported the greatest percentage (26%) of histoplasmosis cases. All three diseases were more common among males, and the proportion for blastomycosis (70%) was substantially higher than for histoplasmosis (56%) or coccidioidomycosis (52%). Coccidioidomycosis incidence was approximately four times higher for non-Hispanic American Indian or Alaska Native (AI/AN) persons (17.3 per 100,000 population) and almost three times higher for Hispanic or Latino persons (11.2) compared with non-Hispanic White (White) persons (4.1). Histoplasmosis incidence was similar across racial and ethnic categories (range: 0.9–1.3). Blastomycosis incidence was approximately six times as high among AI/AN persons (4.5) and approximately twice as high among non-Hispanic Asian and Native Hawaiian or other Pacific Islander persons (1.6) compared with White persons (0.7). More than one half of histoplasmosis (54%) and blastomycosis (65%) patients were hospitalized, and 5% of histoplasmosis and 9% of blastomycosis patients died. States in which coccidioidomycosis is not known to be endemic had more cases in spring (March, April, and May) than during other seasons, whereas the number of cases peaked slightly in autumn (September, October, and November) for histoplasmosis and in winter (December, January, and February) for blastomycosis.InterpretationCoccidioidomycosis, histoplasmosis, and blastomycosis are diseases occurring in geographical niches within the United States. These diseases cause substantial illness, with approximately 20,000 coccidioidomycosis cases reported in 2019. Although substantially fewer histoplasmosis and blastomycosis cases were reported, surveillance was much more limited and underdiagnosis was likely, as evidenced by high hospitalization and death rates. This suggests that persons with milder symptoms might not seek medical evaluation and the symptoms self-resolve or the illnesses are misdiagnosed as other, more common respiratory diseases.Public Health ActionImproved surveillance is necessary to better characterize coccidioidomycosis severity and to improve detection of histoplasmosis and blastomycosis. These findings might guide improvements in testing practices that enable timely diagnosis and treatment of fungal diseases. Clinicians and health care professionals should consider coccidioidomycosis, histoplasmosis, and blastomycosis in patients with community-acquired pneumonia or other acute infections of the lower respiratory tract who live in or have traveled to areas where the causative fungi are known to be present in the environment. Culturally appropriate tailored educational messages might help improve diagnosis and treatment. Public health response to these three diseases is hindered because information gathered from states’ routine surveillance does not include data on populations at risk and sources of exposure. Broader surveillance that includes expansion to other states, and more detail about potential exposures and relevant host factors can describe epidemiologic trends, populations at risk, and disease prevention strategies.

Primary Cutaneous Blastomycosis with Secondary Pulmonary Involvement: A Case Report

Cutaneous blastomycosis is the second most common presentation of Blastomyces Dermatitidis infection. Commonly, skin involvement results from hematogenous spread of infection from a distant site but direct skin involvement can also occur from trauma and animal scratch or bite resulting in cutaneous inoculation blastomycosis. Clinical features of cutaneous blastomycosis are nonspecific and overlap with other fungal and bacterial infections and skin malignancies. A high degree of suspicion is required for diagnosis while evaluating a patient with recurrent skin lesions not responding to antibiotics. In these cases, fungal cultures and histology are of paramount importance for prompt diagnosis and treatment. We present a case of primary cutaneous blastomycosis with secondary lung involvement.

Mandibular Blastomycosis in a 5-Year-Old Dog.

A case of localized oral mandibular blastomycosis is described in a five-year-old dog. Complete resolution of clinical signs and oral radiographic changes were seen following itraconazole therapy at 5 mg/kg/day for four and a half months. The patient remained free of Blastomyces at the one year follow up based on the Mira Vista Blastomyces urine antigen test by EIA (Enzyme Immunoassay)a. A literature review of localized blastomycosis cases in humans and dogs was performed, available diagnostic tests evaluated, and treatment comparisons made.

A case of cutaneous blastomycosis

A case of cutaneous blastomycosis

The Role of Isavuconazonium Sulphate for the Treatment of Blastomycosis: A Case Series and Antifungal Susceptibility.

Background Blastomyces spp, the etiologic agents of blastomycosis, are endemic dimorphic fungi that require prolonged antifungal therapy, which can be complicated by adverse drug effects. Isavuconazonium sulphate (ISA) is a triazole with in vitro and in vivo activity against Blastomyces spp, but there is a paucity of clinical data supporting its use for treatment of blastomycosis.MethodsThis retrospective case series identified 14 patients with blastomycosis at least partially treated with ISA at the University of Wisconsin between 2015 and 2019. Treatment duration and outcomes were documented. In addition, 29 clinical isolates of Blastomyces spp between 2004 and 2017 were tested for minimum inhibitory concentrations against ISA and other antifungals.ResultsFourteen patients were treated with a median of 255 days of ISA accounting for 68% of total therapy. Half (7 of 14) of the patients were immunocompromised, 11 of 14 (79%) were proven cases of blastomycosis, 7 of 14 (50%) had central nervous system (CNS) involvement, and 11 of 14 (79%) were cured. Antifungal susceptibility testing showed a consistently low minimum inhibitory concentration to ISA ≤ 0.015 mcg/mL.ConclusionsThis case series supports the efficacy and safety for ISA in the treatment of blastomycosis with or without CNS disseminated, especially when alternative triazoles cannot be used.

A rare presentation of blastomycosis as a multi-focal infection involving the spine, pleura, lungs, and psoas muscles in a Saudi male patient: a case report

BackgroundBlastomycosis is a disease caused by the fungus Blastomyces—a thermally dimorphic fungus that can cause granulomatous and/or purulent infection.Case presentationWe report here a case of chronic blastomycosis infection in a 24-year-old male patient from Saudi Arabia who presented with recurrent skin abscesses associated with deep-seated and multilevel paraspinal (dorsal and lumbar) collections and bilateral empyema with pulmonary involvement and bilateral psoas abscesses. The diagnosis was made after a CT-guided pleural biopsy revealed the characteristic histopathological findings of blastomycosis. The patient underwent several drainage procedures and was successfully treated with a long-term course of oral itraconazole.ConclusionsChronic blastomycosis may have clinical and radiologic features similar to thoracic tuberculosis or malignant disease. There is no definite clinical symptom of blastomycosis, and thus a high degree of suspicion is required for early diagnosis. This case is a rare form of blastomycosis with chronic multifocal purulent infection and is the second case of blastomycosis reported in Saudi Arabia.

Blastomycosis-Induced Acute Respiratory Distress Syndrome

Blastomycosis is a systemic mycosis endemic to the Midwestern and South Central United States. Infection is caused by inhaling spores of Blastomyces dermatitidis (B. dermatitidis) that inhabit soil. Acute respiratory distress syndrome (ARDS) is a rare complication of pulmonary blastomycosis with a significantly high mortality rate. We present a case of blastomycosis associated with severe ARDS treated with traditional prone position ventilation (PPV) and neurally adjusted ventilator assist (NAVA) along with antifungal therapy, steroids, and supportive care in a rural setting with no access to extracorporeal membrane oxygenation (ECMO). This case demonstrates that traditional therapies such as prone position ventilation can help patients with blastomycosis-associated ARDS especially in rural settings where advanced therapies such as ECMO are lacking. The use of NAVA in blastomycosis-associated ARDS needs further research.

A Review of Blastomycosis in Indian Subcontinent

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.

Changing Patterns of Disease Severity in Blastomyces dermatitidis Infection, Quebec, Canada.

This retrospective multicenter cohort study assessed temporal changes in the severity and mortality rate of blastomycosis in Quebec, Canada, and identified risk factors for death in patients with blastomycosis in 1988-2016. The primary outcome was 90-day all-cause deaths. Among 185 patients, 122 (66%) needed hospitalization and 30 (16%) died. We noted increases in the proportion of severe cases, in age at diagnosis and in the proportion of diabetic and immunocompromised patients over time. Independent risk factors for death were age (adjusted odds ratio [aOR] 1.04, 95% CI 1.00-1.07), immunosuppression (aOR 4.2, 95% CI 1.5-11.6), and involvement of >2 lung lobes (aOR 5.3, 95% CI 1.9-14.3). There was no association between the Blastomyces genotype group and all-cause mortality. The proportion of severe cases of blastomycosis has increased in Quebec over the past 30 years, partially explained by the higher number of immunosuppressed patients.