Cases Of Blastomycosis Research Articles

OBSERVATIONS ON THE ROENTGEN PATTERNS IN BLASTOMYCOSIS OF BONE

OBSERVATIONS ON THE ROENTGEN PATTERNS IN BLASTOMYCOSIS OF BONE A REVIEW OF CASES FROM THE BLASTOMYCOSIS COOPERATIVE STUDY OF THE VETERANS ADMINISTRATION AND DUKE UNIVERSITY MEDICAL CENTERJOHN A. GEHWEILER, M.D., M. PAUL CAPP, M.D. and ERNEST W. CHICK, M.D.Audio Available | Share

North American blastomycosis

In 35 cases of pulmonary blastomycosis, the roentgenologic features were as follows: consolidation 26%, mass 31%, intermediate-sized nodules 6%, miliary pattern 11%, solitary cavity 9%, fibrotic and cavitary changes 6%, interstitial pattern 6%, diffuse alveolar involvement 3%, and mixed alveolar and interstitial infiltrate 3%. All symptomatic cases of consolidation were acute (symptoms for less than 1 month), and most were in young patients (mean age, 34 years). Consolidation constituted 58% of the acute cases in this series. Two of the nine cases of consolidation were asymptomatic epidemic cases detected by screening. A pulmonary mass was the most common initial manifestation in this series; it tended to occur in patients with chronic symptoms (more than 1 month). The mass was considered suggestive enough of bronchogenic carcinoma to necessitate resection in 55% of cases. The miliary form of pulmonary blastomycosis occurred in older patients with disseminated disease. Fibrotic and cavitary disease was chronic in nature. The presence of intermediate-sized nodules elsewhere in the lung proved to be a helpful diagnostic finding in several patients with consolidation, mass, or cavitary disease. Hilar adenopathy, postinfectious calcification, chest wall invasion, and pleural effusion occurred infrequently or not at all in this series.

Blastomycosis in childhood: treatment with amphotericin B and a review of the literature

A 3-year-old boy with cutaneous, pulmonary, and skeletal lesions due to infection with Blastomyces dermatitidis was treated with amphotericin B for 9 weeks with clearing of these lesions and without serious toxicity. This is the first reported patient less than 14 years of age treated successfully with amphotericin B. Follow-up examination after one year did not reveal any recurrence of the infection by clinical, radiologic, or laboratory investigation. A table is presented reviewing the 21 cases of blastomycosis recorded in children since 1951.

Epidemiologic studies of blastomycosis in Arkansas.

Some of the epidemiologic aspects of blastomycosis were determined based on a study of 127 human and 110 canine cases conducted in Arkansas from April 1960 to January 1966. Epidemiologic aspects included case distribution, age, sex, race or breed, occupation, human contacts of canine cases, epidemics, annual incidence, seasonal incidence, and environmental factors. Environmental factors included altitude, soil types, forest types, and climatic conditions, in Arkansas, the southwest region appeared to be the high incidence area. This area had a total of 39 human blastomycosis cases (rate—13/100,000) and 39 canine cases (rate—91/100,000); 35 (33%) of 107 dogs examined had blastomycosis, and 17 (12%) of 143 dogs skin tested had specific blastomycin reactions. The region had a fairly low altitude, the soil area was the Forested Coastal Plain area, and the forest type was mainly loblolly-shortleaf pine. Temperatures and precipitation appeared high enough to support the growth of Blastomyces dermatitidis.

Effect of thimerosal on the whole yeast phase antigen of Histoplasma capsulatum.

Thimerosal (merthiolate) and formalin treated whole-cell yeast phase antigens ofHistoplasma capsulatum were prepared and their reactivities with sera from cases of histoplasmosis, blastomycosis and coccidioidomycosis were compared. Thimerosal treated antigens often gave complement fixation titers with heterologous sera 2 to 8 fold lower than the titers obtained with formalin treated antigens. However, with certain anti-histoplasmosis sera, thimerosal killed antigens had less reactivity with homologous antisera also. In virtually all cases an equal or higher specificity ratio was obtained with thimerosal killed antigens. The effects of thimerosal and formalin were independent, indicating different sites of reactivity of these reagents. Uptake of thimerosal at several concentrations suggested two types of reactions with live yeast phase cells. Analyses of the cellular fractions for thimerosal showed it was present only in the soluble fractions from which it was readily removed by dialysis. Cellular fractions killed with thimerosal retained several of the same physical and antigenic characteristics of those fractions isolated from frozen and thawed cells.

Antigenic relationships between Paracoccidioides loboi and other pathogenic fungi determined by immunofluorescence.

The fluorescent antibody technique was used to study antigenic relationships betweenParacoccidioides loboi and other pathogenic fungi. The findings suggest thatP. loboi is more closely related antigenically to certainP. brasiliensis strains than to others and that it has antigens in common with the yeast form ofHistoplasma capsulatum, H. duboisii, Blastomyces dermatitidis, Candida albicans and also the mycelial form ofCoccidioides immitis. Serum globulins from 3 cases of keloidal blastomycosis were labelled with fluorescein isothiocyanate. These conjugates showed slight or no reactivity withP. loboi, the yeast forms ofP. brasiliensis, H. capsulatum, H. duboisii andB. dermatitidis, However, they stained brightlyC. albicans, serotypes A and B, the tissue form ofC. immitis and the yeast form ofSporotrichum schenckii. Adsorption of these reagents withC. albicans eliminated all staining except that forS. schenckii. These patients had no history of clinical sporotrichosis.

Blastomycosis in Childhood

Although blastomycosis is no longer considered a rare disease, only sporadic case reports have described it as an infection occurring in childhood (1, 7, 8, 10). Of 60 proved cases of blastomycosis at the University of Arkansas Medical Center, 6 occurred in childhood. The purpose of this article is to review the clinical and radiographic findings in these children. Of particular interest is the involvement of the skull in 3 of the 6 patients, a finding not previously reported. Case Material Clinical records and radiographs were available in 60 patients with proved blastomycosis. The ages of the patients ranged from two years through eighty years. The most frequent age at the time of diagnosis was forty to sixty years. The disease occurred more frequently in males in both the adult and the pediatric age groups. As in prior reports, the most common sites of involvement were the skin and the lungs. Bony involvement was frequent and often multiple. In each instance, the pathologic diagnosis was made by isolat...

A case of South American blastomycosis in California.

A case of South American blastomycosis in California.

Serologic Tests in Diagnosis of Aspergillosis

The complement fixation test was found to be both sensitive and specific for detecting antibodies to Aspergillus fumigatus . Sera from active cases of histoplasmosis, coccidioidomycosis, blastomycosis, cryptococcosis and healthy subjects failed to elicit any reactions against aspergillin. Application of the test to sera from 21 cases of aspergillosis revealed antibodies in 14 active cases only. Of 92 sera assayed for antibodies by the complement fixation and immuno-electrophoretic tests, there was approximately 92 per cent agreement between the tests. Two cases which were initially detected by the complement fixation test only subsequently developed precipitins or were proved by culture. Thus, the complement fixation test provided a means of early provisional diagnosis.

Alterações da função ventilatória na blastomicose pulmonar: correlação radiológica e espirográfica

Os autores estudam 10 casos de blastomicose pulmonar, sendo feita a correlação radiológica e espirográfica. Encontraram em todos os casos as alterações radiológicas clássicas do blastomicose (nodulacões, infiltrados, fibrose e enfisema). Em 4 casos encontraram alterações da função ventilatória caracterizadas por insuficiência ventilatória obstrutiva. Comentam que em 2 casos a radiotugia pulmonar mostrou a presença de enfisema embora a espirografia não mostrasse anormalidades. Chamam a atenção para a importância do estudo da função respiratória na blastomicose pulmonar, acentuando a necessidade do estudo funcional em maior número de pacientes a fim de se estabelecerem conclusões mais significativas sôbre o tipo de alteração ventilatória que ocorre nesses pacientes.

The complement fixation antibody test in the diagnosis of chronic pulmonary histoplasmosis and blastomycosis

A review of the serologic data on 540 proven cases of chronic pulmonary histoplasmosis and 45 proven cases of chronic pulmonary blastomycosis revealed that 92 per cent of the histoplasmosis cases and 72 per cent of the blastomycosis cases had a positive CF test to one or more of the three antigens employed. Of the histoplasmosis cases, 90 per cent had a positive CF test for histoplasmosis. Among the 45 blastomycosis cases, only 36 per cent had a positive CF test for blastomycosis. When the homologous antigens were used, a titer of 1: 32 or greater was recorded for 68 per cent of the histoplasmosis cases, while only 9 per cent of the blastomycosis cases had titers of this magnitude. Ten per cent of the histoplasmosis cases and 64 per cent of the blastomycosis cases had negative tests. Cross reactions of CF antibodies between the antigens of H. capsulatum and B. dermatitidis present problems in diagnosis. The titers were greater for the homologous antigens for 84 per cent of the histoplasmosis cases and only 22 per cent of the blastomycosis cases. The best solution to the problem is to perform the CF test with the antigens of both fungi and also perform the test upon serial serum specimens.

Soluble antigens for immunofluorescence detection of Histoplasma capsulatum antibodies.

Soluble antigens from Histoplasma capsulatum in the mycelial and yeast phase were purified by gel filtration, fixed onto paper discs, and employed in an indirect immunofluorescence procedure to detect antibody in sera from individuals infected with H. capsulatum. The elution patterns of crude histoplasmin passed through Sephadex G-200 revealed two minor peaks of protein showing immunofluorescence, complement fixing, and precipitating-antigen activity. A large peak containing the pigment and other low molecular weight materials showed no serological activity. A polysaccharide antigen obtained from fragmented, deproteinized yeast-phase cells was reactive in the fluorescent-antibody test but showed no antigen activity in complement fixation or precipitin tests. Although certain sera from culturally proven cases of blastomycosis, coccidioidomycosis, and cryptococcosis reacted with the purified Histoplasma antigens, preliminary evaluation indicated that the immunofluorescence technique may be of value as a screening procedure for the serodiagnosis of histoplasmosis.

A Case of South American Blastomycosis

A Case of South American Blastomycosis

Soluble Antigens for Immunofluorescence Detection of Histoplasma capsulatum Antibodies

Soluble antigens from Histoplasma capsulatum in the mycelial and yeast phase were purified by gel filtration, fixed onto paper discs, and employed in an indirect immunofluorescence procedure to detect antibody in sera from individuals infected with H. capsulatum. The elution patterns of crude histoplasmin passed through Sephadex G-200 revealed two minor peaks of protein showing immunofluorescence, complement fixing, and precipitating-antigen activity. A large peak containing the pigment and other low molecular weight materials showed no serological activity. A polysaccharide antigen obtained from fragmented, deproteinized yeast-phase cells was reactive in the fluorescent-antibody test but showed no antigen activity in complement fixation or precipitin tests. Although certain sera from culturally proven cases of blastomycosis, coccidioidomycosis, and cryptococcosis reacted with the purified Histoplasma antigens, preliminary evaluation indicated that the immunofluorescence technique may be of value as a screening procedure for the serodiagnosis of histoplasmosis.

DOS FORMAS CLINICAS MUY RARAS EN NUESTRDS CLIMAS: ACTINOMICOSIS Y BLASTOMICOSIS CUTANEAS DE TIPO VEGETANTE

This study reports a case of a male patient, the first in Spain, afflicted with tuberous and vegetating lesion of the skin: actinomycosis vegetans. The culture for the causative organism remained negative. The histologic sections, however, showed typical, polynuclear-lymphocytic, dermal infiltration with micro-abscesses with the typical actinomycotic granules. Also the first case of Blastomycosis of the skin is presented. There were many round, double contoured bodies in the center of the abscesses. The culture was positive for micrococcus or torula.

Blastomycosis. An important medical problem in the Central United States.

With recent knowledge of blastomycosis, emphasis is placed on the frequency of the disease in the Midwest and South. Comparison of summarized clinical and epidemiologic information with the findings in 183 cases of blastomycosis from the state of Kentucky exemplifies this point: The frequency of this disease in Kentucky suggests that the disease is endemic throughout most of the state, with the exception of the mountainous eastern part. The data presented suggest that recognition is delayed in most cases and that many cases are unrecognized. This supposition is supported by the frequency of cutaneous lesions as opposed to the frequency of purely pulmonary lesions. The pulmonary forms appear to be the most frequently missed. It is hoped that these data will stimulate better recognition and a higher index of suspicion on the part of practicing physicians.

Blastomycosis

With recent knowledge of blastomycosis, emphasis is placed on the frequency of the disease in the Midwest and South. Comparison of summarized clinical and epidemiologic information with the findings in 183 cases of blastomycosis from the state of Kentucky exemplifies this point: The frequency of this disease in Kentucky suggests that the disease is endemic throughout most of the state, with the exception of the mountainous eastern part. The data presented suggest that recognition is delayed in most cases and that many cases are unrecognized. This supposition is supported by the frequency of cutaneous lesions as opposed to the frequency of purely pulmonary lesions. The pulmonary forms appear to be the most frequently missed. It is hoped that these data will stimulate better recognition and a higher index of suspicion on the part of practicing physicians.

Intraoral North American blastomycosis

A case of intraoral North American blastomycosis in a 10-year-old child has been presented. This case apparently represents a focus of dissemination in a systemic mycosis, the other apparent sites of involvement consisting of a small cutaneous ulcer on the hand and minimal pulmonary disease. For 3 months the lesion was treated as a simple oral infection of dental origin, but ultimately Blastomyces dermatitidis was identified in tissue sections and the presence of the organisms was verified by direct exudate smears and by microbiologic culture. Amphotericin B treatment was initiated and resulted in an apparently complete recovery.

Oral South American blastomycosis in the United States of America: Report of a case

A rare case of oral South American blastomycosis in a resident of the United States of America has been presented. Diagnosis was made by biopsy and by culture of the organism. Treatment consisted of local curettage, application of an iodine solution, and oral sulfamethoxazole. The lesion regressed completely, and the patient is in good health at the present writing.

Two very rare clinical diseases in our climate: cutaneous actinomycoses and blastomycosis of a vegetating type.

This study reports a case of a male patient, the first in Spain, afflicted with tuberous and vegetating lesion of the skin: actinomycosis vegetans. The culture for the causative organism remained negative. The histologic sections, however, showed typical, polynuclear-lymphocytic, dermal infiltration with micro-abscesses with the typical actinomycotic granules. Also the first case of Blastomycosis of the skin is presented. There were many round, double contoured bodies in the center of the abscesses. The culture was positive for micrococcus or torula.