Blastomycosis Research Articles

Blastomycosis of the knee and skull after arthroscopy

Blastomycosis of the knee and skull after arthroscopy

Blastomycosis of the Head and Neck

Blastomycosis of the Head and Neck

Growth inhibition of Blastomyces dermatitidis in alveolar and peripheral macrophages from patients with blastomycosis.

Blastomyces dermatitidis evokes a pyogranulomatous disorder with organisms frequently found inside giant cells. Macrophages from bronchoalveolar lavage fluid and peripheral blood in monolayer cell cultures were challenged with live yeast organisms to examine phagocytosis and intracellular growth. A greater number of macrophages from patients recovering from blastomycosis had phagocytized Blastomyces compared with macrophages from healthy control donors. No differences were detected within the groups between alveolar and peripheral macrophages. Intracellular growth of the fungus was reduced in cultures of both cell types from patients compared with those from control subjects. Supernatants from specific Blastomyces antigen-stimulated lymphocyte cultures were collected, and treatment with the supernatant to control donors' macrophages resulted in increased phagocytosis and inhibition of intracellular growth. Antigen-induced lymphocyte stimulation as a correlate of cellular immunity is qualitatively related to alveolar or peripheral macrophage phagocytosis and growth inhibition of this fungus.

Initial experience in therapy for progressive mycoses with itraconazole, the first clinically studied triazole.

The search for antifungal drugs, particularly oral agents with a broad spectrum of activity, led to the study of itraconazole, a triazole. In vitro susceptibility testing suggested activity against a variety of fungal pathogens affecting humans. Pharmacokinetic studies indicated absorption after oral administration to patients, with prolonged serum concentrations and peak levels exceeding the in vitro inhibitory concentrations for most pathogens. Twenty-four patients have been enrolled in efficacy studies; two-thirds of these individuals had experienced a relapse after apparently successful therapy with other drugs, had failed to respond to other drug therapy, and/or had experienced intolerable side effects with other drugs. Fourteen patients have thus far responded to treatment with itraconazole; this group includes two persons each with coccidioidal pneumonia and adenopathy, pulmonary coccidioidomycosis, and dermatophytosis plus onychomycosis as well as one person each with coccidioidal epididymitis, adrenal histoplasmosis, head and neck histoplasmosis, cutaneous blastomycosis, oral-sinonasal alternariosis, chromoblastomycosis, invasive pulmonary aspergillosis with fungus ball, and onychomycosis. Five other patients have had partial responses to therapy, three have failed to respond, and two have been deemed unassessable. Drug toxicity has been limited in 211.8 patient-months of therapy. The results are encouraging and indicate that more extensive studies are warranted.

Characteristics of the pulmonary cellular immune response to two strains of Blastomyces dermatitidis in the mouse.

In order to assess the cellular responses in the lung in murine pulmonary blastomycosis, serial lung lavages were performed in normal BALB/cByJ mice that had received an intranasal inoculation with 1 of 2 strains of Blastomyces dermatitidis of opposite virulence. The virulent strain, ATCC 26199, induced an increasing number of neutrophils recovered from the lung lavages. An early peak of incoming neutrophils was seen at 1 to 2 days, followed by a more rapid accumulation of intraalveolar neutrophils, until by the ninth day after infection, 80% of the cells recovered from the mice were neutrophils. In contrast, the avirulent strain, ATCC 26197, induced the same degree (20%) of neutrophil influx on Days 1 and 2. Thereafter, the percentage of neutrophils consistently declined, so that by Day 6 after inoculation, the differential counts were normal. The total number of cells recovered from the mice challenged with the virulent strain did not increase significantly until Day 4; then the total number of cells consistently increased until the experiment was terminated on Day 14. The total number of cells obtained from the mice challenged with the avirulent organism never exceeded the normal range. To assess the effects of nonviable inert particles, mice were given Sephadex G-25 beads by the intranasal route, and the total number of cells recovered from the lung lavage fluid and the differential counts were determined. The peak neutrophil influx occurred 6 h after aspiration of the beads, compared with 24 to 48 h with the fungi.(ABSTRACT TRUNCATED AT 250 WORDS)

The diagnostic value of fungal autofluorescence

Many pathogenic and saprophytic fungi fluoresce under ultraviolet light. Autofluorescence usually persists even if the specimen has undergone fixation, paraffin embedding, and staining with hematoxylin and eosin. Thus, fluorescence microscopy can help to identify organisms in histopathologic sections of ocular and periocular tissue. It may reveal microorganisms that do not stain with hematoxylin and eosin, and it does not alter or adversely affect microscopic sections. We describe a case of periocular cutaneous blastomycosis which was misdiagnosed clinically and histologically as squamous cell carcinoma. Fluorescence microscopy of the initial hematoxylin and eosin stained section revealed microorganisms that were not appreciated on the first skin biopsy.

North American blastomycosis in Africans

North American blastomycosis in Africans

North American blastomycosis in Africans

Two young adults, one a native of Libya and one a Sudanese from Saudi Arabia, were referred at different times to the chest service at Westminster Hospital in London with a diagnosis of tuberculosis. They both had neurological deficits due to vertebral lesions. In spite of the fact that neither patient had ever been to North America, diagnoses of North American blastomycosis were established; both patients made remarkable recoveries on amphotericin B therapy.

Failure of ketoconazole in two patients with blastomycosis.

Two patients with severe pulmonary blastomycosis were treated with ketoconazole. One patient developed disseminated disease while receiving this drug. After responding to incomplete treatment with amphotericin B, this patient relapsed while continuing ketoconazole therapy. The second patient failed to respond to ketoconazole and died shortly after treatment with amphotericin B was instituted. We conclude that it is dangerous to use ketoconazole as initial treatment in patients with severe forms of blastomycosis. Death, relapse, and prolonged morbidity may be the result. In such cases, amphotericin B is still the drug of first choice despite its toxicity, inconvenience, and expense of administration.

Blastomycosis of the breast

Blastomycosis of the breast

Blastomycosis of bone. A report of six cases.

Blastomycosis of bone. A report of six cases.

Radioimmunoassay: a sensitive screening test for histoplasmosis and blastomycosis.

Currently available serologic tests for histoplasmosis and blastomycosis have limited sensitivity. In order to develop a more sensitive screening test, the radioimmunoassay (RIA) technique was adapted to detect circulating antibodies to Histoplasma mycelial, Histoplasma yeast, and Blastomyces yeast antigens. Results were compared with those of complement fixation (CF) using serums from 4 groups of subjects. Group 1 (n = 104) consisted of consecutive healthy blood donors from an endemic area. Group 2 (n = 8) had active histoplasmosis and Group 3 (n = 12) had active blastomycosis. Group 4 (n = 30) had other chronic lung diseases. Among Group 1 subjects, elevated titers to at least 1 antigen were found in 13% using RIA and 21% using CF. Only 50% of patients with active mycoses (Groups 2 and 3) had elevated CF titers to a homologous antigen, whereas the RIA test was positive in 19 of 20 patients (95%). Elevated titers to 1 or more antigens was found in Groups 1 and 4, and frequent cross-reactions among the antigens occurred with both tests, indicating low specificities for both RIA and CF. The RIA is a sensitive and rapid screening test for histoplasmosis and blastomycosis, and a negative RIA using the 3 antigens tested makes the diagnosis of active infection very unlikely in immunologically competent patients.

Intranasal blastomycosis

North American blastomycosis is a fungal infection that is often fatal when untreated. A case in which the diagnosis was made by an excisional biopsy of a lesion in the nasal vestibule is reported. A review of the literature revealed no other report of blastomycosis presenting as a solitary intranasal lesion. The recognition of this disease and the management of patients with it are discussed.

Serologic response in blastomycosis: diagnostic value of double immunodiffusion assay.

Double immunodiffusion (DID) is a useful, inexpensive antibody screening test that is more specific than complement fixation for blastomycosis. Seven of 10 patients with proved blastomycosis had positive results on DID assays for antibody to the A antigen of Blastomyces dermatitidis. Sputum cytologic examination and skin or other tissue biopsies may be diagnostic if the organism is demonstrated. Culture remains the sina qua non of diagnosis, and a negative DID test result for A precipitin does not rule out this infection. Follow-up serologic studies of patients in remission and in relapse should be undertaken to determine the evolution of the immune response to the A antigen.

Blastomycosis: Clinical and Immunologic Aspects: Clinical Conference in Pulmonary Disease from Wood Veterans Administration Medical Center and Medical College of Wisconsin, Milwaukee

Dr. Basil Varkey: Blastomycosis was first described by Gilchrist in 1894. For some 50 years thereafter, progress in the understanding of the various aspects of this disease evolved very slowly. In the last three decades, however, there have been several important contributions, viz–the evidence emphasizing the respiratory tract as the portal of entry, 1 Schwarz J Baum GL Blastomycosis.. Am J Clin Pathol. 1951; 21: 999-1029 Crossref PubMed Scopus (99) Google Scholar the introduction of amphotericin B therapy 2 Harrell ER Curtis AC The treatment of North American blastomycosis with amphotericin B.. Arch Dermatol. 1957; 76: 561-569 Crossref Scopus (7) Google Scholar and recently the description of a subclinical and an acute self-limited form of the disease. 3 Sarosi GA Hammerman KJ Tosh FE et al. Clinical features of acute pulmonary blastomycosis.. N Engl J Med. 1974; 290: 540-543 Crossref PubMed Scopus (44) Google Scholar Yet, gaps remain in our knowledge of the natural habitat of the organism, the epidemiology, clinical spectrum and immunologic responses of the host. While cognizant of these gaps, we will attempt to summarize the present state of knowledge in these areas and focus on the clinical aspects of the disease. As a starting point, Dr. Lohaus will present a case.

Intravenous Miconazole Therapy of Mycotic Infections

The efficacy and safety of intravenously administered miconazole nitrate was examined in eight patients with the following infections: cutaneous North American blastomycosis (one), extensive dermatophytosis(one), and chronic mucocutaneous candidiasis (six). Mycologic assessment included direct examination for fungal elements, fungal culture, and histopathology. Laboratory evaluations were performed before and at regular intervals during the study. The total miconazole nitrate dosage, which was administered over a seven- to 32-day period, ranged from 4.0 to 46.8 g. Follow-up examinations extended from two to 15 months. Excellent results were obtained in five patients and fair results in three. No renal, cardiac, hepatic, or hematopoietic toxicity was observed. Other side effects, however, necessitated premature cessation of therapy in four patients. Overall, intravenously administered miconazole is an effective antifungal agent for these cutaneous infections.

Blastomycosis with oral lesions

The recent literature suggests that blastomycosis (previously known as North American blastomycosis) with oral lesions may be more common than is generally realized. This report discusses two cases of blastomycosis in which oral lesions played a critical role in the ultimate diagnosis of the disease. The potential importance or oral lesions in early diagnosis and the necessity of culturing the organisms for definitive diagnosis are emphasized.

Blastomycosis-like Pyoderma

Seven patients with blastomycosis-like pyoderma had skin lesions of four months' to six years' duration. The criteria for the diagnosis of blastomycosis-like pyoderma include the clinical presentation of large verrucous plaques with multiple pustules and elevated border, pseudoepitheliomatous hyperplasia with abscess histologically, and the growth of at least one pathogenic bacteria from the culture of a tissue-biopsy specimen. The differential diagnosis includes deep fungus infection (especially North American blastomycosis), bromoderma, pyoderma gangrenosum, mycobacterial infections, giant keratoacanthoma, and squamous cell carcinoma. Generally, the patients had one or more conditions that could have affected their systemic or local immunologic competence to infection. We believe that the clinical and histologic features in these cases of blastomycosis-like pyoderma were produced by an unusual, exaggerated, vegetating-tissue reaction to a primary or secondary bacterial infection.

An Unusual Case of North American Blastomycosis

A patient with a laryngeal tumor first diagnosed as squamous cell carcinoma was subsequently found to have North American blastomycosis. Diagnosis of this condition eventuated in eradication of the lesion as well as removal of a tracheostomy, which was thought to be permanent.

An unusual case of North American blastomycosis

An unusual case of North American blastomycosis