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Andrej Spec, Christopher R Barrios, Usama Ahmad, Laurie A Proia
Severe pulmonary or disseminated histoplasmosis often necessitates presumptive antifungal treatment while awaiting definitive diagnosis. Histoplasma antigen assays have improved sensitivity but results may lag up to 7 days. In order to increase diagnostic certainty, "soft clues" may be looked for in laboratory and radiologic data, such as elevated alkaline phosphatase or ferritin levels and findings of mediastinal adenopathy or hepatosplenomegaly. To determine if elevated aspartate aminotransferase (AST) to alanine aminotransferase (ALT) ratio is specific to histoplasmosis or a non-specific marker for disseminated fungal infection or sepsis in general, we retrospectively examined records of all patients diagnosed with an endemic fungal infection (EFI) at Rush University Medical Center from January of 1997 to October of 2012, and a cohort of septic patients with elevated liver enzymes...
October 14, 2016: Medical Mycology: Official Publication of the International Society for Human and Animal Mycology
Benjamin E Bergstrom, Jean Stiles, Wendy M Townsend
OBJECTIVE: To determine the most common etiologies of panuveitis in a group of dogs, patient response to therapy, and visual outcome. DESIGN: Retrospective study. MATERIALS AND METHODS: Medical records of 55 dogs diagnosed with panuveitis at the Purdue University Veterinary Teaching Hospital between December 2000 and December 2015 were reviewed. Data collected included signalment, season of diagnosis, descriptions of ocular lesions, diagnostic testing, treatment protocols, etiologic diagnoses (when determined), and visual outcome...
October 12, 2016: Veterinary Ophthalmology
Jennifer L Anderson, Jennifer K Meece, Matthew C Hall, Holly M Frost
Relapse or recurrence of blastomycosis in patients is rare. Re-infection of a patient with blastomycosis has not been previously reported. In this report, we describe relapse or reinfection with Blastomyces in 2 immunocompetent patients. This is the first study in which genetic typing was performed on paired Blastomyces isolates from the same patient obtained months apart.
September 2016: Medical Mycology Case Reports
Michael F Rosser, Dana M Lindemann, Anne M Barger, Matthew C Allender, Shih-Hsuan Hsiao, Mark E Howes
A 5-yr-old, intact male red ruffed lemur ( Varecia rubra ) presented for evaluation as the result of a 1-wk history of lethargy and hyporexia. Physical examination findings included thin body condition, muffled heart sounds, harsh lung sounds, and liquid brown diarrhea. Complete blood count and serum biochemistry showed an inflammatory leukogram, mild hyponatremia, and mild hypochloremia. Orthogonal trunk radiographs revealed a severe alveolar pattern in the right cranial lung lobes with cardiac silhouette effacement...
September 2016: Journal of Zoo and Wildlife Medicine: Official Publication of the American Association of Zoo Veterinarians
Richard K Kugblenu, Will K Reeves
We review a unique set of documents, death certificates, catalogued in the US Air Force Mortality Registry, which tracks deaths for current and retired Air Force service members. We screened the records for all deaths caused by fungal diseases between 1970 and 2013. There were 216 deaths caused by a variety of diseases such as aspergillosis, blastomycosis, candidiasis, coccidioidomycosis, cryptococcosis, histoplasmosis, mucormycosis, pneumocystosis, sporotrichosis, and zygomycosis. The single most common identified cause of death was opportunistic candidiasis...
October 2016: U.S. Army Medical Department Journal
Thomas M Jetmore, Jennifer Phan, Abideen O Yekinni
Blastomyces dermatitidis is a thermally dimorphic fungus endemic to the North American soil near the Mississippi, Ohio, and St. Lawrence river valleys, as well as the Great Lakes Basin. It is responsible for blastomycosis, a systemic pyogranulomatous disease. Blastomycosis of the head and neck is decidedly uncommon and often mistaken for cancer. There are only 3 previous case reports of blastomycosis presenting as an intranasal lesion. We report the unusual case of a 24-year-old man with blastomycosis presenting with a 4-week history of a progressively enlarging intranasal mass who had complete resolution of symptoms after treatment with itraconazole and surgical excision of the lesion...
August 2016: Ear, Nose, & Throat Journal
Hans Mouser, Frank H Miller, Senta M Berggruen
History A 35-year-old man from the upper Midwest region of the United States who had no relevant medical history initially presented to an acute care clinic with multiple small tender skin lesions. His temperature was 38.1°C, and physical examination revealed several small fluctuant masses that were draining purulent material. Skin culture of one of the draining lesions was performed at this time, but there was no subsequent bacterial growth. A diagnosis of furunculosis was made, and Bactrim (sulfamethoxazole-trimethoprim; AR Scientific, Philadelphia, Pa) and a regimen of chlorhexidine washes were prescribed...
September 2016: Radiology
Jonathan D Alpern, Nathan C Bahr, Gabriela Vazquez-Benitez, David R Boulware, Jonathan S Sellman, George A Sarosi
The diagnosis of blastomycosis is often delayed. We identified 28 cases of pulmonary blastomycosis in a retrospective chart review. Most patients received multiple antibiotic courses before being diagnosed, and the sputum KOH smear was rarely used. Diagnostic delay can be decreased with higher suspicion for pulmonary blastomycosis and early use of the sputum KOH smear.
April 2016: Open Forum Infectious Diseases
Ilan S Schwartz, John M Embil, Atul Sharma, Stephen Goulet, R Bruce Light
Acute respiratory distress syndrome (ARDS) is an uncommon, highly fatal, and poorly understood manifestation of blastomycosis. Optimal management remains unknown, including the roles of adjunctive corticosteroids and extracorporeal membrane oxygenation (ECMO).We conducted a retrospective chart review of patients with ARDS caused by blastomycosis, managed in intensive care units in Manitoba, Canada, from 1992 to 2014. ARDS was defined using the Berlin definition. Corticosteroid therapy was defined as ≥150 mg cortisol equivalent in 24 hours...
May 2016: Medicine (Baltimore)
Puneet S Kochar, Chinar O Lath, Andrew P Klein, John L Ulmer
We describe the clinical, laboratory, and imaging data of three patients who are proven cases of blastomycosis with cranial involvement. In this review, we discuss the imaging features of cranial blastomycosis with relevant clinical case examples including computed tomography (CT), magnetic resonance imaging (MRI), and advanced MR imaging techniques like magnetic resonance spectroscopy (MRS) and MR perfusion. Literature is reviewed for modern-day diagnosis and treatment of this fatal intracranial infection, if not diagnosed promptly and managed effectively...
January 2016: Indian Journal of Radiology & Imaging
S He, A Cuguilliere
We report a case of pulmonary blastomycosis in a young man recently returned from a journey in Canada. He had acute pneumonia resistant to various antibiotics. Blastomycosis is an endemic mycosis in Canada and the United States, most frequently affecting the lungs, although extrapulmonary dissemination occurs in approximately one third of cases. Diagnosis is made by identification of Blastomyces dermatidis at direct examination or in culture. The lack of precise knowledge concerning the natural habitat of this microorganism is an obstacle to effective prevention...
January 2016: Médecine et Santé Tropicales
Huafeng Wang, Vanessa LeBert, Mengyi Li, Tassanee Lerksuthirat, Kevin Galles, Bruce Klein, Marcel Wüthrich
We investigated how innate sensing by the mannose receptor (MR) influences the development of antifungal immunity. We demonstrate that MR senses mannan on the surface of attenuated Blastomyces dermatitidis vaccine yeast and that MR(-/-) mice demonstrate impaired vaccine immunity against lethal experimental blastomycosis, compared with wild-type control mice. Using naive Blastomyces-specific transgenic CD4(+) T cells, we found that MR regulates differentiation of naive T cells into T-helper type 17 (Th17) effector cells, which are essential in vaccine immunity against systemic dimorphic fungi...
June 1, 2016: Journal of Infectious Diseases
Salvatore Scuderi, Blake O'Brien, Ivan Robertson, David Weedon
Blastomycosis-like pyoderma is a form of pyoderma with variable clinical findings and histopathological features. We present a case series of 39 patients collected over a 35-year period to demonstrate its clinical features and histological findings. The most common clinical presentations found were solitary plaques, solitary nodules, sinuses, crypts, verrucous plaques and discharge, usually on sun-exposed skin. The most common histopathological findings were chronic granulomatous inflammation, suppurative inflammation, sinus and abscess formation, pseudoepitheliomatous hyperplasia, transepidermal elimination and scarring...
January 17, 2016: Australasian Journal of Dermatology
Tariq Yousuf, Jason Kramer, Adam Kopiec, Brody Jones, Joy Iskandar, Khansa Ahmad, Hesam Keshmiri, Muhyaldeen Dia
Post-transplant immunosuppression is necessary to prevent organ rejection. Immunosuppression itself can introduce complications arising from opportunistic infections. We present a case of disseminated blastomycosis manifested only as a skin lesion in an asymptomatic patient post-orthotopic heart transplantation. A 64-year-old female who had recently undergone orthotopic heart transplant for end-stage ischemic cardiomyopathy presented for a scheduled routine cardiac biopsy. The patient had no current complaints other than a crusted plaque noticed at her nasal tip...
February 2016: Journal of Clinical Medicine Research
Caroline G Castillo, Carol A Kauffman, Marisa H Miceli
Blastomycosis is an endemic fungal infection due to Blastomyces dermatitidis that most commonly causes pneumonia; but the organism can disseminate to any organ system, most commonly the skin, bones/joints, and genitourinary tract. Both immunocompetent and immunocompromised persons can be infected, but more severe disease occurs in the immunocompromised. Blastomycosis can be diagnosed by culture, direct visualization of the yeast in affected tissue, and/or antigen testing. Treatment course and duration depend on severity of illness...
March 2016: Infectious Disease Clinics of North America
Paul O Phelps, Zach Seagrave, Kenya M Williams
No abstract text is available yet for this article.
May 2015: Ophthalmology
Devon J O Guinn, Demitre Serletis, Noojan Kazemi
INTRODUCTION: We present a rare case of thoracic vertebral osteomyelitis secondary to pulmonary Blastomyces dermatitides. PRESENTATION OF CASE: A 27-year-old male presented with three months of chest pains and non-productive cough. Examination revealed diminished breath sounds on the right. CT/MR imaging confirmed a right-sided pre-/paravertebral soft tissue mass and destructive lytic lesions from T2 to T6. CT-guided needle biopsy confirmed granulomatous pulmonary Blastomycosis...
2016: International Journal of Surgery Case Reports
Kanika Arora, Ross L Dawkins, David F Bauer, Cheryl A Palmer, James R Hackney, James M Markert
BACKGROUND: Cerebral blastomycosis is a rarely reported disease, and in the absence of associated, underlying systemic infection, poses a great diagnostic difficulty. Magnetic resonance imaging can sometimes provide equivocal information when trying to pinpoint a diagnosis. Classically, cerebral blastomycosis has been treated with amphotericin B. Voriconazole is a newer triazole antifungal with potential as a follow-up treatment of blastomycosis of the central nervous system after initial therapy with amphotericin B...
2015: Surgical Neurology International
Kushal R Patel, Michal Szczodry, Sergey Neckrysh, Krzysztof Siemionow
INTRODUCTION: We describe a patient who had cervical spine osteomyelitis caused by Blastomyces dermatitidis that resulted in cord compression and cervical spine instability. CASE PRESENTATION: A 25-year-old Hispanic woman presented with fever, sweats, neck pain, and an enlarging neck mass with purulent discharge after sustaining a C6 vertebral body fracture. Magnetic resonance imaging confirmed C6 vertebral osteomyelitis, demonstrated by vertebral body destruction, cervical spine instability, prevertebral abscess, and spinal cord compression...
2015: Journal of Medical Case Reports
Daniel Dalcin, Syed Zaki Ahmed
Blastomycosis is an invasive fungal disease caused by Blastomyces dermatitidis and the recently discovered Blastomyces gilchristii. The medical charts of 64 patients with confirmed cases of blastomycosis in northwestern Ontario during a 10-year period (2004 to 2014) were retrospectively reviewed. The number of patients diagnosed with blastomycosis in Ontario was observed to have increased substantially compared with before 1990, when blastomycosis was removed from the list of reportable diseases. Aboriginals were observed to be disproportionately represented in the patient population...
September 2015: Canadian Journal of Infectious Diseases & Medical Microbiology
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