Blastomycosis of the Central Nervous System: A Multicenter Review of Diagnosis and Treatment in the Modern Era

Bariola, J Ryan; Perry, Paul M.; Pappas, Peter G.; Proia, Laurie A.; Shealey, Wesley; Wright, Patty W.; Sizemore, James M.; Robinson, Matthew; Bradsher, Robert W.

doi:10.1086/650579

Cited by 167 publications

(155 citation statements)

References 31 publications

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“…Recently, other cases have been also reported in Canada, Europe, Mexico, Central America, and Africa [1][2][3].…”

Section: Discussionmentioning

confidence: 99%

“…The latter two pathological entities are encompassed under the rubric of cerebral blastomycoma [1]. In patients with intracranial locations, may be single and multiple lesions can be seen, and the cerebellum is frequently involved [2].…”

Section: Discussionmentioning

confidence: 99%

“…Blastomycosis is different by its eventual occurrence in a normal immune state patient. Originally described by Gilchristl as a cutaneous infection, it is now accepted as a systemic disease with many classic and unusual locations [1][2][3].…”

Section: Introductionmentioning

confidence: 99%

“…It is uncommon occurring in only 5-10% of patients and it is potentially a fatal complication of this infection [2,4]. This is possibly due to hematogenous spread of the infection to the brain.…”

Section: Introductionmentioning

confidence: 99%

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Cerebral Blastomycosis in a Tunisian Woman

Bdioui¹,

Abdessayed²,

Mhamdi³

et al. 2018

Am J Res Med Sci

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Background: Blastomycosis is a non-opportunistic fungal infection caused by Blastomyces dermatitides. Infection of the central nervous system is an uncommon localization of this disease occurring only in 5-10% of cases. Case report: We report a new case of a 57-year-old woman, who was admitted in the neurosurgical department for severe headache, vomiting, and a visual disturbance. Physical and biological investigations were normal. Magnetic resonance imaging led to find an intracranial and extracranial expansive processes, measuring 42 mm in length. The microscopic examination revealed a chronic granulomatous inflammation, associating epithelioid and multinucleated giant cells containing thick-walled budding yeast-like forms. Grocott-Gomori methenamine-silver staining led to confirm its fungal nature, and it was precisely Blastomyces dermatitidis. The postoperative course was complicated by cerebral edema associated with an important cerebral hemorrhage. The patient died 11 days after the surgery. Conclusion: Cerebral involvement remains a serious but uncommon manifestation of blastomycosis. It should be suspected in front of a granulomatous inflammation with the presence of spore on the pathological examination. The delay in diagnosis has been reported to play a significant role in the high mortality rate.

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“…Recently, other cases have been also reported in Canada, Europe, Mexico, Central America, and Africa [1][2][3].…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Cerebral Blastomycosis in a Tunisian Woman

Bdioui¹,

Abdessayed²,

Mhamdi³

et al. 2018

Am J Res Med Sci

View full text Add to dashboard Cite

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“…For more severe cases, a 1-2-week course of intravenous lipid amphotericin B prior to itraconazole is recommended (Chapman et al, 2008). Although broad-spectrum azoles, like voriconazole or posaconazole, could also be used in this context (Bariola et al, 2010;Sugar & Liu, 1996, there are conflictual data on their cross-reactivity with itraconazole [Chen et al, 2009;Janssen, 2011;Pinto & Chan, 2009; Thomson Reuters MICROMEDEX (http://www.thomsonhc.com), last accessed 7 August 2011]. Given the severity of the observed allergic reaction, it seemed justified at the time to avoid this drug class, although only future studies could determine their real safety in the context of an itraconazole allergy.…”

Section: Discussionmentioning

confidence: 99%

Treatment of chronic pulmonary blastomycosis with caspofungin

Mardini

Nguyen

Ghannoum³

et al. 2011

Journal of Medical Microbiology

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Current practice guidelines recommend that pulmonary blastomycosis be treated with antifungal agents such as amphotericin B and itraconazole. Echinocandins are not recommended because of poor in vitro activity against Blastomyces dermatitidis and lack of supporting clinical data. We report a case of chronic pulmonary blastomycosis treated successfully with caspofungin. Case reportA 32-year-old male with no prior history of disease and working in construction presented with an insidious onset of right thoracic pain in November 2008. He was living in proximity of the St. Lawrence River, and had recently been exposed to a flooded soil environment. He did not take any medication and had a 42 pack-years smoking history. His chest pain was later followed by haemoptysis and exacerbation of a chronic cough. The patient denied any dyspnoea or expectorations and did not report any constitutional symptoms except for occasional nocturnal diaphoresis. The systems inquiry and physical examination were otherwise unremarkable.Laboratory testing revealed a white blood cell count of 11.2610 9 cells l 21 and an erythrocyte sedimentation rate slightly elevated at 24 mm h 21 . Biochemistry results were in the normal range. A chest X-ray on admission showed discrete opacities in the right paratracheal area. HIV, p-ANCA and c-ANCA testing were negative. In December 2008, a thoracic computed tomography (CT) scan demonstrated a right upper lobe parenchymal consolidation of 47661 mm with occlusion of the left superior lobe bronchus. Bronchocentric nodular opacities and infracentimetric mediastinal lymph nodes were also visualized (Fig. 1a). Bronchoscopy confirmed the presence of an obstructive polypoid mass in the left superior bronchus. An endobronchial biopsy revealed non-necrotizing granulomatous inflammation with several multinucleated giant cells without micro-organisms, neoplasm or vasculitis.In February 2009, further investigation was undertaken because the pulmonary mass had remained identical on control CT scan. A transthoracic needle biopsy demonstrated a fibroinflammatory reaction with multinucleated giant cells and a suppurative infiltrate containing a few 10 mm spherical micro-organisms with a thick wall and broad-based budding consistent with Blastomyces dermatitidis (Fig. 2). Despite negative cultures, histopathology was sufficient to confirm definite diagnosis of blastomycosis (De Pauw et al., 2008).In March 2009, the working diagnosis was chronic pulmonary blastomycosis in an immunocompetent host without evidence of dissemination. Because of the absence of spontaneous resolution at least 3 months after presentation, we decided to initiate antifungal therapy. The patient first received amphotericin B deoxycholate (Fungizone; BristolMyers Squibb) for 4 days but developed acute renal failure (serum creatinine rapidly increased from 70 to 225 mmol l 21 ). Treatment was switched to liposomal amphotericin B (AmBisome; Astellas Pharma) for 5 days with no improvement of renal function. The total administered cumulative dose of ...

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Blastomycosis

2012

Fungal Infection

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Blastomycosis of the Central Nervous System: A Multicenter Review of Diagnosis and Treatment in the Modern Era

Abstract: On the basis of these data, we recommend initial treatment with a lipid formulation of amphotericin B followed by a prolonged course of oral azole therapy, preferably voriconazole.

Cited by 167 publications

References 31 publications

Cerebral Blastomycosis in a Tunisian Woman

Cerebral Blastomycosis in a Tunisian Woman

Treatment of chronic pulmonary blastomycosis with caspofungin

Blastomycosis

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