Clinical aspects of blastomycosis

O’Neill, Richard P.; Penman, Robert W.

doi:10.1136/thx.25.6.708

Cited by 18 publications

(2 citation statements)

References 27 publications

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“…Historically, blastomycosis was considered a primary disease of the skin, hence the name dermatitidis, because of its prominent skin manifestations [16]. But in fact, the primary infection is caused by inhalation of Blastomyces and the prime target organ is the lung.…”

Section: Discussionmentioning

confidence: 99%

Pleural Effusion in Pulmonary and Extrapulmonary Blastomycosis

et al. 2019

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Objective: Pleural effusion secondary to blastomycosis infection is an uncommon clinical manifestation of the disease. We undertook a retrospective study to assess the incidence and involvement of pleural effusion in patients with blastomycosis infection. Study Design: Institutional cytology and surgical pathology records were searched from December 1995 to October 2017 for cases of blastomycosis. The cytologic, surgical pathology, and clinical pertinent information was reviewed in detail. Results: A total of 77 cases of blastomycosis infection were recorded, with a male-to-female ratio of 1.7: 1.0. Forty-eight cases of blastomycosis were pulmonary (62.3%), while 29 cases of blastomycosis were found in extrapulmonary sites (37.7%). The diagnosis of pulmonary blastomycosis was established by 24 lung biopsies/ wedge resections, 22 bronchial alveolar lavages, and 2 lung fine needle aspirations. The 29 cases of extrapulmonary blastomycosis included 13 cases of bone (44.8%), 8 cases of skin

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Section: Discussionmentioning

confidence: 99%

Pleural Effusion in Pulmonary and Extrapulmonary Blastomycosis

et al. 2019

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“…Other organs of involvement include the larynx, upper respiratory mucosa, prostate, and epididymis. Less commonly, infection can spread to the brain, liver, lymph nodes, and spleen.1, 12 The incidence of skeletal involvement has ranged from 14 to 60% and is classically found in the dissemi-nated form.13 Common bony locations include the vertebrae, long bones, ribs, and skull, where osteolytic and osteomyelitis lesions often predominate. When occurring in the skull, it usually occurs in the calvaria, with the frontal bone being the most common location.…”

Section: Discussionmentioning

confidence: 99%

Blastomycosis of the Skull Base

Weingarten¹,

Hohn²,

Goldman³

et al. 1993

Skull Base

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Blastomycosis is a nonopportunistic fungal infection caused by Blastomyces dermatitides. Originally described by Gilchristl as a cutaneous infection, it is now accepted as a systemic disease with many classic and unusual presentations. Although pulmonary and cutaneous involvement is frequently seen, head and neck blastomycoses is less common. Middle ear, paranasal sinus, and temporal bone involvement are exceedingly rare. We present a case of a patient with blastomycosis of the middle ear, temporal bone, and paranasal sinuses, with massive base of skull destruction, in the absence of primary pulmonary involvement. CASE REPORTA 57-year-old black woman was transferred from an outside hospital where she had been treated for intractable otorrhea and lateral head pain. Eighteen months earlier, she had undergone a left Caldwell-Luc procedure, along with placement of a ventilation tube for a left middle ear effusion. She underwent a left radical mastoidectomy for persistent drainage 6 months later. The previous otologic surgeon described removal of a cholesteatoma. Since that time, the patient had persistent drainage from the left ear, progressive left-sided hearing loss, and temporal headaches. At the outside hospital, the patient was receiving parenteral ceftazadime, ampicillin, vancomycin, and metronidazole without resolution of drainage or pain. The remainder of the patient's past medical history was unremarkable. No significant systemic diseases were present. Human immunodeficiency virus serology was negative.The head and neck examination, including neurologic evaluation, was normal with the exception of purulent drainage from the left ear. An audiogram demonstrated a profound left hearing loss. The patient was afebrile on admission, and laboratory values were within normal limits. The white blood cell count was normal. Cultures of the left ear drainage from the previous hospital grew Staphylococcus aureus and stains for acid-fast bacilli were negative. An admission chest radiograph revealed "diffuse interstitial changes likely representative of chronic fibrotic changes." No evidence of granulomatous disease was seen.Magnetic resonance imaging with gadolinium demonstrated an extensive process involving the infratemporal fossa, middle ear, and mastoid air cells (Fig. 1). Extension into the epidural space was evident. Left temporal lobe edema was present. The sphenoid sinus was filled with soft tissue and mucosal thickening of the left maxillary sinus was demonstrated (Fig. 2).Computed tomography revealed multiple destructive lesions involving the base of the skull, sphenoid sinus, right maxillary sinus, with involvement of the hard palate, nasal cavity, and ethmoid sinus. A destructive lesion was also noted to involve the petrous portion of the left temporal bone with obliteration of the foramina contiguous to the sphenoid sinus (Fig. 3). The computed tomography (CT) scan was interpreted by the neuroradiologist as multiple metastatic lesions.Our preoperative differential diagnoses included metastatic carcinoma and ...

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Actinomycotic and Fungal Diseases

Seaton¹

2000

Crofton and Douglas's Respiratory Diseases

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Clinical aspects of blastomycosis

Cited by 18 publications

References 27 publications

Pleural Effusion in Pulmonary and Extrapulmonary Blastomycosis

Pleural Effusion in Pulmonary and Extrapulmonary Blastomycosis

Blastomycosis of the Skull Base

Actinomycotic and Fungal Diseases

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