Computed Tomographic Scan Evaluation of Pulmonary Blastomycosis

Ronald, Suzanne; Strzelczyk, Jacek; Moore, Sean; Trepman, Elly; Cheang, Mary; Limerick, Bill; Wiebe, Lyle; Sarsfield, Pete; Macdonald, Kerry; Meyers, Michael P.; Embil, John M.

doi:10.1155/2009/763018

Cited by 15 publications

(11 citation statements)

References 35 publications

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“…No specific radiographic findings are characteristic enough to suggest the diagnosis of blastomycosis. The most common findings in acute pulmonary blastomycosis include lobar consolidation, air bronchogram, and nodular infiltrates, 26,37,38 Table 1. Miliary nodules and interstitial infiltrates are common in severe cases.…”

Section: Radiographicmentioning

confidence: 99%

“…Miliary nodules and interstitial infiltrates are common in severe cases. 38 Mediastinal or hilar lymphadenopathy 26 and pleural effusions are infrequent. 39 Mass like lesions, often mistaken as malignancy, and cavities within areas of consolidation can be seen in chronic cases.…”

Section: Radiographicmentioning

confidence: 99%

“…Patients present with cough, chest pain, fever, sweats and malaise, usually occurring between one and three weeks following a high-inoculum exposure, 54,55 described as the "epidemic" type of acute pulmonary histoplasmosis, Table 1 56 . Severe cases may culminate in respiratory failure 38,57 and death. 57 Low-level exposure causes mild flu-like illness often lasting for more than a month, referred to herein as subacute pulmonary histoplasmosis.…”

Section: Clinicalmentioning

confidence: 99%

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Endemic mycoses: Overlooked causes of community acquired pneumonia

Hage

Knox

Wheat³

2012

Respiratory Medicine

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The endemic mycoses are important but often overlooked causes for community acquired pneumonia. Delays in recognition, diagnosis and proper treatment often lead to disastrous outcomes. This topic is not usually discussed in reviews and guidelines addressing the subject of community acquired pneumonia. In this review we discuss the three major endemic mycoses in North America that present as community acquired pneumonias; Coccidioidomycosis, Histoplasmosis and Blastomycosis. We discuss their epidemiology, clinical presentations, methods of diagnosis and current treatment strategies.

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Section: Radiographicmentioning

confidence: 99%

Section: Radiographicmentioning

confidence: 99%

Section: Clinicalmentioning

confidence: 99%

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Endemic mycoses: Overlooked causes of community acquired pneumonia

Hage

Knox

Wheat³

2012

Respiratory Medicine

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“…49 Findings on chest computed tomography scans include air bronchograms, consolidation, nodules, and lymphadenopathy. 54 The most devastating form of blastomycosis is the acute respiratory distress syndrome (ARDS), which complicates approximately 7 to 15% of the cases of blastomycosis requiring hospitalization. [55][56][57] In a few cases, blastomycosis-associated ARDS appears to have been precipitated by the use of corticosteroids.…”

Section: Clinical Manifestations Pulmonary Blastomycosismentioning

confidence: 99%

Blastomycosis

Schwartz

Kauffman

2020

Semin Respir Crit Care Med

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Blastomycosis is a serious fungal disease of humans and other mammals caused by environmentally acquired infection with geographically restricted, thermally dimorphic fungi belonging to the genus Blastomyces. The genetic and geographic diversity of these pathogens is greater than previously appreciated. In addition to Blastomyces dermatitidis and the cryptic species Blastomyces gilchristii, which cause blastomycosis in mid-western and various eastern areas of North America, atypical blastomycosis is occasionally caused by Blastomyces helicus in western parts of North America and Blastomyces percursus in Africa. Blastomycosis is acquired by inhalation of the conidia that are produced in the mold phase; in the lungs, temperature-dependent transformation occurs to the yeast phase. In this form, the organism is phagocytized by macrophages and can spread hematogenously to various organs causing disseminated infection. Pulmonary disease is most common and varies from mild, self-limited infection to severe, potentially fatal adult respiratory distress syndrome. Disseminated infection is manifested primarily by skin lesions, but many other organs can be involved. Diagnosis is established by growth of the organism in culture; however, a tentative diagnosis can be made quickly by histopathological identification of the classic yeast form in tissues or by finding Blastomyces antigen in urine or serum. Blastomycosis is treated initially with amphotericin B when the disease is severe, involves the central nervous system, or the host is immunosuppressed. Itraconazole is recommended for primary therapy in mild-to-moderate infection and for step-down therapy after initial amphotericin B treatment. Voriconazole and posaconazole can be used for patients in whom itraconazole is not tolerated.

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“…The initial chest imaging findings of blastomycosis often mimic malignancy or community-acquired pneumonia, resulting in a delay in diagnosis. Ronald et al [52], in a retrospective study with 34 patients with diagnosis of pulmonary blastomycosis, reported that the most prevalent features at CT were consolidations with air bronchograms and nodules, with no side or lobe predilection. When imaging manifestation is a mass, it usually is well circumscribe measuring between 3 and 10 cm in diameter with a tendency to be paramediastinal or perihilar.…”

Section: Imaging Manifestationsmentioning

confidence: 99%

Endemic pulmonary fungal diseases in immunocompetent patients: an emphasis on thoracic imaging

Mango

Zanetti

Penha

et al. 2019

Expert Review of Respiratory Medicine

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Introduction: Systemic endemic mycoses are prevalent in specific geographical areas of the world and are responsible for high rates of morbidity and mortality in these populations, and in immigrants and travelers returning from endemic regions. The most common fungal infections that can affect the lungs of immunocompetent patients include histoplasmosis, coccidioidomycosis, paracoccidioidomycosis, blastomycosis, sporotrichosis, aspergillosis, and cryptococcosis. Diagnosis and management of these diseases remain challenging, especially in non-endemic areas due to the lack of experience. Therefore, recognition of the various radiologic manifestations of pulmonary fungal infections associated with patients' clinical and epidemiologic history is imperative for narrowing the differential diagnosis. Areas covered: This review discusses the clinical and radiological findings of the main endemic fungal diseases affecting the lungs in immunocompetent patients. Specific topics discussed are their etiology, epidemiology, pathogenesis, clinical manifestations, methods of diagnosis, pathology and main imaging findings, especially in computed tomography. Expert commentary: Imaging plays an important role in the diagnosis and management of pulmonary fungal infection and may reveal useful signs. Although definitive diagnosis cannot be made based on imaging features alone, the use of a combination of epidemiologic, clinical and imaging findings may permit the formulation of an adequate differential diagnosis.

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Computed Tomographic Scan Evaluation of Pulmonary Blastomycosis

Abstract: A specific abnormality characteristic of pulmonary blastomycosis was not identified on CT scanning. The diagnosis can only be made in the context of a high index of clinical suspicion with histological or culture confirmation.

Cited by 15 publications

References 35 publications

Endemic mycoses: Overlooked causes of community acquired pneumonia

Endemic mycoses: Overlooked causes of community acquired pneumonia

Blastomycosis

Endemic pulmonary fungal diseases in immunocompetent patients: an emphasis on thoracic imaging

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