Immunology of Blastomycosis

Klein, Bruce S.

doi:10.1007/978-1-4615-3306-1_8

Cited by 11 publications

(9 citation statements)

References 65 publications

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“…Mycelial conidia are acquired via the respiratory route [7]. In the lungs, the conidia convert into the yeast phase, escape containment by macrophages and neutrophils [8], and then disseminate throughout the body and stimulate granulomatous inflammation [9–11]. Bone and joint infections are the second most common extrapulmonary manifestation of blastomycosis after skin infections [10–13].…”

Section: Discussionmentioning

confidence: 99%

An 11-Year-Old Male with Refractory Osteomyelitis

Mauriello

Raustol²,

Aguiar³

et al. 2012

Case Reports in Pediatrics

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We present a case of empirical treatment failure for chronic osteomyelitis in a previously healthy 11-year-old male involving the distal phalanx of the right first digit. After initial debridement, empiric antibiotics were started for presumed Staphylococcus aureus infection. Operative bacterial cultures yielded no growth. Despite three weeks of antistaphylococcal antibiotics the patient's symptoms worsened and the destruction of bone progressed. A repeat plain X-ray revealed a new lesion in the proximal phalanx of the right second digit. The recognition of multifocal osteomyelitis led to reexamination of bone tissue specimens using special stains which demonstrated rare broad-based budding yeast. Fungal cultures eventually grew Blastomyces dermatitidis. Treatment with amphotericin B led to rapid clinical improvement. This case illustrates that clinicians must remain vigilant for warning signs that empiric treatment may be failing for presumptive Staphylococcus aureus, provoking reconsideration of the differential diagnosis and an intensification of efforts to evaluate for alternative etiologies.

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Section: Discussionmentioning

confidence: 99%

An 11-Year-Old Male with Refractory Osteomyelitis

Mauriello

Raustol²,

Aguiar³

et al. 2012

Case Reports in Pediatrics

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“…This is an important step in terms of pathogenesis, because the yeast form, which possesses a thick capsule, is very difficult for phagocytes to ingest and kill. Polymorphonuclear leukocytes, which handle inhaled conidia better than macrophages, are relatively ineffective against yeast forms (67). Proliferation of yeast forms in the alveoli signals the failure of natural resistance to B. dermatitidis.…”

Section: Pathogenesis and Pathologymentioning

confidence: 99%

“…However, the absence of a reliable skin test antigen has made assessment of delayed-type hypersensitivity (DTH) difficult. Much of what is known about cellular immune responses to B. dermatitidis is derived from animal models, in vitro correlates of DTH, and the assumption that host responses to B. dermatitidis are similar to those that H. capsulatum and Coccidioides species elicit (16,67). In addition, the pyogranulomatous response seen during blastomycosis and the presence of yeast cells inside or in contact with monocytes, macrophages, and giant cells suggest an important cellular immune response (16).…”

Section: Pathogenesis and Pathologymentioning

confidence: 99%

Clinical and Laboratory Update on Blastomycosis

2010

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SUMMARY Blastomycosis is endemic in regions of North America that border the Great Lakes and the St. Lawrence River, as well as in the Mississippi River and Ohio River basins. Men are affected more often than women and children because men are more likely to participate in activities that put them at risk for exposure to Blastomyces dermatitidis. Human infection occurs when soil containing microfoci of mycelia is disturbed and airborne conidia are inhaled. If natural defenses in the alveoli fail to contain the infection, lymphohematogenous dissemination ensues. Normal host responses generate a characteristic pyogranulomatous reaction. The most common sites of clinical disease are the lung and skin; osseous, genitourinary, and central nervous system manifestations follow in decreasing order of frequency. Blastomycosis is one of the great mimickers in medicine; verrucous cutaneous blastomycosis resembles malignancy, and mass-like lung opacities due to B. dermatitidis often are confused with cancer. Blastomycosis may be clinically indistinguishable from tuberculosis. Diagnosis is based on culture and direct visualization of round, multinucleated yeast forms that produce daughter cells from a single broad-based bud. Although a long course of amphotericin B is usually curative, itraconazole is also highly effective and is the mainstay of therapy for most patients with blastomycosis.

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“…The conidia convert to yeast phase in the lung. The yeast forms are more resistant to phagocytosis and killing [7]. This is an important step in terms of pathogenesis because this conversion results in a survival advantage and probably contributes to infection by Blastomyces dermatitidis.…”

Section: Pathogenesismentioning

confidence: 99%

Non-resolving Community Acquired Pneumonia (CAP) due to Blastomyces dermatitidis (Pulmonary Blastomycosis): Case Report and Review of Literature

Britto¹

2018

JRI

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Initial diagnostic laboratory work up showed leucocyte count of 14,500 cells/mm 3 (76% segmented neutrophils, 13% lymphocytes and 11% monocytes), hemoglobin 12.9 g/dl, hematocrit 38.9% and platelet count 316,000/mm 3. Serum electrolytes, renal function, and liver function tests were normal. Rapid Influenza test was positive for Influenza A. Urine streptococcal and legionella antigens were negative. Chest X-ray (CXR) showed an ovoid superior segment left lower lobe focus of consolidation (Figure 1). A diagnosis of Influenza A and possible community acquired bacterial pneumonia was made and patient was admitted to the hospital. She was started on oral oseltamivir and intravenous ceftriaxone and azithromycin.

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Immunology of Blastomycosis

Cited by 11 publications

References 65 publications

An 11-Year-Old Male with Refractory Osteomyelitis

An 11-Year-Old Male with Refractory Osteomyelitis

Clinical and Laboratory Update on Blastomycosis

Non-resolving Community Acquired Pneumonia (CAP) due to Blastomyces dermatitidis (Pulmonary Blastomycosis): Case Report and Review of Literature

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