Outcomes of persons with blastomycosis involving the central nervous system

Blastomyces Antigen Detection for Diagnosis and Management of Blastomycosis

“…However, a variety of other diagnostic tests, including antigen testing, antibody testing, and PCR, are commercially available (8,(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22). Given that identification from culture may not be evident for 2 to 4 weeks and that it often requires invasive procedures to obtain specimens, there is great interest in using antigen enzyme immunoassays (EIA) for rapid, noninvasive diagnosis and monitoring of disease progression or resolution (2,4,8,19).…”

“…However, a variety of other diagnostic tests, including antigen testing, antibody testing, and PCR, are commercially available (8,(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22). Given that identification from culture may not be evident for 2 to 4 weeks and that it often requires invasive procedures to obtain specimens, there is great interest in using antigen enzyme immunoassays (EIA) for rapid, noninvasive diagnosis and monitoring of disease progression or resolution (2,4,8,19).We evaluated the use of Blastomyces urine, serum, and bronchoalveolar lavage (BAL) fluid antigen assays for the diagnosis of blastomycosis and the effects of treatment on the clearance of antigenuria at the Marshfield Clinic from 1995 to 2015. Marshfield Clinic is located in Wisconsin where blastomycosis is endemic (1,3,6,9,(23)(24)(25)(26)(27)(28).…”

“…Blastomycosis may be asymptomatic or it can present as isolated pulmonary disease, disseminated disease (pulmonary and extrapulmonary infection), or extrapulmonary disease with manifestations in the central nervous system, bone, skin, or other locations (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11).…”

Blastomycosis

“…16.9) [46]. Magnetic resonance imaging (MRI), alone or in conjunction with computed tomography scans, reveals CNS abnormalities and are used to identify CNS involvement [46,47]. Surgical intervention may be necessary both for diagnosis and to prevent neurologic deterioration [48].…”

Central nervous system blastomycosis presenting as a year-long chronic headache

“…In a recent study that evaluated outcomes of 16 patients with CNS blastomycosis, the most frequent symptoms at presentation were headaches or a focal neurologic deficit in 63 and 56% of patients respectively. [4] Other manifestations include leptomeningeal involvement, single or multiple abscesses intracranially or in the spinal cord, as well as in the epidural space causing cord compression. On the MRI these may present as a single or multiple lesions producing mass effect (particularly in the cerebellum), diffuse leptomeningeal enhancement, cerebritis or obstructive hydrocephalus.…”