... Resources en español Definición Síntomas Riesgo y prevención Fuentes Diagnóstico y pruebas Tratamiento Profesionales de la salud ... Definición Síntomas Las Personas en Riesgo y Prevención Fuentes Diagnóstico y Exámenes Tratamiento y Resultados Profesionales de ...
... the central and southeastern United States, and in Canada, India, Israel, Saudi Arabia, and Africa. The key ... CT scan Chest x-ray Skin biopsy Sputum culture and examination Tissue biopsy Urine culture
Megan E. Huber
Full Text Available Purpose: Blastomycosis is an endemic fungal infection. In rural northern Wisconsin, blastomycosis cases are associated with certain environmental features including close proximity to waterways. Other studies have associated blastomycosis with particular soil chemicals. However, blastomycosis also occurs in urban and suburban regions. We explored the geodemographic associations of blastomycosis cases in the more urban/suburban landscape of eastern Wisconsin. Methods: We conducted a retrospective study of 193 laboratory-identified blastomycosis cases in a single eastern Wisconsin health system, 2007–2015. Controls were 250 randomly selected cases of community-diagnosed pneumonia from a similar time period. Geographic features of home addresses were explored using Google Maps. Categorical variables were analyzed with chi-square or Fisher’s exact tests and continuous variables by two-sample t-tests. Stepwise regression followed by binary logistic regression was used for multivariable analysis. Results: Compared to pneumonia cases, blastomycosis cases were younger (47.7 vs. 55.3 years and more likely to be male (67.9% vs. 45.6%, nonwhite (23.2% vs. 9.7% and machinists, automobile workers/mechanics or construction workers (32.7% vs. 7.2%; P 0.5 acres (30.4% vs. 14.2%, P = 0.0002, be < 0.25 miles from an automobile repair facility or junkyard (35.9% vs. 19.4%, P = 0.0005, and be < 0.1 miles from a park, forest or farm field (54.9% vs. 39.6%, P = 0.002. Only the latter association remained on multivariable analysis. Conclusions: Eastern Wisconsin blastomycosis case subjects were younger, more often male and more likely to live near parks/forests/fields. Novel associations of blastomycosis cases with machinery- and automobile-related occupations and/or facilities should be further explored.
Dubuisson, R.L.; Jones, T.B.
This paper describes the radiologic evaluation of a case of splenic abscess secondary to North American blastomycosis in a known intravenous drug abuser, a disease not believed to be previously reported in the radiologic literature. Dynamic computed tomography proved especially useful in narrowing the diagnostic possibilities and excluding vascular lesions
Rosser, Michael F; Lindemann, Dana M; Barger, Anne M; Allender, Matthew C; Hsiao, Shih-Hsuan; Howes, Mark E
A 5-yr-old, intact male red ruffed lemur ( Varecia rubra ) presented for evaluation as the result of a 1-wk history of lethargy and hyporexia. Physical examination findings included thin body condition, muffled heart sounds, harsh lung sounds, and liquid brown diarrhea. Complete blood count and serum biochemistry showed an inflammatory leukogram, mild hyponatremia, and mild hypochloremia. Orthogonal trunk radiographs revealed a severe alveolar pattern in the right cranial lung lobes with cardiac silhouette effacement. Thoracic ultrasound confirmed a large, hypoechoic mass in the right lung lobes. Fine-needle aspiration of the lung mass and cytology revealed fungal yeast organisms, consistent with Blastomyces dermatitidis. Blastomyces Quantitative EIA Test on urine was positive. Postmortem examination confirmed systemic blastomycosis involving the lung, tracheobronchial lymph nodes, spleen, kidney, liver, cerebrum, and eye. To the authors' knowledge, this is the first report of blastomycosis in a prosimian species.
Ryan R Kroll
Full Text Available In certain parts of the United States and Canada, and northern Ontario in particular, the dimorphic fungus Blastomyces dermatitidis is endemic and can cause infection in exposed individuals. The site of infection is usually pulmonary, causing respiratory and constitutional symptoms, but can also affect other sites in the body. Symptom severity can vary substantially from no symptoms to fatal acute respiratory distress syndrome. The present report describes a 27-year-old professional diver who had recently worked in northern Ontario, who developed symptoms of pneumonia and exhibited atypical findings on chest imaging. He was diagnosed with blastomycosis based on histopathological findings and fungal culture, and was treated with amphotericin B and itraconazole in accordance with treatment guidelines. While outdoor occupations in endemic areas increase the risk of infection, there is no literature specifically identifying professional diving as an occupational risk for blastomycosis.
Dennis J. Baumgardner
Full Text Available Purpose: Blastomycosis is a serious fungal infection contracted by inhalation of Blastomyces spores from the environment. Case occurrence in dogs in Vilas County, Wisconsin, has been associated with antecedent weather. We aimed to explore the effects of weather on the occurrence of human pulmonary blastomycosis in this area, and update exposure factors and symptoms since last published reports. Methods: Mandatory case reports were reviewed. Chi-square test was used for categorical data of exposures, comparing 1979–1996 (n=101 versus 1997–June 2013 (n=95. Linear regression was used to model local weather data (available 1990–2013; n=126; Southern Oscillation Index (SOI, North Atlantic Oscillation Index (NAOI, and Wisconsin River water discharge (WRD from the adjacent county (all available for 1984–2013; n=174; and case counts of known onset by warm (April–September and cold (October–March 6-month periods. Results: Distribution of pulmonary blastomycosis cases did not vary by season. Environmental exposures for the 1997–June 2013 group (mean age 45, 59% male were: residence(76%, excavation (42% and gardening (31%, all similar to the 1979–1996 group. Fishing (23% vs. 37%; P=0.09 and hunting (15% vs. 26%; P=0.13 exposures were less common in 1997–June 2013, but not significantly different. Overall, 69% of cases recalled some prior soil-disturbing activities. Considering the 6-month warm/cold periods, 19% of variation is explained by a direct relationship with total precipitation from two periods prior (P=0.005. There was no association of case occurrence with SOI, NAOI or WRD. Estimated annual incidence of blastomycosis for 1997–June 2013 was 27/100,000 compared with 44/100,000 for 1984–1996. Several symptoms were significantly less frequent in 2002–June 2013 compared to earlier years. Conclusions: As with dogs, human pulmonary blastomycosis occurrence is partially determined by antecedent precipitation. It is unclear if
Luis E. Rodríguez-Tovar
Full Text Available A female coyote (Canis latrans was fatally injured by a vehicle on a road in San Luis Potosi, Mexico. Because of deteriorating clinical signs, the animal was euthanized. Postmortem examination of the lungs showed numerous small multifocal white nodules (0.5–1 cm diameter disseminated throughout. Histopathologic examination revealed multifocal coalescing granulomas with abundant macrophages, numerous neutrophils, fibroblasts, plasma cells, and lymphocytes. Abundant intracellular and extracellular thick-walled, refractile, spherical yeasts (10–15 μm were observed within the granulomas. The yeasts were intensely PAS-positive, with granular protoplasm. Broad-based single budding yeasts were occasionally present. Based on the microscopic findings of the pulmonary lesions and the morphological features of the organism, a diagnosis of chronic pyogranulomatous pneumonia caused by Blastomyces dermatitidis was made. To our knowledge, the case described herein is the first report of pulmonary blastomycosis in a wild coyote.
FitzSimons, R B; Ferguson, A C
In a previously healthy 13-year-old girl with disseminated blastomycosis, immunodeficiency was considered because of lymphopenia and the slow response of her lung disease to therapy with amphotericin B. Cellular immunity was found to be profoundly impaired, with absent delayed cutaneous hypersensitivity to several common antigens, a decreased count of thymus-dependent lymphocytes in the peripheral blood and a greatly diminished in-vitro proliferative response of lymphocytes to phytohemagglutinin (PHA). Humoral immunity was intact. Two additional types of therapy were assessed: subcutaneous injection of transfer factor was associated with an unsustained increase in lymphocyte counts and a positive cutaneous response to PHA but no clinical change; parenteral alimentation to ensure an adequate energy intake was associated with rapid clinical improvement, the development of delayed hypersensitivity to four additional antigens, and the return of lymphocyte counts and proliferative response to normal. These findings suggest that increased energy intake rather than transfer factor therapy was responsible for the child's recovery, and they emphasize the importance of adequate nutrition in the maintenance of intact cellular immunity.
Diana Khuu discusses Blastomycosis Mortality Rates, United States, 1990â2010. Created: 1/5/2015 by National Center for Emerging and Zoonotic Infectious Diseases (NCEZID). Date Released: 1/7/2015.
Full Text Available Twenty-three cases of blastomycosis were reported in a survey conducted in the province of Quebec from 1981–90. Thirteen patients resided south of the St Lawrence River and the other 10, north. Two small geographical clusters were apparent in and around the cities of Sherbrooke and Quebec. The male to female ratio was 1.6:1 and the median age was 47 years (range 26 to 77. Lung involvement was observed in 19 cases and was the only site involved in 11. Cutaneous manifestations were reported in 11 cases while bone infection (three cases and central nervous system (CNS infections were also noted. Diagnosis was confirmed by culture in 21 cases and by histopathology in two cases. Of the 21 culture-positive cases, 12 strains of Blastomyces dermatitidis were isolated from lungs, nine from skin, and one each from bone and brain. Serodiagnostic tests by immunodiffusion or complement fixation were positive for only one of the 10 patients known to have been tested. Ten patients were treated with amphotericin B, 11 with ketoconazole, one with fluconazole and eight underwent surgery. While amphotericin B was used in eight of the 10 earliest treated cases, ketoconazole was administered in 10 of the 13 more recent cases. Of the patients for whom follow-up data have been obtained, 21 are reported cured (one of whom was not treated and one patient died of another cause. This survey confirms that blastomycosis is a rare disease in this endemic area and that patterns of therapy are changing.
Full Text Available El compromiso esofágico es una complicación infrecuente de la tuberculosis incluso en países con alta prevalencia de infección. Se presenta el caso de un paciente de 57 años no seropositivo al virus de inmunodeficiencia humana (VIH, con diagnóstico simultáneo de blastomicosis en cavidad oral y papilomatosis laríngea, ambas confirmadas por anatomía patológica. La biopsia de esófago reveló esofagitis granulomatosa con necrosis; la tinción de Ziehl-Neelsen mostró bacilos ácido-alcohol resistente, sugerentes de tuberculosis. El antecedente de tuberculosis pulmonar en dos oportunidades y abandono de tratamiento determinó el inicio de tratamiento antituberculoso de segunda línea a través de un tubo de gastrostomía, más itraconazol vía oral. La evolución fue favorable.Esophageal involvement is an extremely rare complication of tuberculosis even in countries with high prevalence of infection. We report the case of a 57 year-old hiv-seronegative patient with simultaneous diagnoses of oral blastomycosis and laryngeal papillomatosis. Both were confirmed by anatomopathological analysis. The esophageal biopsy revealed granulomatous esophagitis with necrosis and ziehl-neelsen stain showed acid-fast alcohol resistant bacilli suggestive of tuberculosis. The patient’s history included pulmonary tuberculosis twice and previous abandonment of therapy. Thus, it was necessary to use oral itraconazole combined with second-line anti-tuberculosis drugs administered through a gastrostomy tube. The clinical development was favorable.
Walkty, Andrew; Keynan, Yoav; Karlowsky, James; Dhaliwal, Perry; Embil, John
Blastomyces dermatitidis is a thermally dimorphic fungus that is capable of causing pulmonary and extra-pulmonary disease, including infections of the central nervous system (CNS). Diagnosis of CNS blastomycosis with non-invasive testing can be difficult, and a surgical biopsy may ultimately be required for microbiological and/or histopathological confirmation. A case of B. dermatitidis meningitis is presented where the diagnosis was made by testing cerebrospinal fluid (CSF) using the MVista® Blastomyces Quantitative Antigen Enzyme Immunoassay test. The utility of performing this test on CSF for diagnosis of CNS mass lesions/abscesses caused by B. dermatitidis in the absence of associated meningitis remains unclear. Cross reaction of the Blastomyces antigen test with other dimorphic fungi is a concern, necessitating that positive test results are interpreted in the context of the patient's exposure and travel history. Copyright © 2017 Elsevier Inc. All rights reserved.
... infection. It is most often found in: Africa Canada, around the Great Lakes South central and north ... is diagnosed by identifying the fungus in a culture taken from a skin lesion. This usually requires ...
Alex G Ortega-Loayza
Full Text Available A 55-year-old male presented with back pain and slightly tender annular plaques with central ulceration on his face. A skin biopsy revealed scattered yeast with broad based buds. A CT scan of the abdomen revealed a pathologic T12 fracture. Tissue obtained from the spine confirmed budding yeasts. The patient was diagnosed with disseminated blastomycosis. The patient was treated with amphotericin and itraconazole and completely recovered.Paciente do sexo masculino, com 55 anos de idade, compareceu ao ambulatório com dores na costa e placas anulares ligeiramente sensíveis, com ulceração central na face. Uma biópsia cutânea revelou levedura disseminada, com brotos de base larga. A tomografia computadorizada do abdômen revelou uma fratura patológica da T12. Amostra de tecido obtido da coluna vertebral confirmou levedura em fase de brotamento. O paciente foi diagnosticado com blastomicose disseminada. Após tratamento com anfotericina e itraconazol, o paciente teve recuperação completa.
Apr 17, 1971 ... We wish to thank Dr H. R. J. Wannenburg, Medical Superin- tendent of King Edward VIII Hospital. Durban, for permission to publish the case report; Dr I. G. Murray of the Mycology. Department. London School of Hygiene and Tropical Medicine. for his help in identifying the causal organism; Mr R. Stuart.
Jbeli, Aiham H; Yu, John
Malignant glioblastoma multiform (GBM) is the most common primary malignancy of the brain in the U.S. Temozolomide (TMZ) is the cornerstone of management along with surgical resection and radiotherapy. Because of the reduction in the CD4+ lymphocyte count as a side effect of TMZ use, this patient population is under risk for opportunistic infections like Pneumocystis jiroveci. A male patient with newly diagnosed glioblastoma multiform presented with non-productive cough and chest pain. Before presentation, the patient received the standard therapy including surgical resection, radiation and TMZ. Computerized tomography of the chest showed a very large cavitary lesion in the upper segment of the right lower lobe and multiple nodular lesions with some starting to cavitate. Cytology of the bronchioalveolar lavage with special stain showed large, broad based budding yeast-like cells, morphologically consistent with blastomyces and macrophages filled with yeast-like forms, morphologically consistent with histoplasma. The patient was treated with intraconazole intended for 12 months. To the best of our knowledge, our case represents the first documented case of lung infection with both blastomyces and histoplasma in a patient after receiving TMZ for newly diagnosed GBM. Copyright© South Dakota State Medical Association.
phagocyte oxidative metabolism, chemiluminescence coccidioidomycosis, blastomycosis, paracoccidioidomycosis , candidiasis, toxic oxygen metabolites, oxidative...Paracoccidioides brasiliensis (the etiologic agent of the Latin American Pndemic mycosis, paracoccidioidomycosis ) are also difficult targets for PMN killing, like
... be false positive tests in people with other fungal diseases such as histoplasmosis and blastomycosis , and false negative ... ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 267. Review Date 9/27/2017 Updated by: Jatin M. ...
Muñoz, José F.; Gauthier, Gregory M.; Desjardins, Christopher A.; Gallo, Juan E.; Holder, Jason; Sullivan, Thomas D.; Marty, Amber J.; Carmen, John C.; Chen, Zehua; Ding, Li; Gujja, Sharvari; Magrini, Vincent; Misas, Elizabeth; Mitreva, Makedonka; Priest, Margaret
Three closely related thermally dimorphic pathogens are causal agents of major fungal diseases affecting humans in the Americas: blastomycosis, histoplasmosis and paracoccidioidomycosis. Here we report the genome sequence and analysis of four strains of the etiological agent of blastomycosis, Blastomyces, and two species of the related genus Emmonsia, typically pathogens of small mammals. Compared to related species, Blastomyces genomes are highly expanded, with long, often sharply demarcated...
Ditmyer, Heidi; Craig, Linden
Canine blastomycosis is a common systemic fungal infection within the Ohio and Mississippi River valleys and typically presents as pneumonia, lymphadenitis, or endophthalmitis. This report describes three cases in which mammary tissue samples were submitted to the Department of Pathobiology, University of Tennessee, College of Veterinary Medicine with clinical suspicion of neoplasia or postpartum bacterial mastitis. Pyogranulomatous to granulomatous mastitis and dermatitis with intralesional yeast consistent with Blastomyces dermatitidis were diagnosed. Two of the three dogs also had lymph node and pulmonary involvement. Mycotic mastitis due to Blastomyces dermatitidis is rarely reported and blastomycosis should be considered in the differential diagnosis of dogs with mammary lesions from endemic areas.
....3060 Section 866.3060 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN... reagents are devices that consist of antigens and antisera used in serological tests to identify antibodies to Blastomyces determatitidis in serum. The identification aids in the diagnosis of blastomycosis...
S - S - .. . I I FUNGAL DI SEASES Paracoccidioidomycosis . Paracoccidloidomycosis (South American...ia 3. Diseases Causing Prolife rative Granulomatous Mucosal Masses Paracoccidioidomycosis Histoplasmosis S Rh i nosporidiosis 4. Diseases Causing...Infectious Disease , Ed. 3, Baltimore , Williams and Wilkins , 1968. 7. Cabrera , A.: Paracoccidioidomycosis (South American Blastomycosis): General Rev
... to other illnesses such as the flu or tuberculosis. Some fungal diseases like fungal meningitis and bloodstream ... prevención Fuentes Diagnóstico y pruebas Tratamiento Profesionales de la salud Estadísticas Blastomycosis Definition Symptoms Risk & Prevention Sources ...
Weese, J. S.; Peregrine, A. S.; Armstrong, J.
Zoonotic diseases are an ever-present concern in small animal veterinary practice and are often overlooked. A variety of nonparasitic zoonotic diseases may be encountered in small animal practice, including cat scratch disease (bartonellosis), cat bite abscesses, rabies, leptospirosis, methicillin-resistant Staphylococcus aureus, Clostridium difficile-associated diarrhea, salmonellosis, avian chlamydiosis, campylobacteriosis, dermatophytosis, and blastomycosis. These may cause human disease r...
Domestic violence topped trauma (31 patients I 45). Infections were dominated by ophthalmic Zona (18 patients I 25) and two rare diseases, one case of North American blastomycosis and one case of post surgical eyelid gangrene. Basal cell carcinoma was the first cancer (11 patients I 20). Conclusion: The pathologies of ...
Klein, B.S.; Jones, J.M.
No well-defined Blastomyces-specific antigens are currently available. We used sodium dodecyl sulfate-polyacrylamide gel electrophoresis and immunoblotting to identify immunologically active molecules in the cell wall of B. dermatitidis. A major immunoreactive 120-kD protein (WI-1) was present in all five strains studied and comprised 5% of the protein in the cell wall extract obtained after freezing and thawing yeast cells. WI-1 was recognized by serum from all 10 patients with blastomycosis but by none of those from 5 patients with histoplasmosis. It was purified by electroelution, radiolabeled with 125I, and incorporated into a radioimmunoassay (RIA) for serodiagnosis of blastomycosis. Antibody to WI-1 was detected in 58 (85%) of 68 patients with blastomycosis (geometric mean titer, 1:2,981), in two (3%) of 73 patients with histoplasmosis, coccidioidomycosis, sporotrichosis, or candidiasis (titers, 1:86 and 1:91) and in none of 44 healthy persons. WI-1 was shown to be a surface molecule abundant on B. dermatitidis yeasts that were indirectly stained with serum from a rabbit immunized with WI-1. Approximately 0.93 pg of WI-1 or 4.7 x 10(6) WI-1 molecules were found on the surface of an individual yeast using an antigen-inhibition RIA; none was found on Histoplasma capsulatum or Candida albicans yeasts. We conclude that WI-1 is a novel, immunologically active surface molecule on the invasive form of B. dermatitidis and that WI-1 can be used to reliably detect antibody and study the immunopathogenesis of blastomycosis.
Klein, B.S.; Jones, J.M.
No well-defined Blastomyces-specific antigens are currently available. We used sodium dodecyl sulfate-polyacrylamide gel electrophoresis and immunoblotting to identify immunologically active molecules in the cell wall of B. dermatitidis. A major immunoreactive 120-kD protein (WI-1) was present in all five strains studied and comprised 5% of the protein in the cell wall extract obtained after freezing and thawing yeast cells. WI-1 was recognized by serum from all 10 patients with blastomycosis but by none of those from 5 patients with histoplasmosis. It was purified by electroelution, radiolabeled with 125I, and incorporated into a radioimmunoassay (RIA) for serodiagnosis of blastomycosis. Antibody to WI-1 was detected in 58 (85%) of 68 patients with blastomycosis (geometric mean titer, 1:2,981), in two (3%) of 73 patients with histoplasmosis, coccidioidomycosis, sporotrichosis, or candidiasis (titers, 1:86 and 1:91) and in none of 44 healthy persons. WI-1 was shown to be a surface molecule abundant on B. dermatitidis yeasts that were indirectly stained with serum from a rabbit immunized with WI-1. Approximately 0.93 pg of WI-1 or 4.7 x 10(6) WI-1 molecules were found on the surface of an individual yeast using an antigen-inhibition RIA; none was found on Histoplasma capsulatum or Candida albicans yeasts. We conclude that WI-1 is a novel, immunologically active surface molecule on the invasive form of B. dermatitidis and that WI-1 can be used to reliably detect antibody and study the immunopathogenesis of blastomycosis
A. B. Kulko
Full Text Available The article describes characteristics of two different etiology groups of deep human mycosis — extremely dangerous endemic deep mycoses (histoplasmosis, coccidioidomycosis, blastomycosis, paracoccidioidomycosis, penicilliosis due to Penicillium marneffei and opportunistic deep mycosis (candidiasis, cryptococcosis, aspergillosis, mucormycosis. Information on fungal pathogens and antifungal agents is presented. The own results of cultural studies obtained during pneumomycosis diagnosis in patients with tuberculosis are shown.
Chong, Semin; Lee, Kyung Soo; Yi, Chin A; Chung, Myung Jin; Kim, Tae Sung; Han, Joungho
Histoplasmosis is the most common endemic mycosis in North America, and is followed by coccidioidomycosis and blastomycosis. Although the majority of these infections in immunocompetent persons are self-limited, some patients can develop severe pneumonitis or various forms of chronic pulmonary infection. Cryptococcoci, Aspergillus, Candidas, and Mucorals are ubiquitous organisms, which may affect immunocompromised patients. Specific imaging findings can be expected, depending on the organisms involved, underlying patients' conditions (immune status), and specific situations after immune depleting procedures
Beside deep mycoses very well known: histoplasmosis, candidosis, cryptococcosis, there are other mycoses less frequently described. Some of them are endemic in some countries: South American blastomycosis in Brazil, coccidioidomycosis in California; some others are cosmopolitan and may affect everyone: sporotrichosis, or may affect only immunodeficient persons: mucormycosis. They do not spare Africa, we may encounter basidiobolomycosis, rhinophycomycosis, dermatophytosis, sporotrichosis and, more recently reported, rhinosporidiosis. Important therapeutic progresses have been accomplished with amphotericin B and with antifungus imidazole compounds (miconazole and ketoconazole). Surgical intervention is sometime recommended in chromomycosis and rhinosporidiosis.
Flores Cevallos, L
Special circumstances: Mountains called "Los Andes", the Humbolt maritime current, subtropical region; which makes the peruvian territory present the ecosystem which influence the fauna, flora, and pothology. Contain diseases like parasite dermatosis (mal de Pinto, verruga peruana, leishmaniasis, blastomycosis and pain) have close relation with the different ecosystem of the peruvian territory. This study only includes these dermatosis and are resumed as follows: The disease called, mal del Pinto is only diffused in the arid coast, andean valleys and the virgin forest (it is found in altitudes of 800 to 1,000 m.). The verruga peruvian: Is found in the occidental part of the andean valleys (at 800 and 1,000 m. of altitude). Leishmaniasis exist in two forms: One like bottom of orient with only skin alteration called leishmaniasis andina (uta for the indians), its propagated in the coast and the andean valleys at 200 m. (amount 1,200 to 3,000); the otter form affects the mycosis, called leishmaniasis americana (espundia for the indians), its it propagates general in the virgin forest. The brazilian blastomycosis only exists in the virgin forest. The pain, disease does not exist in the arid coast, nor in the andean valleys. Geographically, for its propagation it is necessary heat, humidity and heavy rainy water, that is why it is only found in the virgin forest.
José F Muñoz
Full Text Available Three closely related thermally dimorphic pathogens are causal agents of major fungal diseases affecting humans in the Americas: blastomycosis, histoplasmosis and paracoccidioidomycosis. Here we report the genome sequence and analysis of four strains of the etiological agent of blastomycosis, Blastomyces, and two species of the related genus Emmonsia, typically pathogens of small mammals. Compared to related species, Blastomyces genomes are highly expanded, with long, often sharply demarcated tracts of low GC-content sequence. These GC-poor isochore-like regions are enriched for gypsy elements, are variable in total size between isolates, and are least expanded in the avirulent B. dermatitidis strain ER-3 as compared with the virulent B. gilchristii strain SLH14081. The lack of similar regions in related species suggests these isochore-like regions originated recently in the ancestor of the Blastomyces lineage. While gene content is highly conserved between Blastomyces and related fungi, we identified changes in copy number of genes potentially involved in host interaction, including proteases and characterized antigens. In addition, we studied gene expression changes of B. dermatitidis during the interaction of the infectious yeast form with macrophages and in a mouse model. Both experiments highlight a strong antioxidant defense response in Blastomyces, and upregulation of dioxygenases in vivo suggests that dioxide produced by antioxidants may be further utilized for amino acid metabolism. We identify a number of functional categories upregulated exclusively in vivo, such as secreted proteins, zinc acquisition proteins, and cysteine and tryptophan metabolism, which may include critical virulence factors missed before in in vitro studies. Across the dimorphic fungi, loss of certain zinc acquisition genes and differences in amino acid metabolism suggest unique adaptations of Blastomyces to its host environment. These results reveal the dynamics
Muñoz, José F; Gauthier, Gregory M; Desjardins, Christopher A; Gallo, Juan E; Holder, Jason; Sullivan, Thomas D; Marty, Amber J; Carmen, John C; Chen, Zehua; Ding, Li; Gujja, Sharvari; Magrini, Vincent; Misas, Elizabeth; Mitreva, Makedonka; Priest, Margaret; Saif, Sakina; Whiston, Emily A; Young, Sarah; Zeng, Qiandong; Goldman, William E; Mardis, Elaine R; Taylor, John W; McEwen, Juan G; Clay, Oliver K; Klein, Bruce S; Cuomo, Christina A
Three closely related thermally dimorphic pathogens are causal agents of major fungal diseases affecting humans in the Americas: blastomycosis, histoplasmosis and paracoccidioidomycosis. Here we report the genome sequence and analysis of four strains of the etiological agent of blastomycosis, Blastomyces, and two species of the related genus Emmonsia, typically pathogens of small mammals. Compared to related species, Blastomyces genomes are highly expanded, with long, often sharply demarcated tracts of low GC-content sequence. These GC-poor isochore-like regions are enriched for gypsy elements, are variable in total size between isolates, and are least expanded in the avirulent B. dermatitidis strain ER-3 as compared with the virulent B. gilchristii strain SLH14081. The lack of similar regions in related species suggests these isochore-like regions originated recently in the ancestor of the Blastomyces lineage. While gene content is highly conserved between Blastomyces and related fungi, we identified changes in copy number of genes potentially involved in host interaction, including proteases and characterized antigens. In addition, we studied gene expression changes of B. dermatitidis during the interaction of the infectious yeast form with macrophages and in a mouse model. Both experiments highlight a strong antioxidant defense response in Blastomyces, and upregulation of dioxygenases in vivo suggests that dioxide produced by antioxidants may be further utilized for amino acid metabolism. We identify a number of functional categories upregulated exclusively in vivo, such as secreted proteins, zinc acquisition proteins, and cysteine and tryptophan metabolism, which may include critical virulence factors missed before in in vitro studies. Across the dimorphic fungi, loss of certain zinc acquisition genes and differences in amino acid metabolism suggest unique adaptations of Blastomyces to its host environment. These results reveal the dynamics of genome evolution
Beltrame, Anna; Danesi, Patrizia; Farina, Claudio; Orza, Pierantonio; Perandin, Francesca; Zanardello, Claudia; Rodari, Paola; Staffolani, Silvia; Bisoffi, Zeno
Lobomycosis is a chronic skin mycosis endemic in Amazon regions characterized by chronic nodular or keloidal lesions caused by Lacazia loboi , an uncultivable fungus. Imported cases in nonendemic countries are rare and diagnosed after years. We describe a case of lobomycosis in a healthy 55-year-old Italian traveler who had acquired the infection during 5-day-honeymoon in the Amazon region of Venezuela in 1999. Several weeks after return, he recalled pruritus and papular skin lesions on the left lower limb, subsequently evolving to a plaque-like lesion. Blastomycosis and cryptococcosis were hypothesized based on microscopic morphology of yeast-like bodies found in three consecutive biopsies, although fungal cultures were always negative. In 2016, exfoliative cytology and a biopsy specimen examination showed round yeast-like organisms (6-12 μm), isolated or in a chain, connected by short tubular projections fulfilling the morphologic diagnostic criteria of Lacazia spp. The microscopic diagnosis was confirmed by molecular identification.
Full Text Available Nocardia spp are gram-positive, aerobic, acid-fast bacteria which exist as saprophytes in nature. Invasive disseminated infections are particularly common in immunocompromised or debilitated hosts. Superficial infections with Nocardia spp occur as a result of local trauma and contamination of the wound. Clinically, it presents as acute infection (abscesses or cellulitis, mycetoma, or sporotrichoid infection. Differential diagnosis includes eumycetoma, chromomycosis, blastomycosis, coccidioidomycosis, sporotrichosis, tuberculosis, botryomycosis, syphilis, yaws, and neoplasia. Its diagnosis is confirmed by demonstrating the causative organism in exudates (as granules, tissue specimens, or cultures. Early diagnosis will obviate need for drastic surgical measures as early institution of chemotherapy is effective in most patients. However, its diagnosis is often delayed due to diverse clinical presentations and for want of clinical suspicion, particularly in non-endemic areas. This paper presents 4 clinical forms of this not so uncommon disease, emphasizing the importance of high index of clinical suspicion, especially in non-endemic regions; and the significance of repeated examination of exudates for Nocardia granules for an early diagnosis.
Full Text Available We describe a case of a 65-year-old male presenting with a large plaque with a rolled-out interrupted margin, atrophic center, and island of normal skin over the left arm. It grew peripherally with central healing, and there was a history of recurrence after inadequate excision. Investigations ruled out other clinical mimickers; namely, squamous cell carcinoma, lupus vulgaris, botryomycosis, and blastomycosis-like pyoderma. Histopathological sections showed irregularly shaped craters filled with keratin and epithelial pearl but no evidence of granuloma or cellular atypia. Clinicopathological correlation proved the lesion to be keratoacanthoma centrifugum marginatum (KCM, a rare variant of keratoacanthoma, which spreads centrifugally, attains a huge size, and never involutes spontaneously. Treatment of KCM has been a problem always and, in our case, systemic retinoid (acitretin for three months proved ineffective. The patient also had a history of recurrence following surgical intervention previously, necessitating wide excision to achieve complete clearance of tumor cells. Hence, after failure of retinoid therapy, the decision of excision with a 1-centimeter margin was taken and the large defect was closed by a split thickness skin graft. The graft uptake was satisfactory, and the patient is being followed-up presently and shows no signs of recurrence after six months, highlighting wide local excision as a useful treatment option.
Meece, Jennifer K.; Anderson, Jennifer L.; Gruszka, Sarah; Sloss, Brian L.; Sullivan, Bradley; Reed, Kurt D.
Background. Blastomyces dermatitidis, the etiologic agent of blastomycosis, has 2 genetic groups and shows varied clinical presentation, ranging from silent infections to fulminant respiratory disease and dissemination. The objective of this study was to determine whether clinical phenotype and outcomes vary based on the infecting organism's genetic group.Methods. We used microsatellites to genotype 227 clinical isolates of B. dermatitidis from Wisconsin patients. For each isolate, corresponding clinical disease characteristics and patient demographic information were abstracted from electronic health records and Wisconsin Division of Health reportable disease forms and questionnaires.Results. In univariate analysis, group 1 isolates were more likely to be associated with pulmonary-only infections (P 1 month (P smoking status (P = .0001) remained predictors for group 2 infections.Conclusions. This study identified previously unknown associations between clinical phenotype of human infection and genetic groups of B. dermatitidis and provides a framework for further investigations of the genetic basis for virulence in B. dermatitidis.
Full Text Available Pyoderma vegetans (PV or blastomycosis-like pyoderma (BLP is a chronic inflammatory disease, by some authors considered a rare variety of pyoderma gangrenosum (PG, and others describe it as a distinct entity. It commonly presents with verrucous plaques with multiple pustules. The etiology of this disease is unknown, but it has been connected with staphylococcal and streptococcal infections, inflammatory bowel disease, hematological diseases, primary immunodeficiency, alcoholism, and nutritional deficit. Here we present a 66-year-old, otherwise healthy female, with a 2-year-long history of well-defined, vegetative livid plaques with multiple pustules on the dorsal side of both hands. Histopathological analysis of the skin biopsy of the hand showed chronic inflammation and micro-abscesses, ruptured follicular cysts and follicular pseudoepitheliomatous hyperplasia. Treatment with anti-tuberculosis drugs and antibiotics showed to be ineffective, as well as the treatment with systemic corticosteroids, dapsone and cyclosporine. Itraconazole was given for its immunomodulatory effects and findings of Penicillium species in one of the swabs, which led to partial regression of lesions. Since the treatment did not lead to complete resolution, acitretin was indicated 3 months later, but the patient was lost to follow-up.
Walter C. Pereira
Full Text Available Several case reports of involvement of the nervous system by Paracoccidioides brasiliensis have been published, changing thus the concept that the nervous system would no be adequate to the proliferation of this fungus. In the material of the Department of Pathology of the University of São Paulo Medical School, collected up to September 1964, 145 cases of paracoccidioidomycosis were found. In 14 of them there were lesions of the nervous system, giving an incidence of 9,65%. This high incidence contradicts the frequent assumption that the involvement of the nervous system in cases of South American blastomycosis is exceptional. In our material most of the cases of neuroblastomycosis had not systemic lesions, 2 of them having isolated involvement of the nervous system. This fact does not agree with the frequent observation of patients with lesions in all organs but the nervous system. There are no pathophysiologic reasons to explain such contradiction, but it can be assumed that individual conditions, in some cases, make the nervous system vulnerable to the parasite. Of the 14 cases studied, 5 had lesions of the meninges and 9 had gra-nulomata of the brain. Of the 5 cases with meningitis, 3 had an isolated basilar leptomeningitis; in 1 case lesions of the pia-arachnoid of the brain convexity were also found, and in another one the spinal meninges were also involved as well the spinal roots. The granulomata of the brain were isolated in 5 cases and multiple in 4. The most frequent site of the lesions was the cerebral hemispheres (6 cases; in 2 cases the cerebellum was involved; the thalamus, pons and medulla were involved in one case each. This predominance of the hemispheric localization must be related to the larger blood supply of this parte of the nervous system, owing to the hematogenic route followed by the parasite. In our material no lesions of the spinal cord were found. However, no definitive conclusions can be drawn, as there was no
Spec, Andrej; Barrios, Christopher R; Ahmad, Usama; Proia, Laurie A
Severe pulmonary or disseminated histoplasmosis often necessitates presumptive antifungal treatment while awaiting definitive diagnosis. Histoplasma antigen assays have improved sensitivity but results may lag up to 7 days. In order to increase diagnostic certainty, "soft clues" may be looked for in laboratory and radiologic data, such as elevated alkaline phosphatase or ferritin levels and findings of mediastinal adenopathy or hepatosplenomegaly. To determine if elevated aspartate aminotransferase (AST) to alanine aminotransferase (ALT) ratio is specific to histoplasmosis or a non-specific marker for disseminated fungal infection or sepsis in general, we retrospectively examined records of all patients diagnosed with an endemic fungal infection (EFI) at Rush University Medical Center from January of 1997 to October of 2012, and a cohort of septic patients with elevated liver enzymes. We identified 90 cases of EFIs during the study period that met all inclusion criteria (Histoplasma 21, Blastomyces 56, Coccidioides 12, Paracoccidioides 1). We also evaluated 10 control patients with bacterial sepsis. The mean ratio of AST to ALT in patients with disseminated histoplasmosis was 2.69 (95% CI:1.22, 4.16) while for other EFIs, the mean ratio ranged from 0.38 to 1.14 with disseminated coccidioidomycosis and blastomycosis respectively (P histoplasmosis in the appropriate host, and to possibly distinguish cross reactivity of the Histoplasma antigen assay with other EFIs. © The Author 2016. Published by Oxford University Press on behalf of The International Society for Human and Animal Mycology. All rights reserved. For permissions, please e-mail: email@example.com.
Meece, Jennifer K.; Anderson, Jennifer L.; Fisher, Matthew C.; Henk, Daniel A.; Sloss, Brian L.; Reed, Kurt D.
Blastomyces dermatitidis, a thermally dimorphic fungus, is the etiologic agent of North American blastomycosis. Clinical presentation is varied, ranging from silent infections to fulminant respiratory disease and dissemination to skin and other sites. Exploration of the population genetic structure of B. dermatitidis would improve our knowledge regarding variation in virulence phenotypes, geographic distribution, and difference in host specificity. The objective of this study was to develop and test a panel of microsatellite markers to delineate the population genetic structure within a group of clinical and environmental isolates of B. dermatitidis. We developed 27 microsatellite markers and genotyped B. dermatitidis isolates from various hosts and environmental sources (n=112). Assembly of a neighbor-joining tree of allele-sharing distance revealed two genetically distinct groups, separated by a deep node. Bayesian admixture analysis showed that two populations were statistically supported. Principal coordinate analysis also reinforced support for two genetic groups, with the primary axis explaining 61.41% of the genetic variability. Group 1 isolates average 1.8 alleles/locus, whereas group 2 isolates are highly polymorphic, averaging 8.2 alleles/locus. In this data set, alleles at three loci are unshared between the two groups and appear diagnostic. The mating type of individual isolates was determined by PCR. Both mating type-specific genes, the HMG and α-box domains, were represented in each of the genetic groups, with slightly more isolates having the HMG allele. One interpretation of this study is that the species currently designated B. dermatitidis includes a cryptic subspecies or perhaps a separate species.
Arival Cardoso de Brito
Full Text Available Lacaziose ou doença de Jorge Lobo é micose crônica, granulomatosa, causada por implantação traumática do fungo Lacazia loboi - patógeno não cultivável até o presente - nos tecidos cutâneo e subcutâneo, manifestando-se clinicamente por lesões nodulares queloidianas predominantes, envolvendo sobretudo pavilhões auriculares, face, membros superiores e inferiores, e não comprometendo as mucosas. A maioria dos casos humanos está registrada em países da América do Sul. Entretanto, a enfermidade apresenta aspectos epidemiológicos destacados, como o aparecimento em tribo Caiabi, no Brasil Central e em mamíferos não humanos, golfinhos de duas espécies (Tursiops truncatus e Sotalia guianensis capturados na costa da Flórida (EUA, na foz do rio Suriname, na costa de Santa Catarina (Brasil, no golfo de Gasconha (baía de Biscaia-Europa, com manifestações cutâneas e achados histopatológicos muito similares às encontradas no homem. O artigo objetiva abordar características do fungo e sua taxonomia, e aspectos históricos, ecoepidemiológicos, clínicos, imuno-histoquímicos, histopatológicos, ultra-estruturais e terapêuticos.Lacaziosis, also known as Jorge Lobo’s disease, lobomycosis and keloidal blastomycosis, is a chronic cutaneous and subcutaneous fungal granulomatous disease, caused by Lacazia loboi - an uncultivated fungal pathogen - characterized by the development of nodular keloidal lesions, particularly on the pinnae, face, upper and lower limbs, and with no involvement of mucous membranes. Most cases in humans were reported in South America, including the Caiabi Indians, in Central Brazil. The disease was described in non-human mammals, such as two species of dolphins (Tursiops truncatus and Sotalia guianensis inhabiting the coasts of Florida (USA, South America (Suriname River estuary, Santa Catarina-Brazil coast and Gulf of Gascony (Biscaya Bay, in Europe. The histopathological findings in dolphins were very similar
Benedicto Oscar Colli
Full Text Available Two cases of intramedullary paracoccidioidomycosis are reported. Paracoccidioidomycosis is a systemic disease that involves the buccopharyngeal mucosa, lungs, lymph nodes and viscera and infrequently the central nervous system. Localization in the spinal cord is rare. Case 1: a 55-year old male admitted with crural pararesis, tactile/painful hypesthesia and sphincter disturbances of 15 days duration. Cutaneous-pulmonary blastomycosis was diagnosed 17 years ago. Myelotomography showed a blockade of T3-T4 (intramedullary lesion. The lesion surgically removed was a Paracoccidioides brasiliensis granuloma. Treatment with sulfadiazine was started after the surgery. Follow-up of 15 month showed an improvement of the clinical signs. Case 2: a 57-year old male was admitted elsewhere 6 months ago and, with a radiologic diagnosis of pulmonary paracoccidioidomycosis, was treated with amphotericin B. He progressively developed paresthesia and tactile/ pain anaesthesia on the left side, sphincter disturbances and tetraparesis with bilateral extensor plantar response and clonus of the feet. Myelotomography showed a blockade of C4-C6 (intramedullary lesion. The lesion was not found during surgical exploration and the patient deteriorated and died. Post-mortem examination revealed an intramedullary tumor above the site of the mielotomy (Paracoccidioides brasiliensis granuloma. The preoperative diagnosis of intramedullary paracoccidioidomycotic granulomas is difficult because the clinical and radiologic manifestations are uncharacteristic. Clinical suspicion was possible in our cases based on the history of previous systemic disease. Contrary to intracranial localizations, paracoccidioidomycotic granulomas causing progressive spinal cord compression may require early surgery because response to clinical treatment is slow and the reversibility of neurological deficits depends on the promptness of the decompression.São relatados dois casos de granuloma blastomic