Blastomycosis

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Summary of Blastomycosis

Blastomycosis is a fungal infection caused by Blastomyces dermatitidis. It causes symptoms suggestive of bacterial pneumonia that may spread to involve skin and bone. It may also result in a granulomatous response. The disease occurs east of the Mississippi River in the United States and also in Central America. Its histological appearance is characterized by broad-based budding and thick walls that are doubly refractive.

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Blastomycosis

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NOTES NOTES SYSTEMIC MYCOSES GENERALLY, WHAT ARE THEY? PATHOLOGY & CAUSES DIAGNOSIS ▪ Fungal infections in internal organs (esp. lungs) DIAGNOSTIC IMAGING CAUSES LAB RESULTS ▪ Dimorphic species of fungi ▪ Transmitted by spore inhalation; lymphohematogenous dissemination SIGNS & SYMPTOMS ▪ X-ray, CT scan, MRI ▪ Culture-based observation, direct microscopy, serologic tests, lab tests (e.g. abnormal blood exams) TREATMENT MEDICATIONS ▪ Cough, chest pain, fever ▪ Antifungal agents BLASTOMYCES SPP. osms.it/blastomyces PATHOLOGY & CAUSES ▪ Blastomycosis ▫ Systemic fungal infection caused by Blastomyces dermatitidis, B. gilchristii; usually manifests as chronic pneumonia ▪ Incubation period: 3–6 weeks ▪ Spore inhalation → conversion to yeast in lungs → phagocytosis by macrophages → acute suppurative inﬂammation ▪ Immune response: mainly cellular, mediated by T-lymphocytes, macrophages ▪ Common sites of infection: primarily lungs (90%); skin, bones, genitourinary tract, central nervous system (CNS) 558 OSMOSIS.ORG Blastomyces spp. ▪ Size: 8–15μm ▪ Broad-based budding (wide connection between two cells before splitting apart during reproduction) ▪ Thermal dimorphism ▫ Mold form (< 37°C/98.6°F): produces spores ▫ Yeast form (37°C/98.6°F): multinucleate; antiphagocytic (e.g. thick cell wall) ▪ Virulence ▫ Thick cell wall: resistance to phagocytosis ▫ BAD-1: cell surface glycoprotein; adhesin ▫ Binds yeast to extracellular matrix, macrophages

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Blastomycosis

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A 36-year-old Caucasian woman comes to the office complaining of a productive cough, chest pain, and high-grade fever. Her medical history is noncontributory. The patient currently works as park keeper for White Mountain National Forest in New Hampshire. Upon medical interrogation, the patient claims that lately she feels diffuse joint pain in her shoulders and knees. She currently takes ibuprofen and reports no improvement of symptoms. Physical examination is notable for multiple granulomatous nodules in her chest. Her temperature is 38.5°C (101.3°F), pulse is 101/min, respirations are 17/min, blood pressure is 120/60 mmHg. A sputum culture is obtained and shows dividing yeast organisms and large broad-based budding from mother cells. Which of the following is the most likely causal organism for this patient's findings?

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