II. Etiology

  1. Blastomyces dermatidis

III. Pathophysiology

  1. Transmitted by exposure to contaminated soil or decomposing timber
    1. Inhalation of spores
    2. Traumatized, non-intact skin exposure (see Cutaneous Blastomycosis)
  2. Endemic regions of United States
    1. Ohio River Basin
    2. Mississippi River Basin
    3. Great Lakes
    4. St. Lawrence River

IV. Symptoms

  1. Pulmonary involvement is initially asymptomatic in 50% of cases
  2. Fever
  3. Sweating
  4. Cough
  5. Nocturnal Joint Pain

V. Signs

  1. Acute disease
    1. See Cutaneous Blastomycosis
    2. Self-limited Pneumonia may clear spontaneously in most patients
  2. Disseminated blastomyces lesions (severe cases may be fatal)
    1. Bone
    2. Nervous system
    3. Lungs
    4. Liver
    5. Spleen
    6. Kidney

VI. Imaging: Chest XRay of Chronic Blastomycosis

  1. Test Sensitivity: 66%
  2. Osteolytic lesions

VII. Lab

  1. Microscopy
    1. Broad-based budding
  2. Skin lesion Evaluation
    1. Pustular discharge for Potassium Hydroxide
    2. Skin biopsy
    3. See Cutaneous Blastomycosis
  3. Systemic disease
    1. Bone Marrow Aspirate
    2. Sputum

VIII. Management

  1. Progressive, refractory, or severe disease or Central Nervous System involvement
    1. Amphotericin B 0.5-0.6 mg/kg daily (MAX 2.0 - 2.5g)
  2. Indolent disease
    1. Adults: Itraconazole 200 mg orally daily for 6 months
    2. Children and Pregnant women: Amphotericin B at dosing above

IX. Course

  1. Incubation: 30-45 days

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Related Studies

Ontology: Blastomycosis (C0005716)

Definition (NCI) A fungal infection caused by inhalation of spores of Blastomyces dermatitidis. It presents with flu-like symptoms including fever, chills, cough, pleuritic chest pain and myalgias. It may lead to a chronic granulomatous pulmonary infection and disseminate to other anatomic sites including skin, nervous system and bones.
Definition (CSP) infection caused by fungi of the genus Blastomyces.
Definition (MSH) A fungal infection that may appear in two forms: 1, a primary lesion characterized by the formation of a small cutaneous nodule and small nodules along the lymphatics that may heal within several months; and 2, chronic granulomatous lesions characterized by thick crusts, warty growths, and unusual vascularity and infection in the middle or upper lobes of the lung.
Concepts Disease or Syndrome (T047)
MSH D001759
ICD9 116.0, 116
ICD10 B40 , B40.9
SnomedCT 187484004, 187071002, 266217003, 154402000, 187075006, 187064007, 69996000, 191950004, 10673008
LNC LA10436-6
English Blastomycoses, Blastomycosis NOS, Blastomycosis, unspecified, Blastomycotic infection NOS, [X]Blastomycosis, unspecified, blastomycosis, blastomycosis (diagnosis), Blastomyces dermatitidis infection, Blastomyces infections, Blastomycosis [Disease/Finding], blastomycoses, [X]Blastomycosis, unspecified (disorder), Blastomycotic infection NOS (disorder), Blastomycosis NOS (disorder), Blastomycotic infection, Infection by Blastomyces dermatitidis, Infection by Blastomyces dermatitidis (disorder), Infection by Blastomyces, Blastomycosis (disorder), Blastomyces; infection, infection; Blastomyces, blastomycotic, dermatitidis, infection; Blastomyces, Blastomycosis, NOS, Blastomycotic infection, NOS, Infection by Blastomyces, NOS, Blastomyces Dermatitidis Infection, Blastomycosis
Italian Infezioni da blastomiceti, Infezione blastomicotica, Infezione da blastomyces dermatitidis, Blastomicosi
Dutch Blastomyces dermatitidis-infectie, Blastomyces; infectie, infectie; Blastomyces, blastomycotisch, dermatitidis, infectie; Blastomyces, Blastomycose, niet gespecificeerd, Blastomyces-infecties, blastomycose, Blastomycose, Mycose, blasto-
French Infection à Blastomyces dermatitidis, Infection blastomycotique, Infections à Blastomycètes, Blastomycose
German Blastomyces dermatitidis-Infektion, Blastomyces-Infektion, Blastomykose, nicht naeher bezeichnet, Blastomyces-Infektionen, Blastomykose
Portuguese Infecção blastomicótica, Infecção por Blastomyces dermatitidis, Infecções a Blastomyces, Blastomicose
Spanish Infección blastomicótica, Infección por Blastomyces dermatitidis, infección por Blastomyces dermatitidis (trastorno), infección causada por dematiditis Blastomyces (trastorno), infección causada por dematiditis Blastomyces, infección por Blastomyces dermatitidis, infección blastomicótica, SAI (trastorno), [X]blastomicosis, no especificada (trastorno), infección blastomicótica, SAI, blastomicosis, SAI, blastomicosis, SAI (trastorno), [X]blastomicosis, no especificada, blastomicosis (trastorno), blastomicosis, infección blastomicótica, infección por Blastomyces, Infecciones por blastomyces, Blastomicosis
Japanese ブラストミセス感染, ブラストミセス・デルマチチジス感染, ブラストミセスショウ, ブラストミセスデルマチチジスカンセン, ブラストミセスカンセン, ブラストミセス症-北アメリカ, 北アメリカブラストミセス症, ブラストミセス症
Swedish Blastomykos
Czech blastomykóza, Infekce Blastomyces dermatitidis, Blastomykóza, Blastomykotická infekce, Infekce blastomycetami
Finnish Blastomykoosi
Korean 상세불명의 분아균증, 분아균증
Polish Drożdżyca północnoamerykańska, Choroba Gildchrista, Blastomikoza, Zakażenie Blastomyces
Hungarian Blastomycoticus fertőzés, blastomycosis, Blastomyces dermatitidis fertőzés, Blastomyces fertőzések