Blastomyces dermatitidis - Revision history

Aidan: /* Extra-Pulmonary Blastomycosis */

2026-02-23T21:07:53Z

Extra-Pulmonary Blastomycosis

← Older revision		Revision as of 21:07, 23 February 2026
Line 49:		Line 49:
	*Next most common feature is dissemination to skin		*Next most common feature is dissemination to skin
	**Lesions usually either verrucous or ulcerative		**Lesions usually either verrucous or ulcerative
	**May be misdiagnosed as pyoderma gangrenosum, keratoacanthoma, BCC, squamous cell carcinoma, or mycosis fungoides		**May be misdiagnosed as [[pyoderma gangrenosum]], [[keratoacanthoma]], [[BCC]], [[squamous cell carcinoma]], or [[mycosis fungoides]]
	**Differential also contains NTM, other fungal infections, lupus		**Differential also contains [[NTM]], other fungal infections, [[lupus]]
	*Osteomyelitis, with or without evidence of lung involvement, is the third most common form		*Osteomyelitis, with or without evidence of lung involvement, is the third most common form
	**There are no specific clinical or radiographical features of blastomycosis		**There are no specific clinical or radiographical features of blastomycosis

Aidan: /* Epidemiology */

2024-10-01T15:11:30Z

Epidemiology

← Older revision		Revision as of 15:11, 1 October 2024
Line 11:		Line 11:
	[[File:Blastomycosis_map.png\|thumb\|Distribution of blastomycosis]]		[[File:Blastomycosis_map.png\|thumb\|Distribution of blastomycosis]]

	*Present in the Mississippi, Ohio, and St. Lawrence River Valleys, the Great Lakes regions, and western Ontario		*Present in the Mississippi, Ohio, and St. Lawrence River Valleys, the Great Lakes regions, and western Ontario[[CiteRef::ashraf2020re]]
	*May also be endemic to Africa and India, though it's unclear whether these are true cases or late reactivation		*May also be endemic to Africa and India[[CiteRef::ashraf2020re]], though it's unclear whether these are true cases or late reactivation
	*Hosts include humans, dogs, cats, horses, brown bears, and exotic pets like the kinkajou and red ruffed lemur		*Hosts include humans, dogs, cats, horses, brown bears, and exotic pets like the kinkajou and red ruffed lemur
	*There have been point-source outbreaks associated with occupational and recreational activities, usually along streams or rivers enriched with decaying vegetation		*There have been point-source outbreaks associated with occupational and recreational activities, usually along streams or rivers enriched with decaying vegetation

Aidan: Undo revision 10888 by Aidan (talk)

2024-10-01T15:10:36Z

Undo revision 10888 by Aidan (talk)

← Older revision		Revision as of 15:10, 1 October 2024
Line 9:		Line 9:
	===Epidemiology===		===Epidemiology===

	[[File:Blastomycosis_map.png\|thumb\|Distribution of blastomycosis~~[[CiteRef::ashraf2020re]]~~]]		[[File:Blastomycosis_map.png\|thumb\|Distribution of blastomycosis]]

	*Present in the Mississippi, Ohio, and St. Lawrence River Valleys, the Great Lakes regions, and western Ontario		*Present in the Mississippi, Ohio, and St. Lawrence River Valleys, the Great Lakes regions, and western Ontario

Aidan: /* Microbiology */

2024-10-01T15:10:09Z

Microbiology

← Older revision		Revision as of 15:10, 1 October 2024
Line 9:		Line 9:
	===Epidemiology===		===Epidemiology===

	[[File:Blastomycosis_map.png\|thumb\|Distribution of blastomycosis]]		[[File:Blastomycosis_map.png\|thumb\|Distribution of blastomycosis[[CiteRef::ashraf2020re]]]]

	*Present in the Mississippi, Ohio, and St. Lawrence River Valleys, the Great Lakes regions, and western Ontario		*Present in the Mississippi, Ohio, and St. Lawrence River Valleys, the Great Lakes regions, and western Ontario

Aidan: /* Other Azoles */

2024-10-01T15:09:16Z

Other Azoles

← Older revision		Revision as of 15:09, 1 October 2024
Line 164:		Line 164:
	** However, relatively high risk of liver toxicity		** However, relatively high risk of liver toxicity
	* If there are contraindications to voriconazole, then consider		* If there are contraindications to voriconazole, then consider
	** [[Posaconazole]], which is recommended by some experts[[CiteRef::schwartz2020bl]] based on some case reports[[CiteRef::proia2012su]][[CiteRef::day2014su]], though liver toxicity is likely around the same as [[voriconazole]][[CiteRef::~~10.1016/s0140-6736(21)00219-1~~]], and [[itraconazole]] and [[fluconazole]][[CiteRef::~~10.1056/NEJMoa061094~~]]		** [[Posaconazole]], which is recommended by some experts[[CiteRef::schwartz2020bl]] based on some case reports[[CiteRef::proia2012su]][[CiteRef::day2014su]], though liver toxicity is likely around the same as [[voriconazole]][[CiteRef::maertens2021po]], and [[itraconazole]] and [[fluconazole]][[CiteRef::cornely2007po]]
	** [[Isavuconazole]], which has clinical data that include both case reports and a case series[[CiteRef::scolarici2022th]][[CiteRef::thompson2016is]], and far fewer hepatobiliary adverse events than [[voriconazole]][[CiteRef::maertens2016is]]		** [[Isavuconazole]], which has clinical data that include both case reports and a case series[[CiteRef::scolarici2022th]][[CiteRef::thompson2016is]], and far fewer hepatobiliary adverse events than [[voriconazole]][[CiteRef::maertens2016is]]

Aidan: added info about second-line/third-line azoles

2024-10-01T15:07:53Z

added info about second-line/third-line azoles

← Older revision		Revision as of 15:07, 1 October 2024
Line 158:		Line 158:
	*Not as good CNS penetration as other [[triazoles]]		*Not as good CNS penetration as other [[triazoles]]
	*Needs therapeutic drug monitoring after 2 weeks with goal of maintaining serum levels between 1.0 and 10.0 μg/ml		*Needs therapeutic drug monitoring after 2 weeks with goal of maintaining serum levels between 1.0 and 10.0 μg/ml

			=== Other Azoles ===

			* [[Voriconazole]] is the second-line azole that is most frequently recommended
			** However, relatively high risk of liver toxicity
			* If there are contraindications to voriconazole, then consider
			** [[Posaconazole]], which is recommended by some experts[[CiteRef::schwartz2020bl]] based on some case reports[[CiteRef::proia2012su]][[CiteRef::day2014su]], though liver toxicity is likely around the same as [[voriconazole]][[CiteRef::10.1016/s0140-6736(21)00219-1]], and [[itraconazole]] and [[fluconazole]][[CiteRef::10.1056/NEJMoa061094]]
			** [[Isavuconazole]], which has clinical data that include both case reports and a case series[[CiteRef::scolarici2022th]][[CiteRef::thompson2016is]], and far fewer hepatobiliary adverse events than [[voriconazole]][[CiteRef::maertens2016is]]

	==Further Reading==		==Further Reading==

Aidan at 01:51, 20 August 2024

2024-08-20T01:51:17Z

← Older revision		Revision as of 01:51, 20 August 2024
Line 85:		Line 85:

	*Can be directly visualized on exudate, sputum, tissue, or really any sample		*Can be directly visualized on exudate, sputum, tissue, or really any sample
	*Fairly easy to see with KOH or calcofluor		*Fairly easy to see with KOH or calcofluor, showing thick-walled, multinucleated, '''broad-based budding yeast'''
	*Can be seen on histology of skin lesion biopsy with Gomori methenamine silver (GMS) and periodic acid-Schiff (PAS) stains		*Can be seen on histology of skin lesion biopsy with Gomori methenamine silver (GMS) and periodic acid-Schiff (PAS) stains
	*Thick-walled, multinucleated, broad-based budding

	===Culture===		===Culture===
Line 99:		Line 98:

	*Antibody		*Antibody
	**~~Serology with complement~~ fixation is insensitive		**Complement fixation is insensitive (Sn 9 to 43%); EIA is more sensitive but less specific
	**~~A antigen antibodies~~ is better (Sn ~~65-80~~%, Sp 100%)		**Immunodiffusion is likely better, though sensitivity still rather poor (Sn 28 to 64%, Sp 100%)
			***Immunodiffusion for A band is what is done in Ontario
	**BAD1 antigen antibodies is 85% sensitive but not yet used		**BAD1 antigen antibodies is 85% sensitive but not yet used
	*Urinary antigen has 93% sens and 80% spec		*Urinary antigen has 93% sens and 80% spec

Aidan at 17:20, 14 September 2020

2020-09-14T17:20:32Z

Show changes

Aidan: /* CNS blastomycosis */

2020-08-20T18:36:16Z

CNS blastomycosis

← Older revision		Revision as of 18:36, 20 August 2020
Line 115:		Line 115:

	=== CNS blastomycosis ===		=== CNS blastomycosis ===
	** [[Is treated by::Amphotericin B]] 5 mg/kg per day for 4-6 weeks followed by an azole for at least 12 months and until resolution of CSF abnormalities		* [[Is treated by::Amphotericin B]] 5 mg/kg per day for 4-6 weeks followed by an azole for at least 12 months and until resolution of CSF abnormalities
	** Azoles include [[Is treated by::fluconazole]] 800 mg daily, [[Is treated by::itraconazole]] 200 mg bid or tid, or [[Is treated by::voriconazole]] 200-300 mg bid		* Azoles include [[Is treated by::fluconazole]] 800 mg daily, [[Is treated by::itraconazole]] 200 mg bid or tid, or [[Is treated by::voriconazole]] 200-300 mg bid
	*** [[Voriconazole]] ''may'' be better for CNS disease		** [[Voriconazole]] ''may'' be better for CNS disease

	=== Immunosuppressed patients with blastomycosis, including AIDS ===		=== Immunosuppressed patients with blastomycosis, including AIDS ===

Aidan: /* Clinical Manifestations */

2020-08-05T14:07:29Z

Clinical Manifestations

← Older revision		Revision as of 14:07, 5 August 2020
Line 30:		Line 30:
	* When symptomatic, may have non-specific and constitutional symptoms		* When symptomatic, may have non-specific and constitutional symptoms
	* Can be primary or reactivation		* Can be primary or reactivation
	* Incubation period 3 weeks to 3 months		* Incubation period [[Usual incubation period::3 weeks to 3 months]]

	=== Respiratory blastomycosis ===		=== Respiratory blastomycosis ===