1/246. lobomycosis. Report of the eighth Colombian case and review of the literature. The eighth Colombian case of lobomycosis and the one hundredth in the world literature is reported here. The patient was a 38-year-old female who showed a bilobed mass on the left forearm which had appeared at the site from where a similar lesion had been excised 19 years previously. She had always lived in a rural area, located in the humid subtropical forest. The tissue reactions to the fungus as well as the fruitless attempts to culture it are described. An analysis of the relevant literature is made and suggestions for experimental animal models are given in the text. ( info) |
2/246. blastomycosis acquired occupationally during prairie dog relocation--colorado, 1998. On August 31, 1998, two suspected cases of fungal pneumonia were reported to the Boulder County (colorado) Health Department (BCHD). Both patients were immunocompetent, otherwise healthy adults working for the City of Boulder Open Space (CBOS) program on a prairie dog relocation project. This report summarizes the epidemiologic investigation by BCHD, the colorado Department of public health and environment, and CDC; the findings indicate that these two persons acquired blastomycosis in colorado, which is outside the area where the disease is endemic. ( info) |
| blastomycosis is endemic in river valley areas of the southeastern and midwestern united states. Pulmonary manifestations include chronic cough and pleuritic pain. Radiographic appearance of the infection can mimic bronchogenic lung carcinoma. pleural effusion is rarely associated with this pulmonary infection, and empyema has not been previously reported. We report a case of pulmonary and pleural blastomyces dermatitidis infection presenting as empyema thoracis. diagnosis and treatment were attained with video-assisted thoracoscopic (VATS) pleural and lung biopsy and debridement. ( info) |
4/246. Isolation of blastomyces dermatitidis from pigeon manure. We recently diagnosed and treated a 45-year-old white male horticulturist with acute progressive blastomycosis. epidemiologic studies revealed that the patient used a load of pigeon manure as fertilizer approximately 6 weeks before becoming ill. He used the pigeon manure only once, resealed the remainder, and stored it in his hothouse. Samples of the pigeon guano were digested with 10 per cent KOH, and the characteristic yeast forms of blastomyces dermatitidis were seen in large numbers. The fungus was cultured from another sample of the same material. This is the first time that the pathogenic fungus B. dermatitidis has been isolated from the environment in association with a human case. ( info) |
5/246. Hepatotoxicity possibly caused by amphotericin b. OBJECTIVE: To report a case of possible amphotericin b-induced hepatotoxicity in a patient with pulmonary blastomycosis. SUMMARY: A 26-year-old white man with life-threatening pulmonary blastomycosis developed elevation of his liver enzymes after the addition of amphotericin b to his initial itraconazole therapy. The hepatotoxicity resolved rapidly with discontinuation of the amphotericin b, and the blastomycosis was successfully treated with itraconazole alone. DISCUSSION: This case illustrates an unusual occurrence of hepatotoxicity associated with a short course of amphotericin b. liver biopsy was compatible with drug-induced changes and showed no evidence of blastomycosis. Discontinuation of amphotericin B with no other therapeutic changes resulted in a rapid resolution of hepatotoxicity. A possible adverse drug interaction with itraconazole and amphotericin b is postulated based on the mechanism of action of each drug. CONCLUSIONS: amphotericin b therapy can be associated with many adverse effects, but reports of hepatotoxicity are rare. Closer monitoring of liver enzymes in patients receiving amphotericin b, especially in combination with potentially hepatotoxic agents, including azole antifungal drugs, would be prudent. ( info) |
6/246. Expanding epidemiology of blastomycosis: clinical features and investigation of 2 cases in colorado. On the basis of case reports of blastomycosis, blastomyces dermatitidis is widely accepted to be endemic in the central United States in and around the ohio and mississippi River Valleys. blastomycosis also occurs in parts of canada and in the southeastern united states. However, there has been no large-scale skin testing, and the environmental range of B. dermatitidis may have been underestimated. We describe 2 immunocompetent patients with blastomycosis acquired while working in the Front Range region of the Rocky Mountains. The patients were coworkers engaged in a prairie dog relocation project. In the course of this work, they had extensive contact with contaminated soil. Significantly above-average rainfall before the exposure may have contributed to favorable conditions for sporulation of the fungus. ( info) |
| blastomycosis is a relatively uncommon fungal disease that most commonly affects the lungs. Other organs may be involved, usually secondary to dissemination of the organism. Laryngeal blastomycosis may occur in isolation from active pulmonary disease. The signs, symptoms, clinical features, and pathological findings of laryngeal blastomycosis mimic those of squamous cell carcinoma. Misdiagnosis may result in inappropriate treatment with potential morbidity. Proper understanding of the clinical presentation and familiarity with the histopathologic features of this disease are therefore imperative. In this paper, we report 2 cases of laryngeal blastomycosis, 1 of which was misdiagnosed as squamous cell carcinoma, clinically and microscopically, with consequent radiotherapy and laryngectomy. In the other case, a clinical diagnosis of glottic squamous cell carcinoma was rendered. However, blastomycosis was identified in a biopsy specimen. We also review cases of isolated laryngeal blastomycosis that have been reported in the English-language literature during the last 80 years. A number of those cases were misdiagnosed clinically and microscopically as squamous cell carcinoma. ( info) |
| infection of the central nervous system by blastomyces dermatitidis is a rare cause of meningoencephalitis. The existence of exclusive clinical infection of the meninges in the absence of pulmonary or other foci of infection has been debated. We describe a 20-year-old man presenting with meningoencephalitis caused by B dermatitidis. Blastomycotic infection was confirmed by isolation of the organism from brain tissue obtained at biopsy. magnetic resonance imaging demonstrated progressive enhancement of basal meninges with involvement of bilateral basal ganglia and thalami. Treatment with amphotericin b arrested further neurologic decline. However, clinical and radiographic follow-up suggested damage to diencephalic structures. The diagnosis of blastomycotic meningoencephalitis is difficult to establish because no sensitive serologic test exists, and attempts to isolate the organism in cerebrospinal fluid obtained by lumbar puncture generally fail. A biopsy specimen of brain tissue is frequently necessary for the diagnosis. survival is possible with timely initiation of therapy. ( info) |
9/246. Histopathological evidence of North American blastomycosis in italy: report of two cases. No clinical reports of blastomycosis in italy have been published until now. We here report two cases of histologically diagnosed, unexpected cutaneous involvement in patients, aged 78 and 52 years, living in North italy and never having been abroad. The histological differential diagnosis between blastomycosis and other fungal pathogens is discussed. Even in the absence of culture the present cases can confidently be considered as genuine examples of blastomyces dermatitidis infection in italy. ( info) |
| Although blastomycosis of the central nervous system (CNS) occurs in approximately 4% of patients with blastomycosis, recurrent CNS blastomycosis is very rare. We review the clinical features, treatment, and outcome of 4 previously reported cases. We also report a case of recurrent CNS blastomycosis successfully treated with surgery and liposomal amphotericin b after an inadequate response to amphotericin b therapy. This treatment may be an alternate approach for management of similar cases. ( info) |