Blastomycosis history and symptoms

Patients with blastomycosis may present with any of several patterns of illness from a flu like illness which resolves within days to asymptomatic presentation (30-50%). Because of the brief and self-limited nature of these symptoms, blastomycosis may go un-diagnosed. Alternatively, patients may present with an acute illness mimicking bacterial pneumonia, with high fever, chills, a productive cough, and pleuritic chest pain which in most cases gets treated with antibiotics. ARDS is the most feared complication of the chronic blastomycosis. Dissemination through blood or lymph can result in extra pulmonary blastomycosis, which commonly involves skin, bone, genitourinary system and central nervous system.

The significant information that needs to focused in the history of the patient includes

• Any history of travel to the endemic areas
• Any ill contact with similar complaints

Clinical manifestations of Blastomycosis range from subclinical infection to fatal disseminated disease. Symptoms are based on the involvement of organ systems:

Presents clinically as acute and chronic. The symptoms often mimic with bacterial pneumonia presentation. Most common symptoms include : ^[1]

• Fever with chills
• Productive cough
• Hemoptysis.
• Weight loss
• Night sweats
• chest pain
• ARDS can develop as a result of endo-bronchial spread of infection which is dreadful complication with high mortality rate.

The most common extra pulmonary sites involved in blastomycosis are skin, bone, genitourinary and CNS.

• Skin is involved in 40-80% of the cases.^[2]

• The cutaneous manifestations of blastomycosis comes in two forms verrucous and ulcerative.^[3]
• Cutaneous blastomycosis is often confused with basal cell or squamous cell carcinomas or pyoderma gangrenosum.

• About 25% of the blastomycosis involve bone.
• Osteomyelitis is the most common presentation of oseous blastomycosis.^[4]
• Most commonly involved bones include vertebrae, ribs, skull and long bones.^[5]
• Infection can spread from the involved bone to surrounding joints (purulent arthritis) or soft tissue (subcutaneous abscess with draining sinus which can lead to the formation of an ulcer.^[5]
• The most common complication of vertebral osteomyelitis is extension of infection from the spine, resulting para-vertebral or psoas abscess.

• About 10 % of the blastomycosis involves genitourinary system.
• In men the most commonly involved organs include prostate, testicles and epididymis.
• Epididymo-orchitis causes swelling and pain, and prostatitis is associated with dysuria and symptoms of obstruction.
• Involvement of female genitourinary system is rare but if involved it causes endometrial infection or tubo-ovarian abscess.

• About 5-10 % of blastomycosis involve CNS.
• It presents as meningitis or mass lesion.^[6]
• CSF analysis of WBC reveals neutrophilic predominance.^[7]
• Laryngeal involvement causes hoarseness.

Blastomycosis can disseminate almost to any other site such as liver, spleen, breast, lymph nodes etc.^[8]

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