Blastomycosis

Blastomycosis

Definition:

Blastomycosis is a rare fungal infection caused by inhaling a fungus (Blastomyces dermatitidis), which is found in wood and soil.

Alternative Names:

North American blastomycosis; Gilchrist's disease

Causes, incidence, and risk factors:

Blastomycosis occurs most often in people living in the south-central and Midwestern US and Canada. Exposure to soil is the key risk factor. The disease usually affects people with compromised immune systems, such as people with HIV or organ transplant recipients.

Men are more likely to be affected than women. Lung infection may produce no symptoms, but when the infection is widespread, skin lesions or bone lesions may appear and the urogenital system (bladder, kidney, prostate, testes) may be affected.

The incidence of blastomycosis is 1-2 out of every 100,000 people in geographic areas where blastomycosis occurs most frequently. It is even less common outside those areas.

Symptoms:

Cough (the sputum may be brown or bloody)
Shortness of breath
Sweating
Fever
Fatigue
General discomfort, uneasiness, or ill-feeling (malaise)
Weight loss
Joint stiffness and joint pain
Muscular stiffness and pain
Rash
Skin lesions
Chest pain

Signs and tests:

History of residence in relevant geographical area
Chest X-ray (may show nodules or pneumonia with cavities)
Tissue biopsy
Skin biopsy
Sputum culture and special stains

Treatment:

Though not all blastomycosis infection in the lungs requires antibiotics, when the disease has spread outside of the lungs or become severe in the lungs, amphotericin B, itraconazole, or other antifungal agents may be prescribed. Periodic follow-up is recommended to detect any recurrence of the disease.

Expectations (prognosis):

Patients with limited skin lesions and relatively mild lung involvement usually recover completely. Untreated, more severe disease is progressive and can lead to death.

Complications:

Large abscesses
Relapse or disease recurrence
Unpleasant side effects to drugs such as amphotericin B

Calling your health care provider:

Call your health care provider if symptoms suggesting blastomycosis occur.

Prevention:

Avoiding travel to areas where the disorder occurs will prevent exposure, but this is not practical for most people. Although other prevention is unknown, the disorder is rare except in people who are immunosuppressed.

Review Date: 7/31/2002
Reviewed By: Christopher Parsons, M.D., Department of Internal Medicine, Division of Infectious Diseases, University of Virginia, Charlottesville, VA. Review provided by VeriMed Healthcare Network.

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