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Blastomycosis


Blastomycosis is a rare fungal infection. It is caused by inhaling a fungus called Blasomyces dermatitidis, which is found in wood and soil. It is also known as Chicago disease or Gilchrist’s disease. It occurs most often in people living in the south-central and Midwestern regions of the United States and Canada, especially along the Mississippi and Ohio Rivers, around the Great Lakes, and in and around Ontario, but has also been reported in locations all over the world. It afflicts men more often than women, usually between the ages of 20 and 40. Outbreaks have been associated with activities around streams or rivers with high content of moist soil enriched with organic debris or rotting wood. The fungus is breathed in from its natural habitat, where it incubates in the lungs over a period of 30 to 100 days, and spreads to other parts of the body. It is especially harmful to those who have weakened immune systems, such as those with HIV, organ transplants, or other medical treatments that lower the immune system. It is also common in dogs, and can be found less commonly in cats.

BLASTOMYCOSIS SYMPTOMS

Blastomycosis often causes no symptoms in its early stages, especially when it infects the lungs. It may begin gradually with a flu-like illness with fever, chills, weakness, headache, and dry cough. In later stages it may be nearly impossible to tell it from bacterial pneumonia or even tuberculosis because of the sputum, high fever, night sweats, and chest pain involved. Other symptoms of blastomycosis may include a cough that produces brown or bloody mucus, shortness of breath, sweating, fever, fatigue, malaise, weight loss, joint stiffness and pain, muscle stiffness and pain, pain suring urination, a rash that may include pus-containing bumps, skin lesions, and chest pains. After some time, when the infection spreads, you may experience skin lesions, bone lesions, and you may find that your bladder, kidney, prostate, and testes may be affected.
blastomycosis
Image: Blastomycosis


In order to diagnose this eclectic group of symptoms, your doctor may request several diagnostic tests. He or she may want to know about the medical history of the region where you live, to see whether blastomycosis is common in the area. You may also require a chest e-ray, a biopsy of your tissues, a biopsy of your skin, and a culture of the sputum produced by your cough. About half of these infections are asymptomatic altogether. Other types of blastomycosis infections are known as:

 Acute pulmonary, which presents as a set of symptoms that mimics bacterial pneumonia;
 Chronic pulmonary, which mimics bronchogenic cancers;
 Skin disease, which presents skin lesions;
 Subcutaneous nodules, which present as infected skin abscesses and are often associate with a blastomycosis infection of the lungs;
 Bone and joint infection, which commonly affect the long bones, ribs, and vertebrae;
 Genitourinary tract infections, which account for 10% to 30% of cases, and can also affect the prostate and epididymus;
 Other areas of infection, which can include any other organ, including the central nervous system, the thyroid, the pericardium, the adrenal glands, and the gastrointestinal tract.

BLASTOMYCOSIS TREATMENT

If it is determined that you do indeed have blastomycosis, it is possible that your infection my resolve itself without treatment, especially if the infection remains within the lungs, but doctors recommend that you begin treatment immediately nevertheless. If the disease becomes very severe, or when it spreads outside the lungs, you may be prescribed an anti-fungal medication such as itraconozole, fluconazole, or ketoconazole. If you have a very severe infection, or if you are pregnant, you may be treated with Amphotericin B, but patients with skin lesions and lung infections can usually recover completely. If the infection is not treated, it can result in death. If you receive a blastomycosis diagnosis or treatment, you should follow up with your doctor, because blastomycosis can return if not guarded against.

BLASTOMYCOSIS COMPLICATIONS

If it is left untreated, blastomycosis can result in serious complications. Skin lesions may develop into large abscesses that seep pus and spread infection. If left untreated or if treatment is discontinued, blastomycosis can return in an even more serious form. And in some cases, there are unpleasant side effects to amphotericin B, the most effective medication, which include loss of appetite, fever, chills, low blood pressure, nausea and vomiting, headache, and shortness of breath.


Among those who get treated quickly, and whose immune systems are not compromised, there is a lower than 2% chance that you will die as a result of your infection. For those with compromised immune systems, the mortality rate is much higher—closer to 30%. For HIV/AIDS patients, a blastomycosis infection carries a 40% chance of death. For those whose symptoms have been left untreated for long that they have become very severe, and who have developed acute respiratory distress syndrome (ARDS), the fatality rate is much higher, at about 69%. On average, the mortality rate of all forms of blastomycosis is about 5%. It is clear that early treatment is very important when dealing with this dangerous fungus.

There is currently no way to determine where blastomycosis dermititidis is present in the soil or other organic material. This makes it virtually impossible to control it at its source, in nature. The solution to this problem may be to develop better diagnostic tools, so that those in high-risk areas can be identified and taught to know what they symptoms of the disease are. With this kind of research, scientists could determine exactly where the fungus grows and how to prevent the growth. Until then, early identification and treatment still presents the best way to return to health after exposure to blastomycosis.

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