Blastomycosis natural history, complications and prognosis
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: ; Vidit Bhargava, M.B.B.S [2]
Overview
Blastomycosis is a granulomatous disease entity, that can produce a wide array of signs and symptoms, but is usually a mild illness in many cases. The most common presentation is a mild acute pneumonia that is self resolving, it can also cause chronic pneumonia and extra-pulmonary manifestations. The most common site of involvement is lungs, but it can often spread to other sites such as skin, bones and genitourinary systems. The route of spread is most commonly either hematogenous or lymphatic.
Natural history
- Symptoms of acute blastomycosis include an influenza like illness with fever, cough, myalgia, arthralgia, and pleurisy developing 3-15 weeks after exposure.
- In most of the individuals the infection resolves spontaneously even without the treatment.
- In some individuals it may progress to a more chronic stage which confounds the diagnosis, mistaking it for tuberculosis, other fungal infections or even a malignancy.
- Patient may develop symptoms of high grade fever, productive cough, hemoptysis and weight loss.
- If left untreated a significant proportion of these cases may further disseminate to other body parts, most commonly to skin, followed by bone and joint, genitourinary system and other sites in the body. (Nervous system, lymphatics etc).
Complications
- Chronic pulmonary involvement and extra-pulonary spread.
- Cutaneous involvement can cause large sores with pus (abscesses).
- Osteomyelitis from bone involvement.[1]
- Prostatitis and epididymo-orchitis in males and tubo-ovarian abscess in females have been reported.[2][3]
- Return of the infection (relapse or disease recurrence)
- Side effects from drugs such as amphotericin B
Prognosis
Mortality rate in treated cases
- 0-2% in treated cases among immuno-competent patients
- 29% in immuno-compromised patients
- 40% in the subgroup of patients with AIDS
- 68% in patients presenting as acute respiratory distress syndrome (ARDS)
Extra-pulmonary manifestations usually require a longer overall duration of treatment. The cases that do relapse after treatment, usually respond well to a second treatment course.
References
- ↑ Moore, RM.; Green, NE. (1982). "Blastomycosis of bone. A report of six cases". J Bone Joint Surg Am. 64 (7): 1097–101. PMID 7118980. Unknown parameter
|month=ignored (help) - ↑ Eickenberg H-U, M.; Amin, R.; Lich, . (1975). "Blastomycosis of the genitourinary tract". J Urol. 113 (5): 650–2. PMID 1173249. Unknown parameter
|month=ignored (help) - ↑ Seo, R.; Oyasu, R.; Schaeffer, A. (1997). "Blastomycosis of the epididymis and prostate". Urology. 50 (6): 980–2. doi:10.1016/S0090-4295(97)00406-8. PMID 9426737. Unknown parameter
|month=ignored (help)