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Image: Blastomycosis30.jpeg|This micrograph shows histopathologic changes that reveal the presence of the fungal agent Blastomyces dermatitidis. <SMALL><SMALL>''[http://phil.cdc.gov/phil/home.asp From Public Health Image Library (PHIL).] ''<ref name=PHIL> {{Cite web | title = Public Health Image Library (PHIL) | url = http://phil.cdc.gov/phil/home.asp}}</ref></SMALL></SMALL>
Image: Blastomycosis30.jpeg|This micrograph shows histopathologic changes that reveal the presence of the fungal agent Blastomyces dermatitidis. <SMALL><SMALL>''[http://phil.cdc.gov/phil/home.asp From Public Health Image Library (PHIL).] ''<ref name=PHIL> {{Cite web | title = Public Health Image Library (PHIL) | url = http://phil.cdc.gov/phil/home.asp}}</ref></SMALL></SMALL>


Image: Blastomycosis30.jpeg|This micrograph shows histopathologic changes that reveal the presence of the fungal agent Blastomyces dermatitidis. <SMALL><SMALL>''[http://phil.cdc.gov/phil/home.asp From Public Health Image Library (PHIL).] ''<ref name=PHIL> {{Cite web | title = Public Health Image Library (PHIL) | url = http://phil.cdc.gov/phil/home.asp}}</ref></SMALL></SMALL>
Image: Blastomycosis31.jpeg| This photomicrograph depicts the fungal agent Blastomyces dermatitidis. <SMALL><SMALL>''[http://phil.cdc.gov/phil/home.asp From Public Health Image Library (PHIL).] ''<ref name=PHIL> {{Cite web | title = Public Health Image Library (PHIL) | url = http://phil.cdc.gov/phil/home.asp}}</ref></SMALL></SMALL>


Image: Blastomycosis30.jpeg|This micrograph shows histopathologic changes that reveal the presence of the fungal agent Blastomyces dermatitidis. <SMALL><SMALL>''[http://phil.cdc.gov/phil/home.asp From Public Health Image Library (PHIL).] ''<ref name=PHIL> {{Cite web | title = Public Health Image Library (PHIL) | url = http://phil.cdc.gov/phil/home.asp}}</ref></SMALL></SMALL>
Image: Blastomycosis32.jpeg|Histopathology of blastomycosis, lung of wolf. Yeast cells of Blastomyces dermatitidis. FA stain. <SMALL><SMALL>''[http://phil.cdc.gov/phil/home.asp From Public Health Image Library (PHIL).] ''<ref name=PHIL> {{Cite web | title = Public Health Image Library (PHIL) | url = http://phil.cdc.gov/phil/home.asp}}</ref></SMALL></SMALL>


Image: Blastomycosis30.jpeg|This micrograph shows histopathologic changes that reveal the presence of the fungal agent Blastomyces dermatitidis. <SMALL><SMALL>''[http://phil.cdc.gov/phil/home.asp From Public Health Image Library (PHIL).] ''<ref name=PHIL> {{Cite web | title = Public Health Image Library (PHIL) | url = http://phil.cdc.gov/phil/home.asp}}</ref></SMALL></SMALL>
Image: Blastomycosis33.jpeg|Histopathology of blastomycosis. Yeast cell of Blastomyces dermatitidis undergoing broad-base budding. <SMALL><SMALL>''[http://phil.cdc.gov/phil/home.asp From Public Health Image Library (PHIL).] ''<ref name=PHIL> {{Cite web | title = Public Health Image Library (PHIL) | url = http://phil.cdc.gov/phil/home.asp}}</ref></SMALL></SMALL>


Image: Blastomycosis30.jpeg|This micrograph shows histopathologic changes that reveal the presence of the fungal agent Blastomyces dermatitidis. <SMALL><SMALL>''[http://phil.cdc.gov/phil/home.asp From Public Health Image Library (PHIL).] ''<ref name=PHIL> {{Cite web | title = Public Health Image Library (PHIL) | url = http://phil.cdc.gov/phil/home.asp}}</ref></SMALL></SMALL>
Image: Blastomycosis34.jpeg|Histopathology of blastomycosis of skin. Budding cell of Blastomyces dermatitidis surrounded by neutrophils. <SMALL><SMALL>''[http://phil.cdc.gov/phil/home.asp From Public Health Image Library (PHIL).] ''<ref name=PHIL> {{Cite web | title = Public Health Image Library (PHIL) | url = http://phil.cdc.gov/phil/home.asp}}</ref></SMALL></SMALL>


Image: Blastomycosis30.jpeg|This micrograph shows histopathologic changes that reveal the presence of the fungal agent Blastomyces dermatitidis. <SMALL><SMALL>''[http://phil.cdc.gov/phil/home.asp From Public Health Image Library (PHIL).] ''<ref name=PHIL> {{Cite web | title = Public Health Image Library (PHIL) | url = http://phil.cdc.gov/phil/home.asp}}</ref></SMALL></SMALL>
Image: Blastomycosis35.jpeg|Nodular skin lesions of blastomycosis, one of which is a bullous lesion on top of a nodule. Aspiration of the bulla revealed yeast forms of Blastomyces dermatitidis. <SMALL><SMALL>''[http://phil.cdc.gov/phil/home.asp From Public Health Image Library (PHIL).] ''<ref name=PHIL> {{Cite web | title = Public Health Image Library (PHIL) | url = http://phil.cdc.gov/phil/home.asp}}</ref></SMALL></SMALL>
 
Image: Blastomycosis36.jpeg|Map of eastern United States and Canada showing distribution of reported cases of blastomycosis. <SMALL><SMALL>''[http://phil.cdc.gov/phil/home.asp From Public Health Image Library (PHIL).] ''<ref name=PHIL> {{Cite web | title = Public Health Image Library (PHIL) | url = http://phil.cdc.gov/phil/home.asp}}</ref></SMALL></SMALL>
 
Image: Blastomycosis37.jpeg|Smear from foot lesion of blastomycosis showing Blastomyces dermatitidis yeast cell undergoing broad-base budding. <SMALL><SMALL>''[http://phil.cdc.gov/phil/home.asp From Public Health Image Library (PHIL).] ''<ref name=PHIL> {{Cite web | title = Public Health Image Library (PHIL) | url = http://phil.cdc.gov/phil/home.asp}}</ref></SMALL></SMALL>


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Revision as of 18:56, 11 June 2015

Blastomycosis Microchapters

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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

Once suspected, the diagnosis of blastomycosis can usually be confirmed by demonstration of the characteristic broad based budding organisms in sputum or tissues by KOH prep, cytology, or histology.

Laboratory Findings

Commonly performed tests include:


  • KOH preparation - shows a broad based budding yeast as shown in the microscopic picture above. sputum, blood, pleural and other body fluids may be used, however this process has a low clinical yield.
  • Tissue biopsy of skin or other organs may be required in order to diagnose extra-pulmonary disease. A granulomatous inflammation might be suggestive of fungal presence but is not diagnostic.
  • Commercially available urine antigen testing appears to be quite sensitive in suggesting the diagnosis in cases where the organism is not readily detected. It appears to be more helpful than serum antigen testing.
  • While culture of the organism remains the definitive diagnostic standard, its slow growing nature can lead to delays in treatment of up to several weeks. Culture on dextrose sabourd agar at 37ºC can be used for diagnosis. Highest diagnostic yield is of bronchoscopy derived fluid, followed by sputum. Real time PCR is being experimentally tested for direct diagnosis from culture or tissue. [1]
  • Serological testing is limited in utility by the fact that there is a considerable overlap with other fungal antigens.

However, sometimes blood and sputum cultures may not detect blastomycosis; lung biopsy is another option, and results will be shown promptly.

Microscopy

Gallery

References

  1. Sidamonidze, K.; Peck, MK.; Perez, M.; Baumgardner, D.; Smith, G.; Chaturvedi, V.; Chaturvedi, S. (2012). "Real-time PCR assay for identification of Blastomyces dermatitidis in culture and in tissue". J Clin Microbiol. 50 (5): 1783–6. doi:10.1128/JCM.00310-12. PMID 22403418. Unknown parameter |month= ignored (help)
  2. 2.00 2.01 2.02 2.03 2.04 2.05 2.06 2.07 2.08 2.09 2.10 2.11 2.12 2.13 2.14 2.15 2.16 2.17 2.18 2.19 2.20 2.21 2.22 2.23 2.24 2.25 2.26 2.27 2.28 2.29 2.30 "Public Health Image Library (PHIL)".

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