Blastomycosis is an infectious disease. Affected individuals become infected with the pathogen Blastomyces dermatitidis during blastomycosis. Blastomycosis occurs in clusters in certain regions of the world. For example, blastomycosis occurs in the southern and eastern United States and the Mississippi basin. Increased cases of blastomycosis have also been reported in Africa and Central America.
What is blastomycosis?
Blastomycosis represents an infectious disease resulting from infection with a specific pathogen. Basically, medicine divides blastomycosis into three different forms, depending mainly on the area of its spread. Thus, there is a North American blastomycosis, a European blastomycosis and a South American blastomycosis. European blastomycosis is also known as cryptococcosis or Cryptococcus mycosis. The causative agent of European blastomycosis is found in a pathogen called Cryptococcus neoformans and Cryptococcus bacillisporus, respectively. North American blastomycosis develops in patients as a result of infection with Blastomyces dermatitidis. This form of blastomycosis manifests as inflammation of the bronchi at the onset of the disease. In addition, North American blastomycosis affects the skin and lungs of affected individuals. North American blastomycosis usually causes patients to lose a lot of weight and become emaciated. This form of blastomycosis is concentrated in North America and is also known as blastomycosis.
is also known as Gilchrist’s disease or Gilchrist’s disease. In South American blastomycosis, the causative agent is found in a fungus called Paracoccidioides brasiliensis. This form of blastomycosis is associated with a variety of changes on the skin. Ulcers develop in certain areas of the skin. The tumors also form preferentially in the area of the lymph nodes as well as on the mucous membrane. South American blastomycosis is concentrated in rural regions of Latin America. South American blastomycosis is particularly common in Brazil. This is because the fungus benefits from the mild air temperatures and high moisture content in the air. In the majority of cases, South American blastomycosis affects males who have already passed the third decade of life. Less frequently, blastomycosis occurs in females or children. South American blastomycosis leads to death of affected patients in up to 25 percent of cases.
Causes
The causes of blastomycosis have been comparatively well studied, so physicians largely understand the mechanisms of pathogenesis. The trigger of blastomycosis is found in specific pathogens, usually fungal species. Blastomyces dermatitidis, for example, is a filamentous fungus that lives in the soil. The fungus is transmitted to humans either through the air or through contact with the skin. Once the fungus enters the human organism, it multiplies in the lung area in the form of yeast.
Symptoms, complaints and signs
When blastomycosis affects the lungs, it usually manifests itself in rather nonspecific symptoms. Patients suffer from pulmonary blastomycosis mainly symptoms similar to those of influenza. In some cases, however, the signs of blastomycosis extend to tuberculosis-like symptoms. In addition, dissemination occurs, developing particularly in the bones. This sometimes results in fistulas in the skin. Cutaneous expression of blastomycosis is formed in some cases by direct inoculation of the pathogen Blastomyces dermatitidis. On the other hand, it is possible that the pathogen spreads from the lungs to other parts of the body. In this case, blastomycosis often manifests itself in small nodules resembling granuloma. As blastomycosis progresses, ulcerations sometimes develop in these nodules, resulting in scarring.
Diagnosis
The diagnosis of blastomycosis should be made by a specialist and also depends on the form of the disease. Thus, in cutaneous blastomycosis, consultation with a dermatologist is recommended. During the anamnesis the doctor tries to find out if there was a possible contact with the pathogens in the recent past.If the patient has recently visited a corresponding risk area of blastomycosis, this also serves as an important clue. The diagnosis of blastomycosis is based primarily on histological examinations of tissue samples. On the one hand, it is possible to take samples of the pus from diseased skin sites and examine them under a microscope. Analysis of the sputum is also possible. In addition, a bronchial lavage is sometimes used to diagnose blastomycosis. In deceased individuals, a biopsy may be considered to establish blastomycosis as the cause of death.
Complications
Fungal diseases such as blastomycosis often present critical complications in critically ill patients. Those with a weakened immune status are particularly at risk. In addition to long-term therapy with corticosteroids, cytostatic treatments and immunosuppression after organ transplantation are among the greatest risk factors for affected individuals from Western industrialized countries. Diseases such as leukemia, malignant lymphoma or AIDS also favor the occurrence of opportunistic fungal infections. A feared complication of blastomycosis is the systemic spread of the pathogens, which can lead to infestation of the gastrointestinal tract, the skeleton, the CNS, and the prostate and epididymis. Due to the massively weakened immune system, the fungi do not remain in the lungs or skin, but spread throughout the body via the blood and lymph channels. If left untreated, the severe complications show rapid progression and are not infrequently fatal. Thanks to effective antifungal drugs, systemic blastomycosis is curable if diagnosed in time. Possible complications of blastomycosis include pneumonia, acute respiratory distress syndrome (ARDS), herd encephalitis, and pleural effusion. Fever of unknown cause is also possible, as well as granulomatous prostatitis, erythema nodosum, and irritable bowel syndrome.
When should you see a doctor?
Since blastomycosis can multiply relatively quickly throughout the body, a doctor should definitely be consulted when the symptoms and signs of this disease appear. Usually, those affected suffer from the symptoms of a typical flu. However, if these complaints persist for a long period of time and do not disappear even with the help of treatment, a doctor should definitely be consulted. Likewise, the formation of fistulas on the skin may be indicative of blastomycosis, so that the skin should be examined. It is not uncommon for patients to suffer from respiratory problems due to blastomycosis. Nodules may form on the skin and continue to change color. If these symptoms occur, a doctor must be consulted immediately. If treatment is not received, the affected person usually dies as a result of blastomycosis. In acute and urgent emergencies, the hospital should be visited directly. To diagnose the disease, a dermatologist or a general practitioner can be consulted. With successful treatment, there is no reduction in the life expectancy of the patient.
Treatment and therapy
Prompt treatment of blastomycosis is very important in any case, as the disease is often fatal without therapy. Patients usually receive drug treatment with the agents amphotericin B or itraconazole. Continuous medical monitoring of the progress of therapy is essential in blastomycosis and improves the likelihood of survival for those with the disease.
Outlook and prognosis
The outlook for cure of blastomycosis depends on the general health of the patient as well as the timing of seeking medical care. Without medical treatment, symptoms steadily increase. Health deteriorates, the patient becomes progressively weaker, and eventually the affected person reaches a critical condition. Due to the progressive course of the disease, the patient is very likely to die. The later medical care is sought, the lower the chance of recovery. People with a weakened immune system and various pre-existing conditions also meet very unfavorable conditions for recovery. In many cases, the body’s own defenses as well as existing resources are no longer sufficient to successfully confront the pathogens in the organism.A good prognosis can be given to people who undergo medical treatment as soon as possible and who have sufficient physical fitness and a stable and healthy immune system. If the instructions of the treating physician are followed, freedom from symptoms can be achieved within a few weeks and the patient is discharged from treatment as cured. In addition to drug therapy, a healthy and balanced diet helps to shorten the healing process. If blastomycosis occurs again, treatment should be initiated as soon as possible to increase the chances of survival.
Prevention
Prevention of blastomycosis is possible to some extent by patients being especially vigilant in known risk areas and avoiding contact with soil whenever possible. However, reliable prevention is not possible in this way.
Follow-up
In blastomycosis, follow-up care focuses primarily on examining the patient’s organism at regular intervals for residues of the pathogen. The patient should avail himself or herself of regular checkups. The physician may initiate further measures depending on whether the fungal infection has been completely overcome or whether pathogens are still present in the body. Depending on the type of blastomycosis, further blood tests may also need to be performed as part of the follow-up. This can ensure that the pathogen has left the organism. Since blastomycosis can be fatal, there is always a burden for the patient. Therefore, treatment of the physical symptoms should be accompanied by therapy or counseling with a psychologist. If the course is positive, two to three follow-up visits are sufficient. If complications or late effects become apparent, the therapy must be continued. Accordingly, follow-up can last several months or even years, since blastomycosis can recur again and again. If not already done, determining the cause of the fungal infection may also be part of the follow-up. In any case, the patient should discuss further measures after therapy with the responsible physician.
What you can do yourself
Blastomycosis represents an extremely serious infectious disease and requires immediate medical therapy. Therefore, in order to increase their own probability of survival, patients with the disease should contact a physician as soon as possible after noticing the first signs of the disease. This is almost the only possibility of self-help for persons with blastomycosis, since doctors and nursing staff then take over the care of the patient. The ill person usually goes to a clinic and receives intensive medical treatment and monitoring. If left untreated, there is an enormous chance of dying from blastomycosis, and this risk persists even with adequate therapy. The patient adheres to prescribed bed rest and refrains from unnecessary physical activities. The patient takes the prescribed medication at the specified times and reports any side effects to the clinic staff. Under no circumstances should the patient become infected with additional pathogens during blastomycosis, as this places additional stress on the immune system and reduces the likelihood of survival. Therefore, quarantine treatment makes sense and must be followed by the patient. The patient takes only the meals prescribed by the medical staff in the hospital and, if necessary, receives artificial nutrition through intravenous infusions if the state of weakness due to blastomycosis is too severe.
