Blastomycosis in man after kinkajou bite.

We report transmission of Blastomyces dermatitidis fungal infection from a pet kinkajou to a man. When treating a patient with a recalcitrant infection and a history of an animal bite, early and complete animal necropsy and consideration of nonbacterial etiologies are needed.

Northern Wisconsin married couple infected with blastomycosis.

Blastomycosis is an uncommon, chronic, granulomatous disease caused by the dimorphic fungus Blastomycosis dermatitidis. The great majority of infections start with primary pulmonary involvement through inhalation of spores. Hematogenous dissemination to other sites occurs in 25% to 30% of cases. The most common secondary site is the skin, followed in order by bone, genitourinary system, and central venous system. We report 2 cases of blastomycosis originating in a husband and wife who were both symptomatic and diagnosed with blastomycosis within 4 months of each other. One presented with pulmonary symptoms, the other with cutaneous symptoms. These 2 cases of husband and wife are of interest not only because of their rarity but also because of the potential mode of transmission.

Blastomycosis and pregnancy.

Blastomycosis is an exceedingly uncommon complication of pregnancy, rarely encountered by the practicing obstetrician. However, recognizing its presence during pregnancy and expeditiously initiating appropriate therapy is of critical importance to the mother and fetus. Mississippi has the highest prevalence of blastomycosis in North America. Nevertheless, there have been only three pregnancies complicated by this fungal disease at the University of Mississippi Medical Center (Jackson, MS) during two decades. During the same time frame there were another 120 blastomycotic patients treated at the University of Mississippi Medical Center. As a condition of partial immunodepression, a nonobligatory opportunistic fungal disease like blastomycosis can complicate pregnancy. From data on our three patients and 16 other published cases, it seems that fetal risk exceeds maternal risk. There were a total of 20 babies born from mothers with blastomycosis. Only two babies (10%) had transplacental infection and both succumbed to blastomycosis. None of the 18 affected mothers for whom data was available died of the disease. Furthermore, there was never progression in the mothers, with 14 complete cures and considerable postpartum regressions of lesions in the other four women. Even the three women who received no treatment had either noticeable improvement or total regression of the disease after delivery. One of the two stillborns with blastomycosis was born to an untreated mother.

A technique for creating localized subcutaneous Blastomyces granulomas in rats.

Our purpose was to develop a simple, reliable method for creating subcutaneous Blastomyces dermatitidis nodules in rats and to describe the histologic appearance of these lesions. We used B. dermatitidis isolated from a dog with blastomycosis to prepare a Blastomyces yeast suspension. Four rats were used to test initial dose concentrations of 10(5), 10(6), 10(9), and 10(10) yeast organisms. The dose was administered subcutaneously over the distal tibia in a volume of 0.1 ml. We then inoculated 35 additional rats with 10(9) or 10(10) yeast organisms. Rats were euthanized 7, 10, 14, 21, or 28 days after inoculation, and the histologic appearance of the nodules was described. A full post-mortem examination sought evidence of systemic spread of Blastomyces organisms. We successfully induced subcutaneous Blastomyces abscesses in 34 of 37 rats injected with 10(9) or 10(10) organisms. Nodules first appeared 3 to 7 days after injection and reached 2 to 15 mm in diameter by 7 to 28 days after inoculation. Histologically the lesions were characterized by a necrotic center surrounded by a layer of viable yeast and granulomatous inflammation. Live yeast organisms were recovered from all lesions. No adverse effects or systemic spread of Blastomyces organisms were observed. We conclude that subcutaneous Blastomyces abscesses can be induced safely and reliably in rats after injection of 10(9) and 10(10) organisms. Histologically, the experimentally induced lesions share both similarities to and differences with lesions of naturally occurring blastomycosis.

Blastomycosis: more evidence for exposure near one's domicile.

BACKGROUND: Our previous publications on the epidemiology of blastomycosis suggested that the etiologic organism, Blastomyces dermatitidis, may be acquired at home, however this view was challenged in an editorial. METHODS: 1) Field study of 2 properties that preliminarily suggested disease acquisition in the home. Owner interviews, site visits and environmental cultures using our in-vitro technique were used. 2) An address registry of human and dog blastomycosis cases was constructed from extensions of our previously published case series. 3) Literature review. RESULTS: 1) Blastomycosis occurred in a dog (December, 1998) and then a cat confined to its home (September, 1999), from a household in urban Manitowoc County, WI; and additionally in a house-confined cat (July, 1998) at a home in Milwaukee, WI. Interviews implicated the basement and the attic or basement, respectively, as the most likely source of infection at these homes. Environmental cultures were negative for Blastomyces. Of the 229 domiciles in the registry, a minimum of 27 (12%) were associated with more than one blastomycosis case, 10 sites with more than two and 7 with more than three. In 4 domiciles, repeat cases occurred in different families. Most cases were separated by 1 year or more (range: 3 weeks to 7 years). Recent case series reveal a minority of outdoor activities and occupations among humans with blastomycosis. The organism has been isolated from an inhabited yard and from a house being razed. CONCLUSIONS: There appears to be growing evidence that blastomycosis may be acquired at home, and that B. dermatitidis may be relatively persistent on certain properties.

Blastomycosis in children.

Children acquire blastomycosis, with rare exceptions, through the respiratory route. Nearly half of those who are infected may be asymptomatic. Cough is the most common symptom and is usually without sputum production, and hemoptysis is not noted. Other symptoms are chest pain (described as tightness or pain when breathing), weight loss, night sweats, and loss of appetite. The severity of illness is variable and may simulate an upper respiratory infection, bronchitis, pleuritis, or pneumonia. As in adults, an overwhelming infection may cause respiratory failure even in immunocompetent children and in immunocompromised children who live in or travel to endemic areas are susceptible to infection. Some reports based on consecutive cases note extrapulmonary dissemination commonly in children, whereas dissemination is rarely noted in outbreak cases. Chronicity of the disease favors extrapulmonary dissemination. Chest radiograph patterns are alveolar infiltrates, consolidation, and nodule(s), and these may be accompanied by cavitation. Diagnosis is suspected when the symptoms that mimic common respiratory infections persist for more than 2 weeks and by a history of residence or travel to an endemic area. Chest radiographic findings of nodule(s) or cavitation further increase the suspicion. Confirmation of diagnosis is by microscopic examination and culture of sputum. When expectorated sputum is unavailable, bronchoscopy with lavage and biopsy or percutaneous needle biopsy of lung is the appropriate next step. Disease that is progressive or severe or disseminated to other organs should be treated. Amphotericin B is effective and results in excellent cure rates. Experience using oral azoles is limited in children.

Two outbreaks of blastomycosis along rivers in Wisconsin. Isolation of Blastomyces dermatitidis from riverbank soil and evidence of its transmission along waterways.

Blastomycosis cannot yet be prevented or controlled, in part because the natural habitat of the causative fungus, Blastomyces dermatitidis, remains ill defined. In investigating 2 outbreaks of blastomycosis that occurred in the summer of 1985 among persons engaged in activities along rivers in contiguous central Wisconsin counties, we isolated B. dermatitidis from soil at one of the riverbanks. Blastomycosis developed in 7 (58%) of 12 residents and guests who had gathered at a pheasant farm on the Tomorrow River in early May, and in 7 (88%) of 8 boys and 1 adult who had visited a site on the Crystal River in early June. Of the 14 patients, 13 (93%) were symptomatic. Two patients visiting the sites only once became ill 23 and 78 days after exposure, respectively. We traced one outbreak to fishing from the bank of the Tomorrow River, and the other to climbing into an underground timber fort along the Crystal River. A culture of soil and organic debris from the fishing site yielded B. dermatitidis. From these and other outbreaks, and studies of endemic disease, we conclude that riverbanks can be a natural habitat of B. dermatitidis, and that the environment around waterways represents the most important site yet identified for transmission of B. dermatitidis.

Disseminated blastomycosis treated with ketoconazole.

A patient with disseminated blastomycosis gave birth to an infant who died three weeks later of diffuse pulmonary blastomycosis. The infant most likely acquired the disease through intrauterine transmission. The patient's extensive skin lesions responded dramatically to ketoconazole.