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Airborne Fungal Diseases
Fungal Infection
Immune Compromised Hosts
Cryptococcus
Candida
Skin Infection with Fungi
Fungal Contamination of Buildings
Fungi in Hospitals
Allergy to Fungi
Fungi in Food
Aspergillus

Blastomycosis
Introductory Article
My Blastomycosis Story
Fatal Brain Infection
Dr G's 2 slide culture
Blastomycosis Images
Blastomycosis Medical Literature
Reflections on an Illness

More About Air and Breathing
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Stephen Gislason MD

Blastomycosis

Blastomyces dermatitidis is a dimorphic fungus found in Canada, the United States and many other countries.

Infection by blastomyces is difficult to recognize even in areas where physicians are aware of this problem. Infection usually begins in the respiratory tract. The illness resembles influenza or pneumonia. Acute blastomycosis is often misdiagnosed as bacterial pneumonia and is treated with antibiotics with no benefit. Lung lesions that resemble tuberculosis or cancer may appear and lead to further misdiagnosis and inappropriate treatment. Lesions in the trachea and larynx are nodular and may be diagnosed as squamous cell carcinoma unless a biopsy is performed and interpreted correctly.

Blastomycosis can spread to any tissue of the body.

In an area, where blastomycosis was known, only 18% of 123 patients at the University of Mississippi Medical Center (Jackson, MS)  were correctly diagnosed at the initial patient evaluation. Pneumonia (40%), malignant tumors (16%) and tuberculosis (14%) were the most common misdiagnoses. The false first impression frequently resulted in unnecessary surgeries or treatment delays, with patients receiving inefficient antibiotic therapy sometimes for months. Sometimes the diagnosis was made in the autopsy room.

Adapted from The US CDC Description of Blastomycosis

Clinical Features Infection presents as a flu-like illness with fever, chest pain, cough, aching, fatigue, weight loss. Some patients fail to recover and develop chronic pulmonary infection or widespread disseminated infection (affecting the skin, bones, and genitourinary tract). Occasionally, the brain becomes infected.

Infection can lead to permanent lung damage with chronic disease. Mortality rate is about 5%.

Transmission  Inhalation of airborne spores after disturbance of contaminated soil.

Risk Groups  Persons in areas with with exposures to wooded, lakes, rivers, beaver dams and construction sites (e.g., farmers, construction and forestry workers, hunters, hikers and campers).

A standard recommendation for quick diagnosis is sputum microscopy -- a simple and inexpensive test that in experienced hands can permit quick diagnosis  patients with a pneumonic presentation. The technique is to place a sample of freshly expectorated sputum on a slide and digest it with drops of potassium hydroxide. Cover it with a cover slip and examine it under a microscope. A standard textbook describes  yeasts, 8-20 micrometers in size, with single, broad-based buds, double refractile walls, and multiple nuclei. I discovered that sputum containing this organisms had white clumps and strings that contained yeast cells. The size variation was much greater than the textbooks describe and that yeast cells transform within hours of cooling and disappear in 24 - 48 hours. Specimens transported to a lab were never properly handled and the diagnosis was never made by inexperienced microscopes.

I diagnosed my own infection by sputum microscopy and developed a novel 2-slide culture method, described in this report.

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