Blastomycosis (also known as "North American blastomycosis," "Blastomycetic dermatitis," and "Gilchrist's disease"[2]) is a fungal infection caused by the

organism Blastomyces dermatitidis. Endemic to portions of North America, blastomycosis causes clinical symptoms similar tohistoplasmosis.[3] Contents [hide]

1 Cause 2 Pathogenesis 3 Signs and symptoms 4 Diagnosis 5 Treatment 6 Prognosis 7 Epidemiology 8 History 9 Additional images 10 See also 11 References 12 External links

Cause[edit] B. dermatitidis is asexual form of Ajellomyces dermatitidis. (These can be differentiated on basis of presence or absence of "A Antigen", B. dermatitidis being positive for it.) It is a dimorphic fungus. Pathogenesis[edit]

Blastomyces dermatitidis from a lesion in dog.

Inhaled conidia of B. dermatitidis are phagocytosed by neutrophils and macrophages in alveoli. Some of these escape phagocytosis and transform into yeast phase rapidly. Having thick walls, these are resistant to phagocytosis and express glycoprotein BAD-1, which is a virulence factor as well as an epitope. In lung tissue, they multiply and may disseminate through blood and lymphatics to other organs, including the skin, bone, genitourinary tract, and brain. The incubation period is 30 to 100 days, although infection can be asymptomatic. Signs and symptoms[edit] Blastomycosis can present in one of the following ways:

a flu-like illness with fever, chills, arthralgia (joint pain), myalgia (muscle pain), headache, and a nonproductive cough which resolves within days. an acute illness resembling bacterial pneumonia, with symptoms of high fever, chills, a productive cough, and pleuritic chest pain. a chronic illness that mimics tuberculosis or lung cancer, with symptoms of low-grade fever, a productive cough, night sweats, and weight loss. a fast, progressive, and severe disease that manifests as ARDS, with fever, shortness of breath, tachypnea, hypoxemia, and diffuse pulmonary infiltrates. skin lesions, usually asymptomatic, can be verrucous (wart-like) or ulcerated with small pustules at the margins. bone lytic lesions can cause bone or joint pain. prostatitis may be asymptomatic or may cause pain on urinating. laryngeal involvement causes hoarseness. 40% immunocompromised individuals have CNS involvement and present as brain abscess, epidural abscess or meningitis.