Blastomycosis in a South Indian patient after visiting an endemic area in USA

Abstract

We describe a case of blastomycosis in a diabetic patient from South India who had visited Milwaukee, Wisconsin, an endemic area for blastomycosis in the USA. After his return to Bangalore, India, the patient developed intermittent fever of moderate to high grade, cough, loss of weight and appetite, and abscesses in the left cubital fossa and thigh regions. Systemic examination at our hospital revealed that he had dullness to percussion over the chest region and decreased breath sounds. Direct examination of Gram-stained smears of the pus from an abscess showed many broad-based budding yeast cells and culture yielded a dimorphic fungus later identified as Blastomyces dermatitidis. Histologic examination of the curettage tissue slides stained with hematoxylin and eosin, periodic acid Schiff's reagent, and Gomori's methenamine silver stain procedures showed many broad-based budding cells characteristic of B. dermatitidis. The patient was successfully treated, initially with amphotericin B, followed by oral itraconazole for a period of 6 months. Blastomycosis cases in India are reviewed and the likely source of infection in this patient is discussed.

Autochthonous Blastomycosis of the Adrenal: First Case Report from Asia

“…In nonendemic areas, systemic mycosis is seen in individuals who visit endemic areas, with the risk of acquisition increasing with immune suppression. 6,7 The asexual form A. dermatitidis exists as a mold in nature. Airborne conidia, when inhaled, gets lodged in the alveoli, where it undergoes transition to yeast form, which is seen in mammalian tissue and culture at 37 C. Wet earth enriched with animal droppings, rotting wood, and decaying vegetables is considered to be the ecological niche for B. dermatitidis.…”

“…2,7 The tissue reaction is characteristically suppurative granulomatous with neutrophilic predominance. However, the nature of fungi is difficult to ascertain only by histology.…”

“…15 The first case of blastomycosis from India was reported in 1983, 15 and since that time, an astounding number of sporadic case reports (31/33) have been published in the literature from India; 70% (24/34) of these cases, however, were misdiagnosed cases of mycosis, where the etiological agent was wrongly identified. 2,7 Of five authentic cases of human infection, two cases were imported, three cases were autochthonous, and none of the cases involved the adrenals. All autochthonous cases have been reported from the states of Rajasthan, Uttar Pradesh, and Madhya Pradesh in northern India.…”

Massive Cerebral Blastomycoma from a Nonendemic Region Diagnosed on Squash Smear Cytology

“…Blastomyces infection, with special reference to CNS involvement, is extremely rare in the Indian subcontinent, and only sporadic cases have been reported. [5][6][7] When no primary focus of infection has been demonstrated, a solitary blastomycoma can be clinically confused with a tumor nodule in the brain. 4 Squash smear cytology can be a useful diagnostic tool in such cases.…”

Pulmonary blastomycosis on autopsy: a rare case report

“…3 In India, autochthonous cases of blastomycosis in humans have been reported mainly from the states of Uttar Pradesh and Madhya Pradesh in northern and central India respectively. 4,5 Most other cases of blastomycosis have been imported cases acquired through travel to endemic areas in U.S.A. 1,6 There is a strong possibility that blastomycocsis is endemic in India but its epidemiology and ecology in India is yet to be studied in detail. Our case report of pulmonary blastomycosis on autopsy of a middle aged man of rural background further strengthens this possibility.…”