Fatal blastomycosis after exogenous immunosuppression in a healthy gardener

Lu, Jessica; Thuraisingam, Thusanth; Chergui, May; Wang, Béatrice; Yansouni, Cédric P.

doi:10.1016/j.jdcr.2018.08.019

Cited by 3 publications

(2 citation statements)

References 7 publications

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“…[55][56][57] In a few cases, blastomycosis-associated ARDS appears to have been precipitated by the use of corticosteroids. [58][59][60][61] The case-fatality rate for blastomycosisassociated ARDS has been reported to be 40 to 89% in various series. [55][56][57]59,62…”

Section: Clinical Manifestations Pulmonary Blastomycosismentioning

confidence: 99%

“…An increasing number of institutions have reported experience in using extracorporeal membrane oxygenation (ECMO) for severe blastomycosis-associated ARDS. 58,60,61,[108][109][110][111][112][113][114] Good outcomes have been reported in many cases 58,61,115 ; however, the fact that most published experience is from individual case reports or small case series warrants interpreting these results with caution because of the potential for reporting bias. One case report suggested that liposomal amphotericin B became sequestered in and occluded the ECMO circuit, 116 but other published reports have not noted this complication.…”

Section: Difficult-to-treat Complications Of Blastomycosismentioning

confidence: 99%

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Blastomycosis

Schwartz

Kauffman

2020

Semin Respir Crit Care Med

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Blastomycosis is a serious fungal disease of humans and other mammals caused by environmentally acquired infection with geographically restricted, thermally dimorphic fungi belonging to the genus Blastomyces. The genetic and geographic diversity of these pathogens is greater than previously appreciated. In addition to Blastomyces dermatitidis and the cryptic species Blastomyces gilchristii, which cause blastomycosis in mid-western and various eastern areas of North America, atypical blastomycosis is occasionally caused by Blastomyces helicus in western parts of North America and Blastomyces percursus in Africa. Blastomycosis is acquired by inhalation of the conidia that are produced in the mold phase; in the lungs, temperature-dependent transformation occurs to the yeast phase. In this form, the organism is phagocytized by macrophages and can spread hematogenously to various organs causing disseminated infection. Pulmonary disease is most common and varies from mild, self-limited infection to severe, potentially fatal adult respiratory distress syndrome. Disseminated infection is manifested primarily by skin lesions, but many other organs can be involved. Diagnosis is established by growth of the organism in culture; however, a tentative diagnosis can be made quickly by histopathological identification of the classic yeast form in tissues or by finding Blastomyces antigen in urine or serum. Blastomycosis is treated initially with amphotericin B when the disease is severe, involves the central nervous system, or the host is immunosuppressed. Itraconazole is recommended for primary therapy in mild-to-moderate infection and for step-down therapy after initial amphotericin B treatment. Voriconazole and posaconazole can be used for patients in whom itraconazole is not tolerated.

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