<i>Notes from the Field:</i>Blastomycosis Cases Occurring Outside of Regions with Known Endemicity — New York, 2007–2017

McDonald, Robert; Dufort, Elizabeth; Jackson, Brendan R; Tobin, Ellis; Newman, Alexandra; Benedict, Kaitlin; Blog, Debra

doi:10.15585/mmwr.mm6738a8

Cited by 33 publications

(22 citation statements)

References 6 publications

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“…While blastomycosis is common in several regions of central and eastern North America, it has been identified with increasing frequency outside of traditionally endemic areas, including the Mohawk Valley region and Capital District of upstate New York 4. Serology is not useful in the diagnosis of blastomycosis, reinforcing the need for microbiological and histological evaluation.…”

Section: Discussionmentioning

confidence: 99%

Disseminated blastomycosis presenting as a retro-orbital mass

Murawski¹,

Farrell

Cordeiro-Rudnisky

et al. 2019

BMJ Case Rep

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A 43-year-old man with history of non-Hodgkins’ lymphoma presented with unilateral eye swelling, pain and vision deficits which had been progressive over 2 months. Symptoms followed a presumed bacterial pneumonia 4 months prior. Imaging demonstrated retro-orbital soft tissue swelling with bony erosion concerning for a mass; surgical decompression was performed with histology confirming disseminated Blastomyces dermatitidis. Symptoms responded rapidly to antifungal therapy with amphotericin followed by itraconazole. Orbital dissemination of blastomycosis is extremely rare; accurate diagnosis requires tissue biopsy to facilitate timely targeted therapy and minimise morbidity.

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Section: Discussionmentioning

confidence: 99%

Disseminated blastomycosis presenting as a retro-orbital mass

Murawski¹,

Farrell

Cordeiro-Rudnisky

et al. 2019

BMJ Case Rep

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“…The geographic range appears to be shifting, with examples of new regions at risk including New York state and Quebec in the east and Saskatchewan in the northwest. 22,23 B. dermatitidis seems to have a predilection for moist, acidic, sandy soils, associated with changing water levels and decaying organic matter. 24 Proximity to water sources is an important risk factor for infection in both humans and dogs.…”

Section: Epidemiologymentioning

confidence: 99%

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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“…13,63 In Upstate New York, 20 confirmed cases have been reported since 2016 along the St. Lawrence River, prompting the State to designate B. dermatitidis an emerging pathogen reportable to local health departments. 64 Presumed locally acquired cases of blastomycosis have been reported in North American regions far removed from known areas of endemicity including Colorado, Oregon, Nebraska, and Florida among others. [65][66][67][68] There are no defined endemic regions outside of North America but sporadic cases have been reported in Hawaii, Israel, India, South America, and Africa.…”

Section: Blastomycosis Epidemiologymentioning

confidence: 99%

Endemic Fungi Presenting as Community-Acquired Pneumonia: A Review

Azar

Malo

Hage

2020

Semin Respir Crit Care Med

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AbstractIn endemic areas, dimorphic fungal infections due to Histoplasma capsulatum, Blastomyces dermatitidis, and Coccidioides posadasii/immitis account for up to 30% of cases of community-acquired pneumonia. Because respiratory manifestations are often indistinguishable from common bacterial causes of pneumonia, the diagnosis of pulmonary histoplasmosis, blastomycosis, and coccidioidomycosis is often delayed and associated with antibiotics overuse. In addition to being highly endemic to certain regions of North America, dimorphic fungi have global significance due to established areas of endemicity in all six inhabited continents, an increasingly interconnected world of travelers and transported goods, and a changing epidemiology as a result of global heating and anthropomorphic land utilization. In this review, we discuss the epidemiology, pathogenesis, clinical presentation, diagnostic modalities, and treatment strategies for histoplasmosis, blastomycosis, and coccidioidomycosis.

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Notes from the Field:Blastomycosis Cases Occurring Outside of Regions with Known Endemicity — New York, 2007–2017

Cited by 33 publications

References 6 publications

Disseminated blastomycosis presenting as a retro-orbital mass

Disseminated blastomycosis presenting as a retro-orbital mass

Blastomycosis

Endemic Fungi Presenting as Community-Acquired Pneumonia: A Review

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