Blastomycosis

Definition

Blastomycosis is an infection caused by breathing in the Blastomyces dermatitidis fungus. The fungus is found in wood and soil.

Alternative Names

North American blastomycosis; Gilchrist's disease

Causes

You can get blastomyocosis by contact with moist soil, most commonly where there is rotting wood and leaves. The fungus enters the body through the lungs, where the infection starts. The fungus then spreads to other parts of the body. The disease may affect the skin, bones and joints, and other areas.

Blastomycosis is rare. It is found in the central and southeastern United States, and in Canada, India, Israel, Saudi Arabia, and Africa.

The key risk factor for the disease is contact with infected soil. It most often affects people with weakened immune systems, such as those with HIV or who have had an organ transplant. Men are more likely to be affected than women.

Symptoms

You may not have any symptoms if the infection remains in the lungs. The following symptoms can develop if the infection spreads to other parts of the body:

Lung infection may not cause any symptoms. Symptoms may be seen if the infection spreads. Symptoms may include:

• Bone and joint pain
• Chest pain
• Cough (may produce brown or bloody mucus)
• Fatigue
• Fever and night sweats
• General discomfort, uneasiness, or ill feeling (malaise)
• Muscle pain
• Unintentional weight loss

Most people develop skin symptoms when infection spreads. You may get papules, pustules, or nodules on exposed body areas.

The pustules:

• May look like warts or ulcers
• Are usually painless
• Vary in color from gray to violet
• May appear in the nose and mouth
• Bleed easily and form ulcers

Over time, these skin lesions can lead to scarring and loss of skin color (pigment).

Exams and Tests

• Chest CT scan
• Chest x-ray
• Skin biopsy
• Sputum culture and examination
• Tissue biopsy
• Urine culture

Treatment

You may not need to take medicine for a mild blastomycosis infection that stays in the lungs. Your doctor recommend the following ant-fungal medicines when the disease is severe or spreads outside of the lungs.

• Fluconazole
• Itraconazole
• Ketoconazole

Amphotericin B may be used for severe infections.

Follow-up regularly with your doctor to make sure the infection doesn't return.

Outlook (Prognosis)

People with minor skin sores (lesions) and relatively mild lung infections usually recover completely. The infection can lead to death if not treated.

Possible Complications

• Large sores with pus (abscesses)
• Return of the infection (relapse or disease recurrence)
• Side effects from drugs such as amphotericin B

When to Contact a Medical Professional

Call your health care provider if you have symptoms of blastomycosis.

Prevention

Avoiding travel to areas where the infection is known to occur may help prevent exposure to the fungus, but this may not always be possible.

References

Kauffman CA. Blastomycosis. In: Goldman L, Schafer AI, eds. Cecil Medicine. 24th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 342.

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