Blastomycosis

Also called North American blastomycosis and Gilchrist's disease, blastomycosis is a fungal infection that usually affects the lungs and produces bronchopneumonia. During the chronic stage of illness, the disease may disseminate through the blood and cause skin disorders (most commonly), osteomyelitis, genitourinary (GU) disorders, and central nervous system (CNS) disorders (rarely). In contrast to other fungal diseases, it seldom acts as an opportunistic infection.

Blastomycosis is found in North America (where Blastomyces dermatitidis normally inhabits the soil). Sporadic cases have been reported in Africa.

Causes

A yeast like fungus, B. dermatitis, causes blastomycosis. The fungus is probably inhaled by people whose work or recreation brings them in close contact with the soil. No occupational link has been found.

Signs and Symptoms

• Cough (the sputum may be brown or bloody)
• Shortness of breath
• Sweating
• Fever
• Rash
• Skin lesions
• Chest pain
• General discomfort, uneasiness, or ill-feeling ( malaise )

Diagnostic tests

Accurate diagnosis of blastomycosis requires the following:

• A culture of B. dermatitis from skin lesions, pus, sputum, or pulmonary secretions.
• Microscopic examination of tissue biopsy from the skin or the lungs or of bronchial washings, sputum, or pus.
• Complement fixation testing (a high titer in extra pulmonary disease suggests a poor prognosis but isn't conclusive).
• Immunodiffusion testing to detect antibodies for the A and B antigen of blastomycosis.
• Suspected pulmonary blastomycosis also requires a chest X-ray, which may show pulmonary infiltrates.

Other abnormal laboratory findings include an increased white blood cell count, an elevated erythrocyte sedimentation rate, slightly increased serum globulin levels, mild normochromic anemia and, with bone lesions, increased alkaline phosphatase levels.

Treatment

Amphotericin B is used to treat all patients with rapidly progressive infections, severe illness, or meningitis. Itraconazole is used to treat patients with mild to moderately severe indolent non-meningeal blastomycosis, and ketoconazole is the alternative treatment.

Alternative treatment

Alternative treatment for fungal infections focuses on creating an internal environment where the fungus cannot survive. This is accomplished by eating a diet low in dairy products, sugars, including honey and fruit juice, and foods like beer that contain yeast. This is complemented by a diet consisting, in large part, of uncooked and unprocessed foods. Supplements of vitamins C, E, A-plus, and B complex may also be useful. Lactobacillus acidophilus and Bifidobacterium will replenish the good bacteria in the intestines. Some anti-fungal herbs, like garlic ( Allium sativum ), can be consumed in relatively large doses and for an extended period of time in order to increase effectiveness. A variety of anti-fungal herbs, such as myrrh ( Commiphora molmol ), tea tree oil ( Melaleuca spp.), citrus seed extract, pau d'arco tea ( Tabebuia impetiginosa ), and garlic may also be applied directly to the infected skin.

Prevention

Avoiding travel to areas where the disorder occurs will prevent exposure, but this is not practical for most people. Although other prevention is unknown, the disorder is rare except in people who are immunosuppressed .