blastomycosis

blastomycosis, infection of the lungs with fungal organisms of the genus Blastomyces. Blastomyces occur in the environment, being abundant especially in decomposing organic matter and damp soil. The organisms are endemic to the Ohio and Mississippi river valleys, the Great Lakes region, and the southeastern United States. Infection most typically occurs following disturbance of soil in areas inhabited by Blastomyces; disturbance releases fungal spores into the air, resulting in their inhalation. Most cases of blastomycosis in humans involve Blastomyces dermatitidis. Infection generally is mild, and some persons are asymptomatic. In other instances, however, such as in persons with weakened immune systems, illness can be severe.

Symptoms of blastomycosis include those associated with lung infection, such as cough, fever, weight loss, night sweats, joint pain, chest pain, and fatigue. These symptoms typically appear following the conversion of fungal spores to yeast in the lungs. The inflammatory response that proceeds can result in the formation of granulomatous nodules and, in severe cases, diffuse areas of pus-forming inflammation involving an entire lobe of the lung. Infection may then spread beyond the lungs, the skin being a common extrapulmonary site of infection. Symptoms of cutaneous blastomycosis often include the formation of papules, which develop into crusted vegetative plaques, sometimes marked by ulceration. Osteomyelitis (infection of bone tissue) may also occur, being detected most commonly in the bones of the lower spine and pelvis.

Blastomycosis may be diagnosed through a combination of methods, including blood and urine tests; imaging tests, such as computed tomography and chest X-ray; analyses of sputum; and, in some instances, histopathological examination of tissue collected via biopsy. Treatment includes the use of antifungal agents, such as itraconazole and amphotericin B. See also chromoblastomycosis; cryptococcosis.