Cutaneous blastomycosis - Clinicals, Diagnosis, and Management

Infectious diseases

Clinicals - History

Fact Explanation
Skin lesion Blastomycosis is a fungal infection caused by Blastomyces dermatitidis. Infection occurs by breathing in the spores that become airborne when contaminated soil or wood is disturbed (Secondary Cutaneous blastomycosis). Very rarely direct contact of non-intact skin with contaminated soil or decomposing timber may occur (Primary Cutaneous blastomycosis). Cutaneous lesions are common on the face, neck and extremities as the infection spreads from the lungs to other parts of the body. Cutaneous manifestation may be solitary or multiple. The lesions often begin as small solid raised lesions that has distinct borders and is less than 1 cm in diameter (papules) or pustules or nodules under the skin. They may be painful. Skin lesion
Blastomycosis is a fungal infection caused by Blastomyces dermatitidis. Infection occurs by breathing in the spores that become airborne when contaminated soil or wood is disturbed (Secondary Cutaneous blastomycosis). Very rarely direct contact of non-intact skin with contaminated soil or decomposing timber may occur (Primary Cutaneous blastomycosis). Cutaneous lesions are common on the face, neck and extremities as the infection spreads from the lungs to other parts of the body. Cutaneous manifestation may be solitary or multiple. The lesions often begin as small solid raised lesions that has distinct borders and is less than 1 cm in diameter (papules) or pustules or nodules under the skin. They may be painful.
Ulcers Within weeks to months the lesions develop into ulcers and form crusty sores with sharp borders. Over a period of months to years lesions grow larger, disfiguring, and may occupy large portion of the body area. These ulcers may bleed easily. Ulcers
Within weeks to months the lesions develop into ulcers and form crusty sores with sharp borders. Over a period of months to years lesions grow larger, disfiguring, and may occupy large portion of the body area. These ulcers may bleed easily.
Scars These ulcers heal to form raised wart-like scars. Lesions may cover much of the face causing severe disfigurement. Irreversible scarring often occurs. Scars
These ulcers heal to form raised wart-like scars. Lesions may cover much of the face causing severe disfigurement. Irreversible scarring often occurs.
At risk population Though Blastomycosis is distributed throughout the world, it is most common in south-central and mid-western USA and Canada. Immunocompromised individuals such as those with human immunodeficiency virus infection (HIV) or organ transplant recipients are at greater risk of severe disease. At risk population
Though Blastomycosis is distributed throughout the world, it is most common in south-central and mid-western USA and Canada. Immunocompromised individuals such as those with human immunodeficiency virus infection (HIV) or organ transplant recipients are at greater risk of severe disease.
Accompanying febrile disease Along with the skin disease, patient may have flu like illness caused by blastomycosis infection which is characterized by fever, chills, headache and non-productive cough. Symptoms may resolve within days without treatment or may go undiagnosed. Accompanying febrile disease
Along with the skin disease, patient may have flu like illness caused by blastomycosis infection which is characterized by fever, chills, headache and non-productive cough. Symptoms may resolve within days without treatment or may go undiagnosed.
Medical history of chronic pulmonary blastamycosis Chronic blastomycosis may simulate lung cancer, or tuberculosis with low-grade fever, weight loss, night sweats, and a productive cough. Sputum is purulent of mucopurulent, hemoptysis may be present. Medical history of chronic pulmonary blastamycosis
Chronic blastomycosis may simulate lung cancer, or tuberculosis with low-grade fever, weight loss, night sweats, and a productive cough. Sputum is purulent of mucopurulent, hemoptysis may be present.
Acute respiratory involvement The cutaneous disease sometimes accompanies with acute illness resembling bacterial pneumonia
which may present with high fever, chills, productive cough and chest pain. Sputum may be yellowish brown.
Acute respiratory involvement
The cutaneous disease sometimes accompanies with acute illness resembling bacterial pneumonia
which may present with high fever, chills, productive cough and chest pain. Sputum may be yellowish brown.

Clinicals - Examination

Fact Explanation
Skin lesion More common on the face, neck, and the extremities. In the early disease course, lesions are sharply demarcated papules or pustules, or sometimes as subcutaneous nodules. Simultaneously or sequentially, multiple lesions may appear . Skin lesion
More common on the face, neck, and the extremities. In the early disease course, lesions are sharply demarcated papules or pustules, or sometimes as subcutaneous nodules. Simultaneously or sequentially, multiple lesions may appear .
Ulcer The primary lesions will evolve into ulcers, within a few weeks to months with indurated dusky or violaceous granulomatous or verrucous borders, It may also evolve into vegetating plaques. Ulcer
The primary lesions will evolve into ulcers, within a few weeks to months with indurated dusky or violaceous granulomatous or verrucous borders, It may also evolve into vegetating plaques.
Lymphadenopathy Sometimes, patient may have regional tender lymph node enlargement along with lymphangitis. Lymphadenopathy
Sometimes, patient may have regional tender lymph node enlargement along with lymphangitis.

Investigations - Diagnosis

Fact Explanation
Skin biopsy Histopathological examination may show epidermal hyperplasia, epidermal microabscesses and abscesses, epidermal necrosis, and dermal infiltration with inflammatory cells. The histopathological examination does not differentiate primary from secondary cutaneous blastomycosis. Skin biopsy
Histopathological examination may show epidermal hyperplasia, epidermal microabscesses and abscesses, epidermal necrosis, and dermal infiltration with inflammatory cells. The histopathological examination does not differentiate primary from secondary cutaneous blastomycosis.

Management - Specific

Fact Explanation
Oral antifungal therapy Various antifungal drugs have been tried in the treatment of cutaneous blastomycosis, and oral triazoles, ketoconazole, fluconazole, and itraconazole, have been found useful. Oral antifungal therapy
Various antifungal drugs have been tried in the treatment of cutaneous blastomycosis, and oral triazoles, ketoconazole, fluconazole, and itraconazole, have been found useful.
Amphotericin B Amphotericin B via intravenous administration is the drug of choice for severe or life-threatening blastomycosis in immunocompromised patients. Amphotericin B
Amphotericin B via intravenous administration is the drug of choice for severe or life-threatening blastomycosis in immunocompromised patients.

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