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Using local epidemiology to make a difficult diagnosis: a case of blastomycosis

Published online by Cambridge University Press:  21 May 2015

Edward W. Kesselman ,
Sean Moore  and
John M. Embil
Edward W. Kesselman
Affiliation:
Emergency Department, Seven Oaks General Hospital, Winnipeg, Man.
Sean Moore
Affiliation:
Emergency Department, Lake of the Woods District Hospital, Kenora, Ont.
John M. Embil*
Affiliation:
Section of Infectious Diseases, Department of Medicine, University of Manitoba, Winnipeg, Man.
*
Infection Prevention and Control Unit, Health Sciences Centre, MS 673–820 Sherbrook St., Winnipeg MB R3A 1R9; 204 787-4654, fax 204 787-4699, jembil@hsc.mb.ca

Abstract

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An otherwise well 21-year-old man from Northwestern Ontario presented to our emergency department in Winnipeg, Manitoba, with a 2-month history of cough, progressively increasing dyspnea, hemoptysis and a 15-kg weight loss. His symptoms were worsening despite antibiotic treatment for presumed bacterial pneumonia. His past history included work as a seasonal labourer clearing brush. He was not hypoxic on room air, but his chest radiograph revealed a miliary pattern and bilateral infiltrates. A Mantoux test for tuberculosis was non-reactive, and the sputum gram stain was unremarkable. Empiric therapy was initiated for blastomycosis and the diagnosis was confirmed with a calcofluor stain of the sputum. Although blastomycosis is rare in most regions in North America, there is an unusually high incidence of blastomycosis in Northwestern Ontario. This case highlights the intolerance and utility of knowledge of the local epidemiology in establishing difficult diagnoses of regional importance, such as fungal pneumonias.

Keywords

community acquired pneumoniaBlastomyces dermatitidisblastomycosisfungal pneumonia
Type
Case Report • Observations de cas
Information
Canadian Journal of Emergency Medicine , Volume 7 , Issue 3 , May 2005 , pp. 171 - 173
Copyright
Copyright © Canadian Association of Emergency Physicians 2005

References

1.Dixon, DM, Shadomy, HJ, Shadomy, S. In vitro growth and sporulation of Blastomyces dermatitidis on woody plant material. Mycologia 1977;69:1193–5.Google Scholar
2.Medoff, G, Painter, A, Kobayashi, GS. Mycelial-to-yeast phase transitions of the dimorphic fungi Blastomyces dermatitidis and Paracoccidiodes brasiliensis. J Bacteriol 1997;169:4055–60.CrossRefGoogle Scholar
3.Laskey, W, Sarosi, GA. Endogenous activation in blastomycosis. Ann Intern Med 1978;88:50–2.Google Scholar
4.Saiz, P, Gitelis, S, Virkus, W, Piaseki, P, Bengana, C, Templeton, A. Blastomycosis of long bones. Clin Orthop 2004;421:255–9.CrossRefGoogle Scholar
5.Lemos, LB, Guo, M, Bilaga, M. Blastomycosis: organ involvement and etiologic diagnosis. A review of 123 patients from Mississippi. Ann Diagn Pathol 2000;4:391–406.Google Scholar
6.Dwight, PJ, Naus, M, Sarsfield, P, Limerick, B. An outbreak of human blastomycosis: the epidemiology of blastomycosis in the Kenora catchment region of Ontario, Canada. Can Commun Dis Rep 2000;26:82–91.Google Scholar
7.Medoff, G, Kobayashi, GS. Systemic fungal infections: an overview. Hosp Prac (Off Ed) 1991;26:41–52.Google Scholar
8.Kepron, MW, Schoemperlen, C, Hershfield, ES, Zylac, CJ, Cherniack, RM. North American blastomycosis in Central Canada: a review of 36 Cases. CMAJ 1972;106:243–6.Google Scholar
9.Crampton, TL, Light, RB, Berg, GM, Meyers, MP, Schroeder, GC, Hershfield, ES, et al.Epidemiology and clinical spectrum of blastomycosis diagnosed in Manitoba hospitals. Clin Infect Dis 2002;34:1310–6.Google Scholar
10.Centers for Disease Control. Blastomycosis – Wisconsin, 1986–1995. MMWR Morb Mortal Wkly Rep 1996;45:601–3.Google Scholar
11.Chapman, SW, Lin, AC, Heindricks, KA, Nolan, RL, Currier, MM, Morris, KR, et al.Endemic blastomycosis in Mississippi: epidemiological and clinical studies. Semin Respir Infect 1997;12:219–28.Google ScholarPubMed
12.Chapman, SW. Blastomyces dermatitidis. In: Mandell, GL, Bennet, JE, Dolin, R, editors. Principles and practice of infectious diseases. 5th ed. Philadelphia: Churchill Livingston; 2000. p. 2353–65.Google Scholar
13.Patel, RG, Patel, B, Petrini, MF, Carter, RR 3rd, Griffith, J. Clinical presentation, radiographic findings and diagnostic methods of pulmonary blastomycosis: a review of 100 consecutive cases. South Med J 1999;92:289x–95.Google Scholar
14.Chapman, SW, Bradsher, RW Jr, Campbell, GD Jr, Pappas, PG, Kauffman, CA. Practice guidelines for the management of patients with blastomycosis. Infectious Diseases Society of America. Clin Infect Dis 2000;30:679–83.CrossRefGoogle ScholarPubMed
15.Hannah, EL, Bailey, AM, Hajjeh, R, Gershman, K, Lindsley, M, Hoffman, RE. Public health response to 2 clinical cases of blastomycosis in Colorado residents. Clin Infect Dis 2001;32:e151–3.Google Scholar