Blastomycosis - A disease from the group of systemic fungal infections, proceeding with a primary lesion of the lungs and hematogenous dissemination of fungal infection in the internal organs, bones and skin. Blastomycosis can occur in different forms: lung (pneumonia), skin (rash, skin ulcers, subcutaneous abscesses), bone (osteomyelitis, arthritis), urogenital (prostatitis, epididymitis), etc. The diagnosis of blastomycosis is confirmed by isolating the causative agent - the fungus Blastomyces dermatitidis at. microscopy, culture, biopsy. Therapy is conducted blastomycosis antifungals (itraconazole, amphotericin B); It can be shown to drain abscesses and sanitation.
fungal disease characterized by the development of lesions polysystemic granulomatous purulent processes in the lungs, skin, skeletal, urogenital tract. Blastomycosis is distributed in the US and Canada; in the form of sporadic cases occur in Latin America, Africa, Europe, Australia, and India. During epidemic outbreaks blastomycosis are more prone to children and young people up to 20 years. Questions treatment and prevention of blastomycosis are located at the junction of different clinical disciplines: Mycology, pulmonology, dermatology, urology, etc.
diabetes, tuberculosis, blood diseases, immunodeficiency states (eg, HIV infection). To be at risk for the incidence of blastomycosis include gardeners, farm workers and other people who frequently come into contact with soil containing Blastomyces spores, as well as persons living in endemic areas.
bronchopneumonia. The incubation period takes an average of 30-45 days. Onset of the disease acute or subacute; in the initial period of intoxication syndrome prevails: low-grade febrile, or fever, chills, muscle and joint pain. Less blastomycosis from the outset developed as a primary chronic, without the expressed clinical symptoms. Worried cough (at first dry, then with purulent sputum), hemoptysis, chest pain, shortness of breath. An objective study auscultated wheezing, pleural rub; radiographically detected verhnedolevye infiltrates, sometimes - the cavern. For others, patients with pulmonary blastomycosis free from infection.
Among extrapulmonary lesions most common cutaneous blastomycosis (40-80% of cases). Cutaneous blastomycosis occurs with vesicles-papular or papular-pustular eruptions, which are transformed into ulcerous defects covered with abundant granulation. Drainage of the sites of ulceration is bloody or purulent. Ulcers can be distributed to the mucous membrane of the oral cavity, pharynx and larynx. ulcer healing occurs with the formation of a thin soft scar. Perhaps the formation of subcutaneous abscesses.
The share of the bone has to form 25-50% of cases of extrapulmonary blastomycosis. It flows mainly in the form of osteomyelitis of the long bones, spine, ribs. The affected area is often formed surrounding soft tissue abscesses, fistulous passages, arthritis joints nearby.
Genitourinary form of blastomycosis (10-30% of cases) more frequently diagnosed in men. The clinical picture is consistent with orchitis, epididymitis, prostatitis; there may be a hematuria and pyuria. Infection of urogenital women blastomycosis are sexually transmitted and occurs rarely. When disseminated blastomycosis can affect the internal organs with the development of liver abscesses, pericarditis, adrenal insufficiency, and so forth. When the involvement of the central nervous system occur cerebral abscesses, meningitis.
pulmonologist, dermatologist, urologist, etc.), should be involved in infectious disease and mycologists.
blastomycosis diagnosis is confirmed by detection of B. dermatitidi in biological material: sputum, purulent fistulas and abscesses, urine, cerebrospinal fluid, biopsy material. Most often used microscopic examination and culturing. For samples of material made puncture abscess and aspiration of their contents, excisional biopsy tissue. Serological diagnosis of blastomycosis performed by ELISA, RSK, RIA. Skin and allergy tests to blastomitsinom have low sensitivity and specificity. With a view to identifying additional changes carried out instrumental research in the internal organs: chest X-ray, bone scan, CT of the brain and spine.
Pulmonary blastomycosis should be differentiated from other chronic lung lesions: bacterial pneumonia, tuberculosis, tumors and lung abscess, empyema, pulmonary forms of aspergillosis, histoplasmosis. When cutaneous pyoderma should be deleted, others ringworm, squamous skin cancer. Genitourinary blastomycosis should be distinguished from bacterial prostatitis and orhiepididimita, prostate cancer, syphilis. Bone blastomycosis requires differential diagnosis of bone tuberculosis and bacterial osteomyelitis.
intravenously. Under indications of antifungal therapy is complemented by surgical methods - drainage of pleural cavity, opening the skin abscesses, etc. necrectomy
Adequate and timely treatment of localized forms of blastomycosis can achieve recovery in 90% of cases. When disseminated forms of treatment in the absence of a high probability of death. To avoid infection, blastomycosis is recommended personal hygiene, respiratory protection when loosening the soil and doing other agricultural work in disadvantaged areas, the use of barrier methods of contraception in casual sex.