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J Emerg Med 2019 Jan 25. Epub 2019 Jan 25.

Medical College of Wisconsin, Milwaukee, Wisconsin; Children's Hospital of Wisconsin, Milwaukee, Wisconsin.

Background: Blastomycosis is caused by a fungus endemic to states and providences bordering the Lawrence Rivers and the Great Lakes. It can lead to significant pathology in both immunocompetent and immunocompromised hosts. This case report describes disseminated blastomycosis in an otherwise healthy 16-year-old patient. Read More

Expert Rev Respir Med 2019 Mar 31;13(3):263-277. Epub 2019 Jan 31.

a Department of Radiology , Universidade Federal do Rio de Janeiro , Rio de Janeiro , Brazil.

Introduction: Systemic endemic mycoses are prevalent in specific geographical areas of the world and are responsible for high rates of morbidity and mortality in these populations, and in immigrants and travelers returning from endemic regions. The most common fungal infections that can affect the lungs of immunocompetent patients include histoplasmosis, coccidioidomycosis, paracoccidioidomycosis, blastomycosis, sporotrichosis, aspergillosis, and cryptococcosis. Diagnosis and management of these diseases remain challenging, especially in non-endemic areas due to the lack of experience. Read More

Med Mycol 2019 Jan 12. Epub 2019 Jan 12.

MiraVista Diagnostics LLC. Indianapolis, Indiana, USA.

The diagnosis of coccidioidomycosis (CM) in dogs is typically based on clinical presentation, serology, and (less frequently) spherule identification. Agar gel immunodiffusion (AGID) is the most commonly employed serological method, but AGID is slow (requiring up to a week for titer). A Coccidioides antigen enzyme immunoassay (EIA) is also available; however, sensitivity is low in CM dogs. Read More

AJR Am J Roentgenol 2018 Dec 27:1-9. Epub 2018 Dec 27.

4 Department of Pediatrics and Child Health, Section of Pediatric Infectious Diseases, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.

Objective: The objective of our study was to characterize and update the radiologic patterns of pediatric pulmonary blastomycosis, and correlate the radiologic patterns with patient age.

Materials And Methods: Patients 0-18 years old with pulmonary blastomycosis who underwent chest imaging from 2005 to 2016 were included in this study. The following data were collected: age, sex, clinical information, and imaging findings including presence of extrapulmonary involvement and scarring on follow-up examinations. Read More

Cutis 2018 Nov;102(5):363-366

Department of Pediatrics, Division of Infectious Disease, University of Illinois at Chicago, USA.

Primary cutaneous blastomycosis is a rare infection, especially among children. We present the case of a 16-year-old immunocompetent adolescent boy with primary cutaneous blastomycosis arising after falling into a flowerbed in a region where the fungus is hyperendemic. Following treatment with itraconazole 200 mg 3 times daily for 3 days, followed by 200 mg 2 times daily for 6 months, the lesion healed with only residual dyschromia. Read More

Mycoses 2018 Dec 19. Epub 2018 Dec 19.

MiraVista Diagnostics, Indianapolis, Indianapolis, Indiana.

Background/objectives: Antibody detection is commonly used for diagnosis of histoplasmosis, and cross-reactions have been recognised due to endemic mycoses but not cryptococcosis. We observed cross-reactions in an anti-Histoplasma antibody enzyme immunoassay (EIA) in the cerebrospinal fluid (CSF) from a patient with cryptococcal meningitis and sought to assess the risk of cross-reactive anti-Histoplasma antibodies in persons with cryptococcal meningitis.

Methods: An anti-cryptococcal antibody EIA was developed to measure CSF antibody response in HIV-infected subjects from Kampala, Uganda and previously healthy, HIV-negative subjects at the National Institutes of Health (NIH) with cryptococcal meningitis. Read More

Med Mycol 2018 Dec 12. Epub 2018 Dec 12.

Department of Biological Sciences, Idaho State University, Pocatello, Idaho, USA.

Four Blastomyces antigens ERC-2 (B. gilchristii, dog, Wisconsin), B5929 (human, Minnesota), 597 (human, Wisconsin), and T-27 (polar bear, Tennessee) were tested against 31 serum specimens from dogs with blastomycosis and 19 from healthy dogs. All antigens detected antibody; efficacy varied. Read More

Med Mycol 2018 Dec 3. Epub 2018 Dec 3.

Integrated Research and Development Laboratory, Marshfield Clinic Research Institute, Marshfield Clinic Health System, Marshfield, Wisconsin, USA.

Based on epidemiologic data during a blastomycosis outbreak, exposure within the home was suspected for two case patients that resided together. Soil and air samples were collected from the basement of their residence. Samples were tested for Blastomyces by culture and polymerase chain reaction (PCR) to compare with an available clinical isolate. Read More

Lancet Infect Dis 2018 Dec;18(12):1410

Department of Medicine, University of Toledo, Toledo, OH, USA.

JAAD Case Rep 2018 Nov 7;4(10):1007-1009. Epub 2018 Nov 7.

J.D. MacLean Centre for Tropical Diseases, Division of Infectious Diseases and Department of Microbiology, McGill University Health Centre, Quebec, Canada.

G Ital Dermatol Venereol 2018 Nov 9. Epub 2018 Nov 9.

Department of Dermatology, R. D. Gardi Medical College, Ujjain, India -

Osong Public Health Res Perspect 2018 Oct;9(5):255-260

Department of Biomedical Laboratory Science, College of Medical Sciences, Konyang University, Daejeon, Korea.

Objectives: Imported systemic mycoses is a severe fungal infection that can cause diseases in healthy people. However, there is a serious lack of epidemiological data about imported systemic mycoses. Therefore, an epidemiological characterization of imported systemic mycoses in Korea was performed. Read More

J Fungi (Basel) 2018 Oct 30;4(4). Epub 2018 Oct 30.

Department of Clinical Bacteriology and Mycology, The Kimron Veterinary Institute, P.O. Box 12, Bet Dagan 50250, Israel.

This review focuses on aspects of antimycotic therapy specific to veterinary medicine. In the first part, drug availability, limited mostly by economic consideration but also by clinical applicability and specific adverse effects, is described for polyenes, 5 fluorocytosine, azoles, echinocandins and terbinafine. In the second part, current knowledge and experience in the treatment of selected fungal infections are overviewed. Read More

Oxf Med Case Reports 2018 Oct 24;2018(10):omy071. Epub 2018 Sep 24.

Department of Internal Medicine, Advocate Illinois Masonic Medical Center, Chicago, IL, USA.

Blastomycosis is a fungal infection caused by Blastomyces species. This infection is endemic to North America particularly states bordering the Mississippi, Ohio and St Lawrence Rivers, and the Great Lakes but also occurs worldwide. While the most common site of infection is the lung, it can also manifest in the bones, skin and central nervous system. Read More

MMWR Morb Mortal Wkly Rep 2018 Sep 28;67(38):1077-1078. Epub 2018 Sep 28.

Infect Dis Clin North Am 2018 09;32(3):667-685

Division of Infectious Diseases, University of North Carolina, CB 7030, 130 Mason Farm Road, Chapel Hill, NC 27599, USA. Electronic address:

The endemic mycoses are a group of thermally dimorphic fungal pathogens occupying a specific geographic range. In North America, the chief endemic mycoses are histoplasmosis, coccidioidomycosis, and blastomycosis. Endemic fungi can cause serious infections in solid organ transplant recipients from primary infection, reactivation of latent disease, or donor-derived infection. Read More

J Am Acad Dermatol 2018 Aug 10. Epub 2018 Aug 10.

University of Iowa, Department of Dermatology and Pathology, 200 Hawkins Drive, Iowa City, IA 52246. Electronic address:

Angioinvasive fungal infections cause significant morbidity and mortality due to their propensity to invade blood vessel walls, resulting in catastrophic tissue ischemia, infarct, and necrosis. While occasionally seen in immunocompetent hosts, opportunistic fungi are emerging in immunosuppressed hosts, including patients with hematologic malignancy, acquired immunodeficiency syndrome (AIDS), organ transplant, and poorly controlled diabetes mellitus. The widespread use of antifungal prophylaxis has led to an "arms race" of emerging fungal resistance patterns. Read More

Med Mycol Case Rep 2018 Sep 25;21:63-65. Epub 2018 May 25.

Marshfield Clinic Research Institute, Marshfield Clinic, Marshfield, WI USA.

Asymptomatic blastomycosis infections are rarely identified or described in the literature, but are believed to comprise 50% of cases. In this report we describe five sporadic cases of blastomycosis in asymptomatic patients. All of these cases were initially identified as incidental findings of lung nodules on CXR or CT. Read More

J Travel Med 2018 Aug;25(1)

Department of Global Health, Boston University School of Public Health, Boston, MA, USA.

Background: International travel has increased in the past few decades, placing more travellers at risk of acquiring systemic endemic mycoses. There are limited published data on systemic endemic mycoses among international travellers. We report epidemiological characteristics of non-migrant, international travellers who acquired systemic endemic mycoses during travel. Read More

J Vet Intern Med 2018 Sep 5;32(5):1684-1691. Epub 2018 Aug 5.

Department of Comparative Biosciences, College of Veterinary Medicine, University of Illinois, Urbana, Illinois.

Background: Hypovitaminosis D is common in humans with tuberculosis, and adequate serum 25-hydroxyvitamin D [25(OH)D] concentrations may improve response to therapy. The pathomechanism of Blastomyces dermatitidis is similar to that of Mycobacterium tuberculosis, but the 25(OH)D status of dogs with blastomycosis has not been investigated.

Objectives: To determine if dogs with blastomycosis have lower 25(OH)D concentrations compared with healthy controls and to explore the prognostic value of 25(OH)D concentrations in blastomycosis. Read More

Med Mycol Case Rep 2018 Sep 1;21:20-22. Epub 2018 Mar 1.

Division of Infectious Diseases, Department of Medicine, University of Toronto, Toronto, Canada M5G2C4.

There are limited data on blastomycosis in solid organ transplant recipients with the subsequent development of the immune reconstitution inflammatory syndrome (IRIS). Herein we describe a case of pulmonary blastomycosis in a renal transplant recipient with the development of concomitant IRIS. Read More

BMC Infect Dis 2018 Jul 18;18(1):336. Epub 2018 Jul 18.

Division of Infectious Diseases, Department of Medicine, Duke Global Health Institute, Duke University Medical Center, 310 Trent Drive, Durham, NC, 27710, USA.

Background: Blastomycosis is an endemic mycosis in North America that is caused by the dimorphic fungus Blastomyces dermatitidis. The illness is a systemic disease with a wide variety of pulmonary and extra-pulmonary manifestations. The initial presentation of blastomycosis may easily be mistaken for other infectious or non-infectious etiologies. Read More

Med Mycol Case Rep 2018 Sep 6;21:1-3. Epub 2018 Mar 6.

Division of Infectious Diseases, Rush University Medical Center, Chicago, IL, USA.

This case report presents a 46-year old man with a failed liver transplant who presented with malaise and dyspnea. Imaging studies revealed diffuse reticulonodular infiltrates and innumerable miliary nodules and a left upper lobe consolidative mass. Examination of bronchoalveolar lavage fluid demonstrated yeast cells with broad-based budding. Read More

Transpl Infect Dis 2018 Oct 20;20(5):e12963. Epub 2018 Jul 20.

Department of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, Illinois.

Background: Although the research is limited, treatment guidelines recommend lifelong suppressive azole therapy for disseminated endemic fungal infection (EFI) after solid organ transplantation (SOT). Suppressive azole therapy may prevent EFI recurrence at the risk of hepatotoxicity and drug interactions. We present real-world safety and effectiveness data of chronic suppressive azole therapy for EFI in SOT recipients over a 10-year period at a single comprehensive transplant center. Read More

N Engl J Med 2018 Jul;379(1):74

John H. Stroger, Jr. Hospital of Cook County, Chicago, IL

Respiration 2018 28;96(3):283-301. Epub 2018 Jun 28.

Division of Clinical Infectious Diseases, Research Center Borstel, Borstel, Germany.

Systemic endemic mycoses cause high rates of morbidity and mortality in certain regions of the world and the real impact on global health is not well understood. Diagnosis and management remain challenging, especially in low-prevalence settings, where disease awareness is lacking. The main challenges include the variability of clinical presentation, the fastidious and slow-growing nature of the fungal pathogens, the paucity of diagnostic tests, and the lack of options and toxicity of antifungal drugs. Read More

J Periodontol 2018 Jun;89 Suppl 1:S74-S84

Division of Periodontology, Niigata University Graduate School of Medical and Dental Sciences, Japan.

Periodontal health is defined by absence of clinically detectable inflammation. There is a biological level of immune surveillance that is consistent with clinical gingival health and homeostasis. Clinical gingival health may be found in a periodontium that is intact, i. Read More

J Clin Periodontol 2018 Jun;45 Suppl 20:S68-S77

Division of Periodontology, Niigata University Graduate School of Medical and Dental Sciences, Japan.

Periodontal health is defined by absence of clinically detectable inflammation. There is a biological level of immune surveillance that is consistent with clinical gingival health and homeostasis. Clinical gingival health may be found in a periodontium that is intact, i. Read More

Med Mycol 2018 Oct;56(7):787-795

Dept of Infectious Disease, Regina Qu'Appelle Health Region, Regina, SK, Canada.

In the literature, cases of blastomycosis in Canada have been documented in provinces bordering the Great Lakes, including Ontario and Quebec, as well as Manitoba. This is the first study to our knowledge reporting cases of mycosis seen in southern Saskatchewan suggesting a broader area of endemicity. We searched the Regina Qu'Appelle Health Region (RQHR) Microbiology Laboratory for all culture-confirmed cases of Blastomyces from January 2000 to December 2015 and identified 15 cases. Read More

Indian J Dermatol Venereol Leprol 2018 ;84(4):523

[This corrects the article DOI: 10.4103/ijdvl.IJDVL_260_17]. Read More

Emerg Infect Dis 2018 07;24(7):1257-1266

Endemic mycoses represent a growing public health challenge in North America. We describe the epidemiology of 1,392 microbiology laboratory-confirmed cases of blastomycosis, histoplasmosis, and coccidioidomycosis in Ontario during 1990-2015. Blastomycosis was the most common infection (1,092 cases; incidence of 0. Read More

Clin Transplant 2018 Jul 19;32(7):e13289. Epub 2018 Jun 19.

Division of Nephrology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.

Invasive fungal infections are a feared complication in kidney transplant recipients (KTRs). Here we present the University of Wisconsin experience with 5 invasive fungal infections-aspergillosis, cryptococcosis, histoplasmosis, blastomycosis, and coccidioidomycosis-in KTRs transplanted between 01/01/1994 and 06/30/2014. During this period, there were 128 cases of fungal infections; aspergillosis was the most common (72), followed by cryptococcosis (29), histoplasmosis (14), blastomycosis (10), and coccidioidomycosis (3). Read More

PLoS Pathog 2018 05 21;14(5):e1007073. Epub 2018 May 21.

Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States of America.

Neutrophils are classically defined as terminally differentiated, short-lived cells; however, neutrophils can be long-lived with phenotypic plasticity. During inflammation, a subset of neutrophils transdifferentiate into a population called neutrophil-DC hybrids (PMN-DCs) having properties of both neutrophils and dendritic cells. While these cells ubiquitously appear during inflammation, the role of PMN-DCs in disease remains poorly understood. Read More

Curr Opin Pediatr 2018 08;30(4):514-519

Department of Paediatrics.

Purpose Of Review: An opportunistic mycosis is a fungal agent of low pathogenicity that specifically infects immunocompromised hosts. Advances in transplantation, preterm care, immunosuppressive therapies and intensive care, have lead to the emergence of pediatric patients with serious immunodeficiency who are vulnerable to nonpathogenic fungi.

Recent Findings: The advent of the use of biologic agents in pediatric disease as well as the advances in care of preterm and immunosuppressed patients opens up a new cohort of patients at risk of opportunistic mycotic infections. Read More

Can Commun Dis Rep 2017 Oct 5;43(10):200-205. Epub 2017 Oct 5.

Northwestern Health Unit, Kenora, ON.

Background: Blastomycosis, caused by the organism is an invasive fungal disease found in Central Canada and Central and Midwestern United States.

Objective: To describe trends in and epidemiology of hospitalized cases of blastomycosis cases reported among northwestern Ontario residents between 2006 and 2015.

Methods: Blastomycosis hospitalization data were extracted from the Discharge Abstract Database (DAD), accessed through IntelliHEALTH Ontario. Read More

Saudi J Ophthalmol 2018 Jan-Mar;32(1):86-89. Epub 2018 Feb 8.

Diagnostic Services of Manitoba, University of Manitoba, Winnipeg, Manitoba, Canada.

species are thermally dimorphic fungi existing as yeast in tissue. We report an initially immunocompetent patient with orbital apex syndrome (OAS) whose presentation suggested giant cell arteritis. Subsequently, metastatic carcinoma was entertained as a cause of OAS until bronchoscopy yielded species. Read More

MBio 2018 04 3;9(2). Epub 2018 Apr 3.

Department of Pediatrics, University of Wisconsin-Madison, Madison, Wisconsin, USA

is a human fungal pathogen of the lung that can lead to disseminated disease in healthy and immunocompromised individuals. Genetic analysis of this fungus is hampered by the relative inefficiency of traditional recombination-based gene-targeting approaches. Here, we demonstrate the feasibility of applying CRISPR/Cas9-mediated gene editing to , including to simultaneously target multiple genes. Read More

J Vet Diagn Invest 2018 Jul 30;30(4):576-579. Epub 2018 Mar 30.

Department of Biomedical and Diagnostic Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, TN.

A 20-y-old female llama ( Lama glama) was euthanized after a history of chronic dyspnea and osteoarthritis. At autopsy, the lungs were covered by clear gelatinous material and expanded by firm, variably discrete, tan-white nodules up to 8 cm diameter containing tan-white, viscous material. The tracheobronchial lymph nodes were firm and enlarged up to 6 × 4 × 3 cm; the thoracic aorta and carotid arteries were lined by hard, tan-white, mineralized intimal plaques. Read More

Cell Host Microbe 2018 04 22;23(4):511-522.e5. Epub 2018 Mar 22.

Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI 53792, USA; Department of Internal Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI 53792, USA; Department of Medical Microbiology and Immunology, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI 53792, USA. Electronic address:

Lung epithelial cells (LECs) are strategically positioned in the airway mucosa to provide barrier defense. LECs also express pattern recognition receptors and a myriad of immune genes, but their role in immunity is often concealed by the activities of "professional" immune cells, particularly in the context of fungal infection. Here, we demonstrate that NF-κB signaling in LECs is essential for immunity against the pulmonary fungal pathogen Blastomyces dermatitidis. Read More

Diagn Cytopathol 2018 Mar 23. Epub 2018 Mar 23.

Department of Laboratory Medicine and Pathology, University of Minnesota Medical School, Minneapolis, Minnesota.

Urinary tract blastomycosis is an uncommon manifestation of disseminated Blastomyces infection. Here, we report a 50-year-old male with common variable immunodeficiency who presented with urinary symptoms and a renal mass concerning for a kidney neoplasm. Urine cytology revealed typical broad-based budding yeasts with thick-walled refractile capsules, leading to diagnosis of urinary tract blastomycosis. Read More

Cureus 2018 Jan 21;10(1):e2095. Epub 2018 Jan 21.

Assistant Clinical Professor of Internal Medicine, West Virginia University School of Medicine.

Blastomycosis is a dimorphic fungus caused by the species of Blastomyces dermatitidisand Blastomyces gilchristii, which are endemic to the Ohio River and Mississippi River Valleys. It is commonly found in soil or decomposing wood. It is capable of infecting both immunocompromised and immunocompetent patients via the respiratory tract by inhaling conidia, where it may remain asymptomatic for a prolonged period of time. Read More

Mil Med 2018 07;183(7-8):e332-e333

Pulmonary and Critical Care Medicine, San Antonio Military Medical Center, 3551 Roger Brooke Drive, Fort Sam Houston, TX.

Introduction: Blastomyces dermatitidis is a dimorphic fungus endemic to the Mississippi River valley. We describe a rare case of chronic pulmonary blastomycosis complicated by large pulmonary cavitation in a young service member who was misdiagnosed with active pulmonary tuberculosis.

Case Presentation: A 25-year-old active duty male presented to his primary care provider with complaints of hemoptysis, fatigue, weight loss, and fever. Read More

Virulence 2018 Aug 1:1-9. Epub 2018 Aug 1.

a Division of Infectious Disease, Department of Medicine , University of Wisconsin School of Medicine and Public Health , 600 Highland Avenue, Madison , WI , USA.

This review article focuses on the mechanisms underlying temperature adaptation and virulence of the etiologic agents of blastomycosis, Blastomyces dermatitidis, Blastomyces gilchristii, and Blastomyces percursus. In response to temperature, Blastomyces undergoes a reversible morphologic switch between hyphae and yeast known as the phase transition. The conversion to yeast for Blastomyces and related thermally dimorphic fungi is essential for virulence. Read More

Transpl Infect Dis 2018 Apr 25;20(2):e12870. Epub 2018 Mar 25.

Division of Infectious Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA.

A 51-year-old woman from Wisconsin with past medical history of kidney transplantation from her sibling 8 weeks prior, presented with symptoms of shortness of breath, cough, and a new skin rash over a 2-week period. Read More

J Cutan Med Surg 2018 Sep/Oct;22(5):519-521. Epub 2018 Feb 28.

3 Wound Care Centre, Women's College Hospital, Toronto, ON, Canada.

Blastomyces dermatitidis is typically contracted through inhalation of the dimorphic conidia, resulting in pulmonary infection as well as extrapulmonary disease through hematogenous spread. Blastomycosis is considered one of the great mimickers in medicine, with verrucous cutaneous blastomycosis resembling skin malignancy and B dermatitidis pulmonary infections often confused with lung cancer. Cutaneous blastomycosis can also often mimic pyoderma gangrenosum and should be considered in the differential diagnosis in any suspected case. Read More

J Drugs Dermatol 2018 Feb;17(2):233-235

Blastomycosis-like pyoderma (BLP) is a rare reactive skin disease that is most commonly caused by bacterial infection. Herein we present a case of BLP arising in lichen planus, a chronic inflammatory disease. We propose Wolf's isotopic response, or the appearance of a new skin disease at the site of an existing and unrelated disease, as the underlying molecular mechanism responsible for this unusual physical presentation. Read More

Eur Heart J Cardiovasc Imaging 2018 04;19(4):473

Aurora Cardiovascular Services, Aurora Sinai/Aurora St. Luke's Medical Centers, University of Wisconsin School of Medicine and Public Health, 2801 West Kinnickinnic River Parkway, Suite 840, Milwaukee, WI, USA.

CMAJ 2017 12;189(49):E1531

Department of Medicine (Dalcin), University of Calgary, Calgary, Alta.; Northern Ontario School of Medicine at Laurentian University (Sandre), Sudbury, Ont.

Curr Probl Pediatr Adolesc Health Care 2018 01 6;48(1):3-25. Epub 2017 Dec 6.

Department of Dermatology, Wright State University, Boonshoft School of Medicine, Dayton, OH.

Cutaneous infections and infestations are common among children and adolescents. Ectoparasitic infestations affect individuals across the globe. Head lice, body lice, scabies, and infestations with bed bugs are seen in individuals who reside in both resource poor areas and in developed countries. Read More

Diagn Microbiol Infect Dis 2018 Feb 31;90(2):102-104. Epub 2017 Oct 31.

Department of Medical Microbiology & Infectious Diseases, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.

Blastomyces dermatitidis is a thermally dimorphic fungus that is capable of causing pulmonary and extra-pulmonary disease, including infections of the central nervous system (CNS). Diagnosis of CNS blastomycosis with non-invasive testing can be difficult, and a surgical biopsy may ultimately be required for microbiological and/or histopathological confirmation. A case of B. Read More