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Perfusion 2019 11 26;34(8):660-670. Epub 2019 Apr 26.

Interdepartmental Division of Critical Care Medicine, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada.

Background: Blastomyces is a dimorphic fungus endemic to regions of North America, which can lead to pneumonia and fatal severe acute respiratory diseases syndrome in up to 89% of patients. Extracorporeal life support can provide adequate oxygenation while allowing the lungs to rest and heal, which might be an ideal therapy in this patient group, although long-term clinical and radiological outcomes are not known.

Clinical Features: We report on five consecutive patients admitted to Toronto General Hospital intensive care unit between January 2012 and September 2016, with progressive respiratory failure requiring veno-venous extracorporeal life support within 24-96 hours following mechanical ventilation. Read More

J Emerg Med 2019 Mar 25;56(3):e23-e26. 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 03 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

AJR Am J Roentgenol 2019 04 27;212(4):905-913. 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

Respiration 2018;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 Gen Intern Med 2018 05 30;33(5):774-775. Epub 2018 Jan 30.

Department of Internal Medicine, University of Kentucky, Lexington, KY, 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.

J La State Med Soc 2017 Jul-Aug;169(4):111-113. Epub 2017 Aug 28.

Tulane University Health Sciences Center, Department of Radiology - New Orleans, LA.

45-year-old female presenting initially with fever, nonproductive cough, night sweats, pleuritic chest pain, fatigue and weight loss over the past month. Read More

Int J Infect Dis 2017 Jun 12;59:86-89. Epub 2017 Apr 12.

Department of Respiratory Medicine, Jinhua Center Hospital, Jinhua, China. Electronic address:

The current case report presents a 29-year old man who worked as a hotel guard in a city in China. The patient had fever and dry cough before and after hospitalization. Chest X-ray and CT revealed nodular and patchy lesions in both lower lungs. Read More

Int J Surg Case Rep 2016 8;19:1-3. Epub 2015 Dec 8.

Department of Neurosurgery, University of AR for Medical Sciences, Little Rock, AR 72205,USA. Electronic address:

Introduction: We present a rare case of thoracic vertebral osteomyelitis secondary to pulmonary Blastomyces dermatitides.

Presentation Of Case: A 27-year-old male presented with three months of chest pains and non-productive cough. Examination revealed diminished breath sounds on the right. Read More

Am J Orthop (Belle Mead NJ) 2014 Nov;43(11):E266-71

Norton Leatherman Spine Center, Louisville, KY.

Blastomycosis is a rare fungal infection that primarily produces acute lung infections but may disseminate to multiple sites, including the spine. Once vertebral involvement occurs, an untreated infection may result in vertebral body destruction and paraspinal and epidural abscess formation followed by neurologic injury and loss of structural integrity of the spine. We report the case of a 30-year-old man who had pulmonary blastomycosis (treated with oral itraconazole for 6 months) and presented with a 2-month history of mild thoracolumbar back pain and numbness and tingling in the lower extremities, but no neurologic deficits. Read More

Lung 2013 Dec 17;191(6):655-62. Epub 2013 Sep 17.

Department of Imaging, AC Camargo Cancer Center, Rua Paulo Orozimbo, 726, Aclimação, São Paulo, SP, 01535-001, Brazil,

Objective: The purpose of this study was to evaluate the clinical and radiological features of patients with fungal infection mimicking thoracic malignancy and to establish a diagnostic approach for both clinicians and radiologists to avoid misdiagnosis.

Methods: In this retrospective study, we reviewed clinical and computed tomography (CT) findings from 27 patients who presented with suspicion of thoracic malignancy who were ultimately diagnosed with fungal disease.

Results: Patients' median age was 55. Read More

Rev Pneumol Clin 2012 Feb 16;68(1):45-9. Epub 2011 Jul 16.

Service d'anatomie pathologie, faculté de médecine et de pharmacie, CHU Mohammed VI, université Cadi Ayyad, Marrakech, Maroc.

Blastomycosis is a rare case. We report a first Moroccan case. A 41-year-old male presented with a 6-month history of dyspnea, fever and significant chest pain associated with night sweats and weight loss. Read More

Radiographics 2011 Oct;31(6):1651-68

Department of Radiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, MC 3252, Madison, WI 53792-3252, USA.

A variety of systemic disorders--infections, noninfectious inflammatory diseases, collagen vascular diseases, hereditary diseases, and acquired immune deficiency diseases--may affect both the skin and the lung. The findings in one organ system can help establish the diagnosis or limit the differential diagnosis. Cutaneous manifestations of many conditions (eg, Kaposi sarcoma) precede thoracic manifestations and sometimes have prognostic implications for respiratory disease; in other conditions (eg, organizing pneumonia in polymyositis and dermatomyositis), thoracic manifestations precede cutaneous ones. Read More

Pediatr Infect Dis J 2011 Oct;30(10):915-6

Department of Paediatrics and Child Health and Department of Medical Microbiology, University of Manitoba, Winnipeg, Manitoba, Canada.

ScientificWorldJournal 2008 Nov 2;8:1098-103. Epub 2008 Nov 2.

Pulmonology Department, A.Mami Hospital, Ariana, Tunisia.

Pulmonary blastomycosis is an uncommon pathologic condition that is quite rare in Africa compared to endemic regions of Canada and the upper Midwest of the U.S. We describe a 45-year-old patient who complained of productive cough, hemoptysis, and dorsal rachiodynia. Read More

Int J Dermatol 2007 Dec;46(12):1294-7

Cytology Section, Veterans Affairs Hospital, Hines, and Department of Pathology, Morris Hospital, Morris, IL, USA.

Background: Empyema necessitatis refers to a collection of exudative fluid that extends directly from the pleural cavity to the thoracic wall to form a mass in the extrapleural soft tissue of the chest. It was an uncommon complication of tuberculous pleural effusion even in the pre-antibiotic era, and has also been associated with bacterial lung abscess, actinomycosis, blastomycosis, and malignancies.

Methods: Seven instances of chest wall mass lesion secondary to empyema necessitatis, diagnosed by fine-needle aspiration biopsy (FNAB), are reported. Read More

Semin Roentgenol 2007 Apr;42(2):122-45

Department of Radiology, Medical College of Wisconsin, Milwaukee, WI, USA.

Pulmonary infection is a common reason for imaging of the lung and a common incidental finding in immunocompetent patients. Findings on chest radiography are nonspecific in defining acute infection; however, the radiologist should be aware of classically described patterns of infection, including air space, bronchopneumonia, and interstitial patterns. The radiologist must also be aware of potential limitations of the sensitivity of chest radiography. Read More

Eur J Radiol 2006 Sep 24;59(3):371-83. Epub 2006 May 24.

Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50, Ilwon-Dong, Kangnam-Ku, Seoul 135-710, Republic of Korea.

Histoplasmosis is the most common endemic mycosis in North America, and is followed by coccidioidomycosis and blastomycosis. Although the majority of these infections in immunocompetent persons are self-limited, some patients can develop severe pneumonitis or various forms of chronic pulmonary infection. Cryptococcoci, Aspergillus, Candidas, and Mucorals are ubiquitous organisms, which may affect immunocompromised patients. Read More

J Am Vet Med Assoc 2003 Jan;222(1):27-8

Department of Small Animal Clinical Sciences, Virginia-Maryland Regional College of Veterinary Medicine, Virginia Polytechnic Institute and State University, Blacksburg 24061, USA.

Chest 2001 Oct;120(4):1309-21

School of Electrical and Computer Engineering, Department of Biomedical Engineering, Purdue University, West Lafayette, IN, USA.

Study Objectives: A novel method for acoustic imaging of the human respiratory system is proposed and evaluated.

Design: The proposed imaging system uses simultaneous multisensor recordings of thoracic sounds from the chest wall, and digital, computer-based postprocessing. Computer simulations and recordings from a life-size gelatin model of the human thorax are used to evaluate the system in vitro. Read More

Arch Pathol Lab Med 2000 May;124(5):712-6

Department of Pathology, University of Texas Medical Branch, Galveston, TX 77555-0588, USA.

Background: Intervertebral disk tissue is resistant to hematogenous infection because of its avascularity. However, spondylodiskitis is being diagnosed with increasing frequency because of advancement in magnetic resonance imaging technology. There is a dearth of information regarding the bacteriology, histomorphologic features, and radiopathologic correlation of spondylodiskitis. Read More

J Am Vet Med Assoc 1999 May;214(9):1357-60, 1335

Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Ohio State University, Columbus 43210, USA.

A 5-year-old Quarter Horse mare was examined because of lethargy, fever, and weight loss of 1 month's duration. Thoracic auscultation revealed decreased lung sounds cranioventrally. Thoracic ultrasonography revealed bilateral anechoic areas with hyperechoic strands, consistent with pleural effusion and fibrin tags. Read More

Clin Infect Dis 1998 Feb;26(2):413-8

Department of Medicine, University of Arkansas for Medical Sciences and the Veterans Affairs Medical Center, Little Rock 72205, USA.

Bone is the third most frequent site of disease in patients with blastomycosis, and the vertebrae are among the bones affected most often. We describe the clinical features and treatment of eight patients with vertebral blastomycosis and review the literature regarding this disease. All eight patients had destructive vertebral lesions evident on radiographs, and all had clinical or radiographic evidence of a contiguous abscess. Read More

Pediatr Infect Dis J 1995 Sep;14(9):816-8

Department of Pediatrics, Istanbul University, Istanbul Faculty of Medicine, Turkey.

AJR Am J Roentgenol 1995 Sep;165(3):651-4

Department of Pediatrics and Child Health, Children's Hospital of Winnipeg, Manitoba, Canada.

Objective: The purpose of this study was to identify characteristic radiographic findings in children with pulmonary blastomycosis.

Subjects And Methods: We reviewed the charts and radiographs of 18 children with culture-proven acute pulmonary blastomycosis. The 10 boys and eight girls were from 1 to 16 years old. Read More

Radiographics 1995 Mar;15(2):255-70

Department of Radiology, Walter Reed Army Medical Center, Washington, DC, USA.

The endemic fungi Histoplasma capsulatum, Blastomyces dermatitidis, and Coccidioides immitis are primary human pathogens whose major portal of entry is the respiratory tract. Their clinical manifestations are categorized as acute, chronic or chronic progressive, or disseminated fungal disease. Most acute pulmonary infections are self-limited, and many are asymptomatic. Read More

Scand J Infect Dis 1994 ;26(1):111-5

Division of Infectious Diseases and Immunology, Saint Louis University School of Medicine, Missouri 63104.

A 36-year-old woman with gallbladder disease had an incidental finding of asymptomatic cavitary lung infection with Blastomyces dermatitidis. No treatment was given initially, and 2 months later she presented with vertebral osteomyelitis, paraspinal abscess, and spinal cord compression due to dissemination of the fungus. The patient recovered following surgical debridement and treatment with 1 g of amphotericin B, followed by itraconazole 400 mg QD for 6 months. Read More

Am J Hematol 1993 Jun;43(2):129-32

Department of Medicine, University of Toronto, Toronto-Bayview Regional Cancer Centre, Ontario, Canada.

Patients presenting with Hodgkin's disease (HD) may show lung involvement characterized by contiguous spread from ipsilateral hilar lymph nodes. Lung consolidation or noncontiguous pulmonary involvement makes an alternative diagnosis more likely. This report describes a patient with HD in whom concurrent pulmonary blastomycosis was recognized only after chemotherapy had started and dissemination had occurred. Read More

Arch Ophthalmol 1988 Apr;106(4):527-30

Department of Ophthalmology, Medical College of Wisconsin, Milwaukee.

A 36-year-old man developed blurred vision and a cough five months after traveling to an area from where a large outbreak of acute blastomycosis had been reported. Examination revealed a left choroidal lesion in the macular region, skin lesions on the right calf, and a left lung apical infiltrate. Histopathologic examination of the skin lesion demonstrated a granulomatous inflammation and broad based, budding yeast characteristic of Blastomyces dermatitidis. Read More

J Comput Assist Tomogr 1985 Nov-Dec;9(6):1108-9

Empyema necessitatis is a collection of fluid that has, by direct extension from the pleural cavity, penetrated the thoracic wall to form a mass in the extrapleural soft tissues of the chest wall. This is a rare condition and usually is associated with tuberculous effusion but may be associated with malignancy, blastomycosis, actinomycosis, and may even follow thoracentesis. Read More

J Am Vet Med Assoc 1985 Jan;186(2):166-9

Sixteen cases of clinically and serologically diagnosed canine ehrlichiosis were studied retrospectively. Findings not previously reported included diffuse, pulmonary interstitial radiopacities; weak-positive results for blastomycosis, using agar gel immunodiffusion; normal platelet counts; hemorrhage despite platelet counts greater than 100,000/mm3, and positive results for platelet factor 3 and antinuclear antibody assays. These atypical findings showed that the differential diagnosis of canine ehrlichiosis, blastomycosis, immune-mediated thrombocytopenia, and primary nasal lesions may be confusing, warranting careful assessment. Read More

Chest 1984 Oct;86(4):580-4

To determine the incidence and significance of pleural disease in blastomycosis, we reviewed the chest roentgenograms and medical records of 26 consecutive patients with biopsy- or culture-proved Blastomyces dermatitidis infection. Twenty-three of the 26 (88 percent) had radiographic evidence of blastomycotic pleural disease. Pleural reaction that regressed on therapy was mild (less than 1. Read More

South Med J 1981 Mar;74(3):284-7

In five cases of blastomycosis, invasive procedures were required before the diagnosis was established; these included thoracotomy in two cases and craniotomy in a third case. Radiologic signs in blastomycosis are nonspecific, and the presentations of the disease may be protean and unusual. Certain factors and radiologic appearances should alert the physician and radiologist to the diagnosis. Read More

Radiology 1978 Feb;126(2):351-7

A retrospective analysis of patients with pulmonary blastomycosis was made. Correlation of the mode of clinical presentation with the thoracic radiograph revealed a spectrum of clinical and radiological disease. The results substantiate the absence of specific clinico-radiological patterns, and amplify current concepts of clinical and radiological manifestations. Read More

Thorax 1970 Nov;25(6):708-15

Radiology 1968 Nov;91(5):958 passim

Rev Inst Med Trop Sao Paulo 1968 Jul-Aug;10(4):214-8

South Med J 1966 Dec;59(12):1441-7

Hospital (Rio J) 1966 Jul;70(1):109-34

Dis Chest 1962 Sep;42:336-7

Dia Med 1959 Aug;31(Spec No):42-4