Blastomycosis (Blastomyces): Gilchrist’s disease, Chicago disease - Summary Sheet
• Morphology
• Geography, Reservoir and Mode of Transmission
- Endemic in North America (Ohio & Mississippi river valleys and the Great Lakes region)
- Sporadic cases in Africa and India
- Reservoir includes: moist soil with decaying vegetative matter, decomposed wood
- Mode of transmission: aerogenic, skin inoculation
• Clinical presentation
- Acute pulmonary blastomycosis – resembles community-acquired pneumonia with variable presentation (infiltrates, consolidation +/- cavitation, reticulonodular patterns, small pleural effusions)
- Chronic pulmonary blastomycosis – can mimic presentation of TB, lung cancer, and histoplasmosis. Radiographic pattern often is described as alveolar or fibronodular infiltrations, mainly with an upper lobe distribution. Absence of mediastinal lymph node involvement in blastomycosis can distinguish it from Histoplasmosis.
- Extrapulmonary disease have been described in two-thirds of patients with chronic blastomycosis
• Diagnosis
• Management - Pulmonary disease
- Mild to moderate: Itraconazole 6-12 months
- Moderate to severe: Lipid Amphotericin B for 1-2 weeks followed by → Itraconazole x 6-12 months
by Fatima Al Dhaheri, MD @FatimaAlDee
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