BLASTOMYCOSIS

Wisconsin Division of Public Health Disease Surveillance Manual (EpiNet, February 2005)

I. IDENTIFICATION

A. CLINICAL DESCRIPTION: An acute or chronic illness caused by inhalation of spores of the dimorphic fungus Blastomyces dermatitidis that primarily affects the lungs and skin, although the clinical presentation may be variable (Table 1).

Table 1. Types & Clinical Presentation in Blastomycosis Patients.

Types of Disease

Clinical Presentation

Asymptomatic

May occur in about 50% of infections.

Acute Pulmonary

Radiologic presentations include lobar or segmental consolidation that mimics a bacterial pneumonia. Symptoms may be highly non-specific mimicking influenza or acute bacterial infection with abrupt onset of cough, fever, chills, myalgias and arthralgias.

Chronic Pulmonary

Radiologic presentations include lobar infiltrates with or without cavitation, mass mimicking bronchogenic carcinoma, or fibronodular infiltrates. This form cannot be differentiated clinically from any other form of chronic lung disease. Symptoms may be suggestive of chronic TB or histoplasmosis. Symptoms may include cough, weight loss, chest pain, night sweats, low-grade fever, skin lesions and hemoptysis.

Skin Disease

Skin lesions begin as a small papulopustular lesion that increases in size. The central part of the lesion is often encrusted. Lesions usually occur in areas of the body (particularly facial areas) exposed to the sun.

Subcutaneous Nodules

Cold abscesses commonly associated with systemic manifestations. They are frequently associated with extra-pulmonary disease or multiple organ involvement.

Bone & Joint Infection

Seen in 10 to 40% of patients and usually lung disease present. Most commonly affect long bones, ribs and vertebrae. Lesions are usually osteolytic and well delineated.

Genitourinary Tract Infection

Involvement in 10 to 30% of cases and affects the prostate, epididymis, seminal vesicle, testis and kidney. Pain, swelling and tenderness of the scrotum may occur.

Others

Almost any other organ can be involved, including the central nervous system, thyroid, pericardium, adrenal glands and gastrointestinal tract.

B. REPORTING CRITERIA: Clinical diagnosis with laboratory confirmation.

C. LABORATORY CRITERIA FOR CONFIRMATION:

Isolation of B. dermatitidis from any sputum, bronchial washing or skin lesions, OR

Visualization of broad-based budding yeast from an appropriate clinical specimen.

D. WISCONSIN CASE DEFINITION: A clinically compatible illness that is laboratory confirmed.

II. ACTIONS REQUIRED / PREVENTION MEASURES

A. WISCONSIN DISEASE SURVEILLANCE CATEGORY II: Report to the patient's local health officer on an Acute and Communicable Disease Case Report (DPH 4151) or other means within 72 hours of the identification of a case or suspected case.

B. EPIDEMIOLOGY REPORTS REQUESTED:

Acute and Communicable Diseases Case Report (DPH 4151).

Blastomycosis Worksheet

C. PUBLIC HEALTH INTERVENTIONS:

Cluster investigation if more than one case occurs in close geographic area within a short period of time. Consult with the BCDP staff for consultation on cluster investigations.

Educate public about signs and symptoms of blastomycosis and importance of seeking medical evaluation and treatment for illness, especially if they reside in or visit endemic areas in Wisconsin (See map under Section V. Disease Trends).

III. CONTACTS FOR CONSULTATION

A. BCDP / COMMUNICABLE DISEASE EPIDEMIOLOGY SECTION: (608) 267-7321.

B. REGIONAL STAFF: See Epinet Introduction: “REGIONAL OFFICE CONTACTS”.

C. WSLH / MYCOLOGY LABORATORY: (608) 224-6261.

IV. RELATED REFERENCES

1. “Blastomycosis” DPH Disease Fact Sheet Series: View a list of all current Communicable Disease Fact Sheets

2. Heymann DL, ed. BLASTOMYCOSIS. In: Control of Communicable Diseases Manual. 18 th ed. Washington , DC : American Public Health Association, 2004: 67-69.

3. Al-Doory Y and DiSalvo AF (eds). Blastomycosis. Plenum Publishing Corporation, New York , NY , 1992.

V. DISEASE TRENDS

Top Ten Counties of Blastomycosis Infections, 1999-2003
Incidence Rate per 100,000 Population

1. Menominee (11) (47.9/100,000) 6. Sawyer (12) (14.3/100,000)
2. Vilas (41) (37.9/100,000) 7. Oneida (25) (13.3/100,000)
3. Lincoln (39) (26.0/100,000) 8. Washburn (10) (12.1/100,000)
4. Forest (11) (21.7/100,000) 9. Bayfield (9) (11.7/100,000)
5. Iron (5) (14.4/100,000) 10. Oconto (21) (11.3/100,000)

Blastomycosis Worksheet

Table 1. Types & Clinical Presentation in Blastomycosis Patients.
Types of Disease	Clinical Presentation
Asymptomatic	May occur in about 50% of infections.
Acute Pulmonary	Radiologic presentations include lobar or segmental consolidation that mimics a bacterial pneumonia. Symptoms may be highly non-specific mimicking influenza or acute bacterial infection with abrupt onset of cough, fever, chills, myalgias and arthralgias.
Chronic Pulmonary	Radiologic presentations include lobar infiltrates with or without cavitation, mass mimicking bronchogenic carcinoma, or fibronodular infiltrates. This form cannot be differentiated clinically from any other form of chronic lung disease. Symptoms may be suggestive of chronic TB or histoplasmosis. Symptoms may include cough, weight loss, chest pain, night sweats, low-grade fever, skin lesions and hemoptysis.
Skin Disease	Skin lesions begin as a small papulopustular lesion that increases in size. The central part of the lesion is often encrusted. Lesions usually occur in areas of the body (particularly facial areas) exposed to the sun.
Subcutaneous Nodules	Cold abscesses commonly associated with systemic manifestations. They are frequently associated with extra-pulmonary disease or multiple organ involvement.
Bone & Joint Infection	Seen in 10 to 40% of patients and usually lung disease present. Most commonly affect long bones, ribs and vertebrae. Lesions are usually osteolytic and well delineated.
Genitourinary Tract Infection	Involvement in 10 to 30% of cases and affects the prostate, epididymis, seminal vesicle, testis and kidney. Pain, swelling and tenderness of the scrotum may occur.
Others	Almost any other organ can be involved, including the central nervous system, thyroid, pericardium, adrenal glands and gastrointestinal tract.