08-27-2021-1125 - Blastomycosis

Blastomycosis is a fungal infection caused by inhaling Blastomyces dermatitidis spores.^[4][5] If it involves only the lungs, it is called pulmonary blastomycosis.^[6] Only about half of people with the disease have symptoms, which can include fever, cough, night sweats, muscle pains, weight loss, chest pain, and feeling tired.^[7] These symptoms usually develop between three weeks and three months after breathing in the spores.^[7] In those with weak immune systems, the disease can spread to other areas of the body, including the skin and bones.^[6]

Blastomyces dermatitidis is found in the soil and decaying organic matter like wood or leaves.^[3] Participating in outdoor activities like hunting or camping in wooded areas increases the risk of developing blastomycosis.^[8] There is no vaccine, but the disease can be prevented by not disturbing the soil.^[8] Treatment is with itraconazole for mild or moderate disease and amphotericin B for severe disease.^[3] With both, the duration of treatment is 6–12 months.^[9]Overall, 4-6% of people who develop blastomycosis die; however, if the central nervous system is involved, this rises to 18%. People with AIDS or on medications that suppress the immune system have the highest risk of death at 25-40%.^[10]

Blastomycosis is endemic to the eastern United States, especially the Ohio and Mississippi River valleys, the Great Lakes, and the St. Lawrence River. It is also endemic to some parts of Canada, including Quebec, Ontario, and Manitoba.^[3] In these areas, there are about 1 to 2 cases per 100,000 per year.^[11] Blastomycosis was first described by Thomas Casper Gilchrist in 1894; because of this, it is sometimes called "Gilchrist's disease".^[12] 

Blastomycosis
Other names	North American blastomycosis[1]
Skin lesions of blastomycosis.

https://en.wikipedia.org/wiki/Blastomycosis

• 40% immunocompromised individuals have CNS involvement and present as brain abscess, epidural abscess or meningitis.

Inhaled conidia of B. dermatitidis are phagocytosed by neutrophils and macrophages in alveoli. Some of these escape phagocytosis and transform into yeast phase rapidly. Having thick walls, these are resistant to phagocytosis and express glycoprotein, BAD-1, which is a virulence factor as well as an epitope. In lung tissue, they multiply and may disseminate through blood and lymphatics to other organs, including the skin, bone, genitourinary tract, and brain. The incubation period is 30 to 100 days, although infection can be asymptomatic.^{[citation needed]}

^{Above. Survivor - eye of the tiger}