North american blastomycosis

Question 1

lesions

Answer 1

chronic slowy progressive verrucous granulomatous and are char by thick crusts, warty begtations, discharging sinuses and pustules along advancing edge.
lesions are multiple. loc on exposed skin.
papillomatous proliferation is most pronounced on hands and feet where patches are very thick. patches tend to involute centrally and to form white scars as they spread peripherally. crusts are thick and dirty gray or brown.
on lower extermity, nodules and plaquees.

promary infection is ammost always on rhe upper and middle lobe of the lung. most cases never develop cutaneous dissemination.

Question 2

etio

Answer 2

Blastomyces dermatitidis - North american blasto. soil and animal habitats.

Microscope and KOH should always be made bec culture of fungus is difficult.

DNA probe detectioj assary is available for rapid culture confirmation.

Question 3

epid

Answer 3

southeeastern US and ohio and mississipi river.

male female ratio 6:1

most pxs are ober 60 yo.

often cutaneous for occurs in pxs without a known hx of pulmo infections.

Question 4

rf for acute pulmo dx.

Answer 4

outdoor activity after periods of heavy rain

Question 5

immuno

Answer 5

serologic tests - immunodiffusion or ELISA

Question 6

tx

Answer 6

mild to mod- itraconazole 200 mg 3. a day for 3 days then 2x a day foe 6-12 mos.

Severe- Amphotericin B 1-2 weeks ff by itraconazole 6-12 mos for more severe disease is indicated.