South American Blastomycosis Follow-up

  • Author: Julie E Dixon, MD, FAAD; Chief Editor: Dirk M Elston, MD   more...
 
Updated: Jan 24, 2012
 

Further Inpatient Care

  • Patients with severe disease who cannot tolerate oral medications must be admitted to the hospital for intravenous antifungal medication and supportive care.
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Further Outpatient Care

  • During and after treatment with antifungal medications, patients must be regularly evaluated to ensure an adequate response and a lack of relapse.
  • Complement fixation tests can be used to track the response to therapy; antibody levels decrease with improvement. Complement fixation also can be used to detect relapse because antibody levels increase again. The new antibody tests directed against P brasiliensis antigenic glycoproteins may prove useful in monitoring disease activity and response to therapy.
  • Absence of symptoms for 2 years after antifungal therapy is considered by some to indicate a cure. Others believe that mycologically negative results in 3 specimens after the cessation of therapy are considered to indicate a cure.
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Inpatient & Outpatient Medications

  • Antifungal medications, as described in Medication, are indicated.
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Deterrence/Prevention

  • No vaccine against P brasiliensis has been developed, although a peptide vaccine is currently being studied.
  • No known control measures prevent South American blastomycosis.
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Complications

  • Superinfection with bacteria or other fungal pathogens is always a concern because patients often have open wounds and an immune system that is already under stress. Superinfection can significantly complicate recovery or even lead to sepsis and death.
  • The destruction of mucous membranes can lead to perforation of the palate or nasal septum.
  • The destruction of the adrenal glands can cause Addison disease.
  • The severe fibrosis that accompanies healing often results in long-term sequelae. These sequelae occur despite adequate treatment.
    • Facial lesions heal with disfiguring facial scarring.
    • Severe pulmonary fibrosis can occur and lead to chronic dyspnea and even cor pulmonale.
    • Mucous membrane scarring can lead to buccal atresia, dysphonia, laryngeal stenosis, or tracheal stenosis.
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Prognosis

  • With appropriate antifungal therapy, most patients survive.
  • Relapses are common, and patients must be evaluated regularly.
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Contributor Information and Disclosures
Author

Julie E Dixon, MD, FAAD  Private Practice, Ironwood Dermatology, Tucson, Arizona

Julie E Dixon, MD, FAAD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, and American Medical Association

Disclosure: Nothing to disclose.

Coauthor(s)

Norman Levine  MD, Private practice, Tucson, AZ

Norman Levine is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Specialty Editor Board

Franklin Flowers, MD  Chief, Division of Dermatology, Professor, Department of Medicine and Otolaryngology, Affiliate Associate Professor of Pediatrics and Pathology, University of Florida College of Medicine

Franklin Flowers, MD, is a member of the following medical societies: American College of Mohs Micrographic Surgery and Cutaneous Oncology

Disclosure: Nothing to disclose.

David F Butler, MD  Professor of Dermatology, Texas A&M University College of Medicine; Chair, Department of Dermatology, Director, Dermatology Residency Training Program, Scott and White Clinic, Northside Clinic

David F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Association of Military Dermatologists, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Jeffrey J Miller, MD  Associate Professor of Dermatology, Pennsylvania State University College of Medicine; Staff Dermatologist, Pennsylvania State Milton S Hershey Medical Center

Jeffrey J Miller, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, Association of Professors of Dermatology, North American Hair Research Society, and Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Catherine M Quirk, MD  Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania

Catherine M Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD  Director, Ackerman Academy of Dermatopathology, New York

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

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Crusted plaques over the central part of the face in a man with South American blastomycosis. Courtesy of Rolando Vasquez, MD, Professor of Dermatology, Guatemala.
Ulcerated nodule on the tongue in a man with South American blastomycosis. Courtesy of Heidi Logemann, Professor of Mycology, Universidad de San Carlos, Guatemala.
 
 
 
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