Pediatric Blastomycosis Follow-up

  • Author: Russell W Steele, MD; Chief Editor: Russell W Steele, MD   more...
 
Updated: Mar 31, 2011
 

Deterrence/Prevention

  • Although immunocompromised patients (including those with HIV/AIDS) living in or visiting blastomycosis-endemic areas cannot completely avoid exposure to B dermatitidis, they should be counseled about reducing the risk of acquiring blastomycosis by avoidance of occupational and recreational activities known to be associated with increased risk (eg, wooded areas along waterways).
  • Although no specific data are available regarding blastomycosis in children with HIV, administering lifelong suppressive therapy with itraconazole after an acute episode of the disease is reasonable.
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Complications

  • Potential complications include progressive pulmonary disease and extrapulmonary dissemination. Diffuse pulmonary infiltrates complicated by acute respiratory distress syndrome have been reported. Extrapulmonary disease, frequently to the skin, bones, and genitourinary system, can occur in 25-40% of patients with blastomycosis.
  • Extensive cutaneous lesions may undergo central healing with scarring and contracture.
  • In compromised individuals, disseminated blastomycosis is more common.
  • CNS involvement manifesting as either meningitis or mass lesions has been reported to occur in approximately 40% of adult patients with AIDS.
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Prognosis

  • Prognosis is poor for immunocompromised patients with blastomycosis.
  • Mortality rates of 30-40% have been reported in patients with AIDS who develop blastomycosis. Most deaths tend to occur within the first few weeks of therapy.
  • Pulmonary disease complicated by respiratory failure and acute respiratory distress syndrome has a high mortality rate.
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Contributor Information and Disclosures
Author

Russell W Steele, MD  Head, Division of Pediatric Infectious Diseases, Ochsner Children's Health Center; Clinical Professor, Department of Pediatrics, Tulane University School of Medicine

Russell W Steele, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Immunologists, American Pediatric Society, American Society for Microbiology, Infectious Diseases Society of America, Louisiana State Medical Society, Pediatric Infectious Diseases Society, Society for Pediatric Research, and Southern Medical Association

Disclosure: Nothing to disclose.

Coauthor(s)

Avinash Shetty, MD  Department of Pediatrics, Division of Pediatric Infectious Diseases, Assistant Professor of Pediatrics, Wake Forest University School of Medicine

Avinash Shetty, MD is a member of the following medical societies: Ambulatory Pediatric Association, American Academy of Pediatrics, Infectious Diseases Society of America, and Pediatric Infectious Diseases Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Itzhak Brook, MD, MSc  Professor, Department of Pediatrics, Georgetown University School of Medicine

Itzhak Brook, MD, MSc is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians-American Society of Internal Medicine, American Federation for Clinical Research, American Medical Association, American Society for Microbiology, Armed Forces Infectious Diseases Society, Association of Military Surgeons of the US, Infectious Diseases Society of America, International Immunocompromised Host Society, International Society for Infectious Diseases, Medical Society of the District of Columbia, New York Academy of Sciences, Pediatric Infectious Diseases Society, Society for Ear, Nose and Throat Advances in Children, Society for Experimental Biology and Medicine, Society for Pediatric Research, Southern Medical Association, and Surgical Infection Society

Disclosure: Nothing to disclose.

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Mark R Schleiss, MD  American Legion Chair of Pediatrics, Professor of Pediatrics, Division Director, Division of Infectious Diseases and Immunology, Department of Pediatrics, University of Minnesota Medical School

Mark R Schleiss, MD is a member of the following medical societies: American Pediatric Society, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, and Society for Pediatric Research

Disclosure: Nothing to disclose.

Robert W Tolan Jr, MD  Chief, Division of Allergy, Immunology and Infectious Diseases, The Children's Hospital at Saint Peter's University Hospital; Clinical Associate Professor of Pediatrics, Drexel University College of Medicine

Robert W Tolan Jr, MD is a member of the following medical societies: American Academy of Pediatrics, American Medical Association, American Society for Microbiology, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, Phi Beta Kappa, and Physicians for Social Responsibility

Disclosure: GlaxoSmithKline Honoraria Speaking and teaching; MedImmune Honoraria Speaking and teaching; Merck Honoraria Speaking and teaching; Sanofi Pasteur Honoraria Speaking and teaching; Baxter Healthcare Honoraria Speaking and teaching; Novartis Honoraria Speaking and teaching

Chief Editor

Russell W Steele, MD  Head, Division of Pediatric Infectious Diseases, Ochsner Children's Health Center; Clinical Professor, Department of Pediatrics, Tulane University School of Medicine

Russell W Steele, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Immunologists, American Pediatric Society, American Society for Microbiology, Infectious Diseases Society of America, Louisiana State Medical Society, Pediatric Infectious Diseases Society, Society for Pediatric Research, and Southern Medical Association

Disclosure: Nothing to disclose.

References

  1. Pappas PG, Pottage JC, Powderly WG, et al. Blastomycosis in patients with the acquired immunodeficiency syndrome. Ann Intern Med. May 15 1992;116(10):847-53. [Medline].

  2. Meyer KC, McManus EJ, Maki DG. Overwhelming pulmonary blastomycosis associated with the adult respiratory distress syndrome. N Engl J Med. Oct 21 1993;329(17):1231-6. [Medline].

  3. Schutze GE, Hickerson SL, Fortin EM, et al. Blastomycosis in children. Clin Infect Dis. Mar 1996;22(3):496-502. [Medline].

  4. Klein BS, Vergeront JM, Weeks RJ, et al. Isolation of Blastomyces dermatitidis in soil associated with a large outbreak of blastomycosis in Wisconsin. N Engl J Med. Feb 27 1986;314(9):529-34. [Medline].

  5. [Guideline] Chapman SW, Bradsher RW JR, Campbell GD Jr, et al. Practice guidelines for the management of patients with blastomycosis. Infectious Diseases Society of America. Clin Infect Dis. Apr 2000;30(4):679-83. [Medline].

  6. Dismukes WE, Bradsher RW Jr, Cloud GC, et al. Itraconazole therapy for blastomycosis and histoplasmosis. NIAID Mycoses Study Group. Am J Med. Nov 1992;93(5):489-97. [Medline].

  7. Dismukes WE, Cloud G, Bowles C. Treatment of blastomycosis and histoplasmosis with ketoconazole. Results of a prospective randomized clinical trial. National Institute of Allergy and Infectious Diseases Mycoses Study Group. Ann Intern Med. Dec 1985;103(6 ( Pt 1)):861-72. [Medline].

  8. Pappas PG, Bradsher RW, Chapman SW, et al. Treatment of blastomycosis with fluconazole: a pilot study. The National Institute of Allergy and Infectious Diseases Mycoses Study Group. Clin Infect Dis. Feb 1995;20(2):267-71. [Medline].

  9. Ta M, Flowers SA, Rogers PD. The role of voriconazole in the treatment of central nervous system blastomycosis. Ann Pharmacother. Oct 2009;43(10):1696-700. [Medline].

  10. Chapman SW, Lin AC, Hendricks KA, et al. Endemic blastomycosis in Mississippi: epidemiological and clinical studies. Semin Respir Infect. Sep 1997;12(3):219-28. [Medline].

  11. Panicker J, Walsh T, Kamani N. Recurrent central nervous system blastomycosis in an immunocompetent child treated successfully with sequential liposomal amphotericin B and voriconazole. Pediatr Infect Dis J. Apr 2006;25(4):377-9. [Medline].

  12. Pappas PG, Threlkeld MG, Bedsole GD, et al. Blastomycosis in immunocompromised patients. Medicine (Baltimore). Sep 1993;72(5):311-25. [Medline].

  13. Sarosi GA, Hammerman KJ, Tosh FE, Kronenberg RS. Clinical features of acute pulmonary blastomycosis. N Engl J Med. Mar 7 1974;290(10):540-3. [Medline].

  14. Shetty AK, Quinonez JM, Steele RW. Fever, hemoptysis and pneumonia in a twelve-year-old girl. Pediatr Infect Dis J. Sep 1998;17(9):849; 852-3. [Medline].

  15. Steele RW, Abernathy RS. Systemic blastomycosis in children. Pediatr Infect Dis. Jul-Aug 1983;2(4):304-7. [Medline].

  16. Sugar AM, Picard M. Macrophage- and oxidant-mediated inhibition of the ability of live Blastomyces dermatitidis conidia to transform to the pathogenic yeast phase: implications for the pathogenesis of dimorphic fungal infections. J Infect Dis. Feb 1991;163(2):371-5. [Medline].

 
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Cutaneous blastomycosis.
Lateral chest radiograph reveals the ill-defined lingular opacity and an absence of pleural effusions.
 
 
 
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