Cutaneous and Disseminated Blastomycosis: A Pediatric Case Series
ABSTRACT Blastomycosis is a rare fungal infection that most often initially infects the lungs and can progress to disseminated involvement of the skin, bones, and central nervous system (CNS). Pediatric blastomycosis constitutes a small portion of total cases, but delay in diagnosis may result in significant morbidity. Seventeen pediatric cases of blastomycosis were identified at Children's Hospital of Wisconsin from 1999 to 2009 through retrospective chart review; 53% had evidence of dissemination (bone, skin, or CNS) confirmed by culture. Six cases presented with cutaneous lesions, and five of these were found to have other systemic involvement. These five nonimmunosuppressed cases of primary pulmonary disease with cutaneous involvement plus dissemination to bone or the CNS are reported in detail. The diagnosis of blastomycosis in children is often delayed, and dissemination by the time of diagnosis may be more common than in adults. Cutaneous dissemination may occur in immunocompetent children, may indicate underlying systemic involvement, and can be more readily identified than symptoms of bony or neurologic involvement. These reported cases indicate the importance of dermatologists recognizing and investigating all potentially involved organ systems when a patient presents with characteristic skin lesions with or without a history of respiratory illness.
Article: Blastomycosis in children.[Show abstract] [Hide abstract]
ABSTRACT: Children acquire blastomycosis, with rare exceptions, through the respiratory route. Nearly half of those who are infected may be asymptomatic. Cough is the most common symptom and is usually without sputum production, and hemoptysis is not noted. Other symptoms are chest pain (described as tightness or pain when breathing), weight loss, night sweats, and loss of appetite. The severity of illness is variable and may simulate an upper respiratory infection, bronchitis, pleuritis, or pneumonia. As in adults, an overwhelming infection may cause respiratory failure even in immunocompetent children and in immunocompromised children who live in or travel to endemic areas are susceptible to infection. Some reports based on consecutive cases note extrapulmonary dissemination commonly in children, whereas dissemination is rarely noted in outbreak cases. Chronicity of the disease favors extrapulmonary dissemination. Chest radiograph patterns are alveolar infiltrates, consolidation, and nodule(s), and these may be accompanied by cavitation. Diagnosis is suspected when the symptoms that mimic common respiratory infections persist for more than 2 weeks and by a history of residence or travel to an endemic area. Chest radiographic findings of nodule(s) or cavitation further increase the suspicion. Confirmation of diagnosis is by microscopic examination and culture of sputum. When expectorated sputum is unavailable, bronchoscopy with lavage and biopsy or percutaneous needle biopsy of lung is the appropriate next step. Disease that is progressive or severe or disseminated to other organs should be treated. Amphotericin B is effective and results in excellent cure rates. Experience using oral azoles is limited in children.Seminars in Respiratory Infections 10/1997; 12(3):235-42.
- Wilderness and Environmental Medicine 02/2002; 13(4):250-2. DOI:10.1580/1080-6032(2002)013[0250:AOOBOA]2.0.CO;2 · 0.79 Impact Factor
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ABSTRACT: Chronic disseminated cutaneous blastomycosis is rare in children. We discuss an 11-year-old immunocompetent boy who presented with a history of persistent and multiple skin lesions of >1 year's duration. These lesions proved to be secondary to chronic Blastomyces dermatitidis infection. Complete resolution of clinical disease occurred after a 6-month course of oral itraconazole. We also present a brief review of the literature focusing on the epidemiology, manifestations, diagnosis, and treatment of pediatric blastomycosis.Pediatric Dermatology 11/2006; 23(6):541-5. DOI:10.1111/j.1525-1470.2006.00306.x · 1.52 Impact Factor