Blastomycosis

Blastomycosis remains the most enigmatic of human mycotic infections. The enigmas encompass the natural habitat of the etiologic agent, extent of exposure and subclinical infections in endemic areas, distribution of en demic foci throughout the world, inconsistency of serologic evaluation of infected patients, and varying response of such patients to standard treat ment regimens. In spite of diligent investigations by many competent investigators, we still do not know the ecological niche inhabited by the etiologic agent. We have many tantalizing clues but no definite answers. Nor do we know the extent of the endemic areas in the world for this disease. Skin testing, so useful in defining the distribution of histoplasmosis and coccidioidomycosis, has been of no value in mapping endemic areas for blastomycosis. Even the serologic evaluation of known cases of the disease has been too erratic in results to be useful as a diagnostic or prognostic procedure. The enigmas of blastomycosis go straight to the disease itself. There is an extensive literature on the debate concerning the presence and extent of subclinical infections. Case report series demonstrate that such transient infections do occur but, unlike other mycoses, the extent to which this phe nomenon is common in the general population still cannot be assessed. Even the diagnosis of established disease is a major clinical problem.

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1 Introduction.- 1. History.- 2. The Disease.- 3. The Fungus.- References.- 2 Taxonomy and Biology of Blastomyces Dermatitidis.- 1. Introduction.- 2. Taxonomy.- 3. Morphology.- 4. Ultrastructure.- 5. Genetics and Reproduction.- 6. Physiology.- 7. Dimorphic Phase Transition.- 8. Summary.- References.- 3 Virulence of Blastomyces Dermatitidis.- 1. In Vivo.- 2. In Vitro.- 3. Virulence Factors.- References.- 4 The Ecology of Blastomyces Dermatitidis.- 1. Introduction.- 2. Source in Nature.- 3. Experimental Ecology.- 4. Geographic Distribution.- 5. Conidia as Infectious Particles.- 6. Isolation from Nature.- 7. Summary.- References.- 5 The Epidemiology of Blastomycosis.- 1. Introduction.- 2. Transmission.- 3. Incubation Period.- 4. Skin Testing.- 5. Demographic Aspects.- 6. Outbreaks.- 7. Possible Hosts.- 8. Occupational Mycosis.- 9. Seasonality.- 10. Strain Synonyms.- 11. Summary.- References.- 6 Diagnosis of Blastomycosis.- 1. Specimen Selection.- 2. Specimen Collection.- 3. Direct Microscopic Examination.- 4. Processing and Culturing Clinical Specimens.- 5. Identification.- References.- 7 Immunodiagnosis of Blastomycosis.- 1. Introduction.- 2. Diagnostic Tests.- 3. Summary.- References.- 8 Immunology of Blastomycosis.- 1. Introduction.- 2. Inflammatory Response to B. dermatitidis.- 3. Antigens of B. dermatitidis.- 4. Genetic Factors in Resistance to B. dermatitidis Infection.- 5. Natural Resistance to B. dermatitidis Infection.- 6. Acquired Resistance to B. dermatitidis Infection.- 7. Immunomodulation.- 8. Summary.- References.- 9 Clinical Aspects of Blastomycosis.- 1. Introduction.- 2. Pulmonary Blastomycosis.- 3. Extrapulmonary Infections.- 4. Blastomycosis in Pregnancy.- 5. Combined Fungal Infections.- 6. Blastomycosis in Children.- 7. Compromised Host.- References.- 10Pathologic Features of Blastomycosis.- 1. Clinicopathologic Features.- 2. Gross Pathology.- 3. Morphologic and Tinctorial Features of B. dermatitidis in Tissue Sections.- 4. Microscopic Pathology.- 5. Immunohistologic Diagnosis: Applications and Current Status.- 6. Differential Diagnosis.- References.- 11 Experimental Blastomycosis.- 1. Introduction.- 2. Experimental Infection and Pathogenicity.- 3. Importance of Cellular Immunity in Blastomycosis.- 4. Cell-Mediated Immunoprotection in Blastomycosis (Whole Animal Study).- 5. Immune Monitoring in Blastomycosis.- 6. Thymosin, Lymphotoxin, and Immune Reaction.- 7. B. dermatitidis as a Biologic Response Modulator.- 8. Immunoadjuvant Effects of B. dermatitidis against EL4 Lymphoma.- References.- 12 Prognosis and Therapy of Blastomycosis.- 1. Introduction.- 2. Initiation of Therapy.- 3. Amphotericin B.- 4. Ketoconazole.- 5. Itraconazole.- 6. Other Modes of Therapy.- 7. Summary.- References.- 13 Blastomycosis in Animals.- 1. Introduction.- 2. Epidemiology of Blastomycosis in Animals.- 3. Clinical Aspects of Animal Blastomycosis.- 4. Diagnostic Procedures.- 5. Therapy.- 6. Prognostic Factors.- 7. Public Health Aspects of Animal Blastomycosis.- References.