Blastomycosis was first reported in 1894 by T. C. Gilchrist,[1] who initially postulated that the disease was caused by a protozoan. In collaboration with Stokes, Gilchrist subsequently isolated the organism, established that the disease was caused by a fungus, and, finally, infected a dog with the newly isolated fungus.[2-4]

1.. Gilchrist TC: Protozoan dermatitis. J Cutan Gen Dis1894; 12:496-499.

2.. Gilchrist TC: A case of blastomycetic dermatitis in man. Johns Hopkins Hosp Rep 1896; 1:269-283.

3.. Gilchrist TC, Stokes WR: The presence of an oidium in the tissues of a case of pseudo-lupus vulgaris. Johns Hopkins Hosp Rep 1896; 7:129-133.

4.. Gilchrist TC, Stokes WR: Case of pseudo-lupus vulgaris caused by Blastomyces. J Exp Med 1898; 3:53-78.

Blastomycosis is a rare infection that may develop when people breathe in (inhale) a fungus called Blastomyces dermatitidis, which is found in wood and soil.

North American blastomycosis; Gilchrist's disease

Blastomycosis occurs in people living in the south-central and midwestern United States and Canada. The infection is seen in 1-2 out of every 100,000 people in areas where the fungus most often occurs. It is even less common outside those areas.

Being around infected soil is the key risk factor.

The disease usually affects people with weakened immune systems, such as those with HIV or who have had an organ transplant. Men are more likely to be affected than women.

Lung infection may produce no symptoms, but when the infection spreads, skin or bone sores (lesions) may appear. The bladder, kidney, prostate, and testes may be affected.

Other symptoms may include:

• Chest pain
• Cough (may produce brown or bloody mucus)
• Fatigue
• Fever
• General discomfort, uneasiness, or ill feeling (malaise)
• Joint stiffnessand pain
• Muscle stiffness and pain
• Rash
• Shortness of breath
• Sweating
• Unintentional weight loss

• Chest x-ray
• Skin biopsy
• Sputum cultureand examination under the microscope after applying special stains to sputum
• Tissue biopsy

Medicines may not be needed for a blastomycosis infection that stays in the lungs, unless it becomes severe. When the disease is severe, or when it spreads outside of the lungs, the following medicines (anti-fungals) may be prescribed:

• Fluconazole
• Itraconazole
• Ketoconazole

Amphotericin B may be used for severe infections.

Follow-up regularly with your doctor to make sure the infection doesn't return.

Patients with minor skin sores (lesions) and relatively mild lung infections usually recover completely. If the infection is not treated, it can become severe enough to cause death.

• Large sores with pus (abscesses)
• Return of the infection (relapse or disease recurrence)
• Side effects from drugs such as amphotericin B

Call your health care provider if you have symptoms of blastomycosis.

Avoiding travel to areas where the infection is known to occur may help prevent exposure to the fungus, but this may not always be possible.

Chapman SW. Plastomyces dermatitidis. In: Mandell GL, Bennett JE, Dolin R, eds. Principles and Practice of Infectious Diseases. 6th ed. Philadelphia, Pa: Elsevier Churchill Livingstone; 2005: chap 263.

A skin lesion of blastomycosis is a symptom of an infection with the fungus Blastomyces dermatitidis. The skin becomes infected as the fungus spreads throughout the body.

Blastomycosis is a rare fungal infection. It is most common in the central and southeastern United States, and in Canada, India, Israel, Saudi Arabia, and Africa. A person gets infected by inhaling fungal particles that are found in moist soil, particularly where there is rotting vegetation. People with immune system disorders are at highest risk for this infection.

The fungus enters the body through the lungs, infecting them. The fungus then spreads (disseminates) to other areas of the body. The infection may affect the skin, bones and joints, genitourinary tract, and other systems.

Skin symptoms occur in about 80% of people infected with blastomycosis. It is a sign of widespread (disseminated) infection. Skin lesions may look like warts or like ulcers. They may also affect the nose and mouth.

• Papules, pustules, or nodules
  • May appear wartlike
  • May vary from gray to violet in color
• Pustules that ulcerate
  • May bleed easily
  • May occur in the nose or mouth
• Subcutaneous(beneath the skin) nodules

With time, these lesions can lead to scarring and loss of skin color (pigment). The lesions are most frequently found on exposed body areas.

The infection is diagnosed by identifying the fungus in a culture taken from a skin lesion. This usually requires a skin biopsy.

This infection is treated with antifungal drugs such as amphotericin B, itraconazole, ketoconazole, or fluconazole. Either oral or intravenous (directly in the vein) drugs are used, depending on the form and stage of the disease.

What happens depends on the form of blastomycosis and the individual's immune system. In immunosuppressed individuals, long-term treatment may be required to prevent symptoms from coming back.

• Abscesses (pockets of pus)
• Additional (secondary) skin infection caused by bacteria
• Complications related to medications (for instance, amphotericin B can have severely unpleasant side effects)
• Spontaneously draining nodules

Some of the skin problems caused by blastomycosis can be similar to skin problems caused by other illnesses. Tell your doctor if you develop any worrisome skin problems.