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Harrison's Principles of Internal Medicine, 18e
| Part 8. Infectious Diseases > Section 16. Fungal Infections > |
Chapter 201. Blastomycosis
Sections: Blastomycosis: Introduction, Prognosis, Further Readings.
Topics Discussed: blastomycosis; fungal infections, invasive.
Excerpt:"Blastomycosis is a systemic pyogranulomatous infection, involving primarily the lungs, that arises after inhalation of the conidia of Blastomyces dermatitidis. Pulmonary blastomycosis varies from an asymptomatic infection to acute or chronic pneumonia. Hematogenous dissemination occurs frequently. Extrapulmonary disease of the skin, bones, and genitourinary system is common, but almost any organ can be infected.B. dermatitidis is the asexual state of Ajellomyces dermatitidis. Two serotypes have been identified on the basis of the presence or absence of the A antigen. B. dermatitidis exhibits thermal dimorphism, growing as the mycelial phase at room temperature and as the yeast phase at 37°C. Primary isolation is most dependable for the mycelial phase incubated at 30°C. Definitive identification usually requires conversion to the yeast phase at 37°C or, more commonly, the use of nucleic acid amplification techniques (e.g., AccuProbe, Gen-Probe, San Diego, CA) that detect mycelial-phase growth. Yeast cells are usually 8–15  m in diameter, have thick refractile cell walls, are multinucleate, and reproduce by a single, large, broad-based bud...."
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