Blastomycosis is a chronic systemic mycosis characterized by primary pulmonary infection, which in some cases is followed by hematogenous dissemination to skin and other organs.
The fungus is endemic to countries in Central America, North and South America, most notably Brazil, Argentina, Colombia, and Venezuela, in regions classified as subtropical mountain forests. Infection with P brasiliensis is usually subclinical; however, the fungus sometimes proliferates, causing severe disease.
North American blastomycosis is caused by the yeast-like fungus Paracoccidioides brasiliensis that is acquired by breathing in the spores of the fungus
B.dermatitidis infection acquired from inhalation of dust from soil, decomposed vegetation, or rotting wood. Asymptomatic primary pulmonary infection usually resolves spontaneously. Hematogenous dissemination may occur to skin, skeletal system, prostate, epididymis, or mucosa of nose, mouth, or larynx. Reactivation may occur within lung or in sites of dissemination.
Risk factors for dissemination: T cell dysfunction; advanced HIV disease.
Symptoms include ulcers in the mouth, larynx and nose, in addition to large, draining lymph nodes, cough, chest pain, swollen lymph glands, weight loss, and lesions on the skin, genitals, and intestines. There may also be lesions in the liver, spleen, intestines, and adrenal glands.
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