http://cmr.asm.org/content/23/2/367.full.pdf
Geoff McKee, MD
Resident Physician
Public Health and Preventive Medicine
University of British Columbia
http://www.metal-archives.com/images/1/2/8/3/128324_logo.jpg?1645
Dr. Michelle Kates – primary veterinarian
Dr. Eleni Galenis – Zoonosis Lead, BCCDC
Dr. Linda Hoang – Medical Microbiologist, BCCDC
Dr. Mohammed Morshed – Medical Microbiologist, BCCDC
Dr. Theresa Burns - Public Health Veterinarian (involved in case)
http://cmr.asm.org/content/23/2/367/F8.expansion.html
A systemic pyogranulomatous infection endemic to regions of mid-western and eastern North
America
Caused by Blastomyces spp.
First identified by Dr. T. Caspar
Gilchrist, a dermatologist in
Baltimore http://www.photogravure.com/photo gravure_images/large/Ulmann_03_32.j
pg
Eastern United States
Central Canada
Globally
Southeast Asia
Africa
Europe
Middle East http://img.medscape.com/article/821/652/821652-figure.jpg
Typically exist in mycelial form in environment
Spores bound tightly to filaments and become unbound in presence of high humidity
Transmission typically associated with humid environments (Rivers, streams etc) https://www.gov.mb.ca/mit/floodinfo/floodoutlo ok/images/pembina_river_above_lorne_lake.jpg
http://www.cdc.gov/fungal/images/blastomycosislifecycle.jpg
Hosts
Humans
Dogs, cats, foxes, pandas, lions etc
Transmission
Primarily through inhalation of airborne conidia
Cutaneous infection possible through direct inoculation
Pathophysiology
Conversion to yeast form dependant on temperature and nutrients http://www.cdc.gov/fungal/images/blastomycosis-lifecycle.jpg
Presentation
Pulmonary
Cutaneous
Systemic Illness involving other organs
Treatment
Mild Disease
Azoles -> itraconazole etc.
Moderate to Severe Disease
Amphoteracin B
Brömel, C., & Sykes, J. E. (2005)
López-Martínez, R., & Méndéz-Tovar, L. J. (2012).
1.5 year old Portuguese Water
Dog presented to vet in
January 2015 for skin lesions on its back.
Diagnosed with sterile nodular panniculitis on biopsy with negative bacterial cultures
Treated with steroids
Developed fulminant illness compatible with blastomycosis (fever, respiratory distress, enlarged lymph nodes)
Lymph node aspirate sent for testing - Blastomyces visualized on microscopy and confirmed via PCR
*Not from actual speciman http://cmr.asm.org/content/23/2/367.full.pdf
The dog was started on
fluconazole and, following an increase in dose, improved dramatically.
Likely to test urine for Blastomyces antigen prior to halting treatment
BCCDC was notified following the diagnosis of blastomycosis
A repeat lymph node aspirate was obtained by PHSA labs and the diagnosis was confirmed on microscopy. Blastomyces was also cultured from the sample.
Exposure History
Traveled via car to southwestern Manitoba
6 months prior to the onset of symptoms.
While in Manitoba, the dog swam in a river.
Travel in BC was also documented with trips to the Interior, Vancouver Island and various locations on the lower mainland.
Travel to Washington State also documented
The dog lived in a condo in Vancouver, with no backyard.
http://www.gov.mb.ca/health/rha/m ap.html
Considering likelihood of exposures:
Blastomycosis endemic to Manitoba (particularly eastern Manitoba) and likely
Saskatchewan
No cases of locally acquired blastomycosis reported in British Columbia
No evidence of local acquisition of blastomycosis in Washington State (although exposure history of several cases unclear as per consultation with WA Public
Health)
Blastomyces likely acquired during trip to Manitoba
Unable to prove or disprove acquisition in British Columbia
Further investigation required if subsequent cases arise in BC with uncertain exposure histories
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