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)

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http://cmr.asm.org/content/23/2/367/F8.expansion.html
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 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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