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A fungus that can cause a lot of grief in some patients would be Blastomycosis. It has symptoms that can be clinically silent but it is also potentially deadly if the disease spreads out without treatment. It can appear similar to pneumonia so watch out!

The number of pathogens that can cause problems with your lungs is astounding. As we have moved through this exploration of suspicious densities on the lungs, we have seen that numerous bacteria, viruses and even fungi are able to cause these markings. Fungi are typically not the first consideration when someone thinks of diseases of the lungs but they should not be forgotten. One of the most common types of fungi that has lung involvement would be histoplasmosis. When thinking of the signs of histoplasmosis, this is a fungus that is more dangerous based on your geographical location and symptoms can be silent in most cases. Another common fungus that also depends on your geography is Blastomycosis. In this article, we will explore some of the signs of Blastomycosis and how you can treat this disease. 

What is Blastomycosis? 

Unlike Histoplasmosis that is found in most tropical regions around the globe, Blastomycosis prefers areas in a more temperate climate. The geographical region with the highest concentrations of Blastomycosis would be in the northern United States and southern Canada [1].  There are cases of the disease now in South Africa and Asia, though, so it is becoming a global phenomenon [2]. Thankfully, this is a relatively sparse area in terms of population so the number of cases of Blastomycosis is much lower than it could be but cases are expected to rise in the coming years. According to the CDC, it is believed that nearly 50 in 100,000 people in Wisconsin are currently infected with the disease [3].  

This is a fungus that dwells in the soil and as a result, males are more likely to be infected than females. Disturbing contaminated soil during construction, fishing or hiking are some of the more common sources of outbreaks of the fungus. The spores are inhaled as they fly through the air and once the spores are internalized, the symptoms may begin [4]. 

The symptoms can range from subclinical to a potentially fatal disease so you don't want to miss the disease. Unfortunately, blastomycosis is typically a disease where doctors are unable to diagnose it during the first work-up so it has the potential to spread throughout the body before a culprit is identified [5]. It is completely clinical silent in roughly 50 percent of cases. Some of the first signs of blastomycosis that you will notice will be a dry cough and skin manifestations of the disease. Between 40 to 80 percent of patients with blastomycosis will have these cutaneous manifestations [6]. 

How Can You Treat It? 

Once a doctor is able to piece together what could be at the bottom of your illness, the first thing that they will need to do is to order a chest X-ray in order to check for suspicious densities on the lungsBlastomycosis will create a strange mass-like infiltrate on the chest X-ray that can look similar to a lesion for lung cancer [7]. It often looks like a typical pneumonia infection on chest X-ray so doctors may follow the wrong diagnostic work-up if they get stuck on the signs of a lung infection

Once the disease is diagnosed, what a patient needs to begin immediately would be starting therapy. Two drugs that have proven to be effective for this disease would be amphotericin B and ketoconazole.

Amphotericin B is the medication of choice for most patients but it does come with some side effects that can be problematic for patients to continue the therapy. Ketoconazole was found to be very effective against the dermal manifestations of the disease, more so than Amphotericin B. In one investigation, 46 patients with Blastomycosis were followed during their therapy to determine the effectiveness of these two medications. The therapy lasted for at least a month in 43 patients. In this treatment, 35 patients were fully cured of the disease 17 months after therapy and 6 had relapses of the disease. Three patients who had extensive forms of the fungus ultimately died from this infection. [8

As you can see, it can be a dangerous disease but in all likelihood, it will not be in its most fatal form because of modern medicine. In a 20-year cohort study, it was determined that there were only a little over 1,000 patients who died from Blastomycosis in the 50 million sample that was followed. Men were more likely to be infected and die at a younger age compared to females in this population. Based on this study, it was also determined that African Americans and Native Americans had a much higher likelihood of dying because of Blastomycosis compared to Caucasian patients. The more potent strains of Blastomycosis seemed to be found in the southern United States. [9]

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