Blastomikoz – the disease from group of system mycoses proceeding with primary damage of lungs and a hematogenic disseminatsiy fungal infection in internals, bones and skin. Blastomikoz can proceed in various forms: pulmonary (bronchial pneumonia), skin (rash, skin ulcers, hypodermic abscesses), bone (osteomyelitis, arthritises), urinogenital (prostatitis, epididymite), etc. The diagnosis of a blastomikoz is confirmed by allocation of the activator - Blastomyces dermatitidis mushroom at microscopy, a cultural research, a biopsy. Therapy of a blastomikoz is carried out by antifungal medicines (, In); drainage and sanitation of abscesses can be shown.
In medical literature different types of blastomikoz are described: North American (Dzhilkrayst's disease), South American (), European () and keloidny (Lobo's disease) from which the North American type has the greatest prevalence. North American – the fungal disease which is characterized by polysystem defeat with development of purulent granulematozny processes in lungs, skin, a skeleton, an urinogenital path. Blastomikoz is widespread in the USA and Canada; in the form of sporadic cases meets in Latin America, Africa, Europe, Australia, India. During epidemic flashes of incidence blastomikozy children and young people up to 20 years are more subject. Questions of treatment and prevention of blastomikoz are on a joint of various clinical disciplines: mycology, pulmonology, dermatology, urology, etc.
Reasons of a blastomikoz
North American is caused by the dimorphous (two-phase) saprofitiruyushchy mushroom of Blastomyces dermatitidi living in the soil. The mushroom gets in the air and dust way at inhalation into a human body a fungus dispute with dust particles. In an organism treat the main ways of distribution of the activator hematogenic and limfogenny. The sexual way of transfer of a blastomikoz is possible. The activator of a blastomikoz can exist in two forms: mitselialny and barmy. In a mitselialny form the mushroom exists at a temperature below 30 °C, and in the struck organism (at t of 37 °C) it passes into a barmy phase.
Having got into lungs, mikrokonidiya of a mushroom pass into a barmy phase and cause development of primary infiltrative centers of an inflammation. At later stages in the centers granulomas with sites of suppuration and a necrosis are formed. Damage of skin and internals has secondary character and arises owing to an infection drift from lungs. Development of a blastomikoz is promoted by associated diseases: diabetes, tuberculosis, blood diseases, immunodeficiency (for example, HIV infection). The gardeners, agricultural workers and other people who are often contacting to the soil containing disputes of blastomitset, and also the persons living in endemic areas treat risk groups on incidence blastomikozy.
Symptoms of a blastomikoz
Distinguish the following clinical forms of a blastomikoz: pulmonary, skin, bone, urinogenital and other (defeats of TsNS, pericardium, liver, spleen, thyroid gland, adrenal glands). System (disseminirovanny) can develop years later after primary damage of lungs.
The pulmonary form of a blastomikoz makes 60–90% of all cases of a fungal infection and proceeds in the form of bronchial pneumonia. The incubatory period on average takes 30–45 days. Beginning of a disease sharp or subsharp; in an initial stage the intoksikatsionny syndrome prevails: subfebrilny or febrilny temperature, fever, muscular and articulate pains. Less often from the very beginning develops as primary and chronic, without the expressed clinical symptomatology. Cough (in the beginning dry, then with a purulent phlegm), a blood spitting, thorax pains, short wind disturbs. At an objective research rattles, noise of friction of a pleura are listened; radiological verkhnedolevy infiltrates, sometimes – cavities come to light. For people around patients with a pulmonary blastomikoz are noncontagious.
The skin form of a blastomikoz (40–80% of cases) most often occurs among extra pulmonary defeats. Skin proceeds with vezikulo-papular or papular and pustulous rashes which are transformed to the ulcer defects covered with plentiful granulations. Separated from sites of an ulceration has bloody or purulent character. Ulcers can extend to a mucous membrane of a mouth, a throat and a throat. Healing of ulcers happens to formation of a thin soft hem. Formation of hypodermic abscesses is possible.
25–50% of cases of a blastomikoz of extra pulmonary localization fall to the share of a bone form. Proceeds mainly in the form of osteomyelitis of long tubular bones, a backbone, edges. In a zone of defeat abscesses of surrounding soft fabrics, the svishchevy courses, arthritises of nearby joints are quite often formed.
The urinogenital form of a blastomikoz (10–30% of cases) is more often diagnosed for men. The clinical picture corresponds to an orkhit, an epididymite, prostatitis; the gematuriya and a piuriya can be noted. Infection of women with an urinogenital blastomikoz occurs sexually and meets seldom. At a disseminirovanny blastomikoz internals with development of abscesses of a liver, a perikardit, nadpochechnikovy insufficiency and so forth can be surprised. When involving TsNS there are brain abscesses, meningitis.
Diagnostics of a blastomikoz
First of all, it is necessary to suspect at the patients who arrived from endemic areas and having signs of damage of lungs, skin, bones, urinogenital system. Therefore to inspection of such patients, except narrow experts (the pulmonologist, the dermatologist, the urologist, etc.), infectiologists and mycologists have to be attracted.
The diagnosis of a blastomikoz is confirmed at detection of B. dermatitidi in biological material: to a phlegm, purulent separated from fistulas and abscesses, urine, a likvor, biopsiyny material. The microscopic research and microbiological crops is most often applied. For receiving samples of material the puncture of abscesses and aspiration of their contents, an ekstsizionny biopsy of fabrics is carried out. Serological diagnostics of a blastomikoz is carried out by the IFA, RSK, RIA methods. Skin and allergic tests with blastomitsiny have low sensitivity and specificity. For the purpose of identification of changes in internals additional tool researches are conducted: thorax X-ray analysis, osteostsintigrafiya, KT of a brain and backbone.
Pulmonary it is necessary to differentiate from other chronic damages of lungs: bacterial pneumonia, tuberculosis, new growths and abscesses of lungs, empiyema of a pleura, pulmonary form of aspergillomycosis, histoplasmosis. At a skin form it is necessary to exclude a piodermiya, other dermatomikoza, planocellular cancer of skin. Urinogenital it is necessary to distinguish from bacterial prostatitis and an orkhiepididimit, a prostate cancer, syphilis. Bone demands performing differential diagnostics with tuberculosis of bones and bacterial osteomyelitis.
Treatment of a blastomikoz
Sharp pulmonary can end with recovery without special treatment. In all other cases the basis of treatment of various forms of a blastomikoz is made antifungal therapy. At the easy course of a disease it is appointed or inside within 6 months; at heavy - In intravenously kapelno. According to indications antifungal therapy is supplemented with surgical methods – drainage of a pleural cavity, opening of abscesses of skin, nekrektomiy, etc.
Adequate and timely therapy of the localized forms of a blastomikoz allows to reach recovery in 90% of cases. At disseminirovanny forms in lack of treatment the probability of a lethal outcome is high. In order to avoid infection blastomikozy observance of rules of personal hygiene, protection of respiratory organs when loosening the soil and carrying out other agricultural works in the unsuccessful area, use of barrier methods of contraception at casual sexual contacts is recommended.