Current reviewsBlastomycosis of the head and neck
Introduction
Blastomycosis is caused by Blastomyces dermatitidis (B. dermatitidis), a thermally dimorphic fungus that occasionally causes systemic pyogranulomatous disease in humans [1]. Almost all cases of blastomycosis are thought to originate from a pulmonary focus, with secondary seeding via lymphohematagenous spread causing disseminated disease [2]. The most common sites of dissemination are osteoarticular structures, skin, and the genitourinary tract. Blastomycosis in the head and neck region is especially rare and requires a high index of clinical suspicion, especially if patients present with no pulmonary symptomatology.
To the best of our knowledge, there is currently no comprehensive review of blastomycosis with specific attention to involvement of head and neck structures. A literature search was conducted using the Pubmed and Ovid databases with the terms “blastomycosis AND. . . “ followed by all terms related to anatomical regions of the head and neck (e.g. “ear”, “nasal”, “nose”, “sinus”, “oral”, “mouth”, “throat”, “larynx”, “neck,” etc.). The references sections of relevant reports were also evaluated for additional literature sources that were not identified in the MEDLINE search. Forty-nine publications discussed pertinent otolaryngologic involvement, yielding a total of 77 patient cases. This review does not discuss brain infections and isolated cutaneous infections of the face without involvement of other head and neck structures. We review the clinical presentations and diagnostic challenges of blastomycosis pertaining to the practice of otolaryngology.
Section snippets
Larynx
Laryngeal blastomycosis is the most commonly reported presentation of B. dermatitidis involving the head and neck structures with 28 cases documented in the literature [3], [4], [5], [6], [7], [8], [9], [10], [11], [12], [13], [14], [15], [16]. Patients almost universally presented with progressive hoarseness of one to several months duration. Presence of cough, sputum production, dysphagia, or dyspnea was variable; hemoptysis was occasionally reported. While pulmonary involvement varied among
Discussion
Blastomycosis is an uncommon entity in the United States, with less than 800 cases annually in one nationwide survey [55]. Blastomycosis in the head and neck region is especially rare and clinical suspicion for this diagnosis is often low, particularly when patients present without pulmonary symptomatology.
In the largest published case series on the subject, Reder and Neel reviewed records from the Mayo Clinic between 1960 and 1990 and found that 23 of the 102 patients with blastomycotic
Conclusion
Blastomycotic infection of the head and neck is a rare clinical entity. Similarity to other disease processes, especially squamous cell carcinoma, often results in initial misdiagnosis. Potentially serious sequelae resulting from this diagnostic delay include disease progression or inappropriate medical and surgical interventions, but initiation of appropriate antifungal agents generally leads to good outcomes.
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Laryngeal Blastomycosis, an Unexpected Diagnosis: A Case Report
2022, Journal of VoiceA case of tracheal and pulmonary blastomycosis presenting as asymptomatic pulmonary nodules
2021, Medical Mycology Case ReportsCitation Excerpt :While clearly present in a much larger distribution than originally thought, it is difficult to precisely define the endemic area of this fungal disease. Pulmonary manifestations are the most common form of blastomycosis due to the inhalation of conidia as the most common route of initial pathogenesis [17]. Blastomycosis is primarily a lower respiratory infection.
Bronchoscopy in the diagnosis of pulmonary blastomycosis
2020, International Journal of Infectious DiseasesNonsquamous Pathologic Diseases of the Hypopharynx, Larynx, and Trachea
2020, Gnepp's Diagnostic Surgical Pathology of the Head and Neck, Third EditionIdentification and Management of Chronic Laryngitis
2019, Otolaryngologic Clinics of North AmericaCitation Excerpt :It may present as progressive hoarseness and possibly hemoptysis.16 Exophytic or verrucous polypoid masses or ulceration and diffuse erythema may be visualized on the true and false vocal folds; true vocal folds may be hypomobile.16,18 Histology demonstrates epithelial atypical and pseudoepitheliomatous hyperplasia, and possible giant cells and microabscesses; broad-based budding yeasts may be identified on Grocott methenamine silver (GMS) stain.16,18
Destructive and painful ulcer in the posterior oral cavity and oropharynx
2017, Journal of the American Dental Association