BLASTOMYCOSIS: A BRIEF REVIEW OF THE LITERATURE AND A REPORT OF A CASE INVOLVING THE MENINGES

Abstract

Although this disease is quite uncqmmon, the authors emphasize the importance of systemic and cutaneous blastomycqsis because either of these can mimic myriad other clinical conditions. The disease caused by Blastomyces dermatitidis was first recognized by Gilchrist in 1894, and since that time has been known by 19 different names. This confusion was possibly the result of our failure to appreciate the varying clinical picture pf the disease plus the fact that the morphology of the organism itself varies so widely. However, recent serol., morphological and bacteriological investigations have reliably established the identity of the organism. The disease is now known as Blastomycosis, North American Blastomycosis, or Gilchrist''s disease. Martin and Smith believe that the disease is peculiar to the U. S., but this is open to question. 90% of the systemic cases terminate fatally. The cutaneous type carries no threat to life, but usually runs a very chronic course and tends to recur even after supposedly effective treatment. The lungs are involved in > 95% of the cases of the systemic variety. Bones and joints are involved in a majority of the systemic cases, but no organ or tissue in the body is immune to attack. Involvment of the meninges is very rare and the authors have added another case to the records. Treatment of the systemic and cutaneous types of the disease is very unsatisfactory. A combination of iodide and vaccine therapy is the best available treatment for the systemic disease while roentgen-ray treatment is probably best in early small skin lesions.