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. 1993 Mar;4(2):89-94.
doi: 10.1155/1993/249823.

Blastomycosis in Quebec (1981-90): Report of 23 cases and review of published cases from Quebec

G St-Germain  1 , G Murray, R Duperval
Affiliations

Blastomycosis in Quebec (1981-90): Report of 23 cases and review of published cases from Quebec

G St-Germain et al. Can J Infect Dis. 1993 Mar.

Abstract
in English, French

Twenty-three cases of blastomycosis were reported in a survey conducted in the province of Quebec from 1981-90. Thirteen patients resided south of the St Lawrence River and the other 10, north. Two small geographical clusters were apparent in and around the cities of Sherbrooke and Quebec. The male to female ratio was 1.6:1 and the median age was 47 years (range 26 to 77). Lung involvement was observed in 19 cases and was the only site involved in 11. Cutaneous manifestations were reported in 11 cases while bone infection (three cases) and central nervous system (CNS) infections were also noted. Diagnosis was confirmed by culture in 21 cases and by histopathology in two cases. Of the 21 culture-positive cases, 12 strains of Blastomyces dermatitidis were isolated from lungs, nine from skin, and one each from bone and brain. Serodiagnostic tests by immunodiffusion or complement fixation were positive for only one of the 10 patients known to have been tested. Ten patients were treated with amphotericin B, 11 with ketoconazole, one with fluconazole and eight underwent surgery. While amphotericin B was used in eight of the 10 earliest treated cases, ketoconazole was administered in 10 of the 13 more recent cases. Of the patients for whom follow-up data have been obtained, 21 are reported cured (one of whom was not treated) and one patient died of another cause. This survey confirms that blastomycosis is a rare disease in this endemic area and that patterns of therapy are changing.

De 1981 à 1990, 23 cas de blastomycose nous ont été signalés dans le cadre d’une enquête menée au Québec. Treize patients résident au sud du fleuve St-Laurent et 10 au nord. On remarque deux petits foyers dans les régions de Sherbrooke et Québec. Le ratio homme-femme est de 1.6:1 et l’âge médian de 47 ans, variant de 26 à 77 ans. Une atteinte des poumons est observée dans 19 cas et pour 11 de ceux-ci, il s’agit du seul site impliqué. On signale 11 atteintes cutanées. trois osseuses et une du système nerveux central. Le diagnostic est confirmé par culture dans 21 cas et par histopathologie pour les deux autres cas. Des 21 cas cultivés, Blastomyces derniatitidis est isolé 12 fois des poumons. neuf fois de la peau et une fois des os et du cerveau. Les tests de sérodiagnostic par immunodiffusion ou fixation du complément sont négatifs pour les 10 patients chez lesquels on rapporte avoir effectué ces épreuves. Dix patients ont été traités avec l’amphotéricine B, 11 avec le kétoconazole et un avec le fluconazole. Dans huit cas, on a eu recours à la chirurgie. Alors que l’amphotéricine B est utilisée pour le traitement de huit des 10 cas les plus anciens, le kétoconazole a été administré dans 10 des 13 cas les plus récents. Parmi les patients pour lesquels nous avons obtenu un suivi, 21 sont rapportés guéris, dont 1 sans traitement; un patïent est décédé d’autres causes. Cette enquête confirme que la blastomycose est une maladie rare dans cette région endémique et qu’un changement important s’est opéré dans le choix du traitement.

Keywords: Blastomyces dermatitidis; Blastomycosis; Quebec.

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Figures

Figure 1
Figure 1
Geographical distribution of 23 cases of blastomycosis diagnosed in Quebec from 1981 to 1990. ▴ Individual cases
Figure 2
Figure 2
Hematoxylin-eosin stained skin biopsy specimen from the first case (1981). Typical broad-based budding yeast cells of Blastomyces dermatitidis are shown. Bar is 10 μm
See this image and copyright information in PMC

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