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. 2017 Mar;7(1):119-129.
doi: 10.23907/2017.014. Epub 2017 Mar 1.

Blastomycosis in Wisconsin: Beyond the Outbreaks

Katrina Thompson  1 , Alana K Sterkel  1 , Erin G Brooks  1
Affiliations

Blastomycosis in Wisconsin: Beyond the Outbreaks

Katrina Thompson et al. Acad Forensic Pathol. 2017 Mar.

Abstract

In the summer of 2015, many individuals visiting the Little Wolf River in Waupaca County were exposed to the pathogenic fungus, Blastomyces. Over time, 59 confirmed and 39 probable cases were reported to the Wisconsin Department of Health Services (W-DHS), making this one of the largest outbreaks in recent state history. Though most instances of blastomycosis are not associated with common source outbreaks, cases such as this highlight the need for vigilance regarding this preventable cause of death. In the state of Wisconsin, an average of 118.6 cases (range, 84-174) of confirmed blastomycosis are diagnosed annually; the majority of these cases are sporadic rather than outbreak-associated. In the current study, we review characteristics of blastomycosis cases diagnosed at our academic medical center, as well as examine statewide W-DHS data, in order to familiarize pathologists with the epidemiologic and histologic characteristics of this disease.

Keywords: Blastomyces; Blastomycosis; Forensic pathology; Outbreak; Wisconsin.

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Conflict of interest statement

DISCLOSURES & DECLARATION OF CONFLICTS OF INTEREST The authors, reviewers, editors, and publication staff do not report any relevant conflicts of interest

Figures

Image 1
Image 1
Pulmonary blastomycosis results in markedly heavy lungs with numerous fibrous adhesions causing irregularity of the pleural surfaces. The patches of discoloration represent areas of hemorrhage and necrosis.
Image 2
Image 2
White, firm, granulomatous lesions are common within Blastomyces infected organs. Within the lungs, granulomas can vary in size and may be either focal or diffuse in a miliary pattern (as seen above). Formalin fixation can increase tissue contrast, allowing for better visualization of small granulomas.
Image 3
Image 3
Microscopic lung sections showing: A) Diffuse intersitial and intra-alveolar organizing fibrosis, scattered hyaline membranes, intra-alveolar hemorrhage, and necrosis (H&E, x40), B) Histocytes and giant cells containing round, encapsulated, yeast (H&E, x400), and C) The characteristic broad-based budding (arrow) associated with Blastomyces (H&E, x1000).
Figure 1
Figure 1
Confirmed cases of blastomycosis in the state of Wisconsin between 2003 and 2015. Bars in black represent years with known outbreaks (2006, 2009, 2010, 2015).
Image 4
Image 4
Gross image of a verrucous cutanous Blastomyces lesion. The lesions are characteristically round, pustular, and vary in size from 0.5-1.5 cm in diameter.
Image 5
Image 5
Special stains available to better visualize Blastomyces in tissue section. A) Periodic acid–Schiff with diastase (PAS-D, x500), B) Grocott's/Gomori Methenamine Silver (GMS, x500).
Image 6
Image 6
Potassium hydroxide (KOH) mount of Blastomyces with calcofluor white staining visualized under florescent light (aqua color is computer generated). Notice broad-based budding of yeast, which is characteristic of Blastomyces.
See this image and copyright information in PMC

References

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