title: Blastomycosis in a South Indian patient after visiting an endemic area in USA.
abstract: We describe a case of blastomycosis in a diabetic patient from South India who had visited Milwaukee, Wisconsin, an endemic area for blastomycosis in the USA. After his return to Bangalore, India, the patient developed intermittent fever of moderate to high grade, cough, loss of weight and appetite, and abscesses in the left cubital fossa and thigh regions. Systemic examination at our hospital revealed that he had dullness to percussion over the chest region and decreased breath sounds. Direct examination of Gram-stained smears of the pus from an abscess showed many broad-based budding yeast cells and culture yielded a dimorphic fungus later identified as Blastomyces dermatitidis. Histologic examination of the curettage tissue slides stained with hematoxylin and eosin, periodic acid Schiff's reagent, and Gomori's methenamine silver stain procedures showed many broad-based budding cells characteristic of B. dermatitidis. The patient was successfully treated, initially with amphotericin B, followed by oral itraconazole for a period of 6 months. Blastomycosis cases in India are reviewed and the likely source of infection in this patient is discussed.
authors.affiliation: Department of Microbiology, St John's Medical College and Hospital, Bangalore, India.
authors.forename: Jayanthi
authors.initials: J
authors.lastname: Savio
authors.forename: S
authors.initials: S
authors.lastname: Muralidharan
authors.forename: R S
authors.initials: RS
authors.lastname: Macaden
authors.forename: G
authors.initials: G
authors.lastname: D'Souza
authors.forename: S
authors.initials: S
authors.lastname: Mysore
authors.forename: P
authors.initials: P
authors.lastname: Ramachandran
authors.forename: I
authors.initials: I
authors.lastname: Garg
authors.forename: P
authors.initials: P
authors.lastname: Rout
authors.forename: B M
authors.initials: BM
authors.lastname: Hemashettar
authors.forename: A A
authors.initials: AA
authors.lastname: Padhye
mesh_terms: D000328:Adult; D000666:Amphotericin B / Q000627:therapeutic use*; D000935:Antifungal Agents / Q000627:therapeutic use; D001758:Blastomyces / Q000302:isolation & purification* / Q000502:physiology; D001759:Blastomycosis / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D019353:Endemic Diseases; D006801:Humans; D017964:Itraconazole / Q000627:therapeutic use*; D008297:Male; D012196:Review Literature as Topic; D016896:Treatment Outcome; D014481:United States
chemical_list: D000935:Antifungal Agents; D017964:Itraconazole; D000666:Amphotericin B