Blastomycosis in India: report of an imported case and current status.
We report a case of disseminated blastomycosis in a female resident of Delhi, who acquired the infection during travel to the USA, which was successfully treated with oral itraconazole. In addition, we present a critical literature review, indicating that blastomycosis is endemic in India but its areas of endemicity, prevalence, and the natural habitat of the etiologic agent, remain undetermined. The diagnosis of blastomycosis was made by examination of Gomori's methenamine silver stained sections of tissue obtained from a biopsy of a subcutaneous, abdominal nodular. These studies revealed thick-walled, broad-based budding yeast cells compatible with Blastomyces dermatitidis, and consistent with the isolation of the fungus in cultures inoculated with posterior auricular lymph node aspirate. Microscopically, the isolate had thin, septate hyphae and characteristic spherical to pyriform, smooth-walled microconidia. Its identity was confirmed by conversion to its typical yeast form on pea seed agar at 37°C and by DNA sequencing of ITS and BAD 1 promoter regions.
Department of Medical Mycology, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, India. hsrandh5@yahoo.co.in
Harbans S
HS
Randhawa
Anuradha
A
Chowdhary
Shallu
S
Kathuria
Pradip
P
Roy
Deepti S
DS
Misra
Sarika
S
Jain
Tulsi D
TD
Chugh
D000284:Administration, Oral; D000328:Adult; D000935:Antifungal Agents / Q000008:administration & dosage* / Q000494:pharmacology; D001483:Base Sequence; D001758:Blastomyces / Q000187:drug effects / Q000235:genetics / Q000302:isolation & purification*; D001759:Blastomycosis / Q000382:microbiology / Q000473:pathology*; D004271:DNA, Fungal / Q000737:chemistry / Q000235:genetics; D021903:DNA, Ribosomal Spacer / Q000737:chemistry / Q000235:genetics; D005260:Female; D005800:Genes, Fungal / Q000235:genetics; D006801:Humans; D025301:Hyphae; D007194:India; D017964:Itraconazole / Q000008:administration & dosage* / Q000494:pharmacology; D008826:Microbial Sensitivity Tests; D008969:Molecular Sequence Data; D011401:Promoter Regions, Genetic / Q000235:genetics; D017422:Sequence Analysis, DNA; D013172:Spores, Fungal; D014195:Travel; D014481:United States
D000935:Antifungal Agents; D004271:DNA, Fungal; D021903:DNA, Ribosomal Spacer; D017964:Itraconazole