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\def\citeauthor{~Masinamoni~Sravani,
              ~Mudedla~Hasini,
              ~Patha~Bhargavi,
              ~Eluduti~Himabindu,
              ~Alli~Sowjanya,
              ~Nakarakanti~Navya}
\def\citetitle{\textbf{Case Report on a Dimorphic Fungal Disease - Blastomycosis}}
\def\copyrightstmt{This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial- ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.}
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\def\RunningAuthor{Masinamoni Sravani et al.}
\firstPage{19}
\articleType{Case Report}
\receivedDate{05 Mar 2022}
\acceptedDate{24 Mar 2022}
\revisedDate{22 Mar 2022}
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\journalDoi{ijebr.v1i1.364}
\copyrightYear{2022}
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\def\journalTitle{International Journal of Experimental and Biomedical Research}

\title{\textbf{Case Report on a Dimorphic Fungal Disease - Blastomycosis}}
\author{Masinamoni~Sravani\textsuperscript{*}\textsuperscript{\href{https://orcid.org/0000-0003-3447-5226}{\XeTeXLinkBox{\includegraphics[height=7pt]{orcid-logo-pharmascope.pdf}}}},  
            Mudedla~Hasini\textsuperscript{\href{https://orcid.org/0000-0003-4729-6382}{\XeTeXLinkBox{\includegraphics[height=7pt]{orcid-logo-pharmascope.pdf}}}},  
            Patha~Bhargavi\textsuperscript{\href{https://orcid.org/0000-0002-0215-9571}{\XeTeXLinkBox{\includegraphics[height=7pt]{orcid-logo-pharmascope.pdf}}}},  
            Eluduti~Himabindu\textsuperscript{\href{https://orcid.org/0000-0002-0442-4367}{\XeTeXLinkBox{\includegraphics[height=7pt]{orcid-logo-pharmascope.pdf}}}},  
            Alli~Sowjanya\textsuperscript{\href{https://orcid.org/0000-0002-2651-788X}{\XeTeXLinkBox{\includegraphics[height=7pt]{orcid-logo-pharmascope.pdf}}}}, 
            Nakarakanti~Navya\textsuperscript{\href{https://orcid.org/0000-0003-4047-3083}{\XeTeXLinkBox{\includegraphics[height=7pt]{orcid-logo-pharmascope.pdf}}}}~\\[5pt]{St. Mary's Group of Institution, Deshmukhi (Village), Pochampally (Mandal), Yadadri Bhuvanagiri (Dist)-508284, Telangana, India}}

\begin{abstract}
Blastomycosis is a dimorphic fungal disease caused by the fungus Blastomyces dermatitidis. The fungus is found in soils and water, and it can be transmitted to humans through contact with infected animals or inhaling spores from the air. The disease may cause fever, cough, fatigue, headache, muscle pain and joint pain. The symptoms vary depending on whether the infection has been localized or disseminated throughout the body. Localized infection can progress to disseminated infection if not treated early enough. A case study of 18 years old female is admitted in area hospital with symptoms like fever, cough and weight loss and fever with chills and night sweats who had a dry cough or expectoration. The diagnosis of this disease is made by taking a blood test or skin biopsy from the infected area which will show up in the laboratory as positive for blastomycosis. She was given an antifungal medication called amphotericin B intravenously, which helped her to recover from the infection. 
\end{abstract}\def\keywordstitle{Keywords}

\begin{keywords}Blastomycosis,\newline Fungal Infection,\newline Antibiotic Treatment,\newline Blastomyces Dermatitidis
\end{keywords}
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\makeatletter{\raggedright{\Large$^\ast$}Corresponding Author\par Name:\ Masinamoni~Sravani~\\ Phone:\ +91 6300789610~\\  Email:\ machanamonisravani867@gmail.com
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        \makeatother
        
    
\section{Introduction}
Blastomycosis is a fungal infection caused by the genus Blastomyces. Blastomyces dermatitidis is found in soil, decaying vegetation and in water. The fungus enters through the skin or lungs and causes an infection that can be fatal. Blastomycosis is seen most often in people who are exposed to these environments such as construction workers, farmers, landscapers, or loggers. Blastomycosis can also be transmitted from mother to child during pregnancy and childbirth. It can also be contracted from exposure to infected animals such as dogs, cats or livestock. Blastomycosis is a fungal infection caused by the fungus Blastomyces dermatitidis. The infection is usually acquired by inhalation of the spores of B. dermatitidis, which are present in soil and water. Blastomycosis is a rare fungal infection that can affect the skin, lungs, sinuses, and other parts of the body. The fungus that causes blastomycosis is found in soil and water. Blasto is not contagious. The symptoms of blastomycosis may include fever, headache, chest pain, cough, weight loss, and night sweats \unskip~\cite{1381765:24669345}.

Blastomycosis is a rare disease that is most often found in parts of the United States with high humidity. It can be transmitted to humans through contact with moist soil or water, or from an infected animal. When the disease is not treated it can lead to serious complications like lung and kidney damage. Blastomyces dermatitidis is a dimorphic fungus, meaning it has two forms: an infective form (blastospore) and a saprophytic form (spherule). Blastomycosis is a dimorphic fungal disease caused by the Blastomyces dermatitidis fungus. The disease is endemic to North America, especially in the Ohio and Mississippi River valleys. Blastomycosis was first described in 1883 by Dr. Edward Tyzzer, an American physician who noted its occurrence among coal miners in Pennsylvania. The name "Blastomyces dermatitidis" was given to the causative organism by Dr. Walter Reed and Dr. James Carroll in 1907, after they isolated it from a patient with blastomycosis during an outbreak at Washington Barracks (now Fort Detrick). The clinical presentation of blastomycosis varies depending on whether the infection is acute or chronic. The acute form presents with fever, chills, headache, dry cough and chest pain while chronic blastomycosis manifests as subacute or subclinical symptoms that are often misinterpreted as other illnesses such as asthma or bronchitis \unskip~\cite{1381765:24669346}.

\textbf{Pathogenesis}

Blastomycosis is a dimorphic fungal disease caused by the organism Blastomyces dermatitidis. It is endemic in North America and Latin America, with cases also reported in Africa, Europe, India, and Australia. Blastomycosis is acquired through inhalation of aerosolized spores of the fungus from soil or from the environment. The incubation period can be as long as 6 months to 2 years. The most common clinical manifestations are fever, headache, weight loss, lymphadenopathy and hepatosplenomegaly. The diagnosis is made on clinical grounds alone but culture of sputum or tissue biopsy may be needed for confirmation. Blastomyces dermatitidis is a dimorphic fungus that can exist in two forms: one being airborne yeast and the other being a mold found in soil and water [Figure~\ref{f-072c6aabe7d0}]. The infection from this fungus can occur when someone breathes in the airborne yeast form of the fungus, or when they come into contact with contaminated soil or water [Figure~\ref{f-8b660fa9690c}]. 

The infection starts by getting into the lungs and then spreads to other organs such as lymph nodes, skin, bones, brain and heart which causes pneumonia. Blastomycosis is a rare, chronic, and progressive infection caused by the fungus Blastomyces dermatitidis. The infection is typically acquired by inhalation of airborne spores from soil contaminated with infected animal droppings. 

The disease starts with an incubation period of 2-6 weeks in which there are no symptoms \unskip~\cite{1381765:24669344}. The first sign of the disease is usually a non-specific flu-like illness characterized by fever, headache, muscle aches and joint pain. This initial phase can last up to two weeks before progressing to the chronic phase when patients may experience symptoms such as cough, weight loss, night sweats and fatigue. Blastomycosis has been reported in Africa, North America and South America but most cases have been reported in the Ohio River Valley region of the United States \unskip~\cite{1381765:24669342}.

\textbf{Case Report}

A case study of 18 years old female is admitted in area hospital with symptoms like fever, cough and weight loss and fever with chills and night sweats. The patient also have a dry cough or expectoration. There may be chest pain and breathing difficulties due to lung involvement in this rare disease. Blastomycosis is a fungal disease caused by the fungus Blastomyces dermatitidis. It is characterized by acute febrile illness, pneumonia, and disseminated infection. The diagnosis of this disease is made by taking a blood test or skin biopsy from the infected area which will show up in the laboratory as positive for blastomycosis. The patient's condition worsened and she was admitted to the hospital for further evaluation. On examination, she had diffuse rales on chest auscultation, bilateral lower extremity edema and erythema, hepatomegaly, splenomegaly and mild jaundice. Her blood pressure was 110/70 mm Hg; pulse rate 98 beats per minute; temperature 39 degrees celsius (102 degrees fahrenheit); oxygen saturation. The 18-year-old female was diagnosed with blastomycosis after she had been experiencing symptoms for about a month. She was given an antifungal medication called amphotericin B intravenously, which helped her to recover from the infection. She had no complications from her treatment and recovered fully after a few days of hospitalization.
    
\section{Discussion }
Blastomycosis is a dimorphic fungal disease that affects the lungs, skin and central nervous system. It is caused by the Blastomyces dermatitidis fungus and it can be transmitted through contact with infected soil or water, or by inhaling the spores that are found in dust. Blastomycosis is a rare disease, with an incidence of 1 in 10 million people per year. It mostly affects males between 20 to 40 years old and has a higher incidence in rural areas where there are more dogs. The symptoms of blastomycosis include fever, fatigue, weight loss and night sweats. The most common symptom is chest pain which can be severe enough to mimic a heart attack. Other symptoms include shortness of breath, cough with blood-tinged sputum cx czr. The 18-year-old female was diagnosed with blastomycosis after she had been experiencing fever and fatigue for six months, but had not been able to identify any other symptoms of her illness. The diagnosis was made after she was given an MRI scan and there were abnormal findings on her brain that were consistent with blastomycosis. She also had a fever that ranged from 99\ensuremath{^\circ}F to 102\ensuremath{^\circ}F, which persisted despite antibiotic treatment \unskip~\cite{1381765:24669347}.


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  \cAlignHack 146 &
  \cAlignHack 130 - 160 g/L\\
\cAlignHack Hematocrit &
  \cAlignHack 0.39 &
  \cAlignHack 0.37 {\textendash} 0.49\\
\cAlignHack Platelet count &
  \cAlignHack 447 &
  \cAlignHack 150 - 450 x 109/L\\
\cAlignHack WBC Count &
  \cAlignHack 19.2 &
  \cAlignHack 4.5 {\textendash} 13.5 x 109/L\\
\cAlignHack Erythrocyte sedimentation rate &
  \cAlignHack 97 &
  \cAlignHack 0 {\textendash} 10 mm/h\\
\cAlignHack HIV antibody &
  \cAlignHack Negative &
  \cAlignHack Negative\\
\cAlignHack Antinuclear antibodies &
  \cAlignHack Negative &
  \cAlignHack Negative\\
\cAlignHack Blood cultures (6 sets) &
  \cAlignHack No growth (5 days) &
  \cAlignHack No growth (5 days)\\
\multicolumn{3}{p{\dimexpr(1\linewidth-2\tabcolsep)}}{\cAlignHack \textbf{WBC Differential}}\\
\cAlignHack Neutrophils &
  \cAlignHack 0.88 &
  \cAlignHack 0.40 {\textendash} 0.70\\
\cAlignHack Lymphocytes &
  \cAlignHack 0.05 &
  \cAlignHack 0.15 {\textendash} 0.45\\
\cAlignHack Monocytes &
  \cAlignHack 0.00 &
  \cAlignHack 0.01 {\textendash} 0.08\\
\cAlignHack Eosinophils &
  \cAlignHack 0.01 &
  \cAlignHack 0.00 {\textendash} 0.06\\
\tblbottomrule 
\end{tabulary}\par 
\end{table*}

\bgroup
\fixFloatSize{images/03b4d65b-1f4a-4138-99e4-5d4ddde5976a-upicture1.png}
\begin{figure}[!htbp]
\centering \makeatletter\IfFileExists{images/03b4d65b-1f4a-4138-99e4-5d4ddde5976a-upicture1.png}{\includegraphics{images/03b4d65b-1f4a-4138-99e4-5d4ddde5976a-upicture1.png}}{}
\makeatother 
\caption{\boldmath {Blastomycetes Dermatitis - Conidia Found in the Mold Form}}
\label{f-072c6aabe7d0}
\end{figure}
\egroup

\bgroup
\fixFloatSize{images/4ad8d727-0d47-4ffe-96c1-e1eaa52ca5c4-upicture2.png}
\begin{figure}[!htbp]
\centering \makeatletter\IfFileExists{images/4ad8d727-0d47-4ffe-96c1-e1eaa52ca5c4-upicture2.png}{\includegraphics{images/4ad8d727-0d47-4ffe-96c1-e1eaa52ca5c4-upicture2.png}}{}
\makeatother 
\caption{\boldmath {Blastomyces Dermatitidis - a Thick-Walled, Budding Yeast Form}}
\label{f-8b660fa9690c}
\end{figure}
\egroup
The diagnosis of blastomycosis is usually done by culturing the patient's sputum or urine sample in a laboratory [Table~\ref{tw-b264b761db3b}]. Blood tests also help in diagnosing this disease. Blastomycosis can be treated with antibiotics and antifungal drugs such as ketoconazole and amphotericin B. Blastomycosis is diagnosed by taking a sample of tissue from an infected area of the body and examining it under a microscope for signs of blastomyces dermatitidis. The symptoms of blastomycosis vary depending on whether the person has acute (sudden) or chronic (long-term) disease. 

Acute disease can present as fever, cough, chest pain, headache, fatigue, weight loss and night sweats. Chronic disease may present as dry cough and weight loss \unskip~\cite{1381765:24669343}. 

If left untreated, blastomycosis can cause serious complications such as pneumonia or meningitis. In some cases it can lead to death. Treatment for blastomycosis includes antifungal medications given intravenously for at least three weeks.
    
\section{Conclusion}
Blastomycosis is a rare fungal disease that is caused by a fungus called Blastomyces dermatitidis. The fungus lives in the soil and infects humans through the air or by coming into contact with infected animals. The patient was diagnosed with Blastomycosis and was put on treatment, she had to take antifungal medications for 4-6 months to get rid of the infection. It is important that you see your doctor as soon as possible if you have any symptoms of this disease because it can lead to serious complications if left untreated. The patient's condition improved after she started taking the medication, but she still has some complaints of fatigue and weakness. In conclusion, this case study highlights that patients with Blastomycosis should be monitored closely for the long term and should take their medications as prescribed by their physician.
    
\section{Acknowledgement}
I would like to thank Principal sir (Dr. Kamal Has- 398 san), St. Mary's Group of Institutions, Deshmukhi (Village), Pochampally (Mandal), Yadadri Bhuvana- 400 Giri(Dist), Telangana-508284, India. 

\textbf{Funding Support} \textbf{\space }

The authors declare that they have no funding support for this study. 

\textbf{Conflict of Interest} \textbf{\space }

The authors declare that there is no conflict of interest.
    
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