Department of Pediatrics, University of Modena and Reggio Emilia, Modena, Italy.
Ital J Pediatr. 2012 Dec 10;38:69. doi: 10.1186/1824-7288-38-69.
Blastomycosis, caused by the thermally dimorphic fungus Blastomyces dermatitidis is a systemic pyogranulomatous infection, endemic in United States and Canada, with few reported cases in Africa and Asia. It is uncommon among children and adolescents, ranging from 3% to 10%. Clinical features vary from asymptomatic spontaneously healing pneumonia, through acute or chronic pneumonia, to a malignant appearing lung mass. Blastomycosis can originate a "metastatic disease" in the skin, bones, genitourinary tract and central nervous system. Bone is the third most common site of blastomycotic lesions, after lung and skin. Bones may be involved in 14-60% of cases of blastomycosis. Direct visualization of single broadbased budding yeast with specific stains in sputum or tissue samples at microscopy is the primary method for diagnosis, while culture is timeconsuming and other methods are unreliable.
We report a case of severe osteoarticular Blastomycosis occurring in a 3-years-old presented to our Emergency Department with pain and swelling of the left knee, successfully treated with surgical curettage and antifungal therapy. To our knowledge this is the first case reported in Europe.
Blastomycosis represents a challenge for European physicians, and it should be included in the differential diagnosis of unexplained infections in patients coming from endemic areas.
由热变形真菌皮炎芽生菌引起的芽生菌病是一种全身化脓性肉芽肿感染，流行于美国和加拿大，在非洲和亚洲报道的病例很少。在儿童和青少年中并不常见，占 3%至 10%。临床表现从无症状的自发性愈合性肺炎，到急性或慢性肺炎，再到恶性肺肿块不等。芽生菌病可在皮肤、骨骼、泌尿生殖道和中枢神经系统引发“转移性疾病”。骨骼是仅次于肺和皮肤的芽生菌病的第三大常见病变部位。骨骼可能在 14-60%的芽生菌病病例中受累。直接观察痰或组织样本中特定染色后的单个宽基出芽酵母是诊断的主要方法，而培养是耗时的，其他方法不可靠。
我们报告了一例 3 岁儿童严重的骨关节炎芽生菌病病例，该患儿因左膝疼痛和肿胀就诊于我们的急诊科，经手术刮除和抗真菌治疗后成功治愈。据我们所知，这是在欧洲首例报告。
芽生菌病对欧洲医生来说是一个挑战，对于来自流行地区的不明原因感染的患者，应将其纳入鉴别诊断。
