Stritch School of Medicine, Loyola University Health Systems, Maywood, IL.
Department of Pediatrics, Ronald McDonald Children's Hospital, Loyola University Health Systems, Maywood, IL.
Am J Otolaryngol. 2014 May-Jun;35(3):390-5. doi: 10.1016/j.amjoto.2013.12.013. Epub 2014 Jan 2.
Blastomyces dermatitidis infection of head and neck structures is a rare clinical entity. However, the potential for significant morbidity warrants clinical consideration and timely diagnosis.
To describe the clinical presentations, diagnostic challenges, and outcomes of otolaryngologic blastomycosis.
A literature search of the Pubmed and Ovid databases with the terms "blastomycosis AND. . . " followed by all terms related to anatomical regions of the head and neck.
All publications which discussed pertinent otolaryngologic involvement from blastomycotic infections were evaluated.
The larynx was the most commonly reported site of infection, followed by the oral cavity, neck, ear, nasal cavity/paranasal sinuses, and skull base/orbit/calvarium. Diagnosis of blastomycosis was almost universally delayed due to the resemblance of presentation to more common clinical entities, most notably squamous cell carcinoma. A substantial portion of cases (42%) presented without clinical or radiographic evidence of pulmonary infection. The initial diagnostic confusion often resulted in disease progression and trials of invasive therapies. Most patients experienced complete resolution of symptoms and lesions within months of initiation of proper antifungal medications. Permanent sequelae were relatively uncommon and related to the structures involved in the primary infection.
芽生菌性皮炎感染头颈部结构是一种罕见的临床实体。然而，其具有较高的发病率，因此需要临床关注和及时诊断。
描述耳鼻咽喉芽生菌病的临床表现、诊断挑战和结果。
在 Pubmed 和 Ovid 数据库中使用“blastomycosis AND... ”搜索词，然后使用与头颈部解剖区域相关的所有术语进行搜索。
评估了所有讨论了由芽生菌感染引起的相关耳鼻咽喉科受累的出版物。
喉是最常报道的感染部位，其次是口腔、颈部、耳朵、鼻腔/副鼻窦和颅底/眼眶/颅骨。由于表现与更常见的临床实体（尤其是鳞状细胞癌）相似，芽生菌病的诊断几乎普遍延迟。相当一部分病例（42%）在无临床或影像学肺部感染证据的情况下出现。最初的诊断混淆常常导致疾病进展和侵袭性治疗的尝试。大多数患者在开始适当的抗真菌药物治疗后数月内症状和病变完全缓解。永久性后遗症相对较少，与原发性感染涉及的结构有关。
