Patient Encounter 1 Part 1

A 39-year-old male with chronic steroid-dependent asthma who recently relocated to Phoenix, Arizona presents with a 4-week history of increasing fever, dry cough, and pain upon deep inspiration. He also reports arthralgias and night sweats over the last 3 weeks. A chest radiograph reveals a small area of consolidation in the left lower lobe and some hilar adenopathy. Otherwise, all other routine tests and cultures appear negative.

What are this patient's risk factors for developing an endemic fungal infection? What is the most likely endemic fungal pathogen based on this patient's history? What additional information is needed to select antifungal therapy?

The clinical presentation of blastomycosis covers a wide spectrum ranging from asymptomatic infections to flu-like illness resembling other upper respiratory tract illnesses; to infections resembling bacterial pneumonia with acute onset, high fever, lobar infiltrates, and cough; to subacute or chronic respiratory illness with complex symptoms resembling tuberculosis or lung cancer or fulminant lung infections with high fever, diffuse infiltrates, and an ARDS-like presentation.6 As mentioned previously, the skin is the most common site ofdissemination typically involving sunlight exposed body areas (i.e., nose, face, and arms) and mucous membranes.

Coping with Asthma

Coping with Asthma

If you suffer with asthma, you will no doubt be familiar with the uncomfortable sensations as your bronchial tubes begin to narrow and your muscles around them start to tighten. A sticky mucus known as phlegm begins to produce and increase within your bronchial tubes and you begin to wheeze, cough and struggle to breathe.

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