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    Ep 125 Blastomycosis: How fungus became amongus

    enSeptember 19, 2023

    Podcast Summary

    • First recorded case of blastomycosis in man in 1896The first recorded case of blastomycosis in man in 1896 marked the beginning of research into this overlooked field of medical mycology caused by the fungus Blastomyces dermatitidis, which can present with non-specific symptoms and is often difficult to diagnose.

      The first recorded case of blastomycosis in man was reported by T.C. Gilchrist in 1896. This case, which presented as chronic scrofuloderma, contained curious bodies that appeared to be parasites, but could not be definitively linked to the tubercle bacillus. These bodies, later identified as blastomycetes, were the first description of what we now know as the causative agents of blastomycosis. The case generated significant interest, as similar bodies had previously only been observed in animals. Gilchrist expressed the opinion that these bodies were of plant origin, and further examination supported this conclusion. Blastomycosis is a disease caused by the fungus Blastomyces dermatitidis, and the first recorded case in man marked the beginning of research into this overlooked field of medical mycology. The disease can present with a variety of symptoms, and can be difficult to diagnose due to its non-specific signs and symptoms. Despite its significant burden of disease, medical mycology remains an overlooked field, with many fungal diseases receiving little attention.

    • Thermally dimorphic fungus Blastomyces gilchristiae causes disease in humans and animalsBlastomyces gilchristiae transforms into a yeast form in warmer hosts, evading the immune system and reproducing effectively. Upregulated genes help the yeast stick to cells and inhibit the immune response.

      Blastomyces gilchristiae is a thermally dimorphic fungus causing disease not only in humans but also in various animals and even marine life. It exists as a mold in the environment and transforms into a yeast form when it enters a warmer host, such as humans. This dimorphism allows the fungus to evade the host's immune system and reproduce effectively. The transformation process also involves the upregulation of genes that help the yeast stick to cells and inhibit the host's immune response. Blastomycosis is just one of many thermally dimorphic fungi of medical importance, and understanding this unique characteristic can provide valuable insights into the infection process and potential treatment strategies.

    • Understanding Blastomycosis: A Complex and Often Misunderstood Fungal InfectionBlastomycosis is a fungal infection affecting anyone, with half developing symptoms ranging from mild to severe. Diagnosis is challenging due to delayed symptoms and similarities to other infections. Environmental sources are unknown, making exposure timelines difficult to determine.

      Blastomycosis is a fungal infection that can affect anyone, not just those with compromised immune systems. About half of those exposed will develop symptoms, which can range from mild pulmonary infections to severe cases like acute respiratory distress syndrome. Symptoms can take weeks to months to appear and can be hard to distinguish from other infections due to similar symptoms and x-ray appearances. Diagnosis is challenging due to these factors, and there's no clear answer on whether the infection can spontaneously resolve. The environmental sources of the fungus are not well characterized, making it difficult to pinpoint exposure timelines. Overall, blastomycosis is a complex and often misunderstood infection.

    • Blastomycosis: A Fungal Infection with Deadly ConsequencesBlastomycosis is a fungal infection that can cause lung infection, skin lesions, bone infections, genitourinary infections, and central nervous system infections. It can be difficult to diagnose and requires prolonged antifungal therapy. If it progresses to acute respiratory distress syndrome or disseminates to other organs, it can be fatal.

      Blastomycosis is a fungal infection that can affect various parts of the body, including the lungs, skin, bones, genitourinary system, and central nervous system. The lung infection can progress to acute respiratory distress syndrome, which has a high mortality rate. Once the fungus transforms into its yeast form, it can disseminate through the body, leading to skin lesions, bone infections, genitourinary infections, and central nervous system infections. The infection can be difficult to diagnose due to non-specific x-ray findings, and treatment is prolonged and requires months of antifungal therapy. It's important to note that blastomycosis is not limited to endemic areas and can occur anywhere. The infection can be fatal, especially if it progresses to acute respiratory distress syndrome or if it disseminates to other organs.

    • A complex and challenging disease: BlastomycosisBlastomycosis is a difficult-to-diagnose and treat fungal infection that can affect the brain and bones, causing symptoms ranging from mild to severe. Diagnosis is often challenging due to similarities to pneumonia, and treatment may involve antifungals and careful monitoring.

      Blastomycosis is a difficult-to-diagnose and difficult-to-treat fungal infection that can lead to central nervous system involvement. The symptoms can range widely, from headaches and confusion to seizures and visual disturbances. The infection can spread through the bloodstream or from a bone infection in the skull. While antifungals can help, their effectiveness may depend on the severity and location of the infection. The disease can affect both immunocompetent and immunocompromised individuals. Early diagnosis is challenging due to the infection's similarity to pneumonia, and testing depends on the region and severity of the infection. Some people may be able to clear the infection on their own, but it's essential to consider that many cases go undiagnosed. The gold standard for diagnosis is still culture, which can take weeks, but PCR-based testing is becoming more common and can test for multiple pathogens at once. Overall, Blastomycosis is a complex and challenging disease that requires careful monitoring and treatment.

    • Understanding Fungal Infections in HumansDespite being less common, fungal infections in humans can be serious and require understanding of the unique ways fungi overcome our immune systems to cause disease. Few hundred pathogenic fungi exist, but research and attention are lacking, leading to underestimation of global burden.

      Fungal infections in humans are less common compared to bacterial and viral infections due to our warm-bloodedness and robust immune systems. Fungi are mostly adapted to living in cooler environments, making it challenging for them to infect warm-blooded mammals like humans. Despite the vast number of estimated fungal species on Earth, only a few hundred are known to be pathogenic to humans and other mammals. The lack of research and media attention on fungal pathogens contributes to an underestimation of the global burden of fungal infections in humans. However, those fungi that do infect humans have unique ways of overcoming our immune systems and thriving in our bodies. Understanding the biology of these fungal pathogens and the mechanisms they use to cause disease can lead to the development of new diagnostic tools and treatments.

    • Body temperature regulation strategies for endotherms vs ectothermsEndotherms maintain body temperature internally, while ectotherms rely on their environment. Ectotherms are more susceptible to fungal infections due to temperature matching, but endothermy comes with costs like high energy consumption and frequent feeding. Advantages of endothermy include thermoregulation, enhanced aerobic capacity, and parental care.

      Body temperature regulation strategies differ significantly between endotherms (warm-blooded animals) and ectotherms (cold-blooded animals). Endotherms maintain their body temperature internally, while ectotherms rely on their environment. Ectotherms, such as reptiles, amphibians, and fish, are more susceptible to fungal infections due to their body temperatures closely matching the environment. However, being endothermic comes with costs, including high energy consumption and the need for frequent feeding. The leading hypotheses for the evolution of endothermy suggest advantages in thermoregulation, enhanced aerobic capacity, and parental care. These hypotheses may not be mutually exclusive, and ongoing research continues to explore the interplay among these factors.

    • The role of fungal infections in the rise of mammalsThe fungal infection hypothesis suggests that mammals survived the Cretaceous Paleogene extinction event due to their ability to regulate body temperature and protect embryos from fungal diseases, providing a survival advantage over ectothermic animals.

      The fungal infection mammalian selection hypothesis suggests that the massive fungal bloom following the Cretaceous Paleogene extinction event played a significant role in the rise of mammals. The hypothesis posits that ectothermic animals, which were already struggling due to the cooling planet and ecological collapse, were further weakened by their inability to fight off fungal infections. Endothermic mammals, on the other hand, were better equipped to regulate their body temperature and protect their embryos from fungal diseases, giving them a survival advantage. This hypothesis is still debated, but it offers an intriguing explanation for the dominance of mammals in the post-extinction world.

    • Fungal infections in endotherms and ectothermsDespite endotherms' advantages, fungi with specific traits can cause major health issues and millions of infections, resulting in thousands of deaths annually. Further research is needed to understand the complex relationship between fungi, parasitism, and ecosystem dynamics.

      The ability of endotherms (warm-blooded organisms) to maintain their body temperature and specialized immune systems offers some protection against fungal infections. However, fungi possessing specific traits, such as thermotolerance and the ability to adapt to varying oxygen levels, can still cause massive global health issues, including millions of infections and hundreds of thousands of deaths annually. These fungi often thrive in soil environments and can be opportunistic or accidentally infect humans. The exact evolutionary relationship between fungal traits and human pathogenicity is still a topic of debate. Regardless, it's crucial to acknowledge the significant impact fungal infections have on ecosystems and human health. The conversation also touched upon the potential survival strategies of ectotherms (cold-blooded organisms) during periods of fungal blooms. The speakers encouraged further research in this area to better understand the complex relationship between fungi, parasitism, and ecosystem dynamics.

    • Blastomyces: A Fungus with Unique TraitsBlastomyces, first identified as a human pathogen in the late 1800s, exhibits unique traits like morphological shifts and potential interactions with other microbes, expanding our understanding of fungal infections and their ecological niches.

      Blastomyces, a medically relevant fungus, exhibits unique traits that help it evade host immune responses and thrive in various ecosystems. These traits include morphological shifts and potential interactions with other microbes. The history of Blastomyces shows that it was one of the first identified fungal infections in humans, with cases likely occurring long before its discovery in the late 1800s. Despite early misconceptions about its nature, Blastomyces was eventually recognized as a fungus and not a plant or parasite. Its distribution and impact on human health have since expanded our understanding of its ecological niches and the importance of considering fungal infections in a broader context.

    • Understanding the elusive ecology of BlastomycosisBlastomycosis is a deadly fungal infection with a complex ecology, primarily found in the Midwest, Southeast, East, and South Central US, and linked to rotting wood and freshwater. Despite effective antifungal drugs, it can be fatal, and its prevalence is underreported due to non-mandatory reporting.

      Blastomycosis is a deadly fungal infection with a currently incomplete understanding of its ecology. The fungus is believed to reside near rotting wood and freshwater, but its reliable isolation from environmental sources has been a challenge. The disease is most commonly found in the Midwest, Southeast, East, and South Central US, and has also been reported in Africa and India, although cases are rare. The vast majority of cases are sporadic, but some occupations or situations have led to outbreaks. Blastomycosis is not a reportable disease in most areas where it is endemic in the US, leading to limited data on its prevalence. Despite the introduction of effective antifungal drugs, the disease can be deadly, with a case fatality rate of 100% prior to their use. The ecology of Blastomycosis is still not fully understood, and the impact of climate change on the growth and distribution of the fungus is a concern.

    • Fungal Disease Blastomycosis Linked to Environmental Factors and Climate ChangeBlastomycosis is a fungal disease that primarily affects mammals, including humans, and its epidemiology is linked to environmental factors. With climate change, there's a concern that the disease's range and distribution may expand, leading to potential outbreaks and increased infection rates.

      Blastomycosis is a fungal disease that primarily affects mammals, including humans, and its epidemiology is linked to environmental factors, particularly in areas with high case numbers like parts of Ontario, Wisconsin, and Villas County. The disease can lead to significant outbreaks, as seen in a paper mill in Michigan in 2023, which resulted in over 100 cases and one death. The disease's seasonality is linked to autumn and spring, with lower infection rates during colder winter months. However, with climate change, there is a concern that the disease's range and distribution may expand, and overall infection rates may rise. Blastomycosis is just one of several fungal diseases that may be impacted by climate change, and its potential effects on human and animal health, as well as wildlife, are significant. The disease is transmitted through inhalation of spores and can infect a wide range of mammals, making it a fascinating area of study. The ongoing research on outbreaks like the one in Michigan will likely provide valuable insights into the disease's environmental exposure, infectious dose, and other factors.

    • Exploring the World of Blastomycosis: Evolution, Pathogenesis, and Clinical ImplicationsThree key works discuss Blastomycosis's role in mammalian evolution, fungi's pathogenic traits, and the infection's history and clinical aspects.

      Blastomycosis, a fungal infection, has been a topic of interest for researchers due to its impact on human health and the intricacies of its biology. Three specific works stand out: "Updating the Fungal Infection Mammalian Selection Hypothesis at the end of the Cretaceous Period" by Casa Duvall and Damon (2020), "Evolution of the Human Pathogenic Lifestyle and Fungi" by Rokas (2022), and "Blastomycosis" by Al Dore and DeSalvo (2012). These works cover various aspects of Blastomycosis, from its potential role in shaping mammalian evolution to the traits that make fungi pathogenic to humans, and the history of its discovery. Other works provide broader overviews of the infection and its clinical manifestations and treatment. These sources, along with many others, can be found on the podcast's website, thispodcastwillkillyou.com. The importance of understanding Blastomycosis is underscored by its potential impact on public health and the ongoing research to better understand its mechanisms and potential prevention strategies.

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