Last reviewed: November 2017
Last updated: July  2017

Summary

Definition

History and exam

Key diagnostic factors

  • primary skin lesion
  • nodular lymphangitis lesions

Other diagnostic factors

  • respiratory symptoms
  • joint swelling/erythema
  • male 30 to 60 years old
  • fever
  • lymphadenopathy
  • meningitis-like symptoms

Risk factors

  • trauma to the skin
  • outdoor occupation/hobbies
  • animal bites and scratches
  • alcoholism
  • diabetes mellitus
  • AIDS
  • COPD
  • corticosteroid treatment
  • chemotherapy in patients with hematologic malignancy
  • hematopoietic stem cell/solid organ transplantation
  • TNF-alpha inhibitor therapy

Diagnostic investigations

1st investigations to order

  • skin lesion fungal culture
  • skin lesion histopathology (Gomori methenamine silver, periodic acid-Schiff staining)
  • CBC
  • ESR
  • joint x-ray
  • fungal culture of arthrocentesis synovial fluid
  • sputum or bronchoalveolar lavage (BAL) fungal culture
  • lumbar puncture for CSF analysis
  • CSF fungal culture
  • fungal blood culture
Full details

Investigations to consider

  • synovial tissue biopsy for fungal culture
  • synovial tissue histopathology (Gomori methenamine silver, periodic acid-Schiff staining)
  • bronchial biopsy fungal culture
  • bronchial biopsy histopathology
  • CXR
  • CT of chest
  • serum itraconazole levels
  • serum BUN
  • serum creatinine
  • LFTs
Full details

Emerging tests

  • serologic testing
  • immunohistochemical staining
  • PCR
Full details

Treatment algorithm

Contributors

Authors VIEW ALL

Chief

Fungal Pathogenesis Unit

Laboratory of Clinical Infectious Diseases

National Institutes of Allergy and Infectious Diseases

National Institutes of Health

Bethesda

MD

Disclosures

ML declares that he has no competing interests.

Chief

Clinical Mycology Section

Laboratory of Clinical Infectious Diseases

National Institute of Allergy and Infectious Diseases

National Institutes of Health

Bethesda

MD

Disclosures

JEB declares that he has no competing interests.

Peer reviewers VIEW ALL

Professor of Internal Medicine/Infectious Diseases

University of Crete

Department of Internal Medicine

Gallos University Campus

Crete

Greece

Disclosures

GS declares that he has no competing interests.

Assistant Clinical Professor of Dermatology and Pathology

University of Iowa

Iowa City

IA

Disclosures

BLS declares that he has no competing interests.

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