Search

Four cases of blastomycosis seen in two acute care hospitals in Harare, Zimbabwe, are described. All patients had symptoms of at least 2 months' duration before presentation, and all had radiographic evidence of pulmonary consolidation. Three patients had confirmed bone involvement, and two had chronic discharging sinuses. The features of blastomycosis in Africa are reviewed, and problems of diagnosis and treatment are discussed. It is concluded that blastomycosis in Africa may often be misdiagnosed as tuberculosis or pyogenic infection in the absence of adequate facilities for mycologic investigation.

A case of histoplasmosis duboisii in a 30 year-old engineer is presented. The diagnosis was made with the help of light microscopy, electron microscopy and cultures. Although diagnosed in Chile, the patient probably acquired the disease in the endemic African area, more precisely in the Ivory Coast. Differential diagnosis between Histoplasma capsulatum var. capsulatum and Histoplasma capsulatum var. duboisii is based primarily on the larger in-vivo yeast form size of the latter. Electron microscopy study, the first done on the duboisii variety of Histoplasma capsulatum in human material to our knowledge, was not essential for this purpose. Differential diagnosis between Histoplasma capsulatum var. duboisii and Blastomyces dermatitidis is based on morphological tissue changes and mycologic characteristics. Once more, a case of an "exotic" or geographically restricted disease is detected far from its endemic area, thanks to easier means of transportation. Earth is a shrinking planet.

The most common systemic mycoses imported into France are the histoplasmosis caused by H. capsulatum, which comes from Black Africa and from the French overseas departments and territories (Guyane, Martinique, Guadeloupe, New Caledonia), and the histoplasmosis caused by the larger H. duboisii, which is exclusively Central African. In recent years, histoplasmosis has become an opportunistic infection in immunocompromised patients, particularly those with AIDS. Blastomycosis, imported from North America as well as from North Africa and Central Africa, and paracoccidioidomycosis, imported from Latin America, are pulmonary mycoses with cutaneous manifestations on the face and extremities and with various deep localizations which often follow a chronic course. Coccidioidomycosis, strictly limited to the desertic regions in the western part of the American continent, is also a pulmonary mycosis with multiple granulomas in the skin, bones, lymph nodes and meninges. Penicilliosis caused by Penicillium marneffei is a mycosis from South-East Asia which has recently been observed in European AIDS patients who had travelled in that part of the world.