Over the course of a year, a man’s voice grew hoarse and his speech shrill and abrasive, but he didn’t know why.
When examining the man, doctors discovered the reason: fungus was growing in his throat.
According to the report of the man’s case, published Thursday (Aug. 4) in the magazine JAMA Otolaryngology–Head and Neck Surgerythe man appeared otherwise healthy when he attended a Pennsylvania clinic that treats head and neck conditions.
The man, in his 60s, reported that he had developed “a progressively worsening hoarseness” and shortness of breath over the past 12 months. His GP had previously treated him with inhaled corticosteroids – a standard treatment for asthma – but his symptoms had not improved.
To examine the man’s vocal folds and larynx, the hollow “voice box” that holds the vocal folds, doctors used a rapid imaging technique called videothroboscopy. This examination revealed a “severe” swelling in the tissue lining the patient’s throat, and this swelling had narrowed the airway.
The doctors also biopsied tissue from the man’s larynx and confirmed that the tissue was swollen, irregular and “friable” to the touch, meaning it tore easily.
A close-up examination of the sampled tissue revealed patches of dead laryngeal cells surrounded by clusters of immune cells, indicating that the cells had died from intense inflammation in the throat. The study also revealed budding yeast cells, which had surrounded and engulfed the immune cells.
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A diagnostic test identified the yeast as: Blastomyces dermatitidisa fungus that causes an infection called blastomycosis.
B. dermatitis grows in outdoor environments, usually in moist soil and decomposing wood and leaves, according to the Centers for Disease Control and Prevention (CDC).
In the US, the species is mainly found in areas around the Ohio and Mississippi River valleys, the Great Lakes, and the St. Lawrence River.
Humans can develop blastomycosis after inhaling B. dermatitis spores float in the air, although most people exposed to the fungus do not get sick.
Having a weakened immune system increases the risk of infection, and those who get sick usually develop symptoms between three weeks and three months after inhaling the fungal spores.
Sometimes the infection can spread to the lungs, skin, bones or central nervous system, meaning the brain and spinal cord, according to the CDC.
In the man’s case, the fungus only grew in his larynx, which is quite unusual. “Laryngeal blastomycosis, first reported in 1918, is a rare extrapulmonary manifestation,” his doctors noted in the case report.
Due to the man’s significant airway obstruction, he underwent surgery that involved placing a breathing tube in his windpipe and a feeding tube in his stomach. He was given a long-term prescription for the antifungal drug itraconazole, and at a two-month follow-up appointment, his hoarseness had significantly improved and his feeding tube was removed.
At a five-month follow-up, video stroboscopy showed that the swelling in the man’s throat had decreased and his vocal folds had regained some mobility. At this point, his breathing tube was also removed.
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This article was originally published by Live Science. Read the original article here.
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