PATHOGENIC FUNGI EMERGING DISEASE CASE STUDY Pulmonary Blastomycosis Phil was glad he had spent the summer fishing, hiking, and camping in western Ontario. Canada is beautiful, and he had needed time off from his two jobs and full schedule of nursing classes. Now he was back in college, and remembrances of Canada were helping him cope with the stress. However, Phil didn't feel well. He thought he was coming down with the flu-fever and chills, shivering and coughing, muscle aches, tiredness, a general feeling of yuckiness, and no runny nose; yes, it must be the flu. Or was it? He knew from microbiology class that many diseases of bacteria, protozoa, and viruses have flulike symptoms. Phil had forgotten fungi. Phil tried every over-the-counter remedy, to no avail. He tried the health clinic on campus, but the antibiotics he received made things worse, not better. He was losing weight, and pus-filled, raised sores had appeared on his face, neck, and legs. More However, are windstorms and earthquakes, alarming: his testes were swollen and aching This was getting serious Blastomyces, an emergent, dimorphic fungus, was attacking Phil. Inhaled spores from hyphae growing on wet leaves primarily in Wisconsin and Ontario had germinated in Phil's lungs. The yeast phase was multiplying and spreading throughout his body, producing skin lesions that lasted for months, finally resolving into raised, wartlike scars. Researchers don't know why reports of blastomycosis are becoming more prevalent. Perhaps it has to do with better diagnosis and reporting, perhaps it has to do with a growing number of AIDS patients who are susceptible to infection, or perhaps it has to do with more people like Phil adventuring into the wilderness. The good news is that with proper diagnosis, Phil got the treatment he needed-itraconazole for six months. He graduated, and now he is a nurse who knows that Bulike symptoms can sometimes indicate serious fungal infection. (For more about pulmonary blastomycosis, see p. 644) 1. Blastomyces is dimorphic; what does this adjective mean? 2. Why does AIDS increase the incidence of blastomycosis? 3. Given that Blastomyces is a mold that grows on dead leaves, how does it cause disease in people