50 years of care at the CHUS, 50 years of stories | Zachary

Unable to wear himself on his left ankle and suffering from excruciating pain, Zachary Bournival was admitted to the Hôtel-Dieu in Sherbrooke to undergo surgery to clean up the traces of an infection suspected of being of bacterial origin. However, the pain and fever did not leave him. “On the MRI, we saw even more marked signs of infection, even though he has a standard course of antibiotics that should work in theory,” says Dalila Touati, a resident in microbiology and infectious diseases. A second operation did not bring the expected improvement and Zachary started having chest pain, coughing and coughing up blood. An examination, a pulmonary angioscan, reveals pneumonia.

“We say it's weird, why would he get pneumonia? He only has an ankle infection. Why all of a sudden, he would have pneumonia concurrently. We had to change the focus of our diagnosis! ”, explains Dalila Touati.

The team made up of residents and students, supervised by Dr. Philippe Martin, microbiologist-infectious disease specialist, now suspects the presence of a fungus. “We are doing diagnostic categories to see what's in it Fit and we were very happy to have the diagnosis, it was really like in an episode of Dr. House! ” she underlines with a smile, satisfied to have added a rare case to her learning, because an ankle infection is an atypical presentation of blastomycosis. “For Zachary, it may not be fun, but for us, it's really a good case and we remember a lot of things from it! ”

“Blastomycosis is caused by a fungus found in soils, especially moist soils, where decomposed vegetation is found. It is a fungus that can be breathed in and it can, among other things, infect the lungs,” explains the head of the microbiology department at the CIUSSS de l'Estrie - CHUS, Dr. Martin, who adds that this fungus, Blastomyces dermatitidis, is very present in the region and that cases of infection are more frequently diagnosed in Estrie than elsewhere in Quebec.

“The entire large team at CIUSSS, doctors and laboratory staff, now has expertise that is probably unique in the world,” says Dr. Martin.

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Microbiologists-infectious diseases, pneumologists, radiologists, radiologists, dermatologists and pathologists have developed their reflexes, here in Sherbrooke, to suspect and diagnose blastomycosis, which can be confused with, sometimes lung cancer, sometimes a skin or musculoskeletal problem. “There are various clinical presentations that can go from an asymptomatic infection to a pneumonia that leads to intensive care. We have had people who unfortunately died of blastomycosis, so it is an infection that can be very severe if we do not intervene in time,” explains the microbiologist-infectious disease specialist.

How to prevent?

“It's quite difficult because we don't know exactly where this mushroom is. We know that it is in wooded areas and soils,” explains Dr. Martin. A gardening session or a walk in the forest can be the source of such an infection, adds the specialist, who indicates that one should not help but consult if a cough sets in or if a wound on the skin does not heal.

“Currently, I would tell you that we don't really have any preventive measures, it's more a question of early diagnosis”, he concludes.

Reassuring care

Zachary stayed in the hospital for two weeks. “It's really weird to say, but I enjoyed my experience! I felt supported throughout the diagnosis process,” says the young man, who considers himself lucky to have fallen into the hands of specialists and an entire healthcare team on the lookout for the smallest signs. “It was worrying, but I felt reassured. I saw residents, doctors, nurses, attendants...” Zachary gladly submitted himself to numerous questions to help the staff see more clearly.

“They did their part, I'm going to do mine,” he said before leaving the hospital. I will be assiduous in my treatment.” Blastomycosis requires antifungal treatment for up to a year and sometimes longer.

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