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Key Features

  • Most often in men infected during outdoor activities

  • Geographically limited to south central and midwestern US and Canada

Clinical Findings

  • Chronic pulmonary infection most common; may be asymptomatic

  • Cough, fever, dyspnea, chest pain; may resolve or progress, with purulent sputum, pleurisy, fever, chills, weight loss, prostration

  • When disseminated, lesions mostly affect skin, bones, urogenital system

  • Raised, verrucous cutaneous lesions commonly present in disseminated disease

  • Bone lesions often in ribs and vertebrae

  • Epididymitis, prostatitis, and other involvement of the male urogenital system

  • CNS involvement uncommon

  • In HIV-infected persons, disease may progress rapidly; dissemination common

Diagnosis

  • Leukocytosis and anemia

  • Chest radiograph or CT scan: lobar consolidations or masses

  • Clinical specimen: organism is a thick-walled cell 5–20 mcm in diameter; may have single broad-based bud. Blastomyces grows readily on culture

  • Serum enzyme immunoassay based on the surface protein BAD-1

    • Has better sensitivity and specificity than urinary antigen test

    • Not yet commercially available

  • A urinary antigen test is available

    • Has considerable cross reactivity with other dimorphic fungi

    • May be useful in monitoring disease resolution or progression

Treatment

  • Itraconazole, 200–400 mg orally once daily for at least 6–12 mo, for non–life-threatening, non-CNS disease; response rate of > 80%

  • Liposomal amphotericin B, 3–5 mg/kg/day intravenously, is given initially for severe disease, treatment failures, or CNS involvement

  • Monitor patients several years for relapse

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