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For further information, see CMDT Part 36-09: Blastomycosis
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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
With disseminated, lesions most frequently occur in 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
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Leukocytosis and anemia
Chest radiograph or CT scan: lobar consolidations or masses
Clinical specimen: organism is a 5–20 mcm thick-walled cell; may have single broad-based bud. Blastomyces grows readily on culture
Serum enzyme immunoassay based on the surface protein BAD-1
A urinary antigen test is available
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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