Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content + Download Section PDF Listen ++ For further information, see CMDT Part 36-09: Blastomycosis + Key Features Download Section PDF Listen +++ ++ Most often in men infected during outdoor activities Geographically limited to south central and midwestern US and Canada + Clinical Findings Download Section PDF Listen +++ ++ 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 + Diagnosis Download Section PDF Listen +++ ++ 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 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 Download Section PDF Listen +++ ++ 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