Blastomycosis

Most often in men infected during outdoor activities

Geographically limited to south central and midwestern US and Canada

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

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

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