eMedicine Specialties > Pulmonology > Infectious Lung Diseases

Blastomycosis: Follow-up

Author: Basil Varkey, MD, FCCP, Professor, Department of Internal Medicine, Division of Pulmonary and Critical Care, Medical College of Wisconsin; Consulting Pulmonologist, Froedtert Memorial Lutheran Hospital
Coauthor(s): Gregory J Raugi, MD, PhD, Professor, Department of Internal Medicine, Division of Dermatology, University of Washington at Seattle; Chief, Dermatology Section, Primary and Specialty Care Service, Veterans Administration Medical Center of Seattle
Contributor Information and Disclosures

Updated: May 21, 2008

Follow-up

Further Inpatient Care

  • The need for inpatient and ICU care is based on the acuity and pace of the disease progression as well as the immune status of the patient.
  • Admit severely and progressively ill patients to the ICU, including those with ARDS.
  • Inpatient care often is needed for workup and treatment of blastomycosis presenting as an undiagnosed pneumonia, for pleural effusion, and for extrapulmonary involvement.
  • Perform initial treatment of amphotericin B in an inpatient setting, preferably.

Further Outpatient Care

  • Complete treatment in an outpatient setting.
  • Consider giving amphotericin B through an indwelling central venous line in an observation room with a trained staff.

Prognosis

Miscellaneous

Medicolegal Pitfalls

  • Failure to diagnose and failure to diagnose in a timely manner are 2 major areas with medicolegal implications. Blastomycosis is a disease that can be mistaken for more common diseases listed in the Differential Diagnosis section.
  • Consider this diagnosis in any patient with pneumonia that is not resolving. Blastomycosis may present as a community-acquired pneumonia.
  • In endemic areas, consider blastomycosis as a cause of ARDS.
  • Be cognizant of the extrapulmonary manifestations in general and the propensity of blastomycosis to mimic carcinoma.
 


More on Blastomycosis

Overview: Blastomycosis
Differential Diagnoses & Workup: Blastomycosis
Treatment & Medication: Blastomycosis
Follow-up: Blastomycosis
Multimedia: Blastomycosis
References
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References

  1. Rooney PJ, Sullivan TD, Klein BS. Selective expression of the virulence factor BAD1 upon morphogenesis to the pathogenic yeast form of Blastomyces dermatitidis: evidence for transcriptional regulation by a conserved mechanism. Mol Microbiol. Feb 2001;39(4):875-89. [Medline].

  2. Klein BS, Vergeront JM, Weeks RJ, Kumar UN, Mathai G, Varkey B, et al. Isolation of Blastomyces dermatitidis in soil associated with a large outbreak of blastomycosis in Wisconsin. N Engl J Med. Feb 27 1986;314(9):529-34. [Medline].

  3. Pappas PG, Threlkeld MG, Bedsole GD, Cleveland KO, Gelfand MS, Dismukes WE. Blastomycosis in immunocompromised patients. Medicine (Baltimore). Sep 1993;72(5):311-25. [Medline].

  4. Pappas PG, Pottage JC, Powderly WG, Fraser VJ, Stratton CW, McKenzie S, et al. Blastomycosis in patients with the acquired immunodeficiency syndrome. Ann Intern Med. May 15 1992;116(10):847-53. [Medline].

  5. Meyer KC, McManus EJ, Maki DG. Overwhelming pulmonary blastomycosis associated with the adult respiratory distress syndrome. N Engl J Med. Oct 21 1993;329(17):1231-6. [Medline].

  6. Sugar AM, Liu XP. Efficacy of voriconazole in treatment of murine pulmonary blastomycosis. Antimicrob Agents Chemother. Feb 2001;45(2):601-4. [Medline].

  7. Abuodeh RO, Chester EM, Scalarone GM. Comparative serological evaluation of 10 Blastomyces dermatitidis yeast phase lysate antigens from different sources. Mycoses. Apr 2004;47(3-4):143-9. [Medline].

  8. Chapman SW, Bradsher RW Jr, Campbell GD Jr, Pappas PG, Kauffman CA. Practice guidelines for the management of patients with blastomycosis. Infectious Diseases Society of America. Clin Infect Dis. Apr 2000;30(4):679-83. [Medline].

  9. Davies SF, Sarosi GA. Epidemiological and clinical features of pulmonary blastomycosis. Semin Respir Infect. Sep 1997;12(3):206-18. [Medline].

  10. Varkey B. Blastomycosis in children. Semin Respir Infect. Sep 1997;12(3):235-42. [Medline].

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Further Reading

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Keywords

blastomycosis, Gilchrist disease, Gilchrist's disease, fungal infection, fungus infection, Blastomyces dermatitidis, B dermatitidis, pulmonary infection, adult respiratory syndrome, ARDS, antifungal treatment

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Contributor Information and Disclosures

Author

Basil Varkey, MD, FCCP, Professor, Department of Internal Medicine, Division of Pulmonary and Critical Care, Medical College of Wisconsin; Consulting Pulmonologist, Froedtert Memorial Lutheran Hospital
Basil Varkey, MD, FCCP is a member of the following medical societies: American Association of Physicians of Indian Origin, American College of Chest Physicians, American Federation for Clinical Research, American Thoracic Society, and Royal College of Physicians
Disclosure: Nothing to disclose.

Coauthor(s)

Gregory J Raugi, MD, PhD, Professor, Department of Internal Medicine, Division of Dermatology, University of Washington at Seattle; Chief, Dermatology Section, Primary and Specialty Care Service, Veterans Administration Medical Center of Seattle
Gregory J Raugi, MD, PhD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.

Medical Editor

Michael Peterson, MD, Chief of Medicine, Vice-Chair of Medicine, University of California at San Francisco; Endowed Professor of Medicine, University of California at San Francisco-Fresno
Michael Peterson, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, and American Thoracic Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Robert S Crausman, MD, MMS, Chief Administrative Officer, Rhode Island Board of Medical Licensure and Discipline, Rhode Island Department of Health; Associate Professor, Department of Medicine, Brown University School of Medicine
Robert S Crausman, MD, MMS is a member of the following medical societies: American College of Chest Physicians and American College of Physicians
Disclosure: Nothing to disclose.

CME Editor

Timothy D Rice, MD, Associate Professor, Departments of Internal Medicine and Pediatrics and Adolescent Medicine, Saint Louis University School of Medicine
Timothy D Rice, MD is a member of the following medical societies: American Academy of Pediatrics and American College of Physicians
Disclosure: Nothing to disclose.

Chief Editor

Zab Mosenifar, MD, Director, Division of Pulmonary and Critical Care Medicine, Director, Women's Guild Pulmonary Disease Institute, Executive Vice Chair, Department of Medicine, Cedars Sinai Medical Center; Professor of Medicine, David Geffen School of Medicine at UCLA
Zab Mosenifar, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, American Federation for Medical Research, and American Thoracic Society
Disclosure: Nothing to disclose.

 
 
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