Blastomycosis Treatment & Management

  • Author: Basil Varkey, MD, FCCP; Chief Editor: Zab Mosenifar, MD   more...
 
Updated: Feb 8, 2011
 

Medical Care

Patients with a subclinical disease (presence of serologic or other markers without symptoms) can be observed and do not require antifungal treatment. All patients with clinical manifestations of blastomycosis require treatment; specifics are discussed Medication.

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Consultations

Since blastomycosis is rarely encountered, it is advisable for primary care physicians to seek consultation from a physician more experienced with this disease. In cases with extrapulmonary involvement, consult a specialist (pulmonologist or infectious disease specialist) for diagnosis and treatment recommendations.

Consult a pulmonologist or an intensivist for blastomycosis that presents with or develops ARDS.

Surgical consultation may be needed for a tissue biopsy, but only rarely for adjunctive surgical treatment (eg, evacuation of a joint abscess, pleural empyema). Alert the microbiologist to the possibility of blastomycosis before sending any specimen to the laboratory.

Consultation with a dermatologist may facilitate making the diagnosis by recognition of typical skin lesions, aspiration or expression of microbiologically diagnostic pus, or skin biopsy.

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Contributor Information and Disclosures
Author

Basil Varkey, MD, FCCP  Professor Emeritus, 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 and American College of Chest 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 School of Medicine; 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.

Specialty Editor Board

Michael Peterson, MD  Chief of Medicine, Vice-Chair of Medicine, University of California, San Francisco, School of Medicine; Endowed Professor of Medicine, University of California, San Francisco-Fresno, School of Medicine

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.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Timothy D Rice, MD  Associate Professor, Departments of Internal Medicine and Pediatrics and Adolescent Medicine, St 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, Professor and Executive Vice Chair, Department of Medicine, Cedars Sinai Medical Center, University of California, Los Angeles, David Geffen School of Medicine

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.

References

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  3. 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].

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  10. Durkin M, Witt J, Lemonte A, Wheat B, Connolly P. Antigen assay with the potential to aid in diagnosis of blastomycosis. J Clin Microbiol. Oct 2004;42(10):4873-5. [Medline]. [Full Text].

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  12. Chapman SW, Dismukes WE, Proia LA, et al. Clinical practice guidelines for the management of blastomycosis: 2008 update by the Infectious Diseases Society of America. Clin Infect Dis. Jun 15 2008;46(12):1801-12. [Medline].

  13. Lentnek AL, Lentek IA. Successful management of Blastomyces dematitidis meningitis. Infect Med. 2006;23:39.

  14. Lutsar I, Roffey S, Troke P. Voriconazole concentrations in the cerebrospinal fluid and brain tissue of guinea pigs and immunocompromised patients. Clin Infect Dis. Sep 1 2003;37(5):728-32. [Medline].

  15. Wuthrich M, Warner T, Klein BS. IL-12 is required for induction but not maintenance of protective, memory responses to Blastomyces dermatitidis: implications for vaccine development in immune-deficient hosts. J Immunol. Oct 15 2005;175(8):5288-97. [Medline].

 
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