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Blastomycosis: Symptoms, Causes, and Treatment

Overview

Blastomycosis is an endemic fungal infection caused by Blastomyces dermatitidis (and B. gilchristii), found in moist soil, decaying wood, and near waterways (Great Lakes, Ohio/Mississippi River valleys).

Transmission

Inhalation of conidia (spores) → conversion to yeast at body temperature → primary pulmonary infection → hematogenous dissemination.

Clinical Manifestations

  • Pulmonary (50–75%): Cough, fever, weight loss, hemoptysis; mimics TB, cancer, pneumonia
  • Cutaneous (25–40%): Verrucous or ulcerative lesions, often on face and extremities
  • Osteoarticular (25%): Lytic bone lesions, septic arthritis
  • Genitourinary: Prostatitis, epididymitis
  • CNS: Rare; meningitis, brain abscess

Risk Factors

  • Immunocompromise (HIV, transplant, TNF inhibitors)
  • Outdoor exposure in endemic areas
  • Age 30–50, male predominance

Diagnosis

  • Culture (gold standard; 2–4 weeks)
  • Antigen detection (urine, serum; rapid, sensitive)
  • Microscopy: broad-based budding yeast
  • PCR, serology (supportive)

Treatment

  • Mild to moderate pulmonary: Itraconazole 200 mg twice daily × 6–12 months
  • Severe or disseminated: Liposomal amphotericin B → step-down to itraconazole for ≥12 months
  • CNS: Amphotericin B + azole; prolonged course

Not contagious person-to-person. Early diagnosis improves outcomes.

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