II. Etiology
- Blastomyces dermatidis
III. Pathophysiology
- Transmitted by exposure to contaminated soil or decomposing timber
- Inhalation of spores
- Traumatized, non-intact skin exposure (see Cutaneous Blastomycosis)
- Endemic regions of United States
- Ohio River Basin
- Mississippi River Basin
- Great Lakes
- St. Lawrence River
IV. Symptoms
- Pulmonary involvement is initially asymptomatic in 50% of cases
- Fever
- Sweating
- Cough
- Nocturnal Joint Pain
V. Signs
VI. Imaging: Chest XRay of Chronic Blastomycosis
- Test Sensitivity: 66%
- Osteolytic lesions
VII. Lab
- Microscopy
- Broad-based budding
- Skin lesion Evaluation
- Pustular discharge for Potassium Hydroxide
- Skin biopsy
- See Cutaneous Blastomycosis
- Systemic disease
VIII. Management
- Progressive, refractory, or severe disease or Central Nervous System involvement
- Amphotericin B 0.5-0.6 mg/kg daily (MAX 2.0 - 2.5g)
- Indolent disease
- Adults: Itraconazole 200 mg orally daily for 6 months
- Children and Pregnant women: Amphotericin B at dosing above
IX. Course
- Incubation: 30-45 days