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Blastomycosis — Clinical Guidelines

Overview

Blastomycosis is a fungal infection caused by Blastomyces dermatitidis, typically affecting the lungs and disseminating to other organs. It can present with pulmonary and extrapulmonary manifestations, including skin lesions and gastrointestinal involvement 1 2 4 5.

Diagnosis

Clinical Presentation: Pulmonary infiltrates, skin lesions, lymphadenopathy, and gastrointestinal symptoms 1 2 4.

Diagnostic Tests: Cytologic examination of aspirates (e.g., lymph nodes), sputum culture, and histopathology 1.

Geographic Consideration: Suspect blastomycosis in non-endemic areas with atypical presentations, especially if tuberculosis is prevalent 2.

Management

First-Line Treatment: Itraconazole or other triazoles (specific dose not detailed in abstracts; miconazole shown effective in one case 3).

Alternative Treatments: Miconazole (orally, effective and safe in one case report 3).

Adjunctive Therapies: No specific adjunctive therapies mentioned in the abstracts.

Special Populations

Pediatrics: Case reported of an 8-year-old with gastrointestinal blastomycosis treated with co-trimoxazole 4.

Comorbidities: No specific guidance provided for comorbidities; management likely tailored to individual patient needs 1 2 3 4 5.

Key Recommendations

Consider blastomycosis in differential diagnosis for atypical respiratory and extrapulmonary infections, even in non-endemic regions 2 (Evidence: Moderate).

Utilize cytologic examination and histopathology for diagnosis, especially in lymph node aspirates 1 (Evidence: Weak).

Miconazole may be considered as an effective treatment option for blastomycosis, though broader evidence is needed 3 (Evidence: Weak).

References

1 Meschter C, Heiber K. Blastomycosis in a cat in lower New York State. The Cornell veterinarian 1989. link 2 Berkowitz I, Diamond TH. Disseminated Blastomyces dermatitidis infection in a non-endemic area. A case report. South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde 1987. link 3 Bleeker PA, Haanen C. Blastomycosis treated successfully with miconazole. Tropical and geographical medicine 1979. link 4 Penna FJ. Blastomycosis of the colon resembling clinically ulcerative colitis. Gut 1979. link 5 Silveira E, Billis A, Trevisan MA, Vieira RJ. South American blastomycosis of the ureter. The American journal of tropical medicine and hygiene 1976. link

Blastomycosis