Treatment of blastomycosis
- Robert W Bradsher, Jr, MD
Robert W Bradsher, Jr, MD
- Professor of Medicine
- University of Arkansas for Medical Sciences
Blastomycosis is a systemic pyogranulomatous infection, primarily involving the lungs, which arises after inhalation of the conidia of Blastomyces dermatitidis. Blastomycosis of the lung can be asymptomatic or manifest as acute or chronic pneumonia. Hematogenous dissemination occurs frequently; extrapulmonary disease of the skin, bones, and genitourinary system is common, but almost any organ can be involved.
Unlike acute histoplasmosis, for which treatment often is not necessary, most patients with blastomycosis require therapy. (See "Diagnosis and treatment of pulmonary histoplasmosis".)
The antifungal agents proven to be useful in the treatment of blastomycosis will be reviewed here. The approach is generally in keeping with the 2008 Infectious Diseases Society of America clinical practice guidelines for the treatment of blastomycosis (table 1) [1,2]. The mycology, pathogenesis, epidemiology, and clinical manifestations of blastomycosis are discussed separately. (See "Mycology, pathogenesis, and epidemiology of blastomycosis" and "Clinical manifestations and diagnosis of blastomycosis".)
Treatment options for patients with blastomycosis include amphotericin B or one of the azole drugs (usually itraconazole) . Several factors must be considered when deciding upon the appropriate regimen:
●The clinical form and severity of disease – All patients with extrapulmonary disease or progressive pulmonary disease require therapy:
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- GENERAL APPROACH
- STUDIES OF ANTIFUNGALS
- Amphotericin B
- - Ketoconazole
- - Itraconazole
- - Fluconazole
- - Voriconazole
- - Other azoles
- CHOICE OF THERAPY
- Pulmonary blastomycosis
- - Moderately severe to severe
- - Mild to moderate
- Disseminated blastomycosis
- - Moderately severe to severe disseminated
- - Mild to moderate disseminated
- - Central nervous system
- Immunocompromised hosts
- SUMMARY AND RECOMMENDATIONS