Blastomycosis in Africa: clinical features, diagnosis, and treatment

Four cases of blastomycosis seen in two acute care hospitals in Harare, Zimbabwe, are described. All patients had symptoms of at least 2 months' duration before presentation, and all had radiographic evidence of pulmonary consolidation. Three patients had confirmed bone involvement, and two had chronic discharging sinuses. The features of blastomycosis in Africa are reviewed, and problems of diagnosis and treatment are discussed. It is concluded that blastomycosis in Africa may often be misdiagnosed as tuberculosis or pyogenic infection in the absence of adequate facilities for mycologic investigation.