Blastomycosis: fungal infections of the lung update: 1989

Three additions to the understanding of blastomycosis have been noted over the past several years. First, Blastomyces dermatitidis has now been grown from soil in association with epidemics of infection, indicating that microfoci of the organism exist in nature. Second, immune markers of previous infections have been used to help confirm that subclinical or asymptomatic cases occur in endemic areas. This is well recognized for other fungal infections, like histoplasmosis, and is increasingly recognized for blastomycosis. Third, alternatives to amphotericin B have been discovered effectively to treat clinical blastomycosis. Ketoconazole and itraconazole, which are orally absorbed imidazole antifungal agents, have been shown to be impressive antibiotics for blastomycosis that is less than life-threatening. Amphotericin B remains the agent of choice to treat patients with central nervous system or overwhelming blastomycosis.