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Blastomycosis in the immunocompromised patient

P G Pappas1

  • 1Division of Infectious Diseases, University of Alabama at Birmingham, USA.

Seminars in Respiratory Infections
|October 6, 1997
PubMed
Summary

Blastomycosis is a serious infection in immunocompromised individuals, often leading to severe, disseminated disease and high mortality. Early treatment with amphotericin B is recommended for these high-risk patients.

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Area of Science:

  • Mycology
  • Infectious Diseases
  • Immunology

Background:

  • Blastomycosis is increasingly recognized as a significant threat in immunocompromised populations.
  • Risk factors include T-lymphocyte dysfunction from conditions like HIV/AIDS, immunosuppressive therapy, and transplantation.
  • The infection presents unique challenges in immunocompromised hosts compared to the general population.

Purpose of the Study:

  • To highlight the increased severity and mortality of blastomycosis in immunocompromised patients.
  • To discuss clinical manifestations and complications specific to this patient group.
  • To provide therapeutic recommendations for managing blastomycosis in immunocompromised individuals.

Main Methods:

  • Review of clinical data and literature concerning blastomycosis in immunocompromised hosts.
  • Analysis of disease presentation, complications, and outcomes.
  • Evaluation of current treatment guidelines and therapeutic strategies.

Main Results:

  • Immunocompromised patients experience more severe blastomycosis with widespread organ involvement, including the central nervous system.
  • Complications like adult respiratory distress syndrome and miliary pulmonary involvement are more frequent.
  • Mortality rates exceed 30%, with rapid progression often observed.

Conclusions:

  • Amphotericin B is the recommended initial therapy for most immunocompromised patients to control severe blastomycosis.
  • Itraconazole may be suitable for initial treatment only in focal, uncomplicated cases.
  • Chronic azole suppressive therapy is often necessary to prevent disease relapse in patients with persistent immunosuppression.

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