Therapy of blastomycosis

Blastomycosis is a rare but important fungal infection that is diagnosed primarily in the south-central and midwestern United States. Although some patients have subclinical infection and are not treated, the majority of patients with a clinical diagnosis of blastomycosis are treated with antifungal agents. Amphotericin B is curative but, because of toxicity, oral agents have been examined as therapy. Ketoconazole was shown to be effective for less than overwhelming blastomycosis, but adverse effects were relatively common. Itraconazole is a triazole agent that is more effective than ketoconazole, because it is often effective when ketoconazole fails or after relapse of infection following a response to ketoconazole. Fluconazole is not as effective therapy for blastomycosis based on the need for much higher doses than with itraconazole. In a patient with lifethreatening or central nervous system blastomycosis, amphotericin B should be given.