Blastomycosis
[Lancet Infect Dis 2021;21:e364-74]
Usual Pathogens
Blastomyces dermatitidis and gilchristii (primarily in southeast/southcentral USA bordering Mississippi and Ohio river, in northcentral states bordering the Great Lakes and areas surrounding St. Lawrence Seaway from Quebec to Saskatchewan)
Blastomyces helicus (western Canada and USA)
Blastomyces percursus (Africa and Middle East)
Blastomyces emzantsi (South Africa)
- Epidemiology - Blastomyces is found in soil near freshwater drainage systems.
- Causes CNS (chronic meningitis), cutaneous, pulmonary or extrapulmonary disease.
- All forms of disease require antifungal therapy
- Infectious Diseases consult recommended.
Central Nervous System (CNS)
| Empiric Therapy | Duration | |
|---|---|---|
| Amphotericin B, liposomal | 5mg/kg IV daily | 4-6 weeks |
| followed by | ||
| Voriconazole |
6mg/kg PO bid x 2 doses, then 4mg/kg PO bid |
To complete at least 12 months and until CSF parameters normal |
| or | ||
| Itraconazole |
Oral solution: 2.5mg/kg PO bid, or Capsules: 200mg PO bid |
To complete at least 12 months and until CSF parameters normal |
| or | ||
| Fluconazole | 800mg PO daily | To complete at least 12 months and until CSF parameters normal |
Non-CNS: Cutaneous, pulmonary, extrapulmonary
Severe
| Empiric Therapy | Duration | |
|---|---|---|
| Amphotericin B, liposomal | 3-5mg/kg IV daily | 1-2 weeks |
| or | ||
| Amphotericin B, lipid complex | 5mg/kg IV daily |
1-2 weeks |
| followed by | ||
| Itraconazole |
Oral solution: 2.5mg/kg PO tid, or Capsules: 200mg PO tid |
3 days |
| then | ||
| Itraconazole |
Oral solution: 2.5mg/kg PO daily or bid or Capsules: 200mg PO daily or bid |
6-12 months |
Mild to moderate
| Empiric Therapy | Duration | |
|---|---|---|
| Itraconazole |
Oral solution: 2.5mg/kg PO tid or Capsules: 200mg PO tid |
3 days |
| then | ||
| Itraconazole |
Oral solution: 2.5mg/kg PO daily or bid or Capsules: 200mg PO daily or bid |
6-12 months |