Last reviewed: 5 Oct 2024
Last updated: 12 Jul 2024
Summary
Definition
History and exam
Key diagnostic factors
- recreational or occupational exposures
- primary residence in or travel to endemic areas
Full details
Other diagnostic factors
- male sex
- age 30 to 50 years
- constitutional symptoms
- cough
- skin lesions
- animal exposure
- bone or joint pain
- genitourinary symptoms
- headache or focal neurologic complaints
Full details
Risk factors
- male sex
- recreational or occupational exposures
- travel to or residence in an area of endemicity
- immunocompromise
Full details
Diagnostic tests
1st tests to order
- Blastomyces dermatitidis enzyme immunoassay (EIA) urine antigen testing
- chest x-ray
- respiratory tract specimen smear and culture
Full details
Tests to consider
- bronchoscopy
- tissue biopsy or cytology (lung, skin, or bone)
- arthrocentesis
- fungal serology panel
- fungal blood cultures
- MRI brain
- B dermatitidis polymerase chain reaction
Full details
Treatment algorithm
ONGOING
ambulatory immunocompetent nonpregnant adults
hospitalized immunocompetent nonpregnant adults
immunosuppressed nonpregnant adults with or without CNS disease
pregnant
neonates <30 days old
infants/children ≥30 days old
Contributors
Authors
Nathan Cummins, MD
Associate Professor of Medicine
Division of Infectious Diseases
Mayo Clinic
Rochester
MN
Disclosures
NC declares that he has no competing interests.
Larry Baddour, MD
Professor Emeritus of Medicine
Division of Infectious Diseases
Mayo Clinic
Rochester
MN
Disclosures
LB declares that he has no competing interests.
Peer reviewers
Adriana M. Rauseo, MD
Assistant Professor of Medicine
Division of Infectious Diseases
Department of Internal Medicine
Washington University in St Louis
St Louis
MO
Disclosures
AMR declares that she has no competing interests.
Differentials
- Community-acquired pneumonia
- Histoplasmosis
- Coccidioidomycosis
More DifferentialsGuidelines
- Clinical testing guidance for coccidioidomycosis, histoplasmosis, and blastomycosis in patients with community-acquired pneumonia for primary and urgent care providers
- Global guideline for the diagnosis and management of the endemic mycoses
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