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Blastomycosis

Last reviewed: 9 Apr 2025
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

Associate Professor of Medicine

Division of Infectious Diseases

Mayo Clinic

Rochester

MN

Disclosures

NC declares that he has no competing interests.

Professor Emeritus of Medicine

Division of Infectious Diseases

Mayo Clinic

Rochester

MN

Disclosures

LB declares that he has no competing interests.

Peer reviewers

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.

References

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Key articles

Thompson GR 3rd, Le T, Chindamporn A, et al. Global guideline for the diagnosis and management of the endemic mycoses: an initiative of the European Confederation of Medical Mycology in cooperation with the International Society for Human and Animal Mycology. Lancet Infect Dis. 2021 Dec;21(12):e364-e374. Abstract

Limper AH, Knox KS, Sarosi GA, et al. American Thoracic Society Fungal Working Group. An official American Thoracic Society statement: treatment of fungal infections in adult pulmonary and critical care patients. Am J Respir Crit Care Med. 2011 Jan 1;183(1):96-128. Abstract

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
  • Blastomycosis images
  • Differentials

    • Community-acquired pneumonia
    • Histoplasmosis
    • Coccidioidomycosis
    More Differentials
  • Guidelines

    • 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
    More Guidelines
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