Blastomycosis

Last reviewed: 28 Apr 2022
Last updated: 01 Mar 2022

Summary

Definition

History and exam

Key diagnostic factors

  • recreational or occupational exposures
  • primary residence in or travel to endemic areas
More key diagnostic factors

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 neurological complaints
Other diagnostic factors

Risk factors

  • male sex
  • recreational or occupational exposures
  • travel to or residence in an area of endemicity
  • immunocompromise
More risk factors

Diagnostic investigations

1st investigations to order

  • chest x-ray
  • sputum smear and culture
More 1st investigations to order

Investigations to consider

  • bronchoscopy
  • tissue biopsy or cytology (lung, skin, or bone)
  • arthrocentesis
  • fungal serology panel
  • Blastomyces dermatitidis antigen testing (urine, bronchoalveolar lavage, or serum)
  • fungal blood cultures
  • MRI brain
  • B dermatitidis polymerase chain reaction
More investigations to consider

Treatment algorithm

ONGOING

ambulatory immunocompetent non-pregnant adults

hospitalised immunocompetent non-pregnant adults

immunosuppressed non-pregnant 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

Kyle Hogarth, MD, FCCP

Assistant Professor of Medicine

Department of Medicine

Section of Pulmonary and Critical Care

University of Chicago

Chicago

IL

Disclosures

KH declares that he has no competing interests.

Ware Kuschner, MD

Associate Professor of Medicine

Stanford University

Stanford

Staff Physician

US Department of Veterans Affairs

Palo Alto Health Care System

Palo Alto

CA

Disclosures

WK declares that he has no competing interests.

  • Blastomycosis images
  • Differentials

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

    • Global guideline for the diagnosis and management of the endemic mycoses
    • Endemic fungal infections in solid organ transplant recipients
    More Guidelines
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