Summary
Definition
History and exam
Key diagnostic factors
- recreational or occupational exposures
- primary residence in or travel to endemic areas
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
Risk factors
- male sex
- recreational or occupational exposures
- travel to or residence in an area of endemicity
- immunocompromise
Diagnostic tests
1st tests to order
- Blastomyces dermatitidis enzyme immunoassay (EIA) urine antigen testing
- chest x-ray
- respiratory tract specimen smear and culture
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
Treatment algorithm
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.
References
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.
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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