Blastomycosis 2004

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Blastomycosis 2004

• L. Joseph Wheat
• 4444 Decatur Blvd. Suite 300
• Indianapolis, IN 46241
• 317 856 2681
• www.miravistalabs.com

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Epidemiology

• Proximity to water
• Outdoor activities
• Beaver dams
• Small outbreaks
• Microfoci

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Fungal Stain
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Clinical Syndromes

• Pulmonary
• Focal Pneumonia
• Diffuse infiltrates with ARDS
• Nodules
• Disseminated
• Cutaneous gt50
• Bone 10-50
• Genitourinary 10-30
• CNS 1-5
• Other sites
• Immunosuppressed host-more severe

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Blasto?ARDS

• Chronic illness? ARDS Sepsis
• Dissemination 33
• Mortality80
• Survival 7 days

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Cutaneous
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Consolidation Invasion
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Pericardium and Chest Wall
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Consolidation Cavitation
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Consolidation Nodules
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Miliary
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CNS Involvement
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Antigen Detection
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Antigenuria
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Other Body Fluids
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Antigenuria
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Diagnosis
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New 2nd Gen Bd Assay

• Durkin JCM 2004
• 2nd gen Bd assay April 2005
• 6 false-neg in orig pos in 2nd gen assay
• Results higher in 2nd gen assay

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Blasto Antigen in Dogs
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Clearance B. dermatitidis Antigen
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Sustained AntigenFailure
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Sustained AntigenFailure
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Diagnostic Approach

• Sputum or BAL cytology, culture
• Aspirate/biopsy cytology, culture
• Antigen EIA
• Urine, serum, BAL, CSF, other
• Serology not recommended
• Accuracy uncertain

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Indications Treatment

• Mild pulmonary in non-IS host
• Monitor for spontaneous resolution
• Pulmonary in immunosuppressed host
• Progressive pulmonary
• Extrapulmonary dissemination

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Treatment Studies
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Reasons Itraconazole Failure

• Inadequate drug exposure
• Adherence/tolerance
• Drug-interactions
• Absorption
• Resistance
• Not reported
• Measure drug levels

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Newer Triazoles
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Recommendations