Information for Healthcare Professionals About Blastomycosis
Blastomycosis is asymptomatic in approximately 50% of cases.1 Symptomatic persons usually present 3 weeks to 3 months after exposure. The clinical presentation of acute pulmonary blastomycosis is often non-specific; symptoms may include:2,3
- Night sweats
- Chest pain
Acute pulmonary blastomycosis can progress to acute respiratory distress syndrome (ARDS). Approximately 25% to 40% of symptomatic cases will develop extrapulmonary infection, which typically manifests as cutaneous, osteoarticular, genitourinary, or central nervous system disease.4
Blastomycosis is caused by the dimorphic fungus Blastomyces. Phylogenetic analysis suggests that some infections in the United States previously classified as B. dermatitidis might be a new species, B. gilchristii. Furthermore, recent infections in the western United States have been attributed to a newly described species B. helicus.5,6
The fungus lives in the environment, particularly in soil and decaying organic matter such as wood or leaves. Endemic areas in the United States include the midwestern, south-central, and southeastern states, particularly areas surrounding the Ohio and Mississippi River valleys, the Great Lakes, the Saint Lawrence River, and the western United States.7,8 Parts of Canada are also endemic, particularly Ontario,7 Quebec,9 and Manitoba.10 Autochthonous cases have also been reported from Africa11 and India.12
Blastomycosis is typically acquired via inhalation of airborne conidia. Primary cutaneous blastomycosis is uncommon but can result from traumatic inoculation.13
People in endemic areas, particularly those who have occupations or participate in activities that expose them to soil, may beat increased risk. Immunocompromised persons and people in some racial/ethnic groups may be at higher risk for developing severe forms of the disease.15
- Antigen detection: Enzyme immunoassay (EIA) is typically performed on urine or serum, but can also be used on bronchoalveolar lavage fluid. Cross-reactions can occur with histoplasmosis and other fungal diseases.
- Antibody tests: Antibody tests such as immunodiffusion (ID) and complement fixation (CF) are available, but have low sensitivity and specificity. Antibody EIAs have also been developed and have better sensitivity and specificity but can be difficult to interpret.
- Culture: The gold standard for diagnosing blastomycosis. A commercially available DNA probe (AccuProbe, GenProbe Inc.) can be used to confirm.
- Microscopy: Important for detection of yeast in tissue or respiratory secretions.
- Polymerase chain reaction (PCR): Blastomyces PCR can be used to confirm culture or histopathologic identification and on blood to detect disseminated disease.
Amphotericin B is recommended for moderate to severe disease, central nervous system disease, immunosuppressed patients, or pregnant patients. Itraconazole is recommended for mild to moderate disease and step-down therapy. Therapeutic drug monitoring should be considered for certain antifungals like itraconazole when treating blastomycosis. For more detailed treatment guidelines, please refer to the Infectious Diseases Society of America’s Clinical Practice Guidelines for the Management of Blastomycosis
People in endemic areas, particularly those who have occupations or participate in activities that expose them to soil. Immunocompromised persons may be at higher risk for developing severe forms of the disease.14
Blastomycosis is reportable in certain states. Check with your local, state, or territorial public health department for more information about disease reporting requirements and procedures in your area. Get blastomycosis statistics.
- Klein BS, Vergeront JM, Weeks RJ, Kumar UN, Mathai G, Varkey B, et al. Isolation of Blastomyces dermatitidis in soil associated with a large outbreak of blastomycosis in Wisconsin. N Engl J Med. 1986 Feb 27;314(9):529-34.
- Saccente M, Woods GL. Clinical and laboratory update on blastomycosis. Clin Microbiol Rev. 2010 Apr;23(2):367-81.
- Baumgardner DJ, Halsmer SE, Egan G. Symptoms of pulmonary blastomycosis: northern Wisconsin, United States. Wilderness Environ Med. 2004 Winter;15(4):250-6.
- Chapman SW, Dismukes WE, Proia LA, Bradsher RW, Pappas PG, Threlkeld MG, et al. Clinical practice guidelines for the management of blastomycosis: 2008 update by the Infectious Diseases Society of America. Clin Infect Dis. 2008 Jun 15;46(12):1801-12.
- Brown EM, McTaggart LR, Zhang SX, Low DE, Stevens DA, Richardson SE. Phylogenetic analysis reveals a cryptic species Blastomyces gilchristii, sp. nov. within the human pathogenic fungus Blastomyces dermatitidis. PLoS One. 2013;8(3):e59237.
- Schwartz IS, Wiederhold NP, Hanson KE, Patterson TF, Sigler L. Blastomyces helicus, a new dimorphic fungus causing fatal pulmonary and systemic disease in humans and animals in Western Canada and the United States. Clin Infect Dis. 2019 Jan 7; 68(2):188-195.
- Furcolow ML, Busey JF, Menges RW, Chick EW. Prevalence and incidence studies of human and canine blastomycosis. II. Yearly incidence studies in three selected states, 1960–1967. Am J Epidemiol. 1970;92(2):121–31.
- Bradsher RW, Chapman SW, Pappas PG. Blastomycosis. Infect Dis Clin North Am. 2003;17(1) 21-40, vii.
- Morris SK, Brophy J, Richardson SE, Summerbell R, Parkin PC, Jamieson F, et al. Blastomycosis in Ontario, 1994-2003. Emerg Infect Dis. 2006 Feb;12(2):274-9.
- Litvinov IV, St-Germain G, Pelletier R, Paradis M, Sheppard DC. Endemic human blastomycosis in Quebec, Canada, 1988-2011. Epidemiol Infect. 2013 Jun;141(6):1143-7.
- Fanella S, Skinner S, Trepman E, Embil JM. Blastomycosis in children and adolescents: a 30-year experience from Manitoba. Med Mycol. 2011 Aug;49(6):627-32.
- Cheikh Rouhou S, Racil H, Ismail O, Trabelsi S, Zarrouk M, Chaouch N, et al. Pulmonary blastomycosis: a case from Africa. ScientificWorldJournal. 2008 Nov 2;8:1098-103.
- Chakrabarti A, Slavin MA. Endemic fungal infections in the Asia-Pacific region. Med Mycol. 2011 May;49(4):337-44.
- Gray NA, Baddour LM. Cutaneous inoculation blastomycosis. Clin Infect Dis. 2002 May 15;34(10):E44-9.
- Pappas PG, Threlkeld MG, Bedsole GD, Cleveland KO, Gelfand MS, Dismukes WE. Blastomycosis in immunocompromised patients. Medicine. 1993 Sep;72(5):311-25.