Blastomycosis chronic pulmonary

Blastomycosis is caused by Blastomyces dermatitidis and generally is an asymptomatic, self-limited disease however, reactivation can lead to chronic disease. Although treatment for self-limited disease is controversial, patients with chronic pulmonary disease or extrapulmonary disease... 

All patients with disseminated blastomycosis, as well as those with extrapuhnonary disease, require therapy. Ketoconazole 400 mg/ day oraUy for 6 months cures more than 80% of patients with chronic pulmonary and nonmeningeal disseminated blastomycosis. Amphotericin B is more efficacious but more toxic and therefore is reserved for noncomphant patients and patients with overwhelming or life-threatening disease, CNS infection, and treatment failures. Cumulative amphotericin B dosages of more than 1 g have resulted in cure without relapse in 70% to 91 % of patients with blastomycosis. Relapse rates depend on the total dosage of amphotericin B administered. Patients with genitourinary tract disease should be treated initially with 600-800 mg/day of ketoconazole because of the low concentrations of drug achieved in the urine and prostate tissue. 

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