Blastomycosis disseminated

Blastomycosis can disseminate to virtually every other body organ, including skin, bones, and joints, or the genitourinary tract, without any evidence of pulmonary disease. 

All patients with disseminated blastomycosis and those with extrapulmonary disease require therapy (ketoconazole, 400 mg/day orally for 6 months). CNS disease should be treated with amphotericin B for a total cumulative dose greater than 1 g. 

Amphotericin-B, an amphoteric polyene macrolide remains the most effective for severe systemic mycoses. It is indicated for systemic mycoses such as disseminated candidiasis, cryptococcosis, aspergillosis, mucormycosis, coccidioidomycosis, histoplasmosis, extracutaneous sporotrichosis and blastomycosis. It is a fungicidal antibiotic without antibacterial activity. It binds to ergosterol in the... 

Itraconazole is most useful in the long-term suppressive treatment of disseminated histoplasmosis in AIDS and in the oral treatment of nonmeningeal, non-life-threatening blastomycosis. It appears to be the drug of choice for all forms of sporotrichosis except meningitis and may have a lower relapse rate in the treatment of disseminated coccidioidomycosis than does fluconazole. 

Cryptococcosis blastomycosis systemic candidiasis disseminated forms of moniliasis, coccidioidomycosis, and histoplasmosis zygomycosis sporotrichosis and aspergillosis (Fungizone) IV Infusion Dosage based on patient tolerance, severity of infection. Initially, 1-mg test dose is given over 20-30 min. If test dose is tolerated, 5-mg dose may be given the same day. Subsequently, increases of 5 mg/dose are made q 12-24h until desired daily dose is reached. Alternatively, if test dose is tolerated, a dose of 0.25 mg/kg is given same day increased to 0.5 mg/kg the second day. Dose increased until desired daily dose reached. Total daily dose 1 mg/kg/day up to 1.5 mg/kg every other day. Do not exceed maximum total daily dose of 1.5 mg/kg. 

Blastomycosis Lungs, skin may disseminate to other tissues Amphotericin B Itraconazole... 

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. 

Amphotericin B - Amphotericin B has been used intravenously for meningitis, pyelonephritis, and pulmonary infections caused by Cryptococcus neoformans, an encapsulated yeast. Successful therapy of pulmonary histoplasmosis required 30 mg/kg of amphotericin B while 20 patients with presumed Histoplasma chorioretinitis (eye infection) failed to respond. 5 86 other reports concern amphotericin B in the treatment of primary renal candidiasis, rhinocerebral phyco-mycosis, blastomycosis, chromoblastomycosis, geotrichosis, and disseminated infections caused by Torulopsis glabrata and Beauverla bassiana, a fungus normally pathogenic to in-sects. V-93 Topical application of amphotericin B was an qj. effective treatment of Candida granuloma and maduromycosis. ... 

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