Peter G. Pappas, MD; John C. Pottage, MD; William G. Powderly, MD; Victoria J. Fraser, MD; Charles W. Stratton, MD; Stacey McKenzie, MD; Tapper Michael L., MD; Herman Chmel, MD; Frank C. Bonebrake, MD; Raymond Blum, MD; Robert W. Shafer, MD; Coleman King, MD; William E. Dismukes, MD
▪ Objective: To describe the clinical, demographic, radiographic, diagnostic, and therapeutic aspects of blastomycosis in patients with the acquired immunodeficiency syndrome (AIDS).
▪ Design: A retrospective survey.
▪ Setting: Ten university medical centers and community hospitals, six in geographic areas endemic for Blastomyces dermatitidis, and four outside the endemic area.
▪ Patients: We identified 15 patients with blastomycosis and positive serologic test results for human immunodeficiency virus (HIV).
▪ Measurements: A diagnosis of blastomycosis was based on a positive culture (14 patients) or typical histopathologic features (one patient) for B. dermatitidis in clinical specimens.
▪ Results: Twelve of 15 patients had a previous or concomitant AIDS-defining illness at the time of diagnosis of blastomycosis, and only one patient had a CD4 lymphocyte count of greater than 200 cells/mm3. Two patterns of disease emerged: localized pulmonary involvement (seven patients), and disseminated or extrapulmonary blastomycosis (eight patients). Central nervous system involvement was common (40%). Six patients died within 21 days of presentation with blastomycosis, including four patients with disseminated and two with fulminant pulmonary disease. Among the nine patients who survived longer than 1 month, all received amphotericin B as initial antifungal therapy, and most received subsequent therapy with ketoconazole. Only two of these nine patients died with evidence of progressive blastomycosis.
▪ Conclusions: Blastomycosis is a late and frequently fatal infectious complication in a few patients with AIDS. In these patients, overwhelming disseminated disease including involvement of the central nervous system is common, and it is associated with a high early mortality. Initial therapy with amphotericin B is appropriate in patients with AIDS and presumptive blastomycosis.
Pappas PG, Pottage JC, Powderly WG, et al. Blastomycosis in Patients with the Acquired Immunodeficiency Syndrome. Ann Intern Med. 1992;116:847–853. doi: https://doi.org/10.7326/0003-4819-116-10-847
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Published: Ann Intern Med. 1992;116(10):847-853.
HIV, Infectious Disease.
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