Blastomycosis can present in one of the following ways:

 a flu-like illness with fever, chills, myalgia, headache, and a nonproductive cough
which resolves within days.
 an acute illness resembling bacterial pneumonia, with symptoms of high fever,
chills, a productive cough, and pleuritic chest pain.
 a chronic illness that mimics tuberculosis or lung cancer, with symptoms of low-
grade fever, a productive cough, night sweats, and weight loss.
 a fast, progressive, and severe disease that manifests as ARDS, with fever,
shortness of breath, tachypnea, hypoxemia, and diffuse pulmonary infiltrates.
 skin lesions, usually asymptomatic, appear as ulcerated lesions with small
pustules at the margins
 bone lytic lesions can cause bone or joint pain.
 prostatitis may be asymptomatic or may cause pain on urinating.
 laryngeal involvement causes hoarseness.

Cause

Infection occurs by inhalation of the fungus from its natural soil habitat. Once inhaled in
the lungs, they multiply and may disseminate through the blood and lymphatics to
other organs, including the skin, bone, genitourinary tract, and brain. The incubation
period is 30 to 100 days, although infection can be asymptomatic.

Diagnosis

Once suspected, the diagnosis of blastomycosis can usually be confirmed by

demonstration of the characteristic broad based budding organisms [4] in sputum or
tissues by KOH prep, cytology, or histology. Tissue biopsy of skin or other organs may
be required in order to diagnose extra-pulmonary disease. Commercially available urine
antigen testing appears to be quite sensitive in suggesting the diagnosis in cases where
the organism is not readily detected. While culture of the organism remains the
definitive diagnostic standard, its slow growing nature can lead to delays in treatment
of up to several weeks.

However, sometimes blood and sputum cultures may not detect blastomycosis; lung
biopsy is another option, and results will be shown promptly.

Treatment

Itraconazole given orally is the treatment of choice for most forms of the disease.
Ketoconazole may also be used. Cure rates are high, and the treatment over a period of
months is usually well tolerated. Amphotericin B is considerably more toxic, and is
usually reserved for immunocompromised patients who are critically ill and those with
central nervous system disease. Fluconazole has also been tested on patients in
Canada.

Prognosis

Mortality rate in treated cases

 0-2% in treated cases among immunocompetent patients

 29% in immunocompromised patients
 40% in the subgroup of patients with AIDS
 68% in patients presenting as acute respiratory distress syndrome (ARDS)

Histoplasma capsulatum. Symptoms of this infection vary greatly, but the disease
primarily affects the lungs.[2] Occasionally, other organs are affected; this is called
disseminated histoplasmosis, and it can be fatal if left untreated. Histoplasmosis is
common among AIDS patients because of their depressed immune system.

Chest X-ray of a patient with acute pulmonary histoplasmosis.

If symptoms of histoplasmosis infection occur, they will start within 3 to 17 days after
exposure; the average is 12–14 days. Most affected individuals have clinically silent
manifestations and show no apparent ill effects.[4] The acute phase of histoplasmosis is
characterized by non-specific respiratory symptoms, often cough or flu-like. Chest X-ray
findings are normal in 40–70% of cases.[4] Chronic histoplasmosis cases can resemble
tuberculosis;[5][6] disseminated histoplasmosis affects multiple organ systems and is fatal
unless treated.[7]

While histoplasmosis is the most common cause of mediastinitis, this remains a

relatively rare disease. Severe infections can cause hepatosplenomegaly,
lymphadenopathy, and adrenal enlargement.[2] Lesions have a tendency to calcify as
they heal. Ocular histoplasmosis damages the retina of the eyes. Scar tissue is
left on the retina which can experience leakage, resulting in a loss of vision not unlike
macular degeneration.

Antifungal medications are used to treat severe cases of acute histoplasmosis and all
cases of chronic and disseminated disease. Typical treatment of severe disease first
involves treatment with amphotericin B, followed by oral itraconazole.[11] Treatment with
itraconazole will need to continue for at least a year in severe cases. [12]
In many milder cases, oral itraconazole or ketoconazole is sufficient. Asymptomatic
disease is typically not treated. Past infection results in partial protection against ill
effects if reinfected.