Blastomycosis history and symptoms

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: ; Vidit Bhargava, M.B.B.S [2] Aditya Ganti M.B.B.S. [3]


Patients with blastomycosis may present with any of several patterns of illness from a flu like illness which resolves within days to asymptomatic presentation (30-50%). Because of the brief and self-limited nature of these symptoms, blastomycosis may go un-diagnosed. Alternatively, patients may present with an acute illness mimicking bacterial pneumonia, with high fever, chills, a productive cough, and pleuritic chest pain which in most cases gets treated with antibiotics. ARDS is the most feared complication of the chronic blastomycosis. Dissemination through blood or lymph can result in extra pulmonary blastomycosis, which commonly involves skin, bone, genitourinary system and central nervous system.


The significant information that needs to focused in the history of the patient includes

  • Any history of travel to the endemic areas
  • Any ill contact with similar complaints


Clinical manifestations of Blastomycosis range from subclinical infection to fatal disseminated disease. Symptoms are based on the involvement of organ systems:

Pulmonary Blastomycosis

Presents clinically as acute and chronic. The symptoms often mimic with bacterial pneumonia presentation. Most common symptoms include : [1]

Extra-Pulmonary blastomycosis

The most common extra pulmonary sites involved in blastomycosis are skin, bone, genitourinary and CNS.

Cutaneous blastomycosis

  • Skin is involved in 40-80% of the cases.[2]
Verrucous Ulcerative
Location Above the subcutaneous abscess Drain-out from subcutaneous abscess through skin
Morphology Irregularly shaped lesions with raised and crusted borders Heaped up borders with or without exudative base


Oseous blastomycosis


Central nervous system

Other sites of disease

Blastomycosis can disseminate almost to any other site such as liver, spleen, breast, lymph nodes etc.[8]


  1. Smith JA, Gauthier G (2015). "New Developments in Blastomycosis". Semin Respir Crit Care Med. 36 (5): 715–28. doi:10.1055/s-0035-1562898. PMID 26398538.
  2. Smith, Jeannina; Gauthier, Greg (2015). "New Developments in Blastomycosis". Seminars in Respiratory and Critical Care Medicine. 36 (05): 715–728. doi:10.1055/s-0035-1562898. ISSN 1069-3424.
  3. Kauffman, Carol (2011). Essentials of clinical mycology. New York: Springer. ISBN 978-1-4419-6639-1.
  4. CARNESALE PL, STEGMAN KF (1956). "Blastomycosis of bone; report of four cases". Ann. Surg. 144 (2): 252–7. PMC 1465309. PMID 13355200.
  5. 5.0 5.1 Sanders, Louis L. (1967). "Blastomycosis arthritis". Arthritis & Rheumatism. 10 (2): 91–98. doi:10.1002/art.1780100203. ISSN 0004-3591.
  6. Bariola, J. Ryan; Perry, Paul; Pappas, Peter G.; Proia, Laurie; Shealey, Wesley; Wright, Patty W.; Sizemore, James M.; Robinson, Matthew; Bradsher, Robert W. (2010). "Blastomycosis of the Central Nervous System: A Multicenter Review of Diagnosis and Treatment in the Modern Era". Clinical Infectious Diseases. 50 (6): 797–804. doi:10.1086/650579. ISSN 1058-4838.
  7. Harley WB, Lomis M, Haas DW (1994). "Marked polymorphonuclear pleocytosis due to blastomycotic meningitis: case report and review". Clin. Infect. Dis. 18 (5): 816–8. PMID 8075280.
  8. Saccente, M.; Woods, GL. "Clinical and laboratory update on blastomycosis". Clin Microbiol Rev. 23 (2): 367–81. doi:10.1128/CMR.00056-09. PMID 20375357.