Smears of clinical samples or cultures of sputum, bronchial washings, pus, or tissue are required for diagnosis. Antigen detection in urine and serum may help diagnose infection and monitor pts during therapy.
Treatment: Blastomycosis - Every pt should be treated because of the high risk of dissemination.
- - For immunocompetent pts with nonsevere disease that does not involve the CNS, itraconazole (200-400 mg/d for 6-12 months) is recommended.
- - Immunocompetent pts with severe disease or CNS manifestations should be treated initially with AmB (deoxycholate, 0.7-1 mg/kg IV qd; liposomal, 3-5 mg/kg IV qd); once their clinical condition improves, therapy can be switched to itraconazole (or, for those with CNS disease, fluconazole, 800 mg/d).
- - Immunocompromised pts with any form of infection should be treated initially with AmB, with a switch to a triazole, as above, once clinical improvement has occurred.
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