Etiology • Blastomyces dermatitidis produces the North American form of
this disease; Paracoccidioides brasiliensis causes South American form and some endemic outbreaks in the United States.
• Transmission is usually by spore inhalation; most infections are confined to the lungs. Extrapulmonary spread is hematogenous to skin, mucosa, bone, viscera, meninges, and the genitourinary tract.
Clinical Presentation • Acute: pneumonitis, fever, weight loss, night sweats, productive
this disease; Paracoccidioides brasiliensis causes South American form and some endemic outbreaks in the United States.
• Transmission is usually by spore inhalation; most infections are confined to the lungs. Extrapulmonary spread is hematogenous to skin, mucosa, bone, viscera, meninges, and the genitourinary tract.
Clinical Presentation • Acute: pneumonitis, fever, weight loss, night sweats, productive
cough • Chronic: granulomatous lesions of oropharyngeal mucosa,
skin; pulmonary signs mimicking tuberculosis • Skin and mucosal lesions are characterized by proliferative
verrucous growth, ulceration, and scarring. Mucosal lesions may mimic carcinoma. Mucocutaneous disease indicates disseminated disease.
Diagnosis • Cytologic or histopathologic examination of tissue with identi-
fication of organism • Culture of sputum or fresh biopsy material • Potassium hydroxide preparation from lesion scraping
Differential Diagnosis • Malignant tumor • Tuberculosis • Tertiary syphilis
Treatment • Systemic antifungals: oral itraconazole
Prognosis • Guarded • Untreated disease slowly progressive, fatal