What is Blastomycosis Treatment?
Blastomycosis, also known as blastomycosis, is a fungal infection caused by inhalation of Blastomyces dermatitidis spores. The most common symptoms include cough, fever, fatigue and skin lesions. The infection often resembles pneumonia or skin lesions resembling tuberculosis at first. If left untreated, it can spread to other organs in the body like skin, bones, genitals and central nervous system.
Diagnosing Blastomycosis
Blastomycosis is usually diagnosed through clinical examination, chest x-rays, culture tests or biopsy of infected tissues. A doctor will collect samples from infected areas like sputum, blood, skin lesions or other fluids and tissues to examine under a microscope for the presence of Blastomyces yeast cells or fungi structures. Culturing samples on specific media also allows diagnosis by growing the fungus for identification. Serological tests detect antibodies produced by the body’s immune response to the fungus.
Treating the Infection
The primary treatment involves using antifungal medications. For mild to moderate lung infections, oral antifungals like itraconazole or fluconazole are prescribed. More severe infections or those involving other organs may require initial intravenous antifungal therapy in a hospital followed by long term oral medication at home. Therapy usually lasts for at least 6-12 months to fully treat the infection and prevent relapse. Additional supportive treatments may include medications for fever, anti-inflammatory drugs for skin lesions and respiratory treatments.
Itraconazole Therapy
Itraconazole is among the preferred oral medications for blastomycosis treatment. It works by inhibiting ergosterol production, essential for fungal cell membrane formation. Initial dosage is 200-400mg per day for 3 days, followed by 100-200mg once or twice daily. Length of treatment ranges from 6-12 months depending on severity and response. Common side effects include nausea, vomiting, rashes and liver damage requiring monitoring. It has good oral absorption and achieves desirable tissue levels, making it effective for mild-moderate infections.
Fluconazole Therapy
For patients unable to tolerate itraconazole, fluconazole is an alternative oral antifungal. The standard adult dose is 400mg daily. Length of treatment also averages 6-12 months based on clinical assessment. Unlike itraconazole, fluconazole has limited ability to penetrate tissues like bone and central nervous system, so it may not be suitable for advanced blastomycosis. Side effects are generally mild like abdominal discomfort, diarrhea and headaches. Periodic blood tests monitor potential liver toxicity. Fluconazole has the advantage of fewer drug interactions than itraconazole.
Intravenous Amphotericin B Therapy
The gold standard intravenous therapy for severe or disseminated blastomycosis is amphotericin B deoxycholate. It is administered in high doses of 0.7-1mg/kg daily over 4-6 hours via peripheral or central line in a hospital setting. Due to its nephrotoxic side effects, patients require intensive monitoring of kidney function and electrolytes. Less toxic lipid formulations of amphotericin B like liposomal may be prescribed instead in some situations. Treatment typically lasts 1-2 months before transitioning to oral antifungals for long term control. Its excellent tissue penetration makes it effective against deep seated or systemic infections.
Supportive blastomycosis treatments may involve:
– Cough suppressants and analgesics for respiratory symptoms.
– Anti-inflammatory drugs for skin lesions and arthritis.
– Immunomodulators like interferon-gamma to boost immune response.
– Surgical drainage of accessible abscesses.
– Respiratory therapies for lung complications.
Preventing Blastomycosis Relapse
Adhering to the full antifungal treatment regimen is key to prevent relapse which occurs in 10-30% of cases if therapy is stopped prematurely. Monthly serum antigen and urine antigen tests monitor response and check for signs of ongoing infection during and after treatment ends. Patients are also advised to avoid areas where blastomycosis is endemic to reduce reinfection risk. With appropriate medical management, the prognosis is excellent even for disseminated disease. However, mortality may reach 10% among severely immunocompromised patients who develop widespread infection.
In summary, blastomycosis is a treatable fungal infection requiring months of antifungal therapy. The mainstay treatments involve oral medications itraconazole or fluconazole and intravenous amphotericin B based on severity. Supportive therapies address related complications. Complete adherence to prescribed long term antifungal regimens gives the best chance of cure and preventing recurrence of this systemic mycosis. With multidisciplinary monitoring and care, outcomes are favorable.
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*Note:
- Source: Coherent Market Insights, Public sources, Desk research
- We have leveraged AI tools to mine information and compile it
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