The cytological diagnosis of pulmonary blastomycosis.

We reviewed 30 episodes of pulmonary blastomycosis among 29 patients to compare the methods of diagnosis and to assess the usefulness of cytological sputum examination. Complement fixation and skin tests were not helpful in diagnosis. Confirmation by culture of sputum or tissue required, on average, five weeks. We compared the cytological examination of bronchial secretions with that of microbiologic wet smears. The cytological technique yielded a positive diagnosis in 93% of patients and in 70% on the first specimen. Sixty-one percent of microbiologic wet smears proved positive, with 32% positive on the first specimen. The cytological findings were reported significantly sooner. In addition, cytological diagnosis of Blastomyces dermatitidis in sputum and bronchial washings of patients suspected of having a pulmonary cancer or infection reduced the time of diagnostic workup and the incidence of major surgery.