North American blastomycosis: a review.

North American blastomycosis, first reported in 1894, and once thought to be a geographically localized disease, has now been reported worldwide. The greatest number of cases occur in the Mississippi, Missouri, and Ohio River basins. The organism enters the body via the lungs with subsequent dissemination to other organs, including the skin, eyes, bones, and genitourinary system. Patients most often present with cutaneous or pulmonary complaints. Demonstration of characteristic fungal morphology in microscopic smears or in histologic specimens is highly suggestive of Blastomyces dermatitidis. However, proof of the diagnosis is obtained only by mycologic culture. Some progress has been made using other laboratory methods to produce a rapid diagnosis. This paper reviews in detail the varied clinical presentations of blastomycosis, the laboratory diagnosis, and current treatment.