Clinical aspects of blastomycosis.

Blastomycosis is a specific granulomatous disease which tends to be chronic and indolent. It frequently presents in extrapulmonary form by means of haematogenous dissemination from the lungs. It has been shown that tuberculosis, histoplasmosis and coccidioidomycosis are, in the majority of cases, mild and subclinical in effect and often heal without therapy. It is probable that blastomycosis behaves in a like manner. The exact mortality is not known but is probably in the range of 13% in hospitalized cases with disseminated disease (Blastomycosis Cooperative Study of the Veterans Administration, 1964). The most effective form of therapy in active disease is amphotericin B; 2-hydroxy-stilbamidine is also used. Blastomycosis has largely been considered to be a disease of the American continent. However, cases have been reported from Africa and Europe and therefore a wider appreciation of this disease is considered pertinent. The relevant literature has been reviewed and four illustrative cases are presented.