Blastomycosis

Stratification by disease severity

There are no commonly accepted schematic classifications for blastomycosis, including formal criteria for severity of illness. The general approach to treatment is based upon the severity of disease and clinical manifestations. The most severe manifestation of the disease determines the treatment choice. Infectious diseases consultation should be considered in the management of moderate-to-severe disease or in complicated cases.

• Mild-to-moderate disease generally refers to pulmonary, cutaneous, or genitourinary disease amenable to ambulatory care management with itraconazole.

• Moderate-to-severe disease generally refers to disease that requires hospitalization: more severe pulmonary disease, central nervous system or bone disease, or disease in pregnant or immunosuppressed patients. However, clinical judgment is involved in making treatment decisions.