title: Blastomycosis in patients with the acquired immunodeficiency syndrome.
abstract: OBJECTIVE
  To describe the clinical, demographic, radiographic, diagnostic, and therapeutic aspects of blastomycosis in patients with the acquired immunodeficiency syndrome (AIDS).
  
  
  METHODS
  A retrospective survey.
  
  
  METHODS
  Ten university medical centers and community hospitals, six in geographic areas endemic for Blastomyces dermatitidis, and four outside the endemic area.
  
  
  METHODS
  We identified 15 patients with blastomycosis and positive serologic test results for human immunodeficiency virus (HIV).
  
  
  METHODS
  A diagnosis of blastomycosis was based on a positive culture (14 patients) or typical histopathologic features (one patient) for B. dermatitidis in clinical specimens.
  
  
  RESULTS
  Twelve of 15 patients had a previous or concomitant AIDS-defining illness at the time of diagnosis of blastomycosis, and only one patient had a CD4 lymphocyte count of greater than 200 cells/mm3. Two patterns of disease emerged: localized pulmonary involvement (seven patients), and disseminated or extrapulmonary blastomycosis (eight patients). Central nervous system involvement was common (40%). Six patients died within 21 days of presentation with blastomycosis, including four patients with disseminated and two with fulminant pulmonary disease. Among the nine patients who survived longer than 1 month, all received amphotericin B as initial antifungal therapy, and most received subsequent therapy with ketoconazole. Only two of these nine patients died with evidence of progressive blastomycosis.
  
  
  CONCLUSIONS
  Blastomycosis is a late and frequently fatal infectious complication in a few patients with AIDS. In these patients, overwhelming disseminated disease including involvement of the central nervous system is common, and it is associated with a high early mortality. Initial therapy with amphotericin B is appropriate in patients with AIDS and presumptive blastomycosis.
authors.affiliation: University of Alabama, School of Medicine, Birmingham.
authors.forename: P G
authors.initials: PG
authors.lastname: Pappas
authors.forename: J C
authors.initials: JC
authors.lastname: Pottage
authors.forename: W G
authors.initials: WG
authors.lastname: Powderly
authors.forename: V J
authors.initials: VJ
authors.lastname: Fraser
authors.forename: C W
authors.initials: CW
authors.lastname: Stratton
authors.forename: S
authors.initials: S
authors.lastname: McKenzie
authors.forename: M L
authors.initials: ML
authors.lastname: Tapper
authors.forename: H
authors.initials: H
authors.lastname: Chmel
authors.forename: F C
authors.initials: FC
authors.lastname: Bonebrake
authors.forename: R
authors.initials: R
authors.lastname: Blum
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000150:complications*; D000328:Adult; D000935:Antifungal Agents / Q000627:therapeutic use; D001759:Blastomycosis / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy / Q000401:mortality; D006801:Humans; D008172:Lung Diseases, Fungal / Q000150:complications; D008297:Male; D008875:Middle Aged; D009894:Opportunistic Infections / Q000150:complications*; D012189:Retrospective Studies; D016019:Survival Analysis
chemical_list: D000935:Antifungal Agents