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Blastomycosis in Patients with the Acquired Immunodeficiency Syndrome
- Peter G. Pappas, MD;
- John C. Pottage, MD;
- William G. Powderly, MD;
- Victoria J. Fraser, MD;
- Charles W. Stratton, MD;
- Stacey McKenzie, MD;
- Tapper Michael L., MD;
- Herman Chmel, MD;
- Frank C. Bonebrake, MD;
- Raymond Blum, MD;
- Robert W. Shafer, MD;
- Coleman King, MD; and
- William E. Dismukes, MD
Abstract
▪ Objective: To describe the clinical, demographic, radiographic, diagnostic, and therapeutic aspects of blastomycosis in patients with the acquired immunodeficiency syndrome (AIDS).
▪ Design: A retrospective survey.
▪ Setting: Ten university medical centers and community hospitals, six in geographic areas endemic for Blastomyces dermatitidis, and four outside the endemic area.
▪ Patients: We identified 15 patients with blastomycosis and positive serologic test results for human immunodeficiency virus (HIV).
▪ Measurements: 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.
Article and Author Information
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From the University of Alabama at Birmingham, School of Medicine, Birmingham, Alabama. For current author addresses, see end of text.
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Grant Support: By National Institute of Allergy and Infectious Diseases contract N01-AI-15082.
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Requests for Reprints: Peter G. Pappas, MD, University of Alabama at Birmingham, Division of Infectious Diseases, 229 Tinsley Harrison Tower, University Station, Birmingham, AL 35294-0006.
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Current Author Addresses: Drs. Pappas and Dismukes: University of Alabama at Birmingham, Division of Infectious Diseases, 229 Tinsley Harrison Tower, University Station, Birmingham, AL 35294-0006. Dr. Pottage: Rush-Presbyterian-St. Lukes Medical Center, Section of Infectious Diseases, 1740 West Harrison, Room 140-143 Academic Facility, Chicago, IL 60612.
Drs. Powderly and Fraser: Washington University Medical Center, Infectious Diseases Section, 4511 Forest Park, Suite 304, St. Louis, MO 63110.
Drs. Stratton and McKenzie: Vanderbilt University Medical Center, Department of Pathology, C3321 MCN, Nashville, TN 37232.
Dr. Tapper: Lenox Hill Hospital, 100 East 77th Street, New York City, NY 10021.
Dr. Chmel: St. Francis Medical Center, 601 Hamilton Avenue, Trenton, NJ 08629.
Dr. Bonebrake: Dean Medical Center, 1313 Fish Hatchery Road, Madison, WI 53715.
Dr. Blum: University of Colorado Medical Center, 4200 B-168, Denver, CO 80262.
Dr. Shafer: Division of Infectious Diseases, SUMC, Stanford, CA 94305.
Dr. King: Medical Center Clinic, 8333 N. David Highway, Pensacola, FL 32514.
- © 1992 American College of Physicians
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