Aggressive electrolyte replacement throughout course
Patient Discharge Instructions
copy discharge instructions
Discharge instructions for Blastomycosis (Disseminated)
What is disseminated blastomycosis
A fungal infection that has spread from the lungs to other parts of the body
Caused by breathing in fungal spores from soil near rivers, lakes, and decaying vegetation
Your antifungal medication
Take itraconazole exactly as prescribed with a fatty meal or orange juice to improve absorption
Do not stop taking antifungal medication without talking to your doctor
You will need to take this medication for at least 6-12 months or longer
Follow-up appointments
Infectious disease follow-up within 1-2 weeks of discharge
Blood level testing for your antifungal medication at 2 weeks
Liver blood tests every 1-3 months while on medication
Return to the emergency department immediately for
Worsening shortness of breath or new need for oxygen
New or worsening skin lesions
Headache, confusion, vision changes, or weakness in one side of the body
New bone pain or swelling of joints
Fever not improving after 48-72 hours of medication
Nausea, vomiting, or yellowing of skin or eyes (signs of liver problems)
Swelling of the legs or decreased urine output
Activity and lifestyle
Avoid moist soil, decaying leaves, and vegetation near waterways during treatment
Avoid excessive alcohol intake while on antifungal medication
Maintain adequate hydration
Expected recovery
Clinical improvement typically within 1-2 weeks of appropriate antifungal therapy
Skin lesions may take weeks to months to resolve
Complete the full treatment course to prevent relapse
Relapse occurs in approximately 5-8% of patients
References
Guidelines and key sources
IDSA Clinical Practice Guidelines for Blastomycosis
Chapman SW, Dismukes WE, Proia LA, et al. Clinical Practice Guidelines for the Management of Blastomycosis: 2008 Update by the Infectious Diseases Society of America. Clinical Infectious Diseases. 2008. doi:10.1086/588300
Primary guideline for antifungal selection and duration
Severity-based treatment stratification
Infectious Disease Clinics of North America 2025
Zhou S, Kauffman CA, Miceli MH. Blastomycosis. Infectious Disease Clinics of North America. 2025. PMID 39701898
Comprehensive review of diagnosis and management
Updated epidemiology and treatment recommendations
Seminars in Respiratory and Critical Care Medicine 2020
Schwartz IS, Kauffman CA. Blastomycosis. Seminars in Respiratory and Critical Care Medicine. 2020. PMID 32000282
Immunocompromised host considerations
Dissemination patterns and risk factors
Epidemiology and outcomes studies
Outcomes in immunocompetent and immunocompromised patients
McBride JA, Sterkel AK, Matkovic E, et al. Clinical Manifestations and Outcomes in Immunocompetent and Immunocompromised Patients With Blastomycosis. Clinical Infectious Diseases. 2021. PMID 32179889
Dissemination rates similar across immunologic spectrum
Severity differences by immune status documented
ICU and hospital outcomes
Ahluwalia V, Almodallal Y, Alkurashi AK, et al. Intensive Care Unit and Hospital Outcomes of Patients Admitted With Blastomycosis: A 14-Year Retrospective Study. Lung. 2022. PMID 34988618
ICU admission rate approximately 35%
Renal failure independently associated with mortality
ARDS outcomes
Rush B, Lother S, Paunovic B, Mooney O, Kumar A. Outcomes With Severe Blastomycosis and Respiratory Failure in the United States. Clinical Infectious Diseases. 2021. PMID 32227089
Mechanical ventilation mortality approximately 40%
Vasopressor use in 84% of ARDS cases
Schwartz IS, Embil JM, Sharma A, Goulet S, Light RB. Management and Outcomes of ARDS Caused by Blastomycosis. Medicine. 2016. PMID 27149459
ECMO case series outcomes
Diagnostic references
ATS Laboratory Testing Guideline
Hage CA, Carmona EM, Epelbaum O, et al. Microbiological Laboratory Testing in the Diagnosis of Fungal Infections in Pulmonary and Critical Care Practice. American Journal of Respiratory and Critical Care Medicine. 2019. PMC6727169
Recommends using more than one diagnostic test
Antigen testing performance characteristics
Global Endemic Mycoses Guideline
Thompson GR, Le T, Chindamporn A, et al. Global Guideline for the Diagnosis and Management of the Endemic Mycoses. The Lancet Infectious Diseases. 2021. PMID 34364529
International consensus recommendations
Diagnostic and treatment approach
CNS Blastomycosis
Bariola JR, Perry P, Pappas PG, et al. Blastomycosis of the Central Nervous System: A Multicenter Review of Diagnosis and Treatment in the Modern Era. Clinical Infectious Diseases. 2010. PMID 20166817
CNS involvement characteristics and outcomes
Antifungal selection for CNS disease
SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.