North American blastomycosis in Iowa: review of 34 cases

We have reviewed 34 patients with blastomycosis seen from 1937–1971 at the University of Iowa Hospitals, 29 men and 5 women, ages 19–78; 86 per cent of our patients were followed to death or for 5 or more years after hospitalization. Thirty-six per cent had a probable occupational soil exposure. A majority of patients had symptoms for 4–12 months before diagnosis. Fever was unusual and symptoms varied according to the anatomical site involved. The disease has been analyzed in patients with cutaneous, pulmonary, osseous, genito-urinary and disseminated blastomycosis. The disease should be diagnosed by culture, but the presence of round, thick-walled, single-budding yeast in KOH skin scraping preparations is highly suggestive. Treatment with dihydroxystilbamidine or Amphotericin B has reduced the recurrence rate from 20 per cent to 9 per cent and the death rate from 8 per cent to zero. Surgical treatment by lobectomy was done in 3 patients.