A clinician's view of blastomycosis.

In summary, blastomycosis is a rarely reported but important infection in certain endemic areas. Better understanding of the number with subclinical infection is dependent on studies with more reliable and specific immunologic testing. The illness may mimic several other conditions but particularly neoplastic disease. Therefore, fungal cultures and smears, which will allow a firm diagnosis, should be obtained during invasive procedures aimed at the diagnosis of cancer. Therapy of blastomycosis has been broadened with the addition of ketoconazole. Itraconazole appears to have even greater efficacy while fluconazole remains to be confirmed as an effective agent for this infection. The role of amphotericin B or itraconazole depends on comparative clinical trials.