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Previous Volume 329:1231-1236 October 21, 1993 Number 17 Next

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ABSTRACT

Background and Methods Few cases of overwhelming pulmonary blastomycosis associated with the adult respiratory distress syndrome have been reported. We describe 10 patients with this condition who were treated at one center in Wisconsin.

Results All 10 patients presented with fever, cough, and dyspnea; radiographic evidence of diffuse pulmonary infiltrates; and marked impairment of oxygenation. The mean alveolar-arterial oxygen gradient was 616 mm Hg. Six of the patients had no underlying disease associated with altered immunity, and two had no recent exposure to environmental reservoirs of Blastomyces dermatitidis. In all 10 patients, large numbers of broad-based budding yeasts were seen on microscopical examination of tracheal secretions. All patients were treated with intravenous amphotericin B (0.7 to 1.0 mg per kilogram per day). Of the five survivors, four received full doses of amphotericin B in the first 24 hours, and four required mechanical ventilatory support for 7 to 151 days. Long-term follow-up of three survivors showed good recovery of pulmonary function.

Conclusions Overwhelming infection with B. dermatitidis can cause diffuse pneumonitis and the adult respiratory distress syndrome, even in immunocompetent hosts. With prompt diagnosis by microscopical examination of tracheal secretions, intensive therapy with amphotericin B, and ventilatory support, good recovery of pulmonary function is possible.

Source Information

From the Sections of Pulmonary and Critical Care Medicine (K.C.M.) and Infectious Diseases (E.J.M., D.G.M.), Department of Medicine, and the Center for Trauma and Life Support (K.C.M., D.G.M.), University of Wisconsin Medical School, Madison. Presented in part at the Annual Meeting of the American Thoracic Society, Las Vegas, May 11, 1988, and the 28th Interscience Conference on Antimicrobial Agents and Chemotherapy, Los Angeles, October 25, 1988.

Address reprint requests to Dr. Maki at the University of Wisconsin Hospitals and Clinics, H4/574, Madison, WI 53792.

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