Treatment Overview
For many people, a diagnosis of blastomycosis comes as a surprise, often following weeks or months of unexplained cough, fatigue, or skin lesions. This fungal infection, caused by inhaling spores found in moist soil and decomposing matter, can mimic common respiratory illnesses, making the journey to diagnosis frustratingly long. Once identified, however, the path forward is clear. While the condition can be serious if it spreads, it is highly treatable with established medical therapies.
Treatment is essential to eliminate the fungus from the body and prevent it from spreading from the lungs to other systems, such as the skin, bones, or central nervous system. The goal is to cure the infection completely to prevent relapse. Because the severity of blastomycosis ranges from mild pneumonia-like symptoms to life-threatening widespread infection, treatment plans are tailored to the individual. Doctors consider the extent of the disease and the patient’s immune health when selecting the appropriate medication (Centers for Disease Control and Prevention, 2021).
Overview of treatment options for Blastomycosis
The management of blastomycosis relies almost entirely on antifungal medications. Unlike bacterial infections that might be treated in a week or two, fungal infections like blastomycosis require a long-term commitment to therapy. Treatment typically lasts anywhere from six months to a year, depending on which organs are affected.
For mild to moderate pulmonary cases, oral medication is the standard approach. For severe infections, particularly those involving the brain or resulting in acute respiratory distress, aggressive intravenous (IV) therapy is required initially. The primary objective is to stop the fungal growth swiftly in severe cases, then transition to maintenance therapy to ensure complete eradication. Surgery is rarely needed but may be used occasionally to drain abscesses.
Medications used for Blastomycosis
The two main classes of antifungal drugs used to treat blastomycosis are azoles and polyenes.
For mild to moderate blastomycosis, the azole antifungal itraconazole is the treatment of choice. It is an oral medication that is highly effective for infections contained in the lungs or skin. Clinical experience suggests that itraconazole is successful in treating the vast majority of non-life-threatening cases. Other azoles, such as fluconazole or voriconazole, are generally considered second-line options if itraconazole cannot be tolerated or absorbed.
For severe blastomycosis, or when the infection has spread to the central nervous system, doctors typically start with a polyene antifungal called amphotericin B. This is a potent medication administered intravenously in a hospital setting. It acts quickly to control the infection. Once the patient stabilizes usually after one to two weeks, treatment is stepped down to oral itraconazole for the remainder of the course (usually 6 to 12 months) to prevent the infection from returning (National Institutes of Health, 2023).
How these medications work
Antifungal drugs target the structural integrity of fungal cells. Fungi, such as Blastomyces, require a cell membrane stabilized by ergosterol, similar to cholesterol in human cells.
Azoles, like itraconazole, inhibit the enzyme that creates ergosterol, weakening the fungal cell membrane and preventing growth/reproduction.
Polyenes, like amphotericin B, bind directly to existing ergosterol, creating pores in the membrane. This causes the cell contents to leak out, rapidly killing the fungus, which is why it’s used for severe cases (MedlinePlus, 2022).
Side effects and safety considerations
Antifungal medications have notable side effects. Itraconazole commonly causes GI issues (nausea, vomiting, diarrhea) and can affect the liver, necessitating blood tests to monitor liver enzymes. Due to many drug interactions, patients must list all current medications.
Amphotericin B is known for more severe, flu-like “shake and bake” side effects (fever, chills, aches) during infusion and can be kidney-toxic, requiring close hospital monitoring of kidney function and electrolytes.
To reduce liver stress, patients should avoid alcohol. Pregnant women need alternative management, as some antifungals may harm the fetus. Seek immediate medical attention for signs of liver damage, such as jaundice (yellowing skin/eyes) or dark urine.
Since everyone’s experience with the condition and its treatments can vary, working closely with a qualified healthcare provider helps ensure safe and effective care.
References
- Centers for Disease Control and Prevention. https://www.cdc.gov
- National Institutes of Health. https://www.nih.gov
- MedlinePlus. https://medlineplus.gov
- Mayo Clinic. https://www.mayoclinic.org
Medications for Blastomycosis
These are drugs that have been approved by the US Food and Drug Administration (FDA), meaning they have been determined to be safe and effective for use in Blastomycosis.