Current and future therapeutic strategies for treatment of blastomycosis

Abstract

Introduction: Blastomyces dermatitidis causes a broad spectrum of disease ranging from asymptomatic, self-limited infection to fulminant sepsis or acute respiratory distress syndrome. B. dermatitidis can cause disease in nearly every organ in the body, but has a predilection for pulmonary, osseous, CNS and skin manifestations. Treatment of blastomycosis depends upon the location of the infection, the severity of clinical disease and the immune status of the host.

Areas covered: This article discusses advances in the diagnosis and management of blastomycosis, including the use of newer antifungal agents for this infection. Additionally antifungal agents that may have potential clinical utility for this infection and are in late-stage clinical trials are reviewed. The use of azole therapy including recommendations for therapeutic drug monitoring will also be discussed.

Expert opinion: For serious disease the liposomal amphotericin products are preferred, and novel methods of drug delivery including continuous infusion will be discussed. Azole antifungals, typically itraconazole, are the primary agents for less severe disease and for step-down therapy. However, there has been increasing use of voriconazole for CNS infection with good results, and it is our recommendation to use voriconazole for CNS and ocular disease.

Keywords::

• amphotericin
• blastomycosis
• itraconazole
• therapeutic drug monitoring
• voriconazole

Notes

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