Blastomycosis.

Blastomycosis is a systemic mycosis with a high prevalence in the Midwest of the United States. The fungus inhabits soil, and human infection occurs through inhalation. Its asexual phase is called Blastomyces dermatitidis and its sexual phase, Ajellomyces dermatitidis. It is more common in men. Signs and symptoms are usually severe, starting with an infection resembling pneumonia that later disseminates to the skin, bones, and central nervous system. Infection in dogs is common in endemic areas. The diagnosis can be achieved by identifying the organism with direct microscopy, culture, histopathology, serologic tests, and molecular techniques, although these are still in trial phase. The treatments of choice are azoles (itraconazole, fluconazole, and posaconazole), and in severe cases, amphotericin B.