BLASTOMYCOSIS IN CHILDREN

Infections due to Blastomyces dermatitidis are not commonly encountere d in children and adolescents. Knowledge of the diagnosis and treatmen t of this disease is largely based upon experience with adult patients . We recently reviewed our experience with blastomycosis to evaluate t he difficulties in diagnosis and treatment of this disease in the pedi atric population. Ten patients with blastomycosis were identified duri ng our review, and five had pulmonary disease alone. Of these five pat ients, four required open-lung biopsy for diagnosis, even though three had previously undergone bronchoalveolar lavage. The response to trea tment with the oral azole antifungal agents (ketoconazole, fluconazole , and itraconazole) was limited, and the agent with the greatest succe ss remains amphotericin B. Until more data are available, amphotericin B should be used for complicated and life-threatening cases of blasto mycosis. If oral azole agents are used for non-life-threatening cases, patients should be followed closely, and if clinical deterioration oc curs or serum levels of medications are not adequate, then amphoterici n B should be substituted for the oral azole agent.