OVERWHELMING PULMONARY BLASTOMYCOSIS ASSOCIATED WITH THE ADULT-RESPIRATORY-DISTRESS-SYNDROME

Background and Methods. Few cases of overwhelming pulmonary blastomyco sis 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 f ever, cough, and dyspnea; radiographic evidence of diffuse pulmonary i nfiltrates; and marked impairment of oxygenation. The mean alveolar-ar terial oxygen gradient was 616 mm Hg. Six of the patients had no under lying disease associated with altered immunity, and two had no recent exposure to environmental reservoirs of Blastomyces dermatitidis. In a ll 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 p er day). Of the five survivors, four received full doses of amphoteric in B in the first 24 hours, and four required mechanical ventilatory s upport for 7 to 151 days. Long-term follow-up of three survivors showe d good recovery of pulmonary function. Conclusions. Overwhelming infec tion with B. dermatitidis can cause diffuse pneumonitis and the adult respiratory distress syndrome, even in immunocompetent hosts. With pro mpt diagnosis by microscopical examination of tracheal secretions, int ensive therapy with amphotericin B, and ventilatory support, good reco very of pulmonary function is possible.