BLASTOMYCOSIS AND HUMAN-IMMUNODEFICIENCY-VIRUS - 3 NEW CASES AND REVIEW

Reports of blastomycosis in individuals infected with the human immuno deficiency virus (HIV) are increasing. We report on 3 patients co-infe cted with blastomycosis and HIV (to add to the previously reported 21) , and review important clinical aspects and outcomes in all cases. The percentage of patients co-infected with blastomycosis and HIV who had disseminated blastomycosis (63%) was similar to the blastomycosis pat ients in the general population (67%); however, as a group the patient s with HIV were severely immunosuppressed and fared poorly. Severe imm unodeficiency was indicated by CD4 counts <200/mm(3) in 85% of co-infe cted patients. Central nervous system (CNS) involvement occurred in 46 % of this group, approximately 5 to 10 times more frequently than in i ndividuals not infected with HIV previously reported at 5% to 10%. The mortality rate from blastomycosis for patients with both HIV infectio n and blastomycosis is 54%, about 5 times the mortality rate of blasto mycosis patients in the general population, previously reported at <10 %. Disseminated blastomycosis in individuals with HIV may appear as de ep cutaneous ulcers, as was the case in two of our patients. Although blastomycosis is not an AIDS-defining infection, it may be reasonable to consider HIV testing and measurement of CD4 counts in patients with blastomycosis. Such testing could help identify individuals who are H IV positive but asymptomatic who have blastomycosis, as well as provid e useful information regarding a possible association between CD4 cell deficiency and various clinical manifestations of blastomycosis. Pati ents with HIV and blastomycosis should be examined carefully far any e vidence of CNS involvement. Lifetime therapy with ketoconazole or itra conazole is likely to be of benefit to patients with HIV who have been treated successfully for blastomycosis.