Radical treatment for blastomycosis following unsuccessful liposomal amphotericin. Issue 12 (December 2022)

• Record Type: Journal Article
• Authors: Chew, Christopher; Thapa, Nikhilesh; Ogbuagu, Henry; Varghese, Merin; Patel, Dhaval; Abbas, Raza; Oh, Jason; Teshome, Molla; Mohammed, Khaja; Saleem, Sohail; Aggarwal, Deepak; Barns, Barry; McDonald, April; Ormenisan-Gherasim, Claudia
• Is Part Of: Lancet infectious diseases. Volume 22:Issue 12(2022)
• Page Start: e377
• Page End: e381
• Publication Date: 2022-12
• Subjects: Communicable diseases -- Periodicals; Infection -- Periodicals; Communicable Diseases -- Periodicals; Infection -- Periodicals; Maladies infectieuses -- Périodiques; Infection -- Périodiques; Communicable diseases; Infection; Periodicals; 616.905
• DOI: 10.1016/S1473-3099(22)00352-8
• Languages: English
• ISSNs: 1473-3099

Abstract

Summary: Pulmonary blastomycosis is a respiratory disease that is caused by the fungus Blastomyce s spp, which is acquired through inhalation of the fungal spores. Blastomycosis is relatively uncommon, with yearly incidence rate of 1–2 cases per 100 000 people. Blastomycosis is a disease that is endemic to the midwest and southern regions of the USA, most commonly affecting immunocompromised patients. About 50% of patients are asymptomatic, but for those who progress to acute respiratory distress syndrome (ARDS) mortality can be as high as 80%. Patients with severe blastomycosis are initially treated with intravenous amphotericin B, followed by long-term itraconazole maintenance therapy. In this Grand Round, we present the case of an immunocompetent 35-year-old man diagnosed with chronic pulmonary blastomycosis who had a poor response to 10 days of intravenous liposomal amphotericin B (L-AmB). He was endotracheally intubated and eventually cannulated for extracorporeal membrane oxygenation (ECMO), due to worsening respiratory function. L-AmB was replaced with a continuous infusion of intravenous amphotericin B deoxycholate (AmB-d). He improved significantly and was decannulated from ECMO on day 9 of AmBd continuous infusion and extubated on day 12 Although L-AmB is considered first-line treatment for blastomycosis, mortality remains high for patients with ARDS associated with blastomycosis. This case highlights the importance of considering AmB-d continuous infusions for patients with severe blastomycosis who might have poor clinical responses to L-AmB.