I've set up a group on Mendeley for Blastomycosis Research.
Join the group here: http://www.mendeley.com/groups/1494983/blastomycosis/.
A basic membership is free.
Previous work - will keep up here until I have them all added to the group on Mendeley.
I'm building a list of scientific references for blastomycosis. You can go to your local library to see if they will get these articles by Inter-Library Loan. If you have a University near by that offers a science program, their University library may subscribe to the electronic version of these journals.
I've included the abstract where possible.
Arceneaux, K. A., Taboada, J., & Hosgood, G. (1998). Blastomycosis in dogs: 115 cases (1980-1995). Journal of the American Veterinary Medical Association, 213(5), 658-664.
OBJECTIVE: To characterize diagnostic results, treatment, and outcome of dogs with blastomycosis during a 15-year period in Louisiana. DESIGN: Retrospective case series. ANIMALS: 115 dogs with blastomycosis. PROCEDURE: Medical records were reviewed for dogs with blastomycosis examined between 1980 and 1995. Additional data were collected from the state veterinary diagnostic laboratory, via telephone interviews of owners, and by use of a random survey of the hospital population. RESULTS: Blastomycosis was detected mainly in young, large-breed dogs. Proximity to a body of water was a significant risk factor for affected dogs. Most dogs were affected in January and August through October. Clinical signs and results of physical examination reflected the multisystemic nature of the disease. Commonly affected systems included the respiratory tract and lymphatic, ocular, and cutaneous systems. Nodular interstitial and interstitial patterns were common findings on thoracic radiographs. Cytologic examination was successful in identifying organisms in samples from vitreous, skin, and lymph nodes. Similar results were achieved for dogs treated with a combination of amphotericin B and ketoconazole, compared with dogs treated with itraconazole. CLINICAL IMPLICATIONS: Results of this study should assist veterinarians with the recognition and management of blastomycosis in dogs. Blastomycosis should be considered as a differential diagnosis for large-breed dogs that live close to a body of water in areas in which the disease is endemic or in dogs with a history of being transported to endemic areas that subsequently develop signs of pulmonary, ocular, lymphatic, or cutaneous disease. Treatment with itraconazole was as effective as treatment with a combination of amphotericin B and ketoconazole.
Archer, J. R., Trainer, D. O., & Schell, R. F. (1987). Epidemiologic study of canine blastomycosis in wisconsin. Journal of the American Veterinary Medical Association, 190(10), 1292-1295.
An epidemiologic study was designed to investigate the increasing number of cases of canine blastomycosis being reported in Wisconsin. From January 1980 through July 1982, 200 cases of canine blastomycosis from 39 Wisconsin counties were examined to assess epidemiologic and environmental aspects of this disease. Based on a survey of 176 dog owners, principal disease characteristics for canine blastomycosis were anorexia, lethargy, shortness of breath, chronic cough, and weight loss. The greatest number of cases of canine blastomycosis was in the northwest, north central, northeast, central, and southeast regions of Wisconsin. The northeast and central regions were determined to be new enzootic areas. Sporting breeds accounted for the largest percentage of cases among the various breeds of dogs in Wisconsin. Most of the affected dogs were 3 years old or younger and there was no apparent sexual predilection. Canine blastomycosis was diagnosed more frequently from late spring through late fall. Enzootic areas, except for the southeast region of Wisconsin, were located where the soil was sandy and acid. The results of this study suggested a possible association of enzootic areas with waterways, especially impoundments.
Baumgardner, D. J., & Burdick, J. S. (1991). An outbreak of human and canine blastomycosis. Reviews of infectious diseases, 13(5), 898-905.
In the summer and fall of 1988, three humans and one dog in a lakeshore community in northern Wisconsin were found to have blastomycosis on the basis of the results of cultures and histologic studies; the infection was also suspected in one human and four dogs on the basis of clinical data. Serologic testing with use of enzyme immunoassay for antibody to the A antigen of Blastomyces dermatitidis was performed for 77 additional human residents and visitors in the area an average of 9 months after the outbreak. Titers of antibody of greater than or equal to 1:32 were considered presumptive evidence of blastomycosis, and measurement of such titers enabled identification of 18 additional suspected cases in this group, compared with none in a control group (n = 40). Of the 22 humans with confirmed and suspected cases, 16 (73%) were asymptomatic. Epidemiologic and meteorologic data gathered during this period suggested an associated between this outbreak and the presence of dust from excavation for a hotel across the lake. The result of this study further confirm the common occurrence of self-limited and subclinical infection with B. dermatitidis and suggest that excavation in an area endemic for B. dermatitidis is a risk factor for human and canine infection.
Baumgardner, D. J., & Paretsky, D. P. (1997). Identification of blastomyces dermatitidis in the stool of a dog with acute pulmonary blastomycosis. Journal of medical and veterinary mycology : bi-monthly publication of the International Society for Human and Animal Mycology, 35(6), 419-421.
We report the identification of Blastomyces dermatitidis by microscopic examination of a direct faecal smear from a dog with pulmonary blastomycosis. A simultaneously obtained faecal culture grew Blastomyces dermatitidis. The fungus was also cultured from a transtracheal sample from this same dog. This report suggests that yeast-phase cells of B. dermatitidis may be recovered in the stool of dogs with pulmonary blastomycosis following transit through the gastrointestinal tract of swallowed infected sputum. Implications regarding the ecology of Blastomyces dermatitidis are discussed.
Baumgardner, D. J., Paretsky, D. P., & Yopp, A. C. (1995). The epidemiology of blastomycosis in dogs: North central wisconsin, USA. Journal of medical and veterinary mycology : bi-monthly publication of the International Society for Human and Animal Mycology, 33(3), 171-176.
The epidemiological features of 59 consecutive cases of blastomycosis in domestic dogs, from a single veterinary practice in Eagle River, Wisconsin over a 3-year period, were examined by owner interview. The control sample included: (i) all porcupine quill-injured dogs during this time period (outdoor exposed dogs); and (ii) every sixth dog receiving a rabies vaccination during the second year of study (representative of all dogs in the practice). The estimated mean annual incidence of blastomycosis in dogs in this region was 1420:100,000. Blastomycosis cases were more likely to reside within 400 m of a waterway (95%) than quill-injured dogs (63%, P < 0.001) or vaccinated dogs (74%, P = 0.001). Exposure to an excavation was significantly more likely among blastomycosis cases compared to quill-injured dogs, however, no differences were found for age, sex, hunting, swimming and reported exposure to beavers. The geographical clustering of cases in dogs is similar to that previously reported for humans in this region. A close proximity to waterways and an exposure to excavation are significant risk factors for blastomycosis.
Bradsher, R. W. (1992). Blastomycosis. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 14 Suppl 1, S82-90.
Blastomycosis is a rare but important fungal infection that occurs primarily in the south central and midwestern United States. Epidemics of blastomycosis related to a point-source exposure include patients of all ages and both sexes; however, cases of endemic blastomycosis are usually in young to middle-aged adults and are reported more for men than for women. Pneumonia is the most common manifestation of blastomycosis, and the lungs are almost always the organ initially infected. Skin, bone, prostate, and central nervous system are the next most frequently infected organs in descending order. Amphotericin B is curative, but because of its toxic effects, oral agents have been investigated as therapy for blastomycosis. ketoconazole should replace amphotericin B as therapy for blastomycosis that is not life threatening. Itraconazole is an experimental agent that is perhaps even more effective than ketoconazole. The therapeutic usefulness of fluconazole for blastomycosis remains unproven. For patients with life-threatening or central nervous system blastomycosis, amphotericin B remains the treatment of choice.
Bradsher, R. W. (1996). Histoplasmosis and blastomycosis. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 22 Suppl 2, S102-11.
Histoplasmosis and blastomycosis are caused by dimorphic fungi, can be epidemic or endemic, and can produce a spectrum of illness, from subclinical infection to progressive disseminated disease. Diagnosis of both is best made by visualization of yeast in tissue or by culture. Itraconazole is the drug of choice for treatment of both histoplasmosis and blastomycosis, except in cases of life-threatening infection, for which amphotericin B is indicated. A heavy inoculum of Histoplasma capsulatum may cause acute pulmonary infection in an otherwise healthy host, resulting in fever, hypoxia, and pulmonary infiltrates. Opportunistic histoplasmosis develops as chronic pulmonary histoplasmosis in those with a structural defect in the lung (emphysema) or as disseminated histoplasmosis in patients with cellular immune deficiency (due to immunosuppressants or AIDS). Blastomyces dermatitidis causes both pulmonary and extrapulmonary disease. Lung involvement may mimic bacterial pneumonia, while chronic presentations mimic lung cancer or tuberculosis. Skin is the most common extrapulmonary site of disease, followed by bone, prostate, and central nervous system.
Brooks, D., Legendre, A., Gum, G., Laratta, L., Abrams, K., & Morgan, R. (1991). The treatment of canine ocular blastomycosis with systemically administered itraconazole. Prog Vet Comp Ophthalmol, 1, 263-268.
Buyukmihci, N. (1982). Ocular lesions of blastomycosis in the dog. Journal of the American Veterinary Medical Association, 180(4), 426-431.
Twenty-one dogs with ocular disease and blastomycosis were studied clinically. The most common ocular lesion was uveitis. Other findings included retinal separation, panophthalmitis, and glaucoma. The results of the study indicated that when uveitis is found in dogs in central United States, east of the Mississippi River, blastomycosis should be a diagnostic consideration. When the uveitis was associated with lung, lymph node, skin, bone, or testicular lesions, the likelihood of blastomycosis was greater.
Chapman, S. W., Bradsher Jr, R. W., Campbell Jr, G. D., Pappas, P. G., & Kauffman, C. A. (2000). Practice guidelines for the management of patients with blastomycosis. Clinical Infectious Diseases, 30(4), 679-683.
Dismukes, W. E., Bradsher, R. W.,Jr, Cloud, G. C., Kauffman, C. A., Chapman, S. W., George, R. B., et al. (1992). Itraconazole therapy for blastomycosis and histoplasmosis. NIAID mycoses study group. The American Journal of Medicine, 93(5), 489-497.
OBJECTIVE: To assess the efficacy and toxicity of orally administered itraconazole in the treatment of nonmeningeal, nonlife-threatening forms of blastomycosis and histoplasmosis. DESIGN: Prospective, nonrandomized, open trial. SETTING: Multicenter trial at 14 university referral centers. PATIENTS: Eighty-five patients with culture or histopathologic evidence of blastomycosis (48 patients) or histoplasmosis (37 patients). Patients receiving other systemic antifungal therapy were excluded. INTERVENTIONS: Itraconazole was administered orally at doses of 200 to 400 mg/d. Patients in whom treatment was considered a success were treated for a median duration of 6.2 months (blastomycosis) and 9.0 months (histoplasmosis). Disease activity was assessed at baseline; drug efficacy and toxicity were evaluated at monthly intervals during therapy, and efficacy was evaluated at regular follow-up visits after completion of therapy. The median duration of posttreatment evaluation for successfully treated patients was 11.9 months (blastomycosis) and 12.1 months (histoplasmosis). MEASUREMENTS AND MAIN RESULTS: Among the 48 patients with blastomycosis, success was documented in 43 (90%). The success rate for patients treated for more than 2 months was 95% (38 of 40). Among the 37 patients with histoplasmosis, success was documented in 30 (81%). The success rate for patients treated for more than 2 months was 86% (30 of 35). All patients with histoplasmosis in whom treatment failed had chronic cavitary pulmonary disease. Toxicity was minor; only 25 (29%) patients experienced any side effects, and itraconazole toxicity necessitated stopping therapy in only 1 patient. CONCLUSIONS: Itraconazole is a highly effective therapy for nonmeningeal, nonlife-threatening blastomycosis and histoplasmosis. The drug is associated with minimal toxicity.
Furcolow, M. L., Chick, E. W., Busey, J. F., & Menges, R. W. (1970). Prevalence and incidence studies of human and canine blastomycosis. 1. cases in the united states, 1885-1968. The American Review of Respiratory Disease, 102(1), 60-67.
Gnann, J. W.,Jr, Bressler, G. S., Bodet, C. A.,3rd, & Avent, C. K. (1983). Human blastomycosis after a dog bite. Annals of Internal Medicine, 98(1), 48-49.
Heymann, D L. (2004). Control of Communicable Diseases Manual, 18th edition. Washington, DC: American Public Health Association. p.67-69.
Howard, J., Arceneaux, K. A., Paugh-Partington, B., & Oliver, J. (2000). Blastomycosis granuloma involving the cranial vena cava associated with chylothorax and cranial vena caval syndrome in a dog. Journal of the American Animal Hospital Association, 36(2), 159-161.
A four-year-old, sexually intact, male dachshund was diagnosed with pulmonary blastomycosis. Itraconazole was administered for 60 days, and the dog was considered to be disease-free at three- and 12-month reevaluations. Two years following discontinuation of itraconazole, the dog developed a granuloma of the cranial vena cava resulting in chylothorax and cranial vena caval obstruction. To the authors' knowledge, this is the first case of a blastomycotic granuloma involving the vena cava reported in the dog. Blastomycosis should be considered as a differential diagnosis for both chylothorax and cranial vena caval syndrome in the dog.
Kesselman E, Moore S, Embil J. (2005) Using local epidemiology to make a difficult diagnosis: a case of blastomycosis. Canadian Journal of Emergency Medicine; 7(3): 171-3.
Klein, B. S., Vergeront, J. M., Weeks, R. J., Kumar, U. N., Mathai, G., Varkey, B., et al. (1986). Isolation of blastomyces dermatitidis in soil associated with a large outbreak of blastomycosis in wisconsin. The New England journal of medicine, 314(9), 529-534.
In investigating six cases of blastomycosis in two school groups that had separately visited an environmental camp in northern Wisconsin in June 1984, we identified a large outbreak of the disease and isolated Blastomyces dermatitidis from soil at a beaver pond near the camp. Of 89 elementary-school children and 10 adults from the two groups, 48 (51 percent) of the 95 evaluated in September had blastomycosis. Of the cases, 26 (54 percent) were symptomatic (the median incubation period was 45 days; range, 21 to 106 days). No cases were identified in 10 groups that visited the camp two weeks before or after these two groups. A review of camp itineraries, a questionnaire survey, and environmental investigation showed that blastomycosis occurred in two of four groups that visited a beaver pond and in none of eight groups that did not. Walking on the beaver lodge (P = 0.008) and picking up items from its soil (P = 0.05) were associated with illness. Cultures of soil from the beaver lodge and decomposed wood near the beaver dam yielded B. dermatitidis. We conclude that B. dermatitidis in the soil can be a reservoir for human infection.
Legendre, A. M., & Becker, P. U. (1980). Evaluation of the agar-gel immunodiffusion test in the diagnosis of canine blastomycosis. American Journal of Veterinary Research, 41(12), 2109-2111.
The agar-gel immunodiffusion test was used to evaluated 35 dogs with histopathologically confirmed blastomycosis and 98 dogs without blastomycosis. The test had a sensitivity of 91% and a specificity of 96%. Thirteen of the dogs treated for blastomycosis were tested at 6 to 33 months after treatment with amphotericin B. Ten of 13 dogs became seronegative and 3, though clinically normal, remained seropositive at 19, 20, and 20 months, respectively, after amphotericin treatment.
Legendre, A. M., Selcer, B. A., Edwards, D. F., & Stevens, R. (1984). Treatment of canine blastomycosis with amphotericin B and ketoconazole. Journal of the American Veterinary Medical Association, 184(10), 1249-1254.
The treatment of 62 dogs with blastomycosis was reviewed to identify prognostic factors and response to various treatment regimens. Severity of lung involvement, as determined by radiography, and the number of nonsegmented neutrophils were useful prognostic factors. Females survived treatment better than did males, but females were more prone to relapse. Ketoconazole treatment at a dose of 10 mg/kg daily for 60 days was not as effective as amphotericin B. The most notable adverse effect of amphotericin B treatment was nephrotoxicosis . Treatment with amphotericin B followed by ketoconazole was as effective as amphotericin B alone and resulted in less nephrotoxicosis . Most dogs that had relapses were retreated effectively with amphotericin B and/or ketoconazole. Canine blastomycosis was shown to be a treatable disease, with a cure rate of approximately 75%.
Legendre, A. M., Walker, M., Buyukmihci, N., & Stevens, R. (1981). Canine blastomycosis: A review of 47 clinical cases. Journal of the American Veterinary Medical Association, 178(11), 1163-1168.
In a limited retrospective survey, canine blastomycosis was found to be a disease affecting predominantly young, male dogs of the larger breeds. Clinical signs usually related to weight loss and to respiratory and ocular problems. The agar-gel immunodiffusion test was helpful in establishing a diagnosis. The diagnosis was confirmed by microscopic evaluation of aspiration or excision biopsies. Of 22 dogs treated with amphotericin B, 18 were clinically normal 6 months after initiation of therapy.
Lester, R.S., DeKoven, J.G., Kane, J., Simor, A.E., Krajden, S., Summerbell, R.C. (2000). Novel cases of blastomycosis acquired in Toronto, Ontario. Canadian Medical Association Journal, 163(10), 1309-1312.
Blastomycosis a potentially fatal fungal disease, is well known from defined areas of endemicity in Ontario, primarily in the northern part of the province. We present 2 unusual cases that appear to extend the area of endemicity into urban southern Ontario, specifically Toronto. Both patients presented to a dermatology clinic with skin lesions. Chest radiography, history and general physical evaluation indicated no disease at other body sites. Both cases appeared to represent "inoculation blastomycosis" connected with minor gardening injuries and a cat scratch respectively. Atypical dissemination could not be completely excluded in either case. Neither patient had travelled recently to a known area of high endemicity for blastomycosis, nor had the cat that was involved in one of the cases. Physicians must become aware that blastomycosis may mimic other diseases, including dermal infections, and may occur in patients whose travel histories would not normally suggest this infection.
Morris S, Brophy J, Richardson S, Summerbell R, Parkin P, Jamieson F, Limerick B, Wiebe L, Ford-Jones L. (Feb 2006). Blastomycosis in Ontario, 1994-2003. Emerging Infectious Diseases; 12(2), 274. Link: www.cdc.gov/eid
Pappas, P. G., Pottage, J. C., Powderly, W. G., Fraser, V. J., Stratton, C. W., McKenzie, S., et al. (1992). Blastomycosis in patients with the acquired immunodeficiency syndrome. Annals of Internal Medicine, 116(10), 847-853.
OBJECTIVE: To describe the clinical, demographic, radiographic, diagnostic, and therapeutic aspects of blastomycosis in patients with the acquired immunodeficiency syndrome (AIDS). DESIGN: A retrospective survey. SETTING: Ten university medical centers and community hospitals, six in geographic areas endemic for Blastomyces dermatitidis, and four outside the endemic area. PATIENTS: We identified 15 patients with blastomycosis and positive serologic test results for human immunodeficiency virus (HIV). MEASUREMENTS: A diagnosis of blastomycosis was based on a positive culture (14 patients) or typical histopathologic features (one patient) for B. dermatitidis in clinical specimens. RESULTS: Twelve of 15 patients had a previous or concomitant AIDS-defining illness at the time of diagnosis of blastomycosis, and only one patient had a CD4 lymphocyte count of greater than 200 cells/mm3. Two patterns of disease emerged: localized pulmonary involvement (seven patients), and disseminated or extrapulmonary blastomycosis (eight patients). Central nervous system involvement was common (40%). Six patients died within 21 days of presentation with blastomycosis, including four patients with disseminated and two with fulminant pulmonary disease. Among the nine patients who survived longer than 1 month, all received amphotericin B as initial antifungal therapy, and most received subsequent therapy with ketoconazole. Only two of these nine patients died with evidence of progressive blastomycosis. CONCLUSIONS: Blastomycosis is a late and frequently fatal infectious complication in a few patients with AIDS. In these patients, overwhelming disseminated disease including involvement of the central nervous system is common, and it is associated with a high early mortality. Initial therapy with amphotericin B is appropriate in patients with AIDS and presumptive blastomycosis.
Pappas, P. G., Threlkeld, M. G., Bedsole, G. D., Cleveland, K. O., Gelfand, M. S., & Dismukes, W. E. (1993). Blastomycosis in immunocompromised patients. Medicine, 72(5), 311-325.
Among the endemic mycoses, blastomycosis has been least often associated with disorders of immune function, but the data presented herein suggest that blastomycosis may occur more commonly in immunocompromised patients than was previously recognized. We have observed a marked increased in the number of immunocompromised patients with blastomycosis over the last 15 years, increasing from about 3% of patients seen between 1956 and 1977 to almost 24% patients seen between 1978 and 1991. The disease appears to be much more aggressive in immunocompromised than in normal hosts. Almost 30% of the patients in our series died secondary to blastomycosis, with most deaths occurring within 5 weeks following the diagnosis. Furthermore, almost one third of those patients who died of other causes had evidence of persistent blastomycosis at death. Multiple organ and central nervous system involvement were relatively common in this series. For these reasons, early and aggressive therapy with amphotericin B is indicated for most immunocompromised patients with blastomycosis. Oral therapy with an azole compound should probably be reserved for patients who have responded to a primary course of amphotericin B but who require additional or long-term suppressive therapy. Until more data are available, the newer azoles should be used with caution as primary therapy in immunocompromised patients with blastomycosis, and considered only in patients with limited disease and a stable underlying condition. Caring for the immunocompromised patient poses many diagnostic and therapeutic challenges to the clinician, and among those patients who have been exposed to areas endemic for blastomycosis, B. dermatitidis must be regarded as a potentially important opportunistic pathogen.
Public Health Agency of Canada (PHAC). An outbreak of human blastomycosis: The epidemiology of blastomycosis in the Kenora catchment region of Ontario, Canada. (26 May 2000 )Public Health & Epidemiology Report Ontario, Volume 11, Number 4. Link: http://www.phac-aspc.gc.ca/publicat/ccdr-rmtc/00vol26/dr2610eb.html
Public Health Agency of Canada (PHAC). Blastomyces dermatitidis - Material Safety Data Sheets (MSDS) Link: http://www.phac-aspc.gc.ca/msds-ftss/msds17e-eng.php
Sarosi, G. A., Eckman, M. R., Davies, S. F., & Laskey, W. K. (1979). Canine blastomycosis as a harbinger of human disease. Annals of Internal Medicine, 91(5), 733-735.
Blastomycosis occurred in six patients in five households. In each instance one or more dogs living with the family or living near the family also developed blastomycosis. The recognition of canine blastomycosis helped in the early diagnosis of human cases. Because both dogs and patients were probably infected at the same place, canine blastomycosis may be an important epidemiologic marker, alerting physicians to the possible presence of concomitant blastomycosis in humans.
Turner, S., Kaufman, L., & Jalbert, M. (1986). Diagnostic assessment of an enzyme-linked immunosorbent assay for human and canine blastomycosis. Journal of clinical microbiology, 23(2), 294-297.
Walker, M. A. (1981). Thoracic blastomycosis: A review of its radiographic manifestations in 40 dogs. Vet Radiol, 22, 22-26.
Ware, W. A., & Fenner, W. R. (1988). Arterial thromboembolic disease in a dog with blastomycosis localized in a hilar lymph node. Journal of the American Veterinary Medical Association, 193(7), 847-849.
An 8-year-old mixed-breed dog was evaluated for caudal paresis. Transient lameness of the left hind and left forelimbs had developed during the preceding week. Clinical findings included conscious proprioceptive deficits, hyporeflexive tendon reflexes and decreased pain perception, coolness in the hind limbs and left forelimb, and absence of femoral pulses. A fluid-dense mass was radiographically identified adjacent to the left atrium. Echocardiography revealed a mass in the left atrium and spontaneous contrast in the left ventricular lumen and aortic root. The dog was euthanatized because of its deteriorating condition. A large mass was adhered to the dorsal left atrial wall and had eroded into the atrial lumen. A sterile blood clot was attached to this site, and sterile thrombi were in the terminal portion of the aorta. Histologically, the mass was found to be hilar lymph node with chronic pyogranulomatous inflammation containing organisms characteristic of Blastomyces dermatitidis.
White, L.J., Legendre, A.M. (2007). Blastomycosis in Dogs MiraVista Diagnostics. Blastomycosis can be rapidly fatal if not suspected and diagnosed early. In addition to histopathology, antigen detection can aid in early diagnosis. A fungal polysaccharide antigen is shed into the blood and urine, yielding a positive result in over 90% of cases. Itraconazole is the treatment of choice, yet about half of the cases are fatal or recur when treatment is stopped. Causes for failure include severe disease at the time the diagnosis is made, inadequate itraconazole blood levels, and persistent infection when treatment is discontinued. Amphotericin B alone or combined with itraconazole for the first week may improve outcome in severe cases, and itraconazole treatment for four to six months, and until the antigen test in the urine is negative may reduce the relapse rate. Itraconazole blood level monitoring may improve outcome by assuring adequate dosing and adherence. Posaconazole and voriconazole also are potential treatments for blastomycosis, but are more expensive and unlikely to be more effective than itraconazole. Link: http://www.miravistalabs.com/Files/pdf/BlastomycosisinDogs2007.pdf