Some patients who are exposed to Blastomyces dermatitidis may clinically recover following an asymptomatic or limited infection. The decision to treat or not treat the patient depends on a number of factors.
A patient who has been exposed to Blastomyces dermatitidis may not need to be treated if all of the following are present:
(1) the patient is clinically well
(2) there is no evidence of extrapulmonary spread
(3) there is no evidence of residual pulmonary infection
(4) the patient is immunocompetent and not receiving immunosuppressive therapy
(5) the patient agrees to prolonged monitoring for reactivation
(6) the patient is able to promptly return for evaluation if symptoms occur
In general the tendency is to treat patients with blastomycosis because of concern for reactivation later or sudden development of miliary disease.
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