Treatment of Mild to Moderate Pulmonary Blastomycosis in Immunocompetent Adults (Age ≥18)

This protocol covers acute pulmonary blastomycosis presenting as mild to moderate disease in immunocompetent adults aged 18 years or older who are not immunosuppressed. Management in this group requires careful clinical judgement — some cases are self-limited while others benefit from active antifungal treatment.

Clinical scenario

Mild to moderate pulmonary blastomycosis in an immunocompetent adult (age 18 or older), not immunosuppressed. In this population, acute blastomycosis can follow a mild, self-limited course; however, treatment decisions depend on the specific degree of disease and clinical presentation.

First-line approach

Guidelines recommend an oral antifungal agent as the cornerstone of first-line treatment for mild to moderate disease in this population. The specific agent, its induction schedule, and the full duration of therapy are detailed in the structured protocol.

The complete regimen — including drug selection, dosing stepdown, and total treatment length — is available in the full protocol below.

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1086/588300

For mild to moderate disease, oral itraconazole, 200 mg 3 times per day for 3 days and then once or twice per day for 6–12 months, is recommended (A-II).

In the immunocompetent host, acute pulmonary blastomycosis can be mild and self-limited and may not require treatment.

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