Acute pulmonary blastomycosis in a host with impaired immunity requires a distinct treatment approach. Immunosuppressed patients — including those living with AIDS and solid-organ transplant recipients — represent a higher-risk subpopulation in whom the clinical trajectory and management differ from immunocompetent cases.
This protocol applies to patients presenting with pulmonary blastomycosis in the setting of immunosuppression, including AIDS or organ transplantation. The underlying immune deficit shapes both the severity of disease and the therapeutic strategy required.
Management begins with an initial course of intravenous antifungal therapy, followed by an oral step-down agent to complete an extended total duration of treatment.
Full regimen details, sequencing, and duration are available in the complete protocol.
DOI: 10.1086/588300
AmB, given as a lipid formulation, 3–5 mg/kg per day, or AmB deoxycholate, 0.7–1 mg/kg per day, for 1–2 weeks or until improvement is noted, is recommended as initial therapy for patients who are immunosuppressed, including those with AIDS (A-III).
Itraconazole, 200 mg 3 times per day for 3 days and then twice per day, is recommended as step-down therapy after the patient has responded to initial treatment with AmB and should be given to complete a total of at least 12 months of therapy (B-III).
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