Document 0042
 DOCN  M9480042
 TI    Blastomycosis and human immunodeficiency virus: three new cases and
       review.
 DT    9410
 AU    Witzig RS; Hoadley DJ; Greer DL; Abriola KP; Hernandez RL; Department of
       Medicine, Tulane University School of Medicine, New; Orleans, LA 70112.
 SO    South Med J. 1994 Jul;87(7):715-9. Unique Identifier : AIDSLINE
       MED/94294860
 AB    Reports of blastomycosis in individuals infected with the human
       immunodeficiency virus (HIV) are increasing. We report on 3 patients
       co-infected with blastomycosis and HIV (to add to the previously
       reported 21), and review important clinical aspects and outcomes in all
       cases. The percentage of patients co-infected with blastomycosis and HIV
       who had disseminated blastomycosis (63%) was similar to the
       blastomycosis patients in the general population (67%); however, as a
       group the patients with HIV were severely immunosuppressed and fared
       poorly. Severe immunodeficiency was indicated by CD4 counts < 200/mm3 in
       85% of co-infected patients. Central nervous system (CNS) involvement
       occurred in 46% of this group, approximately 5 to 10 times more
       frequently than in individuals not infected with HIV previously reported
       at 5% to 10%. The mortality rate from blastomycosis for patients with
       both HIV infection and blastomycosis is 54%, about 5 times the mortality
       rate of blastomycosis patients in the general population, previously
       reported at < 10%. Disseminated blastomycosis in individuals with HIV
       may appear as deep cutaneous ulcers, as was the case in two of our
       patients. Although blastomycosis is not an AIDS-defining infection, it
       may be reasonable to consider HIV testing and measurement of CD4 counts
       in patients with blastomycosis. Such testing could help identify
       individuals who are HIV positive but asymptomatic who have
       blastomycosis, as well as provide useful information regarding a
       possible association between CD4 cell deficiency and various clinical
       manifestations of blastomycosis. Patients with HIV and blastomycosis
       should be examined carefully for any evidence of CNS involvement.
       Lifetime therapy with ketoconazole or itraconazole is likely to be of
       benefit to patients with HIV who have been treated successfully for
       blastomycosis.
 DE    Adult  Antigens, CD4/ANALYSIS  Blastomycosis/DRUG
       THERAPY/*ETIOLOGY/MORTALITY  Case Report  CD4-CD8 Ratio  Human  HIV
       Infections/*COMPLICATIONS/IMMUNOLOGY  HIV Seropositivity/COMPLICATIONS
       Itraconazole/THERAPEUTIC USE  Ketoconazole/THERAPEUTIC USE  Male  Middle
       Age  Survival Rate  JOURNAL ARTICLE

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