IMMUNOLOGIC TYPES OF BLASTOMYCOSIS: A REPORT ON 40 CASES

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Abstract
In a study of 40 cases of blastomycosis, it was found that the prognosis depends, at least in part, on the immunologic status of the patient. The following combinations of immunologic reactions are theoretically possible and have been found, in approx. equal numbers, in a series of 40 cases: (1) skin test positive-complement fixation negative, (2) skin test positive-complement fixation positive, (3) skin test negative-complement fixation positive, and (4) skin test negative-complement fixation negative. The prognosis is best in patients who have positive skin tests and no demonstrable antibodies in their serum, good in those with both positive skin tests and complement-fixing antibodies, and poor in those with negative skin tests and a high titer of complement-fixing antibodies. Patients having positive skin tests should be desensitized before being treated with iodides, regardless of the presence or absence of antibodies. Patients with neither positive skin tests nor complement-fixing antibodies should be actively immunized with a heat-killed vaccine made from the yeast phase of Blastomyces dermatitidis before being treated with iodides.