NORTH AMERICAN BLASTOMYCOSIS: CLINICAL FORMS OF THE DISEASE AND TREATMENT WITH STILBAMIDINE AND 2-HYDROXYSTILBAMIDINE

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Abstract
Observation of 25 cases of North American blastomycosis in 7 yrs. is recorded. The sites of infection were chiefly cutaneous, pulmonary and osteomyelitic. Cutaneous lesions occurred alone in 5 cases and in a total of 16 cases. Pulmonary lesions occurred alone in 5 cases and in a total of 18 cases. Osteomyelitic lesions occurred alone in 1 case and in a total of 5 cases. Central nervous system, laryngeal and prostatic infections were seen in 1 case and all were associated with other lesions. The series showed a lowered fatality rate and a greater number of cases with benign courses than have been reported by others. Treatment with stilbamidine or 2-hydroxystilbamidine resulted in prompt arrest of the disease in the majority. Among 11 cases treated before the aromatic diamidines were available none showed a prompt remission of lesions with the exception of 3 in which surgical excision was found possible. Four of the arrested cases remained well for 9 to 59 mos. Two died of generalized North American blastomycosis and 2 died of unrelated cause. Among 7 cases treated with stilbamidine, 5 showed a prompt remission, and 1 a relatively slow remission. Four of these cases remained arrested for from 10 to 20 mos. and 1 of these died of an unrelated cause. One of these cases arrested after treatment with stilbamidine relapsed after a symptom-free period of 19 mos. Among 12 cases treated with 2-hydroxystilbamidine, 9 showed prompt improvement and 7 of these were arrested. Continuation of the arrested state was observed in 3 cases for from 15 to 24 mos. Two patients were generally improved but pulmonary lesions persisted. Two patients were refractory to therapy. No definite superiority of the therapeutic effects of either drug was observed. Stilbamidine was followed by troublesome neuro-toxicity. Further development of precautions to avoid toxicity, adjustment of dosage to avoid relapses, or to cure refractory cases, and longer periods of observation are needed to define the optimal results of therapy with these therapeutic agents.

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