Three forms of pulmonary infection have been described. Asymptomatic infection is rarely identified because of the lack of an inexpensive, reliable screening test. Chest radiographs often demonstrate an alveolar process that may resemble a parenchymal mass. Acute pneumonia is the most common form of human blastomycosis. Alveolar or reticulonodular patterns without hilar lymphadenopathy are often seen on chest radiographs.
Chronic pneumonia is characterized by several months of weight loss, cough, night sweats, and fever.
Extrapulmonary or disseminated disease occurs in immunocompetent individuals and is usually preceded by pulmonary symptoms. Laryngeal blastomycosis is relatively common, usually following primary infection of the upper airway, and presents as a laryngeal mass. Cutaneous disease follows hematogenous or direct inoculation of the subcutaneous tissue and appears as either verrucous or ulcerative lesions. Osteomyelitis occurs in one quarter of patients with extrapulmonary infections and usually involves flat bones such as the skull, vertebrae, and ribs. Fungal abscesses may form anywhere, including the heart and its surrounding structures, the orbit, and the sinuses.