However, people with the progressive form are treated with intravenous amphotericin B or oral fluconazole. Alternatively, the doctor may treat the infection with itraconazole or ketoconazole. Although drug treatment can be effective in localized infections, such as those in skin, bones, or joints, relapses often occur after treatment is stopped. Treatment must be continued for years, often for the rest of the patient's life. Untreated meningitis is always fatal.
Blastomycosis is primarily a lung infection, but occasionally it spreads through the bloodstream.
Spores of Blastomyces probably enter the body through the respiratory tract when they are inhaled. It is not known where in the environment the spores originate, but beaver huts were linked to one outbreak. Most infections occur in the United States, chiefly in the Southeast and the Mississippi River valley. Infections have also occurred in widely scattered areas of Africa. Men between the ages of 20 and 40 are most commonly infected.