A STUDY OF NORTH AMERICAN BLASTOMYCOSIS AND ITS TREATMENT WITH STILBAMIDINE AND 2-HYDROXYSTILBAMIDINE

Abstract

Six patients with systemic North American blastomycosis are reported in detail. One of these patients departed from the usual form of cutaneous involvement in that mucous membrane granulomas occurred. All 6 patients were treated with either stilbamidine or 2-hydroxystilbamidine or combinations of both drugs and all patients were followed for at least one year before being included in this study. No correlation was found to exist between apparent cure and total dosage of these drugs. Evidence exists that daily amounts of 300 mg of stilbamidine or 450 mg of 2-hydroxystilbamidine are more efficacious than the usually prescribed dosage of one-half these amounts. There appeared to be some correlation between the outcome of the treated disease and the elicited immunologic response. The 4 patients who were found to have negative blastomycin skin tests have exhibited repeated relapses following apparent successful treatment. Complement-fixation studies were done on 3 of these 4 patients and found to be positive in significant titers. No complement-fixing antibodies were demonstrated on the 2 cases who obtained apparent cures following treatment. Toxicity in the form of trigeminal nerve sensory changes occurred in 4 of the 6 cases. No correlation existed though between the amounts of drug administered and the occurrence of these changes.