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Introduction; Y. AlDoory. Taxonomy and Biology of Blastomyces
Dermatitidis; A.M. Sugar. Virulence of Blastomyces Dermatitidis; E.
Brummer. The Ecology of Blastomyces Dermatitidis; A.F. DiSalvo. The
Epidemiology of Blastomycosis; A.F. DiSalvo. Diagnosis of
Blastomycosis; N.L. Goodman. Immunodiagnosis of Blastomycosis; L.
Kaufman. Immunology of Blastomycosis; B.S. Klien. Clinical Aspects
of Blastomycosis; W.B. Causey, G.D. Campbell. Pathologic Features
of Blastomycosis; F.W. Chandler, J.C. Watts. Experimental
Blastomycosis; G.C. Cozad. Prognosis and Therapy of Blastomycosis;
R.W. Bradsher. Blastomycosis in Animals; A.M. Legendre. Index.
Blastomycosis remains the most enigmatic of human mycotic
infections. The enigmas encompass the natural habitat of the
etiologic agent, extent of exposure and subclinical infections in
endemic areas, distribution of en demic foci throughout the world,
inconsistency of serologic evaluation of infected patients, and
varying response of such patients to standard treat ment regimens.
In spite of diligent investigations by many competent
investigators, we still do not know the ecological niche inhabited
by the etiologic agent. We have many tantalizing clues but no
definite answers. Nor do we know the extent of the endemic areas in
the world for this disease. Skin testing, so useful in defining the
distribution of histoplasmosis and coccidioidomycosis, has been of
no value in mapping endemic areas for blastomycosis. Even the
serologic evaluation of known cases of the disease has been too
erratic in results to be useful as a diagnostic or prognostic
procedure. The enigmas of blastomycosis go straight to the disease
itself. There is an extensive literature on the debate concerning
the presence and extent of subclinical infections. Case report
series demonstrate that such transient infections do occur but,
unlike other mycoses, the extent to which this phe nomenon is
common in the general population still cannot be assessed. Even the
diagnosis of established disease is a major clinical problem.
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