246.2 📚 國考版

246.2.0.1 必背 — Pathogen

• Blastomyces dermatitidis — dimorphic fungus
• Broad-based budding yeast (8-15 µm) on histology — pathognomonic

246.2.0.2 必背 — Geography

• USA endemic: Mississippi + Ohio River valleys + Great Lakes
• Africa: sub-Saharan
• Soil near water + decaying organic matter

246.2.0.3 必背 — Clinical

• Pulmonary (most common): acute pneumonia / chronic cavitary
• Cutaneous: verrucous + ulcerative lesions
• Osseous + GU + CNS

246.2.0.4 必背 — Treatment

• Mild-Moderate: itraconazole 200 bid × 6-12 mo (TDM)
• Severe / disseminated / immunocompromise: liposomal AmB → itraconazole 12 mo
• CNS: liposomal AmB 5 mg/kg/d × 4-6 wk → itraconazole 12+ mo
• Pregnancy: AmB

246.2.0.5 必背 — Diagnosis

• Broad-based budding yeast on histology
• Blastomyces urinary antigen (cross-reacts histoplasmosis)
• Culture (slow gold standard)

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