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This is a disease caused by Blastomyces dermatidis, a fungus found in moist soil enriched with decomposing organic debris. Blastomycosis is endemic in parts of the south central, southeastern and Midwestern United States. Symptomatic infection, appearing in 50 percent of cases, usually presents as a flu-like illness with fever, chills, productive cough, muscle and joint pain, and pleuritic chest pain. Some patients fail to recover and develop chronic pulmonary infection or widespread disseminated infection affecting the skin, bones and genitourinary tract. Blastomycosis occasionally affects the membranes covering the brain and spinal cord.