Blastomycosis fungal outbreak at Michigan paper mill: 1 dead, 12 hospitalized

It’s a blast you don’t want to have. Blastomycosis can occur when you breathe in spores of a fungus called Blastomyces. And an outbreak of blastomycosis is what recently happened at the Billerud paper mill in Escanaba, Michigan, according to Public Health Delta and Menominee Counties (PHDM). On March 3, the PHDM informed Billerud of the first reported case of blastomycosis. Since then, this fungal epidemic has been the opposite of fun. It has already resulted in 21 confirmed cases of blastomycosis, 76 probable cases, 12 hospitalizations and, unfortunately, one death. This also led to the plant being temporarily shut down for additional cleaning on Thursday April 13, 2023.

The 97 confirmed and probable cases had spent time at the Billerud paper mill as employees, contractors or other types of visitors. To be considered a confirmed case, the person had to have shown symptoms of blastomycosis with a culture sample that eventually developed Blastomyces mushroom. A probable case is when a person has symptoms of blastomycosis and a positive antigen or antibody test, but no such culture. Since symptoms only appear in about half of people infected with Blastomycesthere is a good chance that many more people than 97 breathed Blastomyces spores at the stationery and was infected.

So what are the typical symptoms of blastomycosis? Well, blastomycosis has been called “the big contender” not because it was in a band with Chrissie Hynde, but because it can be easily confused with other diseases. Like the mushroom, specifically either Blastomyces dermatitidis Or Blastomyces gilchristii, usually initially enters through the airways and descends into the lungs, the first set of symptoms are usually typical of a respiratory infection: fever, cough, and chest pain. There may also be night sweats, muscle pain, joint pain, weight loss, and fatigue. As you can imagine, blastomycosis is not the first thing you may think of when you have such respiratory symptoms. It might not even be the second, third or twelfth thing you think of in such a situation. Additionally, there may be a delay between inhaling the spores and the development of such symptoms. Since that timeframe is often three weeks to three months, it’s not as easy as 1-2-3 to think about having your blood, urine, or lung fluid tested for the presence of Blastomyces.

The resulting respiratory infection can range from mild to very severe. You can get acute pneumonia which can become chronic and last a very long time. The infection can even lead to acute respiratory distress syndrome (ARDS). The problem is that symptoms and imaging findings can be relatively indistinguishable from more standard bacterial pneumonia, tuberculosis, or lung cancer. “Are you sure you don’t have blastomycosis” isn’t the first thing people might ask you when you have a fever and cough.

Blastomyces is something you might not want to get rid of on your chest, at least in a patchy way. In about 25-40% of blastomycosis cases, according to a Clinical Chest Medicine article, the fungus will spread to other parts of your body, resulting in what is called extrapulmonary or disseminated blastomycosis. The most common site of dissemination is the skin, which can lead to various types of skin damage, some of which can lead to permanent bad scarring. The second most common site of dissemination are bones and joints. This can manifest as painful bone and soft tissue damage that can mimic bone cancer or Pott’s disease, which is when TB affects the bones. Blastomyces can also go into your genitourinary tract. You can develop a prostate infection, swollen scrotum, or enlarged testicles (but not in a good way) if you have any of these body parts. You may develop inflammation of your ovaries, fallopian tubes, or the lining of your uterus, if you have these types of body parts. If you are unsure whether you have a scrotum or a uterus, consult your doctor.

The most concerning site of spread is your central nervous system (CNS), which occurs in less than 5-10% of people with strong immune systems and more often in those with weaker immune systems. When the fungus reaches your brain, you may have a brain abscess or meningitis, leading to headaches, confusion, visual disturbances, seizures, and other life-threatening neurological problems.

All of these possibilities mean that blastomycosis is not something you can simply eliminate or treat with lots of Nutella or a piece of cake. No, when you have blastomycosis you need to see a doctor as soon as possible. Treatment can be very effective when you catch the infection early enough. This standard treatment is a prescription antifungal medication like itraconazole if you have mild to moderate blastomycosis or amphotericin B if you have more severe blastomycosis. can last from six months to a year.

So how do you avoid getting blastomycosis? Well, if you have a habit of inhaling damp earth or rotting wood and leaves, stop. THE Blastomyces fungi tend to live in such material, especially in the west-central, south-central, and southeastern parts of the United States. Speaking of rotting wood and leaves, you might think that’s what beavers use. Indeed, people used to blame beavers for blastomycosis because the fungus was found in some beaver dams. But there is no evidence that you can catch the fungus from beavers or other animals. So, fear of blastomycosis shouldn’t be a reason not to engage with your favorite beaver.

There is also no evidence that humans can transmit the fungus to each other. So something in the Escanaba Billerud paper mill must have been contaminated with Blastomyces mushroom spores. PHDM is working with Billerud Paper Mill, the Michigan Department of Health and Human Services, the National Institute for Occupational Safety and Health (NIOSH), and the Centers for Disease Control and Prevention (CDC) to investigate further about this epidemic. In a press release, Christoph Michalski, President and CEO of Billerud, announced: “As a precautionary measure, we will temporarily idle the Escanaba plant for up to three weeks to facilitate additional appropriate cleaning on based on recommendations from NIOSH and other organizations, requiring larger portions of the mill will be vacant while this work is being carried out.

The press also included the following statement from Kevin Kuznicki, President of Billerud for North America: “Although the source of the infection has not been established and we have not received any information from the investigation from the factory, public health officials or any of the organizations assisting in this investigation, who indicate that visiting or working at the factory is unsafe, we take this matter very seriously.” He added, “We follow the recommendations of experts from these organizations, including deep cleaning high-traffic areas of the plant; inspecting ventilation systems and replacing filters, and testing various raw materials entering the plant; conducting a risk assessment on-site health to investigate the health and safety of Escanaba employees with the assistance of NIOSH, CDC, MDHHS, and PHDM; communicate regularly with employees, contractors, and visitors, encouraging them to wearing NIOSH and OSHA recommended N95 masks and recommending that they contact their local health care providers if they have symptoms.

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