Blastomycosis Fungal Outbreak In Michigan Paper Mill: 1 Dead, 12 Hospitalized

This is one blast that you don’t want to have. Blastomycosis can result when you breathe in the spores of a fungus called Blastomyces. And a blastomycosis outbreak is what’s recently occurred at the Billerud Paper Mill in Escanaba, Michigan, according to Public Health Delta and Menominee Counties (PHDM). March 3 was when the PHDM told Billerud about the first reported blastomycosis case. Since then, this fungal outbreak has been the opposite of fun. It’s already resulted in 21 confirmed cases of blastomycosis, 76 probable cases, 12 hospitalizations, and, unfortunately, one death. It’s also led to the temporary shutdown of the mill for further cleaning 0n Thursday, April 13, 2023.

All 97 of the 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 had blastomycosis symptoms along with a culture sample that ended up growing out the Blastomyces fungus. A probable case is when someone had symptoms of blastomycosis and a positive antigen or antibody test but no such culture. Since symptoms appear in only around half of those who have been infected with Blastomyces, there’s a good chance that a lot more people than 97 have breathed in Blastomyces spores at the paper mill and gotten infected.

What are typical blastomycosis symptoms?

So, what are typical blastomycosis symptoms? Well, blastomycosis has been called “the great pretender,” not because it’s been in a band with Chrissie Hynde, but because it can be readily mistaken for other diseases. As the fungus, specifically either Blastomyces dermatitidis or Blastomyces gilchristii, usually initially enters through your respiratory tract and goes down to your lungs, the first set of symptoms are usually typical for a respiratory infection: fevers, a cough, and chest pain. There can also be night sweats, muscle aches, joint pain, weight loss, and fatigue. As you can imagine, blastomycosis is not the first thing that you may think of when you have such respiratory symptoms. In may not even be the second, third, or twelfth thing that you think of in such a situation. Plus, there can be quite a delay between your inhaling the spores and developing such symptoms. Since this delay often is three weeks to three months, it isn’t easy as 1-2-3 to think of getting your blood, urine, or lung fluid tested for the presence of Blastomyces.

The resulting respiratory infection can be, in the words of that Queen song We Will Rock You, “all over the place.” It can range from being mild to being very severe. You can get an acute pneumonia that can turn chronic and last for a long, long time. The infection can even result in acute respiratory distress syndrome (ARDS), which will make anyone go, “arrgh.” The trouble is the symptoms and imaging findings can be relatively indistinguishable from a more standard bacterial pneumonia or more severe problems like tuberculosis, or lung cancer.

What is disseminated blastomycosis?

Blastomyces is something that you may not want to get off your chest, at least in a disseminated type of way. According to a Clinical Chest Medicine article, in about 25% to 40% of blastomycosis cases, the fungus will spread to other parts of your body, resulting in what’s called extrapulmonary or disseminated blastomycosis.

The most common site for dissemination is the skin. This can really get under your skin, resuling in various types of skin lesions such as ulcers. This can leave some very bad and permanent scarring.

The second most common site for dissemination are bones and joints. This can manifest as painful bone and soft tissue lesions. In the lines with “the great pretender” moniker, such lesions can mimic bone cancer or Pott’s disease, which is when tuberculosis affects bones.

Blastomyces can go to your genitourinary tract as well. You can develop a prostate infection, scrotal swelling, or testicular enlargement (but not in a good way) if you have any of these body parts. Alternatively, if you have ovaries, Fallopian tubes, or a uterus, these things can get inflamed as well. If you aren’t sure about whether you have a scrotum or a uterus or are somehow not able to distinguish between the two, see your medical doctor.

The most concerning location of dissemination is your central nervous system (CNS), which occurs in less than 5 to 10% of those with strong immune systems and more often in those with weaker immune systems. Anytime anything goes to your CNS, big trouble can result. When the fungus infects your brain, you can have a brain abscess or meningitis, resulting in headaches, confusion, visual disturbances, seizures, and other neurological problems that can be life-threatening.

What is blastomycosis treated?

All of these possibilities means that blastomycosis isn’t something that you can simply walk off or treat with lots of Nutella or a piece of cake. No, when you have blastomycosis, you should see a medical doctor as soon as possible, a real medical doctor and not someone who will tell you to put ozone in your rectum. Treatment can be very effective when you catch the infection early enough. The standard treatment is a prescription antifungal medication like itraconazole if you’ve got mild to moderate blastomycosis or amphotericin B if you’ve got more severe blastomycosis. Getting such antifungal treatment isn’t like getting a shot of expresso, though. You’ve got to keep taking the meds for quite a long time, potentially six months to one year.

How can you get blastomycosis?

So how to avoid getting blastomycosis? It’s certainly not super common so you shouldn’t curl up in a ball and worry about getting blastomycosis each day and dodging space laser fire at the same time. But, if you do have the habit of inhaling moist soil or decomposing wood and leaves, stop it. There are a lot better things to inhale like the smell of melting chocolate. The Blastomyces fungus tends to live in soil and decomposing matter, especially in the midwestern, south-central, and southeastern portions of the U.S. Speaking of decomposing wood and leaves, you may think, dam, that’s what beavers use. Indeed, people used to blame beavers for blastomycosis because the fungus was found in some beaver dams. But there’s no evidence that you can catch the fungus from beavers or other animals. So, fear of blastomycosis shouldn’t a reason to not engage with your favorite beaver.

There’s also no evidence that human can pass the fungus to one another. So something in the Escanaba Billerud Paper Mill must have gotten contaminated with Blastomyces fungus spores. The PHDM is working with Billerud Paper Mill, Michigan Department of Health and Human Services, National Institute for Occupational Safety and Health (NIOSH), and Centers for Disease Control and Prevention (CDC) to figure out the root cause of this outbreak. In a press release, Christoph Michalski, Billerud President and CEO, has announced, “As a precautionary measure, we will temporarily idle the Escanaba Mill for up to three weeks to facilitate additional proper cleaning based on recommendations from NIOSH and other organizations, which requires larger portions of the mill to be vacant while this work is performed.”

The press also included the following statement from Kevin Kuznicki, Billerud President North America: “Although the source of the infection has not been established, and we have not received any information from the mill’s investigation, public health officials, or any of the organizations assisting in this investigation, that indicates visiting or working at the mill is unsafe, we take this matter very seriously.” He added, “We are following recommendations from experts at these organizations, including deep cleaning in high traffic areas throughout the mill; inspecting ventilation systems and replacing filters, and testing various raw materials coming into the mill; conducting an onsite Health Hazard Evaluation to study the health and safety of Escanaba employees with the assistance of NIOSH, CDC, MDHHS and PHDM; communicating regularly with employees, contractors and visitors, encouraging them to wear NIOSH and OSHA-recommended N95 masks and recommending they contact their local healthcare providers if they are experiencing any symptoms.”

Clearly, it’s not good to hear a news blast of a blastomycosis outbreak. Fortunately, blastomycosis cases are rather uncommon with only around one to two cases per 100,000 people in the population each year in the U.S. and Canada, according to the CDC. It’s most common in Wisconsin, which has 10 to 40 cases per year per 100,000 persons in some of its northern counties. The U.S. had 1,216 reported blastomycosis-related deaths in the twenty-year period from 1990 to 2010.

Nevertheless, you don’t want to be the person to have a blast of blastomycosis. While you shouldn’t necessarily soil yourself worrying about blastomycosis, you may want to be careful and vigilant if you work or play with soil or decomposing matter in areas that tend to have Blastomyces.