Epidemiological and Clinical Features of a Large Blastomycosis Outbreak at a Paper Mill in Michigan

Details

• Personal Author:
  Blankenship HM ; Chiller T ; De Perio, Marie A. ; Gade L ; Hennessee I ; Hughes A ; Kramer R ; Litvintseva AP ; McFadden J ; Miles-Jay A ; Nawaz MY ; Palmer S ; Parnell LA ; Reik R ; Snyder M ; Stobierski MG ; Toda M ; Yin RL
• Corporate Authors:
  Centers for Disease Control and Prevention (U.S.) Michigan Blastomycosis Outbreak Investigation Team
• Description:
  Background: Blastomycosis is an environmentally acquired fungal infection that can result in severe pulmonary illness and high hospitalization rates. In 2023, a blastomycosis outbreak was detected among workers at a paper mill in Delta County, Michigan. Methods: We included patients with clinical and laboratory evidence of blastomycosis who had spent ≥40 hours in Delta County since 1 September 2022 and had illness onset 1 December 2022-1 July 2023. We assessed epidemiological and clinical features of patients and evaluated factors associated with hospitalization. We performed whole-genome sequencing to characterize genetic relatedness of clinical isolates from 8 patients. Results: In total, 131 patients were identified; all had worked at or visited the mill. Sixteen patients (12%) were hospitalized; 1 died. Compared with nonhospitalized patients, more hospitalized patients had diabetes (P = .03) and urine antigen titers above the lower limit of quantification (P < .001). Hospitalized patients were also more likely to have had ≥1 healthcare visits before receiving a blastomycosis diagnostic test (P = .02) and to have been treated with antibiotics prior to antifungal prescription (P = .001). All sequenced isolates were identified as Blastomyces gilchristii and clustered into a distinct outbreak cluster. Conclusions: This was the largest documented blastomycosis outbreak in the United States. Epidemiologic evidence indicated exposures occurred at or near the mill, and genomic findings suggested a common exposure source. Patients with diabetes may have increased risk of hospitalization, and elevated urine antigen titers could indicate greater disease severity. Early suspicion of blastomycosis may prompt earlier diagnosis and treatment, potentially reducing unnecessary antibiotic prescriptions and improving patient outcomes. [Description provided by NIOSH]
• Subjects:
  Communicable Diseases Diagnosis Epidemiology Occupational Health Paper Risk Assessment Risk Factors Safety
• Keywords:
  Author Keywords: Blastomycosis Blastomyces Blastomycosis Clinical Symptoms Diagnostic Tests Disease Outbreaks Disease Transmission Epidemiological And Clinical Features Of Fungal Infections Fungal Infections Infectious Diseases Paper Mills Risk Factors

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• ISSN:
  1058-4838
• Document Type:
  Text
• Genre:
  Journal Article
• Place as Subject:
  Atlanta Region [OSHA] ; Chicago Region [OSHA] ; Georgia ; Michigan ; Ohio
• CIO:
  National Institute for Occupational Safety and Health (NIOSH)
• Division:
  OD - Office of the Director
• Topic:
  Workplace Safety & Health
• Location:
  North America
• Pages in Document:
  356-363
• Volume:
  80
• Issue:
  2
• NIOSHTIC Number:
  nn:20070228
• Citation:
  Clin Infect Dis 2025 Feb; 80(2):356-363
• Contact Point Address:
  I. Hennessee, Mycotic Diseases Branch, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Mailstop H24-10, Atlanta, GA 30329
• Email:
  xye0@cdc.gov
• Federal Fiscal Year:
  2025
• Peer Reviewed:
  True
• Source Full Name:
  Clinical Infectious Diseases
• Collection(s):
  National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:39583139199a068ae604deb386bfb71f3022cbcf3b86af74d653765f14f3ed0191d6ae1693db8233e8d583ba67d0f68cebeeb554eef1e816fa3b842cf7b15f91
• Download URL:
  https://stacks.cdc.gov/view/cdc/208479/cdc_208479_DS1.pdf
• File Type:
  [PDF - 709.44 KB ]