Epidemiological and clinical features of a large blastomycosis outbreak at a paper mill in Michigan.

Autor:	Hennessee I; Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.; Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, USA., Palmer S; Michigan Department of Health and Human Services, Lansing, Michigan, USA., Reik R; Michigan Department of Health and Human Services, Lansing, Michigan, USA., Miles-Jay A; Michigan Department of Health and Human Services, Lansing, Michigan, USA., Nawaz MY; Michigan Department of Health and Human Services, Lansing, Michigan, USA., Blankenship HM; Michigan Department of Health and Human Services, Lansing, Michigan, USA., Kramer R; Michigan Department of Health and Human Services, Lansing, Michigan, USA., Hughes A; Michigan Department of Health and Human Services, Lansing, Michigan, USA., Snyder M; Public Health Delta & Menominee Counties, Escanaba, Michigan, USA., Yin RL; Public Health Delta & Menominee Counties, Escanaba, Michigan, USA., Litvintseva AP; Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA., Parnell LA; Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA., Gade L; Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA., Chiller T; Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA., de Perio MA; Office of the Director, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Cincinnati, Ohio, USA., Stobierski MG; Michigan Department of Health and Human Services, Lansing, Michigan, USA., McFadden J; Michigan Department of Health and Human Services, Lansing, Michigan, USA.; Field Assignments Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA., Toda M; Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
Jazyk:	angličtina
Zdroj:	Clinical infectious diseases : an official publication of the Infectious Diseases Society of America [Clin Infect Dis] 2024 Oct 18. Date of Electronic Publication: 2024 Oct 18.
DOI:	10.1093/cid/ciae513
Abstrakt:	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 September 1, 2022 and had illness onset December 1, 2022-July 1, 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 eight patients. Results: In total, 131 patients were identified; all had worked at or visited the mill. Sixteen patients (12%) were hospitalized; one died. Compared with non-hospitalized patients, more hospitalized patients had diabetes (p=0.03) and urine antigen titers above the lower limit of quantification (p<0.001). Hospitalized patients were also more likely to have had ≥1 healthcare visits before receiving a blastomycosis diagnostic test (p=0.02) and to have been treated with antibiotics prior to antifungal prescription (p=0.001). 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 for 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. (Published by Oxford University Press on behalf of Infectious Diseases Society of America 2024.)
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu