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

IF 8.2 1区 医学 Q1 IMMUNOLOGY Clinical Infectious Diseases Pub Date : 2024-10-18 DOI:10.1093/cid/ciae513
Ian Hennessee,Sara Palmer,Rebecca Reik,Arianna Miles-Jay,Muhammad Yasir Nawaz,Heather M Blankenship,Rebecca Kramer,Adam Hughes,Michael Snyder,Robert L Yin,Anastasia P Litvintseva,Lindsay A Parnell,Lalitha Gade,Tom Chiller,Marie A de Perio,Mary Grace Stobierski,Jevon McFadden,Mitsuru Toda,
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Abstract

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.
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密歇根州一家造纸厂爆发的大规模囊霉菌病的流行病学和临床特征。
背景 浆霉菌病是一种环境获得性真菌感染,可导致严重的肺部疾病和较高的住院率。方法我们纳入了自 2022 年 9 月 1 日以来在德尔塔县逗留时间≥40 小时且于 2022 年 12 月 1 日至 2023 年 7 月 1 日发病的临床和实验室证据显示患有布氏杆菌病的患者。我们评估了患者的流行病学和临床特征,并评估了与住院治疗相关的因素。我们对 8 名患者的临床分离株进行了全基因组测序,以确定其遗传相关性。16名患者(12%)住院治疗,其中一人死亡。与非住院患者相比,更多住院患者患有糖尿病(p=0.03),尿液抗原滴度超过定量下限(p<0.001)。住院患者也更有可能在接受囊霉菌病诊断检测前就诊≥1次(P=0.02),并在开具抗真菌处方前接受过抗生素治疗(P=0.001)。所有测序分离物均被鉴定为吉尔吉斯布氏杆菌,并聚集成一个独特的疫情群。流行病学证据表明,暴露发生在工厂或工厂附近,基因组研究结果表明存在共同的暴露源。糖尿病患者住院的风险可能会增加,尿液抗原滴度升高可能预示着病情更加严重。对囊霉菌病的早期怀疑可促使早期诊断和治疗,从而减少不必要的抗生素处方并改善患者的预后。
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来源期刊
Clinical Infectious Diseases
Clinical Infectious Diseases 医学-传染病学
CiteScore
25.00
自引率
2.50%
发文量
900
审稿时长
3 months
期刊介绍: Clinical Infectious Diseases (CID) is dedicated to publishing original research, reviews, guidelines, and perspectives with the potential to reshape clinical practice, providing clinicians with valuable insights for patient care. CID comprehensively addresses the clinical presentation, diagnosis, treatment, and prevention of a wide spectrum of infectious diseases. The journal places a high priority on the assessment of current and innovative treatments, microbiology, immunology, and policies, ensuring relevance to patient care in its commitment to advancing the field of infectious diseases.
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