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Cited by 90Fungal Infections and StudiesAntifungal resistance and susceptibilityActinomycetales infections and treatment

A large community outbreak of blastomycosis in Wisconsin with geographic and ethnic clustering

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Roy, Monika, Benedict, Kaitlin, Deak, Eszter, Kirby, Miles A., McNiel, Jena T., Sickler, Carrie J., Eckardt, Eileen, Marx, Ruth K. +7 more·2013·Clinical Infectious Diseases
DOI 10.1093/cid/cit366PMC PMC6276927
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Abstract

BACKGROUND: Blastomycosis is a potentially life-threatening infection caused by the soil-based dimorphic fungus Blastomyces dermatitidis, which is endemic throughout much of the Midwestern United States. We investigated an increase in reported cases of blastomycosis that occurred during 2009-2010 in Marathon County, Wisconsin. METHODS: Case detection was conducted using the Wisconsin Electronic Disease Surveillance System (WEDSS). WEDSS data were used to compare demographic, clinical, and exposure characteristics between outbreak-related and historical case patients, and to calculate blastomycosis incidence rates. Because initial mapping of outbreak case patients' homes and recreational sites demonstrated unusual neighborhood and household case clustering, we conducted a 1:3 matched case-control study to identify factors associated with being in a geographic cluster. RESULTS: Among the 55 patients with outbreak-related cases, 33 (70%) were hospitalized, 2 (5%) died, 30 (55%) had cluster-related cases, and 20 (45%) were Hmong. The overall incidence increased significantly since 2005 (average 11% increase per year, P < .001), and incidence during 2005-2010 was significantly higher among Asians than non-Asians (2010 incidence: 168 vs 13 per 100 000 population). Thirty of the outbreak cases grouped into 5 residential clusters. Outdoor activities were not risk factors for blastomycosis among cluster case patients or when comparing outbreak cases to historical cases. CONCLUSIONS: This outbreak of blastomycosis, the largest ever reported, was characterized by unique household and neighborhood clustering likely related to multifocal environmental sources. The reasons for the large number of Hmong affected are unclear, but may involve genetic predisposition.

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  • Blastomycosis is endemic throughout much of the midwestern US, particularly along the Great Lakes and the Mississippi, Ohio, and Saint Lawrence River valleys.

    “It is endemic throughout much of the midwestern US [171,172], particularly along the Great Lakes and the Mississippi, Ohio, and Saint Lawrence River valleys [173,174].”

    From Race and ethnicity: Risk factors for fungal infections? (2023) · cites this paper as [171]

  • One study showed case clustering of blastomycosis among persons of Hmong ethnicity.

    “including one study showing case clustering among persons of Hmong ethnicity [171].”

    From Race and ethnicity: Risk factors for fungal infections? (2023) · cites this paper as [171]

  • Peaks in Wisconsin blastomycosis incidence corresponded to a known outbreak at a yard waste site in 2006, an outbreak likely associated with multiple sources in 2010, and an outbreak linked to recreational tubing on the Little Wolf River in 2015.

    “Peaks in incidence in Wisconsin corresponded to a known outbreak at a yard waste site in 2006 (20), an outbreak likely associated with multiple sources in 2010 (21), and an outbreak linked to recreational tubing on the Little Wolf River in 2015 (22).”

    From Blastomycosis Surveillance in 5 States, United States, 1987–2018 (2021) · cites this paper as [21]

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Authors
Roy, M., Benedict, K., Deak, E., Kirby, M. A., McNiel, J. T., Sickler, C. J., Eckardt, E., Marx, R. K., Heffernan, R. T., Meece, J. K., Klein, B. S., Archer, J. R., Theurer, J., Davis, J. P., & Park, B. J.
Affiliations
  • Centers for Disease Control and Prevention (US)
  • Wisconsin Division of Public Health (US)
  • Marshfield Clinic Research Foundation (US)
  • University of Wisconsin–Madison (US)
Corresponding author
Roy, Monika
ORCID
Venue
Clinical Infectious Diseases
Publisher
Oxford University Press (OUP)
Published
2013-06-03
Volume
57
Issue
5
Pages
655-662
ISSN
  • 1058-4838 (ISSN-L)
  • 1537-6591
DOI
10.1093/cid/cit366
PMC
PMC6276927
OpenAlex
W2103923656
Cited by
90
References
20
Citations by year
2025: 6 · 2024: 6 · 2023: 7 · 2022: 4 · 2021: 8 · 2020: 9 · 2019: 10 · 2018: 6 · 2017: 7 · 2016: 7 · 2015: 11 · 2014: 7 · 2013: 2
FWCI
6.55
Type
journal article
Language
en
Open access
Licence
public-domain
Locations
  • Clinical Infectious Diseases (publishedVersion, public-domain)
  • Europe PMC (PubMed Central) (publishedVersion, public-domain)
  • PubMed Central (publishedVersion, public-domain)
  • PubMed (publishedVersion)
Funders
National Institute of Allergy and Infectious Diseases (R01AI040996, R37AI035681)
Topics
  • Health Sciences › Medicine › Epidemiology › Fungal Infections and Studies
  • Health Sciences › Medicine › Infectious Diseases › Antifungal resistance and susceptibility
  • Health Sciences › Medicine › Microbiology › Actinomycetales infections and treatment
Keywords
blastomycosis, Blastomyces dermatitidis, community outbreak, geographic clustering, household clustering, ethnic disparities, dimorphic fungal infection, recreational exposure, environmental risk factors, Wisconsin
MeSH terms
Adolescent, Adult, Aged, Aged, 80 and over, Blastomyces, Blastomycosis, Child, Child, Preschool, Disease Outbreaks, Ethnicity, Female, Geography, Humans, Male, Middle Aged, Wisconsin, Cluster Analysis, Case-Control Studies, Community-Acquired Infections, Young Adult

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