Blastomycosis

Blastomycosis

Blastomycosis is an uncommon, but potentially serious infection caused by the fungus Blastomyces. This fungus lives in moist soil and decomposing plant matter such as leaves or wood. You are most likely to be exposed to it if you are in central or eastern United States.

Learn About Blastomycosis - Key Facts

• Blastomyces is a fungus that grows in moist soil and rotting wood, and when inhaled, about half of the people exposed become sick with blastomycosis.
• Blastomycosis is a type of pneumonia caused by Blastomyces that is more likely to make people over 50, those who are living with a chronic lung disease or who have a weakened immune system seriously ill.
• Blastomycosis is treatable, but your healthcare provider must test for it.

How Blastomycosis Affects Your Body

You can get sick with blastomycosis by inhaling microscopic fungal spores, called Blastomyces that live in the environment in moist soil and decomposing plant matter like wood and leaves. They are released into the air by activities and weather events that disturb the soil or plant material. Once the inhaled spores enter your lungs, they are warmed up by your body temperature and turn into yeast. This yeast may stay in your lungs and cause fungal pneumonia or spread through your bloodstream to other parts of your body.
Blastomycosis is not contagious, meaning it is not spread from one person to the next. It used to be called Gilchrist disease or Chicago disease.

Who Is at Risk?

There are two types of risk factors to consider:
Risk of exposure:

• Anyone can get blastomycosis if you spend time in an area where Blastomyces lives and are doing outdoor activities that may disrupt areas where the fungal spores are accumulating, predominantly near lakes or rivers.  
  • Blastomyces lives in the Central and Eastern parts of the United States. Wisconsin and Minnesota typically record the highest number of illnesses.
  • Some hobbies place you at increased risk, such as hiking, camping, fishing or riding an all-terrain vehicle.
  • Some jobs place you at increased risk such as if you work at a construction or excavation site, or work in forestry.

Risk of infection:

• Certain individuals are more likely to become seriously ill from Blastomyces, including people who:
  • Have a weakened immune system due to pregnancy, HIV/AIDS, have had an organ transplant or are on certain long-term medications such as corticosteroids.
  • Are living with COPD or another chronic lung disease.
  • Are older than 50.
  • Have a racial or ethnic background including American Indian, Alaskan Native, Asian, Native Hawaiian or Pacific Islander.

Blastomycosis Symptoms and Diagnosis
What Are the Symptoms of Blastomycosis?

Blastomycosis is a specific type of fungal pneumonia. Approximately 50% of people with blastomycosis do not have any symptoms. For those who do, symptoms typically start anywhere from three weeks to three months after exposure, can vary from mild to severe, and almost always begin in the lungs. Your initial symptoms may include:

• Fever
• Chills
• Cough
• Shortness of breath
• Night sweats
• Muscle and joint pain
• Chest pain
• Fatigue (tiredness)

Untreated, these symptoms can progress to acute respiratory distress syndrome  or an invasive infection. An invasive infection happens when Blastomyces spores travel via your bloodstream and impact other body parts including your skin, bones, spinal cord and brain. These complications can be fatal.
Blastomycosis is often initially misdiagnosed. The symptoms are non-specific, meaning they do not point to a single cause of illness, so your healthcare provider is likely to start you on a course of antibiotic treatment for the most common cause of pneumonia. However, only antifungal medications can treat fungal pneumonia so unless you have the correct diagnosis you will be taking a medication that doesn’t work for your illness. If you have taken more than one course of antibiotics, are still experiencing symptoms and were potentially exposed to Blastomyces, ask your healthcare provider about testing for fungal pneumonia. 
The best way to avoid becoming severely ill is to tell your healthcare provider when you are experiencing initial symptoms, and if your symptoms do not resolve, so you can begin appropriate treatment.

How Blastomycosis is Diagnosed

The first thing your healthcare provider will do is take a detailed medical history, including any travel history and potential exposure. Then they will complete a physical examination and analyze your symptoms.
To diagnosis blastomycosis, your healthcare provider may take a sample of your blood, saliva, skin, urine or sputum (mucus you cough up from your lungs). They will send the sample to a lab to look for Blastomyces yeast, test for signs of Blastomyces or try to grow Blastomyces. They may also use a chest x-ray or CT scan to look at your lungs and may request a lung biopsy.

For Healthcare Providers

The Centers for Disease Control and Prevention have created clinical diagnostic algorithms for blastomycosis. You can also download a PDF of the algorithm to help with diagnosis. Diagnostic Algorithms  Download Resource

Treating and Preventing Blastomycosis
How Blastomycosis is Treated

Half of the people infected with Blastomycosis never develop symptoms. In mild and moderate cases, blastomycosis needs to be treated with antifungal medication. You may be on medication for as few as a couple weeks, or in some cases, a year or longer. This depends on how ill you are, if the fungus has spread beyond your lungs and your overall health status, including if you are currently living with a chronic lung disease or have a compromised immune system.
It will be important to maintain communication with your healthcare provider about your symptoms once you begin treatment. If your shortness of breath and cough aren’t getting better after a week, or if you experience new symptoms that are worrisome, your healthcare provider needs to know.
Signs of serious illness that require care at an emergency department include severe shortness of breath, chest pain, coughing up blood, seizures, confusion and high fever.
Recovery from blastomycosis may take weeks, months or even a year or more.  
iframe video

Recovery from serious lung infections, such as pneumonia, can take longer than you expect. Learn what you can do to help your body recover, when to reach out to your healthcare provider and how to help prevent future infections. Watch Video 

Preventing Blastomycosis

There isn’t a reliable test to determine if a specific area has Blastgomyces, so it’s best to simply be aware of where it is commonly found. This includes most of central and eastern United States. Among those areas, Wisconsin and Minnesota record the highest number of illnesses.
There aren’t very many practical measures to prevent exposure. There are a few things you can do to lower your risk of exposure, including avoiding large areas of dirt and near water. And if you aren’t able to do that, you could wear an N95 mask to help filter the air you breathe.

Learn More: Avoiding Diseases From the Dirt (blog)

Finding Support

To talk to a trained respiratory professional who can help answer your questions and connect you with additional support, call the Lung Association's Lung HelpLine at 1-800-LUNGUSA. For more severe or chronic forms of blastomycosis, join an in-person or virtual support group through the Better Breathers Clubs, become a member of the Patient & Caregiver Network which is an online support program through the American Lung Association, and connect with others on our Living with Lung Disease Support Community page. Learn More
Source: https://www.lung.org/lung-health-diseases/lung-disease-lookup/blastomycosis