Hennessee Ian, Palmer Sara, Reik Rebecca, Miles-Jay Arianna, Nawaz Muhammad Yasir, Blankenship Heather M, Kramer Rebecca, Hughes Adam, Snyder Michael, Yin Robert L, Litvintseva Anastasia P, Parnell Lindsay A, Gade Lalitha, Chiller Tom, de Perio Marie A, Stobierski Mary Grace, McFadden Jevon, Toda Mitsuru
Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
Clin Infect Dis. 2025 Feb 24;80(2):356-363. doi: 10.1093/cid/ciae513.
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.
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.
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.
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.
芽生菌病是一种通过环境感染的真菌感染性疾病，可导致严重的肺部疾病和较高的住院率。2023年，密歇根州德尔塔县一家造纸厂的工人中检测到芽生菌病疫情。
我们纳入了自2022年9月1日起在德尔塔县停留≥40小时且发病时间为2022年12月1日至2023年7月1日的有芽生菌病临床和实验室证据的患者。我们评估了患者的流行病学和临床特征，并评估了与住院相关的因素。我们进行了全基因组测序，以表征8例患者临床分离株的遗传相关性。
共识别出131例患者；所有患者均在该工厂工作或到访过该工厂。16例患者（12%）住院治疗；1例死亡。与未住院患者相比，更多住院患者患有糖尿病（P = 0.03）且尿抗原滴度高于定量下限（P < 0.001）。住院患者在接受芽生菌病诊断测试前也更有可能进行过≥1次医疗就诊（P = 0.02），并且在开具抗真菌药物处方之前接受过抗生素治疗（P = 0.001）。所有测序分离株均被鉴定为吉尔克里斯芽生菌，并聚集形成一个独特的疫情集群。
这是美国有记录以来最大的芽生菌病疫情。流行病学证据表明暴露发生在工厂或其附近，基因组学研究结果表明存在共同的暴露源。糖尿病患者住院风险可能增加，尿抗原滴度升高可能表明疾病严重程度更高。早期怀疑芽生菌病可能会促使更早的诊断和治疗， potentially reducing unnecessary antibiotic prescriptions and improving patient outcomes.（此处英文原文有误，正确翻译应为：可能减少不必要的抗生素处方并改善患者预后。）
