Miliary Tuberculosis: A Case Report Highlighting the Diagnostic ...
Feds Back In U.P. To Find Source Of Largest Fungal Outbreak In U.S. History
It's been more than seven weeks since a small town paper mill in Michigan's Upper Peninsula became the epicenter of a rare fungal infection outbreak.
Yet the source of the infection remains a mystery.
Health officials have identified, as of April 21, 104 cases of blastomycosis, all connected to the Billerud Paper Mill in Escanaba. Among the infected employees, contractors and visitors, 13 were sick enough to be hospitalized and one died, according to the local health department in Delta County.
Most of the more than 800 mill workers are home, with pay, while the mill has been idled since April 14 to allow for deep cleaning and inspection of the plant and raw materials coming into the mill. Their expectation is to return to work the second week of May.
Federal health and safety officials have visited the roughly 2,200-acre site twice — in late March and late April — and, as of Tuesday, April 25, are in the process of interviewing hundreds of employees in search of patterns that could help uncover the source of the infections.
"I like to say we're very resilient," said Jamie Dier, a 12-year mill worker and vice president of the United Steel Workers Local 21 union, which represents more than 650 mill workers.
"With COVID, we were essential and we managed to keep that mill running for two years while COVID was ravaging the country. I think it just shows how strong our workforce can be when they need to be."
Blastomycosis is a rare infection caused by the fungus Blastomyces, known to be found in areas of the Midwest, including around the Great Lakes. It lives in the environment, particularly in moist soil and composing matter like wood and leaves.
Most people who breathe in the spores don't get sick, according to the U.S. Centers for Disease Control and Prevention. Some people, however, will develop symptoms like cough, fever, chest pain, difficulty breathing, night sweats, fatigue, weight loss, muscle aches, and joint pain.
Blastomycosis is treatable with antifungal medicine, but can cause severe illness if left untreated. Treatment can take from six months to a year, depending on case severity.
Annually, the U.S. Reports one to two cases of blastomycosis per 100,000 people. Wisconsin has the highest known incidence in the country with a yearly rate closer to 10 to 40 cases per 100,000 people in some of its northern counties.
Local health officials in the U.P. Said there's never been an industrial outbreak of Blastomycosis of this nature documented in the U.S.
A 2013 study published in the journal Clinical Infectious Diseases called a 2009-2010 outbreak in Marathon County, Wisconsin, the "largest ever reported." In that case, there were 55 infections. Among them, 33 were hospitalized and two died.
Billerud said it first learned of the blastomycosis fungal infections within its workforce March 3.
At first, sick workers were being treated for bacterial pneumonia but weren't getting better, Dier recalled. He said the willingness of those who were first sick to share their private health information on a union message board likely got others tested and medicated sooner, and allowed for faster diagnosis in subsequent cases.
"So while we have some brothers and sisters who are very, very sick and are going to be for a while, I believe those people saved their fellow members a lot of pain and suffering by getting that information out," Dier said.
Management from the mill requested a health hazard evaluation to investigate and help control the outbreak. A team from the National Institute for Occupational Safety and Health (NIOSH) evaluated the site March 27 and 28. Members spoke with management and employees to assess the mill's work process and potential sources of exposure.
"Our top priority now and always is protecting the health and safety of our employees and contractors who work at our Escanaba Mill," Christoph Michalski, Billerud president and CEO, said in a statement. "We care deeply about their well-being and are doing everything we can to protect them and identify and address the root cause of the blastomycosis fungal infections."
Federal officials recommended the company inspect its HVAC systems, limit activities that disrupt soil, contract with a ventilation engineer or building scientist to inspect ductwork for water incursion or microbial growth, and continue to provide N95 masks to all employees for voluntary use to minimize exposure.
For a more efficient cleaning process, the mill agreed to close for three weeks, with the exception of a few dozen workers in the boiler room.
NIOSH officials returned to the mill last week to collect environmental samples to test for the presence of Blastomyces. They also organized sessions for employees to ask questions, and offered voluntary interviews and urine testing to better understand the outbreak.
"Unfortunately, there aren't well-established ways for doing this, so interpretation of the results might be difficult," NIOSH representatives said in a statement. "Even though this testing may not be fully informative about the cause of the outbreak, we think it is important to try because it might help in guiding prevention and control efforts."
Dier said one big takeaway from the session he attended was how little is known about Blastomyces. Experts did not give numerous questions clear answers, and he said they were relying on knowledge of other fungi and fungal diseases.
Around 500 employees have signed-on to be interviewed by NIOSH, according to Dier, and the union hopes more will follow to give investigators the most information possible to determine a cause and prevent future infections.
"They haven't been able to find a pinpoint source," Dier said. "That's what we're hoping this NIOSH visit will help figure out, patterns and stuff ... It happened there somewhere but we can't pinpoint the exact spot."
NIOSH will eventually share a final report, to be made public on the NIOSH website. But that's not expected for months.
Billerud Paper Mill began making paper in 1911 as the Escanaba Pulp and Paper Co. The mill produces about 660,000 metric tons of paper per year for use in magazines, catalogs, books and specialty papers used in label and converting applications.
Ed Legault, executive director for the Delta County Economic Development Alliance, called the company an anchor for the community. It's one of the area's largest and highest-paying employers, at times employing second- and third-generation workers.
In total, the mill generates an estimated annual impact in the local community of nearly $360 million, including wages, salaries and taxes paid, as well as raw materials and services purchased
Even during the COVID pandemic when employers struggled with staffing levels, Legault said the mill never had a problem.
"Unlike a lot of people that get into the job market now where they work three years here, five years there ... Most of these employees have worked over 35 years and then retired from the paper mill," he said. "It's certainly a generational company that has helped out many people."
The multi-week shutdown could have a short-term impact on some of the suppliers that work with the mill, which contracts an average of 97 workers per day and works with about 747 different vendors per year. But Legault said the interruption should be minimal given the company's timeline and openness about its reopening plan.
Billerud, a Swedish manufacturer that acquired the facility in 2022. Is planning a $1 billon project to expand its Escanaba mill into a paperboard production facility that can manufacture a stiff multi-ply product used for packaging cosmetics, healthcare, beverages and candy products.
Dier said mill workers have been given all assurances that the expansion project is "still a go."
"This is hopefully just a hiccup along the road and we'll get past it and move on," Dier said. "The leadership from Sweden has made it clear that people are first for them. The health and safety of their people is their most important goal and I think they're proving it with this. It's a massive undertaking to idle the mill and clean and do what they're going to do and with a billion dollar project on the horizon, I think people are optimistic that this will all go well for us."
Read more on MLive:
Tax incentive greenlit for $1.5B District Detroit, residents call it 'arrogance of billionaires'
Michigan schools say group's DIY sex ed opt-out forms won't fly
Michigan school district sued for making boys remove 'Let's go Brandon' sweatshirts
Free genetic screening program found risks in 1 in 5 Michigan patients
Young Michigan growers want to farm – but they can't afford land
If you purchase a product or register for an account through one of the links on our site, we may receive compensation.
A Rare Fungal Infection Broke Out At A Paper Mill. Here's What To Know About Blastomycosis In Wisconsin.
Authorities are still trying to determine how a recent fatal outbreak of a rare fungal disease at a paper mill in the Upper Peninsula happened.
"It's the largest known blastomycosis outbreak in U.S. History," the Detroit Free Press reported April 23.
While it's a relatively uncommon disease, the fungus that causes blastomycosis is endemic in Wisconsin, and the state is considered a "hot spot" for the fungal infection, according to Dr. Bruce Klein, a professor at the University of Wisconsin-Madison, who's researched blastomycosis for decades.
Over the years, there have been multiple blastomycosis clusters and outbreaks reported, mostly in the northern half of Wisconsin, according to Dr. Suzanne Gibbons-Burgener, mycotic diseases program coordinator with the Wisconsin Department of Health Services.
The Wisconsin DHS is monitoring the ongoing investigation in Escanaba, and "we are collaborating with public health professionals at the Michigan Department of Health and Human Services," Gibbons-Burgener said.
© USA TODAY NETWORK-Wisconsin Billerud paper mill on Tuesday, April 18, 2023 in Wells Township, Delta County, MI. A contract employee recently died from blastomycosis, a fungal infection that has affected nearly 100 employees. The paper mill will close for up to three weeks as cleaning and investigation intensify in response to the fungal infection outbreak at the plant.Wm. Glasheen USA TODAY NETWORK-Wisconsin What happened in Michigan? One person died and roughly 100 people were affected by the blastomycosis outbreak at the Billerud paper mill in Escanaba, the Detroit Free Press reported in mid-April.
"The first cases involving employees at the Billerud plant were diagnosed early last month, presenting as atypical pneumonia," the article states. "... All of those infected are either contractors, employees or visitors to the Billerud Paper Mill."
The mill closed temporarily as authorities investigate and perform a deep cleaning of the facility.
More: As mystery of Escanaba paper mill's blastomycosis outbreak deepens, its victims try to heal
What is blastomycosis?Blastomycosis is an uncommon illness caused by a fungus so small it cannot be seen by the human eye, according to the Wisconsin DHS.
The fungus, Blastomyces, lives in the environment, particularly in moist soil and in decomposing matter, such as wood and leaves, according to the Centers for Disease Control and Prevention.
When dirt is disturbed, the fungus can get into the air, and people and animals may breathe it in. After the spores enter the lungs, a person's body temperature allows the spores to transform into yeast. In some cases, blastomycosis can spread outside of the lungs to other parts of the body, most commonly to the skin, bone, genitourinary tract and central nervous system, Klein said.
"Blastomycosis doesn't spread between people or between people and animals through the air," according to the CDC.
What are the symptoms of blastomycosis?Symptoms include fever or chills, cough, night sweats, shortness of breath, chest or back pain, skin sores that look crusted or get bigger, fatigue and extreme tiredness, weight loss and muscle aches or joint pain, according to the CDC and Wisconsin DHS.
"Approximately 50% of people who inhale the spores either don't become ill or develop a mild, self-resolving respiratory illness," Gibbons-Burgener said. "Symptoms can occur two to 15 weeks after breathing in the fungal spores."
People who think they may have blastomycosis should contact their health care provider. There are diagnostic tests and treatments available for humans and pets, Gibbons-Burgener said.
© USA TODAY NETWORK-Wisconsin file Blastomycosis is a fungal infection that often has flu-like symptoms. In 2009 and into 2010, blasto sickened 55 people in Marathon County. Where is the fungus found? Most cases occur in the United States or Canada, according to the CDC.
In the United States, the fungus "mainly lives in the Midwestern, south-central, and southeastern states, particularly in areas surrounding the Ohio and Mississippi River valleys, the Great Lakes, and the Saint Lawrence River" the CDC said.
How common is blastomycosis?In states where blastomycosis is reportable, yearly incidence rates are approximately 1 to 2 cases per 100,000 population, the CDC said.
Wisconsin reports "the highest incidence of Blastomyces infection in the country," according to the CDC's Morbidity and Mortality Weekly Report in March.
From 2016 to 2020, the average annual number of reported blastomycosis cases in Wisconsin was 116, ranging from 101 cases during 2019 to 133 in 2017, according to Gibbons-Burgener. The statewide average annual incidence rate during that time period was two cases per 100,000 Wisconsin residents.
Blastomycosis contributed to the deaths of 61 patients during that five-year span, which is consistent with Wisconsin's previously observed 10% case fatality rate, according to Gibbons-Burgener.
"Blastomycosis is more likely to be diagnosed and reported to public health in patients with moderate to severe illness, so the overall case fatality rate should be lower when accounting for unreported cases of mild illness," she said.
Why is Wisconsin a 'hot spot'?"I don't think anybody has really gotten to the root cause," said Klein, with UW-Madison.
The fungus flourishes in habitats that are prevalent in Wisconsin, he said, with its many lakes, rivers and streams, where people like to go fishing, canoeing and hunting. That said, other states have similar conditions, according to Klein.
It may also have to do with the fact that Wisconsin is one of only a handful of states where blastomycosis is a required notifiable disease.
"The fact that we're watching and require reporting, this may have something to do with the apparent increased incidents," Klein said. "But there is something about Wisconsin, just aside from the increased reporting, that I think is responsible for us being the hot spot in certain parts of the state."
© Courtesy of University of Wisconsin-Madison Dr. Bruce Klein Has an outbreak happened at a paper mill before? What happened at the Escanaba paper mill is "unusual" and appears to be "unprecedented," Klein said.
"I'm not aware of any prior outbreak in a setting like that," he added.
Given Wisconsin's many paper mils and that blastomycosis is carefully tracked here, "I'm sure it would have come to attention previously" if an outbreak had happened, Klein said.
Transmission usually occurs outdoors, so the Escanaba mill outbreak "is unusual because exposure to Blastomyces spores possibly occurred indoors during winter months," according to Gibbons-Burgener.
Still, at this time, the Wisconsin DHS believes "that exposure to Blastomyces during indoor activities at home or in a building is very unlikely," she said.
On April 15, the United Steelworkers union called for testing and cleaning in paper mills across the industry.
"What happened in the Escanaba facility reinforces the need to be proactive with occupational health and safety, and the best way to prevent another outbreak is to institute safeguards before anyone else encounters this disease at work," a USW spokesperson told The Post-Crescent in an email on April 20.
"Our union continues to work with the company and national health and safety experts to determine the cause of the outbreak in Escanaba, which will help inform further efforts to keep all workers safe," the email states.
More: Why tissue, packaging and specialty papers look promising for Wisconsin's paper industry
How are Wisconsin paper mills responding?The Post-Crescent asked paper mills in the state if they were monitoring the Escanaba and if they are responding in any way.
Cascades, which has a tissue facility in Eau Claire, said "physicians from our Health Center of Excellence" are monitoring developments and recommendations. "At this time, it is not our intention to test our employees," a spokesperson said in an email on April 20.
"Our internal audit team meets regularly and plans to discuss what is learned from this situation and make any necessary adjustments to our cleaning and testing procedures," said Ryan Day, plant manager at BPM Inc., which has a mill in Peshtigo.
Ahlstrom's four Wisconsin plants in Rhinelander, Mosinee, Kaukauna and De Pere "undertake housekeeping measures on a regular basis," and "we are confident in our health and safety measurers at this time," while monitoring what happens in Michigan, a spokesperson said.
"We are sending our thoughts and support to the Escanaba team," the spokesperson said in an email.
More: Here's how some Wisconsin paper mills have remained family or locally owned amid industry shifts
What types of blastomycosis cases have happened in Wisconsin?One person died and dozens of cases were reported from a blastomycosis outbreak in 2015 after people went tubing on the Little Wolf River near New London. Two people died from blastomycosis in Lincoln County in 2006 and 2010. Around 2009 and 2010, Marathon County experienced 55 cases, with 30 hospitalizations and two deaths.
A police dog with the Kronenwetter Police Department, Officer Chip, died of the disease in 2012. And in 2022, a veterinarian in St. Croix County helped identify a cluster of cases among dogs and humans.
Scientists at the Marshfield Clinic found that people with certain ethnic and racial backgrounds may need more aggressive treatment and closer monitoring for blastomycosis infection, according to a 2019 news release. Another study from the UW School of Medicine and Public Health determined that a specific genetic variation among Hmong people makes them more likely to get sick from blastomycosis.
A lot of progress has been made, but like many fungal infectious diseases, there's still more to learn about blastomycosis, Klein said, including about how to reliably diagnose an infection quickly, as well as how to to detect the organism in the environment.
Researchers are also still working to better understand, he said, why some people develop a progressive infection, while others have little to no symptoms at all.
Can you prevent getting blastomycosis?"People are most at risk for blastomycosis if they move soil, especially near waterways, that has not been disturbed for a long time," Gibbons-Burgener said.
The CDC and Wisconsin DHS recommend people be aware and cautious during activities such as excavation, landscaping, off-path exploring or recreating along a waterway. You can take precautions to protect yourself, she said, by wearing a well-fitted mask.
"There is currently no consistent way to identify areas where the organism grows," Gibbons-Burgener said. "Testing for the fungus in soil or the environment is rarely successful, and only attempted for research or investigation purposes."
In general, "it's always good to have heightened awareness for this fungal infection in Wisconsin," Klein said.
More information about blastomycosis can be found at dhs.Wisconsin.Gov/disease/blastomycosis.Htm and cdc.Gov/fungal/diseases/blastomycosis/.
Reach Becky Jacobs at bjacobs@gannett.Com or 920-993-7117. Follow her on Twitter at @ruthyjacobs.
This article originally appeared on Appleton Post-Crescent: A rare fungal infection broke out at a paper mill. Here's what to know about blastomycosis in Wisconsin.
7 At-Home Yeast Infection Tests Of 2023
Final VerdictWe chose myLAB Box V Box as our pick for the most comprehensive at-home yeast infection test because, in addition to screening for yeast, it also checks for other common vaginal infections including chlamydia, gonorrhea, trich, BV, genital herpes, and UTI. This is important because vaginal infections share many common symptoms, including itching, pain during sex and urination, or redness—but treatment is different. If anything comes back positive, you'll have the option to consult with a myLAB Box physician, who can prescribe medication as needed.
If you're looking for an affordable way to monitor pH levels over time, Loyal All My [pH]eels and Nutrablast Feminine pH Test Strips are both good options. Ideal for those who experience chronic yeast infections and want to be able to catch one before it becomes a full-on infection, or for anyone who wants to see how lifestyle tweaks affect their pH, these strips come 100 to a pack and work well for regularly tracking pH.
Compare At-Home Yeast Infection Tests Guide to Choosing an At-Home Yeast Infection Test When Should You Take an At-Home Yeast Infection Test?If you suspect you have symptoms of a yeast infection, you may want to take an at-home yeast infection test. "The most common signs of a yeast infection include itching, irritation, thick vaginal discharge, and swelling or redness in the vulva or vagina," says Modglin, adding that pain during intercourse or urination can also occur. You may also use an at-home yeast infection test if you're wondering how something like intercourse or a new soap affects your pH.
What Types of At-Home Yeast Infection Tests Are Available?Many at-home yeast infection tests measure the pH of vaginal fluid, which offers a barometer of whether the pH is within a normal range. Typically, you can inserting a cotton swab into the vagina and then rub it onto the test strip, or carefully insert the strip itself. Results are available in under a minute.
Testing kits with lab results provide more comprehensive results. These kits often contain a swab and collection container which is then sent to a lab for testing. These at-home tests are more diagnostic and will take longer to return results, but that's because they typically test for more infections.
What Are the Benefits and Downsides of At-Home Yeast Infection Tests?At-home yeast infections offer many benefits, but there are also some potential downsides to be aware of. "At-home yeast infection tests offer convenience, privacy, and cost savings," Modglin says. You won't need to carve out time to visit a doctor, and it can be more comfortable to test yourself from home.
She adds that they may also be a good option for women with recurrent infections who find it helpful to monitor their vaginal pH on an ongoing basis. The downside is that they may not be as accurate as tests done by a doctor. "Many tests, such as pH strips, cannot accurately diagnose a yeast infection," she says.
Are At-Home Yeast Infection Tests as Effective as Lab Tests?At-home yeast infection tests can be quite accurate, but there are some things that might impact their accuracy. "[These] tests can be as accurate as lab tests when the sample is collected correctly and sent to an accredited lab—often the same labs used by healthcare providers," says Modglin, adding that accuracy varies from test to test and from lab to lab. And, as with all at-home tests, user error can happen, so it's important to carefully read the instructions before beginning your test.
"The most accurate way to diagnose a yeast infection is still through your doctor," says Modglin. Also, it's important to note that a company claiming a certain level of accuracy is not a guaranteed accuracy. However, a specific test's accuracy that is supported by an independent, peer-reviewed study is more likely to be on point.
How to Compare the Best At-Home Yeast Infection TestsThere are several factors to consider when deciding which at-home yeast infection test is right for you.
Signs of a yeast infection include:
As mentioned previously, these symptoms can also denote other types of vaginal infections and even STIs, so getting tested for a broader spectrum of infections can be helpful. And remember, at-home tests should not be relied upon to provide an accurate diagnosis—you should always consult a healthcare practitioner if you've received a positive result.
The cost of at-home yeast infection tests varies widely depending on the type of test. PH test strips that are typically bought in packs of 100 will hover somewhere around $15; these can indicate an abnormal pH but cannot definitively tell you if you have a yeast infection. More diagnostic tests that require a vaginal swab to be sent to a lab will be more expensive because they yield more information and sometimes include a telemedicine visit with a doctor and a prescription. You can expect these to be somewhere between $150 and $200 which does not necessarily include the cost of a doctor's visit or medication.
Some at-home yeast infection tests will yield results in a few minutes; this is often the case with pH strips. When samples are taken at home and sent to a lab to be analyzed, you can expect results within two to 10 days.
The best treatment for a yeast infection is not to get one in the first place, which starts with keeping your vagina clean and free of irritating elements. Specifically, Modglin says to avoid tight clothes, scented soaps, or other harsh chemicals that can disrupt the body's natural balance, and try to wear breathable cotton underwear whenever possible.
Research suggests prebiotics and probiotics can help maintain a healthy vaginal balance and prevent recurrent vaginal infections, including yeast infections but always speak with your healthcare provider before taking any dietary supplement or probiotics.
Yeast infections are best treated by a doctor, Modglin says, but some over-the-counter antifungal medications may help reduce symptoms. "Your medical provider may prescribe a cream, oral medication, or suppository to treat the infection," she says.
We researched over 50 companies that specialize in reproductive health tests for this review. Our top priorities in choosing winners were tests that offer accurate results that are sent via secure, virtual platforms that are easy to understand, a good value, and have processing done in an accredited lab.
We considered several factors that are important to consumers, including the cost of shipping, speed of results, how fast you can receive treatment when needed, and whether there is an option to speak with a health professional.
Comments
Post a Comment