Abstract
Much of our understanding of the epidemiologic features of infection with Blastomyces dermatitidis has come from cluster and outbreak investigations which have established the association of human disease with recreational pursuits and the presence of infectious microfoci in areas of moist soil with high organic content. This report describes the clustering of eight cases of pulmonary blastomycosis without an apparent common source exposure which occurred during a 90 day period in a 96 square mile area (population 4,450) within Oconto County, Wisconsin. We conclude that multiple high-risk environmental foci may have existed following a sustained five-year period of diminished precipitation in the cluster area. A case-control study which included family and community controls concluded that multiple earth-disturbing activities engaged in by case-patients was statistically associated with illness. Lymphocyte-proliferation assays of whole blood samples detected previously unrecognized infection withB. dermatitidis among five of 32 family controls.
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References
Klein BS, Jones JM. Isolation, purification, and radiolabeling of a novel 120-kD surface protein on Blastomyces dermatitidis yeasts to detect antibody in infected patients. J Clin Invest 1990; 85: 152–161.
Soufleris AJ, Klein BS, Courtney BT, Proctor ME, Jones JM. Utility of anti-WI-1 serological testing in the diagnosis of blastomycosis in Wisconsin residents. Clin Infect Dis 1994; 19: 87–92.
Bradsher RW, Alford RH. Blastomyces dermatitidis antigen-induced lymphocyte reactivity in human blastomycosis. Infect Immun 1981; 33: 485–490.
Bradsher RW. Development of specific immunity in patients with pulmonary or extrapulmonary blastomycosis. Am Rev Respir Dis 1984; 129: 430–434.
Denton JF, McDonough ES, Ajello L, Ausherman RJ. Isolation of Blastomyces dermatitidis from soil. Science 1961; 133: 1126–1127.
Denton JF, DiSalvo AF. Isolation of Blastomyces dermatitidis from natural sites at Augusta, Georgia. Am J Trop Med Hyg 1964; 13: 716–722.
Dean AG, Dean JA, Coulombier D, Brendel KA, Smith DC, Burton AH, Dicker RC, Sullivan K, Fagan RF, Arner TG. Epi Info, Version 6: A word processing, database, and statistics program for epidemiology on microcomputers. Centers for Disease Control and Prevention, Atlanta, GA, USA, 1994.
Rothman KJ. Modern Epidemiology. Boston; Little, Brown and Company, 1986.
Soil survey of Oconto County, Wisconsin, September, 1988. U.S. Department of Agriculture, Soil Conservation Service.
Centers for Disease Control. Blastomycosis - Wisconsin, 1986-1995. MMWR 1996; 45: 601–603.
Tosh FE, Hammerman KJ, Weeks RJ, Sarosi GA. A common source epidemic of North American blastomycosis. Am Rev Respir Dis 1974; 109: 525–529.
Centers for Disease Control. Blastomycosis-North Carolina. MMWR 1976; 25: 205–206.
Kitchen MS, Reiber CD, Eastin GB. An urban epidemic of North American blastomycosis. Am Rev Respir Dis 1977; 155: 1063–1066.
Cockerill FR III, Roberts GD, Rosenblatt JE, Utz JP, Utz DC. Epidemic of pulmonary blastomycosis (Namekagon Fever) in Wisconsin canoeists. Chest 1984; 86: 688–692.
Klein BS, Vergeront JM, DiSalvo AF, Kaufman L, Davis JP. Two outbreaks of blastomycosis along rivers in Wisconsin. Amer Rev Respir Dis 1987; 136: 1333–1338.
Lowry PW, Kelso KY, McFarland LM. Blastomycosis in Washingtom Parish, Louisiana, 1976-1985. Am J Epidemiol 1989; 130: 151–159.
DiSalvo AF. The ecology of Blastomyces dermatitidis. In: Al-Doory Y, DiSAlvo AF, eds. Blastomycosis. New York: Plenum Publishing Coorporation, 1992: 43–73.
Vaaler AK, Bradsher RW, Davies SF. Evidence of subclinical blastomycosis in forestry workers in northern Minnesota and northern Wisconsin. Amer J Med 1990; 89: 470–476.
Klein BS, Bradsher RW, Vergeront JM, Davis JP. The development of long-term specific immunity after acute Blastomyces dermatitidis infection: Assessments following a large point-source outbreak in Wisconsin. J Infect Dis 1990; 161: 97–101.
Klein BS, Davis JP. A laboratory-based surveillance of human blastomycosis in Wisconsin between 1973 and 1982. Am J Epidemiol 1985; 122: 897–903.
Archer JR, Trainer DO, Schell RF. Epidemiologic study of canine blastomycosis in Wisconsin. JAMA 1987; 190: 1292–1295.
Armstrong CW, Jenkins SR, Kaufman L, Kerkering TM, Rouse BS. A common source outbreak of blastomycosis in humans and dogs (abstract No. 1103). Proceedings of the 25th Interscience Conference on Antimicrobial and Chemotherapy, Minneapolis, MN, September 29-October 2, 1985.
Klein BS, Vergeront JM, Weeks RJ. Kumar UN, Mathai G, Varkey B, Kaufman L, Bradsher RW, Stoebig JF, Davis JP, and the Investigation Team. Isolation of Blastomyces dermatitidis in soil associated with a large outbreak of blastomycosis in Wisconsin. N Engl J Med 1986; 314: 529–534.
DeGroote MA, Bjerke R, Smith H, Rhodes LV. Expanding epidemiology of blastomycosis: clinical features and investigation of two cases in Colorado. Clin Infect Dis 2000; 30: 582–584.
Menges RW, Doto IL, Weeks RJ. Epidemiologic studies of blastomycosis in Arkansas. Arch Environ Health 1969; 18: 956–971.
Furcolow ML, Busey JF, Menges RW. Prevalence and incidence studies of human and canine blastomycosis II. Yearly incidence studies in three selected states, 1960-1967. Amer J Epidemiol 1970; 92: 121–131.
Manetti AC. Hyperendemic urban blastomycosis. Amer J Public Health 1991; 81: 633–636.
Sarosi GA, Serstock DS. Isolation of Blastomyces dermatitidis from pigeon manure. Amer Rev Respir Dis 1976; 114: 1179–1183.
Steck WD. Blastomycosis. Dermatol Clinics 1989; 7: 241–250.
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Proctor, M.E., Klein, B.S., Jones, J.M. et al. Cluster of pulmonary blastomycosis in a rural community: Evidence for multiple high-risk environmental foci following a sustained period of diminished precipitation. Mycopathologia 153, 113–120 (2002). https://doi.org/10.1023/A:1014515230994
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DOI: https://doi.org/10.1023/A:1014515230994