Current Fungal Infection Reports

, Volume 6, Issue 4, pp 327–335 | Cite as

Epidemiologic and Ecologic Features of Blastomycosis: A Review

  • Kaitlin Benedict
  • Monika Roy
  • Tom Chiller
  • Jeffrey P. Davis
Epidemiological Aspects of Fungal Infections (T Chiller and J Baddley, Section Editors)

Abstract

Blastomycosis is a potentially fatal infection caused by Blastomyces dermatitidis, a fungus endemic to North America in areas surrounding the Ohio and Mississippi River valleys and the Great Lakes. The clinical manifestations, diagnostic techniques, and treatment strategies for blastomycosis are relatively well-described in the literature; however, the epidemiologic features of disease are not as clearly defined as those of other endemic mycoses, such as histoplasmosis and coccidioidomycosis. We review the ecologic and epidemiologic aspects of B. dermatitidis and blastomycosis, including geographic distribution, environmental niche, seasonality, and possible risk factors.

Keywords

Blastomycosis Blastomyces Fungus Epidemiology Ecology Risk factor Prevention 

Notes

Disclaimer

The findings and conclusions of this article are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

Disclosure

K. Benedict: none; M. Roy: none; T. Chiller: none; J. P. Davis: none.

References

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. 1.
    Klein BS, Vergeront JM, Davis JP. Epidemiologic aspects of blastomycosis, the enigmatic systemic mycosis. Semin Respir Infect. 1986;1(1):29–39.PubMedGoogle Scholar
  2. 2.
    Furcolow ML, Busey JF, Menges RW, Chick EW. Prevalence and incidence studies of human and canine blastomycosis. II. Yearly incidence studies in three selected states, 1960–1967. Am J Epidemiol. 1970;92(2):121–31.PubMedGoogle Scholar
  3. 3.
    Evans ME, Haynes JB, Atkinson JB, et al. Blastomyces dermatitidis and the adult respiratory distress syndrome. Case reports and review of the literature. Am Rev Respir Dis. 1982;126(6):1099–102.PubMedGoogle Scholar
  4. 4.
    Recht LD, Philips JR, Eckman MR, Sarosi GA. Self-limited blastomycosis: a report of thirteen cases. Am Rev Respir Dis. 1979;120(5):1109–12.PubMedGoogle Scholar
  5. 5.
    Gnann Jr JW, Bressler GS, Bodet 3rd CA, Avent CK. Human blastomycosis after a dog bite. Ann Intern Med. 1983;98(1):48–9.PubMedGoogle Scholar
  6. 6.
    Larsh HW, Schwarz J. Accidental inoculation blastomycosis. Cutis. 1977;19(3):334–5. 337.PubMedGoogle Scholar
  7. 7.
    Baumgardner DJ, Halsmer SE, Egan G. Symptoms of pulmonary blastomycosis: northern Wisconsin, United States. Wilderness Environ Med. 2004;15(4):250–6.PubMedCrossRefGoogle Scholar
  8. 8.
    Stovall SH, Schutze GE. Blastomycosis. In: Feigin RD, Cherry JD, Demmler-Harrison GJ, Kaplan SL, editors. Feigin & Cherry’s textbook of pediatric infectious diseases. 6th ed. Philadelphia: Saunders Elsevier; 2009. p. 2732–40.Google Scholar
  9. 9.
    • Saccente M, Woods GL. Clinical and laboratory update on blastomycosis. Clin Microbiol Rev. 2010;23(2):367–81. This comprehensive review summarizes the clinical manifestations, current diagnostic methods, and treatment options for blastomycosis. PubMedCrossRefGoogle Scholar
  10. 10.
    Smith JA, Kauffman CA. Blastomycosis. Proc Am Thorac Soc. 2010;7(3):173–80.PubMedCrossRefGoogle Scholar
  11. 11.
    Klein BS, Kuritsky JN, Chappell WA, et al. Comparison of the enzyme immunoassay, immunodiffusion, and complement fixation tests in detecting antibody in human serum to the A antigen of Blastomyces dermatitidis. Am Rev Respir Dis. 1986;133(1):144–8.PubMedGoogle Scholar
  12. 12.
    Klein BS, Vergeront JM, Kaufman L, et al. Serological tests for blastomycosis: assessments during a large point-source outbreak in Wisconsin. J Infect Dis. 1987;155(2):262–8.PubMedCrossRefGoogle Scholar
  13. 13.
    Turner S, Kaufman L, Jalbert M. Diagnostic assessment of an enzyme-linked immunosorbent assay for human and canine blastomycosis. J Clin Microbiol. 1986;23(2):294–7.PubMedGoogle Scholar
  14. 14.
    Bariola JR, Hage CA, Durkin M, et al. Detection of Blastomyces dermatitidis antigen in patients with newly diagnosed blastomycosis. Diagn Microbiol Infect Dis. 2011;69(2):187–91.PubMedCrossRefGoogle Scholar
  15. 15.
    • Babady NE, Buckwalter SP, Hall L, Le Febre KM, Binnicker MJ, Wengenack NL. Detection of Blastomyces dermatitidis and Histoplasma capsulatum from culture isolates and clinical specimens by use of real-time PCR. J Clin Microbiol. 2011;49(9):3204–8. This paper describes the use of a newly developed real-time PCR assay for the detection of B. dermatitidis and H. capsulatum. The results indicate that the assay is a sensitive and specific method for detecting and differentiating these two fungi from culture isolates and directly from certain types of clinical specimens. PubMedCrossRefGoogle Scholar
  16. 16.
    Sidamonidze K, Peck MK, Perez M, et al. Real-time PCR assay for identification of Blastomyces dermatitidis in culture and in tissue. J Clin Microbiol. 2012;50(5):1783–6.PubMedCrossRefGoogle Scholar
  17. 17.
    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(1):152–61.PubMedCrossRefGoogle Scholar
  18. 18.
    Klein BS, Jones JM. Purification and characterization of the major antigen WI-1 from Blastomyces dermatitidis yeasts and immunological comparison with A antigen. Infect Immun. 1994;62(9):3890–900.PubMedGoogle Scholar
  19. 19.
    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(1):87–92.PubMedCrossRefGoogle Scholar
  20. 20.
    Chapman SW, Dismukes WE, Proia LA, et al. Clinical practice guidelines for the management of blastomycosis: 2008 update by the Infectious Diseases Society of America. Clin Infect Dis. 2008;46(12):1801–12.PubMedCrossRefGoogle Scholar
  21. 21.
    National Institute of Allergy and Infectious Diseases Mycoses Study Group. Treatment of blastomycosis and histoplasmosis with ketoconazole. Results of a prospective randomized clinical trial. Ann Intern Med. 1985;103(6 Pt 1):861–72.Google Scholar
  22. 22.
    Pappas PG, Bradsher RW, Kauffman CA, et al. Treatment of blastomycosis with higher doses of fluconazole. The National Institute of Allergy and Infectious Diseases Mycoses Study Group. Clin Infect Dis. 1997;25(2):200–5.PubMedCrossRefGoogle Scholar
  23. 23.
    Baily GG, Robertson VJ, Neill P, Garrido P, Levy LF. Blastomycosis in Africa: clinical features, diagnosis, and treatment. Rev Infect Dis. 1991;13(5):1005–8.PubMedCrossRefGoogle Scholar
  24. 24.
    Randhawa HS, Khan ZU, Gaur SN. Blastomyces dermatitidis in India: first report of its isolation from clinical material. Sabouraudia. 1983;21(3):215–21.PubMedCrossRefGoogle Scholar
  25. 25.
    Sarosi GA, King RA. Apparent diminution of the blastomycin skin test; follow-up of an epidemic of blastomycosis. Am Rev Respir Dis. 1977;116(4):785–8.PubMedGoogle Scholar
  26. 26.
    Baddley JW, Winthrop KL, Patkar NM, et al. Geographic distribution of endemic fungal infections among older persons, United States. Emerg Infect Dis. 2011;17(9):1664–9.PubMedCrossRefGoogle Scholar
  27. 27.
    Smith Jr JG, Harris JS, Conant NF, Smith DT. An epidemic of North American blastomycosis. J Am Med Assoc. 1955;158(8):641–6.PubMedCrossRefGoogle Scholar
  28. 28.
    Tosh FE, Hammerman KJ, Weeks RJ, Sarosi GA. A common source epidemic of North American blastomycosis. Am Rev Respir Dis. 1974;109(5):525–9.PubMedGoogle Scholar
  29. 29.
    Kitchen MS, Reiber CD, Eastin GB. An urban epidemic of North American blastomycosis. Am Rev Respir Dis. 1977;115(6):1063–6.PubMedGoogle Scholar
  30. 30.
    Cockerill 3rd FR, Roberts GD, Rosenblatt JE, Utz JP, Utz DC. Epidemic of pulmonary blastomycosis (Namekagon fever) in Wisconsin canoeists. Chest. 1984;86(5):688–92.PubMedCrossRefGoogle Scholar
  31. 31.
    Klein BS, Vergeront JM, Weeks RJ, et al. Isolation of Blastomyces dermatitidis in soil associated with a large outbreak of blastomycosis in Wisconsin. N Engl J Med. 1986;314(9):529–34.PubMedCrossRefGoogle Scholar
  32. 32.
    Armstrong CW, Jenkins SR, Kaufman L, Kerkering TM, Rouse BS, Miller Jr GB. Common-source outbreak of blastomycosis in hunters and their dogs. J Infect Dis. 1987;155(3):568–70.PubMedCrossRefGoogle Scholar
  33. 33.
    Klein BS, Vergeront JM, DiSalvo AF, Kaufman L, Davis JP. Two outbreaks of blastomycosis along rivers in Wisconsin. Isolation of Blastomyces dermatitidis from riverbank soil and evidence of its transmission along waterways. Am Rev Respir Dis. 1987;136(6):1333–8.PubMedCrossRefGoogle Scholar
  34. 34.
    Baumgardner DJ, Burdick JS. An outbreak of human and canine blastomycosis. Rev Infect Dis. 1991;13(5):898–905.PubMedCrossRefGoogle Scholar
  35. 35.
    Frye MD, Seifer FD. An outbreak of blastomycosis in eastern Tennessee. Mycopathologia. 1991;116(1):15–21.PubMedCrossRefGoogle Scholar
  36. 36.
    Proctor ME, Klein BS, Jones MJ, Davis JP. Cluster of pulmonary blastomycosis in a rural community: evidence for multiple high-risk environmental foci following a sustained period of diminished precipitation. Mycopathologia. 2001;153:113–20.CrossRefGoogle Scholar
  37. 37.
    Baumgardner DJ, Egan G, Giles S, Laundre B. An outbreak of blastomycosis on a United States Indian reservation. Wilderness Environ Med. 2002;13(4):250–2.PubMedCrossRefGoogle Scholar
  38. 38.
    MacDonald PD, Langley RL, Gerkin SR, Torok MR, MacCormack JN. Human and canine pulmonary blastomycosis, North Carolina, 2001-2002. Emerg Infect Dis. 2006;12(8):1242–4.PubMedCrossRefGoogle Scholar
  39. 39.
    • Pfister JR, Archer JR, Hersil S, et al. Non-rural point source blastomycosis outbreak near a yard waste collection site. Clin Med Res. 2011;9(2):57–65. This paper describes the blastomycosis outbreak that occurred in Lincoln County, Wisconsin during 2006. A large yard waste site was identified as the probable source of exposure, and B. dermatitidis nucleic acid was detected in an environmental sample from this site. PubMedCrossRefGoogle Scholar
  40. 40.
    Blastomycosis in Wisconsin, 1985–1994. Wis Epidemiol Bull. 1995;16(2):1–5.Google Scholar
  41. 41.
    Herrmann JA, Kostiuk SL, Dworkin MS, Johnson YJ. Temporal and spatial distribution of blastomycosis cases among humans and dogs in Illinois (2001–2007). J Am Vet Med Assoc. 2011;239(3):335–43.PubMedCrossRefGoogle Scholar
  42. 42.
    Carlos WG, Rose AS, Wheat LJ, et al. Blastomycosis in Indiana: digging up more cases. Chest. 2010;138(6):1377–82.PubMedCrossRefGoogle Scholar
  43. 43.
    Morris SK, Brophy J, Richardson SE, et al. Blastomycosis in Ontario, 1994–2003. Emerg Infect Dis. 2006;12(2):274–9.PubMedCrossRefGoogle Scholar
  44. 44.
    Vaaler AK, Bradsher RW, Davies SF. Evidence of subclinical blastomycosis in forestry workers in northern Minnesota and northern Wisconsin. Am J Med. 1990;89(4):470–6.PubMedCrossRefGoogle Scholar
  45. 45.
    McKinnell JA, Pappas PG. Blastomycosis: new insights into diagnosis, prevention, and treatment. Clin Chest Med. 2009;30(2):227–39.PubMedCrossRefGoogle Scholar
  46. 46.
    Denton JF, McDonough ES, Ajello L, Ausherman RJ. Isolation of Blastomyces dermatitidis from soil. Science. 1961;133:1126–7.PubMedCrossRefGoogle Scholar
  47. 47.
    Reed KD, Meece JK, Archer JR, Peterson AT. Ecologic niche modeling of Blastomyces dermatitidis in Wisconsin. PLoS One. 2008;3(4):e2034.PubMedCrossRefGoogle Scholar
  48. 48.
    Burgess JW, Schwan WR, Volk TJ. PCR-based detection of DNA from the human pathogen Blastomyces dermatitidis from natural soil samples. Med Mycol. 2006;44(8):741–8.PubMedCrossRefGoogle Scholar
  49. 49.
    Denton JF, Disalvo AF. Isolation of Blastomyces dermatitidis from natural sites at Augusta, Georgia. AmJTrop Med Hyg. 1964;13:716–22.Google Scholar
  50. 50.
    Denton JF, DiSalvo AF. Additional isolations of Blastomyces dermatitidis from natural sites. AmJTrop Med Hyg. 1979;28(4):697–700.Google Scholar
  51. 51.
    Sarosi GA, Serstock DS. Isolation of Blastomyces dermatitidis from pigeon manure. Am Rev Respir Dis. 1976;114(6):1179–83.PubMedGoogle Scholar
  52. 52.
    Baumgardner DJ, Steber D, Glazier R, et al. Geographic information system analysis of blastomycosis in northern Wisconsin, USA: waterways and soil. Med Mycol. 2005;43(2):117–25.PubMedCrossRefGoogle Scholar
  53. 53.
    Baumgardner DJ, Paretsky DP. Blastomycosis: more evidence for exposure near one’s domicile. WMJ. 2001;100(7):43–5.PubMedGoogle Scholar
  54. 54.
    Baumgardner DJ. Microecology of Blastomyces dermatitidis: the ammonia hypothesis. Med Mycol. 2009;47(7):745–52.PubMedCrossRefGoogle Scholar
  55. 55.
    McDonough ES, Wisniewski TR, Penn LA, Chan DM, McNamara WJ. Preliminary studies on conidial liberation of Blastomyces dermatitidis and Histoplasma capsulatum. Sabouraudia. 1976;14(2):199–204.PubMedCrossRefGoogle Scholar
  56. 56.
    Archer JR, Trainer DO, Schell RF. Epidemiologic study of canine blastomycosis in Wisconsin. J Am Vet Med Assoc. 1987;190(10):1292–5.PubMedGoogle Scholar
  57. 57.
    Baumgardner DJ, Buggy BP, Mattson BJ, Burdick JS, Ludwig D. Epidemiology of blastomycosis in a region of high endemicity in north central Wisconsin. Clin Infect Dis. 1992;15(4):629–35.PubMedCrossRefGoogle Scholar
  58. 58.
    Baumgardner DJ, Knavel EM, Steber D, Swain GR. Geographic distribution of human blastomycosis cases in Milwaukee, Wisconsin, USA: association with urban watersheds. Mycopathologia. 2006;161(5):275–82.PubMedCrossRefGoogle Scholar
  59. 59.
    Maddy KT. Ecological factors of the geographic distribution of Coccidioides immitis. J Am Vet Med Assoc. 1957;130(11):475–6.PubMedGoogle Scholar
  60. 60.
    Garcia-Solache MA, Casadevall A. Global warming will bring new fungal diseases for mammals. mBio. 2010;1(1). doi: 10.1128/mBio.00061-10.PubMedCrossRefGoogle Scholar
  61. 61.
    Dworkin MS, Duckro AN, Proia L, Semel JD, Huhn G. The epidemiology of blastomycosis in Illinois and factors associated with death. Clin Infect Dis. 2005;41(12):e107–11.PubMedCrossRefGoogle Scholar
  62. 62.
    Baumgardner DJ, Brockman K. Epidemiology of human blastomycosis in Vilas County, Wisconsin. II: 1991–1996. WMJ. 1998;97(5):44–7.PubMedGoogle Scholar
  63. 63.
    Lowry PW, Kelso KY, McFarland LM. Blastomycosis in Washington Parish, Louisiana, 1976–1985. Am J Epidemiol. 1989;130(1):151–9.PubMedGoogle Scholar
  64. 64.
    Vasquez JE, Mehta JB, Agrawal R, Sarubbi FA. Blastomycosis in northeast Tennessee. Chest. 1998;114(2):436–43.PubMedCrossRefGoogle Scholar
  65. 65.
    Light RB, Kralt D, Embil JM, et al. Seasonal variations in the clinical presentation of pulmonary and extrapulmonary blastomycosis. Med Mycol. 2008;46(8):835–41.CrossRefGoogle Scholar
  66. 66.
    Klein BS, Davis JP. A laboratory-based surveillance of human blastomycosis in Wisconsin between 1973 and 1982. Am J Epidemiol. 1985;122(5):897–903.PubMedGoogle Scholar
  67. 67.
    Kralt D, Light B, Cheang M, et al. Clinical characteristics and outcomes in patients with pulmonary blastomycosis. Mycopathologia. 2009;167(3):115–24.PubMedCrossRefGoogle Scholar
  68. 68.
    Chapman SW, Lin AC, Hendricks KA, et al. Endemic blastomycosis in Mississippi: epidemiological and clinical studies. Semin Respir Infect. 1997;12(3):219–28.PubMedGoogle Scholar
  69. 69.
    Choptiany M, Wiebe L, Limerick B, et al. Risk factors for acquisition of endemic blastomycosis. Can J Infect Dis. 2009;20(4):117–21.Google Scholar
  70. 70.
    Crampton TL, Light RB, Berg GM, et al. Epidemiology and clinical spectrum of blastomycosis diagnosed at Manitoba hospitals. Clin Infect Dis. 2002;34(10):1310–6.PubMedCrossRefGoogle Scholar
  71. 71.
    Chu JH, Feudtner C, Heydon K, Walsh TJ, Zaoutis TE. Hospitalizations for endemic mycoses: a population-based national study. Clin Infect Dis. 2006;42(6):822–5.PubMedCrossRefGoogle Scholar
  72. 72.
    Cano MV, Ponce-de-Leon GF, Tippen S, Lindsley MD, Warwick M, Hajjeh RA. Blastomycosis in Missouri: epidemiology and risk factors for endemic disease. Epidemiol Infect. 2003;131(2):907–14.PubMedCrossRefGoogle Scholar
  73. 73.
    Roy M, Deak E, Benedict K, et al. The lung fungus among us: a large urban outbreak of blastomycosis–Marathon County, Wisconsin, 2010 (oral presentation). In: Abstracts of the 60th Annual Epidemic Intelligence Service Conference. Atlanta, GA, April 11–15, 2011, p. 54.qqGoogle Scholar
  74. 74.
    Sarosi GA, Eckman MR, Davies SF, Laskey WK. Canine blastomycosis as a harbinger of human disease. Ann Intern Med. 1979;91(5):733–5.PubMedGoogle Scholar
  75. 75.
    Brown S. The fungus among us: blasto isolated in the home environment. In: National Environmental Health Association 76th Annual Education Conference & Exhibition. San Diego, CA, 2012.Google Scholar
  76. 76.
    Pappas PG, Threlkeld MG, Bedsole GD, Cleveland KO, Gelfand MS, Dismukes WE. Blastomycosis in immunocompromised patients. Medicine. 1993;72(5):311–25.PubMedCrossRefGoogle Scholar
  77. 77.
    • Grim SA, Proia L, Miller R, et al. A multicenter study of histoplasmosis and blastomycosis after solid organ transplantation. Transpl Infect Dis. 2012;14(1):17–23. Results of a multicenter retrospective review of solid organ transplant recipients demonstrated that although the incidence of posttransplant blastomycosis in the overall study cohort was low (<1 %), the infection was associated with a high mortality rate. PubMedCrossRefGoogle Scholar
  78. 78.
    Pappas PG. Blastomycosis in patients with the acquired immunodeficiency syndrome. Ann Intern Med. 1992;116:847–53.PubMedGoogle Scholar
  79. 79.
    Moraes-Vasconcelos D, Grumach AS, Yamaguti A, et al. Paracoccidioides brasiliensis disseminated disease in a patient with inherited deficiency in the beta1 subunit of the interleukin (IL)-12/IL-23 receptor. Clin Infect Dis. 2005;41(4):e31–7.PubMedCrossRefGoogle Scholar
  80. 80.
    Vinh DC, Schwartz B, Hsu AP, et al. Interleukin-12 receptor beta1 deficiency predisposing to disseminated Coccidioidomycosis. Clin Infect Dis. 2011;52(4):e99–e102.PubMedCrossRefGoogle Scholar
  81. 81.
    Zerbe CS, Holland SM. Disseminated histoplasmosis in persons with interferon-gamma receptor 1 deficiency. Clin Infect Dis. 2005;41(4):e38–41.PubMedCrossRefGoogle Scholar
  82. 82.
    Klein BS, Sondel PM, Jones JM. W1-1, a novel 120-kilodalton surface protein on Blastomyces dermatitidis yeast cells, is a target antigen of cell mediated-immunity in human blastomycosis. Infect Immun. 1992;60(10):4291–300.PubMedGoogle Scholar
  83. 83.
    • Wuthrich M, Krajaejun T, Shearn-Bochsler V, et al. Safety, tolerability, and immunogenicity of a recombinant, genetically engineered, live-attenuated vaccine against canine blastomycosis. Clin Vaccine Immunol. 2011;18(5):783–9. This study demonstrated that a live attenuated vaccine against blastomycosis in dogs is safe, well-tolerated, and immunogenic. These findings underscore the importance of future research on a potential human vaccine against blastomycosis. PubMedCrossRefGoogle Scholar
  84. 84.
    Fisher MC, Henk DA, Briggs CJ, et al. Emerging fungal threats to animal, plant and ecosystem health. Nature. 2012;484(7393):186–94.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Kaitlin Benedict
    • 1
  • Monika Roy
    • 1
  • Tom Chiller
    • 1
  • Jeffrey P. Davis
    • 2
  1. 1.Mycotic Diseases Branch, Centers for Disease Control and PreventionAtlantaUSA
  2. 2.Bureau of Communicable Diseases and Emergency Response, Wisconsin Division of Public HealthMadisonUSA

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