Do you know about a small enemy in the environment? Let's talk about Blastomycosis!

We all love spending time outdoors, in nature, don't we? But sometimes, without us knowing, we can be bothered by the little creatures around us. Blastomycosis is a disease caused by a tiny, invisible fungus called Blastomyces that enters the body through breathing. It starts like a cold and can sometimes spread from the lungs to other parts of the body. So, let's talk about this in a little more detail today, because awareness is the best defense.

What is Blastomycosis? Simply put...

Simply put, Blastomycosis is an infection caused by a fungus called Blastomyces . This fungus lives mostly in moist soil and rotting wood , especially in areas near water. Unlike the large mushrooms we see, this is a fungus that is too small to be seen with the naked eye. When you dig in the soil or stir up dust in such an area, the spores of this fungus can enter the air and be inhaled. In the past, it was also called Gilchrist disease or Chicago disease.

What are the symptoms of this disease?

Blastomycosis symptoms can vary slightly from person to person. And, surprisingly, not everyone who is infected with this fungus will develop symptoms. Some studies suggest that up to half of those infected do not show any symptoms at all . However, if symptoms do occur, they can typically include:

• Fever .
• Feeling like you're going cold (Chills).
• Feeling tired and exhausted all the time.
• Coughing . Sometimes the cough can last for a long time.
• Difficulty breathing (dyspnea) or a feeling of chest tightness.
• Body aches, muscle aches .
• Some people may cough up blood .
• Night sweats .
• Skin sores, ulcers, bumps or blisters may also occur. Let's look at these in more detail.

What does Blastomyces dermatitidis look like on the skin?

Blastomycosis can sometimes spread outside the lungs, especially to the skin. That's why we call it Blastomyces dermatitidis . When it occurs on the skin like this, it can look different.

• Like big bumps .
• Like warts .
• Like sores .
• Sometimes these can be large, open wounds , or they can be closed clusters of bumps .
• Often these become scabbed or crusted over and begin to peel off.

If you have a skin problem like this, especially if it is accompanied by symptoms like fever and cough, it is very important to see a doctor.

Why do we get Blastomycosis? What are the causes?

The main cause of this disease is several types of fungi called Blastomyces . Among them, Blastomyces dermatitidis (B. dermatitidis) is the type that causes us the most diseases.

So, where is this fungus most prevalent?

Blastomyces is a fungus that thrives in aquatic environments . It thrives in moist soil and decaying wood, especially in areas such as riverbanks and lake bottoms. It has been reported from many parts of the world, but is most common in certain parts of North America . Specifically:

• It is most common in the Midwestern US states , especially in Wisconsin and Minnesota.
• In the South Central and Southeast US states .
• Southeastern Canada : In areas like Ontario, Quebec, Manitoba, and Saskatchewan.
• In addition, patients have also been reported from the northeastern regions of the United States (US Northeast).

Although this is not very common in Sri Lanka, it is very important to be aware if you travel to such areas or work in such environmental conditions.

How does this disease spread to us?

Blastomycosis is caused by breathing in spores of the fungus Blastomyces, which are airborne from damp soil or decaying wood. These spores start growing in your lungs. Sometimes, they can spread to other parts of your body through your blood .

There have been reports of large amounts of soil being stirred up during large construction projects or excavations, resulting in many people becoming infected at once.

The most important thing is that blastomycosis is not contagious. This means that you cannot catch it by talking to, shaking hands with, or being around someone who has the disease.

Who is at higher risk of developing this disease?

Anyone who lives in or travels to areas where Blastomyces is prevalent is at risk of developing the disease. However, there are some people who are at a slightly higher risk. Let's take a look at who they are:

• If your job or hobby involves moving soil or working near rivers or lakes :
• People working in the construction field.
• People who go hunting.
• Fishing.
• People going camping.
• Mountain climbers (Hiking).
• Very rarely, there have been cases where veterinarians have contracted the disease from a contaminated needle while treating an infected animal.

Also, some people are at higher risk of developing complications or worsening of the disease if they develop this disease. These are:

• People with a weakened immune system . For example, people with HIV or those taking immunosuppressive medications are at higher risk.
• People with chronic lung diseases such as COPD (Chronic Obstructive Pulmonary Disease) .
• People over 50 years old .

What are the complications that can occur due to this disease?

Two of the main complications of blastomycosis are acute respiratory distress syndrome (ARDS) and the spread of the fungus to other parts of the body. Starting in the lungs, the fungus can travel through the bloodstream and affect organs such as:

• Skin : As we mentioned before, skin lesions and bumps can occur.
• Bones : Infection can spread to the bones, causing pain and swelling.
• Central nervous system : This means that if it spreads to important areas like the brain and spinal cord, it can be very dangerous.

How do doctors diagnose this disease? (Diagnosis)

If you suspect you have blastomycosis, a doctor will ask you about your symptoms and examine you. Then, they may do tests like these to confirm the diagnosis:

• A sample of your blood , urine , or sputum (phlegm from the lungs) may be taken.
• If you have skin lesions, a small piece of tissue (biopsy) can be taken from the lesion and sent for testing.

These samples are sent to a lab and tested for the following:

• Attempting to culture the Blastomyces fungus : This is the best way to confirm the disease. However, this can take several weeks, so your doctor may start treatment before then.
• Testing for the presence of Blastomyces yeast : PCR (Polymerase Chain Reaction) technology can be used to detect the presence of DNA from this fungus in a tissue sample or body fluid.
• You can also test your body for antibodies or antigens against the Blastomyces fungus .

Additionally, you may also have a chest X-ray or a CT scan (Computed Tomography scans) to check the condition of your lungs.

How do you suspect you have blastomycosis?

The symptoms of blastomycosis can be very similar to those of other diseases, such as pneumonia . So it can sometimes be difficult to recognize it. However, be careful if you experience any of the following:

• If you have symptoms such as fever, cough, and difficulty breathing, and are not getting better despite taking antibiotics , or if your illness seems to be getting worse.
• If you live in an area where Blastomyces fungus is common, or have recently traveled to such an area .
• If your job or hobby involves a dusty, dusty environment .

If there is something like this, it is very important to see a doctor and tell them these details.

What is the treatment for this?

Doctors treat blastomycosis with antifungal treatments . The two main drugs used are amphotericin B (amB) and itraconazole . In some severe cases, corticosteroids may also be given to reduce inflammation in the body.

What happens after treatment? How long does it take to recover?

The important thing is that Blastomycosis is not a self-limiting disease . You will need to take antifungal medication. This is usually for a few weeks. However, in some cases, treatment may be required for a year or more . These include:

• If you have a serious illness .
• If the fungus has spread beyond the lungs to other parts of the body .
• If you have chronic lung disease .
• If your immune system is compromised .

Therefore, it is very important to follow the doctor's instructions exactly and take the medication on time.

What is the survival rate of this disease?

The good news is that most people who develop blastomycosis have a greater than 90% chance of recovery . However, as mentioned earlier, people with chronic lung disease and those with weakened immune systems are at risk of developing severe, life-threatening disease. Therefore, it is important to diagnose the disease early and begin treatment.

When should I see a doctor?

If you have any of these symptoms, definitely see a doctor:

• If symptoms of a cold or flu, such as fever, cough, and difficulty breathing, do not improve after a week , or if the illness seems to be getting worse over time .
• If you think you may have been exposed to the fungus that causes blastomycosis through your work or hobbies , or if you have traveled to an area where the fungus is common , tell your doctor .

When should I go to an Emergency Treatment Unit (ETU) ?

Sometimes the symptoms can be severe. If this happens, you should go to an emergency room immediately. Such severe symptoms include:

• Very high fever (over 103 Fahrenheit/40 Celsius).
• Severe or sudden difficulty breathing .
• Chest pain .
• Coughing up blood .
• Confusion or other mental changes .
• Symptoms of epilepsy (Seizures) .
• Blue discoloration of the skin, lips, or fingernails (cyanosis) .

If you see something like this, don't delay, go to a hospital immediately.

What questions should I ask my doctor?

When you go to see a doctor, it may be helpful to ask questions like these:

• Am I at increased risk of developing severe blastomycosis?
• Are there any specific precautions I can take to reduce my risk of blastomycosis?
• How should I use my medications ?
• What severe symptoms should I be concerned about ?

Ask questions like these and clear your doubts.

How do we protect ourselves from Blastomycosis? (Prevention)

If you live in an area where Blastomyces is common, it may be difficult to completely avoid breathing in this fungus. However, there are a few things you can do to reduce your risk:

• Avoid stirring up large amounts of soil and dust, especially in areas near water .
• If your job or hobby exposes you to soil that may contain Blastomyces, wear an N95 (or KN95) type respirator mask . This will help filter the air you breathe and reduce the entry of fungal spores.

Can Blastomyces fungus be found indoors?

In general, the chances of having Blastomyces fungus inside your home are very low. Unless you have soil on your clothes outside, you're at risk. Because this fungus thrives on decaying wood and damp soil, it won't survive after you wash your clothes.

Finally, things to remember

There's nothing like a breath of fresh air outside, right? But, like us, other creatures love the outdoors. That means fungi like Blastomyces can sometimes grow in places they don't belong, like our lungs.

The best part is that Blastomycosis is a treatable disease . However, a doctor should be able to diagnose it and run the appropriate tests. So, if you have been in an area where Blastomyces is likely to be present and have symptoms like a fever and chills for more than a week, be sure to tell your doctor. Starting treatment early can help stop the fungus from spreading and prevent the disease from getting worse. So, be careful, be aware!

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