Study suggests more aggressive treatments, monitoring for fungal infections in certain populations

A new study from Marshfield Clinic suggests people with certain racial and ethnic backgrounds require more aggressive treatments and monitoring for fungal infections. 

Jennifer Meece, director of the Integrated Research and Development Laboratory at the Marshfield Clinic Research Institute, explains most prior studies of certain fungal infections have been restricted to non-Hispanic white patients. She says that fails to capture the different ways people of varying backgrounds experience these infections. 

“We know patients of other ethnic and racial backgrounds, including Hispanic, Native American/Alaska natives and Asian, may be more likely to have infections isolated to the lung and may have more severe illness requiring hospitalization,” Meece said. “Providers need to be aware of this so they can better treat these patients.” 

Study authors focused on blastomycosis, a lung infection caused by inhaling spores from the fungus, which is found in Wisconsin. It’s located in wet soil and places where biological matter like wood and leaves is breaking down. 

Individuals exposed to forestry work, as well as hunting or camping, are at higher risk of breathing in the spores. Exposure and disease due to outdoor activities often occurs in late fall and early winter. 

Researchers identified blastomycosis patients through Marshfield Clinic Health System and collected data from electronic health records. After analyzing 477 patients, they found significant age differences between infected groups. Non-Hispanic whites were oldest, with a median age of 48 years, while Asians were youngest, at 26 years. 

They also found odds of hospitalization were up to three times higher for Hispanic whites — referring to people from various Spanish cultures who self-identify as white — than they were for non-Hispanic white patients. Similar ratios were observed when comparing non-Hispanic whites to Asians, and to American Indian or Alaska Natives. 

Also, more than half of African Americans and non-Hispanic whites with blastomycosis had underlying medical conditions, compared to less than a third of Hispanic whites and Asians. 

Ultimately, the scientists concluded that Hispanic whites, American Indian or Alaska Natives, and Asian patients with blastomycosis were younger and healthier overall, but were more frequently hospitalized. 

“This information will help providers recognize blastomycosis earlier in patients to guide care and improve clinical outcomes,” said Jennifer Anderson, one of the study’s primary investigators. 

Most patients involved in the study were diagnosed with the fungal infection about a month before their symptoms began and were hospitalized. Nearly 90 percent of the patients were treated with itraconazole, an antifungal medication. Thirty-one cases resulted in the patient dying. 

Study authors note that blastomycosis poses “a significant public health threat,” and has led to numerous outbreaks in Wisconsin. 

Previous studies have found higher rates of blastomycosis in aboriginal populations in Canada, as well as in American Indians and Asians, as compared to whites. And they’ve shown related infections, disease and mortality are higher in African American patients as well. 

Still, the study notes that strain virulence, host immune factors, level of exposure and other variables likely play a role in outcomes for diverse patients with blastomycosis. Plus, the likelihood of developing fungal infections has previously been linked to changes in certain immune response genes. 

“We continue to research blastomycosis and its effects on different populations,” Meece said. “We look to expand the research outside of Wisconsin and engage collaborators in other highly endemic areas.” 

See the full study: