The dirt on blastomycosis

wet leaves

Five years ago, Kendall Idle’s life turned upside down when he was on his way to work. He suddenly passed out and rolled his car into an empty field.

Idle broke his back, a severe injury which he eventually recovered from. But while he was trapped in his car until help arrived, Idle inhaled some fungal spores which were present in the field. “As I was recovering from my broken back, they just took root in my lungs,” he says. “Right around the time my back was healing up, my lungs started acting up.”

It turns out that Idle developed a serious case of blastomycosis, a disease caused by the fungus, Blastomyces dermatitidis, that lives in the environment, and grows in moist soil and decomposing matter like wood or leaves. Blastomycosis is mostly found in the Midwest and the South, especially around the Ohio and Mississippi Rivers and the Great Lakes. It’s most likely to occur during the fall and early winter months.

A blastomycosis infection settles in the lungs and later spreads to other parts of the body. “You can get it from inhaling the spores of the fungus. It is not spread from person to person. So, if someone has blastomycosis you will not catch it from another person,” says Nicole Pirlot, an infection preventionist with OSF HealthCare. 

Idle’s symptoms started a few months after his car accident. He had trouble sleeping, waking up to a nagging cough and mucus. “That's when I started feeling like I had chest pain. It was getting harder to breathe,” he explains. “I went to a PromptCare and they told me they thought it was a common cold or something like that, and just keep an eye on it. And if it didn't get better to go see my primary care, and of course, it didn’t get better.”

Outbreaks of blastomycosis are rare. But in 2023, health officials in Escanaba, Michigan, saw more than 120 cases of the fungal infection that was linked to a paper mill in town. More than a dozen people were hospitalized, and one death was reported.

Although most people who breathe in the spores don’t get sick, some people will develop symptoms like fever and cough, and the infection can sometimes become serious if not treated. Pirlot says signs and symptoms normally are vague and are often treated first as a respiratory illness or pneumonia before being diagnosed as blastomycosis. Pirlot adds that about 50% of cases are asymptomatic. And of those cases, most of those will resolve without treatment.

“The signs and symptoms are typical respiratory illness, fevers, cough that is dry. As the disease progresses, it will show cavitary lesions on a chest X ray or a CT exam,” she says. “And then you can also get chest pain with your cough. It can spread into other organs or cause skin lesions.”

Symptoms usually appear between three weeks and three months after a person breathes in the fungal spores.

“Individuals who are immunocompromised or have underlying illness, such as diabetes, tend to get severely sicker, and those people may end up needing hospitalization,” Pirlot says. (2:35-2:48) And that’s likely what happened to Kendall Idle during his car accident. Doctors believe his sugar level spiked, causing him to pass out. He was later diagnosed with diabetes.

Most people who have symptoms from blastomycosis are treated with prescription antifungal medication. Depending on the severity of the infection and the patient’s immune system, treatment can last from six months to a year.

Idle had a battery of tests done and was hospitalized for a few days. He says it took nearly a year of antifungal medication for him to recover. Fortunately, he didn’t need surgery to repair his back – he wore a brace that helped the compression fractures heal on their own.

But five years later, he still has some lingering effects from his bout with blastomycosis. “I’ll have some scarring on my lungs for the rest of my life,” he says. “When I do any kind of heavy activity or exercise, I get short of breath quicker than I used to, for sure.”

While contracting blastomycosis is rare, Pirlot says it’s important to know your surroundings.

“When you're camping around areas of water, where there is the wet soil with decomposing leaves and wood, those are the areas that it frequents,” she says. “So, if you're digging or doing outdoor activities, those are your higher risk areas. It's just about being aware.”