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Posted on 01-29-2008
Doctors don't know everything about rare, evasive 'blasto'
Letter to the Editor:
I would like to comment on a previous letter to the editor from
Teena Bennett dated Jan. 8, 2008. I feel as I must preface my
response with a little background.
My name is Ken Sullivan. I am a physician residing in Eagle
River, but currently practicing emergency medicine at Good
Samaritan Hospital in Merrill.
Blasto is a soil-borne organism that produces spores that become
aerosolized when soil is disturbed. The soil is typically moist
such as being found around rivers and/or lakes. Northern
Wisconsin (i.e., Eagle River and Merrill) has long been a “hot
spot,” however. Blasto prevails through much of the Mississippi
and Ohio River valley basins. Other parts of the country have
their own “versions” such as histoplasmosis and coccidiomycosis.
Cases have been reported as far away as Africa.
Blastomycosis is a fungus that can affect any and all organ
systems. The lungs are probably the most commonly affected
organs since they are typically the point of entry into the
body. One difficulty we (the medical community) face is that
blasto looks like any other pneumonia on chest X-rays. It is
pneumonia, but there are three main types: 1) viral, for
example, influenza, 2) bacterial, such as pneumococcus, and 3)
fungal — blasto!
It sometimes may also mimic cancer or even autoimmune syndromes
such as sarcoidosis. Antibiotics are effective against bacterial
pneumonia, but not viral or fungal. Viral pneumonias usually
resolve with supportive care: oxygen and nebulizer (aerosol)
treatments.
Fungal infections require antifungal medications, which are not
without potential complications or side effects. People with a
history of diabetes, chronic lung disease or any immune system
problem are at an especially high risk for complications,
including death.
Unfortunately, making the diagnosis is not always easy. Not
everyone coughs up sputum (phlegm) and, even if they do, it may
not readily demonstrate the fungal elements. A culture (attempt
to grow in an incubator) of the sputum is almost always
performed, but the organism is hard to grow and may not reveal a
positive result for as much as three weeks.
There is always the possibility of a bronchoscopy (putting a
scope through your mouth into the lungs to obtain a specimen) or
even a lung biopsy (cutting out a piece of lung tissue through
an incision in the chest). However, these tests are not without
risk and, even with these invasive tests, the organism can still
be very evasive. Waiting three weeks for the culture results may
not be a viable option either when the patient is getting worse.
Blasto also can affect any other tissue in your body: skin,
bones, heart, lung, brain, urinary tract, gastrointestinal
tract. Symptoms vary greatly, but may present with chronic
intermittent low-grade fever, persistent cough, nonhealing skin
lesion/abscess, or just bone pain. In the realm of pneumonia,
viral and bacterial infections are still much more common than
fungal infections.
I, too, have seen numerous patients with blasto here in Merrill
and previously in Eagle River, both current and past infections.
Even with treatment, some have succumbed as Emmett Klessig did,
but some have recovered without any treatment at all. One of the
difficulties faced by the medical community is who will do well
and who won’t. As we see in Emmett’s case, young and otherwise
healthy people are not exempt from possible complications. I was
not involved in Emmett’s care and don’t pretend to know any
specifics with regard to his case.
Common things being common, most pneumonias are viral or
bacterial and, in the scope of things, blasto is still rare!
Other pneumonias are still responsible for more deaths than
fungal infections by far. Historically, influenzae has been one
of the largest killers due to pneumonia, accounting for millions
of deaths worldwide, young and old alike.
This is why we strongly encourage flu vaccines on a yearly
basis. Most practitioners in the North Country always have
blasto in the back of their minds because of the potential for
bad outcomes, but the diagnosis is not always easy to come by.
My best advice is simple: 1) take your medications as prescribed
by your doctor, 2) keep your doctor informed if you are not
getting better and especially if you are getting worse, 3) make
sure you discuss your concerns with your doctor and have your
questions answered, and 4) remember, no one is “too healthy” to
get that sick.
I, too, am saddened by the recent loss of a young man’s life.
Sixteen-year-old Emmett Klessig recently died from complications
from blastomycosis pneumonia. Unfortunately, as large as our
fund of medical knowledge has become, I will be the first to
admit, we don’t know everything. Whether you believe it is God’s
will, fate or the “luck of the draw,” please keep Emmett’s
family in mind and offer them all of the support you can.
Respectfully,
Ken Sullivan, M.D.
Eagle River
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