ESCANABA — More than 100 people who worked at or visited the Escanaba paper mill have been infected with blastomycosis, a fungal respiratory infection, according to Public Health Delta and Menominee Counties.

To date, a total of 104 confirmed and probable cases of blastomycosis have been identified. A confirmed case is a person with symptoms of blastomycosis and where the fungus has either been grown by culture or seen by microscope in a test specimen. A probable case is a person with symptoms of blastomycosis and who has a positive antigen or antibody test. PHDM will no longer be reporting the number of confirmed and probable cases separately, as all reported cases have a blastomycosis diagnosis.

Thirteen of the 104 total cases have been hospitalized. All 104 of the cases are either employees, contractors or visitors of the Billerud Paper Mill in Escanaba.

One previously reported death, a contractor who was working at the mill, has been associated with this outbreak.

The company announced April 13 it was shutting down the Escanaba mill for up to three weeks to allow for a deep cleaning and other work to be done at the facility “as a precautionary measure.”

PHDM is continuing to work with Billerud Paper Mill, Michigan Department of Health and Human Services, National Institute for Occupational Safety and Health and Centers for Disease Control and Prevention to investigate the outbreak of blastomycosis.

Blastomycosis is a rare disease associated with a fungus that grows in moist soil and decomposing matter such as wood and leaves. People can get blastomycosis infection by breathing in fungal spores from the air. Blastomycosis does not spread from person to person or between animals and people.

Most people who inhale the fungal spores do not get sick. On average over the past five years, only 26 cases have been reported across Michigan annually. However, the Upper Peninsula is a known risk area for blastomycosis infection.

Those who do get sick can develop symptoms such as cough — sometimes with blood — fever, chest pain, difficulty breathing, night sweats, fatigue, weight loss, muscle aches and joint pain. Those experiencing these symptoms should contact their health care provider and discuss whether testing for blastomycosis is recommended.

Blastomycosis is treatable with antifungal medicines, but it is important to get diagnosed early. Most people with blastomycosis will need treatment with prescription antifungal medication. Depending on the severity of the infection and the person’s immune status, the course of treatment can range from six months to one year.

In addition to the PHDM website, https://phdm.org, two additional websites have been launched to assist those who may be affected by the outbreak. NIOSH has established a site at https://www.cdc.gov/niosh/newsroom/alerts/blastomycosishhe.html and Billerud has established a site at https://escanabamillinfo.com.