Blastomycosis: Island physicians reconsider blasto after patient’s death

Distribution of blastomycosis in North America.

EDITOR’S NOTE: While blastomycosis is not a new health hazard on Manitoulin Island, it is rare enough here that its symptoms are not easily recognized by the general population. This health feature series, prompted by a recent tragic fatality linked to the condition, will examine aspects of the disease, how best to avoid contracting blastomycosis and some of the possible symptoms people can exhibit. It will talk to the medical and scientific community, survivors of the disease and the family of the individual fatally infected with blastomycosis.

MANITOULIN—This newspaper’s ongoing series on the fungal infection blastomycosis (most often contracted by breathing in fungal spores) has had many readers question the protocols at the two-site Manitoulin Health Centre (MHC) for those exhibiting signs of the hard-to-detect disease. In this fourth part of the series, MHC Chief of Staff Dr. Stephen Cooper explains the process of a physician’s diagnosis, including for blastomycosis.

There are two ways a physician will develop a path to diagnosis that he or she will begin to follow when a patient comes in exhibiting certain symptoms. In the case of blastomycosis, this is typically a cough, the doctor explains. Firstly, doctors will use an algorithm, or decision-making tree, which charts various ailments leading from that symptom or set of symptoms. In the case of a cough, blastomycosis would be near the bottom of this tree. Secondly, the patient or doctor could have ‘a hunch’ as to what the problem might be and start diagnostics from there.

“If this was a second or third visit with a cough, the patient or doctor may say ‘this could be blasto’,” and the decision making tree would again be consulted, Dr. Cooper explained. “With both these methods, we realize there’s a margin of error—there could be a one to two percent chance that a diagnosis could be mixed.”

Physicians also have to be careful in that they do not become a burden on the health care system by ordering tests for everything. There are some physicians that will have ‘a hunch,’ order a test, “and low and behold they’re right,” but this isn’t always the case.

“If that’s done a lot it can use a lot of resources and sometimes strike a lot of fear,” Dr. Cooper continued, giving the example of a patient with back problems who undergoes an MRI diagnostic test (at a cost of $2,000) which uncovers a previously undiagnosed problem and now the patient has to go for surgery. “We need to make sure we’re doing the right test at the right time.”

The chief of staff said he realized the public was looking for answers from their health care providers on diagnosing blasto, especially in light of the tragic death of Sheguiandah’s Gwen Young, the story of her eight-month battle with what turned out to be blastomycosis and her ultimate death from the disease told in the pages of last week’s Expositor.

Dr. Cooper explained that two weeks ago, the doctors of the Little Current site met on their bi-weekly rounds to discuss Ms. Young’s case and review their practices surrounding blasto.

“Blasto is the great pretender, as has been highlighted in previous (Expositor) articles,” Dr. Cooper said, referencing the fact that its symptoms are often mistaken for pneumonia or even lung cancer. (The symptoms of blastomycosis are varied and wide and include a persistent cough, muscle aches, joint pain, tiredness, chills, low-grade fever, skin sores or unexplained weight loss.) He agreed that there is now a heightened awareness of the disease and that the public is asking that, when someone comes into the MHC with blasto-like symptoms, to place it higher on their list of potential illnesses and that physicians have had these discussions in recent weeks. Dr. Cooper said it would also become important for locum doctors who come to Manitoulin to be made aware of the possibility of blastomycosis in patients.

“The problem now becomes, ‘how do we keep this fresh in people’s minds,’ and I don’t know the answer to that,” he admitted.

Lyme disease is another illness endemic to Manitoulin Island, also with non-specific symptoms, that locals have become good at self-diagnosing, or at least making the suggestion of Lyme disease to their physician “and the college (of Physicians and Surgeons) has a clear guideline of how to investigate these things, again as a matter of resources.”

At the most recent meeting of the Medical Advisory Committee, Ms. Young’s case and the topic of blastomycosis was brought up and it was suggested that the disease would be a good teaching tool for Northern Ontario School of Medicine residents who are on Manitoulin. An expert on the disease would be brought in for discussion with the session open to all health care providers on Manitoulin, Dr. Cooper explained.