Exploring the environmental drivers of human blastomycosis cases in the Midwestern United States

Abstract

Blastomycosis is a fungal infection endemic to the eastern United States (US) and Canada caused by the inhalation of the fungi Blastomyces spp. Currently, the environmental drivers of disease dynamics are poorly understood. The goal of our work was to explore what environmental conditions are associated with the annual presence of blastomycosis cases, and therefore are potentially explanatory of the ecological niche of Blastomyces. We examined the relationships between reported cases of blastomycosis in three Midwestern US states (Michigan, Minnesota, and Wisconsin) from 2007–2017 in relation to eleven hypothesized environmental conditions, including climate, stream and soil mineral content, and land cover variables. Then, we fit logistic regression models to explore the relationships between the environmental variables and yearly blastomycosis case occurrence. Mean soil moisture, stream sediment mercury content, percent of water within the county, and woody wetlands land cover were all positively associated with the presence of annual cases, with woody wetlands having the most consistent signal across the three states. We also found significant differences in the likelihood of case presence between US states that were not explained by the variables in our model, suggesting state-level differences in case reporting and disease awareness. Our results provide a perspective on potential biological hypotheses to further test regarding environmental controls on the life cycle and ecological niche of Blastomyces.