A Multistate Outbreak of Sporotrichosis associated with Sphagnum Moss

Abstract

In the spring of 1988, the largest documented US outbreak of cutaneous sporotrichosis to date occurred, with 84 cases among persons from 15 states who were exposed to Wisconsin-grown sphagnum moss used in packing evergreen tree seedlings. In New York State, 13 cases occurred among 109 forestry workers. All 13 cases occurred among 76 workers who had handled evergreen seedlings and moss (attack rate = 17%). For those exposed to evergreens and moss, the risk of infection increased as worktime exposure to moss increased (attack rates: less than 10 hours, 8%; 10-19 hours, 12%; greater than 19 hours, 33%). While environmental samples of moss from the Wisconsin supplier were negative, Sporothrix schenckii was cultured from multiple samples of the sphagnum moss obtained from one of six Pennsylvania tree nurseries, representing the nursery that was identified as the source for 79 (94%) of the moss-associated cases. Differences in tree-handling procedures at this nursery--including the use of 1- to 3-year-old moss to pack seedlings, use of a pond water source to wet the moss, use of an organic polymer gel on the seedling root system, and underground storage and longer storage of moss-packed seedlings before shipping--suggested possible explanations for the association. Efforts to prevent sporotrichosis among persons handling evergreen seedlings should include the use of alternate types of packing material (e.g., cedar wood chips or shredded paper) and protective clothing such as gloves and long-sleeved shirts.

Occupation, Lifestyle, Diet, and Invasive Fungal Infections

“…In the developed world, factors such as immigration, increasing numbers of tourists in the tropics, and increasing participation in outdoor activities during leisure time, have Table 1 Occupations associated with invasive fungal infections acquired after inhalational exposure. moved these fungal infections from the area of medical curiosity to clinical practice [27][28][29][30][31][32][33][34][35][36][37][38][39][40][41]. Table 2 provides an overview of the main subcutaneous mycoses and the associated activities/occupations.…”

Population‐Based Surveillance and a Case‐Control Study of Risk Factors for Endemic Lymphocutaneous Sporotrichosis in Peru

“…In addition, the authors noted that the majority of patients did not adhere to prescribed medical regimens, principally because of cost [11]. Despite the low rate of mortality associated with LS, morbidity and absence from work can be substantial [4]; thus, in regions where costs of treatment can be prohibitive, it is important to identify risk factors that may prevent LS. To describe the overall burden of disease in this area and to identify activities and potentially modifiable risk factors associated with sporadic LS, we conducted population-based surveillance and a case-control study in this area of hyperendemicity and assisted in implementation of a government-sponsored treatment program.…”

Hypersensitivity Pneumonitis in Peat Moss Processing Plant Workers

“…Cutaneous sporotricosis is the most frequently reported disease associated with the handling of peat products (8), but other organs can also be infected (9). Considering that Penicillium molds are known to be responsible for some cases of HP (1), the lack of prior description of this disease in workers exposed to this material is surprising.…”