DEADLY FUNGUS IN BOOTHEEL RAISES QUERIES

CHARLESTON -- Researchers from the Missouri Department of Health and national Center for Disease Control will survey Southeast Missouri residents next week in an effort to find the source of a fungal infection that has claimed five lives in recent years.

Sue Tippen, communicable disease coordinator for the Department of health's southeast district, said residents in Cape Girardeau, Scott, Mississippi, New Madrid, Pemiscot, Butler, Stoddard and Dunklin counties will be randomly selected to participate in a blastomycosis study. Most will be asked to complete a lengthy questionnaire, although some blood testing also will be done in conjunction with a genetic study being led by the National Institute on Health.

"We're calling family members of people who have been diagnosed and also randomly elected community members," said Tippen. "We're trying to create awareness so people will know to see a physician for early diagnosis and treatment, and also so they'll let medical communities know we do have this illness."

Blastomycosis is an environmental disease caused when airborne spores from contaminated wooded sites are inhaled. The disease is endemic along the Ohio and Mississippi River valleys and into southeastern states.

Underlying ailments, like diabetes, cancer or other diseases that affect the immune system, can cause an affected person to have a more serious reaction to the disease than might otherwise occur.

Tippen said she hopes there will be good participation in the study to help determine "the difference between those who got the disease and those who didn't."

Typically, only one to two cases per 100,000 population occur in contaminated soil, with only 5 percent of those cases resulting in death. At least five cases of blastomycosis have resulted in death since 1992 in Southeast Missouri. Of those, four were Mississippi County residents and one lived in Scott County.

Tippen said she was unsure how many cases have actually been reported in the region.

"It's nonreportable by law, so we're trying to determine exactly how many people may have had the disease," she said. "We still have some reviewing to do."

The state health department became aware of a blastomycosis outbreak in the region after receiving a letter from administrators at Missouri Delta Hospital, where there have been multiple diagnoses of the disease.

"There was a concern about the number of cases, but it's one of those things where it's environmental so you don't really know what to do," Tippen said.

Latoya Robinson is very familiar with the disease because her older brother, Ronnie, died from it in March 1996. Ronnie Robinson, a Mississippi County resident, had worked for the Regional Planning Commission as a housing inspector after the 1995 floods. He became ill in the fall of that year, showing flu-like symptoms. He was treated for bronchitis and flu, but after continued weight loss, fever and cough, he was diagnosed with pneumonia and hospitalized.

"It was so bad to the point he had to sit up at night if he wanted to sleep," said Latoya Robinson. "It was really hard watching him be so sick and nothing they were doing was helping."

While he was hospitalized, Ronnie Robinson broke out in boils all over his body. An infection specialist was called, who determined blastomycosis was the cause of Robinson's illness.

"We felt so blessed when he started testing him for all sorts of stuff," his sister said. "He got on the medicine and started gaining weight, and the pneumonia cleared up. He was better."

Robinson appeared to be cured from the disease for about six months, but in January 1996, he began complaining of painful headaches and began losing weight. He was treated for minor illnesses and later hospitalized. A CAT-scan revealed an apparent brain tumor, and surgery was scheduled.

Doctors later determined what appeared to be a tumor was actually another boil. Within three days of the surgery, Ronnie Robinson died.

Latoya Robinson said her family wasn't sure whether the blastomycosis had returned or if it had never left.

"We didn't know anything about it," she said. "You don't know what this disease is caused by, you don't know what it does."

Robinson's family lives in Pinhook, a farming community. Even after her brother was diagnosed, the family had not considered doing anything different.

We've lived on a farm all our life, so we didn't even consider making any type of change," she said.

Tippen said the uncertainty about the disease has caused some concern for area residents. Because it is under investigation, health officials are trying to create an awareness and encourage people to see a physician for early diagnosis and treatment, she said.

"There's just no way of knowing that you're walking in an area where there might be blastomycosis," she said. "You can't tell people to stay inside and stay out of the dirt, that would be useless."

ABOUT BLASTOMYCOSIS

WHAT IS IT?

Blastomycosis is a fungal infection most often resulting in an isolated pulmonary disease. The infection can usually resolve itself. However, there are certain factors than can make this infection a more sever form requiring antifungal therapy.

SYMPTOMS

* Isolated skin lesions

* Lesions of bone, central nervous system and organs

* Lesions in the genito-urinary system in males

INCIDENCE

* 1 to 2 cases per 100,000 population in contaminated areas

* Death can occur in about 5% of cases reported

TRANSMISSION

Inhaling airborne spores after disturbance of contaminated soil. Soil primarily in wooded areas and along waterways, specifically the Ohio and Mississippi river valleys and southeastern states.

RISK GROUPS

Persons with exposure to contaminated wooded sites including farmers, foresters, hunters and campers.

PREVENTION

Do not go into areas fitting the above descriptions. Exposure occurs when a person inhales the fungus. There is no way to avoid that.