Fungal Diseases

Outbreaks

Disease detectives collecting soil samples to test for fungus

When fungal disease outbreaks occur, CDC’s Mycotic Diseases Branch works with federal, state, and local and territorial public health officials and other partners to reduce illness and deaths and to learn how to prevent future outbreaks.

Fungal outbreaks have been linked to a variety of sources, including exposure to disease-causing fungi in the natural environment or injections with contaminated medication. With systems in place for early identification for these types of events, CDC and partners can continue to track, test for, respond to, and better understand emerging fungal health threats.

Some fungal diseases may be more common than previously realized, and rare but newly-emerging fungi are becoming increasingly problematic. Some types of fungal infections can be deadly if they are not identified and treated quickly, so early recognition is essential in order to reduce the risk of serious complications and save lives.

Recent Fungal Outbreaks

Histoplasmosis in an Illinois Prison

Histoplasmosis outbreak at a state prison in Illinois, August – September 2013

This investigation is ongoing; information below may be subject to change.

Number of cases: 78
Pathogen: Histoplasma capsulatum
Type of infection: pulmonary
Setting: adult prison in east-central Illinois
Source: likely related to disruption of soil contaminated with bird droppings
Outbreak investigation partners: Illinois Department of Public Health and Illinois Department of Corrections

Coccidioidomycosis (Valley fever) in California Prisons

High rates of coccidioidomycosis (Valley fever) at two state prisons in California's Central Valley, June 2013

This investigation is ongoing; information below may be subject to change.

Pathogen(s): Coccidioides
Type of infection: mostly pulmonary
Setting: Two prisons in California’s Central Valley
Source: Natural environment
Outbreak investigation partners: California Department of Public Health, California Correctional Healthcare Services, and California Department of Corrections and Rehabilitation
Resources and publications

Valley Fever: Diagnosis and Treatment

Photo: Dr. Benjamin Park - Valley Fever: Diagnosis and Treatment - Medscape

July 24, 2013

CDC expert Dr. Benjamin Park talks to clinicians about diagnosis and treatment of valley fever, a respiratory infection caused by inhaling the airborne spores of the fungus Coccidioides.

More Information about Valley Fever
Valley Fever Fact Sheet [PDF - 2 pages]

Fungal meningitis after contaminated steroid injections

Multistate outbreak of fungal meningitis and other fungal infections associated with contaminated steroid injections, October 2012

This investigation is ongoing. For more details about this investigation, please see the Multistate Fungal Meningitis Outbreak Investigation page.

Number of cases: 751
Pathogen(s): Exserohilum rostratum and others
Type of infection: Meningitis, localized spinal or paraspinal infections, and infections in a peripheral joint space, such as a knee, shoulder, or ankle
Setting: Outpatient clinics in 20 states
Source: Contaminated steroid injections from a compounding pharmacy
Outbreak investigation partners: State and local health departments and the U.S. Food and Drug Administration
Selected publications
- Bell BP, Khabbaz RF. Responding to the Outbreak of Invasive Fungal Infections: The Value of Public Health to Americans. JAMA. 2013;():1-2. doi:10.1001/jama.2013.526.
- Smith RM, Schaefer MK, Kainer, MA, et al. Fungal infections associated with contaminated methylprednisolone injections – Preliminary Report. New Engl J Med 2012 Dec.
- Kainer MA, Reagan DR, Nguyen DB, et al. Fungal infections associated with contaminated methylprednisolone in Tennessee. New Engl J Med 2012 Nov.
- Lyons JL, Gireesh ED, Trivedi JB, et al. Fatal Exserohilum meningitis and central nervous system vasculitis after cervical epidural methylprednisolone injection. Ann Intern Med 2012 Oct.
- Pettit AC, Kropski JA, Castilho JL, et al. The index case for the fungal meningitis outbreak in the United States. New Engl J Med 2012 Oct.

Fungal Infection Outbreak: What Should Physicians Be Doing?

October 31, 2012

CDC expert Dr. Tom Chiller provides clinical guidance related to the multistate fungal meningitis outbreak among patients who received contaminated steroid injections.

More Information about the Fungal Meningitis Outbreak

Fungal endophthalmitis after contaminated injections

Multistate outbreak of postprocedural fungal endophthalmitis associated with products from a single compounding pharmacy, March 2012

Number of cases: 43
Pathogen(s): Fusarium incarnatum-equiseti species complex (a colorless mold) and Bipolaris (a black mold)
Type of infection: Endophthalmitis (an infection in the interior of the eye)
Setting: Outpatient facilities in 9 states
Source: Contaminated triamcinolone and Brilliant Blue-G dye from a compounding pharmacy
Outbreak investigation partners: State and local health departments and the U.S. Food and Drug Administration
Resources and publications
- CDC. Notes from the Field: Multistate Outbreak of Postprocedural Fungal Endophthalmitis Associated with a Single Compounding Pharmacy—United States, March–April 2012. MMWR 2012;61:310.
- Mikosz CA, Smith RM, Kim M, Tyson C, Lee EH, Adams E, et al. Fungal endophthalmitis associated with compounded products. Emerg Infect Dis 2014; 20:248-256.

Fungal Endophthalmitis: Diagnosis and Treatment

November 12, 2012

CDC expert Dr. Rachel Smith discusses diagnosis and treatment of fungal endophthalmitis, an inflammation in the intraocular cavities of the eye.

Mucormycosis after a natural disaster

Outbreak of mucormycosis after the Joplin, Missouri tornado, May 2011

Number of cases: 13
Pathogen(s): Apophysomyces trapeziformis
Type of infection: Soft-tissue
Setting: Joplin, Missouri
Source: Natural environment after a tornado
Outbreak investigation partners: Missouri Department of Health and Senior Services, University of Texas Health Science Center, and the Translational Genomics Research Institute
Resources and publications
- CDC’s Public Health Matters Blog
- CDC. Notes from the Field: Fatal Fungal Soft Tissue Infections after a Tornado—Joplin, Missouri, 2011. MMWR 2011;60:992.
- Fanfair RN et al. A Large Outbreak of Necrotizing Cutaneous Mucormycosis Following a Tornado, Joplin Missouri, 2011. New Eng J Med 2012; 367:2214-2225.
- Etienne K et al. Whole genome sequence typing to investigate the Apophysomyces outbreak following a tornado in Joplin, Missouri, 2011. PLoS One. 2012;7(11):e49989.

Mucormycosis: When to Think Fungal Infection

October 3, 2012

CDC expert Dr. Benjamin Park explains to clinicians when to suspect fungal infections.

More Information about Mucormycosis
Murcormycosis Fact Sheet [PDF - 1 page]

Blastomycosis in Wisconsin

Outbreak of blastomycosis, Marathon County, Wisconsin, 2010-2011

Number of cases: 55
Pathogen(s): Blastomyces dermatitidis
Type of infection: Mostly pulmonary
Setting: Marathon County, Wisconsin
Source: Likely multiple foci in the natural environment
Outbreak investigation partners: Marathon County Health Department, Wisconsin Department of Health Services, Marshfield Clinic Research Foundation, and the University of Wisconsin
Resources and publications
- Roy M et al. A Large Community Outbreak of Blastomycosis in Wisconsin with Geographic and Ethnic Clustering. Clin Infect Dis 2013; 57:655-662.

Trichosporon among ICU patients in Jamaica

Trichosporon among intensive care unit patients, Kingston, Jamaica, 2010

Number of cases: 63
Pathogen(s): Trichosporon asahii
Type of infection: Colonization and invasive disease
Setting: Hospital in Kingston, Jamaica
Source: Likely contaminated washbasins
Outbreak investigation partners: Jamaica Ministry of Health
Resources and publications
- Fanfair RN et al. Trichosporon asahii among intensive care unit patients at a medical center in Jamaica. Infect Control Hosp Epidemiol 2013; 34:638-641.