At least one person died, and 96 others were infected, in an outbreak of the fungus disease at a northwest Michigan paper mill, local health authorities confirmed Friday. Federal investigators are preparing to intensify their investigation into this unprecedented number of rare and potentially fatal fungal infections.

Delta and Menominee County Public Health’s latest tally in the outbreak associated with the Escanaba Billerud Paper Mill includes 21 confirmed cases, as labs were able to detect the fungus in samples collected from symptomatic people. An additional 76 cases are considered “probable,” as these people showed symptoms and tested positive on an antibody or antigen test.

The Ministry of Health said that a contractor who was working in the factory died after being diagnosed with the explosive fungus. His name was not immediately revealed.

At least 12 people They were taken to the hospital.

All of the cases are among workers, contractors, or visitors to a paper and packaging materials plant in Escanaba, Michigan, which owner Bellrod has temporarily closed in order to address the unprecedented outbreak.

“Everyone at Bellrod is deeply saddened by this news,” Brian Peterson, Bellrod’s vice president of operations for the plant, said in a statement shared by the local health department.

“Anyone who works in our facility is part of our team, and we keep that individual, their family, co-workers and friends in our thoughts and close to our hearts,” added Peterson.

Cases of blastomycosis have been reported sporadically throughout North America, from the Midwest to the Southeast. A total of 240 cases were reported to the US Centers for Disease Control and Prevention in 2019 nationwide. Only 26 cases are reported across Michigan on average each year, according to Delta and Menomine County Public Health.

Investigators from the National Institute for Occupational Safety and Health (NIOSH) of the Centers for Disease Control and Prevention (CDC) visited the plant for the first time last month at the request of Billerud’s management. An agency spokesperson said the team plans to return from April 20 through April 29.

About half of people develop symptoms after inhaling spores of the fungus Blastomyces, says the CDC, which often begin with common respiratory problems like fever, fatigue, and cough.

People often become infected after exposure to damp soil or decaying wood and leaves where the fungus grew.

Last month, the CDC reported an outbreak in a handful of Wisconsin neighborhoods that sickened four residents, one of whom died, and also infected several pets. An outbreak may be the result of building spores kicking in.

Severe illness can range from serious lung complications to the fungus spreading to other parts of the body. Surgery is sometimes necessary when the fungus affects the spine and other parts of the nervous system.

Mycosis fungoides can be fatal, especially in people with weakened immune systems or who are not diagnosed early with the infection.

According to a letter released by NIOSH after its initial visit last month, the agency urged the company to take a range of additional precautions to reduce additional cases, including providing N95 respirators, checking ventilation systems and limiting projects such as excavations that could stir up soil.

On return visits, federal investigators plan to offer urine tests to check for missing fungal infections among employees, collect samples from across campus, as well as administer worker surveys that can help trace down the original source of the fungus.

Billerud initially said Tuesday that it was following federal recommendations and was able to continue running mill operations “without interruption” at the plant despite outbreaks among its employees and contractors.

That changed Thursday, after the company announced that it had decided to “pause” the plant in order to find and treat the root cause of the mycosis fungoides.

“As a precaution, we will pause the Escanaba mill for up to three weeks to facilitate additional proper cleanup based on recommendations from NIOSH and other organizations, which would require larger portions of the mill to be vacant while this work is being carried out,” Kristof Michalski, Billerud’s president and CEO, said on Thursday in a statement.

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