A rare fungus outbreak has infected at least 109 people – with one person killed and another 13 sick in hospital.
The upsurge in cases in Michigan, US, is thought to be linked to a paper mill in Escanaba, Upper Peninsula, and are caused by the infection blastomycosis – a rare fungal disease developed after breathing in spores of disturbed rotten wood or leaf litter.
Experts believe the outbreak is one of the largest fungal clusters in America's history. Infected people cannot pass the fungus on to other humans, however.
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One person so far has died and 13 people have been hospitalised but it isn't clear if any are in a critical condition, reports the Mail.
Even more cases of the fungus are expected to be confirmed in the coming weeks as it can often take months for symptoms to develop.
All those affected so far have been employees, contractors or visitors to the paper mill, according to health officials. The mall was shut in April because the source of the outbreak was not found.
Several cases have been reported every week in April by the mill, with the latest update covering the week to April 28.
And while investigators still haven't identified the source of the outbreak, it may well be the wood at the paper mill. The mill's ventilation system is now being cleaned over fears it could spread the infection.
Local health officer Michael Snyder said authorities were continuing to see "fewer new cases" reported every week.
"Many of these cases have been showing signs and symptoms since March," he said in a statement.
It is believed, however, to be the largest blastomycosis outbreak in US history to date – with the previous largest in Wisconsin in 2010 leading to 55 infections, 30 hospitalizations and two deaths.
The fungus is thought to be behind about 6,700 cases and 60 deaths every year across America.
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Blastomycosis was first diagnosed at the plant in late February, but it took more than a month to order the mill's closure – with staff initially told to wear face masks.
Billerud, the Swedish company that owns the mill, said it was first alerted to the blastomycosis outbreak in early March when workers first tested positive for the fungus.
Jamie Dier, vice president of the union, told the Mail those who had fallen seriously ill were "not able to breathe" and "coughing up blood or mucus".
"Their lungs are filling up with nodules [of the fungus]," he said. "There is like fungal masses on their lungs that are preventing them from breathing."
Mr Dier said he had to battle a six-week infection with the fungus but has since recovered.
The Centers for Disease Control and Prevention (CDC) and the local Department of Health have been working with the mill to minimise the outbreak.
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