Northern Vermont Is a Hot Spot for a Rare Fungal Infection

Beth Foy started feeling sick a few months after floodwaters inundated Johnson. She had spent summer 2023 in crisis mode as Johnson’s selectboard chair and a member of the town’s emergency management team. Although Foy’s home was untouched, she was in and out of her neighbors’ flooded houses, leading tours of the water-stricken town for federal and state officials surveying damage.

Then, in November that year, she developed a cough. Right before Thanksgiving, Foy finally decided to go to her physician, who told her that she likely had bronchitis and put Foy on antibiotics.

But the 46-year-old woman, who had been relatively healthy, felt increasingly ill as time went on. She became lethargic and developed a low-grade fever. Foy sweated constantly and had trouble breathing. She took medical leave from her job as a delivery manager for a technology company.

Foy’s doctor prescribed medication for postnasal drip and acid reflux, but nothing helped. By the end of January, she was desperate and headed to the emergency room at the University of Vermont Medical Center.

There, doctors ordered a CAT scan of Foy’s chest, which revealed what appeared to be a mass taking up most of her upper right lung. They worried that pneumonia was masking something else, possibly cancer. They prescribed Foy more antibiotics, hoping that would clear the problem, and told her that if she didn’t feel better in a week, she should come back for more testing.

Distressed, Foy headed back to Johnson, where she drifted in and out of sleep in front of the TV. Then she happened to see a WCAX-TV segment about a fungal disease found to be more common in Vermont than previously understood.

“It was very serendipitous,” Foy said. “I immediately took out my computer and looked it up, and the symptoms matched my own.”

Her doctor agreed to test her for the disease through a urine sample and soon called with the result. Foy didn’t have pneumonia or lung cancer. The test revealed that her suspicion was correct: What had resembled a mass in her lung in medical imaging was in fact an infectious disease. She had blastomycosis — a rare but treatable fungal infection.

The illness, endemic to the Eastern U.S., is not new to Vermont. Yet a recent study by the Vermont Department of Health and the U.S. Centers for Disease Control and Prevention shows that while the disease remains relatively rare, the number of Vermonters who are getting sick from Blastomyces fungi is greater than previously understood.

Three counties in North Central Vermont — Lamoille, Orleans and Washington — had the highest count of cases. Although the counties are home to only 18 percent of the state’s population, 49 percent of all blastomycosis patients and 65 percent those hospitalized with the disease resided there.

Infectious disease specialists in Vermont are noting an increase in the number of cases they see in patients overall.

The new research, and growing concern, have led the Vermont Department of Health to start tracking the disease, joining five other states in doing so. Specialists and researchers hope that the data collected will help physicians understand its prevalence and diagnose it more quickly.

“During my training, it was rare,” said Jessica Crothers, a UVM pathologist who is leading a new study into blastomycosis in Vermont. “Now it feels like on a weekly basis we’re seeing people diagnosed.”

Blastomycosis is a fungal infection caused by Blastomyces dermatitidis, a fungus that is found in moist soil near waterways and in decaying organic matter. Blastomyces has adapted to thrive as both a mold in the environment and a yeast in tissue. That makes it particularly well suited for infecting mammals. Dogs in particular — with their penchant for digging — are at a heightened risk for blastomycosis and often act as the canary in the coal mine for human infection.

In fact, Grace Johnstone, a chiropractor and practitioner of hyperbaric oxygen therapy in Hardwick, realized she had blastomycosis only after her dog was diagnosed with the disease in 2023. For months, she had been struggling with lethargy, shortness of breath and joint pain. Johnstone’s doctor initially thought it was asthma.

“When people show up with this stuff, this needs to be one of the things we screen for,” Johnstone said. “It’s like how we thought about Lyme disease 20 years ago.”

Since being diagnosed, Johnstone has been on antifungal medication, and she is starting to feel better. She’s not sure how she contracted the disease, but she likes to garden and spend time outside.

The fungal disease can be contracted by inhaling spores or through an open wound on the skin. Blastomycosis can spread to other parts of an infected person’s body, but it is not contagious. Any activity that involves disturbing soil — such as gardening, construction or even hiking — increases a person’s risk. Immunocompromised individuals are at an increased risk. But experts say most Vermonters should not be alarmed and don’t need to avoid these activities.

The illness can be difficult to diagnose because it can resemble other respiratory infections. It can cause lesions, but they look “like any other generic skin abscess,” said Lindsay Smith, an infectious disease physician with the UVM Health Network.

“Patients will get antibiotics over and over until somebody puts the pieces together,” she said.

Treatment typically involves an oral antifungal medication, such as itraconazole or amphotericin B. The length of treatment depends on the severity of the infection, but it typically takes more than a year to recover. The longer the infection goes undiagnosed, the more difficult it can be to treat. While blastomycosis is relatively rare, and most cases are mild, when left untreated it can cause serious illness or death.

Case in point: Jeff Hensley, a 35-year-old Newport resident, was sick for almost six months before being diagnosed. Hensley was told at one point that he had tuberculosis and was quarantined. He had a fever that spiked to 104 degrees and could barely breathe. Hensley was put on oxygen and moved to an ICU, and was told he was close to death. That’s when doctors finally realized Hensley had blastomycosis.

“It was a pretty nightmarish experience,” Hensley said. “I can’t blame the doctors, though. It’s such a weird, rare thing.”

Scientists don’t know exactly why, but Blastomyces is primarily found near the Ohio and Mississippi River valleys, the Great Lakes, and the St. Lawrence River. Cases have cropped up in Michigan, Ohio, Ontario, Missouri and Illinois. In fact, it’s colloquially known as “Chicago’s disease.”

Only five states — Arkansas, Louisiana, Michigan, Minnesota and Wisconsin — have public health surveillance for blastomycosis, meaning they track cases year to year. But it is unknown how common the disease is in other states.

Blastomycosis has been found in Vermont for decades, but the Vermont Department of Health has not tracked cases until this year. In 2024, though, a team of researchers from the Centers for Disease Control and Prevention and the Vermont Department of Health used insurance claims over a 10-year period, from 2011 to 2020, to estimate how common blastomycosis is in Vermont.

What they found was eye-opening: With an average rate of 1.8 cases per 100,000 people every year, Vermont had higher rates of blastomycosis than all but one of the states that monitored the disease between 1987 and 2017. Between 2011 and 2020, 114 patients were diagnosed with blastomycosis, with a median of 10.5 cases per year.

“We don’t know why,” said Natalie Kwit, Vermont’s public health veterinarian and one of the authors of the study, which was published in February 2024. But as a result of the stark findings, blastomycosis has been added to Vermont’s list of reportable diseases — a data-collecting mechanism all doctors use — so that physicians can alert health officials to its presence and monitor trends.

With new data coming online this year, other health experts — such as Crothers and Smith — are hoping to learn more about the nature of blastomycosis in Vermont. Crothers and Smith are curious to see whether areas that have experienced increased flooding might present a higher number of blastomycosis cases.

They hypothesize that mucking out basements and spending time around wet soil could increase potential exposure. And wetter summers resulting from global warming may mean that soil in Vermont is becoming more suitable for Blastomyces.

“Blastomyces is just one of the many infectious organisms that is changing due to climate change,” Smith said.

For that reason, Smith and Crothers hope to educate clinicians across the state about blastomycosis and its risks.

Doctors suspect that Foy, the former Johnson Selectboard chair, may have contracted blastomycosis during her flood recovery work. Once she got on antifungal medication, Foy started feeling noticeably better.

“It makes you appreciate things,” she said. “When we have flood events, we should be distributing materials regarding the risks of blastomycosis.”

It took a full year of treatment — a milestone she hit this past February — but Foy said she finally feels back to her old self.

This article appears in May 7-13, 2025.

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