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Two major outbreaks of sometimes deadly fungal infection in Wisconsin have disproportionately affected the inhabitants of Hmong, and UW-Madison researchers now think they know why: Hmongs are genetically more vulnerable.
Hmongs are much more likely than whites to have two identical copies of genes that control certain immune response factors, which greatly reduces their protection against the fungus responsible for blastomycosis, the researchers said recently in the journal mBio.
The results suggest that Hmongs should try to avoid exposure to the fungus, usually present in the earth near lakes or rivers.
The research could also help scientists explain why other ethnic minorities, including blacks and Hispanics, are at a higher risk of similar fungal infections, said Dr. Bruce Klein, UW-Madison Infectious Disease Specialist , who participated in the study.
Physicians should pay special attention to these patients when they develop pneumonia or other symptoms of infections, Klein said. "It's important to get them in quickly and manage the infection so that it does not worsen or become fatal," he said.
Blastomycosis is present throughout the Midwest, and Wisconsin may have the highest rate in the country, according to the Centers for Disease Control and Prevention. People breathe in spores that become yeast in the lungs and can cause pneumonia.
Fever, chills, cough, fatigue, chest or back pain, shortness of breath, and crusty skin lesions are the symptoms.
Another outbreak in 2015 sickened 90 people, most of whom had tubed on the Little Wolf River, southeast of Wausau. Once again, the Hmongs have been disproportionately affected, Klein said.
The two epidemics were the largest ever recorded in the United States at the time of their occurrence. When investigating the first outbreak, gardening and other outdoor exposures did not explain why such a high rate of Hmong people was sick.
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Klein and other scientists from UW-Madison, including Dr. Caitlin Pepperell, a microbiologist, and graduate students Donny Xiong and Mary O'Neill, have studied blood samples of nine people Hmong involved in the first focus. They compared the samples with blood of people of European descent.
Hmongs were much more likely to have two identical copies – one from each parent – of genes that influence the production of immune responders called interleukin-6 and interleukin-17. Whites usually have two different copies of the genes. Having different copies is badociated with higher levels of immune factors.
With less IL-6 and IL-17, Hmongs are less able to fight blastomycosis, Klein said.
Genetic susceptibility may come from less mixing with other ethnic groups, Pepperell said. The Wisconsin Hmongs have "experienced a long history of displacement and forced migration," which could contribute to genetic isolation, she said in a statement.
Many fungal infections – such as Candida auris, a significant global threat in recent years due to its resistance to many medications – mostly affect people who are already sick.
Blastomycosis usually affects healthy people, like two similar fungi: histoplasmosis, which can come from the droppings of bats and birds, and coccidioidomycosis, or fever from the valley, present in the San Joaquin Valley in California and in other Southwestern states.
Blacks are more exposed to three infections than whites, Klein said. Hispanics seem to have a higher risk of blastomycosis and histoplasmosis, he said, and valley fever particularly affects Filipinos.
It is unclear whether Hmongs are more likely than whites to have histoplasmosis or valley fever, Klein said.
Hmongs should consider avoiding near-ground exposure to water or wearing a mask when they are exposed, Klein said. Doctors, who usually suspect bacteria or viruses in patients with pneumonia, should be alert to the possibility of a fungal cause, especially among Hmongs and other minorities, he said.
Dogs can also suffer from blastomycosis, particularly in northern Wisconsin, Klein said. Infection is rarely transmitted from dog to human or person to person, he said.
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