The FDA put out an advisory today about the risk of histoplasmosis in patients taking ant-TNF agents. The association of this fungal infection with these agents is already well known but there have been several reports of infections not being diagnosed in a timely fashion. There have been 240 cases and twenty-one deaths. The majority of cases have been in the Mississippi River valley area, well known as an endemic region for histoplasmosis. Montreal and the St Lawrence River valley is another endemic region and I'm aware of a case that occurred here a few years ago. Montreal was also put on the histoplasmosis map when an article was published in 1964 in the CMAJ about an epidemic in 1963. It was thought that the outbreak may have been related to massive construction, including the digging of the new subway system, or possibly related to the particularly mild weather that year. Given our climate prognosis, I'm hoping the big dig was responsible.
Construction of the Montreal subway. Spores galore.