Mississippi River Valley Research Articles

Disseminated histoplasmosis from western Mexico—rethinking our geographic distribution of endemic fungal species: a case report and review of literature

BackgroundHistoplasma is a fungal pathogen found in many parts of the world. In North America, its distribution is traditionally thought to be endemic to the Ohio and Mississippi River valleys. Development of histoplasmosis after Histoplasma exposure is related to degree of inoculum exposure and susceptibility, for example, immunocompromised status. Most exposed, healthy individuals are asymptomatic and few develop pulmonary symptoms. A limited number of infectious etiologies (that is, Histoplasma, Coccidioides, and Mycobacterium tuberculosis) can cause miliary pattern on chest imaging, and thus, histoplasmosis should be considered whenever a patient presents with pulmonary symptoms and these unique radiographic findings.Case presentationA previously healthy 13-year-old Hispanic male presented as a transfer from an outside hospital with fever and hypoxia in the setting of a progressive, subacute gastrointestinal illness. Given hypoxia, the concern for sepsis, and unclear etiology of his illness, broad-spectrum antimicrobial therapy and noninvasive ventilation were started. Initial evaluation demonstrated miliary pulmonary infiltrates, and travel history raised suspicion for coccidioidomycosis or tuberculosis. After a complete evaluation, lab studies confirmed a diagnosis of histoplasmosis, and the patient made a full recovery after the initiation and completion of antifungal therapy.ConclusionHerein, we present a patient who acquired histoplasmosis from an area of Mexico not currently acknowledged as endemic and review recently published data emphasizing new areas of Histoplasma endemicity in North America, particularly the southwest USA and most states of Mexico. Though limited surveillance data exist, mounting case reports/series and local epidemiologic studies illustrate the expanding worldwide endemicity of Histoplasma and underscore histoplasmosis as a growing global health concern.

Quantifying Pleistocene loess provenance in midcontinental North America using a mixing model: Implications for glacial lobe evolution along the southern Laurentide ice sheet

Quaternary glaciations have significantly impacted the midcontinental North American landscape, leaving behind a proglacial sediment record of glacial lake deposits, glacio-fluvial sand and gravel, and windblown loess. This paper aims to expand upon a previous study using detrital zircon provenance analysis to investigate midcontinental North American loess provenance in relation to the glacial history of the southern Laurentide ice sheet during the middle to late Pleistocene. The study incorporates previously published detrital zircon data from last glacial tills (representing the Huron-Erie Lobe, Lake Michigan Lobe, Green Bay Lobe, Superior Lobe, Des Moines Lobe, and James Lobe), middle to late Pleistocene loess from several sites along the Illinois and Mississippi River valleys, and suspended sediment load inputs from the Missouri River and Arkansas River. A statistical mixing model (DzMix version 2.2) was used to estimate the relative proportions of glacial and nonglacial sources to Wisconsin Episode, Illinois Episode, and pre–Illinois Episode age loess. We show that mixing models that include the modern suspended sediment loads of the Missouri and Arkansas Rivers significantly improve (up to 23% increase in cross-correlation value) the source characterization of Wisconsin Episode (last glacial) and Illinois Episode (penultimate glacial) loess deposits within the Mississippi River drainage basin. These river sources are dominant inputs for certain loess sites (as much as 51%), but their relative contributions are not static across time and space, which has implications for temporal and spatial differences in relative sediment source estimates and glacial and fluvial sediment transport evolution. Specifically, differences in relative sediment proportion estimates among Wisconsin, Illinois, and pre–Illinois Episode loess support previous evidence for the persistence of a Quebec-Labrador ice dome source through multiple glacial cycles, even with the inclusion of river sources in updated mixing models. Illinois and pre–Illinois Episode loess in the southern portion of our study area received ~20% detrital zircon input from sources similar to the present-day Missouri and Arkansas Rivers, suggesting that these river systems were contributing a significant amount of detritus to the lower Mississippi River valley region during the middle Pleistocene.

Tracing histoplasmosis genomic epidemiology and species occurrence across the USA

ABSTRACT Histoplasmosis is an endemic mycosis in North America frequently reported along the Ohio and Mississippi River Valleys, although autochthonous cases occur in non-endemic areas. In the United States, the disease is provoked by two genetically distinct clades of Histoplasma capsulatum sensu lato, Histoplasma mississippiense (Nam1) and H. ohiense (Nam2). To bridge the molecular epidemiological gap, we genotyped 93 Histoplasma isolates (62 novel genomes) including clinical, environmental, and veterinarian samples from a broader geographical range by whole-genome sequencing, followed by evolutionary and species niche modelling analyses. We show that histoplasmosis is caused by two major lineages, H. ohiense and H. mississippiense; with sporadic cases caused by H. suramericanum in California and Texas. While H. ohiense is prevalent in eastern states, H. mississipiense was found to be prevalent in the central and western portions of the United States, but also geographically overlapping in some areas suggesting that these species might co-occur. Species Niche Modelling revealed that H. ohiense thrives in places with warmer and drier conditions, while H. mississippiense is endemic to areas with cooler temperatures and more precipitation. In addition, we predicted multiple areas of secondary contact zones where the two species co-occur, potentially facilitating gene exchange and hybridization. This study provides the most comprehensive understanding of the genomic epidemiology of histoplasmosis in the USA and lays a blueprint for the study of invasive fungal diseases.

Historical and contemporary drivers of knickpoint retreat and morphological evolution along Bayou Pierre, Mississippi

AbstractChannel incision in rivers can cause marked ecological and economic damages. This phenomenon is abundant and generally well documented along impacted streams in the loess hills adjacent to the Lower Mississippi River valley. Bayou Pierre, an ecologically important small tributary of the Mississippi River, is currently incising but causes are not well understood. In this study, we examine diverse data sources to: (1) reconstruct a history of erosional stimuli and possible origins and (2) examine effects of contemporary controls. Review of long‐term planform and land use data for the Mississippi River revealed episodic foreshortening events followed by episodic deforestation and reforestation. Hydrologic data suggest an increase in rainfall over the last few decades. Estimates of knickpoint retreat place origins prior to Mississippi River channel straightening (1929–1944). Planform analysis in three focal reaches of Bayou Pierre demonstrates slow change prior to 1982, but accelerated changes after those periods. Mean rainfall and 3‐day storm intensity correlate to some planform changes; however, the storm of 1983 may be a better explanation of sudden planform change. We found some evidence of potential internal feedback loops in patterns of bar growth. Together, our analyses provide a synthesis of stimuli experienced by Bayou Pierre over the last ~200 years and suggest both channel migration events before straightening of the Mississippi River and more recent hydrologic events have influenced patterns of geomorphic change in Bayou Pierre.

A rare case of Disseminated Histoplasmosis with Hemophagocytic Lymphohistiocytosis mimicking a flare of Systemic Lupus Erythematosus in a middle-aged man: A Case Report

Abstract Introduction/Objective Disseminated histoplasmosis is a progressive granulomatous disease caused by Histoplasmosis capsulatum which is an intracellular dimorphic fungus endemic to Ohio and Mississippi River valleys in the United States. The progressive spread of the infection to organs is thought to be due to the failure of the activation of the T-cell mediated immune response. Hemophagocytic lymphohistiocytosis is a rare but potentially fatal condition in which histiocytes and lymphocytes build up in and damage organs and other blood cells. Diagnosing Disseminated Histoplasmosis with Hemophagocytic Lymphohistiocytosis in a patient with Systemic Lupus Erythematosus is diagnostically challenging due to the rare presentation. Hence, we are reporting this case to alert physicians to keep a high index of suspicion in such presentations. Methods/Case Report We present a 37-year-old man with a past medical history of Systemic Lupus Erythematosus complicated by Lupus Nephritis on immunosuppressive therapy who presented to the emergency department with hypotension and was admitted for acute kidney injury. Prior to the presentation, he had persistent fever, myalgias, cough, mild shortness of breath, and back pain. CT Chest shows “eggshell” calcification and further parasitology evaluation revealed a diagnosis of histoplasmosis using a blood sample where intracellular Histoplasma organisms were identified. A diagnosis of Hemophagocytic lymphohistiocytosis was made clinically after “Clinical and Testing Criteria” was evaluated. Despite further management, he developed coagulopathy and sepsis which led to his death. Results (if a Case Study enter NA) At autopsy, we found organomegaly of the liver, spleen, and kidneys. Microscopically, these enlarged organs show old fibrotic granulomas and granulomatous inflammation with suspected fungal organisms. Periodic Acid Schiff (Fungus) and Gomori's Methenamine Silver special stain confirm these fungal organisms to be consistent with Histoplasma species (3-5 micron budding yeasts). Conclusion This case report highlights that physicians should be aware of the diagnostic challenge that Disseminated Histoplasmosis with Hemophagocytic Lymphohistiocytosis could pose in patients with Systemic Lupus Erythematosus, especially those on immunosuppression. The clinical presentation could easily mimic a flare of Systemic Lupus Erythematosus, leading to more aggressive immunosuppression. Failure to recognize the infection promptly could lead to grievous complications and sometimes death.

Disseminated histoplasmosis diagnosed on peripheral blood smear: a case report

Abstract Introduction/Objective Histoplasmosis is an infection caused by the inhalation of a dimorphic fungus, Histoplasma capsulatum. H. Capsulatum var capsulatum is the main variety we encounter in the United States and is endemic in the Mississippi river valley. In immunocompetent individuals the infection is usually asymptomatic or presents as flu- like symptoms. Disseminated histoplasmosis is a severe and often fatal opportunistic infection if not treated, usually seen in immunocompromised patients. Methods/Case Report We report a case of a 27-year-old female intra-venous drug user with past medical history of untreated HIV diagnosed in 2018, who is being admitted for suspected necrotizing fasciitis of the vulva. On admission, her complete blood count shows pancytopenia with a white blood cell count of 2.9 × 109/L (NR 4.3-10.8 × 109/L), hemoglobin 6.1 g/dL (NR 12-16 g/dL), and a platelet count of 43 × 109/L (NR 150-400 × 109/L). A peripheral blood smear obtained showing rare neutrophils with intracellular organism highly suggestive of histoplasma capsulatum. CT Chest showing diffuse ground glass opacities and a subsequent cytology from bronchoalveolar lavage performed revealed numerous macrophages filled with ovoid organism surrounded by a cytoplasmic halo, GMS stain highlights the rim consistent with histoplasma capsulatum. Patient expired after one week in the ICU for severe acute respiratory distress syndrome, sepsis, histoplasmosis, strep pneumonia and hepatic failure. Results (if a Case Study enter NA) NA Conclusion Careful examination of Peripheral blood smear along with correct clinical history can aid in early diagnosis of disseminated histoplasmosis.

Diverging climate response of corn yield and carbon use efficiency across the U.S.

In this paper, we developed an open-source package to analyze the overall trend and responses of both carbon use efficiency (CUE) and corn yield to climate factors for the contiguous United States. Our algorithm enables automatic retrieval of remote sensing data through the Google Earth Engine (GEE) and U.S. Department of Agriculture (USDA) agricultural production data at the county level through application programming interface (API). Firstly, we integrated satellite products of net primary productivity and gross primary productivity based on the Moderate Resolution Imaging Spectroradiometer (MODIS) sensor, and climatic variables from the European Centre for Medium-Range Weather Forecasts. Secondly, we calculated CUE and commonly used climate metrics. Thirdly, we investigated the spatial heterogeneity of these variables. We applied a random forest algorithm to identify the key climate drivers of CUE and crop yield, and estimated the responses of CUE and yield to climate variability using the spatial moving window regression across the U.S. Our results show that growing degree days (GDD) has the highest predictive power for both CUE and yield, while extreme degree days (EDD) is the least important explanatory variable. Moreover, we observed that in most areas of the U.S., yield increases or stays the same with higher GDD and precipitation. However, CUE decreases with higher GDD in the north and shows more mixed and fragmented interactions in the south. Notably, there are some exceptions where yield is negatively correlated with precipitation in the Missouri and Mississippi River Valleys. As global warming continues, we anticipate a decrease in CUE throughout the vast northern part of the country, despite the possibility of yield remaining stable or increasing.

The Southern Picturesque: Visions of the New and Old South in the Lower Mississippi River Valley

Abstract This essay examines the southern picturesque, an architectural vision of the Old South formulated in the 1910s through 1930s in the Lower Mississippi River valley. This vision offered an oblique approach to the plantation big house that evoked a mythical antebellum past, presenting this fulcrum of chattel slavery and resource extraction as an image of leisurely natural order where climate assumed primary importance in the shaping of architectural form. Drawings and texts composed by architect and Tulane University professor Nathaniel Curtis, architect-artist William Spratling, and writer Natalie Scott participated in this maudlin display of the Old South. As this article argues, their work represented a kind of partially uprooted modernism that was in fact made possible by the expansion of the oil industry into the very same environment celebrated by the southern picturesque for its agrarian, nonindustrial authenticity.

Pulmonary Histoplasmosis: A Clinical Update.

Histoplasma capsulatum, the etiological agent for histoplasmosis, is a dimorphic fungus that grows as a mold in the environment and as a yeast in human tissues. The areas of highest endemicity lie within the Mississippi and Ohio River Valleys of North America and parts of Central and South America. The most common clinical presentations include pulmonary histoplasmosis, which can resemble community-acquired pneumonia, tuberculosis, sarcoidosis, or malignancy; however, certain patients can develop mediastinal involvement or progression to disseminated disease. Understanding the epidemiology, pathology, clinical presentation, and diagnostic testing performance is pivotal for a successful diagnosis. While most immunocompetent patients with mild acute or subacute pulmonary histoplasmosis should receive therapy, all immunocompromised patients and those with chronic pulmonary disease or progressive disseminated disease should also receive therapy. Liposomal amphotericin B is the agent of choice for severe or disseminated disease, and itraconazole is recommended in milder cases or as "step-down" therapy after initial improvement with amphotericin B. In this review, we discuss the current epidemiology, pathology, diagnosis, clinical presentations, and management of pulmonary histoplasmosis.

Refractory Pneumonia in a 12-year-old Girl with Hemoglobin SS Disease

Refractory Pneumonia in a 12-year-old Girl with Hemoglobin SS Disease

Elizabeth L. Jemison. Christian Citizens: Reading the Bible in Black and White in the Postemancipation South.

Scholars have long recognized that citizenship was perhaps the most hotly contested concept in America in the second half of the nineteenth century. From Dred Scott v. Sandford to the Fourteenth Amendment to Plessy v. Ferguson, both the meaning of citizenship and its relationship to equality were unstable. As Elizabeth L. Jemison argues in Christian Citizens: Reading the Bible in Black and White in the Postemancipation South, Christianity’s role in shaping the meaning of citizenship in postemancipation America has not been fully appreciated. Jemison’s main contention is that Christian identity was central to emerging conceptions of citizenship and thus is indispensable for understanding both African Americans’ aspirations for equality and white southerners’ attempts to maintain a racial hierarchy through violence and segregation. Jemison builds on the taxonomy of three competing religious visions for the postemancipation South—of Black southerners, of white southerners, and of white northern missionaries—that Daniel W. Stowell established in Rebuilding Zion: The Religious Reconstruction of the South, 1863–1877. The first vision maintained that African Americans’ status as Christians meant they should be equal citizens. In contrast, white southern Christians adapted the paternalistic rhetoric of proslavery theology to defend a racially exclusivist understanding of citizenship. Lastly, white northern missionaries advanced their own form of paternalism that separated Black Christian identity from Black civil and political rights. Jemison’s book, which examines the lower Mississippi River valley of Arkansas, Louisiana, Mississippi, and western Tennessee, mostly confirms Stowell’s earlier work on Georgia and eastern Tennessee.

Using a New Cenozoic Glacial History Paradigm to Explain Saline-Smoky Hill River Drainage Divide Area Topographic Map Evidence: Kansas, USA

A recently proposed glacial history paradigm (new paradigm) explains previously ignored Saline-Smoky Hill River drainage divide area topographic map drainage system and erosional landform evidence by headward erosion of the east-oriented Saline River valley across large and prolonged south-oriented meltwater floods which flowed in complexes of closely-spaced anastomosing channels. The eastward sloping drainage divide extends from the Saline River’s western Kansas headwaters between the Saline River (north) and the Smoky Hill River (south) until in central Kansas the Smoky Hill River turns in a southeast and then north direction to join the Saline River with their combined flow continuing as the Smoky Hill River in an east direction to join the Republican River with the combined flow then becoming the Kansas River. Evidence for closely-spaced south-oriented anastomosing channels consists of previously undescribed low points (divide crossings) which are found along the drainage divide and which link north-oriented Saline River tributaries with south-oriented Smoky Hill River tributaries. Evidence that Saline River valley headward erosion beheaded and reversed south-oriented anastomosing channels also consists of the numerous low points along the drainage divide and of barbed tributaries to the now north-oriented Saline River tributaries which suggest large south-oriented meltwater floods extended much further west than commonly accepted glacial history interpretations permit. The topographic map evidence is consistent with the new paradigm interpretation that a thick continental icesheet by its weight and by deep erosion created and occupied a deep “hole” as massive south-oriented meltwater floods flowed across the rising deep “hole” rim until the deep “hole” rim uplift diverted the floodwaters toward what became the deep “hole’s” only remaining southern outlet (the Mississippi River valley).

900: A REPORT OF DISSEMINATED HISTOPLASMOSIS IN AN IMMUNOCOMPROMISED PATIENT FOLLOWING COVID-19 INFECTION

Introduction: Histoplasmosis results from spore inhalation of Histoplasma capsulatum, an endemic fungus in the soil of the Ohio and Mississippi River Valleys of the United States. While the majority of infections with H. capsulatum are asymptomatic and self-limited, immunosuppressed patients may develop severe, disseminated disease. Few reports have described disseminated histoplasmosis following SARS-CoV-2 (COVID-19) infection such as described in this case. Description: A 69-year-old female was evaluated for shortness of breath. Her medical history was significant for rheumatoid arthritis on methotrexate and recent COVID-19 infection treated with dexamethasone. Initial CT-angiography of the chest showed patchy bilateral ground glass opacities. She had leukopenia with white blood cell count of 1.3 K/uL and elevated procalcitonin of 5.88 ng/mL. Broad spectrum empiric antibiotics were initiated. On day 6, the patient decompensated and required ICU transfer. Urine histoplasma antigen, M and H precipitin bands, and serum galactomannan antigen returned positive. Amphotericin B was initiated. The patient underwent bronchoscopy with bronchoalveolar lavage showing atypical reactive macrophages with rare intracellular organisms suspicious for fungi. Repeat CT of the chest, abdomen, and pelvis showed extensive bilateral ground glass opacities, bilateral pulmonary calcifications consistent with granulomas, and calcifications in the spleen and liver. On hospital day 10, the patient required intubation due to hypoxemic respiratory failure. Despite appropriate antifungal therapy, she had worsening encephalopathy, leukocytosis, erythema nodosum, and renal failure. She passed away on day 19. Discussion: This case highlights the development of disseminated histoplasmosis in an immunocompromised adult following COVID-19 infection. It was not until treatment with high dose glucocorticoids that the patient developed disseminated disease and declined. It is important to be aware of the impact that the COVID-19 pandemic has on the emergence of infectious disease and the role its treatment plays in immune suppression. Disseminated histoplasmosis is a consideration for immunocompromised patients in high risk, H. capsulatum endemic areas who are being treated for COVID-19 with high doses of steroids for prolonged periods.

The influence of sedimentary architecture on the formation of earthquake-induced liquefaction features: A case study in the New Madrid seismic zone

This study is aimed at understanding how the arrangement of fluvial sedimentary deposits and their physical properties influences the formation and location of liquefaction features resulting from earthquake strong ground motions. The study site is located in the Mississippi River floodplain in the New Madrid seismic zone of the central United States, an area that hosts abundant liquefaction deposits resulting from both historic and prehistoric earthquake sequences. We combine satellite imagery, electrical resistivity tomography, soil textural analyses and ditch exposures of liquefaction features to develop a model of how the spatial distribution of sedimentary deposits, such as point bars, overbank, levee, backswamp and channel-fill, contribute to pore pressure build-up and subsequent development of liquefaction features, such as sand dikes and sand blows, as water and entrained sediment forcefully flow toward the surface. The model helps to explain (1) the abundance of earthquake-induced liquefaction features present in the Mississippi River valley, where fine- to medium-grained saturated sands are interbedded with or overlain by fine-grained portions of channel-fill, levee, overbank or backswamp deposits, and (2) the concentration of liquefaction features along the margins of abandoned-channel fill, point bar and overbank deposits, as seen in other locations worldwide. This understanding can contribute to identifying areas where liquefaction may be a threat to engineered structures and limiting the extent of areas in which detailed engineering geology measurements (e.g., in situ testing) may be necessary.

The Other Large Bifaces: Late Mississippian Woodworking Tools from Southwestern Indiana

Abstract Mississippian cultures left behind two types of large utilitarian bifaces: hoes and so-called woodworking tools. The former have attracted considerable scholarly attention, while the latter have not. We attempt to address this bias by focusing on a substantial number of woodworking tools from three sites in southwestern Indiana. All belong to Caborn-Welborn, a late Mississippian culture that developed at the Ohio-Wabash confluence after the decline of the Angel polity and the establishment of the “Vacant Quarter” across a large portion of the Mississippi and Ohio River valleys. In this article, we examine these specimens’ technomorphological characteristics and use-wear traces, as well as the sources of the cherts from which they were made. In addition, our study has two comparative components: First, we investigate similarities and differences between the Caborn-Welborn woodworking tools and those from both the Angel culture and other parts of the Mississippian world; second, we explore the woodworking tools in relation to hoes from both Caborn-Welborn and Angel phase sites.

Blastomycosis-Some Progress but Still Much to Learn.

Blastomycosis, caused by Blastomyces spp., is an endemic mycosis capable of causing significant disease throughout the body. Higher rates of infection are seen in the Mississippi and Ohio River valleys, the Great Lakes region of the United States and Canada, much of Africa, and, to a lesser extent, in India and the Middle East. Limited reporting inhibits our true understanding of the geographic distribution of blastomycosis. An estimated 50% of those infected remain asymptomatic. Of those who present with symptomatic disease, pulmonary involvement is most common, while the most common extrapulmonary sites are the skin, bones, genitourinary system, and central nervous system. Itraconazole is the standard therapy for mild–moderate disease. Data for other azoles are limited. Amphotericin is used for severe disease, and corticosteroids are occasionally used in severe disease, but evidence for this practice is limited. Despite increasing incidence and geographic reach in recent years, there are still significant knowledge gaps in our understanding of blastomycosis. Here, we provide an updated review of the epidemiology, clinical presentations, and diagnostic and therapeutic approaches for this infection. We also discuss areas needing further research.

A patient with fever and umbilicated papules

A patient with fever and umbilicated papules

Morphology and stratigraphy of aeolian sand stringers in southeast Minnesota and western Wisconsin, USA

AbstractSand stringers are subtle, aeolian landforms that reach hundreds to thousands of metres in length and lack a slipface. While hundreds of sand stringers exist beyond the Last Glacial Maximum margin in the Upper Midwest, USA, little is known about the timing and nature of their formation. This research characterizes the morphology and stratigraphy and provides geochronological data from two sand stringers in the upper Mississippi River basin in Minnesota and Wisconsin.The sand stringers investigated have similar west–northwest to east–southeast orientations and are located ~100 km from each other on uplands west and east of the Mississippi River valley. The sand stringer in Goodhue County, Minnesota (GC site) is ~870 m long and 50–80 m wide. To the east, the sand stringer in Eau Claire County, Wisconsin (ECC site) is ~925 m long and 30–50 m wide. The main body of the GC sand stringer is characterized by an ~80–270 cm‐thick silt‐rich surface unit overlying a sandy unit that is underlain by a dark brown paleosol, while the main body of the ECC sand stringer is sandier/coarser, stratified, and overlies outwash.14C ages, interpreted as minima, at GC indicate formation began prior to 25–20 cal yr BP, while OSL and14C ages indicate ECC formed ~11.25–8.9 ka. We interpret the main body of GC as equivalent to Peoria Loess, with minor inputs of reworked outwash. We interpret ECC as composed of reworked outwash and local bedrock‐derived sands. Pedogenesis at GC and ECC indicates stabilization with possible minor modification of near‐surface sediments through the Holocene. Differences in stratigraphy and chronology between the two sites highlight the complexity of aeolian systems in the Upper Midwest, interpreted as indicative of the variety of sediment sources contributing to landform development via aeolian processes due to spatial and temporal variability in deglaciation and permafrost melting.

A RARE CASE OF DISSEMINATED BLASTOMYCOSIS IN IMMUNOCOMPETENT PATIENT COMPLICATED BY SUPERIOR MESENTERIC ARTERY SYNDROME

TYPE: Case Report TOPIC: Chest Infections INTRODUCTION: Blastomycosis is a fungal infection, endemic to the Mississippi and Ohio River valleys. Here we report a case of disseminated blastomycosis in an immunocompetent patient with severe systemic symptoms but delayed diagnosis resulting in superior mesenteric artery syndrome (SMA) CASE PRESENTATION: A 25-year-old male presented with 3 months of intense lower back pain that progressively worsened and a 35lbs unintentional weight loss. He had been previously evaluated at an outside hospital and discharged on pain regimen with no improvement. CT Chest AP demonstrated fine miliary nodules on bilateral lungs, multiple paravertebral abscesses, osteolytic lesions throughout the axial skeleton, and most surprisingly, an incidental finding of dilation of the descending and transverse portions of the duodenum. Initial AFB smear, HIV, hepatitis, and other immunodeficiency workup was unremarkable. Patient underwent IR guided abscess aspiration of paravertebral abscess with a final culture result of BLASTOMYCES DERMATITIDIS. General Surgery was consulted due to the abnormal upper GI findings, a final diagnosis of SMA syndrome due to significant and fast weight loss from systemic disease was made. The patient ultimately required a loop duodenojejunostomy to bypass the obstruction. DISCUSSION: SMA syndrome is an uncommon cause of Upper GI obstruction, to our knowledge, this is the first case reported in association with disseminated blastomycosis. Our patient was started on Amphotericin B and later transitioned to Itraconazole long-term with marked improvement of symptoms. CONCLUSIONS: A high degree of suspicion and prompt diagnosis for blastomycosis is important, particularly in immunocompetent patients. Delayed diagnosis might represent significant morbidity such as in our patient. DISCLOSURE: Nothing to declare. KEYWORD: blastomycosis

Detection of Foreign Material in Soybean (Glycine max) Grain

The United States (US) is ranked second in the world in exporting soybean with Louisiana ranked 17th for exporting agricultural products, including soybean. Importing countries maintain high standards for the level of foreign material (FM) accepted in soybean grain shipments. While it has been identified that changes are needed, there is limited research on what comprises the FM, specifically weed seeds, in these samples. The objective of the study was to determine what proportion of the FM consists of weed seeds and to quantify those seeds in Louisiana grain elevators and in Mississippi River Valley (MRV) barges bound for Louisiana. Fifty soybean samples were taken from barges traveling down the Mississippi River Valley (MRV) as well as 56 total samples from Louisiana grain elevators. Each sample was weighed, and each fraction of the FM was separated, weighed, and counted to determine the exact proportion of each fraction. Twelve different weed seeds were found within the FM samples. The amount of weed seeds found was not consistent based on where the sample was retrieved, grain elevator or MRV barge, however the total FM was <1% for all MRV barge samples. A better understanding of the FM in soybean grain samples will allow the midsouthern US to know more accurately which weed seeds are found within grain bound for exportation.