GRAND RAPIDS, Mich. (WOOD) — The public health department representing Delta and Menominee counties has reported 81 likely cases of a rare fungal infection known as blastomycosis.

Testing has been able to confirm the fungus in 19 cases. An additional 62 people are considered probable cases because they have shown common symptoms and have tested positive for antigens or antibodies.

The outbreak appears to be connected to the Billerud Paper Mill in Escanaba. The first cases were reported weeks ago, with several mill employees complaining of common blastomycosis symptoms: extreme fatigue, fever, cough, chest pains, night sweats and muscle and joint pain.

Billerud has been working with local health officials and the Michigan Department of Health and Human Services since the start of the outbreak. Officials from the National Institute for Occupational Safety and Health and the mycology branch of the MDHHS have also been brought in to investigate.

Public Health Delta & Menominee Counties says the investigators have met with the mill’s occupational health and safety team and union representatives.

The fungus grows in moist soil and decomposing matter. People are infected by directly breathing the fungal sports, which means it cannot be spread from person to person.

According to PHDM, blastomycosis infections are not common even with exposure to the fungus.

The best way to avoid infection is to take precautions when near moist soil, disturbed soil or participating in activities in heavily wooded areas.

PHDM recommends wearing personal protective equipment, like face masks, eye protection and gloves when “engaging in higher risk activities.” It also recommends waiting to move leaf litter until it is dry and avoiding moving or disturbing soil on windy days.