Vol 63, No 1 (2012)
Original article
Submitted: 2013-02-18
Published online: 2012-06-05
Outbreak of pulmonary histoplasmosis involving a group of four Polish travellers returning from Ecuador
Piotr Kajfasz, Wojciech Basiak
Vol 63, No 1 (2012)
MARITIME MEDICINE Original article
Submitted: 2013-02-18
Published online: 2012-06-05
Abstract
Exploring caves is, without doubt, a very exciting adventure; however, it carries some dangers.
Three of four travellers were admitted to hospital with lung changes after returning from Ecuador,
successively. Epidemiological studies revealed that the travellers visited caves infested by
bats, and had contact with bats’ guano. They gave a history of fever, fatigue, myalgia, dry cough,
and chest pain during the stay or just after returning from Ecuador. In two patients, symptoms
persisted in mild nature. Chest X-ray films showed diffuse nodules (coin-like lesions) in the lungs
in each case. Histoplasmosis was taken into consideration. Differential diagnosis included paragonimiasis,
pulmonary tuberculosis, and pulmonary infection of other causes. Direct examination
of sputum was negative. Cultures were negative. Final diagnosis was made on epidemiological
histories, as well as typical radiological changes, and was supported by positive tests for
antibodies to Histoplasma capsulatum. Immunodiffusion test (ID), complement fixation test (CFTs),
and Western blot test were positive. In two cases antifungal treatment was established. Ketoconazole
followed by Itraconazole were used. Persons who are going to explore caves should be
equipped with anti-dusk masks to prevent pulmonary histoplasmosis. The threat of Histoplasma
capsulatum infection in bat-inhabited caves should be emphasized to travellers and also to
physicians.
Abstract
Exploring caves is, without doubt, a very exciting adventure; however, it carries some dangers.
Three of four travellers were admitted to hospital with lung changes after returning from Ecuador,
successively. Epidemiological studies revealed that the travellers visited caves infested by
bats, and had contact with bats’ guano. They gave a history of fever, fatigue, myalgia, dry cough,
and chest pain during the stay or just after returning from Ecuador. In two patients, symptoms
persisted in mild nature. Chest X-ray films showed diffuse nodules (coin-like lesions) in the lungs
in each case. Histoplasmosis was taken into consideration. Differential diagnosis included paragonimiasis,
pulmonary tuberculosis, and pulmonary infection of other causes. Direct examination
of sputum was negative. Cultures were negative. Final diagnosis was made on epidemiological
histories, as well as typical radiological changes, and was supported by positive tests for
antibodies to Histoplasma capsulatum. Immunodiffusion test (ID), complement fixation test (CFTs),
and Western blot test were positive. In two cases antifungal treatment was established. Ketoconazole
followed by Itraconazole were used. Persons who are going to explore caves should be
equipped with anti-dusk masks to prevent pulmonary histoplasmosis. The threat of Histoplasma
capsulatum infection in bat-inhabited caves should be emphasized to travellers and also to
physicians.
Keywords
Histoplasma capsulatum; pulmonary histoplasmosis; bat-inhabited caves; exposure; source of infection; outbreaks
Title
Outbreak of pulmonary histoplasmosis involving a group of four Polish travellers returning from Ecuador
Journal
International Maritime Health
Issue
Vol 63, No 1 (2012)
Article type
Original article
Pages
59-62
Published online
2012-06-05
Page views
609
Article views/downloads
2109
Bibliographic record
IMH 2012;63(1):59-62.
Keywords
Histoplasma capsulatum
pulmonary histoplasmosis
bat-inhabited caves
exposure
source of infection
outbreaks
Authors
Piotr Kajfasz
Wojciech Basiak