open access

Vol 63, No 1 (2012)
Original article
Submitted: 2013-02-18
Published online: 2012-06-05
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Outbreak of pulmonary histoplasmosis involving a group of four Polish travellers returning from Ecuador

Piotr Kajfasz, Wojciech Basiak
International Maritime Health 2012;63(1):59-62.

open access

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.
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Keywords

Histoplasma capsulatum; pulmonary histoplasmosis; bat-inhabited caves; exposure; source of infection; outbreaks

About this article
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

Bibliographic record

International Maritime Health 2012;63(1):59-62.

Keywords

Histoplasma capsulatum
pulmonary histoplasmosis
bat-inhabited caves
exposure
source of infection
outbreaks

Authors

Piotr Kajfasz
Wojciech Basiak

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