Tags

Type your tag names separated by a space and hit enter

Outbreak of Severe Histoplasmosis Among Tunnel Workers-Dominican Republic, 2015.
Clin Infect Dis. 2018 05 02; 66(10):1550-1557.CI

Abstract

Background

Histoplasmosis is a fungal infection associated with exposure to bat guano. An outbreak of an unknown severe febrile illness occurred among tunnel workers in the Dominican Republic, and resulted in several deaths. We conducted an investigation to confirm etiology and recommend control measures.

Methods

A case was defined as fever and ≥2 symptoms consistent with histoplasmosis in a tunnel worker, July-September 2015. We interviewed workers and family members, reviewed medical records, tested serum and urine for Histoplasma antigen/antibody, and conducted a cohort study to identify risk factors for histoplasmosis and severe infection (intensive care).

Results

A crew of 36 male workers removed large amounts of bat guano from tunnels without respiratory protection for a median of 24 days per worker (range, 1-25 days). Median age was 32 years (range, 18-62 years); none were immunocompromised. Thirty (83%) workers had illness that met the case definition, of whom 28 (93%) were hospitalized, 9 (30%) required intensive care, 6 (20%) required intubation, and 3 (10%) died. The median time from symptom onset to antifungal treatment was 6 days (range, 1-11 days). Twenty-two of 34 (65%) workers had laboratory evidence of infection.

Conclusions

Severe illnesses and death likely resulted from exposure to large inocula of Histoplasma capsulatum spores in an enclosed space, lack of respiratory protection, and delay in recognition and treatment. Clinician education about histoplasmosis, improved laboratory capacity to diagnose fungal infections, and occupational health guidance to protect workers against endemic fungi are recommended in the Dominican Republic.

Authors+Show Affiliations

Epidemic Intelligence Service, Mycotic Diseases Branch, Division of Foodborne, Waterborne, and Environmental Diseases (DFWED), National Center for Emerging and Zoonotic Infectious Diseases (NCEZID), Centers for Disease Control and Prevention (CDC), Atlanta, Georgia.Epidemic Intelligence Service, Industrywide Studies Branch, Division of Surveillance, Hazard Evaluations and Field Studies, National Institute for Occupational Safety and Health (NIOSH), Cincinnati, Ohio.Centers for Disease Control and Prevention, Santo Domingo, Dominican Republic.Centers for Disease Control and Prevention, Santo Domingo, Dominican Republic.Mycotic Diseases Branch DFWED, NCEZID, CDC, Atlanta, Georgia.Epidemic Intelligence Service, Global Water, DFWED, NCEZID, CDC, Atlanta, Georgia.Dirección General de Epidemiología, Santo Domingo, Dominican Republic.Dirección General de Epidemiología, Santo Domingo, Dominican Republic.Mycotic Diseases Branch DFWED, NCEZID, CDC, Atlanta, Georgia.Hazard Evaluations and Technical Assistance Branch, Division of Surveillance, Hazard Evaluations and Field Studies, NIOSH, Cincinnati, Ohio.Dirección General de Epidemiología, Santo Domingo, Dominican Republic.Mycotic Diseases Branch DFWED, NCEZID, CDC, Atlanta, Georgia.

Pub Type(s)

Journal Article
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

29211836

Citation

Armstrong, Paige A., et al. "Outbreak of Severe Histoplasmosis Among Tunnel Workers-Dominican Republic, 2015." Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America, vol. 66, no. 10, 2018, pp. 1550-1557.
Armstrong PA, Beard JD, Bonilla L, et al. Outbreak of Severe Histoplasmosis Among Tunnel Workers-Dominican Republic, 2015. Clin Infect Dis. 2018;66(10):1550-1557.
Armstrong, P. A., Beard, J. D., Bonilla, L., Arboleda, N., Lindsley, M. D., Chae, S. R., Castillo, D., Nuñez, R., Chiller, T., de Perio, M. A., Pimentel, R., & Vallabhaneni, S. (2018). Outbreak of Severe Histoplasmosis Among Tunnel Workers-Dominican Republic, 2015. Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America, 66(10), 1550-1557. https://doi.org/10.1093/cid/cix1067
Armstrong PA, et al. Outbreak of Severe Histoplasmosis Among Tunnel Workers-Dominican Republic, 2015. Clin Infect Dis. 2018 05 2;66(10):1550-1557. PubMed PMID: 29211836.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Outbreak of Severe Histoplasmosis Among Tunnel Workers-Dominican Republic, 2015. AU - Armstrong,Paige A, AU - Beard,John D, AU - Bonilla,Luis, AU - Arboleda,Nelson, AU - Lindsley,Mark D, AU - Chae,Sae-Rom, AU - Castillo,Delia, AU - Nuñez,Ramona, AU - Chiller,Tom, AU - de Perio,Marie A, AU - Pimentel,Raquel, AU - Vallabhaneni,Snigdha, PY - 2017/07/21/received PY - 2017/11/29/accepted PY - 2017/12/7/pubmed PY - 2019/10/12/medline PY - 2017/12/7/entrez SP - 1550 EP - 1557 JF - Clinical infectious diseases : an official publication of the Infectious Diseases Society of America JO - Clin Infect Dis VL - 66 IS - 10 N2 - Background: Histoplasmosis is a fungal infection associated with exposure to bat guano. An outbreak of an unknown severe febrile illness occurred among tunnel workers in the Dominican Republic, and resulted in several deaths. We conducted an investigation to confirm etiology and recommend control measures. Methods: A case was defined as fever and ≥2 symptoms consistent with histoplasmosis in a tunnel worker, July-September 2015. We interviewed workers and family members, reviewed medical records, tested serum and urine for Histoplasma antigen/antibody, and conducted a cohort study to identify risk factors for histoplasmosis and severe infection (intensive care). Results: A crew of 36 male workers removed large amounts of bat guano from tunnels without respiratory protection for a median of 24 days per worker (range, 1-25 days). Median age was 32 years (range, 18-62 years); none were immunocompromised. Thirty (83%) workers had illness that met the case definition, of whom 28 (93%) were hospitalized, 9 (30%) required intensive care, 6 (20%) required intubation, and 3 (10%) died. The median time from symptom onset to antifungal treatment was 6 days (range, 1-11 days). Twenty-two of 34 (65%) workers had laboratory evidence of infection. Conclusions: Severe illnesses and death likely resulted from exposure to large inocula of Histoplasma capsulatum spores in an enclosed space, lack of respiratory protection, and delay in recognition and treatment. Clinician education about histoplasmosis, improved laboratory capacity to diagnose fungal infections, and occupational health guidance to protect workers against endemic fungi are recommended in the Dominican Republic. SN - 1537-6591 UR - https://www.unboundmedicine.com/medline/citation/29211836/full_citation L2 - https://academic.oup.com/cid/article-lookup/doi/10.1093/cid/cix1067 DB - PRIME DP - Unbound Medicine ER -