A large outbreak of histoplasmosis among American travelers associated with a hotel in Acapulco, Mexico, spring 2001.
During spring 2001, college students from Pennsylvania reported an acute febrile respiratory illness after returning from spring break vacation in Acapulco, Mexico. Acute pulmonary histoplasmosis was presumptively diagnosed and the cluster of illness was reported to the Centers of Disease Control and Prevention. A large investigation then ensued, which included finding student-travelers for interviews and requesting sera for histoplasmosis testing. We defined a clinical case by fever and at least one of the following: cough, shortness of breath, chest pain, or headache, in an Acapulco traveler during March-May 2001. A laboratory-confirmed case had positive serology. An initial study determined that the likely site of histoplasmosis exposure was Hotel H; we therefore performed a large cohort study among travelers who stayed at Hotel H. Of 757 contacted, 262 (36%) met the clinical case definition. Of 273 serum specimens tested, 148 (54%) were positive. Frequent use of Hotel H's stairwells, where construction was ongoing, was associated with increased risk of illness (relative risk = 10.5, 95% confidence interval = 3.7-30.5; P < 0.001). This is the first histoplasmosis outbreak associated with a hotel undergoing construction. Hotels in endemic areas should consider construction precaution measures to prevent histoplasmosis among their guests.
Morgan
Juliette
J
Mycotic Diseases Branch, Division of Bacterial and Mycotic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA. JMorgan1@cdc.gov
Cano
Maria V
MV
Feikin
Daniel R
DR
Phelan
Maureen
M
Monroy
Oscar Velazquez
OV
Morales
Pablo Kuri
PK
Carpenter
Joseph
J
Weltman
Andre
A
Spitzer
Peter G
PG
Liu
Hans H
HH
Mirza
Sara A
SA
Bronstein
David E
DE
Morgan
Daniel J
DJ
Kirkman
Laura A
LA
Brandt
Mary E
ME
Iqbal
Naureen
N
Lindsley
Mark D
MD
Warnock
David W
DW
Hajjeh
Rana A
RA
D000293:Adolescent; D000328:Adult; D015331:Cohort Studies; D004196:Disease Outbreaks; D005260:Female; D005334:Fever; D006660:Histoplasmosis / Q000097:blood / Q000453:epidemiology* / Q000209:etiology; D006798:Housing; D006801:Humans; D008172:Lung Diseases, Fungal / Q000097:blood / Q000453:epidemiology* / Q000209:etiology; D008297:Male; D008800:Mexico / Q000453:epidemiology; D008875:Middle Aged; D010414:Pennsylvania; D014195:Travel