title: A large outbreak of histoplasmosis among American travelers associated with a hotel in Acapulco, Mexico, spring 2001.
abstract: 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.
authors.affiliation: 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
authors.forename: Juliette
authors.initials: J
authors.lastname: Morgan
authors.forename: Maria V
authors.initials: MV
authors.lastname: Cano
authors.forename: Daniel R
authors.initials: DR
authors.lastname: Feikin
authors.forename: Maureen
authors.initials: M
authors.lastname: Phelan
authors.forename: Oscar Velazquez
authors.initials: OV
authors.lastname: Monroy
authors.forename: Pablo Kuri
authors.initials: PK
authors.lastname: Morales
authors.forename: Joseph
authors.initials: J
authors.lastname: Carpenter
authors.forename: Andre
authors.initials: A
authors.lastname: Weltman
authors.forename: Peter G
authors.initials: PG
authors.lastname: Spitzer
authors.forename: Hans H
authors.initials: HH
authors.lastname: Liu
authors.forename: Sara A
authors.initials: SA
authors.lastname: Mirza
authors.forename: David E
authors.initials: DE
authors.lastname: Bronstein
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Morgan
authors.forename: Laura A
authors.initials: LA
authors.lastname: Kirkman
authors.forename: Mary E
authors.initials: ME
authors.lastname: Brandt
authors.forename: Naureen
authors.initials: N
authors.lastname: Iqbal
authors.forename: Mark D
authors.initials: MD
authors.lastname: Lindsley
authors.forename: David W
authors.initials: DW
authors.lastname: Warnock
authors.forename: Rana A
authors.initials: RA
authors.lastname: Hajjeh
mesh_terms: 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