Histoplasmosis associated with exploring a bat-inhabited cave in Costa Rica, 1998-1999.
Between October 1998 and April 1999, 51 persons belonging to two separate groups developed acute pulmonary histoplasmosis after visiting a cave in Costa Rica. The first group consisted of 61 children and 14 adults from San Jose, Costa Rica; 44 (72%) were diagnosed with acute histoplasmosis. The second group comprised 14 tourists from the United States and Canada; 9 (64%) were diagnosed with histoplasmosis. After a median incubation time of 14 days, the most common symptoms were headache, fever, cough, and myalgias. Risk factors for developing histoplasmosis included crawling (odds ratio [OR] = 17.5, 95% confidence interval [CI] = 2.3-802) and visiting one specific room (OR = 3.4, 95% CI = 1.0-12.3) in the cave. Washing hands (OR = 0.1, 95% CI = 0.01-0.6) after exiting the cave was associated with a decreased risk of developing histoplasmosis. Histoplasma capsulatum was isolated from bat guano collected from inside the cave. Persons who explore caves, whether for recreation or science, should be aware of the risk bat-inhabited caves pose for developing histoplasmosis, especially if they are immunocompromised in any way.
Lyon
George M
GM
Mycotic Diseases Branch, Division of Bacterial and Mycotic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA. gmlyon@emory.edu
Bravo
Ana V
AV
Espino
Aracelly
A
Lindsley
Mark D
MD
Gutierrez
Rosa E
RE
Rodriguez
Isabel
I
Corella
Ana
A
Carrillo
Flora
F
McNeil
Michael M
MM
Warnock
David W
DW
Hajjeh
Rana A
RA
D000293:Adolescent; D000328:Adult; D000368:Aged; D000818:Animals; D000907:Antibodies, Bacterial / Q000097:blood; D016022:Case-Control Studies; D002648:Child; D002685:Chiroptera / Q000382:microbiology*; D015331:Cohort Studies; D003168:Complement Fixation Tests; D003364:Costa Rica; D004196:Disease Outbreaks; D005243:Feces / Q000382:microbiology; D005260:Female; D006658:Histoplasma / Q000254:growth & development*; D006660:Histoplasmosis / Q000453:epidemiology / Q000382:microbiology*; D006801:Humans; D005779:Immunodiffusion; D008297:Male; D008875:Middle Aged; D012988:Soil Microbiology; D014195:Travel
D000907:Antibodies, Bacterial