Outbreak of pulmonary histoplasmosis involving a group of four Polish travellers returning from Ecuador.
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.
Department of Zoonoses and Tropical Diseases, Medical University of Warsaw, Warsaw, Poland. piotr.t.kajfasz@gmail.com
Piotr
P
Kajfasz
Wojciech
W
Basiak
D000328:Adult; D000818:Animals; D059552:Caves / Q000469:parasitology*; D002685:Chiroptera; D004196:Disease Outbreaks; D004484:Ecuador / Q000453:epidemiology; D005260:Female; D006658:Histoplasma / Q000302:isolation & purification*; D006660:Histoplasmosis / Q000175:diagnosis / Q000453:epidemiology* / Q000635:transmission; D006801:Humans; D008171:Lung Diseases / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000453:epidemiology*; D008297:Male; D011044:Poland / Q000453:epidemiology; D011859:Radiography; D014195:Travel / Q000706:statistics & numerical data*; D057236:Travel Medicine / Q000706:statistics & numerical data*; D055815:Young Adult