Outbreak of Severe Histoplasmosis Among Tunnel Workers – Dominican Republic, 2015

Details

• Personal Author:
  Arboleda N ; Armstrong PA ; Beard JD ; Bonilla L ; Castillo, Dawn N. ; Chae S-R ; Chiller T ; De Perio, Marie A. ; Lindsley MD ; Nuñez R ; Pimentel R ; Vallabhaneni S
  More +
• Description:
  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 (DR), 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). Median age was 32 years (range: 18-62); 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). Twenty-two of 34 (65%) workers had laboratory evidence of histoplasmosis 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 DR to prevent future outbreaks. Description provided by NIOSH
• Subjects:
  • Cohort Studies
  • Fungi
  • Hazardous Substances
  • Hazardous Waste
  • Men
  • Mortality
  • Occupational Exposure
  • Occupational Health
  • Risk Assessment
  • Risk Factors
  More +
• Keywords:
  • Histoplasmosis
  • Fungal diseases
  • Fungal infections
  • Fungi
  • Tunnel workers
  • Animal waste
  • Hazardous waste
  • Hazardous waste cleanup
  • Mortality data
  • Medical treatment
  More +
• ISSN:
  1058-4838
• Document Type:
  Text
• Genre:
  Journal Article
• Place as Subject:
  Georgia ; Ohio ; OSHA Region 4 ; OSHA Region 5 ; OSHA Region 8 ; Utah
• CIO:
  National Institute for Occupational Safety and Health (NIOSH)
• Division:
  DSHEFS - Division of Surveillance, Hazard Evaluations, and Field Studies
• Topic:
  Workplace Safety & Health
• Location:
  North America
• Volume:
  66
• Issue:
  2
• NIOSHTIC Number:
  nn:20050809
• Citation:
  Clin Infect Dis 2018 May; 66(2):1550-1557
• Contact Point Address:
  Paige Armstrong, MD MHS, Centers for Disease Control and Prevention, 1600 Clifton Road, MS C-09, Atlanta, GA 30329
• Email:
  YZU9@cdc.gov
• Federal Fiscal Year:
  2018
• NORA Priority Area:
  Manufacturing
• Peer Reviewed:
  True
• Source Full Name:
  Clinical Infectious Diseases
• Download URL:
  https://stacks.cdc.gov/view/cdc/211021/cdc_211021_DS1.pdf
• File Type:
  [PDF - 753.55 KB]
• Collection(s):
  National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:981c7228ee5307be479507a5a0067cbe36c404b20ad953c7f59964084a8975b0e9c88bee7e2f3741a25a6b13fd3574c0cdd177dbce3fd1a4a92149b16e4ea006