A Multinational Outbreak of Histoplasmosis Following a Biology Field Trip in the Ugandan Rainforest
A Multinational Outbreak of Histoplasmosis Following a Biology Field Trip in the Ugandan Rainforest
复制标题
DOI：
10.1111/jtm.12012
复制
发表时间：
2013-03-01
影响因子：
25.7
通讯作者：
Beeching, Nicholas J.
中科院分区：
文献类型：
--
作者：
Cottle, Lucy E.;Gkrania-Klotsas, Effrossyni;Beeching, Nicholas J.
背景 组织胞浆菌病的爆发越来越多地与前往流行地区旅行有关。据报道，前往美洲旅行后爆发了多起疫情，但短期前往非洲的免疫功能正常的旅行者中发生肺组织胞浆菌病的报道很少。方法 一名生物学学生从乌干达雨林实地考察归来后，被转诊至我们单位，疑似患有肺组织胞浆菌病。该患者告诉我们，她的几位参加同一探险队的跨国学生同事也患有类似的疾病。通过 ProMED 邮件中的警报和向每位有症状的学生转发的调查问卷，我们积累了与此次明显的肺组织胞浆菌病爆发有关的其他病例的数据。结果 24 名学生中有 13 名在探险结束后出现呼吸道症状。胸部X光检查常常提示粟粒性结核，但在大多数情况下，最终诊断为组织胞浆菌病（5例经血清学确诊，6例经临床诊断，2例经回顾性怀疑）。详细询问表明，可能的来源是雨林中一棵被蝙蝠出没的空心大树。结论 这是一次前往非洲短期旅行后不寻常的组织胞浆菌病暴发。对于从流行地区返回或报告表明暴露的活动的旅行者，在急性发热性呼吸道疾病的鉴别诊断中，应始终考虑肺组织胞浆菌病。
Background Outbreaks of histoplasmosis have been increasingly reported in association with travel to endemic areas. Multiple outbreaks have been reported following travel to the Americas, but reports of pulmonary histoplasmosis in short-term immunocompetent travelers to Africa are rare. Methods A biology student was referred to our unit with suspected pulmonary histoplasmosis following her return from a field trip in the Ugandan rainforest. The patient informed us that several of her multinational student colleagues on the same expedition had developed a similar illness. Using an alert in ProMED-mail and a questionnaire forwarded to each of the symptomatic students, we accumulated data on the other cases involved in this apparent outbreak of pulmonary histoplasmosis. Results Thirteen of 24 students developed respiratory symptoms following the expedition. Chest X-ray appearances were often suggestive of miliary tuberculosis but in most cases a final diagnosis of histoplasmosis was made (confirmed with serology in five cases, clinically diagnosed in six, and retrospectively suspected in two). Detailed questioning indicated that the likely source was a large hollow bat-infested tree within the rainforest. Conclusions This is an unusual outbreak of histoplasmosis following short-term travel to Africa. Pulmonary histoplasmosis should always be considered in the differential diagnosis of an acute febrile respiratory illness in travelers returning from endemic areas or reporting activities suggesting exposure.