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Published Date: 2018-12-05 23:15:04
Subject: PRO/EDR> Histoplasmosis - USA: (LA) scout camp attendees
Archive Number: 20181205.6182707
A ProMED-mail post
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International Society for Infectious Diseases

Date: Tue 4 Dec 2018
Source: WAFB [edited]

The Istrouma Area Council of Boy Scouts of America, along with the Louisiana Department of Health (LDH), has closed a campsite on Avondale Scout Reservation to investigate cases of a disease that hospitalized 2 campers, sparking the involvement of the Centers for Disease Control and Prevention (CDC). Louisiana State Epidemiologist Raoult Ratard, speaking for the LDH, tells WAFB at least 15 campers may have been exposed to histoplasmosis, a disease spread through exposure to soil contaminated with bat or bird droppings.

Histoplasmosis is not contagious; it cannot be transmitted from an infected person or animal to another person, and infection does not always result in illness. Symptoms, when present, usually begin 3 to 17 days after exposure and range from mild conditions requiring no treatment to severe systemic illness that is frequently fatal when untreated, according to a report provided by the LDH. The illness is typically flulike, with symptoms such as fever, cough, fatigue, chills, headache, chest pain, and body aches.

"We are aware of reports from Avondale Scout Reservation that some participants were experiencing possible respiratory illness. All of those impacted have received medical attention and 2 participants remain in medical care. Our thoughts are with those who became ill and we pray for their speedy recovery. We will continue to support them however we can," said Gary Mertz, scout executive/CEO for Istrouma Area Council, Boy Scouts of America. A spokesman for the CDC confirmed they were alerted to a case of histoplasmosis by the LDH and are in communication with the department.

Ratard described the incident as isolated, saying investigators had located a tree frequented by birds where they believe the campers may have been exposed to the disease. Ratard did not predict there to be a greater risk to the public related because of this outbreak, but offered a warning for community members to avoid disturbing risk areas, like holes in trees and piles of leaves where animal droppings carrying the disease may be out of site. According to Ratard, those areas may become wet because of rainfall, hiding the droppings from plain sight when they dry.

In Louisiana's history, only 8 hospitalizations due to histoplasmosis have been confirmed between 1999 and 2014 in the region encompassing Ascension, East Baton Rouge, East Feliciana, West Baton Rouge, West Feliciana, Iberville, and Pointe Coupee parishes, according to information provided by the LDH. Avondale Scout Reservation will remain open as originally scheduled, as supported by the LDH.

[Byline: Kevin Foster]

Communicated by:
ProMED-mail from HealthMap Alerts

[_Histoplasma capsulatum_, a dimorphic fungus, is found worldwide in soil enriched by bird or bat droppings. Fungal spores become airborne during activities that disturb the contaminated soil, such as spelunking, mining, construction, excavation, demolition, roofing, chimney cleaning, farming, or gardening, which can lead to clusters of cases of histoplasmosis that follow inhalation of the aerosolized spores. The spores can travel distances downstream from the source in currents of air. Because contaminated soil can be potentially infectious for years, appropriate measures should be taken before starting work where dirt has been contaminated by bat or bird droppings to protect the health of persons in and around the area (https://idph.iowa.gov/cade/disease-information/histoplasmosis).

Birds cannot be infected by the fungus and do not transmit the disease; however, bats can become infected by _H. capsulatum_ and may harbor the fungus in their gut (https://academic.oup.com/jtm/article/15/2/133/1801173).

In the USA, histoplasmosis is endemic in the Ohio, Missouri, and Mississippi river valleys, where it is caused by _H. capsulatum_ var. _capsulatum_. In Africa, histoplasmosis occurs most commonly in west and central Africa, particularly where it is caused by the _duboisii_ variety, which has yeast cells that average about twice the size of _H. capsulatum_ var. _capsulatum_ (http://www.reviberoammicol.com/1997-14/155159.pdf).

Most individuals with histoplasmosis are asymptomatic. The symptoms of histoplasmosis are nonspecific and similar to pneumonia from any cause. However, the pulmonary infection can disseminate throughout the body, and immunocompromised individuals, e.g., patients with HIV/AIDS, may develop a severe form of histoplasmosis called progressive disseminated disease. _H. capsulatum _ var. _duboisii_ commonly involves the skin, bones, and lymph nodes.

Histoplasmosis cannot be transmitted from person to person or from animals to people. Antifungal drugs are used to manage severe cases of acute histoplasmosis and all cases of chronic pulmonary or disseminated disease. For treatment guidelines, see Clinical practice guidelines for the management of patients with histoplasmosis: 2007 update by the Infectious Diseases Society of America. Clin Infect Dis 2007;45:807-825. Available at http://cid.oxfordjournals.org/content/45/7/807.full.

More information on histoplasmosis can be found at https://www.cdc.gov/fungal/diseases/histoplasmosis/.

Avondale Scout Reservation is located on LA Highway 10, 3 miles [4.8 km] east of Clinton, Louisiana, in East Feliciana Parish and has more than 1665 acres of evergreen and hardwood forest, fields, lakes, and abundant wildlife (https://www.iacbsa.org/avondalesr). A map of the reservation can be found at https://www.iacbsa.org/files/10860/Avondale-Reservation, and a map of Louisiana showing the location of Avondale Scout Reservation can be found at https://www.google.com/maps/place/Avondale+Scout+Reservation. - Mod.ML

HealthMap/ProMED-mail map:
Louisiana, United States: http://healthmap.org/promed/p/221]

See Also

Histoplasmosis - Congo DR: (CC) var. duboisii, bat guano, 2011-2014 20181111.6139263
Histoplasmosis - Dominican Republic: (ST) tunnel cleaners, 2015 20171208.5491922
Histoplasmosis - Brazil: (DF) firefighters, bat cave 20170613.5102803
Histoplasmosis - Dominican Republic (02): (ST) tunnel cleaners, update 20150924.3668692
Histoplasmosis - Dominican Republic: (ST) tunnel cleaners 20150918.3654521
Histoplasmosis - Canada: (QC) house renovation 20140104.2150895
Histoplasmosis - USA: (MT) expanded range 20131026.2020454
Histoplasmosis - USA: (IL) prison 20130920.1958172
Histoplasmosis, researchers - UK: ex Uganda, 2011 20130311.1581417
Histoplasmosis - USA (02): travelers, comment 20120922.1304707
Histoplasmosis - USA: (NE) day camp attendees 20120920.1303165
Histoplasmosis - South Africa: (GT) 20120727.1217158
Histoplasmosis, researchers - UK: ex Uganda, alert 20110908.2738
Histoplasmosis, travelers - USA ex El Salvador (02): background 20081222.4030
Histoplasmosis, travelers - USA ex El Salvador 20081219.3994
Histoplasmosis - Taiwan: 1st indigenous case 20070118.0230
Histoplasmosis, researchers - Italy ex Ecuador: alert 20060825.2399

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