Salomon J, Flament Saillour M, De Truchis P, Bougnoux M E, Dromer F, Dupont B, de Saint-Hardouin G, Perronne C
Department of Infectious Diseases and Internal Medicine, Raymond Poincaré University Hospital, 104 Boulevard Raymond Poincaré, 92-380 Garches, France.
J Travel Med. 2003 Mar-Apr;10(2):87-93. doi: 10.2310/7060.2003.31755.
Thirteen clustered cases of American histoplasmosis, a deep mycosis caused by Histoplasma capsulatum and acquired through inhalation of airborne spores was reported. Twenty-five persons traveled in Martinique, French West Indies. Thirteen underwent trekking and passed through a mountain tunnel full of bats (tunnel group). The 12 others performed canyoning and did not go through the tunnel (control group). Fifteen days after exposure, 1 patient of the tunnel group developed fever, chills, and cough.
The index case was diagnosed in the hospital, but 12 cases where initially diagnosed as prolonged influenza. All individuals were contacted and submitted to a phone questionnaire. They were asked about eventual occurrence of influenzalike symptoms, about activities practiced, and the notion of contact with bats. All were invited to have clinical examinations, chest x-ray films, and blood samplings. Serologic testing for histoplasmosis was performed by immunodiffusion. Clinical evidence of infection with H. capsulatum was obtained in all the remaining patients of the tunnel group and in none in the control group. Symptoms occurred with an acute onset in 11 to 23 days: fever and chills, severe asthenia, headaches, digestive tract involvement, and then cough, dyspnea, hepatic involvement. Pulmonary micro- or macronodules and mediastinal adenopathies were seen on radiograph and/or computed tomography scan.
H. capsulatum serologic tests were positive in all 13 cases with presence of specific M and or H precipitins, 5 to 13 weeks after exposure, and were negative in control group. All patients were treated with itraconazole 200 mg per day during at least 2 months. Treatment was well tolerated; patients progressively recovered. Clinical and serologic follow-up was obtained for some patients at 1 and 4 years. The present study reports the first large outbreak of histoplasmosis acquired in Martinique.
Histoplasmosis still occurs and is potentially serious. In patients returning from endemic areas, presenting prolonged influenzalike symptoms, clinicians should look for previous possible exposure to Histoplasma.
报告了13例聚集性美洲组织胞浆菌病病例，该病是由荚膜组织胞浆菌引起的深部真菌病，通过吸入空气中的孢子而感染。25人前往法属西印度群岛的马提尼克岛旅行。其中13人进行了徒步旅行并穿过了一个满是蝙蝠的山间隧道（隧道组）。另外12人进行了峡谷探险且未穿过隧道（对照组）。接触后15天，隧道组中有1名患者出现发热、寒战和咳嗽。
首例病例在医院被诊断出来，但另外12例最初被诊断为持续性流感。所有个体均被联系并接受了电话问卷调查。询问了他们是否出现过类似流感的症状、所进行的活动以及与蝙蝠接触的情况。所有患者均被邀请进行临床检查、胸部X光片和血液采样。通过免疫扩散法进行组织胞浆菌病的血清学检测。在隧道组的所有其余患者中均获得了荚膜组织胞浆菌感染的临床证据，而对照组中无一例出现。症状在11至23天内急性发作：发热、寒战、严重乏力、头痛、消化道受累，随后出现咳嗽、呼吸困难、肝脏受累。在X光片和/或计算机断层扫描上可见肺部微结节或大结节以及纵隔淋巴结肿大。
所有13例患者的荚膜组织胞浆菌血清学检测均呈阳性，出现特异性M和/或H沉淀素，接触后5至13周，对照组检测结果为阴性。所有患者均接受了每天200毫克伊曲康唑治疗，至少持续2个月。治疗耐受性良好；患者逐渐康复。部分患者在1年和4年时进行了临床和血清学随访。本研究报告了在马提尼克岛首次发生的大规模组织胞浆菌病暴发。
组织胞浆菌病仍然存在且可能很严重。对于从流行地区返回且出现持续性类似流感症状的患者，临床医生应寻找先前可能接触荚膜组织胞浆菌的情况。
