Lyon George M, Bravo Ana V, Espino Aracelly, Lindsley Mark D, Gutierrez Rosa E, Rodriguez Isabel, Corella Ana, Carrillo Flora, McNeil Michael M, Warnock David W, Hajjeh Rana A
Mycotic Diseases Branch, Division of Bacterial and Mycotic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.
Am J Trop Med Hyg. 2004 Apr;70(4):438-42.
Between October 1998 and April 1999, 51 persons belonging to two separate groups developed acute pulmonary histoplasmosis after visiting a cave in Costa Rica. The first group consisted of 61 children and 14 adults from San Jose, Costa Rica; 44 (72%) were diagnosed with acute histoplasmosis. The second group comprised 14 tourists from the United States and Canada; 9 (64%) were diagnosed with histoplasmosis. After a median incubation time of 14 days, the most common symptoms were headache, fever, cough, and myalgias. Risk factors for developing histoplasmosis included crawling (odds ratio [OR] = 17.5, 95% confidence interval [CI] = 2.3-802) and visiting one specific room (OR = 3.4, 95% CI = 1.0-12.3) in the cave. Washing hands (OR = 0.1, 95% CI = 0.01-0.6) after exiting the cave was associated with a decreased risk of developing histoplasmosis. Histoplasma capsulatum was isolated from bat guano collected from inside the cave. Persons who explore caves, whether for recreation or science, should be aware of the risk bat-inhabited caves pose for developing histoplasmosis, especially if they are immunocompromised in any way.
1998年10月至1999年4月期间，两组共51人在游览哥斯达黎加的一个洞穴后患上了急性肺组织胞浆菌病。第一组由来自哥斯达黎加圣何塞的61名儿童和14名成年人组成；其中44人（72%）被诊断为急性组织胞浆菌病。第二组包括14名来自美国和加拿大的游客；其中9人（64%）被诊断为组织胞浆菌病。中位潜伏期为14天后，最常见的症状是头痛、发热、咳嗽和肌痛。患组织胞浆菌病的危险因素包括在洞穴中爬行（比值比[OR]=17.5，95%置信区间[CI]=2.3 - 802）以及进入洞穴中的一个特定房间（OR = 3.4，95% CI = 1.0 - 12.3）。离开洞穴后洗手（OR = 0.1，95% CI = 0.01 - 0.6）与患组织胞浆菌病风险降低相关。从洞穴内收集的蝙蝠粪便中分离出了荚膜组织胞浆菌。无论是出于娱乐还是科学目的探索洞穴的人，都应该意识到蝙蝠栖息的洞穴会带来患组织胞浆菌病的风险，特别是如果他们在任何方面存在免疫功能低下的情况。
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