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de Perio MA, Benedict K, Williams SL, Niemeier-Walsh C, Green BJ, Coffey C, Di Giuseppe M, Toda M, Park JH, Bailey RL, Nett RJ. Occupational Histoplasmosis: Epidemiology and Prevention Measures. J Fungi (Basel) 2021; 7:jof7070510. [PMID: 34206791 PMCID: PMC8306883 DOI: 10.3390/jof7070510] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 06/17/2021] [Accepted: 06/18/2021] [Indexed: 11/30/2022] Open
Abstract
In areas where Histoplasma is endemic in the environment, occupations involving activities exposing workers to soil that contains bird or bat droppings may pose a risk for histoplasmosis. Occupational exposures are frequently implicated in histoplasmosis outbreaks. In this paper, we review the literature on occupationally acquired histoplasmosis. We describe the epidemiology, occupational risk factors, and prevention measures according to the hierarchy of controls.
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Affiliation(s)
- Marie A. de Perio
- Office of the Director, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Cincinnati, OH 45226, USA
- Correspondence: ; Tel.: +1-(513)-841-4116
| | - Kaitlin Benedict
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA; (K.B.); (S.L.W.); (M.T.)
| | - Samantha L. Williams
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA; (K.B.); (S.L.W.); (M.T.)
| | - Christine Niemeier-Walsh
- Division of Field Studies and Engineering, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Cincinnati, OH 45226, USA;
| | - Brett J. Green
- Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, WV 26505, USA;
| | - Christopher Coffey
- National Personal Protective Technology Laboratory, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Pittsburgh, PA 15236, USA; (C.C.); (M.D.G.)
| | - Michelangelo Di Giuseppe
- National Personal Protective Technology Laboratory, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Pittsburgh, PA 15236, USA; (C.C.); (M.D.G.)
| | - Mitsuru Toda
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA; (K.B.); (S.L.W.); (M.T.)
| | - Ju-Hyeong Park
- Respiratory Health Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, WV 26505, USA; (J.-H.P.); (R.L.B.); (R.J.N.)
| | - Rachel L. Bailey
- Respiratory Health Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, WV 26505, USA; (J.-H.P.); (R.L.B.); (R.J.N.)
| | - Randall J. Nett
- Respiratory Health Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, WV 26505, USA; (J.-H.P.); (R.L.B.); (R.J.N.)
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Linder KA, Kauffman CA. Histoplasmosis: Epidemiology, Diagnosis, and Clinical Manifestations. CURRENT FUNGAL INFECTION REPORTS 2019. [DOI: 10.1007/s12281-019-00341-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Johnson ME, Rojas-Moreno C, Salzer W, Regunath H. Disseminated histoplasmosis in a patient with common variable immunodeficiency: A coincidence or the result of T cell defects? IDCases 2017; 10:105-107. [PMID: 29085780 PMCID: PMC5651550 DOI: 10.1016/j.idcr.2017.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 10/14/2017] [Accepted: 10/14/2017] [Indexed: 11/25/2022] Open
Abstract
T cell defects can be significant in common variable immunodeficiency. Abnormal T cell activation in common variable immunodeficiency can cause massive splenomegaly. Disseminated histoplasmosis can occur in common variable immunodeficiency as a result of such T cell defects.
Background In endemic regions, histoplasmosis is often seen in hosts with defective cell mediated immunity. We report a case of disseminated histoplasmosis in a patient with common variable immunodeficiency (CVID), a disorder mainly characterized by B cell defects. Case A 35 year old male with CVID developed fever, headache, dyspnea and pancytopenia within few weeks of swimming in the Tennessee River. After a non-revealing initial evaluation he was transferred to a tertiary facility for fever of unknown origin, where massive splenomegaly was noted. Clinical course was complicated by hypoxia from extensive bilateral lung infiltrates requiring non-invasive ventilation. Urine and serum Histoplasma antigens were positive. He was treated with liposomal amphotericin B followed by itraconazole after clinical improvement within 48 h and discharged home by day 6. Fungal blood cultures sent on day 1 grew Histoplasma capsulatum on day 19. After 5 months splenomegaly completely resolved and he successfully completed one year of treatment with itraconazole. Conclusions Our case highlights the significance of T cell defects in CVID. More research focusing on T cell defects in CVID is required to understand the extent of vulnerability to such intracellular pathogens in CVID.
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Key Words
- AST, aspartate aminotransferase
- B, basophils
- CT, computed tomography
- CVID, common variable immuno deficiency
- Common variable immunodeficiency
- Fever of unknown origin
- HIV, human immuno deficiency virus
- Hb, hemoglobin
- Histoplamosis
- IVIG, intravenous immuno globulin
- L, lymphocytes
- LDH, lactate dehydrogenase
- M, monocytes
- Massive splenomegaly
- N, neutrophils
- PCT, procalcitonin
- Pancytopenia
- WBC, white blood cell
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Affiliation(s)
- Molly E Johnson
- Department of Medicine, University of Missouri, One Hospital Dr, Columbia, MO 65212, United States
| | - Christian Rojas-Moreno
- Department of Medicine - Divisions of Hospital Medicine and Infectious Diseases, University of Missouri, One Hospital Dr, Columbia, MO 65212, United States
| | - William Salzer
- Department of Medicine - Divisions of Hospital Medicine and Infectious Diseases, University of Missouri, One Hospital Dr, Columbia, MO 65212, United States
| | - Hariharan Regunath
- Department of Medicine - Divisions of Hospital Medicine, Infectious Diseases and Critical Care, University of Missouri, One Hospital Dr, Columbia, MO 65212, United States
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Insertional mutagenesis enables cleistothecial formation in a non-mating strain of Histoplasma capsulatum. BMC Microbiol 2010; 10:49. [PMID: 20158914 PMCID: PMC2834667 DOI: 10.1186/1471-2180-10-49] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2009] [Accepted: 02/16/2010] [Indexed: 12/30/2022] Open
Abstract
Background Histoplasma capsulatum is a pathogenic ascomycete fungus that rapidly loses mating ability in culture. Loss of mating ability, as well as the organism's low rate of targeted gene replacement, limits techniques available for genetic studies in H. capsulatum. Understanding molecular mechanisms regulating mating in this organism may allow us to reverse or prevent loss of mating in H. capsulatum strains, introducing a variety of classical genetics techniques to the field. We generated a strain, UC1, by insertional mutagenesis of the laboratory strain G217B, and found that UC1 acquired the ability to form mating structures called cleistothecia. The aim of this study was to determine the mechanism by which UC1 gained the ability to form cleistothecia. We also present initial studies demonstrating that UC1 can be used as a tool to determine molecular correlates of mating in H. capsulatum. Results The strain UC1 was found to have increased RNA levels of the mating locus transcription factor (MAT1-1-1), and the putative alpha pheromone (PPG1) compared to G217B. Agrobacterium-mediated transformation and integration of T-DNA from the vector pCB301-GFP-HYG were found to be partially responsible for the increased RNA levels of these genes; however, the site of integration appeared to play the largest role in the strain's ability to form cleistothecia. Silencing HMK1, a putative FUS3/KSS1 homolog, had no effect on cleistothecial production by UC1. Protein kinase C (PKC1) RNA and protein levels were increased in UC1 compared to G217B, and pheromone production was found to be linked with Pkc1 activity in H. capsulatum. Conclusions The site of the T-DNA integration event appears to play the largest role in UC1's ability to form cleistothecia. We show that the UC1 strain can be used as a tool to study cleistothecia production in H. capsulatum by manipulating the strain, or by identifying differences between UC1 and G217B. Using these approaches, we were able to link Pkc1 activity with pheromone production in H. capsulatum; however, further studies are required to determine molecular mechanisms behind this. These studies may reveal regulatory mechanisms that can be manipulated to restore mating ability in H. capsulatum laboratory strains.
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Linos A, Kirch W. Promoting Health for Working Women—Communicable Diseases. PROMOTING HEALTH FOR WORKING WOMEN 2008. [PMCID: PMC7121744 DOI: 10.1007/978-0-387-73038-7_7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Athena Linos
- Department of Hygiene, Epidemiology, and Medical Statistics School of Medicine, National and Kapodistrian University of Athens, 75 M. Asias Street, Goudi, Athens 115 27
| | - Wilhelm Kirch
- Research Association Public Health Saxony and Saxony-Anhalt, Medical Faculty Carl Gustav Carus Technische Universität Dresden, Fiedlerstr. 27, 0/307 Dresden Germany
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Abstract
Infection with Histoplasma capsulatum occurs commonly in areas in the Midwestern United States and Central America, but symptomatic disease requiring medical care is manifest in very few patients. The extent of disease depends on the number of conidia inhaled and the function of the host's cellular immune system. Pulmonary infection is the primary manifestation of histoplasmosis, varying from mild pneumonitis to severe acute respiratory distress syndrome. In those with emphysema, a chronic progressive form of histoplasmosis can ensue. Dissemination of H. capsulatum within macrophages is common and becomes symptomatic primarily in patients with defects in cellular immunity. The spectrum of disseminated infection includes acute, severe, life-threatening sepsis and chronic, slowly progressive infection. Diagnostic accuracy has improved greatly with the use of an assay for Histoplasma antigen in the urine; serology remains useful for certain forms of histoplasmosis, and culture is the ultimate confirming diagnostic test. Classically, histoplasmosis has been treated with long courses of amphotericin B. Today, amphotericin B is rarely used except for severe infection and then only for a few weeks, followed by azole therapy. Itraconazole is the azole of choice following initial amphotericin B treatment and for primary treatment of mild to moderate histoplasmosis.
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Affiliation(s)
- Carol A Kauffman
- Infectious Diseases Division, Department of Internal Medicine, Ann Arbor Veterans Affairs Healthcare System, University of Michigan Medical School, Ann Arbor, MI, USA.
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Abstract
Understanding the uses and limitations of a battery of laboratory methods is essential to diagnose histoplasmosis. Antigen detection and serology are valuable adjuncts to histopathology and culture. Improvements incorporated into the second-generation Histoplasma antigen assay have increased its sensitivity and specificity for diagnosis of histoplasmosis. More recently, the antigen assay has been modified to provide quantitation, which improves reproducibility and facilitates monitoring antigen clearance during treatment. Furthermore, detection of antigen in bronchoalveolar lavage fluid increases the sensitivity for diagnosis of pulmonary histoplasmosis. Serological tests for antibodies are also useful, but may be falsely negative in immunosuppressed patients. In addition, elevated antibody titres persist for several years following initial infection, complicating their interpretation. Although histopathology may provide for rapid diagnosis, its sensitivity is < 50% in patients with disseminated disease and even lower in pulmonary histoplasmosis. Polymerase chain reaction has been described, but sensitivity is less than that of histopathology. Culture, although highly specific, has notable limitations, including insensitivity, a need for invasive procedures and delayed growth. This review provides the background for understanding the role of a battery of diagnostic methods in histoplasmosis. Tests facilitating a rapid diagnosis are expected to improve the outcome in patients with severe disease.
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Affiliation(s)
- L Joseph Wheat
- MiraVista Diagnostics and Mirabella Technologies, 4444 Decatur Blvd, Indianapolis, IN 46241, USA.
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Huhn GD, Austin C, Carr M, Heyer D, Boudreau P, Gilbert G, Eimen T, Lindsley MD, Cali S, Conover CS, Dworkin MS. Two outbreaks of occupationally acquired histoplasmosis: more than workers at risk. ENVIRONMENTAL HEALTH PERSPECTIVES 2005; 113:585-9. [PMID: 15866767 PMCID: PMC1257551 DOI: 10.1289/ehp.7484] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
OBJECTIVE The objective of this study was to determine the etiology and risk factors for acute histoplasmosis in two outbreaks in Illinois among laborers at a landfill in 2001 and at a bridge reconstruction site in 2003. DESIGN We performed environmental investigations during both outbreaks and also performed an analytic cohort study among bridge workers. PARTICIPANTS Workers at the landfill during May 2001 and those at the bridge site during August 2003 participated in the study. At the landfill, workers moved topsoil from an area that previously housed a barn; at the bridge, workers observed bat guano on bridge beams. EVALUATIONS/MEASUREMENTS We defined a case by positive immunodiffusion serology, a > or = 4-fold titer rise in complement fixation between acute and convalescent sera, or positive urinary Histoplasma capsulatum (HC) antigen. Relative risks (RR) for disease among bridge workers were calculated using bivariate analysis. RESULTS Eight of 11 landfill workers (73%) and 6 of 12 bridge workers (50%) were laboratory-confirmed histoplasmosis cases. Three bridge workers had positive urinary HC antigen. At the bridge, seeing or having contact with bats [RR = 7.0; 95% confidence interval (CI), 1.1-43.0], jack-hammering (RR = 4.0; 95% CI, 1.2-13.3), and waste disposal (RR = 4.0; 95% CI, 1.2-13.3) were the most significant job-related risk factors for acquiring histoplasmosis. CONCLUSIONS Workers performing activities that aerosolized topsoil and dust were at increased risk for acquiring histoplasmosis. Relevance to professional and clinical practice: Employees should wear personal protective equipment and use dust-suppression techniques when working in areas potentially contaminated with bird or bat droppings. Urinary HC antigen testing was important in rapidly identifying disease in the 2003 outbreak.
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Affiliation(s)
- Gregory D Huhn
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
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Martins EML, Marchiori E, Damato SD, Pozes AS, Silva ACGD, Dalston M. Histoplasmose pulmonar aguda: relato de uma microepidemia. Radiol Bras 2003. [DOI: 10.1590/s0100-39842003000300005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Os autores relatam uma microepidemia de histoplasmose pulmonar, com cinco crianças que desenvolveram a doença em um período de 7 a 14 dias após a limpeza de um forno desativado para produção de carvão vegetal. Todas apresentaram quadro de febre alta persistente, tosse seca, astenia e anorexia, com 28 dias de evolução. Quando buscaram atendimento médico, uma delas encontrava-se taquipnéica, febril, com hepatomegalia e palidez cutânea, estando as restantes em regular estado geral e já sem febre. As radiografias de tórax demonstravam, em todos os casos, infiltrados reticulonodulares grosseiros, difusos e bilaterais, além de linfonodomegalias hilares. As tomografias computadorizadas evidenciaram pequenos nódulos difusos, com distribuição aleatória, além das linfonodomegalias. Os diagnósticos foram confirmados por meio da imunodifusão em gel para Histoplasma capsulatum, que foi positiva em todas as amostras pareadas coletadas com 15 dias de intervalo. Apenas uma criança necessitou de internação, por causa de importante queda no estado geral, sendo realizado tratamento de suporte e observação. Todas as crianças evoluíram com melhora clínica, sem o uso de antifúngicos, e foram submetidas a tomografias de controle após cerca de 50 dias, que demonstraram importante regressão das lesões.
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