Two Outbreaks of Occupationally Acquired Histoplasmosis: More Than Workers at Risk

Two Outbreaks of Occupationally Acquired Histoplasmosis: More Than Workers at Risk

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 al...

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Published in:Environmental health perspectives Vol. 113; no. 5; pp. 585 - 589
Main Authors: Huhn, Gregory D., Austin, Connie, Carr, Mark, Heyer, Diana, Boudreau, Pam, Gilbert, Glynnis, Eimen, Terry, Lindsley, Mark D., Cali, Salvatore, Conover, Craig S., Dworkin, Mark S.
Format: Journal Article
Language:English
Published: United States National Institute of Environmental Health Sciences. National Institutes of Health. Department of Health, Education and Welfare 01-05-2005
National Institute of Environmental Health Sciences
National Institue of Environmental Health Sciences
Subjects:
Adult
Aerosols
Antigens
Antigens, Fungal - analysis
Bridges
County employees
Disease Outbreaks
Diseases
Dust
Environmental Medicine
Facility Design and Construction
Female
Histoplasma capsulatum
Histoplasmosis
Histoplasmosis - epidemiology
Histoplasmosis - etiology
Humans
Illinois - epidemiology
Land bridges
Landfills
Male
Middle Aged
Occupational Exposure
Occupations
Predisposing factors
Protective Devices
Refuse Disposal
Risk Factors
Soil
Topsoil
USA, Illinois
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Summary: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 ≥ 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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We thank L.J. Wheat, A. Winquist, and J. Morgan for their thoughtful comments during preparation of this manuscript.
The authors declare they have no competing financial interests.
ISSN:0091-6765
1552-9924
DOI:10.1289/ehp.7484