Soil-Transmitted Fungal Pneumonia strikes volunteers in Utah

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RESPIRATORY ILLNESS, UNKNOWN ETIOLOGY - USA (UTAH)

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Source: Deseret News [edited]

<http://deseretnews.com/dn/view/0,1249,295008691,00.html>

VERNAL (Utah): Health officials say soil-transmitted fungal pneumonia may

be the cause of a flu-like illness that struck a group of trail volunteers

at Dinosaur National Monument Sunday. There were 16 people doing volunteer

work at the monument, half of them digging in an Indian sweat cave off the

monument's main road and the other half working on the quarter-mile trail

leading to the cave, called the " Swelter Shelter. "

The 8 volunteers, including one from inside the cave and 7 from the trail,

were taken to Valley Medical Center in Vernal. All but 2 were

released Tuesday, according to ph B. Shaffer, director of the

Tri-County Health Department, which is investigating the mysterious

illness. The 2 still in the hospital are being held for observation at

least through Wednesday.

Health officials ruled out bubonic plague, hantavirus [infection], and

deer-fly bites [which are known to transmit tularemia] as possible causes.

The volunteers have been treated for fungal and bacterial infection,

Shaffer said. The fungal infection comes from the soil, with no possible

person-to-person transmission.

All 16 of the volunteers who became ill high school graduates and college

students were from outside the area. They came from Alaska, Florida,

Kansas, Vermont, Virginia, and one from Poland. Volunteers from Utah and

Colorado were not affected. " My suspicion is we develop a lot of immunities

to things that knock people out who are not living here, " Shaffer said.

The investigation team includes representatives from the Centers for

Disease Control and Prevention and local and state health officials. None

of the young adults is in danger, said Shaffer, who praised the " great

cooperation " between the hospital and public health officials in launching

an immediate investigation.

[byline: Lois M. ]

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ProMED-mail

<promed@...>

[The preceding article does not specify the clinical syndromes other than

to mention " flu-like illness " and suggest the involvement of a fungal

etiology. Histoplasmosis, coccidioidomycosis, and blastomycosis are

illnesses that present with flu-like symptoms, and are infections with

dimorphic fungi found in the soil in the USA, and could be responsible for

these outbreaks.

Histoplasmosis is caused by _Histoplasma capsulatum_ . According to Gideon

<http://www.gideononline.com>: histoplasmosis was first reported in the

United States in 1926. The disease is endemic to the Ohio, Mississippi, and

Missouri River valley areas, with highest rates in Kentucky, Illinois,

Indiana, Missouri, Ohio, and Tennessee. Although the endemic area for

blastomycosis overlaps that of histoplasmosis, blastomycosis is also found

further north, and not as far to the west as histoplasmosis. In 1969, it

was estimated that 40 million Americans were infected [with

histoplasmosis], with 200 000 cases of acute pulmonary disease per year.

Skin test-positivity rates approach 95% in areas of South Kentucky and

Middle Tennessee; 80% to 90% in Kansas City (adults over age 20, 1963).

Coccidioidomycosis is caused by _Coccidioides immitis_. According to

Gideon: Coccidioidomycosis was first reported in the United States in 1893:

The disease is most common in California (the San Joaquin Valley), Arizona,

Texas, New Mexico, southern Nevada, and Utah. The highest incidence occurs

in late summer and early fall -- large outbreaks frequently follow dust

storms. An estimated 100 000 infections occur in the United States

annually, and 1 in 200 infections progresses to disseminated disease.

Blastomycosis is caused by _Blastomyces dermatitidis_. Most cases are

reported from Arkansas, Kentucky, Mississippi, North Carolina, South

Carolina, and Wisconsin. Infection was first reported in Colorado in 1998.

Although the endemic area for blastomycosis overlaps that of

histoplasmosis, blastomycosis is also found further north, and not as far

to the west as histoplasmosis.

By geographic distribution, coccidioidomycosis would be the highest on the

list as possible etiologies followed by blastomycosis and then

histoplasmosis. Additional information on this outbreak would be

appreciated. - Mod.MPP]

[While we are putting forward our best guesses, the history of cave

exploration is of interest. Cave-associated histoplasmosis is well known to

occur among spelunkers exposed to bat excreta. - Man. Ed. DS]

.......................mpp/pg/ds