ArticleClinical infectious diseases : an official publication of the Infectious Diseases Society of America2018
Outbreak of Severe Histoplasmosis Among Tunnel Workers-Dominican Republic, 2015.
Article in Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 18 papers, 1 of them a synthesis that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
18 citing papers in PubMed, 1 synthesis or guideline pooled it, 33 citations in OpenAlex.
- The microbiome of bat guano: for what is this knowledge important?Applied microbiology and biotechnology · 2021Pooled it
- Article
- Assessment of Prior Infection With Histoplasmosis Using Skin Test and Serological Surveys: A Global Systematic Review.Open forum infectious diseases · 2025Review
- Radiological features of chronic pulmonary histoplasmosis: Easily mistaken for tuberculosis.PLoS neglected tropical diseases · 2025Review
- Molecular Detection of Histoplasma in Bat-Inhabited Tunnels of Camino de Hierro Tourist Route, Spain.Emerging infectious diseases · 2025Article
- Histoplasmosis in Taiwan: Case Summary and Literature Review.Life (Basel, Switzerland) · 2024Review
- Fungal Infections in the Caribbean: A Review of the Literature to Date.Journal of fungi (Basel, Switzerland) · 2023Review
- Social determinants of health as drivers of fungal disease.EClinicalMedicine · 2023Review
- Fungal infections: A growing threatBiomedica : revista del Instituto Nacional de Salud · 2023Article
- The relevance of clinical and epidemiological correlation in the early diagnosis of histoplasmosis: report of two clinical cases in Popayán, ColombiaBiomedica : revista del Instituto Nacional de Salud · 2023Review
- Evidence of Histoplasma capsulatum seropositivity and exploration of risk factors for exposure in Busia county, western Kenya: Analysis of the PAZ dataset.PLoS neglected tropical diseases · 2023Article
- Collective outbreak of severe acute histoplasmosis in immunocompetent Chinese in South America: the clinical characteristics and continuous monitoring of serum cytokines/chemokines.BMC primary care · 2022Article
- Occupational Histoplasmosis: Epidemiology and Prevention Measures.Journal of fungi (Basel, Switzerland) · 2021Review
- Endemic and Other Dimorphic Mycoses in The Americas.Journal of fungi (Basel, Switzerland) · 2021Review
- Immunodiagnostic Assays for the Investigation of Fungal Outbreaks.Mycopathologia · 2020Review
- Re-drawing the Maps for Endemic Mycoses.Mycopathologia · 2020Review
- Outbreaks of histoplasmosis: The spores set sail.PLoS pathogens · 2018Review
- Article
Corrections and comments
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Authors and funding
12 authors at 5 institutions in 2 countries.
Funding
Abstract
Background: Histoplasmosis is a fungal infection associated with exposure to bat guano. An outbreak of an unknown severe febrile illness occurred among tunnel workers in the Dominican Republic, and resulted in several deaths. We conducted an investigation to confirm etiology and recommend control measures. Methods: A case was defined as fever and ≥2 symptoms consistent with histoplasmosis in a tunnel worker, July-September 2015. We interviewed workers and family members, reviewed medical records, tested serum and urine for Histoplasma antigen/antibody, and conducted a cohort study to identify risk factors for histoplasmosis and severe infection (intensive care). Results: A crew of 36 male workers removed large amounts of bat guano from tunnels without respiratory protection for a median of 24 days per worker (range, 1-25 days). Median age was 32 years (range, 18-62 years); none were immunocompromised. Thirty (83%) workers had illness that met the case definition, of whom 28 (93%) were hospitalized, 9 (30%) required intensive care, 6 (20%) required intubation, and 3 (10%) died. The median time from symptom onset to antifungal treatment was 6 days (range, 1-11 days). Twenty-two of 34 (65%) workers had laboratory evidence of infection. Conclusions: Severe illnesses and death likely resulted from exposure to large inocula of Histoplasma capsulatum spores in an enclosed space, lack of respiratory protection, and delay in recognition and treatment. Clinician education about histoplasmosis, improved laboratory capacity to diagnose fungal infections, and occupational health guidance to protect workers against endemic fungi are recommended in the Dominican Republic.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.