Outbreak of histoplasmosis among travelers returning from El Salvador--Pennsylvania and Virginia, 2008.

Histoplasmosis is a fungal disease caused by infection with Histoplasma capsulatum. Histoplasmosis, which can be acquired from soil contaminated with bird or bat droppings, occurs worldwide and is one of the most common pulmonary and systemic mycoses in the United States. However, among international travelers returning from areas in which histoplasmosis is endemic, histoplasmosis is rare, accounting for <0.5% of all diseases diagnosed in this group. During February-March 2008, the Pennsylvania and Virginia departments of health investigated a cluster of respiratory illness among three mission groups that had traveled separately to El Salvador to renovate a church. This report summarizes the results of the investigation. Of 33 travelers in the three mission groups for whom information was available, 20 (61%) met the case definition for histoplasmosis. Persons who reported sweeping and cleaning outdoors (relative risk [RR] = 2.1, 95% confidence interval [CI] = 1.3-3.6), digging (RR = 2.6, CI = 1.1-6.1), or working in a bird or bat roosting area (RR = 1.8, CI = 1.3-2.4) had a greater risk for illness. The findings emphasize the need for travelers and persons involved in construction activities to use personal protective equipment and decrease dust-generation when working in areas where histoplasmosis is endemic. Clinicians should consider histoplasmosis as a possible cause of acute respiratory or influenza-like illness in travelers returning from areas in which histoplasmosis is endemic.