Outbreak of Acute Respiratory Febrile Illness Among College Students
--- Acapulco, Mexico, March 2001
On March 30, 2001, CDC was notified by Pennsylvania Department of Health
(PDH) of an acute respiratory febrile illness in 44 students from two colleges who traveled
to Acapulco, Mexico, for spring break vacation during March 3--18. Within 7--14 days
of their return from Acapulco, 21 students presented to health-care providers with
illness characterized by fever, chills, dry cough, chest pain, and headache. Two students
were hospitalized. On the basis of clinical symptoms and chest radiographs that
revealed bilateral, nodular patchy infiltrates, acute pulmonary histoplasmosis was
the suspected illness. While in Acapulco, most of the students stayed at the Calinda
Beach Hotel and participated in group activities at other recreational locations.
All state health departments and selected travel agencies were notified to
identify additional students who traveled to Acapulco during March and became ill. As of
April 9, 37 colleges in 18 states* and the District of Columbia have reported 221
students who returned to the United States from Acapulco with an acute respiratory
febrile illness. Ten students in six states were hospitalized.
A case is defined as an acute respiratory febrile illness characterized by fever
for at least 3 days and one or more of the following symptoms: cough, shortness
of breath, chest pain, or headache in a student who visited Acapulco during March
2001. Preliminary laboratory test results suggest histoplasmosis, an infection caused
by Histoplasma capsulatum, a fungus that is present in soil in areas where the disease
is endemic, and is acquired through inhalation. Gomori methenamine-silver stain
of transbronchial and thoracic lymph node biopsy specimens from a hospitalized
student revealed the presence of yeasts consistent with
H. capsulatum. In addition, of specimens from 27 students in three states serologically tested for
histoplasmosis using immunodiffusion and complement fixation tests, five were positive
(1). However, convalescent-phase serum specimens will be needed for confirmation.
Testing continues for other possible causes (e.g.,
Mycoplasma, Legionella, and
Chlamydia).
Reported by: Pennsylvania Dept of Health. Council of State and Territorial
Epidemiologists, Atlanta, Georgia. American College Health Association, Baltimore, Maryland.
Mycotic Diseases Br, Respiratory Diseases Br, Div of Bacterial and Mycotic Diseases, National
Center for Infectious Diseases; and EIS officers, CDC.
Editorial Note:
CDC recommends that students who have traveled to Acapulco
since March 1 seek medical care if they develop symptoms of fever and/or
cough, shortness of breath, chest pain, or headache. Most cases of acute histoplasmosis
in immunocompetent persons will not require treatment; however, persons with
severe histoplasmosis can be treated with 200 mg of itraconazole, an antifungal
medication, once daily for 6--12 weeks (2). Physicians should notify state health departments
of acute respiratory febrile illness among returning college students and other persons.
On April 3, PDH alerted other health departments of the outbreak through
EPI-X (the Epidemic Information
Exchange); on April 6, CDC issued a travelers' advisory
at http://webdev.cdc.gov/travel/other/res-mexico-apr2001.htm. Information
on histoplasmosis is available at http://www.cdc.gov/ncidod/dbmd/diseaseinfo. The
Mexico Ministry of Health and CDC are conducting an investigation of the outbreak.
Additional information is available from CDC, telephone (888) 688-2732. CDC's Mycotic
Diseases
Branch (MDB) is interested in receiving reports through state and local
health departments of travelers to Acapulco since March who have become ill. MDB will
test serum and lung tissue specimens for histoplasmosis received through state and
local health departments.
References
Kaufman L, Reiss E. Serodiagnosis of fungal disease. In: Rose NR, ed. Manual of
clinical laboratory immunology, 4th edition. Washington DC; ASM Press, 1992:506--28.
Wheat JW, Sarosi G, McKinsey D, et al. Practice guidelines for the management of
patients with histoplasmosis. Clin Infect Dis 2000;30:688--95.
*Arizona, Connecticut, Delaware, Illinois, Indiana, Maryland, Massachusetts,
Michigan, Missouri, New Jersey, New York, North Carolina, North Dakota, Ohio,
Pennsylvania, Rhode Island, Texas, and Wisconsin.
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