Volume 92, Issue 6
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645



Histoplasmosis is a common endemic human mycoses acquired mostly in the Americas. We reviewed 23 cases of histoplasmosis in Israeli travelers; 22 had traveled to Central or South America and one to North America. Fourteen cases had been exposed to bat habitats and were symptomatic, presenting ≤ 3 months after their return. Asymptomatic patients ( = 9) were diagnosed during the evaluation of incidental radiological findings or because a travel partner had been suspected of infection, 16–120 months after their return. Serological testing was positive in 75% of symptomatic cases but only 22% of asymptomatic cases. Histoplasmosis should be considered in travelers returning from the Americas with respiratory or febrile illness within weeks of return, particularly if exposed to bat habitats. Travel history is essential in patients presenting with pulmonary nodules, even years after travel to endemic countries.


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  1. Kauffman CA, , 2007. Histoplasmosis: a clinical and laboratory update. Clin Microbiol Rev 20: 115132.[Crossref]
  2. Wheat LJ, , 2006. Histoplasmosis: a review for clinicians from non-endemic areas. Mycoses 49: 274282.[Crossref]
  3. Wheat J, , 1997. Histoplasmosis. Experience during outbreaks in Indianapolis and review of the literature. Medicine (Baltimore) 76: 339354.[Crossref]
  4. Panackal AA, Hajjeh RA, Cetron MS, Warnock DW, , 2002. Fungal infections among returning travelers. Clin Infect Dis 35: 10881095.[Crossref]
  5. Morgan J, Cano MV, Feikin DR, Phelan M, Monroy OV, Morales PK, Carpenter J, Weltman A, Spitzer PG, Liu HH, Mirza SA, Bronstein DE, Morgan DJ, Kirkman LA, Brandt ME, Iqbal N, Lindsley MD, Warnock DW, Hajjeh RA, , 2003. A large outbreak of histoplasmosis among American travelers associated with a hotel in Acapulco, Mexico, Spring 2001. Am J Trop Med Hyg 69: 663669.
  6. Gascon J, Torres JM, Jimenez M, Mejias T, Trivino L, Gobbi F, Quinto L, Puig J, Corachan M, , 2005. Histoplasmosis infection in Spanish travelers to Latin America. Eur J Clin Microbiol Infect Dis 24: 839841.[Crossref]
  7. Leder K, Torresi J, Libman MD, Cramer JP, Castelli F, Schlagenhauf P, Wilder-Smith A, Wilson ME, Keystone JS, Schwartz E, Barnett ED, von Sonnenburg F, Brownstein JS, Cheng AC, Sotir MJ, Esposito DH, Freedman DO, , 2013. GeoSentinel surveillance of illness in returned travelers, 2007–2011. Ann Intern Med 158: 456468.[Crossref]
  8. Norman FF, Martin-Davila P, Fortun J, Dronda F, Quereda C, Sanchez-Sousa A, Lopez-Velez R, , 2009. Imported histoplasmosis: two distinct profiles in travelers and immigrants. J Travel Med 16: 258262.[Crossref]
  9. Miyaji M, Kamei K, , 2003. Imported mycoses: an update. J Infect Chemother 9: 107113.[Crossref]
  10. Farina C, Rizzi M, Ricci L, Gabbi E, Caligaris S, Goglio A, , 2005. Imported and autochthonous histoplasmosis in Italy: new cases and old problems. Rev Iberoam Micol 22: 169171.[Crossref]
  11. Cottle LE, Gkrania-Klotsas E, Williams HJ, Brindle HE, Carmichael AJ, Fry G, Beeching NJ, , 2013. A multinational outbreak of histoplasmosis following a biology field trip in the Ugandan rainforest. J Travel Med 20: 8387.[Crossref]
  12. Ajello L, Kuttin ES, Beemer AM, Kaplan W, Padhye A, , 1977. Occurrence of Histoplasma capsulatum Darling, 1906 in Israel, with a review of the current status of histoplasmosis in the Middle East. Am J Trop Med Hyg 26: 140147.
  13. Lofgren SM, Kirsch EJ, Maro VP, Morrissey AB, Msuya LJ, Kinabo GD, Saganda W, Diefenthal HC, Ramadhani HO, Wheat LJ, Crump JA, , 2012. Histoplasmosis among hospitalized febrile patients in northern Tanzania. Trans R Soc Trop Med Hyg 106: 504507.[Crossref]
  14. Gopalakrishnan R, Nambi PS, Ramasubramanian V, Abdul Ghafur K, Parameswaran A, , 2012. Histoplasmosis in India: truly uncommon or uncommonly recognised? J Assoc Physicians India 60: 2528.
  15. Subramanian S, Abraham OC, Rupali P, Zachariah A, Mathews MS, Mathai D, , 2005. Disseminated histoplasmosis. J Assoc Physicians India 53: 185189.
  16. McLeod DS, Mortimer RH, Perry-Keene DA, Allworth A, Woods ML, Perry-Keene J, McBride WJ, Coulter C, Robson JM, , 2011. Histoplasmosis in Australia: report of 16 cases and literature review. Medicine (Baltimore) 90: 6168.[Crossref]
  17. Mahvi A, Nachega J, Piron A, Blomme C, Deneys V, Provoost N, Boland B, , 2004. Chronic disseminated histoplasmosis in an apparently immuno-competent Belgian patient. Acta Clin Belg 59: 102105.[Crossref]
  18. Nasta P, Donisi A, Cattane A, Chiodera A, Casari S, , 1997. Acute histoplasmosis in spelunkers returning from Mato Grosso, Peru. J Travel Med 4: 176178.[Crossref]
  19. Lyon GM, Bravo AV, Espino A, Lindsley MD, Gutierrez RE, Rodriguez I, Corella A, Carrillo F, McNeil MM, Warnock DW, Hajjeh RA, , 2004. Histoplasmosis associated with exploring a bat-inhabited cave in Costa Rica, 1998–1999. Am J Trop Med Hyg 70: 438442.
  20. CDC, 2008. Outbreak of histoplasmosis among travelers returning from El Salvador–Pennsylvania and Virginia, 2008. MMWR 57: 13491353.
  21. Segel MJ, Schwartz E, Schwartz E, , 2010. Histoplasmosis and other endemic fungal infections. , ed. Tropical Diseases in Travelers. Oxford, United Kingdom: Wiley-Blackwell, 282293.
  22. Furcolow ML, Schubert J, Tosh FE, Doto IL, Lynch HJ, Jr, 1962. Serologic evidence of histoplasmosis in sanatoriums in the U.S. JAMA 180: 109114.[Crossref]
  23. Wheat LJ, , 2003. Current diagnosis of histoplasmosis. Trends Microbiol 11: 488494.[Crossref]
  24. Baum GL, Racz I, Hofshi E, , 1965. Skin sensitivity to histoplasmin and coccidiodin in Israel. Am J Trop Med Hyg 14: 643646.
  25. Daoud KA, Schwabe CW, , 1958. A skin test survey for histoplasmosis and coccidioidomycosis in the Middle East. Am J Trop Med Hyg 7: 643.

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  • Received : 11 Aug 2014
  • Accepted : 09 Jan 2015

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