Volume 69, Issue 6
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645


During spring 2001, college students from Pennsylvania reported an acute febrile respiratory illness after returning from spring break vacation in Acapulco, Mexico. Acute pulmonary histoplasmosis was presumptively diagnosed and the cluster of illness was reported to the Centers of Disease Control and Prevention. A large investigation then ensued, which included finding student-travelers for interviews and requesting sera for histoplasmosis testing. We defined a clinical case by fever and at least one of the following: cough, shortness of breath, chest pain, or headache, in an Acapulco traveler during March–May 2001. A laboratory-confirmed case had positive serology. An initial study determined that the likely site of histoplasmosis exposure was Hotel H; we therefore performed a large cohort study among travelers who stayed at Hotel H. Of 757 contacted, 262 (36%) met the clinical case definition. Of 273 serum specimens tested, 148 (54%) were positive. Frequent use of Hotel H’s stairwells, where construction was ongoing, was associated with increased risk of illness (relative risk = 10.5, 95% confidence interval = 3.7–30.5; < 0.001). This is the first histoplasmosis outbreak associated with a hotel undergoing construction. Hotels in endemic areas should consider construction precaution measures to prevent histoplasmosis among their guests.


Article metrics loading...

The graphs shown below represent data from March 2017
Loading full text...

Full text loading...



  1. Sacks JJ, Ajello L, Crockett LK, 1986. An outbreak and review of cave-associated histoplasmosis capsulati. J Med Vet Mycol 24 : 313–327. [Google Scholar]
  2. Wheat J, 1997. Histoplasmosis. Experience during outbreaks in Indianapolis and review of the literature, 1997. Medicine (Baltimore) 76 : 339–354. [Google Scholar]
  3. Cano MVC, Hajjeh RA, 2001. The epidemiology of histoplasmosis: a review. Semin Respir Dis 16 : 109–118. [Google Scholar]
  4. Centers for Disease Control and Prevention, 2001. Outbreak of acute respiratory febrile illness among college students - Acapulco, Mexico, March, 2001. MMWR Morb Mortal Wkly Rep 50 : 261–262. [Google Scholar]
  5. Centers for Disease Control and Prevention, 2001. Update: outbreak of acute febrile respiratory illness among college students - Acapulco, Mexico, March 2001. MMWR Morb Mortal Wkly Rep 50 : 359–360. [Google Scholar]
  6. Reiss E, Kaufman L, Kovacs JA, Lindsley MD, 2002. Clinical immunomycology. Rose NR, Hamilton RG, Detrick B, eds. Manual of Clinical Laboratory Immunology. Sixth edition. Washington, DC: American Society for Microbiology Press, 559–583.
  7. Ajello L, Weeks RJ, 1983. Prodedure for the indirect inoculation of Histoplasma capsulatum from soil. DiSalvo AF, ed. Occupational Mycoses. Philadelphia: Lea and Febiger, 232–238.
  8. Formann AK, Kohlmann T, 1996. Latent class analysis in medical research. Stat Meth Med Res 5 : 179–211. [Google Scholar]
  9. Schneider E, Hajjeh RA, Spiegel RA, Jibson RW, Harp EL, Marshall GA, Gunn RA, McNeil MM, Pinner RW, Baron RC, Burger RC, Hutwagner LC, Crum C, Kaufman L, Reef SE, Feldman GM, Pappagianis D, Werner SB, 1997. A coccidioidomycosis outbreak following the Northridge, Calif, earthquake. JAMA 277 : 904–908. [Google Scholar]
  10. Centers for Disease Control and Prevention, 2001. Coccidioidomycosis in workers at an archeological site - Dinosaur National Monument, Utah, June–July 2001. MMWR Morb Mortal Wkly Rep 50 : 1005–1008. [Google Scholar]
  11. Wheat LJ, 1988. Systemic fungal infections: diagnosis and treatment. I. Histoplasmosis. Infect Dis Clin North Am 2 : 841–859. [Google Scholar]
  12. Wheat LJ, 2001. Laboratory diagnosis of histoplasmosis: update 2000. Semin Respir Infect 16 : 131–140. [Google Scholar]
  13. Centers for Disease Control and Prevention, 1995. Exposure of passengers and flight crew to Mycobacterium tuberculosis on commercial aircraft, 1992–1995. MMWR Morb Mortal Wkly Rep 44 : 137–140. [Google Scholar]
  14. Centers for Disease Control and Prevention, 2001. Exposure to patients with meningococcal disease on aircraft - United States, 1999–2001. MMWR Morb Mortal Wkly Rep 50 : 485–489. [Google Scholar]
  15. Centers for Disease Control and Prevention, 1997. Guidelines for prevention of nosocomial pneumonia. MMWR Morb Mortal Wkly Rep 46 : 1–79. [Google Scholar]

Data & Media loading...

  • Received : 07 Jul 2003
  • Accepted : 17 Sep 2003

Most Cited This Month

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error