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Histoplasmosis in Israeli Travelers

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  • Institute of Pulmonology, Department of Imaging, Internal Medicine “C” and Center for Geographic Medicine, Chaim Sheba Medical Center, Tel HaShomer, Ramat Gan, Israel; Sackler Medical School, Tel Aviv University, Tel Aviv, Israel; Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia; Infectious Diseases Unit, Shaare-Zedek Medical Center, Jerusalem, Israel; Institute of Pulmonology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel; Rappaport Faculty of Medicine, Technion—Israel Institute of Technology, Haifa, Israel; Unit of Infectious Diseases, Internal Medicine B, Rambam Medical Center, Haifa, Israel

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 (N = 9) were diagnosed during the evaluation of incidental radiological findings or because a travel partner had been suspected of Histoplasma 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.

Author Notes

* Address correspondence to Eli Schwartz, Internal Medicine “C” and Center for Geographic Medicine, Chaim Sheba Medical Center, Tel HaShomer, Ramat Gan, Israel 52621. E-mail: elischwa@post.tau.ac.il

Authors' addresses: Michael J. Segel, Institute of Pulmonology, Chaim Sheba Medical Center, Tel HaShomer, Ramat Gan, Israel, and Sackler Medical School, Tel Aviv University, Tel Aviv, Israel, E-mail: Michael.Segel@gmail.com. Judith Rozenman, Department of Imaging, Chaim Sheba Medical Center, Tel HaShomer, Ramat Gan, Israel, and Sackler Medical School, Tel Aviv University, Tel Aviv, Israel, E-mail: Yehudit.Rozenman@Sheba.health.gov.il. Mark D. Lindsley, Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, GA, E-mail: mil6@cdc.gov. Tamar Lachish, Infectious Diseases Unit, Shaare-Zedek Medical Center, Jerusalem, Israel, E-mail: LachishT@yahoo.com. Neville Berkman, Institute of Pulmonology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel, E-mail: Neville@Hadassah.org.il. Ami Neuberger, Rappaport Faculty of Medicine, Technion—Israel Institute of Technology, Haifa, Israel, and Unit of Infectious Diseases, Internal Medicine B, Rambam Medical Center, Haifa, Israel, E-mail: A_Neuberger@Rambam.health.gov.il. Eli Schwartz, Internal Medicine “C” and Center for Geographic Medicine, Chaim Sheba Medical Center, Tel HaShomer, Ramat Gan, Israel, and Sackler Medical School, Tel Aviv University, Tel Aviv, Israel, E-mail: elischwa@post.tau.ac.il.

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