Histoplasmosis

FEMS Immunology and Medical Microbiology 45 (2005) 435–441 www.fems-microbiology.org

Identification of the infectious source of an unusual outbreak of histoplasmosis, in a hotel in Acapulco, state of Guerrero, Mexico
´ ´ ´ Maria Lucia Taylor a,*, Guillermo M. Ruız-Palacios b, Marıa del Rocıo Reyes-Montes a, a ´ Gabriela Rodrıguez-Arellanes , Laura E. Carreto-Binaghi a, ´ ´ ´ EsperanzaDuarte-Escalante a, Aurora Hernandez-Ramırez a, Armando Perez c, ´ ´ ´ ´ Roberto O. Suarez-Alvarez a, Yuri A. Roldan-Aragon b, Rafael Romero-Martınez a, a b ´ Jorge H. Sahaza-Cardona , Jose Sifuentes-Osornio , b ´ Luis E. Soto-Ramırez , Gabriela R. Pena-Sandoval a ˜
b

´ ´ ´ Laboratorio de Inmunologıa de Hongos, Departamento de Microbiologıa y Parasitologıa, Facultad de Medicina, ´ ´ ´ UniversidadNacional Autonoma Mexico (UNAM), Ciudad Universitaria s/n, Mexico DF 04510, Mexico ´ ´ ´ ´ ´ Departamento de Infectologıa, Instituto Nacional de Ciencias Medicas y Nutricion ‘‘Salvador Zubiran’’, Mexico DF 14000, Mexico c ´ ´ Departamento de Biologıa Celular y Tisular, Facultad de Medicina UNAM, Mexico DF 04510, Mexico Received 29 April 2005; accepted 27 May 2005 First published online 19 July 2005a

Abstract Three isolates of Histoplasma capsulatum were identified from mice lung, liver, and spleen inoculated with soil samples of the X hotelÕs ornamental potted plants that had been fertilized with organic material known as compost. The presence of H. capsulatum in the original compost was detected using the dot-enzyme-linked immunosorbent assay. Nested-PCR, using a specific protein Hcp100coding gene sequence, confirmed the fungal identification associated with an unusual histoplasmosis outbreak in Acapulco. Although, diversity between the H. capsulatum isolate from the hotel and some clinical isolates from Guerrero (positive controls) was observed using random amplification of polymorphic DNA based-PCR, sequence analyses of H-anti and ole fragment genes revealed a high homology(92–99%) between them. Ó 2005 Federation of European Microbiological Societies. Published by Elsevier B.V. All rights reserved.
Keywords: Outbreak; Histoplasma capsulatum; Nested-PCR; RAPD-PCR; Gene sequencing

1. Introduction In its natural environment, the dimorphic fungus Histoplasma capsulatum var. capsulatum (Darling, 1906) grows favorably in bat and/or bird guano producing a multicellularfilamentous form, characteristic of its mycelial-phase, which presents macro- and microconidia.
* Corresponding author. Tel.: +52 55 5623 2462; fax: +52 55 5573 5564. E-mail addresses: emello@servidor.unam.mx, luciataylor@yahoo. com.mx (M.L. Taylor).

Microconidia together with small hyphal fragments are the main fungal structures that infect susceptible hosts through their inhalation in contaminatedplaces, starting the process of histoplasmosis infection [1]. In Mexico, this disease represents an occupational and environmental health problem, and people in the countryside are particularly affected, especially miners, peasants, and guano collectors, due to their work in given enclosed spaces where guano accumulates [2–6]. Histoplasmosis has been registered in every state of the country, and whenan outbreak suddenly appears,

0928-8244/$22.00 Ó 2005 Federation of European Microbiological Societies. Published by Elsevier B.V. All rights reserved. doi:10.1016/j.femsim.2005.05.017

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M.L. Taylor et al. / FEMS Immunology and Medical Microbiology 45 (2005) 435–441

the lethality percentage gets higher. However, the presence of fungus propagules in urban areas may be also importantto explain clinical cases that do not refer any exposure to high risk infection sites [2]. In 2001, the Department of Health of the USA notified the Centers for Disease Control and Prevention (CDC) of an outbreak of histoplasmosis affecting American tourists in Acapulco. Morgan et al. [7] reported a cohort study of this outbreak of acute pulmonary histoplasmosis among American travelers,...