Histoplasmosis Outbreaks in Brazil: Lessons to Learn About Preventing Exposure
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ORIGINAL PAPER
Histoplasmosis Outbreaks in Brazil: Lessons to Learn About Preventing Exposure Bernardo Teno´rio Guerra . Fernando Almeida-Silva . Rodrigo Almeida-Paes . Rossana Patrı´cia Basso . Joa˜o Paulo Romualdo Alarca˜o Bernardes . Marcos Abreu Almeida . Lisandra Serra Damasceno . Melissa Orzechowski Xavier . Bodo Wanke . Rosely M. Zancope´-Oliveira . Marcus de Melo Teixeira
Received: 30 May 2019 / Accepted: 23 September 2019 Ó Springer Nature B.V. 2019
Abstract Histoplasmosis is considered the most common invasive opportunistic fungal disease in the Americas, with outbreaks and micro-epidemics reported for over 80 years. In Brazil, this disease has been described since 1946, reaching a remarkable incidence in the population, especially during the HIV–AIDS pandemic. In this study, published and unpublished outbreaks and micro-epidemics of histoplasmosis in Brazil were revisited by accessing different database sources and evaluating epidemiological and clinical features. We have found reports spanning 1946–2017, across 10 Brazilian states and with involvement of 370 humans and 2 dogs, and 13 disseminated cases and 3 deaths were reported. Rio de
Janeiro had the largest number of outbreaks (n = 20/ 40; 50%) reported in this study. The majority of outbreaks and micro-epidemics was reported in caves (n = 21/40; 52.5%), followed by reports in abandoned/deactivated sites (n = 6/40; 15%), mines (n = 5/40; 12.5%), chicken coops (n = 4/40; 10%). Histoplasmosis is a serious health issue in Brazil considering the attractive and growing market of ecotourism throughout more than 7000 caves, and all levels of poultry farming activity are important to raise awareness about how dangerous this neglected disease can be and establish ways to decrease exposure to contaminated environmental sources through adequate preventive measures.
Handling editor: Sybren deHoog. B. T. Guerra J. P. R. A. Bernardes M. de Melo Teixeira (&) Nu´cleo de Medicina Tropical, Faculdade de Medicina, Universidade de Brası´lia, Campus Universita´rio Darcy Ribeiro, Asa Norte, Brası´lia, DF CEP 70910-900, Brazil e-mail: [email protected] F. Almeida-Silva R. Almeida-Paes M. A. Almeida B. Wanke R. M. Zancope´-Oliveira Laborato´rio de Micologia, Instituto Nacional de Infectologia Evandro Chagas – Fundac¸a˜o Oswaldo Cruz, Rio de Janeiro, RJ, Brazil
J. P. R. A. Bernardes M. de Melo Teixeira Graduate Program in Genomic Sciences and Biotechnology, Catholic University of Brası´lia, Brası´lia, DF, Brazil L. S. Damasceno Faculdade de Medicina, Universidade Federal do Ceara´, Fortaleza, CE, Brazil M. de Melo Teixeira The Pathogen and Microbiome Institute, Northern Arizona University, Flagstaff, AZ, USA
R. P. Basso M. O. Xavier Faculdade de Medicina, Universidade Federal do Rio Grande (Famed-FURG), Rio Grande, RS, Brazil
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Mycopathologia
Keywords Histoplasmosis Outbreaks Microepidemics Brazil Histoplasma
Introduction Histoplasmosis is a worldwide-distributed systemic mycosis cause
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