Epidemic outbreak of histoplasmosis primary infection in five sisters

Abstract

Histoplasmosis capsulati is a fungal infection caused by the dimorphic fungus Histoplasma capsulatum var. capsulatum. It is an endemic mycoses which has a wide distribution in North, Central and South America. Primary infection is acquired through the inhalation of the conidial forms of the fungus present in the environment, especially in caves with bat droppings and soil inhabited by chickens. Clinical features of primary infection are unespecific and may vary from asymptomatic to disseminated forms depending on the proportion of conidae inhalated. Here we present an outbreak of Histoplasma capsulatum primary infection affecting five Argentinian sisters, during a car trip to the north of Argentina, which included the provinces of Santiago del Estero and Tucumán. Four of them presented with mild to moderate acute respiratory disease; the other one developed severe and uncommon manifestations such as erythema nodosum and phlyctenular keratoconjunctivitis. All patients achieved a good clinical outcome and none of them required antifungal therapy.