[Outbreak of histoplasmosis in province of Neuquén, Patagonia Argentina]. / Brote de histoplasmosis en la provincia de Neuquén, Patagonia Argentina.

BACKGROUND: In Argentina, there are no reports of autochthonous cases of histoplasmosis in the southern regions of the country. AIM: To report a histoplasmosis outbreak in Zapala town, Province of Neuquén, Patagonia Argentina. METHODS: We evaluated the clinical and epidemiological characteristics of 5 patients involved in the outbreak. Environmental studies were conducted to determine the source of infection. The genetic profile of Histoplasma capsulatum strains isolated from the index case (IC) were compared with clinical isolates from Argentinean patients not related to the outbreak, using RAPD-PCR with primers 1281-1283. RESULTS: The patients were residents of Zapala, and had not visited other geographical areas before. All patients had an influenza-like syndrome, and X-ray revealed disseminated micronodular images throughout the lung parenchyma. The IC needed specific antifungal therapy; the remaining 4 patients had mild symptoms, and did not require therapy. All of them had a good clinical outcome. Strains of H. capsulatum isolated from blood culture and lung biopsy of the IC showed a genetic profile different from other strains analyzed. The presence of the fungus in the environment was demonstrated by the detection of anti-Histoplasma antibodies in BALB/c mice inoculated with soil obtained in a culvert where workers had dug up earth after a landslide. CONCLUSIONS: This outbreak suggests the histoplasmosis endemic area is under the 38° S parallel. Patients from Neuquén, Patagonia Argentina, with compatible symptoms of histoplasmosis should be tested, regardless of their travel or exposure history.

Brote de histoplasmosis en la provincia de Neuquén, Patagonia Argentina / Outbreak of histoplasmosis in province of Neuquén, Patagonia Argentina

Antecedentes. La República Argentina no registra casos autóctonos de histoplasmosis en regiones australes del país. Objetivo. Informar de un brote de histoplasmosis ocurrido en Zapala, Provincia de Neuquén, Patagonia Argentina. Métodos. Se evaluó el cuadro clínico y las características epidemiológicas de 5 pacientes involucrados en el brote. Se realizaron estudios ambientales para conocer la fuente de infección. Se analizó el perfil genético generado por RAPD-PCR con los primers 1281-1283 de los aislamientos de Histoplasma capsulatum del caso índice ( CI ) y se comparó con cepas de origen clínico no relacionadas con el brote. Resultados. Los pacientes residían en Zapala y no habían visitado otras áreas geográficas. Todos presentaron un síndrome gripal con imágenes radiológicas micronodulillares diseminadas. El CI necesitó tratamiento específico por la gravedad de su cuadro clínico, y los 4 pacientes restantes presentaron una sintomatología leve y no fueron tratados. La evolución clínica de todos fue favorable. Las cepas de H. capsulatum aisladas de hemocultivo y biopsia pulmonar del CI presentaron un perfil genético diferente al resto de las cepas analizadas. La presencia del hongo en el ambiente pudo inferirse mediante la detección de anticuerpos anti-Histoplasma en suero de ratones BALB/c inoculados con tierra de una alcantarilla que los trabajadores removieron después de un aluvión. Conclusiones. Este brote extiende el área endémica de histoplasmosis por debajo del paralelo 38° de latitud sur. El diagnóstico de histoplasmosis debe considerarse en pacientes de Neuquén, con síntomas compatibles con esta micosis, aun sin existir antecedentes epidemiológicos de viajes a áreas endémicas (AU)

Background: In Argentina, there are no reports of autochthonous cases of histoplasmosis in the southern regions of the country. Aim: To report a histoplasmosis outbreak in Zapala town, Province of Neuquén, Patagonia Argentina. Methods: We evaluated the clinical and epidemiological characteristics of 5 patients involved in the outbreak. Environmental studies were conducted to determine the source of infection. The genetic profile of Histoplasma capsulatum strains isolated from the index case (IC) were compared with clinical isolates from Argentinean patients not related to the outbreak, using RAPD-PCR with primers 1281-1283. Results: The patients were residents of Zapala, and had not visited other geographical areas before. All patients had an influenza-like syndrome, and X-ray revealed disseminated micronodular images throughout the lung parenchyma. The IC needed specific antifungal therapy; the remaining 4 patients had mild symptoms, and did not require therapy. All of them had a good clinical outcome. Strains of H. capsulatum isolated from blood culture and lung biopsy of the IC showed a genetic profile different from other strains analyzed. The presence of the fungus in the environment was demonstrated by the detection of anti- Histoplasma antibodies in BALB/c mice inoculated with soil obtained in a culvert where workers had dug up earth after a landslide. Conclusions: This outbreak suggests the histoplasmosis endemic area is under the 38◦ S parallel. Patients from Neuquén, Patagonia Argentina, with compatible symptoms of histoplasmosis should be tested, regardless of their travel or exposure history (AU)