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From the Centers for Disease Control and Prevention
May 2, 2001

Outbreak of Acute Respiratory Febrile Illness Among College Students—Acapulco, Mexico, March 2001

JAMA. 2001;285(17):2187. doi:10.1001/jama.285.17.2187

MMWR. 2001;50:261-262

On March 30, 2001, CDC was notified by Pennsylvania Department of Health (PDH) of an acute respiratory febrile illness in 44 students from two colleges who traveled to Acapulco, Mexico, for spring break vacation during March 3-18. Within 7-14 days of their return from Acapulco, 21 students presented to health-care providers with illness characterized by fever, chills, dry cough, chest pain, and headache. Two students were hospitalized. On the basis of clinical symptoms and chest radiographs that revealed bilateral, nodular patchy infiltrates, acute pulmonary histoplasmosis was the suspected illness. While in Acapulco, most of the students stayed at the Calinda Beach Hotel and participated in group activities at other recreational locations.

All state health departments and selected travel agencies were notified to identify additional students who traveled to Acapulco during March and became ill. As of April 9, 37 colleges in 18 states* and the District of Columbia have reported 221 students who returned to the United States from Acapulco with an acute respiratory febrile illness. Ten students in six states were hospitalized.

A case is defined as an acute respiratory febrile illness characterized by fever for at least 3 days and one or more of the following symptoms: cough, shortness of breath, chest pain, or headache in a student who visited Acapulco during March 2001. Preliminary laboratory test results suggest histoplasmosis, an infection caused by Histoplasma capsulatum, a fungus that is present in soil in areas where the disease is endemic, and is acquired through inhalation. Gomori methenamine-silver stain of transbronchial and thoracic lymph node biopsy specimens from a hospitalized student revealed the presence of yeasts consistent with H. capsulatum. In addition, of specimens from 27 students in three states serologically tested for histoplasmosis using immunodiffusion and complement fixation tests, five were positive.1 However, convalescent-phase serum specimens will be needed for confirmation. Testing continues for other possible causes (e.g., Mycoplasma, Legionella, and Chlamydia).

Reported by:

Pennsylvania Dept of Health. Council of State and Territorial Epidemiologists, Atlanta, Georgia. American College Health Association, Baltimore, Maryland. Mycotic Diseases Br, Respiratory Diseases Br, Div of Bacterial and Mycotic Diseases, National Center for Infectious Diseases; and EIS officers, CDC.

CDC Editorial Note:

CDC recommends that students who have traveled to Acapulco since March 1 seek medical care if they develop symptoms of fever and/or cough, shortness of breath, chest pain, or headache. Most cases of acute histoplasmosis in immunocompetent persons will not require treatment; however, persons with severe histoplasmosis can be treated with 200 mg of itraconazole, an antifungal medication, once daily for 6-12 weeks.2 Physicians should notify state health departments of acute respiratory febrile illness among returning college students and other persons.

On April 3, PDH alerted other health departments of the outbreak through EPI-X (the Epidemic Information Exchange); on April 6, CDC issued a travelers' advisory at http://www.cdc.gov/travel/other/res-mexico-apr2001.htm. Information on histoplasmosis is available at http://www.cdc.gov/ncidod/dbmd/diseaseinfo. The Mexico Ministry of Health and CDC are conducting an investigation of the outbreak. Additional information is available from CDC, telephone (888) 688-2732. CDC's Mycotic Diseases Branch (MDB) is interested in receiving reports through state and local health departments of travelers to Acapulco since March who have become ill. MDB will test serum and lung tissue specimens for histoplasmosis received through state and local health departments.

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*Arizona, Connecticut, Delaware, Illinois, Indiana, Maryland, Massachusetts, Michigan, Missouri, New Jersey, New York, North Carolina, North Dakota, Ohio, Pennsylvania, Rhode Island, Texas, and Wisconsin.
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