A large outbreak of histoplasmosis among American travelers associated with a hotel in Acapulco, Mexico, spring 2001

Juliette Morgan, Maria V. Cano, Daniel R. Feikin, Maureen Phelan, Oscar Velazquez Monroy, Pablo Kuri Morales, Joseph Carpenter, Andre Weltman, Peter G. Spitzer, Hans H. Liu, Sara A. Mirza, David E. Bronstein, Daniel J. Morgan, Laura A. Kirkman, Mary E. Brandt, Naureen Iqbal, Mark D. Lindsley, David W. Warnock, Rana A. Hajjeh

Research output: Contribution to journalArticlepeer-review

47 Scopus citations


During spring 2001, college students from Pennsylvania reported an acute febrile respiratory illness after returning from spring break vacation in Acapulco, Mexico. Acute pulmonary histoplasmosis was presumptively diagnosed and the cluster of illness was reported to the Centers of Disease Control and Prevention. A large investigation then ensued, which included finding student-travelers for interviews and requesting sera for histoplasmosis testing. We defined a clinical case by fever and at least one of the following: cough, shortness of breath, chest pain, or headache, in an Acapulco traveler during March-May 2001. A laboratory-confirmed case had positive serology. An initial study determined that the likely site of histoplasmosis exposure was Hotel H; we therefore performed a large cohort study among travelers who stayed at Hotel H. Of 757 contacted, 262 (36%) met the clinical case definition. Of 273 serum specimens tested, 148 (54%) were positive. Frequent use of Hotel H's stairwells, where construction was ongoing, was associated with increased risk of illness (relative risk = 10.5, 95% confidence interval = 3.7-30.5; P < 0.001). This is the first histoplasmosis outbreak associated with a hotel undergoing construction. Hotels in endemic areas should consider construction precaution measures to prevent histoplasmosis among their guests.

Original languageEnglish (US)
Pages (from-to)663-669
Number of pages7
JournalAmerican Journal of Tropical Medicine and Hygiene
Issue number6
StatePublished - Dec 2003
Externally publishedYes

ASJC Scopus subject areas

  • Infectious Diseases
  • Virology
  • Parasitology


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