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2019 outbreak of Histaplasmosis in a Guyanese mine

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  • 2019 outbreak of Histaplasmosis in a Guyanese mine


    A medical mystery
    By Indranie Deolall
    July 15, 2021

    Abandoned for more than 50 years, and surrounded by Guyanese jungle, the manganese mine had become home to vast colonies of breeding bats and putrid piles of guano.

    The group of men toiled in the four short tunnels for varying lengths of time, over nearly two weeks, clearing the mounds of waste, shovelling the dark red and black soil and crushing old concrete, in preparation for restarting operations. They wore no proper masks or Personal Protective Equipment (PPE).

    Then, on the last Thursday of March 2019, six of the Chinese employees turned up sick at the nearby Pakera District Hospital, complaining of fever, coughing, headaches, weakness and joint pain. With the men’s hospitalisation prompting worries over H1N1 (Swine Flu) and leptospirosis, the heath chain of command was quickly notified and the emergency protocols activated.

    The next day a patient died after his condition suddenly deteriorated, with major haemorrhagic and multi-organ failure. The remaining men were transferred to the Georgetown Public Hospital in the capital, where a second Chinese worker passed away in early April.

    The close contacts of patients and healthy miners who had entered the same abandoned tunnels were placed under medical observation in the remote interior settlement. By mid-month, 16 cases were identified, including several Guyanese employees...

    ...Bosai had been preparing the mines, when at the beginning of April 2019, the “cluster of febrile illness” struck, prompting the company to report to the China National Health Commission (NHC) and the China Center for Disease Control and Prevention (China CDC). The enterprise applied to the NHC for permission to evacuate about ten patients back to China aboard a medical aid aircraft, for treatment without causing any further transmission. A Chinese medical team of experts in epidemiology, medical bacteriology, clinical and emergency medicines was deployed to Georgetown, to provide support in clinical and public health, to identify the potential etiology and to assess the potential threat, especially the risk of international transmission.

    According to a related online article in China CDC Weekly, co-authored by seven researchers including Lei Zhou of China CDC and Xiao-Ping Dong of the National Institute for Viral Disease Control and Prevention, various tissue specimens from the two fatal cases and blood samples from surviving patients were transferred to the laboratories of China CDC. Next-generation sequencing technology identified different lengths of specific gene sequences of a fungus Histoplasma capsulatum, in seven different samples. The eight other patients were clinically diagnosed.

    Found in the droppings of bats, birds and rodents, especially in humid areas, cases of histaplasmosis have been reported in every continent except Antarctica but are fairly rare in China, the team said.

    “High prevalence of histoplasmosis has been observed in Central America, Caribbean, and South America. Infections of Histoplasma are acquired through a respiratory route, particularly inhalation of aerosols from disturbed soils enriched with excreta from birds and bats. These infections are most common in persons involved with removing soil, visiting caves, cleaning old houses, or felling trees, etc.”...