Re: Re: Check out CDC - Coccidioidomycosis among Workers at an Archeological Site, No

[Guest guest]

the CDC apparently thinks is only in the Southwestern

states..........and I was in South Florida. I think those climates

were a little different.

Florida is Very bad I mean very bad North to South and no one seem to care Most

of all the stores are Full of some type of AC Toxin. I have MCS so I try new

stores and Restaurants they are the worse any thing New don't take my word

investigate the Media has a warning about the Flu I say it all BULL to cover up

the real problems MOLD & Toxin there are so many Toxic sites in the State of

Florida it's a shame I wouldn't advise any one to move here and if you are here

I say Get out fast the down Town areas where all the New Buildings are coming up

WOW and I hear so many of Katrina victims HUD Housing have Open their nasty

doors to many of them out of the frying pan into the fire I hope Dr. Albert F.

Robbins Jump on this for the sake of all the children if nothing more.

To me he's the best for the Job I pray he does the right thing Office #

954-421-1929, Media Ch 7 talking about Bed Bugs in a Collage some place here in

Florida. they had to replace ever thing now there's four MOLD, TOXIC SITES AND

BED BUG.................GO FIGURE Oh let's not forget the AC BAD!?.

Elvira

[] Re: Check out CDC - Coccidioidomycosis among Workers

at an Archeological Site, No

Woah, you had that here in Florida? Where are you and do you know

how you got it. My mother-in-law lost her gallbladder and they took

out her appendix for kicks from that but she was from Bakersfield,

CA. Or as I was told when I was there once by a local, the armpit of

the world!

> This is taken directly from the CDC website. I guess these

archeologists

> must have been eating the dirt they were working with, when they

got sick with

> the mold illnesses at Swelter Shelter. Because according to the

CDC now,

> people can't get sick from inhaling mold spores. I guess farmer's

lung and

> valley fever must be caused from those farmers and filed workers

eating that

> moldy hay.

>

> We knocked their " dose response " that based on a single study of

rats. This

> " digestion is the only way " is the new hooey. They are

contridicting

> themselves left and right.

>

> And who are the " 50 researchers " from the NIH that established

these mold

> lawsuits are not based on science. I only name who probably 15 of

them are.

> Funny they are not identified by name.

>

>

> _CDC - Coccidioidomycosis among Workers at an Archeological Site,

> Northeastern Utah_ (http://www.cdc.gov/ncidod/EID/vol10no4/03-

0446.htm)

>

>

> Research

> Coccidioidomycosis among Workers at an Archeological Site,

Northeastern Utah

> Lyle R. sen,* (http://www.cdc.gov/ncidod/EID/vol10no4/03-

0446.htm#com)

> Stacie L. Marshall,* Barton-Dickson,â? Rana A.

Hajjeh,â?¡ Mark D.

> Lindsley,â?¡ W. Warnock,â?¡ Anil A. Panackal,â?¡ ph B.

Shaffer,§ am B.

> Haddad,â? â?¡ Frederick S. Fisher,¶ T. Dennis,* and

tte â?¡

> *Centers for Disease Control and Prevention, Ft. ,

Colorado, USA; â?

> Utah Department of Health, Salt Lake City, Utah, USA; â?¡Centers

for Disease

> Control and Prevention, Atlanta, Georgia, USA; §TriCounty Health

Department,

> Vernal, Utah, USA; and ¶University of Arizona, Tucson, Arizona,

USA

> Suggested citation for this article: sen LR, Marshall SL,

> Barton-Dickson C, Hajjeh RA, Lindsley MD, Warnock DW, et al.

Coccidioidomycosis among

> workers at archeological site, northeastern Utah. Emerg Infect Dis

[serial

> online] 2004 Apr [date cited]. Available

> from:http://www.cdc.gov/ncidod/EID/vol10no4/03-0446.htm

>

> ____________________________________

>

> In 2001, an outbreak of acute respiratory disease occurred among

persons

> working at a Native American archeological site at Dinosaur

National Monument in

> northeastern Utah. Epidemiologic and environmental investigations

were

> undertaken to determine the cause of the outbreak. A clinical case

was defined by

> the presence of at least two of the following symptoms: self-

reported fever,

> shortness of breath, or cough. Ten workers met the clinical case

definition;

> 9 had serologic confirmation of coccidioidomycosis, and 8 were

hospitalized.

> All 10 were present during sifting of dirt through screens on June

19;

> symptoms began 9â? " 12 days later (median 10). Coccidioidomycosis

also developed in a

> worker at the site in September 2001. A serosurvey among 40 other

Dinosaur

> National Monument workers did not find serologic evidence of

recent infection.

> This outbreak documents a new endemic focus of coccidioidomycosis,

which

> extends northward its known geographic distribution in Utah by

approximately 200

> miles.

> Coccidioidomycosis results from inhaling spores (arthroconidia) of

> Coccidioides immitis, a soil-dwelling fungus endemic to the

southwestern United States

> and parts of Mexico, Central America, and South America. The

organism is

> recovered from soil in areas with yearly annual rainfall averaging

5â? " 20 inches,

> hot summers, infrequent winter freezes, and alkaline soil (_1_

> (http://www.cdc.gov/ncidod/EID/vol10no4/03-0446.htm#1) ). Although

up to 100,000 new

> infections may occur annually (_2_

> (http://www.cdc.gov/ncidod/EID/vol10no4/03-0446.htm#1) ), reported

point source outbreaks are infrequent and have followed

> diverse soil-disrupting activities or events, such as

archeological or

> anthropological digs (_3â? " 5_

(http://www.cdc.gov/ncidod/EID/vol10no4/03-0446.htm#1) ),

> military maneuvers (_6_ (http://www.cdc.gov/ncidod/EID/vol10no4/03-

0446.htm#1)

> ), play involving throwing dirt (_7_

> (http://www.cdc.gov/ncidod/EID/vol10no4/03-0446.htm#1) ),

construction work (_8_

> (http://www.cdc.gov/ncidod/EID/vol10no4/03-0446.htm#1) ),

earthquakes (_9_

> (http://www.cdc.gov/ncidod/EID/vol10no4/03-0446.htm#1) ), dust

storms (_10_

> (http://www.cdc.gov/ncidod/EID/vol10no4/03-0446.htm#1) ,_11_

(http://www.cdc.gov/ncidod/EID/vol10no4/03-0446.htm#11)

> ), model airplane flying competitions (_12_

> (http://www.cdc.gov/ncidod/EID/vol10no4/03-0446.htm#11) ), and

armadillo hunting (_13_

> (http://www.cdc.gov/ncidod/EID/vol10no4/03-0446.htm#11) ).

Figure 1

> _Click to view enlarged image_ (http://www.

> cdc.gov/ncidod/EID/vol10no4/03-0446-G1.htm)

>

> Figure 1. Known geographic distribution of Coccidioides immitis in

the

> United States and location of the 2001 coccidioidomycosis outbreak

in Utah...

>

> Figure 2 _Click to view enlarged image_

> (http://www.cdc.gov/ncidod/EID/vol10no4/03-0446-G2.htm)

>

> Figure 2. Number of persons meeting the clinical case definition,

by date of

> symptom onset. Days worked at the site are indicated.

> We report a point-source outbreak of coccidioidomycosis among

workers who

> participated in soil-disrupting activities at an archeological site

in Dinosaur

> National Monument in northeastern Utah during June and July 2001.

This site

> was approximately 200 miles north of previously known C.

immitisâ? " endemic

> areas for in Utah (_Figure 1_

> (http://www.cdc.gov/ncidod/EID/vol10no4/03-0446.htm#Figure1) ). In

addition, we report results of a serologic survey of Dinosaur

> National Monument employees performed to assess recent exposure to

C.

> immitis.

> Outbreak Setting

> Dinosaur National Monument covers 320 square miles in the Uinta

Basin in

> northeastern Utah and northwestern Colorado (_Figure 1_

> (http://www.cdc.gov/ncidod/EID/vol10no4/03-0446.htm#Figure1) ). A

total of 397,800 visitors were

> recorded in 2000. During summer 2001, 49 permanent and 49 seasonal

employees, as

> well as approximately 120 volunteers, worked at the monument. A

weather

> station, located approximately 0.5 miles from the outbreak site,

has recorded an

> average annual precipitation of 8.7 inches since 1958.

> The outbreak site, at an elevation of 4,825 feet in an arid,

treeless region

> with small hills and rock outcroppings, is under a rock overhang.

The

> overhang faces directly south and receives reflected heat from the

surrounding

> frontier sandstone. Heat trapped within the shelter raises the

temperature several

> degrees above the outside temperature, hence its name, Swelter

Shelter (_14_

> (http://www.cdc.gov/ncidod/EID/vol10no4/03-0446.htm#11) ). Swelter

Shelterâ?Ts

> soil is a fine-grained, sandy loam containing approximately 10%

clay, 10%

> silt, and 80% fine sand. The soil has a low water-holding capacity,

an organic

> matter content of <5%, a pH of 8.5 to 11.0, and salinity of 8 to

16 mmhos/cm

> (_15_ (http://www.cdc.gov/ncidod/EID/vol10no4/03-0446.htm#11) ).

Swelter

> Shelter is on the main automobile tour through Dinosaur National

Monument and is

> accessed by a short trail.

> Archeological excavations conducted at Swelter Shelter in 1964 and

1965 were

> part of a larger archeological survey of the monument that included

many

> Native American sites (_14_

> (http://www.cdc.gov/ncidod/EID/vol10no4/03-0446.htm#11) ). The

inside wall of Swelter Shelter contains Native American petroglyphs

> and pictographs dating from the Fremont Culture before 1200 A.D.

The 1964

> and 1965 excavations identified artifacts as old as 7000 to 6000

B.C., as well

> as two ancient fireplace hearths, one of which contained burned

animal bones

> (_14_ (http://www.cdc.gov/ncidod/EID/vol10no4/03-0446.htm#11) ).

Unknown to

> those working in 2001, an outbreak of respiratory illness had

occurred among

> those conducting the earlier archeological excavations (_16_

> (http://www.cdc.gov/ncidod/EID/vol10no4/03-0446.htm#11) ).

> On June 18, 2001, under the direction of National Park Service

archeologists,

> a team of six student volunteers and two volunteer leaders began

work at

> Swelter Shelter. Work included laying stone steps, building a

retaining wall,

> and sifting dirt for artifactsâ? " an activity that created

considerable dust.

> Within the week before work began, the volunteers and leaders had

arrived from

> their residences throughout the United States; one arrived from

Europe. While

> at the monument, they camped in tents approximately 3 miles away

from Swelter

> Shelter. During June 29 to July 3, all six volunteers, both

leaders, and two

> National Park Service archeologists who worked at the site sought

medical

> care at a local hospital emergency room for acute respiratory and

systemic

> symptoms.

> Methods

> Case Definitions

> Persons working at Dinosaur National Monument were defined as

meeting the

> clinical case definition for coccidioidomycosis if they had onset

after June 18,

> 2001, of at least two of the following symptoms: self-reported

fever,

> difficulty breathing, and cough. Persons meeting the clinical case

definition were

> considered to have had laboratory-confirmed coccidioidomycosis if a

> complement fixation (CF) antibody titer of >1:2 was present or if

either of the

> immunodiffusion tests showed a band of identity. Further

confirmation of infection

> was obtained if there was seroconversion or a >4-fold rise in

antibody titer

> between paired serum samples.

> Cohort Study

> From July 2 to 4, 2001, 18 people (all six student volunteers, both

volunteer

> leaders, and all 10 National Park Service archaeologists at

Dinosaur

> National Monument) were interviewed by using a standardized

questionnaire to

> determine symptoms and activities from June 18 to 29. In addition,

clinical

> information was gathered from emergency room and hospital records

of persons who

> sought medical care and recorded on another standardized form.

Differences in

> categorical variables were assessed with the Fisher exact test.

> Laboratory Studies

> Acute-phase serum samples were obtained on July 1 or July 3 from

persons

> meeting the clinical case definition and were tested for antibodies

to

> Francisella tularensis, Yersinia pestis, Mycoplasma species,

Histoplasma capsulatum,

> and C. immitis by using standard techniques at laboratories at the

Centers for

> Disease Control and Prevention. In addition, all persons had

serologic tests

> for Rickettsia rickettsii, five for Legionella, and five for

hantavirus at

> local laboratories. Blood cultures for bacterial pathogens were

obtained

> during hospitalization.

> Convalescent-phase serum samples were obtained from July 16 to 21,

2001.

> Acute- and convalescent-phase serum samples were assayed for

antibodies to C.

> immitis by CF and immunodiffusion (IDCF), primarily to detect

immunoglobulin

> (Ig) G antibodies. Acute-phase serum samples were assayed by

immunodiffusion

> (IDTP) primarily to detect IgM antibodies (IDTP) (_17_

> (http://www.cdc.gov/ncidod/EID/vol10no4/03-0446.htm#11) ); the

IDTP assay was further performed with

> serum concentrated three- to fivefold.

> Environmental Investigation

> Monthly average temperature and precipitation data for the Dinosaur

National

> Monument quarry area (approximately 0.5 miles from Swelter Shelter)

for 1958

> to 2002 were obtained from the Western Regional Climate Center

(available

> from: _www.wrcc.dri.edu/cgi-bin/cliMONtavt.pl?utdino_

> (http://www.cdc.gov/ncidod/EID/vol10no4/disc14.htm) and

_www.wrcc.dri.edu/cgi-bin/cliMONtpre.pl?utdino_

> (http://www.cdc.gov/ncidod/EID/vol10no4/disc15.htm) ). Daily

rainfall data

> were obtained from weather station records at the monument.

> Serologic Survey of Monument Workers

> From August 15 to 17, 2001, we conducted a serologic survey among

Dinosaur

> National Monument employees to determine the presence of antibodies

to C.

> immitis. Because coccidioidomycosis skin test reagents are

currently unavailable,

> testing for antibodies to coccidioidomycosis was performed to

assess prior

> immunity to C. immitis among persons who reside or work in the

area. Samples

> were tested using CF and IDCF as described earlier.

> Results

> Cohort Study

> Ten of the 18 persons interviewed met the clinical case definition

for

> coccidiodomycosis. The case-patients included all 6 volunteers,

both group

> leaders, and 2 of 10 archeologists. The median age of patients was

17 years; five

> were male; and all were Caucasian. Illness onsets ranged from June

28 to July 1

> (_Figure 2_ (http://www.cdc.gov/ncidod/EID/vol10no4/03-

0446.htm#Figure2) ).

> Because the two group leaders and six volunteers traveled as a

group and all

> became ill, the sites of possible exposure to coccidioidomycosis

were limited

> to Swelter Shelter and their camping area, the only two places

visited b

> efore June 26. All eight of these persons reported engaging in the

same

> activities at each site; thus, determining specific risk factors

at Swelter Shelter or

> the camping area was not possible. However, among the 10

archeologists, 2 of

> 3 who worked at Swelter Shelter in June met the clinical case

definition

> compared to none of 7 who did not work there (p = 0.07). The two

ill

> archeologists worked on June 19, when dirt near the petroglyphs

was sifted with screens

> (archeologists A and B, _Figure 2_

> (http://www.cdc.gov/ncidod/EID/vol10no4/03-0446.htm#Figure2) ). The

archeologist who remained healthy (archeologist C,

> _Figure 2_ (http://www.cdc.gov/ncidod/EID/vol10no4/03-

0446.htm#Figure2) )

> only worked on June 20. On that day, sifting occurred along the

trail

> approximately 15 feet from the petroglyph panel. Sifting did not

occur on other days.

> Therefore, all persons meeting the clinical case definition, and

none of the

> noncase- patients were present at the sifting on June 19 (_Figure

2_

> (http://www.cdc.gov/ncidod/EID/vol10no4/03-0446.htm#Figure2) ) (p

= 0.00002). No

> archeologist had visited the camping area.

> With June 19 being the most likely time of exposure, the median

incubation

> period for the 10 persons who met the clinical case definition was

10 days

> (range 9â? " 12). These persons reported difficulty breathing (10

persons),

> nonproductive cough (9 persons), fever (9 persons), fatigue (8

persons), shortness of

> breath (7 persons), myalgia (6 persons), skin rash (6 persons),

and

> nausea/vomiting (4 persons). Eight persons were hospitalized; the

one person who did

> not report fever had a temperature of 37.8°C on hospital

admission. The mean

> temperature on admission was 38.3°C (range 36.9°Câ? " 39.4°C) and

the average

> respiratory rate was 23 per minute (range 18â? " 32). Results of a

pulmonary

> examination were relatively unremarkable except for dry cough. At

the time of

> evaluation, five patients had a maculopapular rash on the neck,

trunk, and

> extremities. The mean leukocyte count at admission was 11,800 mm3

(range 5,600â? "

> 17,700), with an average of 80% neutrophils (range 67%â? " 92%).

Results of tests of

> liver and renal function, including urinalysis, were within normal

limits. The

> average oxygen saturation was 93% (range 88%â? " 97%) by pulse

oximetry. Chest

> radiographs of all 10 case-patients showed bilateral patchy

infiltrates. All

> persons hospitalized were treated with fluconazole and discharged

within 3

> days.

> Acute-phase serum specimens from 9 of 10 persons who met the

clinical case

> definition contained IgM antibodies to C. immitis, as determined by

IDTP by

> using concentrated serum samples; one was positive by IDTP before

serum

> concentration. The patient without demonstrable IgM antibodies on

convalescent-phase

> serologic testing had pulmonary infiltrates and a skin rash

typical of the

> other patients. Two of the eight patients with convalescent-phase

samples had

> at least a fourfold increase in CF titer. Initial serologic tests

for

> antibodies to F. tularensis, Y. pestis, Mycoplasma species, R.

rickettsii,

> Legionella, and hantavirus were negative. Blood cultures were

negative for bacterial

> pathogens.

>

>

>