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

[Guest guest]

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,† Rana A. Hajjeh,‡ Mark D.

Lindsley,‡ W. Warnock,‡ Anil A. Panackal,‡ ph B. Shaffer,§

am B.

Haddad,†‡ Frederick S. Fisher,¶ T. Dennis,* and tte ‡

*Centers for Disease Control and Prevention, Ft. , Colorado, USA; †

Utah Department of Health, Salt Lake City, Utah, USA; ‡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 9–12 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 5–20

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 (_3–5_

(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. immitis–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 Shelter’s

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 artifacts—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 9–12). 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°C–39.4°C) and the average

respiratory rate was 23 per minute (range 18–32). 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

5,600–

17,700), with an average of 80% neutrophils (range 67%–92%). Results of tests

of

liver and renal function, including urinalysis, were within normal limits. The

average oxygen saturation was 93% (range 88%–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.