Histoplasmosis from NCRC 2008

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Histoplasmosis from NCRC 2008

Postby chrismc » May 28, 2008 2:49 pm

I just got a phone call from my friend Shalom, who took the Level 1 weeklong this year in Mentone, and she just received the lab results that she tested positive for Histoplasmosis. She developed a nasty respiratory infection several days after returning home from NCRC. After fighting it for a week or so she went to the doctor who eventually got a lab test done for Histo. She is now under her doctor's care, and is working through her insurance to get the proper anti-fungal meds.

She is not a recreational caver, and has not been in any caves recently besides the ones that the Level 1's entered, and South Pittsburg Pit (we bounced it on the way down Friday). We did not even get off-rope at the bottom of S. Pittsburg, so its probably not a likely culprit. She said the caves that she entered during the weeklong were the following:

  • Pettijohn's
  • Steward Springs
  • Manitou

I don't want to jump to any unfair conclusions, but it is extremely likely that she acquired Histo from one of these caves during the weeklong seminar. If you were in these caves (especially in the Level 1 class), and have a respiratory infection, please visit a doctor and let him/her know of the potential exposure!
Last edited by chrismc on May 29, 2008 5:13 pm, edited 4 times in total.
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Re: Histoplasmosis from NCRC 2008

Postby Carl Amundson » May 28, 2008 2:53 pm

Wow, that sucks.

Tim, can you send something out to all the folks that took Level 1 (and maybe Levels 2 and 3 also) and warn them about this.
(just a thought...)
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Re: Histoplasmosis from NCRC 2008

Postby Scott McCrea » May 28, 2008 3:13 pm

All of the NCRC sites are very heavily visited caves. If Histo was in one of them, it's likely we would have heard about it before now. Of course, being her first time underground, she could be more susceptible and sensitive. I would guess that more likely exposure happened in her bunk from mice poo and the like. I didn't see any evidence of mice but was she upstairs in that really stinky room?

But what do I know? :shrug: I hope she has a speedy recovery. Her rope skills were certainly impressive.
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Re: Histoplasmosis from NCRC 2008

Postby NZcaver » May 28, 2008 3:14 pm

Wow, not good. Hope she recovers soon.

I wonder if local grottos and cave owners/managers in the area should be contacted too? Of course it would be bad to jump to conclusions and sound the alarm prematurely, but on the other hand it might be good to have some scientist-type people check it out just to be sure.

On Histoplasmosis (and the fungus Histoplasma capsulatum which causes it), the CDC website says:
Where is H. capsulatum found?

H. capsulatum is found throughout the world and is endemic in certain areas of the United States. The fungus has been found in poultry house litter, caves, areas harboring bats, and in bird roosts.

Not to downplay the cave factor, but is there any chance this person may have contracted Histo from one of these other locations recently (during the NCRC training or otherwise)?
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Re: Histoplasmosis from NCRC 2008

Postby wyandottecaver » May 28, 2008 5:05 pm

any idea where they were from? Histo is actually very very common throughout the east and midwest. In fact, most people in those areas will test positive for exposure. If they were from another part of the country even "background" levels might pose a problem.

Of course, even well visited caves can be reservoirs of disease and bad luck or extra sensitivity can make a big difference. Wyandotte Cave in IN has been a commercial cave for over 100 yrs. It has also been heavily travelled off-trail. While I was a manager there, I was aware of a few suspected cases including one from a guide with several yrs experiance and no prior problems. Of course it is also a bat hibernaculum and ANY cave harbouring significant numbers of bats (or mice) has the potential for problems. In fact, since histo is normally more associated with birds, I have often wondered if phoebe's which frequently nest in cave entrances are a significant vector...
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Re: Histoplasmosis from NCRC 2008

Postby Anonymous_Coward » May 29, 2008 10:40 am

Chris,

The cave that Level 1 did litter handling in is called Steward Springs. I remember seeing several bats fly out of the cave (in full daylight) before the 40 level 1 students came thundering out. I did not enter the cave myself but by the looks of everyone that did, it must be a wet, muddy cave.

I also remember that Shalom was ill one night very early in the week, before her class had gone underground at all. I believe she was having stomach problems, so I'm not sure if that relates to histo at all. She took some sort of medication and was feeling better after that.

On a somewhat related note, I was substantially ill for about 10 days after returning home from NCRC. Lots of
wheezing and coughing, sore throat, aching muscles, and fatigue. I lost my voice for several days. I eventually hacked up a bunch of black stuff and felt better after that. I figured it was the same cold that the Texans brought over and that I probably caught from hanging out with Bill Putnam. (It was worth it Bill!) I suppose there could have been lung fungus involved, I hadn't thought of that possibility until now.

I went into Pettijohns (twice), Howard's Waterfall, Sinking Cove Cave, and Cemetery Pit.
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Re: Histoplasmosis from NCRC 2008

Postby shibumi » May 29, 2008 12:09 pm

jaa45993 wrote:Chris,



I also remember that Shalom was ill one night very early in the week, before her class had gone underground at all. I believe she was having stomach problems, so I'm not sure if that relates to histo at all. She took some sort of medication and was feeling better after that.


I had that too, as did several people I talked to. I suspect mild food poisoning since it had a GI trend and once I got it out of my system I felt *much* better.

jaa45993 wrote:
On a somewhat related note, I was substantially ill for about 10 days after returning home from NCRC. Lots of
wheezing and coughing, sore throat, aching muscles, and fatigue. I lost my voice for several days. I eventually hacked up a bunch of black stuff and felt better after that. I figured it was the same cold that the Texans brought over and that I probably caught from hanging out with Bill Putnam. (It was worth it Bill!) I suppose there could have been lung fungus involved, I hadn't thought of that possibility until now.

I went into Pettijohns (twice), Howard's Waterfall, Sinking Cove Cave, and Cemetery Pit.


I got the same cold a couple days after getting home. I usually do after weeklong, the combination of stress,
exposure to people from around the country, and having to talk louder than I usually do. The
symptoms I presented were consistant with what I get from a cold, so I don't suspect Histo, and considering I gave it to two other people, it makes it more likely to be a cold.
http://www.mayoclinic.com/health/histop ... DSECTION=2
for some info on histo from the Mayo Clinic.
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Re: Histoplasmosis from NCRC 2008

Postby Tim White » May 29, 2008 1:12 pm

The former commercial cave that Level 1 used was Manitou Cave.

shibumi wrote: ... the combination of stress,

You stressed?? That's my job. You are the cool one.

I am not aware of histo ever being reported or linked to PJ, Manitou nor Steward Spring.

Berta came down with a horrible sinus, upper respiratory thing with a bad cough that only got better this Monday. I think the only Lvl 1 cave that she might have entered was Manitou. I'll check.

I had a sore throat much of the week of NCRC and a couple of times it was so bad I lost my voice.

I think we all spent to much time with a bunch of Texans. I keep teasing Berta, asking “how did you get the same cold that Bill had?” :devil: :kidding:
Be safe,
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Re: Histoplasmosis from NCRC 2008

Postby shibumi » May 29, 2008 1:23 pm

Tim White wrote:The former commercial cave that Level 1 used was Manitou Cave.

shibumi wrote: ... the combination of stress,

You stressed?? That's my job. You are the cool one.

The secret to command is to appear unflappable. Besides, I had
an excellent set of instructors! You guys did everything I asked
and did it well.

Actually, weeklong is a whole lot of stress for me, but maybe different
than the way it is for you? I spend most of my time out at the Ranch
communing with nature and not interacting with many folks
on a daily basis. So for a week I have to be a ton more social than I
usually am, and on top of that I have to try to be aware of everything
at once. It's a little like I am during a rescue, only without the
adrenaline high :)

Hmmm. I spent the day Saturday with Bill, too. Very suspicious.
And he took me to some deep dark hole in the ground and made
me crawl through several bathtubs :)
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Re: Histoplasmosis from NCRC 2008

Postby Bill Putnam » May 29, 2008 4:44 pm

OK, OK. I confess. Everybody I caved with, drank with, or hung out with at NCRC got sick.
Apparently I'm actually Typhoid Bill. :shrug: :tonguecheek:

But seriously, I am still coughing and suffering from respiratory issues that began at the Mentone seminar. I believe that someone brought a respiratory illness to Mentone and gave it to a bunch of us. Quite a few people have been sick with it, and some were also sick with a 24-hour GI bug during the seminar. I guess that is not too surprising when you consider that 150 people from all over the country were thrown into close contact on a daily basis for more than a week, while working hard and getting minimal sleep. If anyone has a cold or something it's bound to spread around in that kind of situation. Still, I am going to go get tested for TB, Histo (already have positive test from decades of caving, but it has been shown that a substantial exposure can result in infection even for people who have previous exposure), and whatever else they can think to check (Hantavirus? Apergillosis? X-Files Black Oil Alien virus?). I hope we do not all wind up as the subjects of a massive CDC epidemiological investigation.

If it sheds any light on all this, here's my story: I came down with what I thought at the time was a massive hay fever reaction to the pollen at the seminar site. It started mid-week, and by Thursday I had suffered enough and went by a pharmacy in Valley Head to get some Claritin. That helped with the sneezing and congestion, but I was still pretty sick and skipped most of the mock rescue on Friday to sleep in and try to recover.

I felt better Friday night and Saturday, until I got into the water crawl in Sinking Cove Saturday afternoon and realized that I was way low on energy and endurance. The short crawl sans-wetsuit was enough to put me into mild hypothermia, and I ran the heater in the truck all the way to Stevenson but still felt cold. Some hot coffee and hot food fixed that, but the drive back to Mentone seemed endless, and I crashed soon after the obligatory post-cave debriefing session.

Sunday was a journey through Hell just to get back to Atlanta, featuring chills, nausea, and repeated fits of cough-until-you-retch. As soon as I got home I crashed big time. Other symptoms suggested a sinus infection so it was off to the pharmacy for 10 days worth of Amoxycillin, which eventually changed the drainage from green to clear. A bottle of Delsym and another of prescription codine cough syrup got me through the week, but I still coughed until I felt like my abdomen had been someone's punching bag. Weeks later I am still plagued by a nagging cough that just won't go away. My wife and kids apparently caught whatever I had and developed most of the same symptoms, though not as severe as mine (probably due to my stressed immune system). They are still coughing, too.

I'm finishing up a week at the beach and I'm still coughing intermittently, especially at bedtime. Now that I've read all this info from other victims (patients?) it's clearly time to call the doc tomorrow and get in for a chest X-ray and more diagnostic tests. I'm headed fro Lechuguilla in less than a month, and this nonsense has got to stop.

"Typhoid" Bill Putnam
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Re: Histoplasmosis from NCRC 2008

Postby Bill Putnam » May 29, 2008 4:50 pm

For the record, the caves visited by Level 1 students and instructors were:

Steward Spring Cave (stream cave, no colonial bats, no history of histo)
Pettijohn's Cave (dry cave, heavily visited cave, no colonial bats, no history of histo)
Manitou Cave (dry cave, former commercial cave, no bats observed, no known history of histo)
Howards Waterfall Cave (mostly dry, no colonial bats, heavily visited cave, no history of histo)

I have visted all of the caves except Manitou repeatedly without any adverse effect or sign of histo or other respiratory problems.
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Re: Histoplasmosis from NCRC 2008

Postby Stridergdm » May 29, 2008 8:56 pm

Dang, this ain't good at all.

I know the pollen was getting to me. Rolled over one morning while in my bunk and BAM! every drop of fluid in my skull drained into the right side of my head and it felt like someone was stomping on my brain. Fortunately some drugs cleared that up.

But like several others, got back to DC, a bit under the weather, some cough, etc. but seems I avoided the worst of it.

As for spending too much time with the Texans, just remember rule #1 of NCRC, "NEVER fall asleep at the Alamo (or where large numbers of Texans congregate). And of course rule #2 is, "don't ever forget rule #1." I've met a few people who have trouble remembering those rules.

I think we may need a rule #3, "don't hang out too much with Bill Putnam". (Geesh, and to think Bill was worried when I came down in February that I'd infect his bats with WNS. Now I think he was just trying to divert suspicion from himself. :woohoo: )
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Re: Histoplasmosis from NCRC 2008

Postby cavercrew » May 29, 2008 10:16 pm

Man, I really hate to hear about folks getting sick. I hope Shalom and the rest of you get better soon. The combination of travel and the intermingling of people from different geographical areas, physical and mental stress, lack of sleep, change of diet, partying and exposure to all the pollen, cave dust, etc does take it's toll on the caver. I was feeling off for a few days for sure but have not had any respiratory troubles yet. There are a few caves in the south that have histo trouble but like Bill said none we visited. Though it is quite possible that someone who has not had 'any' exposure to southeastern caves and then spends a fair amount of time in several of them could pick up histo especially if they had an underlying condition or compromised immune system. (speculation here, by no means an expert)
After the Sinking Cove trip I got home about midnight and then went to work at 6 AM Sunday and worked my 7 day run after that so I was pretty beat all in all. The lack of sleep is what gets me eventually.
It was a good time though and I'd probably do it again if poked hard enough :big grin:
Ya'll take care and get well soon.

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Re: Histoplasmosis from NCRC 2008

Postby Cavingplum » May 30, 2008 12:51 am

Hey all;

Late nights + early mornings, Level 1, Bill Putnam and a cold water swim in Sinking Cove didn't bring me down and I regrettably had no germs to pass on to the folks here in southeast Alaska - however I did have a bit of a wheeze when I got back to the island - I just figured it was allergies.
Sorry to hear about Shalom, hope she gets well soon! Are the symptoms of histo usually severe, such as a respiratory infection??

PS, thanks for all the fun, everyone...!
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Re: Histoplasmosis from NCRC 2008

Postby johnlhickman » May 30, 2008 9:00 am

Apparently, just like long term exposure to low levels of Histo, you can build up a tolerance to Bill Putnam. I have been around him for years and don't seem to have any visible side-effects.

There was definitely something going around camp matching the symptoms described by others. Three of our five Level 3 instructors weren't doing well mid-week but had gotten better by the end of the week.

It could be that Shalom got sick and then had an exposure to a low level of Histo that was able to take hold. I am not a doctor, so this is all spectulation. Of course, isn't everything on the board.

I was definitely tired after that week. I went home on Saturday and took a two hour nap on Saturday and was woken up to a page for a cave rescue. Fortunately, we were stood down before I had to leave the house.

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