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Histoplasma capsulatum, a dimorphic fungus, is prevalent in soil — particularly soil enriched with bird or bat droppings — in many areas of the world, including Central and South America. Infection with this organism generally produces no (or only mild) symptoms and is self-limiting. Immunocompromised individuals, however, can develop overwhelming pneumonia and systemic disease, requiring antifungal therapy.
During February and March 2008, the Virginia and Pennsylvania departments of health investigated respiratory disease in mission workers from three groups that had sequentially helped to restore a church in El Salvador. Of the 33 people involved, 20 (61%) met the case definition for histoplasmosis (i.e., influenza-like illness beginning ≥…