Solving The Mystery Of "Bamboo Bonfire" Lung Disease

When I first saw Bamboo Bonfire come across my RSS feeds, I believed I had stumbled upon a great new band (feel: Bon Iver).

Alternatively, the phrase appeared in a report final week from the Centers for Disease Control &amp Prevention’s Morbidity and Mortality Weekly Report. by Dr. Dirk Haselow and colleagues at the Arkansas Division of Public Overall health and the Department of Pediatrics at the University of Arkansas.

The case is enough to scare the heck out of any mother or father – and even several physicians – as properly as folks in occupations whose outside work ramps up as the weather improves.

When antibiotics fail

Back in the fall of 2011, an eight-12 months-previous boy and his 5-12 months-previous sister residing in northeastern Arkansas produced vague stomach discomfort, a dry cough, and vomiting. When seen in clinic, they tested optimistic in a quick strep check and had been prescribed a ten-day course of a penicillin derivative, amoxicillin. But 6 days later, the two youngsters have been spiking temps of better than 104°F and their coughs had been worsening, not improving.

They have been subsequently hospitalized with pneumonia and given intravenous versions of two antibiotics, azithromycin (Zithromax® and ceftriaxone (Rocephin® Roche). With their signs and symptoms nonetheless not strengthening two days later on, they were transferred to Arkansas Children’s Hospital in Little Rock.

A a lot more in depth story then emerged:

Extra background exposed that the kids had attended a household gathering 8 days ahead of symptom onset. Participants lower bamboo, created a fort, and burned wood in a small grove that had served as a red-winged blackbird roost. Other attendees were reported to be ill with equivalent signs.

The blackbird roost was the tip to test the individuals for a fungal infection named histoplasmosis. Triggered by spores from a fungus referred to as Histoplasma capsulatum, the condition is sometimes seen in patients with HIV/AIDS or other circumstances the place the immune system is compromised. Outdoors of this situation, histoplasmosis is also referred to as Spelunker’s lung or cave ailment due to the fact its source, bat guano, is often encountered among cavers. But the fungus also grows extremely effectively in bird droppings.

The authors of the report described that, “the loved ones constructed a bamboo bonfire and utilized it to roast hot dogs. Leaf litter or ash was then raked and young children were mentioned to be playing in the grime.”

Liberation of the spores caused 18 of the 19 attendees to build probable or confirmed cases of histoplasmosis. Seven grew to become sick enough to be hospitalized, but all in the long run recovered.

As the clinicians realized why the antibacterial antibiotics had been ineffective, the very first two children have been handled by injections with the antifungal drug itraconazole (Sporonox® Janssen). Their signs and symptoms improved inside of 48 hours. The itraconazole was then continued orally for 3 months.

Red-Winged Blackbird (Male), Colony Farm Regional Park, Port Coquitlam, British Columbia (Photograph credit score: Alan D. Wilson, www.naturespicsonline.com via Wikimedia Innovative Commons license)

The red-winged blackbird (Agelaius phoeniceus) is a notably prolific bird whose assortment encompasses North and Central America. The MMWR situation describes nearby residents telling of a literal darkening of the sky for the duration of yearly migrations to Arkansas.

Even though the birds really don’t carry the fungus, it is endemic to Arkansas and the river valleys of the central United States – the Ohio, Missouri, and Mississippi. Bird and bat feces are a especially rich development medium for histoplasma. Researchers feel that the high acid and salt articles of the droppings permits the a lot more resilient fungus to outcompete standard bacteria development. Any disturbance of histoplasma-contaminated droppings generates an aerosolized disease hazard.

Occupational cases litter the study literature

In 1980, 6 Louisiana workers produced histoplasmosis after they bulldozed a stand of trees containing a bamboo stand heavily laden with blackbird droppings,  then burned the debris.

Solving The Mystery Of "Bamboo Bonfire" Lung Disease