Since 2013, CDC has received reports and investigated serious complications among medical tourists (i.e., persons whose primary purpose for international travel is medical care) upon their return to the United States (1). On May 1, 2017, the New York City Department of Health and Mental Hygiene informed CDC of three patients with nontuberculous mycobacteria (NTM) surgical site infections (SSI), all of whom had undergone cosmetic surgical procedures by a single surgeon at Centro Internacional de Cirugía Plástica Avanzada (CIPLA) in the Dominican Republic (2). | | To identify additional patients, calls for cases were issued via CDC’s Epidemic Information Exchange (Epi-X), state-based health alert systems, the Infectious Diseases Society of America’s Emerging Infections Network, and the American Society of Plastic Surgeons’ email distribution list. State and local health department staff members interviewed reported patients to collect information about medical care received abroad, symptoms, and treatment received after their original surgical procedures. A confirmed case of cosmetic surgery–associated NTM infection was defined as a diagnosed SSI and laboratory evidence confirming the presence of NTM in a U.S. resident who underwent a cosmetic surgery procedure in the Dominican Republic since January 1, 2017.

Background: Histoplasmosis is a fungal infection associated with exposure to bat guano. An outbreak of an unknown severe febrile illness occurred among tunnel workers in the Dominican Republic (DR), and resulted in several deaths. We conducted an investigation to confirm etiology and recommend control measures. Methods: A case was defined as fever and ≥2 symptoms consistent with histoplasmosis in a tunnel worker, July-September, 2015. We interviewed workers and family members, reviewed medical records, tested serum and urine for Histoplasma antigen/antibody, and conducted a cohort study to identify risk factors for histoplasmosis and severe infection (intensive care). Results: A crew of 36 male workers removed large amounts of bat guano from tunnels without respiratory protection for a median of 24 days per worker (range: 1-25). Median age was 32 years (range: 18-62); none were immunocompromised. Thirty (83%) workers had illness that met the case definition of whom 28 (93%) were hospitalized, 9 (30%) required intensive care, 6 (20%) required intubation, and 3 (10%) died. The median time from symptom onset to antifungal treatment was 6 days (range: 1-11). Twenty-two of 34 (65%) workers had laboratory evidence of histoplasmosis infection. Conclusions: Severe illnesses and death likely resulted from exposure to large inocula of Histoplasma capsulatum spores in an enclosed space, lack of respiratory protection, and delay in recognition and treatment. Clinician education about histoplasmosis, improved laboratory capacity to diagnose fungal infections, and occupational health guidance to protect workers against endemic fungi are recommended in the DR to prevent future outbreaks.

BACKGROUND: Colombia, as part of The Andean Countries Initiative has given priority to triatomine control programs to eliminate primary (domiciliated) vector species such as Rhodnius prolixus and Triatoma dimidiata. However, recent events of Trypanosoma cruzi transmission in localities where R. prolixus and T. dimidiata are not present suggest that other species are involved in the T. cruzi transmission cycle. METHODS: We studied T. cruzi transmission on Margarita Island, located on the Magdalena River in the Colombian Caribbean region, where a high number of non-domiciliated triatomines infected with T. cruzi inside human dwellings have been observed. A cross-sectional survey including serological studies in humans and parasitological and molecular methods in vectors and reservoirs was conducted. We investigated risk factors for human infection and house infestation, and evaluated the association between abundance of wild triatomines in palm trees (Attalea butyracea) across municipalities, seasons and anthropogenic land use. RESULTS: The T. cruzi seroprevalence rate in humans was 1.7% (13/743) and autochthonous active T. cruzi transmission was detected. The infection risk was associated with the capture of triatomines in human dwellings. Five wild mammal species were infected with T. cruzi, where Didelphis marsupialis was the main reservoir host with an 86.3% (19/22) infection rate. TcIb was the only genotype present among vectors. Triatomine abundance was significantly higher in Ecosystem 2, as well as in the dry season. Despite the absence of triatomine domiciliation in this area, T. cruzi active transmission was registered with a human seroprevalence rate similar to that reported in areas with domesticated R. prolixus. CONCLUSIONS: This study illustrates the importance of secondary and household invading triatomines in Chagas disease epidemiology in the Caribbean lowlands of Colombia.