Thai Soccer Team Rescued From Cave–but They Could Be at Risk for This Potentially Life-Threatening Infection

Now that the 12 youth soccer players and their coach have all been rescued from the flooded cave in Thailand where they were trapped for more than two weeks, their next trial awaits: a full medical examination and treatment, if necessary, to address any of several health challenges they may have faced.

Initially, the first boys rescued were reported to be in good health, while an official later said in a news conference that some blood tests showed signs of infection, NPR reported.

A medic on the scene told Reuters that an entire section of a nearby hospital had been prepared to treat the 13 rescued people. Hypothermia—when body temperature drops severely—posed the “scariest” threat, the medic said, but she was primarily concerned with infections, particularly histoplasmosis—sometimes called cave disease. “There are all kinds of diseases in the cave, from bats, from dirty water. Everything in there is very dirty.”

So, what is this potentially dangerous lung infection? Health spoke to Amesh Adalja, MD, a spokesperson for the Infectious Disease Society of America to find out.

“Anytime you’re in a cave, there are worries about diseases that can be spread by bats,” says Dr. Adalja. In addition to histoplasmosis, he says the boys and their coach may also be at increased risk of having contracted rabies, cryptococcosis, and gastrointestinal infections. While we don’t yet know what kind of exposure to bats the soccer team faced, here’s what everyone should know about cave disease just in case.

What is histoplasmosis?

This inflection is caused by a fungus called Histoplasma, which is most often found in places where there is a large amount of bird or bat droppings—like a cave. That’s what’s earned histoplasmosis its nicknames “cave disease” and “spelunker’s lung.”

Although you may not have heard of histoplasmosis before, it’s actually frequently found in soil across North and Central America, including in the U.S. Histoplasmosis is particularly common in the Ohio and Mississippi River valleys. “There, most of the population has been infected,” says Dr. Adalja, also a senior scholar at the Johns Hopkins Center for Health Security in Baltimore.

People become infected by inhaling tiny Histoplasma spores. In a person’s lungs, the spores can transform into yeast and spread through the bloodstream to other body parts, according to the Centers for Disease Control and Prevention (CDC).

Histoplasmosis symptoms

While many people may become infected with histoplasmosis, most actually won’t get sick. “The spores remain dormant, and maybe when people have another illness, they may get what’s called disseminated histoplasmosis,” Dr. Adalja says. “But in most people, it doesn’t cause problems.”

For the people who do develop histoplasmosis symptoms, they usually experience flu-like fatigue, fever, and cough, according to the CDC. Acute symptoms tend to show up anywhere from three to 17 days after a person was exposed to the fungus, according to the Mayo Clinic. While these symptoms are certainly unpleasant, they’re usually manageable without medication; people tend to get better from histoplasmosis on their own. “Sometimes you don’t need to treat it, you can let it run its course in the acute stage,” Dr. Adalja says.

However, in other cases, usually if someone’s immune system is already weakened or they’re taking certain immunosuppressant medications like chemotherapy or corticosteroid drugs, histoplasmosis can progress. When it spreads from the lungs to other organs—including the mouth, liver, and adrenal glands, according to the Mayo Clinic—experts call it disseminated or severe histoplasmosis, and it can be life-threatening.

The CDC explains that two studies estimated the death rate from histoplasmosis to be between 4% and 8%, but adds that overall mortality rate is probably lower because these studies only looked at people with serious cases of the infection.

This progression can even occur years after being exposed to Histoplasma fungus, Dr. Adalja adds. If someone with dormant spores in their lungs goes on to develop another lung condition or requires immune-suppressing medications later in life, histoplasmosis may become a problem then, he explains. For this reason, the boys rescued this week should “keep in mind as they grow older that they might have been exposed,” he suggests.

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Histoplasmosis treatment

Most people who develop a mild case of histoplasmosis won’t need any treatment. But in severe cases, doctors usually turn to antifungal medications, either in pill or IV form. Treatment can last several months, Dr. Adalja says.

Anyone with flu-like symptoms after coming in contact with bird or bat droppings is encouraged to talk to a doctor about how they’re feeling, especially if they have a weakened immune system due to an underlying condition like HIV or AIDs or are undergoing treatment for certain other conditions with immunosuppressant drugs.

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