Two men died after they contracted a rare fungal infection from exposure to bat feces, also known as guano, that they were using to grow cannabis plants, according to a report published in a medical journal.
The men, who lived in Rochester, N.Y., were not named in the article, published this month in the journal Open Forum Infectious Diseases. The researchers wrote that the men had been hospitalized and diagnosed with histoplasmosis, a form of pneumonia that is caused by breathing in spores of the fungus histoplasma capsulatum, which is often found in bat guano. Their cases were unrelated, the researchers said.
The spores they inhaled were in fecal matter they had used or planned to use to fertilize homegrown cannabis plants, according to the report.
“Exposure to bat guano among cannabis growers appears to be a recent trend that can lead to histoplasmosis cases and outbreaks,” the researchers wrote. “It is crucial to raise awareness among physicians and patients to reinforce personal preventive measures and establish timely diagnosis.”
One of the men, who was 64 years old, reported having a severe bat infestation in his attic that left behind a thick layer of guano, which he inspected several times and planned to use as cannabis fertilizer, the researchers wrote.
He went on to develop an array of symptoms over several months, including a sodium imbalance and chronic cough. He lost 35 pounds, according to the report, which said he also had severe peripheral arterial disease.
Scans at the hospital revealed lesions on his pancreas and around his abdomen that doctors treated, the report said. He was discharged after the lesions shrank, but he returned to the hospital about a month later and ultimately died.
The other man, 59, was hospitalized with respiratory failure. On his intake form, the man said he had used guano purchased online to fertilize cannabis that he cultivated and smoked. He was treated with two weeks’ worth of antifungal medications, but he continued to have breathing problems and was ultimately moved to comfort care, where he died.
Dr. Paulina Sudnik, an infectious disease fellow at the University of Rochester Medical Center and one of the authors of the report, said that histoplasmosis is a rare disease, but that bat guano’s increasing popularity as a fertilizer could lead to a surge in cases among people who do not handle it properly.
The substance has high levels of nitrogen, phosphate and potassium, all critical nutrients for plant growth. It is safest to handle it in a well-ventilated space, while wearing a mask and gloves, Dr. Sudnik said.
Dr. Sudnik and Dr. Ted Louie, another author of the report, said they had done a brief survey of bat guano products sold in stores and online and found that many of the labels did not indicate the potential risk of being exposed to the fungus, nor did they include instructions for safe handling.
The researchers are now urging regulators to issue guidance on adding such warnings and instructions to product labels.
Symptoms of histoplasmosis can include chest pain, body aches, fever, chills, coughing and fatigue. They usually set in between 3 and 17 days after a person has inhaled spores. According to the Centers for Disease Control and Prevention, not everyone who is exposed to the fungus gets sick.
Dr. Louis Weiss, an infectious disease physician at Montefiore Medical Center’s Einstein campus in the Bronx who was not involved in the research, said the illness usually presents as a pulmonary disease, but can be found throughout the body. People who are immunocompromised are at a higher risk of becoming sick after exposure.
The C.D.C. says that histoplasmosis is often diagnosed late or misdiagnosed entirely because its symptoms resemble those of common bacterial and viral pneumonias. In some cases, the illness can turn into a long-term lung infection or spread to other parts of the body, causing meningitis.
Most cases of histoplasmosis in the United States are reported around the Mississippi and Ohio River Valleys, according to the C.D.C., where around 60 percent to 90 percent of residents are exposed to the fungus in their lifetime. The death rates for those hospitalized range from 5 percent to 7 percent.
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