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Workplace Medical Mystery: Influenza-like Illness strikes Worker at Wildlife Refuge

Posted on by Stephanie Stevens, MA

MM1Michelle was thrilled to have landed a job at a wildlife refuge in the Ohio River Valley the summer before she started veterinary school. She hoped to specialize in zoological medicine and work with zoo animals. Three months into her summer job, Michelle came down with the flu—or so she thought.

An animal lover, Michelle knew she wanted to be a veterinarian from a very young age. When she traveled to Africa to study abroad her junior year of college she fell in love with the large, exotic animals she saw on safari. The refuge where she now worked was home to many of these wild animals after they became ill, retired from zoos or circuses, or were rescued from abusive situations.

Multiple barns at the refuge housed Asian and African elephants, including a “quarantine” barn where new elephants arriving at the refuge stayed. Michelle spent most of her time with these gentle giants and the little bats that took up residence in the barns during the warm summer months. Some of Michelle’s daily tasks included feeding and caring for the elephants and sweeping or shoveling hay, sawdust, and dung—from the elephants and bats—from the elephant stalls. Additionally, she had to clean the barns every day with a high-pressure water sprayer. Michelle also helped with data entry in an administrative office connected to one of the barns.

It was the beginning of August and both the temperature and humidity were soaring. Michelle started experiencing chills, fatigue, and a fever as high as the heat index outside. She also had a cough and pain in her chest.

Thinking she must have the flu, Michelle went to see her family physician after two days of symptoms. Dr. Smith had been the first to diagnose Michelle with diabetes when she was pre-teen and has helped her keep her blood sugar levels in check ever since. Michelle knew if she had the flu she needed antiviral drugs as soon as possible because she was at an increased risk for serious complications due to her diabetes. Dr. Smith wasn’t so sure it was the flu, however. According to the CDC, flu activity peaks between December and February—it was August. Dr. Smith deemed Michelle’s illness to be consistent with a viral respiratory illness but likely not the flu. He recommended some home treatments to help ease her symptoms including rest, fluids, and acetaminophen for her fever, and asked her to call back if her symptoms lasted more than 7 days.

Ten days later, Michelle went to see Dr. Smith again. She reported persistent symptoms and also now a 5 pound weight loss. “This doesn’t appear to be consistent with a viral illness; what could it be?” thought Dr. Smith.

Tune in for the next installment of Workplace Medical Mysteries to see what is ailing Michelle. Think you know? Tell us what you think it is in the comments section below.

Stephanie Stevens, MA, is a Health Communication Specialist in the NIOSH Office of the Director.

This blog is part of the NIOSH Workplace Medical Mystery Series. The names and certain personal details of the characters are fictitious and do not represent an actual person or persons.

Posted on by Stephanie Stevens, MA

15 comments on “Workplace Medical Mystery: Influenza-like Illness strikes Worker at Wildlife Refuge”

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    As an Industrial Hygienist, I gravitate first to potential occupational exposures to various toxicants.

    Although the patient’s symptoms mimic those of tuberculosis, the presence of bats/bat guano, elephant manure and bedding materials tell me she has a fungal infection – histoplasmosis.

    Shoveling out stables and pressure washing is going to stir up spores and get them airborne.

    My second choice would be related to dampness and mold – Aspergillus is ubiquitous especially in straw and animal feeds, animal bedding materials and the like. Her symptoms however do not correspond to hypersensitivity pneumonitis as she is not reporting dyspnea.

    Ag operations like this are troublesome – it’s awfully hard to keep things clean.

    Very interesting hypothesis !

    I would go on the same hypothesis as Dennis P Kelly…

    Look forward for the answer…

    I don’t think taking a guess is the way to go. A diagnosis would be guided by clinical examination and biological sampling together with xrays. There are a whole range of possible conditions that could be related to her symptoms. Sorry but won’t take a guess.

    Fungal from combination of the bat dung, manure, etc. are really high on my list of possibilities. Also, possible bite from blood carrying female Aedes Mosquito could also be a part or all of her illness. Michelle’s low immune fighting capabilities d/t her diabetes put her at a higher risk for contracting many virus and other diseases. I think she should rethink her being a Zoologist/Vet., unless she does not work in areas that compromise her health.

    There are many possibilities where I agree that we should never guess when it comes to a Pt’s signs and symptoms. Vital signs, a full medical exam X-rays and so on would help put it all together. Anthrax is questionable because depending on if she used the correct PPE or not, she may also have scabs and soars associated with cutaneous anthrax. I wouldn’t rule out CO (carbon monoxide) poisoning as she also used a pressure washer daily. I would like to see her spO2 levels.

    My first guess is histoplasmosis, but as many other people above have mentioned – it would be great to have additional vitals and diagnostic information when trying to decide what the patient might likely have.

    It sounds like cryptosporidium would be responsible for her weight loss but by far the fungal burden from Histoplasmosis appears to be the indicator for her symptoms.

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