First-ever case of 'cave disease' diagnosed in the Middle East

Symptoms vary, and in people with normal immune systems, it usually passes by itself.

Dr. Ami Neuberger (photo credit: ERAN ABUKASSIS)
Dr. Ami Neuberger
(photo credit: ERAN ABUKASSIS)
Singers Bob Dylan and Johnny Cash both had it, but a disease found in the central and southern part of the US – which has never before been diagnosed in the Middle East – has been discovered in a woman in the Galilee.
She has fully recovered after treatment in Haifa.
Dubbed “cave disease,” Histoplasmosis, which is caused by a fungus found in soil – usually from bird dropping or bat guano – was discovered by Rambam Medical Center physicians in a woman who had not been abroad.
Symptoms vary, and in people with normal immune systems, it usually passes by itself, but in others, the infection harms the lungs and should be treated with anti-fungal medications. It can be fatal if left untreated.
In 1977, a cave researcher identified the fungus in a bat at the Yodfat cave in the Galilee. Although this report was published, there were no reported human infections, and the disease seemed to exist far away.
“A few months ago, we received a biopsy taken from a woman’s pharynx in the course of a diagnosis in another hospital,” recalled Dr. Ami Neuberger, director of the tropical diseases clinic.
“Such lesions are thought here to usually be malignant, but this case was different; I did not believe the result at the beginning,” Neuberger said. “Specific tests in the microbiological laboratory confirmed the diagnosis. I immediately asked the patient, who lives in the Galilee region, ‘Where did you go?’ To my surprise, it turned out that the woman never left the country.”
Neuberger explained that Histoplasmosis is not transmitted person to person. “In this case, the woman suffered for months from general weakness, significant weight loss and a lump in the throat that caused hoarseness and difficulty in speech. After the Rambam doctors started treatment with an anti-fungal drug, the symptoms went away within a few weeks.”
Confused about how their patient contracted the disease, the Rambam researchers thought about the Yodfat cave.
“It is very close to the area where the woman lives. We tried to find the fungus in the Yodfat cave and in the patient’s neighborhood, but no fungus was found in any of the samples,” said Neuberger. “Perhaps a number of caves were dug to excavate the foundations.”

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