Materiały źródłowe

• #1 Reducing Risk for Histoplasmosis | Histoplasmosis | CDC

  https://www.cdc.gov/histoplasmosis/prevention/index.html

  Avoiding activities that involve plant matter or disturb soil, particularly soil that contains bird or bat droppings, reduces risk for histoplasmosis. […] Avoiding activities that disturb soil or increase exposure to plant matter or bird or bat droppings can help prevent histoplasmosis. […] Large amounts of bird or bat droppings should be cleaned up by professional companies that specialize hazardous waste removal. […] Many of these activities are regularly performed by people in certain occupations. There are additional steps for employers and workers to take to prevent histoplasmosis. For example, construction workers can wear protective masks, like N-95s.

• #2 Treatment and Prevention of Histoplasmosis in Adults Living with HIV

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8229061/

  Histoplasmosis prophylaxis did not reduce risk for histoplasmosis in a placebo-controlled randomized multicenter study in which most sites were not located in the endemic region. […] Itraconazole prophylaxis was studied in a prospective randomized double-blind placebo-controlled study in 4 U.S. cities in the endemic area. In the subset of patients with CD4 counts 100/L, itraconazole significantly reduced cases of histoplasmosis and cryptococcosis but did not improve survival. […] IDSA and NIH/CDC guidelines recommend consideration of prophylaxis during a histoplasmosis outbreak or in settings in which the disease incidence is 10 cases per 100 patient-years for persons with CD4 150/L. […] Given that receipt of trimethoprim sulfamethoxazole (TMP/SMX), which has in vitro activity against H. capsulatum, was associated with lower disease incidence in the case control study, and that patients with Pneumocystis infection, which presumably was treated with TMP/SMX, in French Guiana had a lower incidence of histoplasmosis, it is plausible that TMP/SMX could reduce risk for histoplasmosis; further investigation will be necessary to assess this hypothesis.

• #3 Histoplasmosis – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/histoplasmosis/symptoms-causes/syc-20373495

  It’s difficult to prevent exposure to the fungus that causes histoplasmosis, especially in areas where the disease is widespread. But taking the following steps might help reduce the risk of infection: […] Avoid exposure. Avoid projects and activities that might expose you to the fungus, such as cave exploring and raising birds, such as pigeons or chickens. […] Spray contaminated surfaces. Before you dig soil or work in an area that could harbor the fungus that causes histoplasmosis, soak it with water. This can help prevent spores from being released into the air. Spraying chicken coops and barns before cleaning them also can reduce your risk. […] Wear a respirator mask. Consult the National Institute for Occupational Safety and Health to determine which type of mask will provide protection for your level of exposure.

• #4 Treatment and Prevention of Histoplasmosis in Adults Living with HIV

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8229061/

  The U.S. Centers for Disease Control recommends that the following measures be undertaken to reduce the risk for histoplasmosis in HIV-infected patients with CD4 cell counts 150 cells/L who reside in the endemic area: avoid disturbing soil contaminated with chicken or bird guano; spelunking; remodeling, demolishing or cleaning old buildings; or cleaning chicken coops. […] It is worth noting that the traditional histoplasmosis endemic area in the U.S. has been expanding north and westward, thus increasing the size of the at-risk population. […] Thus, it seems advisable for persons living with HIV to exhibit caution when engaging in known high-risk activities for histoplasmosis exposure even if they do not reside in a traditional endemic region. […] Mitigation of high-risk exposures and/or use of itraconazole prophylaxis in certain patient subsets are strategies likely to reduce the incidence of life-threatening histoplasmosis.

• #5 Histoplasmosis: Causes, Symptoms, Diagnosis & Treatment

  https://my.clevelandclinic.org/health/diseases/24811-histoplasmosis

  Can histoplasmosis be prevented? […] It’s hard to avoid breathing in H. capsulatum fungus if you live in an area where it’s common. While not entirely preventable, there are some steps you can take to reduce your risk of histoplasmosis: […] Avoid areas where you’ll be exposed to dirt or dust, especially in areas where bats or birds live. […] If your job or hobbies expose you to soil that’s likely to have H. capsulatum, use an N95 respirator mask to help filter the air you breathe.

• #6 Elimination and Engineering Controls | Histoplasmosis | CDC

  https://www.cdc.gov/niosh/histoplasmosis/prevention/elimination-and-engineering-controls.html

  There are many ways to prevent Histoplasma exposure through elimination and engineering controls. The best way to prevent exposure to Histoplasma is to prevent bird or bat droppings from accumulating in the first place. […] Disinfectants have occasionally been used to treat contaminated soil and accumulations of bat droppings. However, this occurred when removal was not practical or as a precaution before a removal process was started. […] Any material removed from a work site that might be contaminated with Histoplasma should be disposed of properly and safely. […] In regions where Histoplasma is common, use water sprays or other dust suppression techniques should be used to reduce aerosolized dust during construction, excavation, or demolition.

• #7

  https://www.ccohs.ca/oshanswers/diseases/histopla.html

  Prevention of histoplasmosis relies on avoiding exposure to dust in a contaminated environment. Before anyone cleans chicken coops or other contaminated soil, spraying with water is advisable to reduce dust. […] Persons working in contaminated areas should use protective clothing such as gloves and coveralls. They should also use a respirator equipped with a high-efficiency particulate air (HEPA) filter that is capable of filtering particles down to two microns in size. For major clean-up operations of prolonged exposure, a powered air purifying or supplied air respirator may be necessary.

• #8 Occupational Histoplasmosis: Epidemiology and Prevention Measures

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8306883/

  During the removal of the material, work practices and dust control measures that eliminate or reduce dust generation will lower risk of infection. […] Water sprays or other dust suppression techniques can reduce the amount of dust aerosolized during construction, excavation, or demolition in regions where Histoplasma is common. […] Signs warning people of the health risk should be posted in areas known or suspected to be contaminated with Histoplasma, like bird or bat roosts, attics, or entire buildings that contain accumulations of bat or bird droppings. […] To protect employees from breathing contaminated air when effective engineering controls are not feasible or while being instituted, federal regulations require the use of respirators. […] Although research is limited on the effectiveness of respirators in protecting workers from breathing in dust containing Histoplasma, respirators are expected to offer some level of protection because the diameter of Histoplasma conidia ranges from 1 m to 5 m.

• #9 Histoplasmosis – Epidemiology

  https://www.vdh.virginia.gov/epidemiology/epidemiology-fact-sheets/histoplasmosis/

  How can histoplasmosis be prevented? There is no vaccine to prevent histoplasmosis, and it is not always possible to prevent exposure to the fungus in areas where the fungus is common in the environment. People should avoid areas with accumulations of bird or bat droppings, especially if they have weakened immune systems. Areas with accumulations of bird or bat droppings should be cleaned up by professional companies that specialize in the removal of hazardous waste.

• #10 Histoplasmosis

  https://dph.illinois.gov/topics-services/diseases-and-conditions/diseases-a-z-list/histoplasmosis.html

  The following steps can be taken to reduce exposure to Histoplasma capsulatum: […] prevent bats and birds from entering buildings to prevent the buildup of droppings […] avoid areas that may harbor the fungus, particularly those areas with accumulations of bird or bat droppings. […] if cleaning, excavating, or disturbing soil in an area with accumulated bird or bat droppings: […] minimize exposure to spores in dust by first wetting the area with a low-velocity spray or mist of water before cleaning (a high pressure water stream can cause spores to become airborne before they can be soaked) […] wear disposable clothing and a properly-fitting N-95 (available at hardware and home improvement stores) or better respirator capable of filtering particles 1 micron in diameter […] collect and seal wetted material in heavy-duty plastic bags, a 55-gallon drum, or some other secure container for immediate waste disposal

• #11 Histoplasmosis

  https://dph.illinois.gov/topics-services/diseases-and-conditions/diseases-a-z-list/histoplasmosis.html

  keep the respirator on until finished, then walk into a droppings-free area, remove respirator and protective clothing, and place it in a double-sealed plastic bag for waste disposal […] ensure that people who have compromised immune systems do not clean up areas that may harbor histoplasmosis. […] Large accumulations of bird or bat droppings should be removed by a professional cleanup and restoration firm experienced with hazardous waste disposal. […] You should always take steps to limit exposure to the histoplasmosis fungus, even if you have had histoplasmosis in the past.

• #12 Histoplasmosis Treatment & Management: Approach Considerations, Medical Care, Surgical Care

  https://emedicine.medscape.com/article/299054-treatment

  Most outbreaks are associated with activities that disrupt contaminated soil in endemic areas. Decontaminating infected soil with a 3% formalin solution, with the assistance of local and federal agencies, can prevent aerosolization of conidia and yeast. […] Educate individuals residing or traveling in endemic areas about exposure risks, including both leisure and work activities. Advance preparation reduces exposure to contaminated soil, bat and bird dwellings, and inoculum. […] Workers participating in high-risk activities should wear respirators. Water sprays should be used during demolition work to decrease dust. […] Itraconazole (200 mg/d) has been shown to be effective in the prevention of histoplasmosis in AIDS patients with CD4 counts of less than 150 cells/L who are at high risk for infection.

• #13 Histoplasma Capsulatum

  https://www.tamuk.edu/finance/risk/animal-safety/histoplasma-capsulatum.html

  Prevention of histoplasmosis relies on avoiding exposure to dust in a contaminated environment. Before anyone cleans chicken coops or other contaminated soil, spraying with water is advisable to reduce dust. […] Decontamination with 3% formaldehyde has been shown to be effective; however, such solutions should be used with caution since this chemical may cause adverse health effects following inhalation, ingestion, or skin or eye contact. […] Persons working in contaminated areas should use protective clothing such as gloves and coveralls. […] They should also use a respirator equipped with a high efficiency particulate air (HEPA) filter that is capable of filtering particles down to two microns in size. […] For major clean-up operations of prolonged exposure, a powered air purifying or supplied air respirator may be necessary.

• #14 What is Histoplasmosis?
  — Wildlife Control Services LLC

  https://wildlifecontrolservicesct.com/histoplasmosis

  Prevention of histoplasmosis relies on avoiding exposure to dust in a contaminated environment. Before anyone cleans chicken coops or other contaminated soil, spraying with water is advisable to reduce dust. Decontamination with 3% formaldehyde has been shown to be effective. […] Persons working in contaminated areas should use protective clothing such as gloves and coveralls. They should also use a respirator equipped with a high efficiency particulate air (HEPA) filter that is capable of filtering particles down to two microns in size. Such respirators are suitable as long as the occupational exposure limit for formaldehyde is not exceeded. For major clean up operations of prolonged exposure, a powered air purifying or supplied air respirator may be necessary.

• #15 Occupational Histoplasmosis: Epidemiology and Prevention Measures

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8306883/

  In areas where Histoplasma is endemic in the environment, occupations involving activities exposing workers to soil that contains bird or bat droppings may pose a risk for histoplasmosis. […] Occupational exposures are frequently implicated in histoplasmosis outbreaks. […] Occupational health and safety specialists use the hierarchy of controls to determine how to implement feasible and effective control solutions to occupational hazards. This framework can be used to prevent exposure to histoplasmosis in the workplace. […] Developing a site safety plan with input from management, employee representatives, and health and safety professionals, is an important step in minimizing workplace exposures. […] The best way to prevent exposure to Histoplasma is to prevent the accumulation of bird or bat droppings in the first place.

• #16 Occupational Histoplasmosis: Epidemiology and Prevention Measures

  https://www.mdpi.com/2309-608X/7/7/510

  Occupational exposures are frequently implicated in histoplasmosis outbreaks. […] In this paper, we review the literature on occupationally acquired histoplasmosis. We describe the epidemiology, occupational risk factors, and prevention measures according to the hierarchy of controls. […] Understanding the geographic distribution of histoplasmosis is helpful in targeting prevention and control measures. […] The hierarchy of controls can be used as a framework to prevent exposure to H. capsulatum in laboratory settings. […] Communication and cooperation between clinicians and public health practitioners is important to identify work-related clusters of histoplasmosis. Consideration of occupational risk factors and controlling exposures to workers according to the hierarchy of controls will help prevent disease transmission in the workplace. Future research on the effectiveness of interventions to minimize worker exposures to Histoplasma is needed and should include environmental mitigation and respiratory protection.

• #17 Histoplasmosis: Adult and Adolescent OIs | NIH

  https://clinicalinfo.hiv.gov/en/guidelines/hiv-clinical-guidelines-adult-and-adolescent-opportunistic-infections/histoplasmosis

  People with HIV who live in or visit areas in which histoplasmosis is endemic cannot completely avoid exposure to H. capsulatum, but those with CD4 counts 200 cells/mm3 should be counseled to minimize exposure to activities associated with an increased risk for histoplasmosis (BIII). […] Data from a prospective, randomized, controlled trial indicate that itraconazole can reduce the incidence of histoplasmosis, although not mortality, in people who have advanced HIV (CD4 counts 150 cells/mm3) and live in areas where histoplasmosis is highly endemic. […] Based on these data, the Panel on Guidelines for the Prevention and Treatment of Opportunistic Infections in Adults and Adolescents With HIV (the Panel) continues to recommend itraconazole at a dose of 200 mg daily as primary prophylaxis (BI) to people with CD4 counts 150 cells/mm3 who are at high risk because of occupational histoplasmosis exposure or who live in a community with a hyperendemic rate of histoplasmosis (10 cases/100 person-years) (BI).

• #18 Treatment and Prevention of Histoplasmosis in Adults Living with HIV

  https://www.mdpi.com/2309-608X/7/6/429

  Histoplasmosis prophylaxis was studied in a prospective randomized double-blind placebo-controlled study in 4 U.S. cities in the endemic area. In the subset of patients with CD4 counts <100/μL, itraconazole significantly reduced cases of histoplasmosis and cryptococcosis but did not improve survival. [...] IDSA and NIH/CDC guidelines recommend consideration of prophylaxis during a histoplasmosis outbreak or in settings in which the disease incidence is >10 cases per 100 patient-years for persons with CD4 <150/μL. [...] Given that receipt of trimethoprim sulfamethoxazole (TMP/SMX), which has in vitro activity against H. capsulatum, was associated with lower disease incidence in the case control study, and that patients with Pneumocystis infection, which presumably was treated with TMP/SMX, in French Guiana had a lower incidence of histoplasmosis, it is plausible that TMP/SMX could reduce risk for histoplasmosis; further investigation will be necessary to assess this hypothesis.

• #19 Treatment and Prevention of Histoplasmosis in Adults Living with HIV

  https://www.mdpi.com/2309-608X/7/6/429

  The U.S. Centers for Disease Control recommends that the following measures be undertaken to reduce the risk for histoplasmosis in HIV-infected patients with CD4 cell counts <150 cells/μL who reside in the endemic area: avoid disturbing soil contaminated with chicken or bird guano; spelunking; remodeling, demolishing or cleaning old buildings; or cleaning chicken coops. [...] It is worth noting that the traditional histoplasmosis endemic area in the U.S. has been expanding north and westward, thus increasing the size of the at-risk population. Further, the worldwide distribution of authochthonous cases is much more widespread than previously recognized; in recent years, cases have been identified from regions as diverse as the Yangtze River region of China; Thailand; the southern half of Africa; and several other areas on all continents with the sole exception of Antarctica. Thus, it seems advisable for persons living with HIV to exhibit caution when engaging in known high-risk activities for histoplasmosis exposure even if they do not reside in a traditional endemic region.

• #20 Histoplasmosis: Adult and Adolescent OIs | NIH

  https://clinicalinfo.hiv.gov/en/guidelines/hiv-clinical-guidelines-adult-and-adolescent-opportunistic-infections/histoplasmosis

  However, as with other opportunistic infections in the current era of more effective ART, it may be reasonable to consider withholding primary prophylaxis if ART can be immediately initiated and there is an accompanying rise in CD4 cell count above the threshold of risk (CIII). […] If used, primary prophylaxis should be discontinued in people on ART once CD4 counts are 150 cells/mm3 for 6 months and HIV-1 viral loads are undetectable (BIII). […] Prophylaxis should be restarted if the CD4 count falls to 150 cells/mm3 (BIII).

• #21 Histoplasmosis: Pediatric OIs | NIH

  https://clinicalinfo.hiv.gov/en/guidelines/hiv-clinical-guidelines-pediatric-opportunistic-infections/histoplasmosis

  Routine use of antifungal medications for primary prophylaxis of histoplasmosis infections in children is not recommended (BIII). […] Prophylaxis with itraconazole is recommended for HIV-infected adults with CD4 counts 150 cells/mm3 and who reside in areas where histoplasmosis is highly endemic (that is, incidence 10 cases per 100 patient-years) and in instances in which risk of occupational exposure is high. […] Longer-term suppressive therapy (secondary prophylaxis) with itraconazole may be required in HIV-infected children who are severely immunosuppressed (meaning CD4 percentage 15% at any age or CD4 count 150 cells/mm3 in children aged 6 years) and patients who experience relapse despite receipt of appropriate therapy (AIII).

• #22 AIDS Related Histoplasmosis, Treatment and Prophylaxis: the Mycology Unit of FJ Muniz Hospital Experience

  https://www.scientificarchives.com/article/aids-related-histoplasmosis-treatment-and-prophylaxis-the-mycology-unit-of-fj-muniz-hospital-experience

  AIDS Related Histoplasmosis, Treatment and Prophylaxis: the Mycology Unit of FJ Muniz Hospital Experience […] A retrospective analytical study about the efficacy of treatment and secondary antifungal prophylaxis of histoplasmosis in AIDS patients is presented. […] Initial treatment and secondary antifungal prophylaxis are highly effective in AIDS-related histoplasmosis. […] Itraconazole at a dose of 200 mg/day was indicated in all cases as secondary antifungal prophylaxis together with different antiretroviral drugs. […] Antifungal prophylaxis was interrupted when the patients presented two CD4+ cell counts above 150/l, their HIV viral loads were undetectable (20 RNA copies) and they did not have any signs or symptoms of active histoplasmosis. […] As in our previous studies, antifungal secondary prophylaxis and ART showed a high efficacy in the posttreatment control of AIDS-related histoplasmosis. […] Primary antifungal prophylaxis was not considered necessary in our Hospital due to the relatively low incidence of this opportunistic mycosis as well as its low mortality rate (15.6%).

• #23 AIDS Related Histoplasmosis, Treatment and Prophylaxis: the Mycology Unit of FJ Muniz Hospital Experience

  https://www.scientificarchives.com/abstract/aids-related-histoplasmosis-treatment-and-prophylaxis-the-mycology-unit-of-fj-muniz-hospital-experience

  A retrospective analytical study about the efficacy of treatment and secondary antifungal prophylaxis of histoplasmosis in AIDS patients is presented. […] Itraconazole at a dose of 200 mg/day was indicated in all cases as secondary antifungal prophylaxis together with different antiretroviral drugs. […] Initial treatment and secondary antifungal prophylaxis are highly effective in AIDS-related histoplasmosis.

• #24 IDSA 2025 Guideline Update on the Treatment of Asymptomatic Histoplasma Pulmonary Nodules (Histoplasmomas) and Mild or Moderate Acute Pulmonary Histoplasmosis in Adults, Children, and Pregnant People

  https://www.idsociety.org/practice-guideline/histoplasmosis-2025/

  In patients with asymptomatic, previously untreated Histoplasma pulmonary nodules (histoplasmomas), for which patients should antifungal treatment be initiated? […] In adults and children with asymptomatic non-calcified pulmonary nodules related to histoplasmosis with no evidence of other active sites, or asymptomatic patients with known untreated prior infection, the panel suggests against routinely providing treatment for histoplasmosis to prevent reactivation (conditional* recommendation, very low certainty of evidence). […] Treatment of pregnant individuals should only be considered after carefully weighing the potential benefits vs. harms of treatment, ideally in consultation with a maternal fetal medicine specialist and an infectious diseases specialist, as these cases are rare, complex, and highly variable. If treatment is necessary, azoles should be avoided in the first trimester when possible and liposomal amphotericin B used instead.

• #25 IDSA 2025 Guideline Update on the Treatment of Asymptomatic Histoplasma Pulmonary Nodules (Histoplasmomas) and Mild or Moderate Acute Pulmonary Histoplasmosis in Adults, Children, and Pregnant People

  https://www.idsociety.org/practice-guideline/histoplasmosis-2025/

  Treatment of pregnant individuals should only be considered after carefully weighing the potential benefits vs. harms of treatment, ideally in consultation with a maternal fetal medicine specialist and an infectious diseases specialist, as these cases are rare, complex, and highly variable. If treatment is necessary, azoles should be avoided in the first trimester when possible and liposomal amphotericin B used instead.

• #26 Histoplasmosis: Causes, Symptoms & Treatment

  https://www.rupahealth.com/post/histoplasmosis-causes-symptoms-treatment

  Preventing histoplasmosis requires reducing exposure risks through environmental management, public awareness, and policy enforcement, particularly in high-risk areas. […] Environmental control measures limit exposure to Histoplasma capsulatum, especially in regions where the fungus is endemic. […] Soil contaminated with bird or bat droppings can harbor Histoplasma spores for long periods. Activities such as construction, excavation, farming, and demolition can release fungal spores into the air, increasing the risk of inhalation. To minimize exposure: Avoid soil disturbance in high-risk areas (e.g., caves, old barns, chicken coops). Spraying contaminated soil with water before digging or disturbing it can help reduce airborne spores. […] People who work in high-risk environments, such as construction sites or caves, should wear NIOSH-approved N95 respirators or higher-grade air-purifying respirators to reduce the risk of inhaling fungal spores. Employers should implement workplace safety protocols, including protective clothing and decontamination procedures when dealing with contaminated materials.

• #27 eLCOSH : NIOSH: Histoplasmosis: Protecting Workers at Risk – Revised Edition

  https://www.elcosh.org/document/3532/d000679/NIOSH%253A+Histoplasmosis%253A+Protecting+Workers+at+Risk+-+Revised+Edition.html

  Booklet includes information on what histoplasmosis is, how you are exposed to it, and ways to protect yourself through the use of proper respiratory protection and other PPE. […] The updated information in this booklet will help readers understand what histoplasmosis is and recognize activities that may expose workers to the disease-causing fungus Histoplasma capsulatum. […] The booklet also informs readers about methods they can use to protect themselves and others from exposure. […] This booklet will help prevent such exposures by serving as a guide for safety and health professionals, environmental consultants, supervisors, and others responsible for the safety and health of those working near material contaminated with H. capsulatum. […] Local, State, and national public health professionals may also find this booklet useful for understanding the health risks of exposure to H. capsulatum so that they can provide guidance about work practices and personal protective equipment.

• #28 Histoplasmosis: Causes, Symptoms & Treatment

  https://www.rupahealth.com/post/histoplasmosis-causes-symptoms-treatment

  Community education initiatives can help individuals recognize exposure risks and take precautionary measures. […] Local governments should regulate land use and construction practices in histoplasmosis-endemic areas to minimize soil disturbance. Public health authorities can develop protocols for safely removing bird and bat droppings, including proper waste disposal techniques to prevent airborne contamination.

• #29 eLCOSH : NIOSH: Histoplasmosis: Protecting Workers at Risk – Revised Edition

  https://www.elcosh.org/document/3532/d000679/NIOSH%253A+Histoplasmosis%253A+Protecting+Workers+at+Risk+-+Revised+Edition.html

  We urge employers, health agencies, unions, and cooperatives to distribute the fact sheet to all potentially exposed workers. […] The best way to prevent exposures to H. capsulatum spores is to avoid situations where material that might be contaminated can become aerosolized and subsequently inhaled. […] Dust suppression methods, such as carefully wetting with a water spray, may be useful for reducing the amount of material aerosolized during an activity. […] For some activities, such as removing an accumulation of bat droppings or bird manure from an enclosed place such as an attic, wearing a NIOSH-approved respirator and other items of personal protective equipment may be needed to further reduce the risk of H. capsulatum exposure. […] However, only persons trained in the proper selection and use of personal protective equipment should undertake work where this equipment is needed.

• #30 Histoplasmosis Treatment & Management: Approach Considerations, Medical Care, Surgical Care

  https://emedicine.medscape.com/article/299054-treatment

  Although many exposed immunocompetent individuals from endemic areas do not develop extensive clinical manifestations, reactivation can occur. These individuals, when placed at risk for immunosuppression because of impaired immunity or prolonged drug suppression, may develop active infection from prior lesions. Knowing their history of prior exposures can help to detect and treat subsequent complications. […] Prior infection does not prevent future reinfection. Individuals should take similar precautions when facing increased exposure risk.

• #31 eLCOSH : NIOSH: Histoplasmosis: Protecting Workers at Risk – Revised Edition

  https://www.elcosh.org/document/3532/d000679/NIOSH%253A+Histoplasmosis%253A+Protecting+Workers+at+Risk+-+Revised+Edition.html

  Appropriate exposure precautions should be taken by these people and others whenever contaminated soil, bat droppings, or bird manure is disturbed. […] A previous infection can provide partial immunity to reinfection. […] Since a positive skin test does not mean that a person is completely immune to reinfection, appropriate exposure precautions should be taken regardless of a worker’s past skin-test status whenever disturbances of materials that might be contaminated with H. capsulatum occur. […] Disinfectants have occasionally been used to treat soil and accumulated bat manure when removal was impractical or as a precaution before a removal process was started. […] There is no product or chemical that is registered by the EPA that has the specific claim of being effective against H. capsulatum.

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