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Fever of unknown origin and rhabdomyolysis in an immigrant from Africa
Fiebre de origen no filiado y rabdomiólisis en una inmigrante procedente de África
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Huguet-Embún, Arantzazu Inmaculada Arenas-Miquelez, Andrea de los Mozos-Ruano" "autores" => array:4 [ 0 => array:4 [ "nombre" => "Carlos" "apellidos" => "Ramos-Paesa" "email" => array:1 [ 0 => "ramosprobable@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Laura" "apellidos" => "Huguet-Embún" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "Arantzazu Inmaculada" "apellidos" => "Arenas-Miquelez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 3 => array:3 [ "nombre" => "Andrea" "apellidos" => "de los Mozos-Ruano" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Unidad de Enfermedades Infecciosas, Hospital Universitario Miguel Servet, Zaragoza, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Unidad de Cuidados Intensivos, Hospital Universitario Miguel Servet, Zaragoza, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Servicio de Medicina Interna, Hospital Universitario Miguel Servet, Zaragoza, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Fiebre de origen no filiado y rabdomiólisis en una inmigrante procedente de África" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Since 2014, an increase in the number of cases of fever associated with rhabdomyolysis of unexplained cause has been reported in African refugee immigrants arriving on the Italian coast after voyaging across the Mediterranean. These migrants come mostly from East Africa, Nigeria and Libya, and some from Gambia.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1–3</span></a> This syndrome has been reported in up to 1% of 1500 refugees treated in a hospital in the Italian region of Calabria over three years.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> We present the case of an immigrant woman from West Africa treated in our hospital for fever and rhabdomyolysis of unknown cause after making the crossing of the Strait of Gibraltar to arrive in Spain.</p><p id="par0010" class="elsevierStylePara elsevierViewall">This was a 38-year-old patient from Conakry in Guinea, from where she had set off two months earlier, arriving in Spain a week earlier across the Strait and subsequently having been transferred to the Zaragoza Red Cross. Four days after her journey, the patient developed a fever of 39 °C, fatigue and aching joints and muscles, particularly in her neck, with no apparent focus of infection. She reported no pharmacological, toxic substance, drug or sea water intake; there was also no history of trauma or overexertion in the previous 72 h. On examination, her vital signs were normal, and she had slight diffuse pain across her abdomen, with no hepatomegaly or splenomegaly palpated. Cervical and axillary lymphadenopathy smaller than 2 cm was detected. Blood analysis showed ions and kidney function to be normal throughout her stay in hospital. The patient had a pyrexia of 39 °C and elevation of rhabdomyolysis enzymes [creatine kinase (CK) and lactate dehydrogenase (LDH)] and liver enzymes [glutamate-oxaloacetate transaminase (GOT) and glutamate-pyruvate transaminase (GPT)] (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>), for which she was started on treatment with antipyretics and fluid therapy. The fever disappeared after 24 h and urinary alkalinisation was not considered necessary, as the patient's CK levels were not very high and were showing a tendency to decrease (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>). A study of haemoglobinopathies and glucose-6-phosphate dehydrogenase (G6PDH) activity was performed with no abnormal findings. Malaria, syphilis, HIV, hepatitis C, hepatitis B, hepatitis A, cytomegalovirus (CMV), Epstein-Barr virus (EBV), urinary tract infection and bacteraemia were all ruled out; thyroid hormones were normal. In the absence of suggestive symptoms, the patient was not investigated for the presence of coxsackievirus or adenovirus infection.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Many acquired and inherited causes of rhabdomyolysis have been described. It is a potentially serious condition which can lead to acute kidney injury and be a source of major complications. Many infections have been associated with this syndrome, most commonly influenza viruses, but they also include coxsackievirus B<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> and adenovirus.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> Mechanical causes such as overexertion or prolonged immobilisation, hypernatraemia from ingestion of sea water, the use of medicinal products, toxins or drugs of abuse, haemoglobinopathies or G6PDH deficiency<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6,7</span></a> can cause or contribute to rhabdomyolysis, with a certain genetic or racial predisposition necessary for it to develop.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> A number of authors have identified cases<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1–3</span></a> arriving in Italy after a one to two-day voyage across the Mediterranean. They are young black patients around the age of 20, up to 20% of them asymptomatic, who are found to have CK elevation an average of 10–36 days following their arrival, according to the authors, and they usually recover about two to three weeks after the onset of symptoms.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1–3</span></a> The case we have presented here has the same characteristics and, although we cannot rule out mechanical causes, even though it was more than 72 h since the possible overexertion, or certain viruses listed as potential causes, we believe that our case could be included in the clinical spectrum described by these authors.</p><p id="par0020" class="elsevierStylePara elsevierViewall">In conclusion, we believe that migrants with these characteristics have a high risk of rhabdomyolysis and should be studied in this regard, as the complications are potentially serious. We also believe that in a not insignificant number of cases the aetiology cannot be demonstrated, so this phenomenon and its possible relationship with some type of unproven infection, genetic, racial or geographic factor needs to be investigated. Last of all, we need to be aware of the possibility of this condition in African migrants who reach Spain across the sea.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Ramos-Paesa C, Huguet-Embún L, Arenas-Miquelez AI, de los Mozos-Ruano A. Fiebre de origen no filiado y rabdomiólisis en una inmigrante procedente de África. Enferm Infecc Microbiol Clin. 2019. <span class="elsevierStyleInterRef" id="intr0005" href="https://doi.org/10.1016/j.eimc.2019.10.011">https://doi.org/10.1016/j.eimc.2019.10.011</span></p>" ] ] "multimedia" => array:1 [ 0 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">CK: creatine kinase; GOT: glutamate-oxaloacetate transaminase; GPT: glutamate-pyruvate transaminase; LDH: lactate dehydrogenase.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Day 1 \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Day 3 \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Day 5 \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Day 9 \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">GOT (U/l) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">389 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1102 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">653 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">135 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">GPT (U/l) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">76 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">427 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">322 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">174 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">CK (U/l) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5030 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3158 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">594 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Myoglobin (ng/mL) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3015 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1303 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">LDH (U/l) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1494 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1153 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">777 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2351701.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Changes in transaminases and rhabdomyolysis enzymes during the course of the admission.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:8 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Febrile rhabdomyolysis of unknown origin in refugees coming from West Africa through the Mediterranean" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "S. 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| Year/Month | Html | Total | |
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| 2024 November | 9 | 2 | 11 |
| 2024 October | 69 | 8 | 77 |
| 2024 September | 59 | 14 | 73 |
| 2024 August | 68 | 12 | 80 |
| 2024 July | 71 | 11 | 82 |
| 2024 June | 51 | 9 | 60 |
| 2024 May | 41 | 7 | 48 |
| 2024 April | 47 | 20 | 67 |
| 2024 March | 50 | 5 | 55 |
| 2024 February | 80 | 2 | 82 |
| 2024 January | 64 | 5 | 69 |
| 2023 December | 74 | 7 | 81 |
| 2023 November | 77 | 3 | 80 |
| 2023 October | 108 | 4 | 112 |
| 2023 September | 71 | 2 | 73 |
| 2023 August | 71 | 5 | 76 |
| 2023 July | 78 | 2 | 80 |
| 2023 June | 101 | 0 | 101 |
| 2023 May | 111 | 6 | 117 |
| 2023 April | 84 | 4 | 88 |
| 2023 March | 77 | 6 | 83 |
| 2023 February | 50 | 1 | 51 |
| 2023 January | 65 | 5 | 70 |
| 2022 December | 54 | 9 | 63 |
| 2022 November | 95 | 3 | 98 |
| 2022 October | 77 | 8 | 85 |
| 2022 September | 65 | 16 | 81 |
| 2022 August | 76 | 6 | 82 |
| 2022 July | 59 | 7 | 66 |
| 2022 June | 35 | 9 | 44 |
| 2022 May | 38 | 5 | 43 |
| 2022 April | 53 | 5 | 58 |
| 2022 March | 65 | 5 | 70 |
| 2022 February | 76 | 9 | 85 |
| 2022 January | 48 | 4 | 52 |
| 2021 December | 30 | 7 | 37 |
| 2021 November | 32 | 9 | 41 |
| 2021 October | 32 | 8 | 40 |
| 2021 September | 25 | 6 | 31 |
| 2021 August | 28 | 2 | 30 |
| 2021 July | 11 | 4 | 15 |
| 2021 June | 11 | 6 | 17 |
| 2021 May | 12 | 3 | 15 |
| 2021 April | 23 | 7 | 30 |
| 2021 March | 8 | 5 | 13 |
| 2021 February | 6 | 4 | 10 |
| 2021 January | 1 | 0 | 1 |
| 2020 September | 1 | 0 | 1 |
| 2020 August | 4 | 0 | 4 |
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