Portal de Periódicos da CAPES

Febrile rhabdomyolysis of unknown origin in refugees coming from West Africa through the Mediterranean to Calabria, Italy

2017; Elsevier BV; Volume: 63; Linguagem: Inglês

10.1016/j.ijid.2017.08.009

1878-3511

Alfredo Vallone, Roberto Aparici Marino, Sandro Vento,

Hematological disorders and diagnostics

Silvia Odolini et al. have recently reported 48 cases of severe febrile rhabdomyolysis in refugees arriving in Italy from West Africa and admitted to 12 centers from May 2014 to December 2016 (Odolini et al., 2017Odolini S. Gobbi F. Zammarchi L. Migliore S. Mencarini P. Vecchia M. et al.Febrile rhabdomyolysis of unknown origin in refugees coming from West Africa through the Mediterranean.Int J Infect Dis. 2017; 63: 99-100Abstract Full Text Full Text PDF PubMed Scopus (0) Google Scholar). We describe the experience in Vibo Valentia, Calabria, a region not covered in their report. We retrospectively reviewed the medical records of the 15 patients admitted with severe febrile rhabdomyolysis to Jazzolino Hospital of Vibo Valentia from May 2014 to May 2017. All were refugees from West Africa, 13 were males and the mean age was 21.9 years (range 16-31; Table 1). They all departed from Lybia on board 10 meter inflatable boats (with 150-200 refugees each) and presented to the hospital 3 to 18 (mean 10.2) days after arriving in Calabria, therefore in a considerably shorter time compared to Odolini's report. All patients had high fever (>39°C), intense muscle aches and inability to stand and walk. C reactive protein, AST, ALT, myoglobin, CPK, LDH were elevated in all cases whereas creatinine, sodium and potassium levels were normal (Table 1). None of the patients was anti-HIV, HBsAg or anti-HCV positive. Out of six patients who accepted to answer specific questions, four stated that they had inhaled fuel, had been beaten or had fasted for 72 hours. None of the six had been forced to take drugs, had used alcohol, or had received hyperalimentation after arrival.Table 1Summary data of 15 cases of rhabdomyolysis observed from May 2014 to May 2017 in "Jazzolino" Hospital, Vibo Valentia, Italy.Mean age (years)21.9 (range 16–31)Males No. (%)13 (86.6%)No. of patients coming from Nigeria6No. of patients coming from Gambia3No. of patients coming from Ivory Coast3No. of patients coming from Liberia, Ghana, Senegal3 (1 from each country)Departure port locationLibyaMean incubation (days from arrival in Italy)10.2 (range 3–18)Hepatomegaly7/11 recordedSplenomegaly3/11 recordedESR mean value33.9 mm/hrCRPRaised (in 15/15 cases)CRP mean value51.46 mg/LAST, ALTElevated (in 15/15 cases)AST/ALT mean values483/156 IU/LMyoglobinRaised (in 15/15 cases)Myoglobin mean value1,775 ng/mlCPK levelsElevated (in 15/15 cases)CPK mean value13,353 IU/LLDHRaised (in 15/15 cases)LDH mean value1,246 IU/LGamma globulinsIncreased in 14/15 casesAlpha1 globulinsIncreased in 15/15 casesAlpha2 globulinsIncreased in 13/15 casesAnti-HIV, HBsAg, anti-HCVNegative in 15/15 casesCoxsackievirus serologyNegative in 2/2 patient testedCMV and EBV IgMNegative in 6/6 cases testedCMV and EBV IgGPositive in 6/6 cases tested Open table in a new tab All patients survived; twelve recovered completely within two weeks after supportive treatment with hydration, one was admitted to the intensive care unit due to septic shock and two had pneumonia. During the three-year period under consideration, around 1,500 refugees were assessed at Jazzolino Hospital for various complaints; hence, febrile rhabdomyolysis was observed in around 1% of presenting migrants. Our results in the largest number of patients observed in a single Italian hospital confirm that febrile rhabdomyolysis of unknown origin occurs in migrants from West Africa; we think that active surveillance for the disease is needed in this migrant population and prospective studies are warranted to try and establish the etiology.