Francesco Castelli and Silvia Odolini from the GeoSentinel® Brescia site would like to draw attention to undiagnosed severe febrile rhabdomyolysis in refugees mainly from Nigeria, arriving in Italy from West Africa. Patients with this syndrome have been observed at the Geosentinel® site in Brescia and at twelve other infectious diseases and internal medicine centres located in several Italian cities (Negrar, Verona, Firenze, Mineo, Pavia, Reggio Emilia, Brescia, Rome, Milan, Bologna). A total of 48 patients have been observed, mainly young males (mean age 22.4 ± 5.8 years). All patients had fever and very intense muscle aches with inability to stand and walk. CPK, aspartate aminotransferase (AST), lactate dehydrogenase (LDH) values were always abnormal. Rhabdomyolysis was believed to be related to an infective agent in 16 (33.3%) cases. In detail EBV-DNA was detected in 8 of 32 patients that were tested, IgM for Coxsackie virus in 5 of 27 and IgM for cytomegalovirus in 3 of 29. In the remaining cases, the etiology was undefined. Four out of seven patients tested for abnormal hemoglobin had sickle cell trait and one patient had hemophilia A. The mean time between the date of departure from Libya and symptoms onset was 26.2 days (±39.5; min 2 -max 252 days) and an average of 8.3 days (± 7.85) passed before clinic visit date. Sea-travel mean duration was 1.7 days (±1.26). Seventeen patients (35.4%) reported having a strained position during travel. No seawater ingestion was reported and no cases of hypernatremia were identified. In these cases, the long incubation period does not support a mechanical cause of rhabdomyolysis. Otherwise, common viral infections like Epstein-Barr, CMV, or Coxsackie virus are hardly associated with such severe clinical presentation. It is speculated that other predisposing conditions, in particular genetic factors considering the common area of origin, or unknown viral infections, may be involved. Targeted surveillance of rhabdomyolysis cases is warranted. This information has been posted as a ProMed message.
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Francesco Castelli and Silvia Odolini from the GeoSentinel® Brescia site would like to draw attention to undiagnosed severe febrile rhabdomyolysis in refugees mainly from Nigeria, arriving in Italy from West Africa. Patients with this syndrome have been observed at the Geosentinel® site in Brescia and at twelve other infectious diseases and internal medicine centres located in several Italian cities (Negrar, Verona, Firenze, Mineo, Pavia, Reggio Emilia, Brescia, Rome, Milan, Bologna). A total of 48 patients have been observed, mainly young males (mean age 22.4 ± 5.8 years). All patients had fever and very intense muscle aches with inability to stand and walk. CPK, aspartate aminotransferase (AST), lactate dehydrogenase (LDH) values were always abnormal. Rhabdomyolysis was believed to be related to an infective agent in 16 (33.3%) cases. In detail EBV-DNA was detected in 8 of 32 patients that were tested, IgM for Coxsackie virus in 5 of 27 and IgM for cytomegalovirus in 3 of 29. In the remaining cases, the etiology was undefined. Four out of seven patients tested for abnormal hemoglobin had sickle cell trait and one patient had hemophilia A. The mean time between the date of departure from Libya and symptoms onset was 26.2 days (±39.5; min 2 -max 252 days) and an average of 8.3 days (± 7.85) passed before clinic visit date. Sea-travel mean duration was 1.7 days (±1.26). Seventeen patients (35.4%) reported having a strained position during travel. No seawater ingestion was reported and no cases of hypernatremia were identified. In these cases, the long incubation period does not support a mechanical cause of rhabdomyolysis. Otherwise, common viral infections like Epstein-Barr, CMV, or Coxsackie virus are hardly associated with such severe clinical presentation. It is speculated that other predisposing conditions, in particular genetic factors considering the common area of origin, or unknown viral infections, may be involved. Targeted surveillance of rhabdomyolysis cases is warranted. This information has been posted as a ProMed message.