RESUMEN
Malaria acquired in endemic areas poses a substantial risk to travelers arriving in or returning to the United States. Timely diagnosis and recognition of severe illness are crucial; however, many U.S.-based clinicians lack familiarity with this disease. We conducted a retrospective review of 100 cases of malaria in adults seen at a single urban university hospital during 2000-2017. Descriptive and analytical statistics were calculated, including logistic regression modeling case severity. Most of the patients presented with Plasmodium falciparum (76%), most commonly after travel from sub-Saharan Africa (94%). Prior malaria experience was common (50%), but adherence to a prophylactic regimen was exceedingly rare (4%). Twenty-one patients had severe malaria, including 10 with cerebral malaria. Severity was predicted by high parasitemia, bandemia, hypoglycemia, and hypotension at the time of presentation. In 24 patients, the initial treatment regimen was changed, usually because of the appearance of clinical deterioration or drug toxicity. One patient required intravenous artesunate. All patients survived, although one suffered fetal loss. Among 30 patients initially evaluated at other institutions, 43% had been treated for an alternative diagnosis. The most common reasons for transfer of patients to our hospital were inadequate facilities and lack of expertise with malaria. There needs to be increased awareness among U.S.-based travelers and clinicians regarding malaria as a potentially lethal condition, emphasizing the use of appropriate prophylaxis. Our simple model of disease severity could serve frontline physicians when deciding which patients should be admitted to the intensive care unit or transferred for higher level care.
Asunto(s)
Enfermedades Transmisibles Importadas/patología , Malaria Falciparum/patología , Parasitemia/patología , Plasmodium falciparum/patogenicidad , Viaje , Adulto , África del Sur del Sahara , Antimaláricos/uso terapéutico , Enfermedades Transmisibles Importadas/diagnóstico , Enfermedades Transmisibles Importadas/tratamiento farmacológico , Enfermedades Transmisibles Importadas/parasitología , District of Columbia , Femenino , Hospitalización/estadística & datos numéricos , Hospitales Universitarios , Humanos , Modelos Logísticos , Malaria Falciparum/diagnóstico , Malaria Falciparum/tratamiento farmacológico , Malaria Falciparum/parasitología , Masculino , Persona de Mediana Edad , Parasitemia/diagnóstico , Parasitemia/tratamiento farmacológico , Parasitemia/parasitología , Cooperación del Paciente/estadística & datos numéricos , Plasmodium falciparum/efectos de los fármacos , Plasmodium falciparum/aislamiento & purificación , Profilaxis Pre-Exposición/métodos , Estudios Retrospectivos , Índice de Severidad de la Enfermedad , Triaje/métodosRESUMEN
Histoplasmosis causes a wide spectrum of clinical illness, including disseminated infection in the immunocompromised. We report a case of pulmonary histoplasmosis in an allogeneic stem cell transplant recipient and review the literature on this topic. Histoplasmosis in this patient population is uncommon, but it is associated with poor outcome.