Infectious diseases with changing geography

Abstract

Background: Human migration during the last decades and the subsequent spreading of infectious diseases beyond the boundaries of their usual habitat changed the diagnostic philosophy of infectionists and epidemiologists. We present two cases treated in our clinic with the diagnoses of visceral leishmaniasis and malaria associated with Crimean hemorrhagic fever. Methods & Materials: Clinical observation, epidemiological investigation, laboratory testing with serological and virological diagnostics were done on the two patients. Results: Case 1 - A 33 year old man was treated with serologically proved diagnosis, ELISA (+) of visceral leishmaniasis. The disease started in Tavira, Portugal with fever (up to 39oC) and headache. Objective status: the patient was intoxicated with, anemic syndrome, splenohepatomegaly, Hb-94 g/l, Leuc.-1.95.109/l, Plt-44.109/l. He was treated for 28 days with meglumine antimoniate (amp. 5 ml. daily) combined with allopurinol and ketoconazole. After dynamic tracking the patient was clinically healthy, with normal laboratory indices. Case 2 – A 39 year old man became ill 5 days after he return in Bulgaria from Zambia with symptoms of fever, headache, myalgia, vomiting and blood and mucous in diarrhea. Objective status: the patient was in severe state, intoxicated with craniopharyngeal and hemorrhagic syndromes, hepatosplenomegaly. Laboratory tests showed anemia, thrombocytopenia and uremia. The thick and thin smears proved tropical malaria with high number of plasmodium falciparum (224 000/μl). The PCR was positive for CCHF. He was treated with hyperimmune globulin, artequin and hemostatic drugs. The rarely observed association between the two diseases led to potentiation amid immunodepression with the development of cerebral complications and multiple organ failure with a fatal end. Conclusion: The early diagnosis and adequate therapy of visceral leishmaniasis are crucial for its favorite outcome and the prevention of diagnostic errors with unpredictable effects. The most important measures are: WHO Global Malaria Programme, health education, medicine prophylactics of endemically exposed individuals, detailed epidemiological anamnesis and early etiological treatment after the onset of symptoms.