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一名输入性疟疾、HIV慢性感染和潜伏梅毒男性病例的多学科诊疗方法

Multidisciplinary Approach of a Male Case of Imported Malaria, HIV Chronic Infection, and Latent Syphilis.

作者信息

García-Mendiola Rebeca Eunice, García-Lucas Maritza Micheli, Morales-Vázquez Jennifer, Cruz-Flores Raúl Adrián, Loyola-Cruz Miguel Ángel, Cruz-Cruz Clemente, Durán-Manuel Emilio Mariano, Vásquez-Jiménez Enzo, Castro-Escarpulli Graciela, Sánchez-Guzmán María de Jesús, Gutiérrez-Muñoz Victor Hugo, Cortés-Ortíz Iliana Alejandra, González-Ibarra Misael, Bravata-Alcántara Juan Carlos, Pineda-Migranas Jesús Alejandro, Plascencia-Nieto Estibeyesbo Said, Jiménez-Zamarripa Carlos Alberto, Gómez-Zamora Erika, Calzada-Mendoza Claudia Camelia, Bello-López Juan Manuel

机构信息

Clínica Especializada Condesa Iztapalapa, Mexico City 09730, Mexico.

Hospital Juárez de México, Mexico City 07760, Mexico.

出版信息

Infect Dis Rep. 2024 Nov 27;16(6):1118-1126. doi: 10.3390/idr16060091.

Abstract

BACKGROUND

The current economic and social crisis in Latin America has caused migration to the USA, bringing with it Public Health challenges due to the importation of various infectious diseases. Migrants, particularly those with chronic conditions, such as HIV infection and other sexually transmitted infections (STI), are at greater risk due to pharmacological interruption and access to medical care, so the timely detection of diseases acquired during their migration, such as malaria, is crucial to avoid health complications.

OBJECTIVE

To outline by a multidisciplinary approach (Infectology, Parasitology, Epidemiology, molecular Biology, Venereology, and Public Health) the diagnosis and management of a male case with malaria imported to Mexican territory, HIV chronic infection, and latent syphilis.

METHODS

A male migrant of Venezuelan nationality attended the Clínica Especializada Condesa Iztapalapa in Mexico City for health complications. A comprehensive analysis of laboratory and molecular tests was performed to confirm HIV infection. During the STI diagnostic algorithm, latent syphilis was detected and microscopic observation of blood smears revealed parasitic forms compatible with malaria. Standard and molecular tests were applied under the operational definition for malaria cases for identification, diagnosis, and treatment. Finally, study of clinical history and migration route by questioning for the investigation of the imported case was performed.

RESULTS

The immigrant was diagnosed with HIV chronic-stage infection with interrupted antiretroviral therapy (ART), latent syphilis, and malaria by . The ART administered was chosen based on the possible drug interaction with antimalarials and genetic barrier to the HLA-B* allele. Finally, antimicrobial therapy against syphilis was penicillin. From the analysis of the migratory route, incubation time of imported malaria, and questioning, we speculated that the migrant acquired the infection in Panama.

CONCLUSIONS

This case highlights the complex health problems faced by migrants with HIV infection, particularly when they contract additional infections such as malaria during migration and highlights the need for comprehensive access to healthcare and ART, antimalarial and antimicrobial treatments to mitigate the health risks of this vulnerable population.

摘要

背景

拉丁美洲当前的经济和社会危机导致人们移民至美国,因各种传染病的输入带来了公共卫生挑战。移民,尤其是患有慢性病的移民,如艾滋病毒感染和其他性传播感染(STI)患者,由于药物中断和获得医疗护理的机会,面临更大风险,因此及时检测他们在移民期间感染的疾病,如疟疾,对于避免健康并发症至关重要。

目的

通过多学科方法(传染病学、寄生虫学、流行病学、分子生物学、性病学和公共卫生学)概述一例输入墨西哥境内的男性疟疾病例、艾滋病毒慢性感染和潜伏梅毒的诊断与管理。

方法

一名委内瑞拉国籍的男性移民因健康并发症前往墨西哥城的伊兹塔帕拉帕孔德萨专科医院就诊。对实验室和分子检测进行了全面分析以确诊艾滋病毒感染。在性传播感染诊断流程中,检测出潜伏梅毒,血液涂片的显微镜观察发现了与疟疾相符的寄生虫形态。根据疟疾病例的操作定义应用标准和分子检测进行识别、诊断和治疗。最后,通过询问对临床病史和移民路线进行研究以调查输入病例。

结果

该移民被诊断为艾滋病毒慢性期感染且抗逆转录病毒疗法(ART)中断、潜伏梅毒和疟疾。所给予的抗逆转录病毒疗法是根据与抗疟药可能的药物相互作用以及对HLA - B*等位基因的遗传屏障来选择的。最后,针对梅毒的抗菌疗法是青霉素。通过对移民路线、输入性疟疾的潜伏期分析以及询问,我们推测该移民在巴拿马感染了疟疾。

结论

本病例突出了艾滋病毒感染移民所面临的复杂健康问题,尤其是当他们在移民期间感染了如疟疾等其他疾病时,突出了全面获得医疗保健以及抗逆转录病毒疗法、抗疟和抗菌治疗以减轻这一脆弱人群健康风险的必要性。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f6f8/11675952/b82649962480/idr-16-00091-g001.jpg

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