Posters
Presentation Type
Poster
Discipline Track
Other
Abstract Type
Case Report
Abstract
Abstract: Migration is a complex phenomenon that involves numerous physical and psychological challenges, particularly for individuals undertaking long and arduous journeys. In the case of this 39 year old Guatemalan man, his perilous 25-day journey crossing forests to reach the United States resulted in severe health consequences, including dehydration, acute kidney injury and a possible tick-borne illness. This case report aims to shed light on the healthcare needs of migrants and emphasizing the importance of providing comprehensive care.
A 39 year old male from Guatemala presented to the emergency department with diffuse abdominal pain associated with nausea, vomiting and a recent tick bite on his forearm. A tick was removed from his left forearm and right axilla. The patient reported exposure to extreme heat, limited access to food and water during his journey, and being apprehended by border patrol to be put in the cell. He described progressive symptoms over the course of two days, prompting him to seek medical attention.
On physical exam, he appeared severely dehydrated with dry mucus membranes and decreased skin turgor. Lab investigations revealed elevated serum creatinine, hyponatremia, leukocytosis, elevated liver enzymes and elevated markers of rhabdomyolysis, including markedly elevated creatine kinase (4,327). The patient was diagnosed with severe dehydration, AKI and ATN likely secondary to dehydration and severe rhabdomyolysis and possible tick borne illness. IV fluid resuscitation and Doxycycline therapy were initiated promptly. Febrile agglutinin and Rickettsial fever group IgM/G testing resulted negative. Other tick borne illnesses could not be ruled out. Creatine kinase levels continued to rise ranging from 25,771 to 63,189 and thereafter trended down. Nephrology was consulted for recommendations and aggressive hydration was started with isotonic IV fluids at 250 ml/hour. However, patient developed labored breathing, tachypnea and use of accessory muscles requiring increasing oxygen support. Chest x ray demonstrated volume overload and pulmonary edema. He was later transferred to the ICU for further management acute hypoxemic respiratory failure and hydrostatic pulmonary edema. He was treated with IV diuretics and BiPAP support and improved significantly. Patient was discharged after several days with outpatient referral for follow up care.
This case illustrates the health challenges faced by migrants during their journeys, with the patient experiencing severe dehydration, AKI, and a possible tick-borne illness. Prompt recognition and management of these conditions are crucial to prevent complications and provide appropriate care for this vulnerable population. Healthcare providers should be aware of the unique needs and risks by faced migrants, advocating for comprehensive medical care and preventive strategies to mitigate the impact.
Academic/Professional Position
Resident
Recommended Citation
Mehta, Radhika and Akhtar, Bareera, "Tick-Borne Illness in a Guatemalan Migrant" (2024). Research Symposium. 34.
https://scholarworks.utrgv.edu/somrs/2023/posters/34
Included in
Tick-Borne Illness in a Guatemalan Migrant
Abstract: Migration is a complex phenomenon that involves numerous physical and psychological challenges, particularly for individuals undertaking long and arduous journeys. In the case of this 39 year old Guatemalan man, his perilous 25-day journey crossing forests to reach the United States resulted in severe health consequences, including dehydration, acute kidney injury and a possible tick-borne illness. This case report aims to shed light on the healthcare needs of migrants and emphasizing the importance of providing comprehensive care.
A 39 year old male from Guatemala presented to the emergency department with diffuse abdominal pain associated with nausea, vomiting and a recent tick bite on his forearm. A tick was removed from his left forearm and right axilla. The patient reported exposure to extreme heat, limited access to food and water during his journey, and being apprehended by border patrol to be put in the cell. He described progressive symptoms over the course of two days, prompting him to seek medical attention.
On physical exam, he appeared severely dehydrated with dry mucus membranes and decreased skin turgor. Lab investigations revealed elevated serum creatinine, hyponatremia, leukocytosis, elevated liver enzymes and elevated markers of rhabdomyolysis, including markedly elevated creatine kinase (4,327). The patient was diagnosed with severe dehydration, AKI and ATN likely secondary to dehydration and severe rhabdomyolysis and possible tick borne illness. IV fluid resuscitation and Doxycycline therapy were initiated promptly. Febrile agglutinin and Rickettsial fever group IgM/G testing resulted negative. Other tick borne illnesses could not be ruled out. Creatine kinase levels continued to rise ranging from 25,771 to 63,189 and thereafter trended down. Nephrology was consulted for recommendations and aggressive hydration was started with isotonic IV fluids at 250 ml/hour. However, patient developed labored breathing, tachypnea and use of accessory muscles requiring increasing oxygen support. Chest x ray demonstrated volume overload and pulmonary edema. He was later transferred to the ICU for further management acute hypoxemic respiratory failure and hydrostatic pulmonary edema. He was treated with IV diuretics and BiPAP support and improved significantly. Patient was discharged after several days with outpatient referral for follow up care.
This case illustrates the health challenges faced by migrants during their journeys, with the patient experiencing severe dehydration, AKI, and a possible tick-borne illness. Prompt recognition and management of these conditions are crucial to prevent complications and provide appropriate care for this vulnerable population. Healthcare providers should be aware of the unique needs and risks by faced migrants, advocating for comprehensive medical care and preventive strategies to mitigate the impact.