Babesia is known to be prevalent in the Eastern United States and other temperate countries but the prevalence of babesia is not well known in the tropical malaria-endemic countries because of the higher prevalence of malaria.A 72-year-old Hispanic male from Ecuador presenting with increasing left lower quadrant abdominal pain and distention for one year. He experienced nausea, vomiting, diarrhea, fever, chill, and myalgias. He reported 9 kg weight loss over the last two months. Patient moved to Chicago recently from Ecuador where he worked at a banana plantation and had frequent exposure to many insects and animals.Vital signs were normal but patient appeared chronically ill. Mild tenderness to palpation over the left side of the abdomen with marked splenomegaly, measuring 16 cm below the costal margin.Laboratory results with no leukocytosis hemoglobin 7.8 × 109/L; and platelet count, 55 × 109/L. Sodium was 128 mmol/L. Labs showed elevated LDH, ESR and ferritin values. The haptoglobin was low with a positive Combs test. CT abdomen showed moderate splenomegaly with large patchy, wedge-shaped hypodense area in posterior mid and upper spleen suggesting splenic infarction. Rapid malaria screening was negative, but a peripheral smear identified plasmodium species in more than 0.5% of red blood cells. Treatment with atovaquone and proguanil started.Two weeks later, molecular testing revealed Babesia DNA.This report details a case of babesiosis in a patient coming from a malaria-endemic region. The initial workup and blood work highly suggested a plasmodium infection. However the polymerase chain reaction confirmed the diagnosis of a Babesia microti.Learning objectives: We report the first case of human Babesiosis in previously healthy individual from Ecuador.
Athletes experience significant intrinsic and extrinsic pressures motivating them to set high performance outcomes, especially before competitions. Athletes often turn to several dietary supplements to increase strength and muscle mass or to decrease body weight and fat. However, these supplements may exert adverse effects on various organs and tissues, including the cardiovascular system. Overtraining athletes have increased susceptibility to viral infection and exercise in early phase of myocarditis enhances viral replication in myocardium [1,2]. We report a case of thyroid hormone-associated acute myocarditis complicated by coxsackievirus infection.
Case reportA 25-year-old male with no past medical history presented with one day of chest pain. The patient had exercised with high intensity for a bodybuilding competition. He had fever, malaise, sore throat, and cough 1 week before presentation but he continued rigorous daily exercise. He was tachycardic and tachypneic. Cardiac examination was unremarkable. Electrocardiography showed diffuse ST segment elevation (Fig. 1). Laboratory results showed
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