Table 1: Clinical syndromes requiring ICU admission in critically ill migrants[8, 10]
Syndrome requiring ICU admission / Causative agents and/or infections / Geographic DistributionRespiratory failure
Clinical picture:
Severe Acute Respiratory Syndrome
Pneumonia / Viruses:
Influenza and other common respiratory viruses (coronavirus, rarely rhinovirus, Adenovirus,
Parainfluenza 1-4,Metapneumovirus) / Worldwide
SARS-CoV / Southeast Asia
MERS-CoV / Middle East
Varicella / Worldwide (adult primo-infections during migration)
Measles (especially in immunocompromised hosts) / Worldwide
RSV (especially in young children and immunocompromised adults) / Worldwide
Bacteria:
Pneumococcusspp / Worldwide
Staphylococcus aureus (including CA-MRSA) / Worldwide (America, Africa, Middle East and Pacific regions)
Q fever / Worldwide (exposure to rural areas and infected animal placenta and excreta)
Bordetella pertussis(neonates and unvaccinated/waned immunity) / Widespread, outbreaks reported in North America, Europe
Legionella spp / Widespread
Leptospiraspp / Worldwide, particularly in tropics
Tularemia / Throughout the Northern Hemisphere, except for in the United Kingdom. Sporadic in the United States, the former Soviet Union, Japan, Canada, Mexico and Europe
Pneumonic plague (Yersinia pestis) / Developing countries in Asia and Africa; sporadic in America
Melioidosis (Burkholderiapseudomallei) / Tropical regions of Asia and South America, Central America, various Pacific and Indian Ocean islands, and some countries in Africa
Protozoa-parasites
Malaria / Common in tropical and subtropical areas
Plasmodium falciparum / Wide distribution (subtropical areas)
P. malariae / Wide distribution
P. vivax / Middle East, India, South East Asia, Central America
P. knowlesii / Southeast Asia
Schistosomiasis / Sub-SaharanAfrica (Katayamafever)
Fungi
Aspergillus spp (near-drowning syndrome in saltwater) / Worldwide
Acute coccidioidomycosis / Desert areas in the southwestern United States and northwestern Mexico
Acute histoplasmosis / River valleys in North and Central America, eastern and southern Europe, and parts of Africa, eastern Asia, and Australia
Adult Respiratory Distress Syndrome (ARDS) / Influenza virus / Worldwide, seasonal distribution
Hantavirus (Hantavirus pulmonary syndrome) / Geographic distribution (Central and Northern Asia, Europe, South and North America)
Herpesvirus family (VZV, HSV) / Worldwide
SARS, MERS-CoV, / See above
Leptospiraspp / See above
Plasmodium falciparum malaria / See above
Strongyloidiasis / Subtropical (hyperinfection if corticostreroids therapy is started after migration from endemic areas)
Neurological syndromes
Clinical presentation: usually as altered mental
status, seizures, coma, neuropathies
Various syndromes Encephalitis, meningitis, meningoencephalitis,
myelitis, polyradiculo-neuropathy, Reye’s syndrome, subacutesclerosingpanencephalitis, postinfectious acute
disseminated encephalomyelitis /ADEM / Viruses:
Enteroviruses (enterovirus 71, coxsackie, echovirus,poliovirus: sporadic viral encephalitis or aseptic meningitis) / Worldwide, seasonal distribution
Arboviruses / encephalitis restricted to certain geographic regions
West Nile virus (WNV) (encephalitis, cranial neuropathy) / Widespread
Japanese Encephalitis Virus (JEV) / Japan, Southeast Asia, China, and India
Tick born Encephalitis Virus (TBEV) / Central, East and North Europe, Italy, Asia
Murray ValleyEncephalitis virus (MVEV)
Powassan Encephalitis Virus (PEV) / North America
Lymphocytic Choriomeningitis Encephalitis Virus (LCEV) / North America, South America, and Europe
Saint Louis Encephalitis Virus (SLEV ) / Widely disseminated in America. From Canada to Argentina
Influenza (encephalitis, particularly in H1N1, ADEM) / See above
Bunyavirus encephalitis (Rift Valley fever) / sub-Saharan and North Africa
Herpervirus family (CMV, VZV, HSV: encephalitis, rarely meningitis, neuropathy, myelitis, polyradiculopathy) / Worldwide
acute HIV infection (aseptic meningitis, encephalitis) / Worldwide
Vaccine preventable infections (mumps, measles, rubella: encephalitis) / Worldwide
Rabies (encephalitis, nystagmus, diplopia, hydrophobia) / Widespread
JC virus (PML) / Worldwide
Bacteria:
Neisseria meningitides
(meningitis, meningococcaemia) / Widespread, particularly Sub-Saharan Africa, Middle East
Haemophilusspp(meningitis) / Widespread
Salmonella spp(typhoid fever) / Particularly Indian Subcontinent
Borreliaspp(encephalitis, aseptic meningitis) / Europe, North America, temperate Asia
Ricketsiae(typhus, aseptic meningitis) / Geographic variation of species (North, Central and South America, Asia, Europe)
Tetanus (seizures) / Worldwide
Spirochaetae (encephalitis, aseptic meningitis, neuropathy) / Widespread
Mycobacterium tuberculosis(meningitis, encephalitis, cranial nerves palsies, mass effect, seizures, coma) / Global, resistance rates vary
Allantiasis, Clostridium botulinum (encephalitis, nystagmus, diplopia) / Global
Leptospirosis (aseptic meningoencephalitis) / See above
Parasites:
P.falciparum/vivax/ovale/malariae
(headache, seizures, coma) / Broad band around the equator (tropical areas in Americas, Asia, Sub-Saharan Africa); in Middle East especially due to P.vivax
African Trypanosomiasis (Trypanosoma bruceigambiense or Trypanosoma bruceirhodesiense)(headache, stiff neck, sleep disturbance, and depression, progressive mental deterioration, focal seizures, tremors, and palsies) / 14th latitude north and the 29th latitude south on the African continent. Epidemic in Angola, Democratic Republic of the Congo, Uganda & Sudan; endemic in Cameroon, Congo, Cote d’Ivoire, Central African Republic, Guinea, Mozambique, Tanzania, & Chad.
Chagas disease (Trypanosomacruzi, meningoencephalitis) / Mexico, Central and South America
Echinococcosis (mass effect) / Mainly in South and Central America, Africa, the Middle East, China, Italy, Spain, Greece, Russia, and the western United States
Neurocycticercosis, Taeniasolium
(epilepsy, seizures, lesions in the brain, blindness, tumor-like growth) / Mexico, Latin America, West Africa, Russia, India, Pakistan, Southeast Asia
Schistosoma mansonii (neuroschistosomiasis) / sub-Saharan Africa, Latin America and also Egypt and China
paragonimiasis / East Asia, West Africa, North and South America
Angylostrongylusspp (eosinophilic meningitis) / Asia, islands of the Pacific, and Australia but has also been observed in North, Central, and South America
Gnathostomaspp / Asia, Mexico, Latin America
Toxocariasis (Ascaris and Toxocaraspecies can cause eosinophilic meningitis) / Worldwide
Fungi:
Coccidioidomycosis(eosinophilic meningitis) / desert areas in the southwestern United States and northwestern Mexico,
Histoplamacapsulatum / South America
Cryptococcus neoformans / Worldwide
Aspergillus spp / Worldwide, Africa and South-east Asia
Guillain-Barré syndrome (GBS) / Herpesviruses (HSV, VZV, CMV, EBV) / see above
Influenza / see above
Hantavirus / see above
acute and chronic hepatitis B / see below
Rare causes: WestNile virus, Parvovirus B19, rubella,dengue, Zika virus
Shock/haemorrhagic manifestations /multiorgan failure
Cardiogenic shock /Myocarditis / Enteroviruses (Enterovirus 71, Coxsackie virusesgroup A and B, Echovirus), / Worldwide, seasonal distribution
Respiratoryviruses (Influenza, Adenovirus, RSV) / Worldwide, seasonal distribution
Parvovirus, CMV, HIV-1, / Worldwide
HAV and HEV / Mostly in developing countries
Trichinellaspp / Worldwide
Leptospirosis / See above
Chaga’s disease (dilative cardiomyopathy) / See above
Distributive shock-Hemorrhagic fever
Clinical presentation:Febrile illnesses,
headache, myalgia, nausea, vomiting and
diarrhoea are frequent. Hemorrhagic features,
disseminated intravascular coagulopathy (DIC),
multiple organ system failure and death / Viruses
Arenaviruses
South American HF / South America
LassaFever / endemic in Benin, Guinea, Liberia, Sierra Leone and parts of Nigeria(West African countries)
Bunyaviruses
Rift valley fever / sub-Saharan and North Africa, sporadic in Middle East
CrimeanCongo HF-CCHF / CCHF: Africa, the Balkans, the Middle East and Asia, in countries south of the 50th parallel north
Hantavirus (haemorrhagic fever with renal syndrome) / See above
Filoviruses
Marburg / Large outbreaks in Germany and Serbia in 1967; outbreaks and sporadic cases in Angola, Democratic Republic of the Congo, Kenya, South Africa and Uganda
Ebola / Ebola virus disease (EVD) first appeared in 1976 in Sudan and Congo. Current outbreak (onset in 2014) in Guinea, Liberia and Sierra Leone (sporadic travelers to Mali, Senegal, USA and Nigeria)
Flaviviruses
Yellow fever / 44 endemic countries in Africa and Latin America
Dengue and Dengue HaemorhagicFever (the severe form results from reinfection by the same or other type of the virus) / Endemic in more than 100 countries in the WHO regions of Africa, the Americas, the Eastern Mediterranean, South-East Asia and the Western Pacific (tropical and subtropical areas)
Bacteria
Neisseria meningitidissepticaemia / See above
Leptospiraspp / See above
Leishmaniasis / See above
Ricketsiae / Widespread, geographic distribution of species
Gram negative sepsis / Global (due to primary infections or secondary to other predisposing infections i.e. Strongyloidiasis, Ebola virus disease)
Hypovolemic/distributive shock in the
setting of acute liver failure secondary to
viral hepatitis
Clinical presentation: Nausea and vomiting
with progression to encephalopathy and coma;
cirrhosis / Hepatitis A, B, C, D, E, / HAV and HEV: widespread, mostly in developing countries (HEV rather underestimated)
HBV: worldwide, low risk Europe, North America and Oceania
HCV: Worldwide, mainly Africa and Central and East Asia
HDV: Mediterranean Basin, the Middle East, Central Asia, West Africa, South America and certain South Pacific islands
Herpesviruses (CMV, HSV and EBV) / See above
Adenovirus and influenza virus / See above
Yellow fever / See above
Ebola / Central Africa
Hypovolemic/distributive shock in the
setting of acute pancreatitis / Enteroviruses (Coxsackie B), / Worldwide, seasonal variation
Herpesvirus family (CMV, VZV, HSV-1, EBV) / Worldwide
Respiratoryviruses (influenza A, parainfluenza, adenovirus) / Worldwide, seasonal variation
measles / Worldwide
Fulminant hepatitis HAV or HEV / Mostly in developing countries
Shock in the setting of adrenal insufficiency / viral infections (CMV in HIV-1 infection) / Worldwide
Other life-threatening infections and related conditions
Rhabdomyolysis / Respiratory viruses (Influenza A and B, parainfluenza virus, adenovirus) / Worldwide, seasonal variation
enteroviruses / Worldwide, seasonal variation
Herpervirus family (CMV, EBV,VZV) / Worldwide
measles / Worldwide
Leptospiraspp / Worldwide, particularly in tropics
Special Immunocompromised hosts
Pregnancy / HSV, VZV, CMV, Influenza virus,HEV fulminant hepatitis, Listeria spp, pertussis,
postpartum infections and septic abortions / Listed above
HIV / Opportunistic infections by TB and pathogens rarely encountered in developed countries / Worldwide distribution; frequently undiagnosed/untreated: Africa
Severe skin infections
Bacterial skin infections after wound
Clinical picture: cellulitis, erysipelas, abscess, necrotizing fasciitis / Streptococci, S. aureus (including MRSA) , Gram-negative aerobic bacteria / Global
Dog bites / Capnocytophagacarnimosus(severe in immunocompromised), Pasteurellamultocida / Global
S. aureus, α-, β-, and γ-hemolyticstreptococci gram-negatives and anaerobic microorganisms / Worldwide
Rabies / Worldwide, especially Africa, Asia, Eastern Europe, Central America
Tetanus (unvaccinated or waned immunity) / Global
Soft tissue infections associated with exposure to water
Clinical presentation: Cellulitis, abscesses, ecthymagangrenosum, and necrotizing fasciitis / V. vulnificus infection (in underlying liver disease may manifest as a dramatic cellulitis with hemorrhagic bullae and sepsis) / Global, freshwater
Mycobacterium marinum, / Global (freshwater, aquaria)
Aeromonas spp., Plesiomonas spp., Edwardsiellatarda, Erysipelothrixrhusiopathiae / Global
Footnotes: i)The table represents an extensive list of conditions which could result in ICU admission; however the most common conditions are highlighted in the manuscript ii) Some of these pathogens listed above may cause mild or self-limited disease in the majority of infected persons iii) the table was constructed with information collected from the websites of Center for Disease Control and Prevention (CDC), World Health Organisation (WHO) and European Centre for Disease Prevention and Control listed below
1. 2. 3.
4.
Abbreviations in alphabetic order: ADEM acute disseminated encephalomyelitis, ARDS Adult Respiratory Distress Syndrome, CMV Cytomegalovirus, CCHF Chrimean Congo Hemorrhagic Fever, DIC disseminated intravascular coagulopathy, EBV Epstein Barr virus, Guillain-Barré syndrome(GBS), HAV hepatitis A virus, HBV hepatitis B virus, HCV hepatitis C virus, HEV hepatitis E virus, HIV human immunodeficiency virus, HHV-6 Herpes Virus 6, HHV-8Herpes Virus 8, HF Hemorrhagic Fever, HSV Herpes Simplex Virus, ICU Intensive Care Unit, JEV Japanese Encephalitis Virus, MVEVMurray Valley encephalitis virus, PTLD post-transplant lymphoproliferative disorder, RSV Respiratory Syncytial Virus, SARS SevereAcute Respiratory Syndrome, TBEV tick-borne encephalitis virus, SARS severe acute respiratory syndrome, SLEV St. Louis Encephalitis Virus, VZV Varicella-Zoster Virus, WNV West Nile virus.