Alexandra C Barger

Investigation and Results Information about the patient’s clinical and hospitalization course was provided by the treating facilities through the local health departments. In April 2024, the patient had relocated from Haiti to the United States; he began working in a Kentucky warehouse in August (Figure). Three months later, in November, he sought treatment at a local emergency department (hospital A) for a 4-day history of knee and lower back pain.

Timeline, Investigation, and Outcomes The patient returned to Iowa from Liberia during early October 2024 (day 0), and experienced fever, myalgias, and headache on day 8. After an evaluation in the emergency department of hospital A on day 15, the patient was transferred to hospital B for diagnostic evaluation. On day 19, the patient needed specialized care and was transferred to hospital C, the hospital that contacted the Iowa Department of HHS; the patient died on day 21.

Objective Chlamydia, gonorrhoea and syphilis (primary and secondary) are at high levels in the USA. Disparities by race, gender and sexual orientation have been characterised, but while there are indications that rural poor populations may also be at distinct risk this has been subjected to little study by comparison.