Imported strongyloidiasis is increasingly being diagnosed in non-endemic areas. The aim of this study was to describe the epidemiological, clinical and microbiological characteristics of patients ...with imported strongyloidiasis in Spain.
This is an observational retrospective study that included all patients diagnosed of strongyloidiasis registered in the +REDIVI Collaborative Network from 2009 to 2017. Demographic, epidemiological and clinical information was collected from the +REDIVI database, and extra information regarding microbiological techniques, treatment and follow-up was requested to participant centers.
Overall, 1245 cases were included. Most of them were immigrants (66.9%), and South America was the most frequent area of origin. Detection of larvae in stool samples was observed in 21.9% of the patients, and serological tests allowed making the diagnosis in the rest of the cases. Eosinophilia was present in 82.2% of cases. Treatment with ivermectin (compared with albendazole) was the most strongly associated factor to achieve the cure (OR 2.34).
Given the long latency of the infection and the risk of developing a severe presentation, screening of S. stercoralis infection should be mandatory in patients coming from or had traveling to endemic areas, especially in those with immunosuppressant conditions.
Aims
To compare the clinical and epidemiological characteristics and the evolution of infective endocarditis in adults aged under 65 years, 65–79 years, and 80 years or older.
Methods
An ...observational retrospective cohort study in patients with infective endocarditis was performed in a public hospital in Spain from January 2013 to December 2017.
Results
Seventy-two patients were treated: 26 (36.1%) were under 65 years old, 28 (38.9%) were 65–79 years old, and 18 (25%) were aged 80 or older. Prosthetic valve endocarditis was less common in patients aged 65–79 years (3.6%) than in younger (23.1%;
p
= 0.047) or older (38.9%;
p
= 0.004) patients. In contrast, degenerative heart disease was more prevalent in the 65–79 year age group 64.3% compared to 15.4% (
p
< 0.001) in the youngest group, and 33.3% (
p
= 0.04) in the oldest. Surgical interventions were similar in patients aged 65–79 (50%) and under 65 years (42.3%), but less common in people over 80 years (16.7%;
p
= 0.022).
Conclusions
The characteristics of infective endocarditis are different in patients aged 65–79 years and in those over 80 years.
Introducción. En los últimos años ha aumentado la malaria importada en niños, en quienes la enfermedad es potencialmente grave y mortal.Objetivo. Describir la incidencia y características ...clínico-epidemiológicas de niños con diagnóstico de conmalaria en Alicante, España, en los últimos años.Materiales y métodos. Se hizo un estudio observacional y retrospectivo de los casos de malaria en menores de 15 años, diagnosticados en el Hospital General Universitario de Alicante desde 1994 hasta 2019.Resultados. Se registraron 24 casos. El número de casos pasó de dos en el primer quinquenio a 11 en el último. La mediana de edad fue de 6 años (rango intercuartílico: 3 a 8). El 91,6 % procedía de África subsahariana. Los niños nacidos en España de padres inmigrantes que viajan a una zona endémica para visitar a familiares y amigos (Visiting Friends and Relatives) representaron el 62,5 % (n=15) y solo consta que recibiera quimioprofilaxis antipalúdica un paciente (6,7 %). Los signos clínicos más frecuentes fueron fiebre (86,9 %), hepatoesplenomegalia (70,8 %) y anemia (70,8 %). Plasmodium falciparum fue la especie más frecuentemente identificada (83,3 %; n=20). El tratamiento más empleado fue la combinación de dihidroartemisina y piperaquina por vía oral (41,6 %, n=10), con evolución favorable en todos los casos.Conclusiones. Los casos de paludismo infantil importado están aumentando en los últimos años. Las manifestaciones clínicas son inespecíficas en estos niños, por lo que es importante que los profesionales conozcan la enfermedad y tengan un alto índice de sospecha para iniciar el tratamiento precoz. Además, deben tomarse las medidas preventivas adecuadas antes de un viaje.
Abstract The substantial immigration into Spain from endemic areas of Chagas disease such as Latin America has increased the number of potential donors of organs and tissues. In addition, an ...increasing number of patients with advanced Chagas heart disease may eventually be eligible to receive a heart transplant, a universally accepted therapeutic strategy for the advanced stages of this disease. Therefore, it is necessary to establish protocols for disease management. This document is intended to establish the guidelines to be followed when a potential donor or a tissue or organ recipient is potentially affected by Chagas disease and summarizes the action criteria against the possibility of Chagas disease transmission through the donation of organs, tissues, or hematopoietic stem cells and aims to help professionals working in this field. A single registry of transplants in Trypanosoma cruzi infected donors and/or recipients will provide and disseminate experience in this area, which has shown a low recorded incidence to date.
Immunoregulatory networks may have a role in controlling parasitemia in the chronic phase of human Chagas disease. The aim was to describe the serum cytokine profile of
Trypanosoma cruzi
in ...chronically infected patients and to evaluate its relationship with parasitemia and Chagas cardiomyopathy.
This prospective observational study included adult patients with chronic Chagas disease. Demographic and clinical data were collected, and peripheral blood samples were used to perform
T. cruzi
real-time polymerase chain reaction (RT-PCR) and determine the serum cytokine profile.
Fifty-eight patients were included; 17 (29.3%) had positive RT-PCR results. This group had a higher median concentration of TNF-α (
p
= 0.003), IL-6 (
p
= 0.021), IL-4 (
p
= 0.031), IL-1β (
p
= 0.036), and IL-17A (
p
= 0.043) than those with a negative RT-PCR. Patients with cardiac involvement had a higher median concentration of IL-5 (
p
= 0.016) than those without
.
These results reinforce the key role that cytokines play in Chagas disease patients with parasitemia and cardiac involvement.
There are few studies evaluating awareness of Chagas disease among healthcare professionals attending migrants from Latin America or working in Chagas-endemic areas. The objective of this study was ...to design and validate instruments for assessing knowledge about Chagas disease among healthcare students and residents as well as students and professionals of social and other health science disciplines. Two validated scales have been developed: the 10-item Chagas Level of Knowledge Scale for healthcare professionals (ChaLKS-Medical) and the 8-item ChaLKS-Social&Health for potential aid workers from those fields. Both scales were considered adequate in terms of readability, internal consistency, construct validity, and discriminant validity. The mean number of correct answers on the ChaLKS-Medical among respondents from non-healthcare versus healthcare sectors was 1.80 versus 7.00 (
< 0.001). The scores on the ChaLKS-Social&Health also discriminated between the knowledge levels in these two groups (1.76 versus 6.78,
< 0.001). Knowledge among medical/pharmacy students and residents on the ChaLKS-Medical was acceptable and different (mean: 5.8 and 7.4, respectively;
< 0.001). Respondents' knowledge of Chagas disease was greater in those who had previously received information on the disease; this was true in both respondents from the healthcare sector (mean correct answers, ChaLKS-Medical: 7.2 versus 4.3,
< 0.001) and in potential aid workers (mean correct answers, ChaLKS-Social&Health: 5.1 versus 1.1,
= 0.001). The metric properties of both scales are adequate for their use in supporting aid operations in Chagas-endemic countries or in providing health and social care to migrant populations in non-endemic countries.
Chagas disease (CD) is a chronic parasitic disease caused by Trypanosoma cruzi and is endemic to continental Latin America. In Spain, the main transmission route is congenital. We aimed to assess ...adherence to regional recommendations of universal screening for CD during pregnancy in Latin American women in the province of Alicante from 2014 to 2018.
Retrospective quality study using two data sources: 1) delivery records of Latin American women that gave birth in the 10 public hospitals of Alicante between January 2014 and December 2018; and 2) records of Chagas serologies carried out in those centers between May 2013 and December 2018. There were 3026 deliveries in Latin American women during the study period; 1178 (38.9%) underwent CD serology. Screening adherence ranged from 17.2% to 59.3% in the different health departments and was higher in Bolivian women (48.3%). Twenty-six deliveries (2.2%) had a positive screening; CD was confirmed in 23 (2%) deliveries of 21 women. Bolivians had the highest seroprevalence (21/112; 18.7%), followed by Colombians (1/333; 0.3%) and Ecuadorians (1/348; 0.3%). Of 21 CD-positive women (19 Bolivians, 1 Colombian, 1 Ecuadorian), infection was already known in 12 (57.1%), and 9 (42.9%) had already been treated. Only 1 of the 12 untreated women (8.3%) was treated postpartum. Follow-up started in 20 of the 23 (87.0%) neonates but was completed only in 11 (47.8%); no cases of congenital transmission were detected. Among the 1848 unscreened deliveries, we estimate 43 undiagnosed cases of CD and 1 to 2 undetected cases of congenital transmission.
Adherence to recommendations of systematic screening for CD in Latin American pregnant women in Alicante can be improved. Strategies to strengthen treatment of postpartum women and monitoring of exposed newborns are needed. Currently, there may be undetected cases of congenital transmission in our province.
Strongyloides stercoralis is a globally distributed nematode that causes diverse clinical symptoms in humans. Spain, once considered an endemic country, has experienced a recent increase in imported ...cases. The introduction of serology helps diagnosis and is currently replacing microbiological techniques in some settings, but its sensitivity is variable and can be low in immunocompromised patients. Diagnosis can only be confirmed by identification of larvae. Often, this "gold standard" can only be achieved in severe cases, such as disseminated S.stercoralis infection, or S.stercoralis hyperinfection syndrome, where parasite load is high. In addition, these clinical presentations are not well-defined. Our aim is to describe severe cases of S.stercoralis, their epidemiological profile, and their clinical details.
An observational retrospective study of disseminated S.stercoralis infection, or hyperinfection syndrome. Inclusion criteria: aged over 18, with a diagnosis of disseminated S.stercoralis infection, or hyperinfection syndrome, confirmed by visualization of larvae. Patients were identified through revision of clinical records for the period 2000-2015, in collaboration with eight reference centers throughout Spain.
From the period 2000-2015, eighteen cases were identified, 66.7% of which were male, with a median age of 40 (range 21-70). Most of them were foreigners (94.4%), mainly from Latin America (82.3%) or Western Africa (17.6%). Only one autochthonous case was identified, from 2006. Immunosuppressive conditions were present in fourteen (77%) patients, mainly due steroids use and to retroviral coinfections (four HIV, two HTLV). Transplant preceded the clinical presentation in four of them. Other comorbidities were coinfection with HBV, Trypanosoma cruzi, Mycobacterium leprae or Aspergillus spp. All presented with digestive disorders, with 55.6% also presenting malaise. 44.4% of cases had fever, 27.8% skin complaints, and 16.7% respiratory or neurological disorders. One patient presented anemia, and one other nephrotic syndrome. Diagnosis was confirmed by identification of larvae in fresh stool samples (n = 16; 88.9%), concentration techniques (n = 6; 33.3%), larval culture (n = 5; 29.4%), or digestive biopsies (n = 8; 44%). S.stercoralis forms were identified during necropsy in one case. In addition, ten (55%) had a positive serology. All the cases were treated with ivermectin, six (33%) also received albendazole and one case received thiabendazole followed by ivermectin. All needed inpatient management, involving a mean hospitalization stay of 25 days (range 1-164). Two cases received intensive care and eventually died.
Only eighteen cases of disseminated S.stercoralis infection/hyperinfection syndrome were identified from the 15-year period, most of which were considered to have been imported cases. Among those, immunosuppression was frequent, and mortality due to S.stercoralis was lower than previously described.
Sequencing data from Plasmodium ovale genotypes co-circulating in multiple countries support the hypothesis that P. ovale curtisi and P. ovale wallikeri are 2 separate species. We conducted a ...multicenter, retrospective, comparative study in Spain of 21 patients who had imported P. ovale curtisi infections and 14 who had imported P. ovale wallikeri infections confirmed by PCR and gene sequencing during June 2005-December 2011. The only significant finding was more severe thrombocytopenia among patients with P. ovale wallikeri infection than among those with P. ovale curtisi infection (p = 0.031). However, we also found nonsignificant trends showing that patients with P. ovale wallikeri infection had shorter time from arrival in Spain to onset of symptoms, lower level of albumin, higher median maximum core temperature, and more markers of hemolysis than did those with P. ovale curtisi infection. Larger, prospective studies are needed to confirm these findings.
The aim of the study was to evaluate the availability of different procedures, diagnostic tests, and treatments, as well as the procedures and techniques used in the management of cystic ...echinococcosis (CE) in Spain. This was a cross-sectional study performed from September to December 2018 in Spain. A survey directed to CE-treating clinicians was conducted to collect information regarding the center characteristics and the different protocols of management followed. Thirty-nine centers among 76 contacted centers participated in the survey, most of them belonging to the public health system and attending both adult and children. The median number of patients with CE attended during the last three years per center was 15. Percutaneous techniques were used only in seven centers, and surgery was the most frequently used therapeutic approach. Drugs and duration of treatment (both when administered exclusively or when combined with surgery/puncture, aspiration, injection, and reaspiration) were very variable depending on the centers. There is a high variability in the management of CE among Spanish centers. These results stress the importance of promoting the diffusion of existing knowledge, adapting the WHO recommendations to our setting, and referring patients to referral centers at a national level.
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