Cristina Bocanegra

Prolonged Zika Virus Viremia during Pregnancy

The presence of Zika virus in the blood may be prolonged during pregnancy. In this letter, Zika virus remained detectable for more than 3 months in a pregnant woman.

Immunosuppression and Chagas disease; experience from a non-endemic country

Reactivation of Chagas disease in the chronic phase may occur when immunosuppression is established, sometimes resulting in high parasitaemia and severe clinical manifestations such as meningitis and meningoencephalitis. Although this situation is being increasingly described, there is still scarce information. This retrospective observational study was performed in three Tropical Medicine Units of Barcelona (Spain) included in the International Health Programme of the Catalan Health Institute (PROSICS). The objective of the study was to describe epidemiological, clinical, microbiological, prognostic and therapeutic data from patients with Chagas disease and any kind of immunosuppressive condition attended in these three institutions from January 2007 to October 2014. From 1823 patients with Chagas disease attending these three centres during the study period, 38 (2%) had some kind of immunosuppressive condition: 12 patients had human immunodeficiency virus infection, 8 patients had neoplasia, 4 patients underwent organ transplantation and 14 patients had an autoimmune disease. Eight (21.1%) patients had cardiac involvement, and six (15.8%) patients had gastrointestinal involvement. Acute Trypanosoma cruzi infection was detected in two Spanish patients. Thirty-one (81.6%) patients received treatment with benznidazole, of whom 17 (54.8%) had some kind of adverse event. No patient had a severe manifestation or reactivation of Chagas disease. Patients with Chagas disease under immunosuppressive conditions are being increasingly described, especially in non-endemic countries. More information about this topic is required and international consensus in the diagnosis, treatment and follow up of these patients must be established to reduce the morbidity and mortality.

Arboviral infections diagnosed in a European area colonized by Aedes albopictus (2009–2013, Catalonia, Spain)

BACKGROUND The invasive mosquito Aedes albopictus, with proven vectorial ability to transmit European autochthonous cycles of dengue and chikungunya virus, has currently colonized every coastal department of Eastern Spain. The main objective of the study was to define the epidemiological and clinical characteristics as well as the trends of these two arboviral diseases in a European area heavily colonized by Ae. albopictus. METHOD A voluntarily-based, prospective and multicenter surveillance study was performed in all medical units of the North Metropolitan area of Barcelona (406,000 inhabitants, Catalonia; Spain) with diagnostic capability from 2009 to 2013. Since any possible increase in arboviral cases could be justified by changes in traveling behaviors along the study period (especially longer trips) the trend showed by these two arboviral diseases was compared with that displayed by malaria cases during the same period. RESULTS 38 out of 52 (73.1%) suspected cases could be serologically confirmed (IgM+): dengue 34/38 (89.5%) and chikungunya 4/38 (11.5%). No autochthonous cases were identified. The overall incidence of both arboviruses was 0.19 cases/10,000 inhabitants-year (95% CI: 0.07-0.3); dengue = 0.17 cases/10,000 inhabitants-year (95% CI: 0.05-0.3), and chikungunya = 0.02 cases/10,000 inhabitants-year (95% CI: 0.001-0.03). The Incidence Relative Risk of arboviral disease between 2009 and 2013 shown a significant trend (IRR = 1.27. IC 95%: 1.01-1.59; p = 0.043) when compared with that displayed by malaria (IRR = 1.04. IC 95%: 0.924-1.192). If no unexpected circumstances concur, the arboviral disease incidence tax would equal that of malaria about 2021-2022. CONCLUSIONS The incidence of dengue and chikungunya is steadily increasing in the North Metropolitan area of Barcelona, a region densely colonized by Ae. albopictus, at the entire expense of imported cases (especially Visiting Friends and Relatives travelers). To date, no secondary autochthonous cases have been identified and, thus, they have not taken part in this rise.

Epidemiology of Schistosomiasis and Usefulness of Indirect Diagnostic Tests in School-Age Children in Cubal, Central Angola

Introduction Schistosomiasis remains a public health major problem and little is known in many areas, mainly in Sub-Saharan Africa Objectives To assess the burden and risk factors of schistosomiasis and intestinal parasitic helminthes in the children of Cubal, Angola, and to compare different diagnostic approaches for urinary schistosomiasis under field conditions. Methods A cross-sectional study was conducted. Urine and faeces samples of school children were microscopically studied. A random sample of children was obtained from an alphabetically arranged list of children, taking one of two children. Urine dipstick, colorimetric test and macrohaematuria were considered as indirect diagnostic methods and compared to direct urine examination. Possible risk factors for the infection were sex, age, distance to the river and previous treatment with praziquantel; the assessment was performed using Chi-square test. Results A total of 785 (61.18%) children showed S. haematobium eggs in urine; children living within 500 meters from the river had a higher odds for infection: Odds ratio 1.97 (1.45–2.7 CI 95%); urine dipstick showed sensitivity of 96% and specificity of 61.3%, with a positive predictive value; colorimetric test showed sensitivity of 52.5%, specificity of 74.6% and a positive predictive value of 77%. Proteinuria was present in 653 (51.1%) children, being more frequent in children with S. haematobium in urine (75.2%); 32 of 191 stool samples (16%) showed the presence of other intestinal parasites and 8 (4%) for S. haematobium. Conclusions Prevalence of urinary schistosomiasis in our study area is much higher than the national average, considering it as a high-risk community. Proximity to a source of water was a risk factor for the infection. Indirect tests, as urine dipstick and colorimetric test, were useful tools for diagnosis, due to ease of use and low cost. Proteinuria was a common finding, probably showing an early structural damage due to schistosomiasis in this group of children.

Zika virus dynamics in body fluids and risk of sexual transmission in a non-endemic area

To understand Zika virus (ZIKV) dynamics in fluids of infected individuals and the risk of sexual transmission.

Imported cases of Chikungunya in Barcelona in relation to the current American outbreak

BACKGROUND The Chikungunya virus (CKIKV) is currently present in America. Travel between America and Europe is particularly intense and one of the main vectors of CHIKV, Aedes albopictus, is well established in the Mediterranean basin. We describe a series of imported cases that could originate a European outbreak. METHODS We retrospectively studied cases of CHIKV originating in America and diagnosed in the last year in three Tropical Medicine Units of Barcelona of the International Health Program of the Catalan Health Institute (PROSICS). Clinical, microbiological and epidemiological data were analyzed. RESULTS Forty-two CHIKV cases who had returned from 11 American countries were included. Fever was the most common symptom at onset (96.1%). Three months after symptom onset 50% continued with arthralgias, 35.3% fatigue and 11.8% arthritis. Three patients were viremic at the time of diagnosis by RT-PCR, and the remaining were diagnosed by serology (CHIKV IgM or IgG). Five (11.9%) patients had positive IgM for both dengue virus and CHIKV. CONCLUSIONS The origin of the cases was diverse, the most frequent being initially the Dominican Republic, followed later by Venezuela and Colombia. Symptoms were not severe but persisted, accompanied by unremitting positive IgM. Diagnosis was mainly based on serology and RT-PCR, with the performance of the rapid immunochromatographic test being low. Phylogenetic studies showed that two viremic cases were caused by a strain of Asian lineage with a lower adaptability to Aedes albopictus. Co-infection with the dengue virus was common, but the clinical course was not affected by coinfection. Non-steroidal anti-inflammatory drugs were administered to 71.4% and steroids to 21.4%. The number of imported cases of CHIKV in Spain is rising due to introduction of this virus in America, and this could lead to an autochthonous outbreak if Public Health measures are not taken.

When Information Does Not Translate into Knowledge. Ebola and Hemorrhagic Fevers Knowledge among Primary Care Physicians and Nurses

After the first secondarily-transmitted ebola case in Spain, a wave of divergent opinions flooded mass and sanitary media. Very few of these opinions, however, came from experts on epidemiology or hemorrhagic fevers. This observational study aimed to assess the specific knowledge of Primary Care physicians and nurses about ebola and hemorrhagic fevers by means of analyzing the results obtained from a 5-item self-reported questionnaire dealing on hemorrhagic fevers basic knowledge. Validity and reliability of questionnaire were confirmed by a pilot study. The participants were 138 family doctors and nurses from the 64 public Primary Care centers sited in the North Metropolitan Area of Barcelona (1,400,000 inhab; Catalonia, Spain) taking part in training-the-trainers ebola workshops. Overall, there were 117 (84.8%) respondents out from 138 workshop participants; of them were physicians 61 (51.2%). The main age was 46.7 (8.8) years; stating previous specific knowledge on hemorrhagic fevers 39 (33.3%). On the whole, up to 92 (78.6%) of respondents shown a poor knowledge. Previous specific formation was significantly and independently associated with having proper knowledge (p < 0.001); OR = 8.6 (CI 95%: 3.199 - 23.623). In summary, confusion that accompanied the single secondary-transmitted ebola case in Spain could probably be explained by the existence of a serious gap on hemorrhagic fevers knowledge. More accurate, scientific and formally-presented information should be provided to Primary Care physicians and nurses.

Changes in malaria epidemiology in a rural area of Cubal, Angola

BackgroundScarce information about malaria epidemiology in Angola has been published. The objective of this study is to describe the epidemiology of malaria at the Hospital Nossa Senhora da Paz (Cubal, Angola) and the fatality rate due to malaria (total and in children under five years) in the last five years.MethodsA retrospective, observational study was performed at the Hospital Nossa Senhora da Paz, a 400-bed rural hospital located in Benguela Province of Angola. The study population included all patients who attended the hospital from January 2009 to December 2013. Outcome variables were calculated as follows: the percentage of malaria cases (number of positive thick blood films, divided by the total thick blood films performed); the percentage of in-patients for malaria (number of in-patients diagnosed with malaria, divided by the total number of in-patients); and, the fatality rate (number of deaths due to malaria divided by the number of positive thick blood films).ResultsOverall, 23,106 thick blood films were performed, of which 3,279 (14.2%) were positive for Plasmodium falciparum infection. During this five-year period, a reduction of 40% (95% CI 37-43%, p < 0.001) in the malaria-positive slides was detected. Distribution of positive-malaria slides showed a seasonal distribution with a peak from December to March (rainy season). An average annual reduction of 52% (95% CI 50-54%, p < 0.001) in the admissions due to malaria was observed. The overall fatality rate due to malaria was 8.3%, and no significant differences in the annual fatality rate were found (p = 0.553).ConclusionsA reduction in the number of malaria cases and the number of admissions due to malaria has been observed at the Hospital Nossa Senhora da Paz, during the last five years, and incidence along the study period showed a seasonal distribution. All this information could be useful when deciding which malaria control strategies have to be implemented in this area.

El cribado de las enfermedades parasitarias en la población inmigrante asintomática

Parasitic diseases suppose an important health problem in people from high endemic areas, so these must be discarded properly. Usually, these infections develop asymptomatically but, in propitious situations, are likely to reactivate themselves and can cause clinical symptoms and/or complications in the receiving country. Moreover, in some cases it is possible local transmission. Early diagnosis of these parasitic diseases made by appropriate parasitological techniques and its specific treatment will benefit both, the individual and the community. These techniques must be selected according to geoepidemiological criteria, patients origin, migration route or time spent outside the endemic area; but other factors must also be considered as its sensitivity and specificity, implementation experience and availability. Given the high prevalence of intestinal parasites on asymptomatic immigrants, it is recommended to conduct a study by coproparasitological techniques. Because of its potential severity, the screening of asymptomatic malaria with sensitive techniques such as PCR (polymerase chain reaction) is also advisable. Serological screening for Chagas disease should be performed on all Latin American immigrants, except for people from the Caribbean islands. Other important parasites, which should be excluded, are filariasis and urinary schistosomiasis, by using microscopic examination. The aim of this paper is to review the different techniques for the screening of parasitic diseases and its advices within the care protocols for asymptomatic immigrants.Resumen Las enfermedades parasitarias pueden suponer un importante problema de salud en individuos provenientes de zonas de alta endemicidad, por lo que deben descartarse adecuadamente. Generalmente son asintomaticas, pero en situaciones favorables se pueden reactivar y producir manifestaciones clinicas y/o complicaciones. Aunque no muy frecuentemente, existe tambien la posibilidad de transmision en el pais de acogida. El diagnostico precoz, mediante protocolos de cribado adecuados, permitira un tratamiento especifico que beneficie tanto al individuo como a la comunidad. Estas tecnicas seran seleccionadas segun criterios geoepidemiologicos como el origen del paciente, la ruta migratoria o el tiempo transcurrido fuera del area endemica; pero tambien deben considerarse otros factores como su sensibilidad y especificidad, la experiencia en su implementacion y su disponibilidad. Dada su alta prevalencia y considerando estos criterios, deben descartarse las parasitosis intestinales mediante estudio coproparasitologico. Por su potencial gravedad, es aconsejable el cribado de la malaria utilizando tecnicas muy sensibles como la PCR (reaccion en cadena de la polimerasa). El cribado serologico de la enfermedad de Chagas esta indicado en todos los inmigrantes de origen latinoamericano, excepto en aquellos procedentes de las islas del Caribe. Otras parasitosis importantes, como la filariasis y la esquistosomiasis urinaria, seran descartadas mediante examen microscopico. El objetivo de este trabajo es la revision de las distintas tecnicas de cribado de enfermedades parasitarias y su indicacion dentro de los protocolos de atencion a la poblacion inmigrante asintomatica.

Field and laboratory comparative evaluation of a LAMP assay for the diagnosis of urogenital schistosomiasis in Cubal, Central Angola

To evaluate the performance of Rapid‐Heat LAMPellet assay in field conditions for diagnosis of urogenital schistosomiasis in an endemic area in Cubal, Angola, and to assess the reproducibility in a reference laboratory.