Elena Pisos-Álamo

Helicobacter pylori and cagA seroprevalence in sub-Saharan inmigrants recently arrived to Gran Canaria (Spain)

Non-ulcerous dyspepsia is common among sub-Saharan people migrating into Spain. Given the high prevalence of H. pylori (HP) infection in their countries of origin, we studied the prevalence of infection in this population, and specifically the prevalence of infection by the more virulent, cagA-positive strains (CAP). 140 sub-Saharan immigrants recently arrived to Gran Canaria (Canary Islands, Spain) were studied. 80.7% were male, with a mean age of 24.2 y. 90.7% tested seropositive for HP and 72.2% of them carried antibodies against the ‘pathogenicity island’ cagA. We did not find any relationship between the presence of these antibodies and the clinical variables studied. We can conclude that HP infection is virtually universal in this population, with a high percentage of infection by CAP strains.

Skin and soft tissue infections (patera foot) in immigrants, Spain.

An unusual skin and soft tissue infection of the lower limbs has been observed in immigrants from sub-Saharan Africa who cross the Atlantic Ocean crowded on small fishing boats (pateras). Response to conventional treatment is usually poor. Extreme extrinsic factors (including new pathogens) may contribute to the etiology of the infection and its pathogenesis.

Eritrocitaféresis automatizada en el tratamiento de la malaria grave: estudio de 6 pacientes

Fundamento y objetivo: La elevada mortalidad de la malaria grave por Plasmodium falciparum se relaciona con el grado de parasitemia. La eritrocitaferesis automatizada (EA) es una alternativa segura a la exanguinotransfusion, con los mismos beneficios potenciales pero menores efectos secundarios. Sin embargo, son escasas las referencias sobre la eficacia e indicaciones de esta tecnica. El objetivo de este trabajo ha sido describir las caracteristicas clinicas y evolucion de 6 pacientes con malaria grave en los que se empleo esta tecnica terapeutica complementaria. Pacientes y metodo: Se ha realizado un estudio observacional, descriptivo y retrospectivo de todos los pacientes con malaria ingresados en un unico hospital entre 1996 y 2006. En cada caso se recogieron los datos clinicos, epidemiologicos y parasitologicos basicos. Resultados: La serie se compone de 2 mujeres y 4 varones, con una media de edad de 43 anos. En todos los casos la infeccion fue adquirida en Africa subsahariana. Ningun paciente habia efectuado quimioprofilaxis antipaludica y la especie causal fue Plasmodium falciparum. El grado de parasitemia oscilo entre el 10 y el 35%. De los criterios de gravedad, cuyo numero oscilo entre 1 y 4, el mas frecuente fue la hiperbilirrubinemia. Todos los pacientes recibieron tratamiento convencional. La duracion total del ingreso oscilo entre 5 y 37 dias, y la estancia en la unidad de vigilancia intensiva, entre 1 y 17 dias. Todos los pacientes sobrevivieron. Conclusiones: En resumen, la EA es una tecnica segura, con las mismas ventajas que la exanguinotransfusion, pero sin muchos de sus efectos adversos. De acuerdo con los datos de la bibliografia y estas observaciones, podemos senalar que una parasitemia aislada mayor del 10% o una parasitemia superior al 5% asociada a algun criterio de gravedad son indicacion para la realizacion de EA.

Lesiones periungueales en un viajero procedente de Sudamérica

mas frecuente de enfermedades importadas, cuyo diagnostico y tratamiento es poco conocido. Dentro de los problemas frecuentes en viajeros destacan tres formas de presentacion, con incidencia variable segun las series: la fiebre, la diarrea y las lesiones cutaneas1. Dentro de las lesiones cutaneas, la tunguiasis supone hasta el 6% en algunas series2. La tunguiasis es una ectoparasitosis causada habitualmente por la penetracion de la hembra Tunga penetrans Caso clinico

Immune Reconstitution Inflammatory Syndrome in HIV-Infected Immigrants.

Immune reconstitution inflammatory syndrome (IRIS) includes a group of potentially serious inflammatory processes that may be present in HIV-infected patients after initiating highly active antiretroviral therapy (HAART). Paradoxical IRIS is a worsening of symptoms, after an overwhelming response to a previously diagnosed opportunistic infection (OI); unmasking IRIS reveals a previously occult OI. The main objective of the study was to describe the epidemiological, clinical, and outcome data of HIV-infected immigrants, stratified according to high- or low-income countries of origin, who developed IRIS and to compare them with native-born Spanish patients. This retrospective study reviewed all patients with HIV infection admitted to the Unit of Infectious Diseases and Tropical Medicine between 1998 and 2014. IRIS was identified in 25/138 (18%) immigrant patients and 24/473 (5%) native-born Spanish patients infected with HIV. Most cases, 19/25 (76%), were of unmasking IRIS. The time elapsed between initiation of HAART and development of IRIS was significantly longer in patients with unmasking versus paradoxical IRIS. OIs, in particular due to mycobacteria, were the most frequently involved processes. Twenty percent of patients died. The comparison of immigrant and native-born patients found significant differences for both IRIS type (higher incidence of paradoxical forms among immigrants) and for the absence of malignancies in native-born patients. No significant differences were found when the data of immigrants from low- and high-income countries were compared.

Endomyocardial involvement in asymptomatic sub-Saharan immigrants with helminth-related eosinophilia

Background Among immigrants of sub-Saharan origin, parasitic infection is the leading cause of eosinophilia, which is generally interpreted as a defense mechanism. A side effect of the inflammatory mediators released by eosinophils is damage to host organs, especially the heart. The main objectives of this study were to i) assess cardiac involvement in asymptomatic sub-Saharan immigrants with eosinophilia, ii) relate the presence of lesions with the degree of eosinophilia, and iii) study the relationship between cardiac involvement and the type of causative parasite. Methodology/Principle findings In total, the study included 50 black immigrants (37 patients and 13 controls) from sub-Saharan Africa. In all subjects, heart structure and function were evaluated in a blinded manner using Sonos 5500 echocardiographic equipment. The findings were classified and described according to established criteria. The diagnostic criteria for helminthosis were those reported in the literature. Serum eosinophil-derived neurotoxin levels were measured using enzyme-linked immunosorbent assay. A significant association was found between the presence of eosinophilia and structural alterations (mitral valve thickening). However, the lack of an association between the degree of eosinophilia and heart valve disease and the absence of valve involvement in some patients with eosinophilia suggest the role of other factors in the appearance of endocardial lesions. There was also no association between the type of helminth and valve involvement. Conclusions We, therefore, suggest that transthoracic echocardiography be performed in every sub-Saharan individual with eosinophilia in order to rule out early heart valve lesions.

Utilidad del diagnóstico molecular precoz de fiebre Q y rickettsiosis en pacientes con fiebre de duración intermedia

espanolLa mayor parte de los casos de fiebre de duracion intermedia (FDI) en Espana corresponden a enfermedades infecciosas (principalmente fiebre Q y rickettsiosis). En la practica clinica el diagnostico causal de estas entidades se basa en el inmunodiagnostico, con una escasa utilidad en fases precoces. Por ello, el objetivo de este trabajo fue la evaluacion de la utilidad de tecnicas moleculares en el diagnostico precoz de fiebre Q y rickettsiosis en pacientes con FDI. Se estudio mediante PCR la presencia de material genetico de Coxiella burnetii y Rickettsia spp. en muestras sanguineas de 271 pacientes con FDI. La especificidad de ambas tecnicas es elevada, permitiendo el diagnostico en casos no diagnosticados mediante deteccion de anticuerpos especificos. Estos datos sugieren que el empleo de tecnicas moleculares, con una adecuada seleccion de la muestra de estudio y el empleo de cebadores adecuados, es un elemento util en el diagnostico precoz de las principales causas de FDI, principalmente si la serologia es negativa o no es concluyente. EnglishMost cases of fever of intermediate duration (FDI) in Spain are associated with infectious diseases (mainly Q fever and rickettsia infections). In clinical practice, the causal diagnosis of these entities is based on immunodiagnostic techniques, which are of little help in the early stages. Therefore, the aim of this study was to evaluate the usefulness of molecular techniques for the early diagnosis of Q fever and rickettsia diseases in patients with FDI. A PCR method was used to detect the presence of genetic material of Coxiella burnetii and Rickettsia spp. in blood specimens from 271 patients with FDI. The specificity of both techniques is high, allowing diagnosis in cases undiagnosed by specific antibodies detection. These data suggest that the use of molecular techniques, with proper selection of the study specimen, and using appropriate primers is a useful tool in the early diagnosis of the main causes of FDI, especially if serology is negative or inconclusive.Most cases of fever of intermediate duration (FDI) in Spain are associated with infectious diseases (mainly Q fever and rickettsia infections). In clinical practice, the causal diagnosis of these entities is based on immunodiagnostic techniques, which are of little help in the early stages. Therefore, the aim of this study was to evaluate the usefulness of molecular techniques for the early diagnosis of Q fever and rickettsia diseases in patients with FDI. A PCR method was used to detect the presence of genetic material of Coxiella burnetii and Rickettsia spp. in blood specimens from 271 patients with FDI. The specificity of both techniques is high, allowing diagnosis in cases undiagnosed by specific antibodies detection. These data suggest that the use of molecular techniques, with proper selection of the study specimen, and using appropriate primers is a useful tool in the early diagnosis of the main causes of FDI, especially if serology is negative or inconclusive.

Compartmental syndrome of the upper limb due to Moraxella lacunata infection: a link to patera foot syndrome?

We report a case of compartmental syndrome of the left upper limb secondary to a severe Moraxella lacunata infection, an unusual pathogen, occurring in a young black male immigrant to the island of Gran Canaria, Spain. We propose a pathophysiological relationship with patera foot syndrome.