Joaquín Salas-Coronas

Intravenous Artesunate Reduces Parasite Clearance Time, Duration of Intensive Care, and Hospital Treatment in Patients With Severe Malaria in Europe: The TropNet Severe Malaria Study

Intravenous artesunate improves survival in severe malaria, but clinical trial data from nonendemic countries are scarce. The TropNet severe malaria database was analyzed to compare outcomes of artesunate vs quinine treatment. Artesunate reduced parasite clearance time and duration of intensive care unit and hospital treatment in European patients with imported severe malaria.

Evaluation of eosinophilia in immigrants in Southern Spain using tailored screening and treatment protocols: A prospective study

OBJECTIVE To determine the etiology of eosinophilia in immigrant patients in Southern Spain. METHODS Prospective study of immigrant patients with eosinophilia (> 500 Eo/μL) attended in a reference Tropical Medicine Unit and evaluated through the implementation of a specific protocol structured in different levels meant to be accomplished depending on the findings of each previous level. RESULTS Out of the 549 patients included in the study (89.6% from sub-Saharan countries), a diagnosis of helminthiasis was reached in 417 (75.9%), mainly by Strongyloides stercoralis (n = 190), Schistosoma (n = 33) and Hookworms (n = 126). 30 patients (5.5%) had a non-parasitic disorder (asthma, allergic rhinoconjunctivitis, skin conditions and drug-related eosinophilia). Multiple helminthic infections were very common: in 107 patients (19.5%) 2 helminth species were identified, three in 21 patients (3.8%), and four or more in 6 patients (1.1%). Eosinophilia was resolved in 31 of the 33 patients (93.9%) who received empirical treatment with ivermectin, albendazole and praziquantel as an etiological diagnosis was not reached after applying the whole protocol. CONCLUSIONS Diagnosis of helminthic infections in immigrant patients with eosinophilia can be improved by using tailored protocols based on geographical exposure. The implementation of these protocols may also save costs by systematizing diagnostic explorations. Empirical treatment with ivermectin, albendazol and praziquantel in sub-Saharan population when an etiologic diagnosis of eosinophilia has not been attained is an effective measure.

Hepatitis virales e inmigración: un reto para el sistema sanitario

BACKGROUND Viral hepatitis is a significant health problem in African countries. The increase in the immigrant population from this continent represents a challenge for the Spanish healthcare system. MATERIAL AND METHODS A descriptive study was conducted on the prevalence of the serological markers of hepatitis B (HBV), C (HCV) and D (HDV) in African immigrants treated in a specialised doctors office. RESULTS The study included 2518 patients (87.7% Sub-Saharan natives), with a mean age of 31.3 years. Some 78.8% of the patients had a positive infection marker for HBV, and 638 patients (25.3%) were diagnosed with active hepatitis B (HBsAg +). In 19 cases, antibodies against HDV were detected (4 cases with detection of the viral genome). Sixty-eight patients had antibodies against HCV, 26 of whom had a positive viral load. CONCLUSIONS The high prevalence of viral hepatitis in immigrants, especially HBV infection, represents a significant change in the profile of patients treated in Spain and requires measures aimed at early diagnosis and transmission prevention.

Tuberculosis e inmigración

The incidence of tuberculosis worldwide is declining. However, in Western countries this decline is slower due to the impact of immigration. Tuberculosis in the immigrant population is related to health status in the country of origin and with overcrowding and poverty conditions in the host country. Immigrants with tuberculosis are younger, have a higher prevalence of extrapulmonary forms, greater proportion of drug resistance and higher treatment default rates than those of natives. New molecular techniques not only reduce diagnostic delay time but also allow the rapid identification of resistances and improve knowledge of transmission patterns. It is necessary to implement measures to improve treatment compliance in this population group like facilitating access to health card, the use of fixed-dose combination drugs, the participation of cultural mediators and community health workers and gratuity of drugs.

Newly Arrived African Migrants to Spain: Epidemiology and Burden of Disease

The aim of this study is to describe the epidemiological profile, clinical characteristics, and microbiological findings in African immigrants newly arrived to Spain attended at a specialized reference unit from October 2004 to February 2017. A common protocol for the screening of imported and cosmopolitan diseases was designed to evaluate patients with ≤ 12 months of stay in Spain. A total of 523 patients were included in the study, 488 (93.3%) of sub-Saharan origin. A high number of helminthic infections were diagnosed in sub-Saharan patients, including geohelminthiasis (hookworms 14.3%; Trichuris trichiura 4.1%; Ascaris lumbricoides 3.1%), schistosomiasis (12.3%), strongyloidiasis (17.2%), and filariasis (8.4%). Thirty-five patients (7.2%) had malaria, most by Plasmodium falciparum. Among communicable diseases, 33.6% of sub-Saharans presented HBsAg positivity compared with 5.7% of North African patients (P = 0.001). Thirteen patients were diagnosed with active tuberculosis. Seventy percent of the sub-Saharans and 40% of the North Africans who were tested had a latent tuberculosis infection (LTI). Treatment of LTI was administered in selected cases (14%), achieving end of treatment in 80% of them. In light of these results, effective screening strategies, particularly within the sub-Saharan immigrant population, including potentially communicable diseases and certain potentially serious parasitic diseases (Strongyloides, Schistosoma), should be implemented. It is necessary to facilitate fully and free of charge access to the public health system to newly arrived immigrants, as well as to implement programs and actions aimed at favoring care and follow-up, especially for communicable diseases. Empirical treatment of some parasitic diseases could be a cost-effective action.

Zika Virus Screening among Spanish Team Members After 2016 Rio de Janeiro, Brazil, Olympic Games

We evaluated the risk for the Spanish Olympic Team acquiring Zika virus in Rio de Janeiro, Brazil, during 2016. We recruited 117 team members, and all tested negative for Zika virus. Lack of cases in this cohort supports the minimum risk estimates made before the Games.

Symptomatic Falciparum Malaria After Living in a Nonendemic Area for 10 Years: Recrudescence or Indigenous Transmission?

AbstractWe report the case of a patient from Mali who, after 10 years of living in Spain, presented with symptomatic Plasmodium falciparum malaria without having visited an endemic area during that time. We cannot completely rule out the possibility of indigenous transmission, but this case most likely represents recrudescence of an infection acquired over 10 years earlier.

Hidatidosis muscular primaria

Joaquin Pousibet-Puerto *, Joaquin Salas-Coronas , M. Jose Viciana-Martinez-Lage b y Antonio Villarejo-Ordonez c Unidad de Medicina Tropical, Agencia Sanitaria Poniente, Hospital de Poniente, El Ejido, Almeria, Espana Unidad de Anatomia Patologica, Area de Biotecnologia, Agencia Sanitaria Poniente, Hospital de Poniente, El Ejido, Almeria, Espana c Area de Radiodiagnostico, Agencia Sanitaria Poniente, Hospital de Poniente, El Ejido, Almeria, Espana

Mesenteric venous thrombosis after prolonged air travel-a case report

We present a case of acute mesenteric venous thrombosis after a long distance flight in a traveller presenting with abdominal pain, diarrhoea and vomiting within 48 h of prolonged immobility situation. Venous thrombosis in the lower limbs and venous thromboembolism has been clearly associated with prolonged air travel (economy class syndrome). Thrombosis was diagnosed by computed tomography of the abdomen, and after starting anticoagulant therapy with acenocumarol, symptoms yielded completely in a few weeks. The study of thrombophilia was negative, although the existence of two first-degree relatives (mother and grandmother) with a history of venous thrombosis with a history of venous thrombosis makes it likely a situation of inherited thrombophilia. Although exceptional, mesenteric venous thrombosis should be considered in travellers with acute abdominal pain after prolonged air travel when there are thrombophilic conditions.