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Etiology of traveller's diarrhea in spanish travellers to developing countries

AbstractA cohort of 337 Spanish travellers to developing countries is presented. They all consulted us for travellers diarrhea (TD). Bacteriological, parasitological and virological examinations were performed. A bacterial cause was found in 61.65% of travellers. Toxigenic and classical pathogenic Escherichia coli strains were the main bacterial agents. In comparison with other studies, Spanish travellers harboured Y. enterocolitica and EPEC organisms as a cause of TD. G. lamblia and E. histolytica were the most frequently isolated protozoa. Helminths were found in only 9 patients. No rotavirus infections were diagnosed.Previous antibiotic treatment had been taken by 161 patients. The percentage of isolated enteropathogens was similar in travellers who had previously taken antibiotic treatment and those who had not.

Comparative, clinico-epidemiologic study of Schistosoma mansoni infections in travellers and immigrants in Spain.

The study presented here aimed to contrast the marked clinical differences in the presentation of Schistosoma mansoni-induced infection between immigrants and travellers entering Spain from endemic regions, and to elucidate the therapeutic implications of these infections. A total of 200 African immigrants and 80 travellers with schistosomiasis were included in the study. Among the immigrants, 25 patients were diagnosed with Schistosoma mansoni infection; 15 presented with nonspecific symptoms, and 10 were asymptomatic. Hepatosplenomegaly was observed in nine. Among the travellers, 14 were diagnosed with Schistosoma mansoni infection; four were asymptomatic, four had Katayama syndrome, four had diarrhoea, and two had prostatitis. All of the patients were treated with praziquantel. Patients diagnosed with Katayama syndrome received praziquantel and dexamethasone for 3 days, with the praziquantel treatment being repeated at 3–4 weeks. The significant differences observed in the clinical presentation of Schistosoma mansoni-induced infection, indicate that a well-differentiated therapeutic strategy is required when this infection is diagnosed in a non-immune (traveller) or a semi-immune (immigrant) patient.

Aetiology of traveller’s diarrhoea: evaluation of a multiplex PCR tool to detect different enteropathogens

Travellers diarrhoea (TD) is the most common illness reported in international travellers. TD is caused by a wide range of pathogens, including bacteria, viruses and parasites. Multiplex PCR assays can be especially useful for studying the aetiology of TD. The first objective of this study was to evaluate the utility of the commercially available multiplex PCR (xTAG(®) Gastrointestinal Pathogen Panel (GPP)) for the diagnosis of TD. A total of 185 stool specimens obtained from 174 patients were processed using the GPP assay. This test detected 86 pathogens in 67 stool samples (67/185, 36.2%). Sixteen pathogens out of 86 were also detected by routine testing. The remaining pathogens (n = 70) required further confirmation by alternative techniques. Finally, 60 out of 70 pathogens were confirmed. The second objective of this study was to analyse the aetiology of TD based on the results obtained by the GPP test and routine methods. The primary pathogens causing TD were Shigella (24.2%) followed by enterotoxigenic Escherichia coli (ETEC) (23.2%), enteroaggregative E. coli (14.7%) and Giardia (13.7%). Significant regional differences were observed for ETEC with 19.4% of TD cases acquired in Africa, 11.3% in Asia and none in South Central (SC) America (p 0.01), Giardia was found in 1.5% of cases among those who had travelled to Africa, 14.1% of those who had travelled to Asia and 3% of those who had travelled to SC America (p 0.01). In conclusion, the GPP test improved the detection of enteropathogens and allowed better assessment of the aetiology of TD.

Neurocysticercosis and Population Movements: Analysis of 23 Imported Cases in Spain

Although neurocysticercosis (NCC) is considered to be potentially eradicable, it continues to be present worldwide, principally in the low-income countries of Latin America, Africa and Asia, where it poses a serious health problem. Social, economic and cultural conditions are intrinsically associated with this disease, which is caused by the zoonosis Taenia solium. In many European countries, the improvements made to the public health systems during the last century provided the key to considerably reducing the prevalence of NCC. Owing to changes in the social and public health conditions in Spain, the incidence of NCC in the native population has also decreased considerably. Nevertheless, cases are still being diagnosed, particularly in the rural areas of some autonomous communities, such as Extremadura and Galicia. The increase in intercontinental tourism and the arrival of immigrants from countries in which Taenia solium is endemic have led to a rise in the detection rates of this organism in Spain. This study was conducted to analyse the imported cases of NCC in Spain and to investigate the possible relationship between the increase in the number of NCC cases and population movements—particularly the contacts maintained by Spain with Latin American countries in terms of both north-to-south (tourism and trade) and south-to-north (immigration) traffic. The study covered the 10-year period from 1992 to 2002. During this time, 20 imported cases of NCC were diagnosed at the Tropical Medicine Unit of the University Hospital Clinic in Barcelona and three cases at the Hospital Parc Taul in Sabadell, Spain. These two centres have units for the treatment of diseases imported by both travellers and immigrants. In the same decade, two native non-travellers were also diagnosed with NCC, but these cases were not included in the analysis. The 23 patients with imported NCC included 13 men and 10 women, aged between 5 and 65 years, with a median age of 33 years. The geographic origin of the patients is detailed in Fig. 1. Among the 23 patients, 17 were immigrants and 6 were European travellers, including 3 tourists and 3 expatriates. Two of the expatriates had resided in Latin America, and the third had made several intercontinental trips. In the latter case, it was difficult to establish the country of NCC acquisition. For the three tourists, the length of stay in an NCC-endemic country ranged between 1 and 3 months. Clinical symptoms prompting hospital attendance were generalized tonic/clonic seizures in 16 patients, partial epilepsy in 3, paraesthesias in 3, and headache as a single symptom in 1. Eight patients reported headache as an associated symptom. Subcutaneous nodules were palpable C. Roca ()) International Health Commission, Societat Catalana de Medicina Familiar i Comunit ria, rea b sica de Salut el Clot, Institut Catal de la Salut, Passatge Valeri Serra 10, 7a, 08011 Barcelona, Spain e-mail: 27543lvs@comb.es Tel.: +34-93-3232954 Fax: +34-93-3520156

Severe Imported Malaria in Adults: Retrospective Study of 20 Cases

Severe imported malaria is an important problem in many countries in which this disease is not endemic. This retrospective study describes the characteristics of 20 adults with severe imported malaria admitted to our intensive care unit from 1991 through 2007. All episodes were caused by Plasmodium falciparum and all patients had returned from sub-Saharan Africa, except for one transfusion recipient. All persons were considered non-immune, and none had taken appropriate chemoprophylaxis. The median time between the initiation of symptoms and the diagnosis was seven days. Five patients died (mortality rate = 25%). A higher frequency of unrousable coma and acidosis and a higher median Apache II score at admission was noted in the persons who died. Mortality by severe malaria remains high despite high quality management, which highlights the importance of chemoprophylaxis and early diagnosis and treatment.

A case of urogenital human schistosomiasis from a non-endemic area

Schistosomiasis is a parasitic disease reported in 78 countries, with an additional recent outbreak in Corsica [1,2]. Generally, Schistosoma haematobium causes urogenital problems, whereas S. mansoni, S. japonicum, S. mekongi, S. guineensis, and S. intercalatum generate intestinal symptoms. Occasionally, ectopic tissue tropisms [3] and infections by parasites resulting from hybridization occur [4,5]. Geographical distribution and transmission of Schistosoma species depend on the presence of suitable intermediate snail hosts to complete the life cycle. Here we report on an unusual case of urogenital schistosomiasis in a Dominican adult male, living in Spain, with no history of visiting a known endemic area.