Trypanosoma cruzi infection in a non-endemic country: epidemiological and clinical profile.

Chagas disease has been increasingly diagnosed in non-endemic countries. This is a prospective observational study performed at the Tropical Medicine Units of the International Health Program of the Catalan Health Institute, Barcelona (PROgrama de Salud Internacional del Instituto Catalán de la Salud, PROSICS Barcelona, Spain), that includes all patients with Chagas disease who attended from June 2007 to May 2012. Clinical and epidemiological data were collected. Overall, 1274 patients were included, the mean age of the patients was 37.7 years, 67.5% were women and 97% came from Bolivia. Thirteen patients had immunosuppressive conditions. The prevalence of cardiac involvement was 16.9%, lower than in previous studies performed in endemic areas (20-60%). Cardiac alterations were found in 33.8% of symptomatic and 14.1% of asymptomatic patients. The prevalence of digestive involvement was 14.8%. The rate of digestive involvement is very different among previous studies because of different diagnostic tools and strategies used. Barium enema alterations were found in 21.4% of symptomatic and 10.3% of asymptomatic patients, and oesophageal alterations were found in 3.7% of symptomatic and in 2.3% of asymptomatic patients. As shown in previous studies, Chagas disease in non-endemic countries affects younger patients and has lower morbidity.

[Tuberculosis in recent immigrants in Barcelona]. / Tuberculosis en inmigrantes recién llegados a Barcelona.

BACKGROUND: The aim of the present was to study the prevalence of infection and tuberculous disease as well as the fulfillment of secondary antituberculin chemoprophylaxis in immigrants according to their geographic origin. PATIENTS AND METHODS: A descriptive study was carried out of 1,489 immigrants under the age of 35 years attended in the Tropical and Imported Disease Unit Drassanes in Barcelona, Spain from 1989 to 1994. RESULTS: The patients were from 79 countries, with 81.7% being males and 18.3% females (p < 0.001) of a mean age 26.1 +/- 5.7 and 23.4 +/- 7.5 years, respectively. Forty-three percent of the cases presented Mantoux test response > or = 10 mm of induration. The highest percent of positivity was observed in patients from Subsaharian Africa (52%) followed by Eastern Europeans and Asians (44%), South and Central Americans (38%) and Middle East and Northern Africa (34%) (p < 0.001). Thirty-nine percent of the 359 patients who initiated secondary antituberculin chemoprophylaxis completed the 6 months of treatment with the highest fulfillment being found in Africans (49%) followed by Americans (42%) and Asians (39%). The lowest rate was observed in the Eastern Europeans (20%) (p < 0.001). Fifty-six percent of the patients abandoned secondary antituberculin prophylaxis within the first three months. Eighteen cases of active tuberculosis were diagnosed. CONCLUSIONS: The prevalence of tuberculous infection and disease is high immigrants in Barcelona, Spain. The fulfillment of chemoprophylaxis is low and abandoned early. These facts should be evaluated when designing prevention and control programs.

[Malaria imported by immigrants in Catalonia]. / Paludismo importado por inmigrantes en Cataluña.

BACKGROUND: The aim of the present study was to analyze the epidemiologic aspects and particular features of malaria in immigrants in Catalonia, Spain. METHODS: All the immigrants who visited the Unit of Tropical and Imported Diseases "Drassanes" in Barcelona from endemic zones of malaria from 1990 to 1993 were studied. The diagnosis of malaria was based on the thick blood film, peripheral blood smear exam and, since 1991, the QBC (Quantitative Buffy Coat). RESULTS: One hundred three cases of malaria were diagnosed in 100 individuals from a total of 2,453 visited immigrants. Forty-four percent of the patients presented febrile syndrome, 11% cutaneous syndrome accompanied by other manifestations justifying the same, 9% presented other clinical manifestations and 36% were asymptomatic. Ninety-six percent of the subjects with parasites by Plasmodium were from sub-Saharan Africa and in 2 cases, both were produced by Plasmodium falciparum, with the length of time having been in Spain at the time of diagnosis being more than one year. P. falciparum represented 70% of the total cases, followed by P. malariae (15%), P. vivax (8%), Plasmodium spp. (6%) and P. ovale (1%). CONCLUSIONS: Malaria by P. falciparum in semi-immune immigrants is not usually severe and follows an asymptomatic course in more than one third of the cases. The usual analysis for Plasmodium is recommended in immigrants from sub-Saharan Africa due to the high frequency of presentation and the absence of symptoms. Such analysis is not advised in groups from other areas except when suggestive symptoms are present.

[The diagnosis of malaria by the thick film and the QBC: a comparative study of both technics]. / Diagnóstico de paludismo por gota gruesa y QBC: estudio comparativo de ambas técnicas.

BACKGROUND: The diagnosis of paludism is important because of the severity of the clinical picture caused by Plasmodium falciparum, the increasing number of travellers to endemic zones and the emigration from these zones. A comparative study of the QBC techniques (staining with acridin orange and observation with ultraviolet light) and the thick film with Giemsa staining was carried out. METHODS: The QBC and thick film were performed parallelly for 17 months in a total of 623 samples pertaining to subjects from endemic zones of paludism (emigrants, immigrants and travellers). RESULTS: Of the 623 samples studied 49 were positive for paludism by both techniques. Ten were positive with only the thick film and six were positive only with QBC. The sensitivity of QBC versus thick film was 83% and specificity 98.9%. The time used to determine diagnosis with the QBC technique ranged from 6 to 12 minutes from withdrawal of the sample, while with the thick film the time spent was more than 2 hours. The cases positive by thick film and negative with QBC corresponded to patients with very low parasitation. The intensity of parasitation was difficult to determine quantitatively by QBC. CONCLUSIONS: Although the QBC technique has the advantage of speed it is inexact with respect to the quantification of parasitemia. Moreover, it is less sensitive than the thick film in patient with very low parasitations and cannot thus substitute the thick film.