Multibacillary leprosy mimicking systemic lupus erythematosus: case report and literature review.

Leprosy is an infectious chronic disease with a wide range of clinical and serological manifestations. We report a case of a woman presenting with a malar rash, painless oral ulcers, photosensitivity, arthritis, positive antinuclear antibodies test and leuko-lymphopenia. Our case illustrates an unusual presentation of leprosy initially diagnosed as systemic lupus erythematosus (SLE). After the confirmation of multibacillary leprosy and multidrug therapy recommended by the World Health Organization, a good clinical response was observed. Recognition of rheumatic manifestations in leprosy is important as they may be confused with SLE. A literature review is presented to encourage clinicians to consider leprosy as a differential diagnosis. Specifically in patients with unusual rheumatic manifestations and persistent skin lesions, and when neurological symptoms are present. Leprosy has not been eradicated, so misdiagnosis can be frequent. It is necessary to increase medical practitioner awareness in order start proper treatment.

Vasculitis in systemic lupus erythematosus.

Systemic lupus erythematosus (SLE) is a complex heterogeneous autoimmune disease with a wide variety of clinical and serological manifestations that may affect any organ. Vasculitis prevalence in SLE is reported to be between 11% and 36%. A diverse clinical spectrum, due to inflammatory involvement of vessels of all sizes, is present. Even though cutaneous lesions, representing small vessel involvement, are the most frequent, medium and large vessel vasculitis may present with visceral affection, with life-threatening manifestations such as mesenteric vasculitis, pulmonary hemorrhage, or mononeuritis multiplex, with detrimental consequences. Early recognition and an appropriate treatment are crucial. Recent studies have shown that vasculitis in patients with SLE may present different clinical forms based on the organ involved and the size of the affected vessel. It is noteworthy that the episodes of vasculitis are not always accompanied by high disease activity. Recent articles on this topic have focused on new treatments for the control of vascular disease, such as biological therapies such as Rituximab and Belimumab, among others.

Paucisymptomatic infectious prostatitis as a cause of fever without an apparent origin. A series of 19 patients.

According to the literature, prostatitis is a rare cause of prolonged fever without an apparent origin. However, this syndrome can be easily diagnosed using specific tests, either two-glass pre- and post-prostatic massage or the Meares-Stamey four-glass test. A retrospective study over a 5-year period (between August 1st 2006 and July 31st 2011) was performed. All patients who met the criteria for microbiological prostatitis were included and assigned to one of two groups, either a study group [paucisymptomatic infectious prostatitis (PIP)] or a control group [classic infectious prostatitis (CIP)]. Epidemiological, clinical, microbiological, and treatment-related variables were collected. A comparative study between both groups was performed. Thirty-nine patients were diagnosed with prostatitis. The main risk factors were unprotected anal intercourse, human immunodeficiency virus (HIV) infection, recent travel, and recurrent urinary tract infections. The most significant differences between the PIP (19 patients) and CIP (20 patients) groups were higher frequency of elevated inflammatory markers, higher frequency of monomicrobial etiology, and longer treatment. In monomicrobial prostatitis, the most common causative agents were coagulase-negative Staphylococcus spp., Escherichia coli, and Corynebacterium glucuronolyticum. According to the findings of this study, we believe that prostatitis should be included as a possible diagnosis in a man who complains of prolonged fever without an apparent origin and having at least one of the following risk factors: unprotected anal intercourse, HIV infection, recent travel, and recurrent urinary tract infections.

Fake imported tropical diseases: A retrospective study.

OBJECTIVE: When we evaluate a patient with a suspected imported disease we cannot forget to include any autochthonous causes that may mimic imported pathologies to avoid misdiagnosis and therapeutic delay. METHODS: A descriptive longitudinal retrospective study was designed with patients in whom an imported disease was suspected but who were finally diagnosed with autochthonous processes. The patients were selected from two internal medicine practices specializing in tropical diseases between 2008-2017 in Spain. RESULTS: We report 16 patients, 11 (68.7%) were males, and the mean age was 43.4 ± 13.7 years old. Thirteen patients (81.2%) were travellers. Half of the patients were from Latin America, 7 (43.5%) were from Africa, and 1 (6.2%) was from Asia. The time from trip to evaluation ranged between 1 week and 20 years (median, 4 weeks), and the mean time from evaluation to diagnosis was 58.4 ± 100.9 days. There were 5 (31.2%) cases of autochthonous infection, 5 (31.2%) cases of cancer, 2 (12.5%) cases of inflammatory disease, and 2 (12.5%) cases of vascular disease. CONCLUSIONS: Travel or migration by a patient can sometimes be a confusing factor if an imported disease is suspected and may cause delays in the diagnosis and treatment of an autochthonous disease. We highlight that 1/3 of the patients with autochthonous diseases in this study had cancer. The evaluation of imported diseases requires a comprehensive approach by the internist, especially if he specializes in infectious and/or tropical diseases and is, therefore, the best qualified to make an accurate diagnosis.

[Febrile syndromes in the traveler returning from tropical regions admitted in a monographic unit]. / Síndromes febriles en el viajero que regresa de regiones tropicales atendidos en una unidad monográfica.

OBJECTIVE: The aim was to analyse those syndromes with fever in travellers who return from tropical regions evaluated at our Department of Infectology and Tropical Medicine. Clarifying these conditions intends to reach earlier diagnoses and, perhaps, to avoid the emergence and spread of imported diseases, as well as to establish appropriate preventive measures. METHODS: An observational descriptive transversal study was performed, selecting those patients who returned from tropical regions with fever, amongst all travellers evaluated in our department between 1998 and 2013. We analysed demographic features, information related to the trip, as well as the presenting complaints and the diagnoses. RESULTS: A total of 247 international travellers presenting with fever were analysed. The most common diagnoses were self-limiting fever (29.1%), malaria (25.1%), invasive gastroenteritis (15.4%), other bacterial infections (7.4%) and genitourinary parenchymal infections (4.5%). Of all the cases, only 8.5% required hospitalization, and no case of mortality was recorded. CONCLUSIONS: In the series presented, there are common data with other published data (malaria as a fundamental disease, difficulties in diagnosis) and different ones (less number of pre-trip consultations and admissions, higher incidence of prostatitis and fewer dengue cases).

[Non-febrile syndromes in the traveler returning from tropical regions admitted in a monographic unit]. / Consenso sobre la vacunación anti-neumocócica en el adulto por riesgo de edad y patología de base. Actualización 2017.

OBJECTIVE: The aim was to analyse those syndromes without fever in travellers who return from tropical regions evaluated at our Department of Infectology and Tropical Medicine. Clarifying these conditions intends to reach earlier diagnoses and, perhaps, to avoid the emergence and spread of imported diseases, as well as to establish appropriate preventive measures. METHODS: An observational descriptive transversal study was performed, selecting those patients who returned from tropical regions without fever (n = 281), amongst all travellers evaluated in our department between 1998 and 2013. We analysed demographic features, information related to the trip, as well as the presenting complaints and the diagnoses. RESULTS: A total of 281 international travellers presenting without fever were analysed. Only 39% had received health counsel prior to travelling. The most visited regions were Lat-in America (38.8%), Africa (37.8%) and Asia (13.6%). 15% of patients were asymptomatic or suffered from non-infectious conditions. Among the rest, most had either gastrointestinal (46%) or cutaneous (34%) syndromes. The main gastrointestinal condition was diarrhoea, with a microbiological diagnosis reached in almost 50% of cases. Regarding cutaneous syndromes, arthropods bites (31%) and different bacterial lesions (20%) were most common. CONCLUSIONS: Approximately 10% of patients in Travel Medicine are international travellers returning from tropical regions, half of them with no fever. Most are diagnosed with infectious diseases, mainly gastrointestinal or cutaneous syn-dromes. Eosinophilia is the third problem in frequency among this group of patients, and sexually transmitted infections are rare in our cohort. It is important to emphasize in preventive activities.

[Demographic characteristics, malaria chemoprophylaxis and vaccination in 6,783 international travelers attended in a specialized unit]. / Características demográficas, quimioprofilaxis antimalárica e inmunoprofilaxis en 6.783 viajeros internacionales atendidos en una unidad monográfica.

OBJECTIVE: The objective of this paper was to determine the demographic characteristics and the evolution of international travelers treated at the Unit of Infectious and Tropical Medicine in order to improve precautions prior to travel and, thus reduce the occurrence of these diseases. METHODS: A retrospective study of all international travelers served in UEIMT (Las Palmas de Gran Canaria) during the period 1998-2013 was performed. The following variables were collected using a standardized protocol were analyzed: age, gender, date of consultation, type of traveler, countries of destination and preventive measures undertaken (malaria chemoprophylaxis and vaccines). RESULTS: A total of 6,783 international travelers of which 52% were women were analyzed. The average age was 36 years (SD 13). The most frequent destination continent was Africa (39%) followed by Asia (36%) and Latin America (23%). The most common country of destination was India 13% (882), followed by Senegal 7.5% (509) and Thailand 6.3% (429). The most frequently recommended vaccines were typhoid fever (82.9%) and hepatitis A (66.9%). As for malaria prophylaxis, the indicated drugs were atovaquone-proguanil (56.5%), mefloquine (36.7%), in regard to travelers returning to visit relatives and friends with a 26.81% were children (0-9 years).. CONCLUSIONS: The overall profile of the traveler is a young man who chooses holiday destination Africa followed by Asia and Latin America. Over 50% of travelers received vaccination against typhoid and hepatitis A. The most commonly used malaria chemoprophylaxis was atovaquone / proguanil followed by mefloquine.

[Eoshinophilia: a practical approach]. / Manejo práctico de una eosinofilia.

In this first part of this paper we review the definition of eosinophilia and their classification according to the degree of elevation of eosinophils/microL. Aetiological factors related with eosinophilia were described in three groups of patients: a). autochthonous non-infected by HIV; b). HIV-infected; and c). arrived from tropical countries (imported eosinophilia). We included an algorithmic approach to the diagnosis, including the diagnostic studies that should be performed in patients with or without organ involvement. Pathological consequences of eosinophilia are indicated in the next part of the paper. Finally, therapeutical options used in patients with eosinophilia are reviewed, with an special emphasis on antihelminthic therapies and the management of the hypereosinophilic syndromes.

[Intestinal parasitosis in the asymptomatic Subsaharian immigrant population. Gran Canaria 2000]. / Parasitosis intestinales en población inmigrante subsahariana asintomática. Gran Canaria 2000.

CONTEXT: A prospective study has been conducted in order to known the prevalence and the type of intestinal parasitoses in a cohort of healthy Subsaharian immigrants that reached Gran Canaria along the year 2000. METHODS: 348 fecal samples of 121 immigrants have been studied. In each patient a minimum of two samples and a maximum of three samples was studied. Each sample was evaluated through two techniques: visualization of a direct preparation dyed with Lugol and through the technique of concentration of Kato. RESULTS: 23.1% of the patients presented pathogenic parasites in feces, being observed 2 parasites in 5 of the patients (17.8%). The geohelminths (Ancylostoma duodenale/Necator americanus, Ascaris lumbricoides, Trichuris trichiura and Strongyloides stercolaris) were the parasites more frequently found (87.9%). Specifically, the parasitosis found in the greatest number of participants was hookworm disease (44.8%). In this study the effectiveness of the evaluation of three feces samples is demonstrated in order to increase the percentage of diagnosed intestinal parasitoses. The visualization of a direct preparation dyed with Lugol permitted the diagnosis of 63.6% of the parasitoses, while the technique of Kato detected 56.6% of the helminth infections. CONCLUSIONS: The prevalence of geohelminths in the asymptomatic Subsaharian immigrant population is elevated. The complementary use of the microscopic study of a direct preparation dyed with Lugol and the technique of Kato increase the diagnostic performance.