Spectrum and burden of neglected tropical diseases observed in an infectious and tropical diseases unit in Florence, Italy (2000-2015).

Neglected tropical diseases (NTDs) are a diverse group of acute and chronic conditions with distinct characteristics that thrive mainly among the poorest populations, almost exclusively in tropical countries. To evaluate the relevance and impact of NTDs in a temperate area, the number and features of patients diagnosed with NTDs at the Infectious and Tropical Diseases Unit (ITDU), Azienda Ospedaliero-Universitaria Careggi, Florence, Italy between 2000 and 2015 were retrospectively reviewed. Overall 289 NTD cases were diagnosed in 283 subjects accounting for 2.4% of all patients accessing the center: 96 dengue, 62 schistosomiasis, 36 strongyloidiasis, 22 cystic echinococcosis, 19 Chagas disease, 14 leishmaniasis, 11 chikungunya, 10 cysticercosis, 6 soil-transmitted helminthiasis, 6 lymphatic filariasis, 3 trachoma, 2 onchocerciasis, and 2 leprosy. There was one fatal case of disseminated strongyloidiasis. According to the type of exposure, 145 (50.2%) NTDs were diagnosed in immigrants, 121 (41.9%) in travelers, 18 (6.3%) were autochthonous infections, while in 5 cases (1.7%), the type of exposure was unknown. The number of patients seen at the ITDU with a diagnosis of NTD increased over time (from 29 in 2000-2005 to 81 in 2006-2010, to 173 in 2011-2015). Late diagnosis and mismanagement before coming to the center were common features in several cases. Considering the increasing incidence and possible misdiagnosis of NTDs in non-endemic countries, to raise awareness about NTDs among health care providers seems to be of primary concern.

Encuesta Conocimientos, actitudes y prácticas de los pobladores del Chaco paraguayo sobre las enfermedades infecciosas desatendidas y el dengue / Knowledge, attitudes and practices of the residents of the Paraguayan Chaco about infectious diseases unattended and dengue

A continuación, se expone un avance del proyecto "Abordar las Enfermedades Infecciosas Desatendidas (EID) y las arbovirosis en el Chaco Paraguayo" ejecutado en el periodo 2017-2018 en el Chaco paraguayo por el Ministerio de Salud Pública y Bienestar Social de Paraguay (MSPyBS) con la cooperación técnica de la Representación en el Paraguay de la Organización Panamericana de la Salud/ Organización Mundial de la Salud (OPS/OMS). El proyecto pretende lograr la implementación de un ambicioso sistema de vigilancia integrada (vigilancia epidemiológica, vigilancia de laboratorio y vigilancia entomológica) que proporcione datos de manera oportuna y eficaz para hacer frente a las arbovirosis y a las EID endémicas (enfermedad de Chagas, leishmaniosis, helmintiasis transmitidas por el suelo, teniasis/cisticercosis, además de la lepra y el dengue). Por otra parte, el proyecto busca el involucramiento y la participación de la comunidad en las acciones de prevención, vigilancia y control de estas enfermedades. Uno de los resultados de este proyecto es la generación de evidencias sobre la capacidad de respuesta del país -con énfasis en el Chaco-para ello se ha realizado una "Encuesta de conocimientos, actitudes y prácticas comunitarias en el Chaco Paraguayo" sobre las EID y las arbovirosis. A ese efecto, se realizaron 400 encuestas (110 a personas de población indígena, 160 a personas del área rural y 130 la personas del área urbana) correspondientes a 40 comunidades de 13 distritos de un total de 14, distribuidas en tres regiones sanitarias: Presidente Hayes 60% (240/400), Boquerón 33% (130/400) y Alto Paraguay 8% (30/400). Entre los resultados, se destaca que -de forma global- el conocimiento de las EID es inadecuado y que existen diferencias en los niveles de conocimiento entre los grupos de la población encuestada: urbana, rural e indígena, siendo esta última la que demuestra menor conocimiento de las EID. Dentro de las enfermedades de la encuesta, se destaca al dengue debido a que todos los grupos de las poblaciones de estudio demuestran un amplio conocimiento de esta enfermedad, incluso en lo relacionado a las prácticas y actitudes. Este resultado es esperable por tratarse de una enfermedad con varios episodios epidémicos que también han afectado al Chaco en los últimos años y por la información recibida a través de los medios de comunicación inherentes a estos eventos. Con relación a la enfermedad de Chagas, la población de estudio conoce una sola forma de transmisión -a través de un vector- desconociendo las demás formas de transmisión, signos, síntomas y posibles complicaciones. Las enfermedades de transmisión sexual arrojaron resultados similares. En cuanto a la leishmaniosis y la lepra, el nivel de conocimiento fue mucho más bajo y por consiguiente los niveles de actitudes y prácticas también lo fueron. Por otra parte, se observa pleno conocimiento de las parasitosis en todos los grupos de las poblaciones encuestadas, aunque no fueron observadas actitudes ni prácticas con relación a estas. Las evidencias generadas servirán de base para elaborar planes de información, educación y comunicación que incorpore elementos comunicacionales adaptados a las distintas comunidades y que permitirán mejorar el nivel de conocimientos sobre estas enfermedades, así como promover espacios de participación de las comunidades para mejorar las prácticas de prevención y control, contribuyendo de esta manera a la disminución de la morbilidad y mortalidad de las poblaciones que habitan estas regiones. Tenemos seguridad de que las informaciones resultantes de esta encuesta servirán de base para la elaboración de estrategias adecuadas para la comunicación oportuna y que beneficiará a los pobladores de las tres regiones sanitarias.

[Description of duplicate records held on the Notifiable Diseases Information System, Brazil, 2008-2009]. / Descrição dos registros repetidos no Sistema de Informação de Agravos de Notificação, Brasil, 2008-2009.

OBJECTIVE: to describe the proportion of duplicate records held on the Brazilian Notifiable Diseases Information System, 2008-2009. METHODS: identification of duplicate records of dengue, leprosy, visceral leishmaniasis and cutaneous leishmaniasis, meningitis and tuberculosis was conducted using Reclink III(r); the proportion of duplicate records was calculated by geographical region, state and municipal population size categories. RESULTS: visceral leishmaniasis (VL) and meningitis had higher proportions of duplicate notification (5.3% and 3.6%, respectively) whilst leprosy had the lowest (0.7%); the states with highest repetitions were Rio Grande do Norte (VL 6.8% and leprosy 5.1%), Rio de Janeiro (tuberculosis 2.5% and meningitis 4.9%) and Goiás (dengue 2.0% and meningitis 7.2%). CONCLUSION: the Northeast region had the highest proportion of duplicate records for four of the six diseases analyzed; with the exception of dengue, percentage repetition was lower in municipalities with larger population size.

Dengue: estudo dos casos confirmados e hospitalizados no Instituto de Infectologia Emílio Ribas no período de 2008 à 2013 / Dengue: study of confirmed and hospitalized cases at the Instituto de Infectologia Emilio Ribas from 2008 to 2013

Introdução: A dengue é uma doença infecciosa febril aguda que pode causar desde infecções assintomáticas até formas mais graves e óbitos. O aumento no número de casos nos últimos anos também resultou no aumento das hospitalizações, enfatizando a importância em conhecer os aspectos clínico-epidemiológicos desses pacientes. Objetivo: Analisar os aspectos clínico-epidemiológicos dos casos confirmados e hospitalizados de dengue no Instituto de Infectologia Emílio Ribas, no período de 2008 a 2013. Metodologia: Estudo transversal descritivo com abordagem quantitativa dos casos confirmados e hospitalizados de dengue no período de 2008 a 2013, obtidos através do banco de Sistema de Informação de Agravos de Notificação (SINAN), das Fichas de Investigação Epidemiológica e de prontuários, totalizando 52 casos. Resultados e Discussão: No período estudado, a maioria (55,8%) dos casos foi hospitalizada no ano de 2010. A idade dos pacientes variou de 6 a 83 anos, com predomínio do sexo feminino (55,8%) e da faixa etária de 20 a 39 anos (30,8%). Dos 52 pacientes, 27 (51,9%) foram classificados como Dengue Clássica (DC). Em relação à evolução clínica, houve registro de um (1,9%) óbito. Os sinais e sintomas mais frequentes foram: febre 25/52, mialgia 17/52, cefaleia 16/52 e exantema 16/52. As manifestações hemorrágicas espontâneas foram presentes em 31/52 casos e a prova do laço positiva em 18/31. Cerca de 21% dos pacientes apresentaram ao menos uma comorbidade. Com relação às situações para indicação de hospitalização, a mais frequente foi "outras situações a critério clínico" (59,6%), seguida dos sinais de alarme (30,8%). A média de dias de internação hospitalar (DIH) foi de 5,4 dias. Com relação aos pacientes classificados como DC foi de 5,2 dias, Dengue Com Complicações (DCC) 5,8 dias e Febre Hemorrágica da Dengue (FHD) 6,2 dias. Considerando a média de dias de internação dos pacientes que apresentaram ao menos um sinal de alarme foi de 6,5 dias. Conclusão: Neste estudo houve o predomínio do sexo feminino e da faixa etária de 20 a 39 anos. A maioria dos casos foi classificada como DC e a situação indicativa para internação "outras situações a critério clínico" foi a mais frequente. Os pacientes com ao menos um sinal de alarme tiveram média de DIH superior às demais condições, assim como os pacientes classificados como DCC e FHD

Characteristics of a dengue outbreak in a remote pacific island chain--Republic of The Marshall Islands, 2011-2012.

Dengue is a potentially fatal acute febrile illness caused by four mosquito-transmitted dengue viruses (DENV-1-4). Although dengue outbreaks regularly occur in many regions of the Pacific, little is known about dengue in the Republic of the Marshall Islands (RMI). To better understand dengue in RMI, we investigated an explosive outbreak that began in October 2011. Suspected cases were reported to the Ministry of Health, serum specimens were tested with a dengue rapid diagnostic test (RDT), and confirmatory testing was performed using RT-PCR and IgM ELISA. Laboratory-positive cases were defined by detection of DENV nonstructural protein 1 by RDT, DENV nucleic acid by RT-PCR, or anti-DENV IgM antibody by RDT or ELISA. Secondary infection was defined by detection of anti-DENV IgG antibody by ELISA in a laboratory-positive acute specimen. During the four months of the outbreak, 1,603 suspected dengue cases (3% of the RMI population) were reported. Of 867 (54%) laboratory-positive cases, 209 (24%) had dengue with warning signs, six (0.7%) had severe dengue, and none died. Dengue incidence was highest in residents of Majuro and individuals aged 10-29 years, and ∼95% of dengue cases were experiencing secondary infection. Only DENV-4 was detected by RT-PCR, which phylogenetic analysis demonstrated was most closely related to a virus previously identified in Southeast Asia. Cases of vertical DENV transmission, and DENV/Salmonella Typhi and DENV/Mycobacterium leprae co-infection were identified. Entomological surveys implicated water storage containers and discarded tires as the most important development sites for Aedes aegypti and Ae. albopictus, respectively. Although this is the first documented dengue outbreak in RMI, the age groups of cases and high prevalence of secondary infection demonstrate prior DENV circulation. Dengue surveillance should continue to be strengthened in RMI and throughout the Pacific to identify and rapidly respond to future outbreaks.

[Spatial distribution of endemic diseases in Ribeirão Preto, São Paulo State]. / Distribuição espacial de doenças endêmicas no município de Ribeirão Preto (SP).

The perception that some diseases happen in certain places is old. The concern in studying the relation between the human being and the environment resulted in several studies of medical geography, directed to the analysis of diseases spatial distribution. This sectional study was carried out in Ribeirão Preto, São Paulo State, and aimed to illustrate, through health problems (dengue, leprosy and tuberculosis), how a Geographic Information System tool allows the identification of heterogeneous areas, providing support for the choice of strategies and specific interventions according to the need of residents, as well as, priority of resources to more vulnerable groups. The population comprised cases of dengue, leprosy and tuberculosis notified in Ribeirão Preto in 2000. Data were collected in the Health Secretary Epidemiological Surveillance of the city. In order to obtain the thematic maps, data were geo-codified with the software MapInfo 7.8 e Spring 4.3. The thematic maps showed the density distribution of dengue, leprosy and tuberculosis cases in the city as a way to complement the analysis of health information, pointing priority areas for the control of these diseases.

Distribuição espacial de doenças endêmicas no município de Ribeirão Preto (SP) / Spatial distribution of endemic diseases in Ribeirão Preto, São Paulo State

A percepção de que algumas doenças acontecem em determinados lugares é antiga. A preocupação em estudar as relações entre o homem e o meio resultou em diversos trabalhos de geografia médica, voltados à análise da distribuição espacial das doenças. Este estudo seccional foi desenvolvido no município de Ribeirão Preto (SP) e teve como objetivo ilustrar, por meio de agravos de saúde (dengue, hanseníase e tuberculose), de que forma uma ferramenta de um sistema de informação geográfica permite a identificação de áreas heterogêneas, fornecendo subsídios para a escolha de estratégias e intervenções específicas de acordo com a necessidade dos moradores, bem como a priorização de recursos para grupos mais vulneráveis. A população compreendeu os casos de dengue, hanseníase e tuberculose notificados no ano 2000 em Ribeirão Preto. Os dados foram coletados na Vigilância Epidemiológica da Secretaria Municipal de Saúde do município. Para a obtenção dos mapas temáticos, os dados foram geocodificados com auxílio do software MapInfo 7.8 e Spring 4.3. Os mapas temáticos ilustraram a distribuição da densidade de casos de dengue, hanseníase e tuberculose no município como uma maneira complementar de análise de informações de saúde, apontando as áreas prioritárias para o controle destas doenças.

The perception that some diseases happen in certain places is old. The concern in studying the relation between the human being and the environment resulted in several studies of medical geography, directed to the analysis of diseases spatial distribution. This sectional study was carried out in Ribeirão Preto, São Paulo State, and aimed to illustrate, through health problems (dengue, leprosy and tuberculosis), how a Geographic Information System tool allows the identification of heterogeneous areas, providing support for the choice of strategies and specific interventions according to the need of residents, as well as, priority of resources to more vulnerable groups. The population comprised cases of dengue, leprosy and tuberculosis notified in Ribeirão Preto in 2000. Data were collected in the Health Secretary Epidemiological Surveillance of the city. In order to obtain the thematic maps, data were geo-codified with the software MapInfo 7.8 e Spring 4.3. The thematic maps showed the density distribution of dengue, leprosy and tuberculosis cases in the city as a way to complement the analysis of health information, pointing priority areas for the control of these diseases.

[Status report on public health in Mauritius in 2009]. / Situation et enjeux sanitaires à l'île Maurice en 2009.

Mauritius is an island nation off the coast of Africa in the southwestern Indian Ocean. Improved socio-sanitation conditions over the past years have dramatically decreased the incidence of tropical diseases to levels comparable with those observed in developed countries. Some tropical illnesses including malaria, schistosomiasis, cysticercosis and lymphatic filariasis have been eradicated. Others such as amibiasis, typhoid fever and leprosy have become rare. However, because of the island's geographical proximity to countries with uncontrolled and suboptimal socio-sanitation conditions and its humid subtropical climate, there is a continued risk for certain vector transmitted tropical diseases such as Chikungunya and dengue. In addition, the incidence of HIV infection and AIDS has been rising rapidly since 2004 and tuberculosis remains a public health problem. Better living conditions have also been accompanied by an increase in cardiovascular and metabolic diseases that, along with cancer, are now the main causes of morbidity and mortality.

High incidence of diseases endemic to the Amazon region of Brazil, 2001-2006.

In Brazil, reportable diseases are the responsibility of the Secretariat of Health Surveillance of the Brazilian Federal Ministry of Health. During 2001-2006, to determine incidence and hospitalization rates, we analyzed 5 diseases (malaria, leishmaniasis [cutaneous and visceral], dengue fever, leprosy, and tuberculosis) that are endemic to the Amazon region of Brazil. Data were obtained from 773 municipalities in 3 regions. Although incidence rates of malaria, leishmaniasis, tuberculosis, and leprosy are decreasing, persons in lower socioeconomic classes with insufficient formal education are affected more by these diseases and other health inequalities than are other population groups in the region.

Patología regional argentina: enfermedades prevalentes y exóticas conminantes / Argentina regional pathology

Patologías por protozoarios: enfermedad de chagas; paludismo; leishmaniasis. Patologías por helmintos: hidatidosis; uncinariasis. Patologías por bacterias: brucelosis; lepra. Patologías por hongos: paracoccidioidomicosis; histoplasmosis. Patologías por virus: fiebre hemorrágica argentina. Patologías por intoxicaciones: hidroarsenicismo crónico regional endémico. Patologías exóticas conminantes: cólera; dengue; esquistosomiasis

Patología regional argentina: enfermedades prevalentes y exóticas conminantes / Argentina regional pathology

Patologías por protozoarios: enfermedad de chagas; paludismo; leishmaniasis. Patologías por helmintos: hidatidosis; uncinariasis. Patologías por bacterias: brucelosis; lepra. Patologías por hongos: paracoccidioidomicosis; histoplasmosis. Patologías por virus: fiebre hemorrágica argentina. Patologías por intoxicaciones: hidroarsenicismo crónico regional endémico. Patologías exóticas conminantes: cólera; dengue; esquistosomiasis

Imported communicable diseases in Singapore.

Most communicable diseases in Singapore have been brought under control and some eliminated. In recent years, an increasing proportion of the reported cases turned out to be imported. Between the period 1977 and 1982, 96% of malaria, 44% of paratyphoid, 32% of typhoid, 20% of leprosy, 11% of acute viral hepatitis, 7% of dengue fever/dengue haemorrhagic fever and 7% of cholera were imported. About 10% of the notified tuberculosis cases were non-residents while all the sporadic cases of poliomyelitis (except in 1977) and diphtheria (except in 1982) were contracted outside Singapore. The majority of the infections originated from Southeast Asia and the Indian subcontinent. The main groups of population with imported infections were local residents who travelled to the endemic areas without taking adequate preventive measures, foreign contract workers, and foreign seeking medical treatment in Singapore. Whether or not these imported cases would spread the infection to others in the community and cause epidemics depend on the virulence of the pathogen introduced, the susceptibility of the population and the environmental conditions which favour transmission of infection. Measures taken to reduce the risk of transmission include provision of a high standard of environmental sanitation, epidemiological surveillance to detect and eliminate the focus of infection; maintenance of a high level of herd immunity through immunisation; health education of the medical practitioners and of the public on the need for personal prophylaxis when travelling overseas; and screening of foreign contract workers and returning residents in special situations.

[Pathology in the Republic of Vanuatu]. / La pathologie en République du Vanuatu.

The archipelago of Vanuatu is located in the South-West Pacific at 2,000 km, East of Australia. The so-called "current" pathology is similar to the one met in Europe. Because of its geographical location, a tropical pathology is to be found with a prevalence of Malaria, intestinal nematodoses and filariases ( Wuchereria bancrofti). Leprosy , dengue, ciguatera, eosinophilic meningitis as well as Tokeleau bring its originality to this pathology.