[Reference values in the usual laboratory data for sub-Saharan immigrants. Importance in the management of infectious diseases]. / Valores de referencia en los datos de laboratorio habituales en inmigrantes subsaharianos. Importancia en el manejo de las enfermedades infecciosas.

BACKGROUND AND AIMS: The progressive increase in the number of immigrants to Spain in recent years has made it necessary for health-care professionals to be aware about the specific characteristics of this population. An attempt is made in this study to define the normal range of common laboratory values in healthy sub-Saharan adults. SUBJECTS AND METHODS: Common laboratory values were studied (blood cell counts, clotting tests and blood biochemistry values) and were measured in 150 sub-Saharan immigrants previously defined as healthy according to a complete health evaluation that included a clinical history, physical examination, serologic tests and study of stool parasites. These results were compared to those from a control group consisting of 81 age-and-sex matched healthy blood donors taken from the Spanish native population. RESULTS: Statistically significant differences were obtained in the following values. Mean corpuscular volume (MCV), red cell distribution width (RDW), total leukocytes, and serum levels of creatinine, uric acid, total protein content, creatin-kinase (CK), aspartate aminotransferase (AST), gamma-glutamyl-transpeptidase (GGT), Immunoglobulin G (IgG) and M (IgM). If evaluated according to the normal values in native people, a considerable percentage of healthy sub-Saharan immigrants would present <> values (with potential clinical relevance) in the following parameters. MCV, RDW, total leukocyte counts and serum levels of CK, IgG and IgM. CONCLUSIONS: A proper interpretation of the common laboratory values in sub-Saharan immigrants, and probably in other foreign collectives, requires a previously-established range of normality in these parameters for those populations in order to avoid diagnostic mistakes and inadequate work-up and management.

Valores de referencia en los datos de laboratorio habituales en inmigrantes subsaharianos. Importancia en el manejo de las enfermedades infecciosas / Reference values in the usual laboratory data for sub-Saharan immigrants. Importance in the management of infectious diseases

Fundamento y objetivos. El incremento progresivo del número de inmigrantes en España en los últimos años ha obligado a los profesionales sanitarios a considerar las características específicas de esta población. En este estudio se intentan determinar los valores normales de los inmigrantes procedentes del África subsahariana en los valores analíticos solicitados con mayor frecuencia en la práctica clínica. Sujetos de estudio y métodos. Se estudiaron los valores habituales de laboratorio (hemograma, pruebas de coagulación y estudios bioquímicos sanguíneos) en 150 inmigrantes previamente definidos como sanos tras efectuar un examen de salud que incluía una historia clínica protocolizada, estudios serológicos y estudio coproparasitario. Estos datos se compararon con los de un grupo control de 81 donantes sanos, de edad y sexo similares, de población autóctona. Resultados. Se encontraron diferencias estadísticamente significativas entre ambos grupos en la determinación de volumen corpuscular medio(VCM), amplitud de distribución eritrocitaria, leucocitos totales, creatinina, ácido úrico, proteínas totales, creatin quinasa (CK), aspartato aminotransferasa, gamma glutamil transpeptidasa, inmunoglobulinas G y M (IgG, IgM). Teniendo en cuenta los valores de referencia, un porcentaje significativo de personas subsaharianas sanaspresentarían valores «anormales» en las siguientes magnitudes: VCM, ADE, leucocitos totales proteínas totales, CK, IgG e IgM. Conclusiones. La valoración de los datos de laboratorio en la población subsahariana, y posiblemente en otros grupos de inmigrantes, requiere establecer previamente el rango de normalidad adecuado para evitar errores diagnósticos y actitudes terapéuticas erróneas (AU)

Background and aims. The progressive increase in the number of immigrants to Spain in recent years has made it necessary for health-care professionals to be aware about the specific characteristics of this population. An attempt is made in this study to define the normal range of common laboratory values in healthy sub-Saharan adults. Subjects and methods. Common laboratory values were studied (blood cell counts, clotting tests and blood biochemistry values) and were measured in150 sub-Saharan immigrants previously defined as healthy according to a complete health evaluation that included a clinical history, physical examination, serologic tests and study of stool parasites. These results were compared to those from a control group consisting of 81 age-and-sex matched healthy blood donors taken from the Spanish native population. Results. Statistically significant differences were obtained in the following values. mean corpuscular volume (MCV), red cell distribution width (RDW), total leukocytes, and serum levels of creatinine, uric acid, total protein content, creatin-kinase (CK), aspartate aminotransferase (AST), gamma-glutamyl transpeptidase(GGT), Immunoglobulin G (IgG) and M(IgM). If evaluated according to the normal values in native people, a considerable percentage of healthy sub-Saharan immigrants would present «abnormal» values (with potential clinical relevance) in the following parameters. MCV, RDW, total leukocyte counts and serum levels of CK, IgG and IgM. Conclusions. A proper interpretation of the common laboratory values in sub-Saharan immigrants, and probably in other foreign collectives, requires a previously-established range of normality in these parameters for those populations in order to avoid diagnostic mistakes and inadequate work-up and management (AU)

Candida glabrata fungemia cured by antibiotic-lock therapy: case report and short review.

Catheter removal is now the standard recommendation of catheter-related fungemia even when tunneled devices are used. However, in the clinical practice, this procedure is not always without risks. Antibiotic-lock technique can resolve many cases of catheter-related bacteraemia, but cure of catheter-related candidemia by this method has been attempted in very few instances, reviewed in this article. Herein, we report a case of non-complicated Candida glabrata fungemia related to a Hickman catheter used for parenteral nutrition, cured with intraluminal amphotericin B in addition to systemic therapy. This case demonstrates that 'antifungal-lock therapy' can be effectively used in selected cases of catheter-related candidemia.

Prevalence and incidence of multiple sclerosis in Las Palmas, Canary Islands, Spain.

OBJECTIVES: To determine the prevalence and incidence of multiple sclerosis (MS) in the city of Las Palmas (Canary Islands, Spain), geographically belonging to north-western Africa, but with European ancestry. METHODS: This population-based survey was conducted for a period of 5 years (1998-2002) in a Sanitary District of Las Palmas city (28 degrees 20' N), with a population of 82,623 inhabitants. Multiple sources were periodically investigated for case ascertainment. Patients with definite and probable MS were included. RESULTS: Sixty-four patients with MS were identified on prevalence day, December 31, 2002. According to Poser's criteria the crude prevalence rate was 77.5 per 100,000 (95% CI: 59.7-98.9). This rate decreased to 73.8 (95% CI: 56.5-94.8) according to McDonald's criteria. Age-adjusted rates for the world and European standard populations were 61.6 (95% CI: 47.1-78.9) and 70.6 (95% CI: 55-89), respectively. Prevalence was higher for women aged 25-44 years. In 17 patients onset of MS occurred within the study period. Average annual incidence was 4.1 per 100,000 (95% CI: 2.4-6.6). CONCLUSIONS: The prevalence and incidence rates in Las Palmas city are close to those reported from Continental Spain and other countries of southern Europe with similar social and ethnic background. These results highlight the role of racial-ethnic factors in the genesis of MS.

[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.

Manejo práctico de una eosinofilia / Eosinophilia: a practical approach

En esta revisión se define inicialmente el concepto y grado de eosinofilia. En un segundo apartado se estudian las causas principales de esta alteración hematológica considerando tres tipos de pacientes: a) autóctonos no infectado por VIH; b) infectados por VIH; y c) procedentes de regiones tropicales (eosinofilia importada). En tercer lugar, se desarrolla un protocolo diagnóstico secuencial, indicando las pruebas mas útiles para llegar al diagnóstico en los grupos mencionados previamente. Específicamente, se incluyen las pruebas complementarias útiles en los pacientes con eosinofilia importada, tanto en presencia como en ausencia de datos de focalidad. Tras una breve referencia a las consecuencias patológicas de la eosinofilia, se contemplan las mediadas terapéuticas útiles en estos pacientes. En este ultimo apartado se hace un especial énfasis en el tratamiento antihelmíntico y en el manejo del síndrome hipereosinofílico (AU)

Seroprevalence of infection by Coxiella burnetii in Canary Islands (Spain).

THE AIMS OF OUR STUDY WERE: (i) to know the seroprevalence of Coxiella burnetii infection in the Canary Islands, (ii) to evaluate its epidemiologic features and (iii) to compare the rates of seroprevalence using two different cut-offs (1:20 and 1:80) for the diagnosis of past infection. METHODS: We analysed a representative sample of the canarian population. 662 sera were tested. For the detection of IgG and IgM antibodies against C. burnetii phase II antigens an immuofluorescence assay was used. The serologic screening for IgG detection begun with a 1:20 dilution. A titer of IgG > or = 1:80 along with a negative IgM were used as criteria for previous infection. RESULTS: At an IgG antibody titer against C. burnetii of 1:80 as diagnostic for past infection, the observed global seroprevalence was 21.5%. If the cut-off used was 1:20, the observed prevalence increased up to 35.8% (p = 0.001). Significantly different seroprevalence rates were obtained at these different cut-offs when results were analysed for groups of age and socioeconomic status, but not for either the island of origin or for farmers. CONCLUSION: Our results strongly suggest that Coxiella burnetii infection is endemic in all the Canary Islands. Although it is more frequent in males above 30 years old, it do affect people of all ages, and thus it should be borne in mind in the face of any acute febrile syndrome.

Crioglobulinemia transitoria y leptospirosis

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Isolated renoureteric aspergilloma due to Aspergillus flavus: case report and review of the literature.

In this paper we describe a case in which acute renal colic was associated with elimination of multiple hyphal masses of Aspergillus flavus. Also, we reviewed the literature on similar cases and we found a similar pattern characterized by a marked male predominance, association with at least one underlying medical condition that predisposes to fungal infection, the presence of local symptoms resembling acute ureteral colic, and the absence of systemic manifestations. Moreover, our data suggest that Aspergillus balls must be suspected when a diabetic and intravenous drug user presents with acute renal colic and that non-obstructive renal aspergillosis may be initially treated with itraconazole.

Ventriculoperitoneal shunt infection by Candida glabrata in an adult.

We describe the first case of infection of a neurosurgical shunt by Candida glabrata in an adult. The risk factors, clinical picture and response to therapy have been similar to similar cases caused by other Candida sp. We must emphasize the unequivocal features of infection and the rapid and probably complete response to removal of the device.

Cerebritis due to Listeria monocytogenes: CT and MR findings.

Infections by Listeria monocytogenes are uncommon, with cerebritis being even rarer. We present three cases of cerebritis which occurred during an outbreak of listeriosis. The CT and MR findings at diagnosis and during follow-up are described. Predominant deep white matter lesions with nodular and ring enhancement were seen. The MR yielded a higher resolution of the lesions than CT.