Características clínicas y epidemiológicas de la parasitación intestinal por Blastocystis hominis / Clinical and epidemiological characteristics of intestinal parasite infection by Blastocystis hominis

Objetivos. Blastocystis hominis (B. hominis) es uno de los parásitos intestinales más frecuentemente aislados en el ser humano. Puede producir sintomatología gastrointestinal o, en la mayoría de los casos, permanecer asintomático. Existen dudas sobre el carácter patógeno del parásito. El objetivo de este estudio fue analizar las características clínicas y epidemiológicas de la parasitación por B. hominis, con y sin otras coparasitaciones. Pacientes y métodos. Estudio observacional retrospectivo de aislamientos de B. hominis en heces, desde octubre del 2004 hasta marzo del 2016 en una Unidad de Medicina Tropical. Se revisó a todos los pacientes con parasitación exclusiva, o no, por B. hominis. Resultados. Se estudió a 3.070 pacientes. En 570 (18%) se diagnosticó infección por B. hominis, de los que en 245 (43%) representó el único aislamiento; 325 (57%) presentaron otras coparasitaciones (Entamoeba hystolitica o dispar, Strongyloides stercoralis, uncinarias y Schistosoma sp.). El síntoma principal fue dolor abdominal (41,8%). En un 31,2% el parásito se detectó en el cribado de enfermedades importadas en pacientes asintomáticos. De los que recibieron tratamiento con metronidazol, un 78,2% mejoró y en el 82,6% los parásitos se negativizaron. Conclusiones. La parasitación por B. hominis es una de las enfermedades más frecuentes en nuestra Unidad de Medicina Tropical. La mayoría de los pacientes están asintomáticos o bien la clínica puede ser atribuida a otras parasitaciones. En aquellos casos en los que persisten los síntomas sin poder ser atribuidos a otras causas, es recomendable un tratamiento específico

Objectives. Blastocystis hominis (B. hominis) is one of the most common intestinal parasites isolated in humans. The parasite can cause gastrointestinal symptoms or, in most cases, remain asymptomatic. There are issues concerning the parasite's pathogenic character. The aim of this study was to analyse the clinical and epidemiological characteristics of the parasite infection by B. hominis, with or without other parasitic co-infections. Patients and methods. An observational retrospective study was conducted of B. hominis isolates in faeces from October 2004 to March 2016 in a tropical medicine unit. We reviewed all patients with a parasite infection, exclusively or not by B. hominis. Results. We studied 3070 patients, 570 (18%) of whom were diagnosed with B. hominis infection, which was the only isolate in 245 (43%) of the 570 patients. A total of 325 (57%) patients presented other parasitic co-infections (Entamoeba histolytic or Entamoeba dispar, Strongyloides stercoralis, hookworm and Schistosoma spp.). The main symptom was abdominal pain (41.8%). In 31.2% of cases, the parasite was detected in the imported diseases screening of asymptomatic patients. Of those who underwent treatment with metronidazole, 78.2% improved. The parasite was neutralised in 82.6% of the patients. Conclusions. Parasite infection by B. hominis is one of the most common diseases in our tropical medicine unit. Most patients are asymptomatic, or their symptoms can be attributed to other parasite infections. In those cases in which symptoms persist without being able to attribute them to other causes, a specific treatment is recommended

Clinical and epidemiological characteristics of intestinal parasite infection by Blastocystis hominis. / Características clínicas y epidemiológicas de la parasitación intestinal por Blastocystis hominis.

OBJECTIVES: Blastocystis hominis (B. hominis) is one of the most common intestinal parasites isolated in humans. The parasite can cause gastrointestinal symptoms or, in most cases, remain asymptomatic. There are issues concerning the parasite's pathogenic character. The aim of this study was to analyse the clinical and epidemiological characteristics of the parasite infection by B. hominis, with or without other parasitic co-infections. PATIENTS AND METHODS: An observational retrospective study was conducted of B. hominis isolates in faeces from October 2004 to March 2016 in a tropical medicine unit. We reviewed all patients with a parasite infection, exclusively or not by B. hominis. RESULTS: We studied 3070 patients, 570 (18%) of whom were diagnosed with B. hominis infection, which was the only isolate in 245 (43%) of the 570 patients. A total of 325 (57%) patients presented other parasitic co-infections (Entamoeba histolytic or Entamoeba dispar, Strongyloides stercoralis, hookworm and Schistosoma spp.). The main symptom was abdominal pain (41.8%). In 31.2% of cases, the parasite was detected in the imported diseases screening of asymptomatic patients. Of those who underwent treatment with metronidazole, 78.2% improved. The parasite was neutralised in 82.6% of the patients. CONCLUSIONS: Parasite infection by B. hominis is one of the most common diseases in our tropical medicine unit. Most patients are asymptomatic, or their symptoms can be attributed to other parasite infections. In those cases in which symptoms persist without being able to attribute them to other causes, a specific treatment is recommended.

[Diagnosis and treatment of imported eosinophilia in travellers and immigrants: Recommendations of the Spanish Society of Tropical Medicine and International Health (SEMTSI)]. / Diagnóstico y tratamiento de la eosinofilia importada en viajeros e inmigrantes: recomendaciones de la Sociedad Española de Medicina Tropical y Salud Internacional (SEMTSI).

According to published data, prevalence of imported eosinophilia among travellers and immigrants is set between 8% and 28.5%. Etiological diagnosis is often troublesome, and depending on the depth of the study and on the population analyzed, a parasitic cause is identified in 17% to 75.9% of the individuals. Among the difficulties encountered to compare studies are the heterogeneity of the studied populations, the type of data collection (prospective/retrospective) and different diagnostic protocols. In this document the recommendations of the expert group of the Spanish Society of Tropical Medicine and International Health (SEMTSI) for the diagnosis and treatment of imported eosinophilia are detailed.

Hepatitis virales e inmigración: un reto para el sistema sanitario / Viral hepatitis and immigration: a challenge for the healthcare system

Introducción. Las hepatitis virales representan un importante problema de salud en los países africanos. El incremento de la población inmigrante procedente de este continente supone un reto para el sistema sanitario. Material y métodos. Estudio descriptivo sobre la prevalencia de marcadores serológicos de hepatitis viral B (VHB), C (VHC) y delta (VHD) en inmigrantes africanos atendidos en una consulta especializada. Resultados. Se incluyó a 2.518 pacientes (87,7% subsaharianos) con una edad media de 31,3 años. El 78,8% presentó algún marcador positivo de infección por el VHB y en 638 pacientes (25,3%) se diagnosticó una hepatitis B activa (AgHBs+). En 19 casos se detectaron anticuerpos frente al VHD (4 con detección del genoma viral). Sesenta y ocho pacientes presentaron anticuerpos contra el VHC, de los que 26 tenían carga viral positiva. Conclusiones. La elevada prevalencia de hepatitis virales en inmigrantes, en especial la infección por VHB, ha supuesto un cambio significativo en el perfil de pacientes atendidos en nuestro país, y precisa de medidas encaminadas a un diagnóstico precoz y prevención de la transmisión (AU)

Background. Viral hepatitis is a significant health problem in African countries. The increase in the immigrant population from this continent represents a challenge for the Spanish healthcare system. Material and methods. A descriptive study was conducted on the prevalence of the serological markers of hepatitis B (HBV), C (HCV) and D (HDV) in African immigrants treated in a specialised doctor's office. Results. The study included 2518 patients (87.7% Sub-Saharan natives), with a mean age of 31.3 years. Some 78.8% of the patients had a positive infection marker for HBV, and 638 patients (25.3%) were diagnosed with active hepatitis B (HBsAg +). In 19 cases, antibodies against HDV were detected (4 cases with detection of the viral genome). Sixty-eight patients had antibodies against HCV, 26 of whom had a positive viral load. Conclusions. The high prevalence of viral hepatitis in immigrants, especially HBV infection, represents a significant change in the profile of patients treated in Spain and requires measures aimed at early diagnosis and transmission prevention (AU)

Hepatitis B and Schistosoma co-infection in a non-endemic area.

Schistosomiasis is related to the development of liver fibrosis and portal hypertension. Chronic co-infection with HBV and Schistosoma has been associated in endemic areas with a higher risk for a more severe liver disease. However, no studies have assessed the real importance of this co-infection in non-endemic regions. This is a retrospective observational study of Sub-Saharan immigrants attending between October 2004 and February 2014. Patients with chronic HBV infection with and without evidence of schistosomal infection were compared. Epidemiological, analytical, and microbiological data were analysed. Likelihood of liver fibrosis based on APRI and FIB-4 indexes was established. A total of 507 patients were included in the study, 170 (33.5 %) of them harbouring evidence of schistosome infection. No differences were found in transaminase, GGT, and ALP levels. In fibrosis tests, a higher proportion of patients with HVB and S. mansoni detection reached possible fibrosis scores (F > 2) when compared to patients without schistosomiasis: 17.4 vs 14.2 % and 4.3 % vs 4.2 % (using high sensitivity and high specificity cut-offs respectively), although differences were not statistically significant (p = 0.69, p = 0.96). For possible cirrhosis (F4) score, similar results were observed: 4.3 % of co-infected patients vs 2.1 % of mono-infected ones, p = 0.46. According to these datas, in non-endemic regions the degree of hepatic fibrosis in patients with chronic hepatitis B is not substantially modified by schistosome co-infection.

Viral hepatitis and immigration: A challenge for the healthcare system.

BACKGROUND: Viral hepatitis is a significant health problem in African countries. The increase in the immigrant population from this continent represents a challenge for the Spanish healthcare system. MATERIAL AND METHODS: A descriptive study was conducted on the prevalence of the serological markers of hepatitis B (HBV), C (HCV) and D (HDV) in African immigrants treated in a specialised doctor's office. RESULTS: The study included 2518 patients (87.7% Sub-Saharan natives), with a mean age of 31.3 years. Some 78.8% of the patients had a positive infection marker for HBV, and 638 patients (25.3%) were diagnosed with active hepatitis B (HBsAg +). In 19 cases, antibodies against HDV were detected (4 cases with detection of the viral genome). Sixty-eight patients had antibodies against HCV, 26 of whom had a positive viral load. CONCLUSIONS: The high prevalence of viral hepatitis in immigrants, especially HBV infection, represents a significant change in the profile of patients treated in Spain and requires measures aimed at early diagnosis and transmission prevention.

Eosinofilia e infiltrados pulmonares en paciente natural de Senegal / Eosinophilia and lungs infiltrates in patient originating from Senegal

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Practical diagnosis of red cell disorders in southern Spain.

BACKGROUND: Hereditary red cell disorders are associated with a protective effect against malaria, which results in an increased prevalence in malaria-endemic areas. Migratory flows from these areas are resulting in a marked increase in such abnormalities in Southern Spain. METHODS: All hemoglobin disorders diagnosed between 1997 and 2010 have been recorded. Since 2008, we have performed systematic screening for hemoglobinopathies on African patients. A high-pressure liquid chromatography system was used as screening method for structural hemoglobinopathies and for separation of hemoglobin (Hb) F and A(2). RESULTS: We detected 666 cases in patients of foreign origin and 308 in native Spanish patients. Thalassemias (thal) are the most frequent disorders amongst the local population: ß-thal minor, 57.1% (176/308); α-thal, 18.2% (56/308), and δß-thal, 7.8% (24/308). In ethnic minorities, there is a huge variety of hemoglobinopathies: heterozygous Hb S, 45% (300/666); heterozygous Hb C, 15% (100/666); ß-thal minor, 13.7% (91/666); α-thal, 10.2% (68/666); Hb SS in 14 patients, and Hb CC in 9 patients. Of the native patients, 14 were found to have Hb AS and 9 Hb AC. CONCLUSION: Given the modern migratory flows, greater knowledge of these disorders is needed by all medical staff, and new practical and cost/time-effective diagnostic approaches have to be devised.

Neumonía de la comunidad por Acinetobacter baumannii / Community-acquired Acinetobacter baumannii pneumonia

Fundamento. Describir dos casos de neumonía adquirida en la comunidad por Acinetobacter baumannii. Pacientes y métodos. Se trata de dos pacientes, uno con antecedentes de diabetes mellitus tipo 2 y tromboembolismo pulmonar dos años antes, y el segundo sin factores de riesgo conocidos salvo la edad, ingresados por neumonía adquirida en la comunidad por A. baumannii, que desarrollaron cavitación, con evolución final favorable. Conclusión. El A. baumannii es una causa infrecuente de neumonía de la comunidad, aunque debe ser tomado en consideración en pacientes con situaciones de base debilitantes y que no evolucionan de forma favorable en los primeros días del ingreso con tratamiento convencional (AU)

[Community-acquired Acinetobacter baumannii pneumonia]. / Neumonía de la comunidad por Acinetobacter baumannii.

OBJECTIVES: Description of two cases of community-acquired Acinetobacter baumannii pneumonia. PATIENTS AND METHODS: Two patients, one with a history of diabetes mellitus type 2 and pulmonary thromboembolism 2 years earlier and the second without known risk factors except for the age, were admitted to hospital because of community-acquired A. baumannii pneumonia with cavitation and with favorable final evolution. CONCLUSION: A. baumannii is an infrequent cause of community-acquired pneumonia, although it should be suspected in patients with debilitating illness and in patients who do not evolve favorably on the first days of the admission with conventional treatment.

[Nosocomial infection/colonization of the respiratory tract caused by Acinetobacter baumannii in an Internal Medicine ward]. / Infección/colonización nosocomial de las vías respiratorias por Acinetobacter baumannii en una planta de Medicina Interna.

BACKGROUND: To present the epidemiology of the outbreak and the description of patients with infection or colonization of the respiratory tract caused by A. baumannii in an Internal Medicine ward. METHODS: 20 consecutively patients hospitalized in the Internal Medicine ward were studied during 18 months with isolation of multiresistant A. baumanni in respiratory tract specimens with or without clinical signs of infection. RESULTS: Starting on an index case, that was a patient coming from other hospital with diagnosis of nosocomial Acinetobacter pneumonia, we detected 20 patients. The age of the patients ranged from 48 to 95 years, with a mean of 71.4 years. Eighty percent were males. The clinical features were similar: advanced age, with chronic diseases (35 percent diabetics, 45 percent with chronic lung diseases), and use of broad-spectrum antibiotics agents, fundamentally third generation cephalosporin (70 percent), clarithromycin (55 percent) and quinolones (30 percent). 75 percent of patients were in the same ward. Eight (40 percent) of the patients with chronic lung diseases were subjects with COPD, two with asthma and chronic glucocorticoids treatment, and one with a sleep apnea. In four cases the isolation was considered a colonization. The mean stay was 26.15 days, and the mortality 40 percent. CONCLUSIONS: The nosocomial infection caused by Acinetobacter baumannii is responsible of a high morbi-mortality between the patients hospitalized in an Internal Medicine ward, and produce an increase in length of stay. It is necessary a combination of control measures to prevent the transmission in the hospital and the outbreak of new multiresistant strains.

Infección/colonización nosocomial de las vías respiratorias por Acinetobacter baumannii en una planta de Medicina Interna / Nosocomial Infection/Colonization of the respiratory tract caused by Acinetobacter baumannii in an Internal Medicine Ward

Fundamento: Presentar la epidemiología del brote y la descripción de los pacientes con infección o colonización de las vías respiratorias por Acinetobacter baumannii en el área de hospitalización de Medicina Interna. Métodos: Estudio de 20 pacientes consecutivos ingresados en la planta de hospitalización de Medicina Interna durante 18 meses, en los que se aisló en esputo A. baumannii multirresistente, acompañado o no de signos clínicos de infección. Resultados: A raíz de un caso índice, que fue un paciente trasladado de otro centro hospitalario con el diagnóstico de neumonía nosocomial por A. baumannii, se han detectado 20 pacientes, cuya edad media es de 71.4 años (48-95). El perfil de los pacientes fue similar: edad avanzada, con patología crónica de base (35% diabéticos, 45% con enfermedad respiratoria crónica), con ingresos previos en Medicina Interna (35%), y con antecedente de consumo en el mes previo de antibióticos, fundamentalmente cefalosporinas de tercera generación (70% de los casos), claritromicina (55%) y quinolonas (30%). El 75% de los casos aconteció en el mismo área de hospitalización. De los pacientes con enfermedad pulmonar crónica, 8 (40%) cumplían criterios de EPOC, 2 eran asmáticos corticodependientes y 1 paciente estaba diagnosticado de SAOS. En 4 casos el aislamiento se consideró colonización. La estancia media fue de 26.15 días, con un porcentaje de exitus del 40%. Conclusiones: La infección nosocomial por Acinetobacter baumannii es responsable de una elevada morbimortalidad entre los pacientes ingresados en la planta de Medicina Interna. Es fundamental la adopción de medidas para el control de su transmisión intrahospitalaria y evitar la aparición de nuevas cepas multirresistentes (AU)

Background: To present the epidemiology of the outbreak and the description of patients with infection or colonization of the respiratory tract caused by A. baumannii in an Internal Medicine ward. Methods: 20 consecutively patients hospitalized in the Internal Medicine ward were studied during 18 months with isolation of multiresistant A. baumanni in respiratory tract specimens with or without clinical signs of infection. Results: starting on an index case, that was a patient coming from other hospital with diagnosis of nosocomial Acinetobacter pneumonia, we detected 20 patients. The age of the patients ranged from 48 to 95 years, with a mean of 71.4 years. Eighty percent were males. The clinical features were similar: advanced age, with chronic diseases (35 percent diabetics, 45 percent with chronic lung diseases), and use of broad-spectrum antibiotics agents, fundamentally third generation cephalosporin (70 percent), clarithromycin (55 percent) and quinolones (30 percent). 75 percent of patients were in the same ward. Eight (40 percent) of the patients with chronic lung diseases were subjects with COPD, two with asthma and chronic glucocorticoids treatment, and one with a sleep apnea. In four cases the isolation was considered a colonization. The mean stay was 26.15 days, and the mortality 40 percent. Conclusions: The nosocomial infection caused by Acinetobacter baumannii is responsible of a high morbi-mortality between the patients hospitalized in an Internal Medicine ward, and produce an increase in length of stay. It is necessary a combination of control measures to prevent the transmission in the hospital and the outbreak of new multiresistant strains (AU)