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1.
Int J Infect Dis ; 90: 226-233, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31698135

RESUMO

OBJECTIVES: The objective of this study was to assess the epidemiology and burden of Q fever (QF) in Spain. METHODS: We designed a retrospective descriptive study using the minimum basic data set in patients admitted to hospitals of the National Health System between 1998 and 2015 with a diagnosis of Q fever (ICD-9: 083.0.). RESULTS: We found 4214 hospitalized patients with a mean age (±SD) of 50.9±19.3 years. The male/female ratio was 3:1. The incidence rate was between 0.41 and 0.65 cases per 100,000 person-years over the 18-year period. The highest incidence of cases was from March to August (p=0.024). 21.1% patients had pneumonia, 17.5% had liver disease, and only 3.2% had endocarditis. The average hospital stay was 13.8 days (±12.8). A total of 117 (2.8%) patients died. The total mean cost of QF is approximately €154,232,779 (€36,600±139,422 per patient). CONCLUSIONS: QF is an important zoonosis in Spain with a stable incidence rate and high cost for hospitalization. Older patients have a more severe clinical picture and higher mortality, which can be decreased with early clinical suspicion.

3.
PLoS One ; 14(3): e0214125, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30913249

RESUMO

BACKGROUND: Schistosoma mansoni is the main species causing hepatic and intestinal schistosomiasis in Sub-Saharan Africa, and it is the only species in South America. Adult stages of the parasite reside in the mesenteric venous plexus of infected hosts, and eggs are shed in feces. Collecting patient stool samples for S. mansoni diagnostic purposes is difficult in large-scale field trials. Urine samples would be an alternative approach for molecular S. mansoni detection since they have several advantages over stool samples, including better handling, management and storage. Additionally, loop-mediated isothermal amplification (LAMP) technology is a powerful molecular diagnostic tool for infectious diseases, particularly under field conditions in developing countries. The present study aimed to assess the effectiveness of our previously developed LAMP assay (SmMIT-LAMP) for S. mansoni-specific detection in clinical urine samples. METHODOLOGY/PRINCIPAL FINDINGS: The sensitivity of SmMIT-LAMP in urine was established in simulated fresh human urine samples artificially spiked with genomic DNA from S. mansoni. LAMP for 120 min instead of 60 min improved the sensitivity, reaching values of 0.01 fg/µL. A set of well-defined frozen stored human urine samples collected from Sub-Saharan immigrant patients was selected from a biobank to evaluate the diagnostic validity of SmMIT-LAMP. The set included urine samples from patients with microscopy-confirmed infections with S. mansoni, S. haematobium and other nonschistosome parasites, as well as urine samples from patients with microscopy-negative eosinophilia without a confirmed diagnosis. The SmMIT-LAMP was incubated for 60 and 120 min. A longer incubation time was shown to increase the LAMP-positive results in patient urine samples. We also tested urine samples from mice experimentally infected with S. mansoni, and LAMP-positive results were obtained from the third week after infection. A real-time LAMP assay was also performed with three individual urine samples. CONCLUSIONS/SIGNIFICANCE: The SmMIT-LAMP could effectively detect S. mansoni DNA in mouse urine samples and produced promising results for human clinical samples. The detection of S. mansoni DNA in mouse urine samples from the third week after infection indicates that early diagnosis of active S. mansoni infection is possible using urine as a source of DNA. Further studies are still needed, but our method could be used as a promising molecular tool applicable to urine samples to diagnose human intestinal schistosomiasis caused by S. mansoni.


Assuntos
DNA de Helmintos/genética , DNA de Helmintos/urina , Técnicas de Amplificação de Ácido Nucleico , Schistosoma mansoni/genética , Esquistossomose mansoni/genética , Esquistossomose mansoni/urina , Animais , Feminino , Humanos , Masculino , Camundongos , Sensibilidade e Especificidade
8.
Sci Total Environ ; 636: 709-716, 2018 Sep 15.
Artigo em Inglês | MEDLINE | ID: mdl-29727838

RESUMO

The Canary Islands are one of the outermost regions of the European Union (EU), which are located barely 100 km from the coasts of Morocco. Although these islands are located in Africa, the degree of socioeconomic development and lifestyle in this archipelago is comparable to that of any other region of Europe. It is well established that the main determinants of human exposure to elements have to do both, with their place of residence and with habits related to their lifestyle. For this reason, we wanted to study the pattern of contamination by elements of these two populations so geographically close, but so different both in their lifestyle, and the geological origin of the territory where they live. Thus, we have determined the blood concentrations of 47 elements (including 25 rare earth elements (REE) and other minority elements (ME) widely employed in the hi-tech industry) in a paired sample of Moroccans (n = 124) and Canary Islands inhabitants (n = 120). We found that the levels of iron, selenium, zinc, arsenic, cadmium, strontium, and specially lead, were significantly higher in Moroccans than in Canarians, probably due to the intensive mining activity in this country. We also found significantly higher levels of the sum of REE and ME in Moroccans than in Canarians, possibly related to the inappropriate management of e-waste in this country. On the other hand, in the inhabitants of the Canary Islands we found higher levels of manganese, probably related to a higher degree of exposure to heavy traffic and exposure to Saharan dust of the people living in this region, and niobium and bismuth, probably related to the higher economic development in these islands. Our results indicate that the vicinity of both territories is not a major determinant of each other's contamination.


Assuntos
Exposição Ambiental/estatística & dados numéricos , Poluentes Ambientais/sangue , Oligoelementos/sangue , Humanos , Ilhas , Estilo de Vida , Marrocos , Espanha
10.
Artigo em Inglês | IBECS | ID: ibc-171416

RESUMO

In a global world, knowledge of imported infectious diseases is essential in daily practice, both for the microbiologist-parasitologist and the clinician who diagnoses and treats infectious diseases in returned travelers. Tropical and subtropical countries where there is a greater risk of contracting an infectious disease are among the most frequently visited tourist destinations. The SEIMC considers it appropriate to produce a consensus document that will be useful to primary care physicians as well as specialists in internal medicine, infectious diseases and tropical medicine who help treat travelers returning from tropical and sub-tropical areas with infections. Preventive aspects of infectious diseases and infections imported by immigrants are explicitly excluded here, since they have been dealt with in other SEIMC documents. Various types of professionals (clinicians, microbiologists, and parasitologists) have helped produce this consensus document by evaluating the available evidence-based data in order to propose a series of key facts about individual aspects of the topic. The first section of the document is a summary of some of the general aspects concerning the general assessment of travelers who return home with potential infections. The main second section contains the key facts (causative agents, diagnostic procedures and therapeutic measures) associated with the major infectious syndromes affecting returned travelers [gastrointestinal syndrome (acute or persistent diarrhea); febrile syndrome with no obvious source of infection; localized cutaneous lesions; and respiratory infections]. Finally, the characteristics of special traveler subtypes, such as pregnant women and immunocompromised travelers, are described (AU)


En el mundo global, el conocimiento de las enfermedades infecciosas importadas es esencial en la práctica diaria, tanto para el microbiólogo-parasitólogo como para el clínico en enfermedades infecciosas que atiende a viajeros internacionales. Entre los destinos turísticos más visitados se encuentran muchos países tropicales o subtropicales, donde el riesgo de contraer una enfermedad infecciosa es más elevado. La SEIMC ha considerado pertinente la elaboración de un documento de consenso que sirva de ayuda tanto a médicos de Atención Primaria como a especialistas en Medicina Interna, Enfermedades Infecciosas y Medicina Tropical que atienden a viajeros que regresan con infecciones tras un viaje a zonas tropicales y subtropicales. Se han excluido de forma explícita los aspectos de prevención de estas y las infecciones importadas por inmigrantes, objeto de otros documentos de la SEIMC. Varios tipos de profesionales (clínicos, microbiólogos y parasitólogos) han desarrollado este documento de consenso tras evaluar los datos disponibles basados en la evidencia para proponer una serie de datos clave acerca de este aspecto. Inicialmente se revisan los aspectos generales acerca de la evaluación general del viajero que regresa con una potencial infección. En un segundo bloque se señalan los datos clave (agentes causales, procedimientos diagnósticos y medidas terapéuticas) de los síndromes infecciosos principales en el viajero que regresa (síndrome gastrointestinal (diarrea aguda o persistente), síndrome febril sin foco aparente, lesiones cutáneas localizadas e infecciones respiratorias). Finalmente se describen las características en viajeros especiales como la viajera embarazada y el viajero inmunodeprimido (AU)


Assuntos
Humanos , Masculino , Feminino , Doenças Transmissíveis/epidemiologia , Doenças Transmissíveis/microbiologia , Consenso , Eosinofilia/epidemiologia , Doenças do Sistema Nervoso/epidemiologia , Sociedades Médicas/organização & administração , Sociedades Médicas/normas , Microbiologia , Microbiologia/organização & administração , Saúde do Viajante , Medicina de Viagem/organização & administração
11.
PLoS Negl Trop Dis ; 12(2): e0006272, 2018 02.
Artigo em Inglês | MEDLINE | ID: mdl-29474356

RESUMO

INTRODUCTION: Strongyloides stercoralis is a globally distributed nematode that causes diverse clinical symptoms in humans. Spain, once considered an endemic country, has experienced a recent increase in imported cases. The introduction of serology helps diagnosis and is currently replacing microbiological techniques in some settings, but its sensitivity is variable and can be low in immunocompromised patients. Diagnosis can only be confirmed by identification of larvae. Often, this "gold standard" can only be achieved in severe cases, such as disseminated S.stercoralis infection, or S.stercoralis hyperinfection syndrome, where parasite load is high. In addition, these clinical presentations are not well-defined. Our aim is to describe severe cases of S.stercoralis, their epidemiological profile, and their clinical details. METHODS: An observational retrospective study of disseminated S.stercoralis infection, or hyperinfection syndrome. Inclusion criteria: aged over 18, with a diagnosis of disseminated S.stercoralis infection, or hyperinfection syndrome, confirmed by visualization of larvae. Patients were identified through revision of clinical records for the period 2000-2015, in collaboration with eight reference centers throughout Spain. RESULTS: From the period 2000-2015, eighteen cases were identified, 66.7% of which were male, with a median age of 40 (range 21-70). Most of them were foreigners (94.4%), mainly from Latin America (82.3%) or Western Africa (17.6%). Only one autochthonous case was identified, from 2006. Immunosuppressive conditions were present in fourteen (77%) patients, mainly due steroids use and to retroviral coinfections (four HIV, two HTLV). Transplant preceded the clinical presentation in four of them. Other comorbidities were coinfection with HBV, Trypanosoma cruzi, Mycobacterium leprae or Aspergillus spp. All presented with digestive disorders, with 55.6% also presenting malaise. 44.4% of cases had fever, 27.8% skin complaints, and 16.7% respiratory or neurological disorders. One patient presented anemia, and one other nephrotic syndrome. Diagnosis was confirmed by identification of larvae in fresh stool samples (n = 16; 88.9%), concentration techniques (n = 6; 33.3%), larval culture (n = 5; 29.4%), or digestive biopsies (n = 8; 44%). S.stercoralis forms were identified during necropsy in one case. In addition, ten (55%) had a positive serology. All the cases were treated with ivermectin, six (33%) also received albendazole and one case received thiabendazole followed by ivermectin. All needed inpatient management, involving a mean hospitalization stay of 25 days (range 1-164). Two cases received intensive care and eventually died. CONCLUSIONS: Only eighteen cases of disseminated S.stercoralis infection/hyperinfection syndrome were identified from the 15-year period, most of which were considered to have been imported cases. Among those, immunosuppression was frequent, and mortality due to S.stercoralis was lower than previously described.


Assuntos
Doenças Transmissíveis Importadas/terapia , Gerenciamento Clínico , Strongyloides stercoralis/efeitos dos fármacos , Estrongiloidíase/epidemiologia , Estrongiloidíase/terapia , Adulto , Idoso , Albendazol/administração & dosagem , Albendazol/uso terapêutico , Animais , Antiparasitários/administração & dosagem , Antiparasitários/uso terapêutico , Doenças Transmissíveis Importadas/tratamento farmacológico , Doenças Transmissíveis Importadas/epidemiologia , Doenças Transmissíveis Importadas/parasitologia , Comorbidade , Emigrantes e Imigrantes , Fezes/parasitologia , Feminino , Humanos , Hospedeiro Imunocomprometido , Ivermectina/administração & dosagem , Ivermectina/uso terapêutico , Larva/fisiologia , Masculino , Pessoa de Meia-Idade , Encaminhamento e Consulta , Estudos Retrospectivos , Espanha/epidemiologia , Strongyloides stercoralis/isolamento & purificação , Estrongiloidíase/diagnóstico , Estrongiloidíase/tratamento farmacológico , Adulto Jovem
12.
Enferm. infecc. microbiol. clín. (Ed. impr.) ; 36(2): 120-136, feb. 2018. graf, tab, mapas
Artigo em Espanhol | IBECS | ID: ibc-170701

RESUMO

La detección de eosinofilia periférica es un motivo relativamente frecuente para la remisión de un paciente a una Unidad/Servicio de Enfermedades Infecciosas. En general, se pretende descartar una enfermedad parasitaria, tanto en personas autóctonas como en viajeros o inmigrantes. Excepcionalmente la eosinofilia relacionada con parásitos corresponde a una protozoosis, siendo los helmintos los principales agentes causales de este hallazgo hematológico. La eosinofilia puede ser el único hallazgo anormal o formar parte del cuadro clínico-biológico del paciente. Por otro lado, no todas las helmintosis se asocian de forma sistemática a eosinofilia, y el grado de la misma difiere entre las fases de la infección y el tipo de helminto. El propósito de esta revisión es un estudio sistemático de la relación entre helmintosis y eosinofilia en la literatura española, distinguiendo los casos autóctonos e importados, así como la relación con situaciones de inmunodepresión (AU)


The finding of blood eosinophilia in a patient is a relatively frequent reason to refer him/her to a Clinical Department of Infectious Diseases. The doctor usually intends to rule out a parasitic disease in the autochthonous population, travelers or immigrants. It is uncommon for an eosinophilia to be produced by protozoa infection, whereas helminth parasites are more frequently associated with an increase of eosinophil counts in the infected patient. Eosinophilia can be the only abnormal finding, or it could be part of more complex clinical manifestations suffered by the patient. Furthermore, many, but not all, helminth infections are associated with eosinophilia, and the eosinophil level (low, high) differs according to parasite stages, helminth species, and worm co-infections. The purpose of the present article is to carry out a systematic review of cases and case series on helminth infections and eosinophilia reported in Spain from 1990 to 2015, making a distinction between autochthonous and imported (immigrants and travelers) cases, and studying their relationship with immunodepression situations (AU)


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Helmintíase/epidemiologia , Eosinofilia/epidemiologia , Neurocisticercose/microbiologia , Neurocisticercose/epidemiologia , Fatores de Risco , Espanha/epidemiologia , Eosinófilos , Eosinófilos/microbiologia , Emigrantes e Imigrantes/estatística & dados numéricos , Controle Sanitário de Viajantes , Platelmintos/microbiologia , Esquistossomose/epidemiologia , Helmintíase/microbiologia , Eosinofilia/microbiologia
14.
Enferm Infecc Microbiol Clin ; 36(3): 187-193, 2018 03.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-28396090

RESUMO

In a global world, knowledge of imported infectious diseases is essential in daily practice, both for the microbiologist-parasitologist and the clinician who diagnoses and treats infectious diseases in returned travelers. Tropical and subtropical countries where there is a greater risk of contracting an infectious disease are among the most frequently visited tourist destinations. The SEIMC considers it appropriate to produce a consensus document that will be useful to primary care physicians as well as specialists in internal medicine, infectious diseases and tropical medicine who help treat travelers returning from tropical and sub-tropical areas with infections. Preventive aspects of infectious diseases and infections imported by immigrants are explicitly excluded here, since they have been dealt with in other SEIMC documents. Various types of professionals (clinicians, microbiologists, and parasitologists) have helped produce this consensus document by evaluating the available evidence-based data in order to propose a series of key facts about individual aspects of the topic. The first section of the document is a summary of some of the general aspects concerning the general assessment of travelers who return home with potential infections. The main second section contains the key facts (causative agents, diagnostic procedures and therapeutic measures) associated with the major infectious syndromes affecting returned travelers [gastrointestinal syndrome (acute or persistent diarrhea); febrile syndrome with no obvious source of infection; localized cutaneous lesions; and respiratory infections]. Finally, the characteristics of special traveler subtypes, such as pregnant women and immunocompromised travelers, are described.


Assuntos
Doenças Transmissíveis Importadas/diagnóstico , Doenças Transmissíveis Importadas/terapia , Humanos , Viagem
15.
Enferm Infecc Microbiol Clin ; 36(2): 120-136, 2018 02.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-26827134

RESUMO

The finding of blood eosinophilia in a patient is a relatively frequent reason to refer him/her to a Clinical Department of Infectious Diseases. The doctor usually intends to rule out a parasitic disease in the autochthonous population, travelers or immigrants. It is uncommon for an eosinophilia to be produced by protozoa infection, whereas helminth parasites are more frequently associated with an increase of eosinophil counts in the infected patient. Eosinophilia can be the only abnormal finding, or it could be part of more complex clinical manifestations suffered by the patient. Furthermore, many, but not all, helminth infections are associated with eosinophilia, and the eosinophil level (low, high) differs according to parasite stages, helminth species, and worm co-infections. The purpose of the present article is to carry out a systematic review of cases and case series on helminth infections and eosinophilia reported in Spain from 1990 to 2015, making a distinction between autochthonous and imported (immigrants and travelers) cases, and studying their relationship with immunodepression situations.


Assuntos
Eosinofilia/epidemiologia , Helmintíase/epidemiologia , África/etnologia , Emigrantes e Imigrantes , Doenças Endêmicas , Eosinofilia/etiologia , Geografia Médica , Helmintíase/sangue , Helmintíase/parasitologia , Humanos , Hospedeiro Imunocomprometido , Enteropatias Parasitárias/epidemiologia , América Latina/etnologia , Espanha/epidemiologia , Doença Relacionada a Viagens
16.
PLoS One ; 12(12): e0189449, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-29284005

RESUMO

BACKGROUND: Strongyloides stercoralis is a parasite that causes strongyloidiasis, a neglected tropical disease. S. stercoralis is a soil-transmitted helminth that is widely distributed in tropical and subtropical regions of the world. Strongyloidiasis can occur without any symptoms or as a chronic infection characterized by mild, unspecific symptoms such as pruritus, abdominal pain or discomfort; respiratory impairment also may manifest as a potentially fatal hyperinfection or disseminated infection. Most studies on strongyloidiasis in Spain have been related to chronic forms in immigrants or travellers from endemic zones and have mainly analysed out-patient populations. Studies of the impact of strongyloidiasis cases admitted to hospitals in Spain are lacking. Therefore, the aim of this study was to analyse the impact of strongyloidiasis in hospital care in Spain. METHODOLOGY: We designed a retrospective descriptive study using the Minimum Basic Data Set (MBDS, CMBD in Spanish) for inpatients with ICD-9: 127.2 (strongyloidiasis) diagnoses admitted to hospitals in the Spanish National Health System between 1998 and 2014. PRINCIPAL FINDINGS: A total of 507 hospitalizations with diagnosis of strongyloidiasis were recorded, 324 cases (63.9%) were males. The mean (±SD) age was 42.1±20.1 years. The impact of strongyloidiasis on the total population of Spain was 0.06 cases per 105 person-years, and the infection burden increased progressively over time (from 0.01 cases per 105 person-years in 1999 to 0.10 cases per 105 person-years in 2014). 40 cases (7.9%) died. The total cost was approximately €8,681,062.3, and the mean cost per patient was €17,122.4±97,968.8. CONCLUSIONS: Our data suggest that strongyloidiasis is frequent in Spain and is increasing in incidence. Therefore, it would be desirable to improve the oversight and surveillance of this condition. Due to the fact that strongyloidiasis can be fatal, we believe that there is a need to establish risk categories for inclusion in national guidelines/protocols for screening individuals at risk of developing strongyloidiasis.


Assuntos
Vigilância da População , Estrongiloidíase/epidemiologia , Adulto , Feminino , História do Século XX , História do Século XXI , Humanos , Masculino , Pessoa de Meia-Idade , Espanha/epidemiologia , Adulto Jovem
17.
Enferm. infecc. microbiol. clín. (Ed. impr.) ; 35(10): 655-658, dic. 2017. tab
Artigo em Espanhol | IBECS | ID: ibc-169566

RESUMO

La mayor parte de los casos de fiebre de duración intermedia (FDI) en España corresponden a enfermedades infecciosas (principalmente fiebre Q y rickettsiosis). En la práctica clínica el diagnóstico causal de estas entidades se basa en el inmunodiagnóstico, con una escasa utilidad en fases precoces. Por ello, el objetivo de este trabajo fue la evaluación de la utilidad de técnicas moleculares en el diagnóstico precoz de fiebre Q y rickettsiosis en pacientes con FDI. Se estudió mediante PCR la presencia de material genético de Coxiella burnetii y Rickettsia spp. en muestras sanguíneas de 271 pacientes con FDI. La especificidad de ambas técnicas es elevada, permitiendo el diagnóstico en casos no diagnosticados mediante detección de anticuerpos específicos. Estos datos sugieren que el empleo de técnicas moleculares, con una adecuada selección de la muestra de estudio y el empleo de cebadores adecuados, es un elemento útil en el diagnóstico precoz de las principales causas de FDI, principalmente si la serología es negativa o no es concluyente (AU)


Most cases of fever of intermediate duration (FDI) in Spain are associated with infectious diseases (mainly Q fever and rickettsia infections). In clinical practice, the causal diagnosis of these entities is based on immunodiagnostic techniques, which are of little help in the early stages. Therefore, the aim of this study was to evaluate the usefulness of molecular techniques for the early diagnosis of Q fever and rickettsia diseases in patients with FDI. A PCR method was used to detect the presence of genetic material of Coxiella burnetii and Rickettsia spp. in blood specimens from 271 patients with FDI. The specificity of both techniques is high, allowing diagnosis in cases undiagnosed by specific antibodies detection. These data suggest that the use of molecular techniques, with proper selection of the study specimen, and using appropriate primers is a useful tool in the early diagnosis of the main causes of FDI, especially if serology is negative or inconclusive (AU)


Assuntos
Humanos , Febre Q/diagnóstico , Febre Q/microbiologia , Diagnóstico Precoce , Infecções por Rickettsiaceae/microbiologia , Coxiella burnetii/isolamento & purificação , Infecções por Rickettsiaceae/complicações , Testes Imunológicos/métodos , Testes Sorológicos/métodos
18.
Rev. esp. quimioter ; 30(6): 436-442, dic. 2017. graf, mapas
Artigo em Espanhol | IBECS | ID: ibc-169397

RESUMO

Introducción. El objetivo fue analizar los síndromes febriles en pacientes que regresan de regiones tropicales, atendidos en la Unidad de Enfermedades Infecciosas y Medicina Tropical (UEIMT) de nuestro centro. El conocimiento de estas enfermedades persigue realizar un diagnóstico precoz y, de esta forma, evitar la emergencia y diseminación de enfermedades importadas, así como establecer actividades preventivas adecuadas. Métodos. Se realizó un estudio observacional descriptivo transversal, seleccionando de la cohorte de viajeros atendidos en la UEIMT entre 1998 y 2013 aquéllos que consultaban al regreso con fiebre (n = 247). Se analizaron las características demográficas relativas al viaje, así como motivos de consulta y el diagnóstico final. Resultados. Se incluyeron 241 viajeros con fiebre al regreso. Los diagnósticos más comunes fueron: fiebre autolimitada sin foco (29,1%), malaria (25,1%), gastroenteritis invasiva (15,4%), otras infecciones bacterianas (7,4%) e infecciones parenquimatosas genitourinarias (4,5%). De todos los casos sólo un 8,5% requirió ingreso hospitalario, no registrándose ningún caso de mortalidad. Conclusiones. En la serie presentada existen datos comunes con otras publicadas (malaria como enfermedad fundamental, dificultades en el diagnóstico) y otros diferentes (menor número de consultas pre-viaje e ingresos, mayor incidencia de prostatitis y menor número de casos de dengue) (AU)


Background. 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) (AU)


Assuntos
Humanos , Febre/etiologia , Doenças Negligenciadas/epidemiologia , Doenças Transmissíveis Emergentes/epidemiologia , Zona Tropical , Viagem , Fatores de Risco , Estudos Retrospectivos , Malária/epidemiologia
19.
Environ Int ; 109: 20-28, 2017 12.
Artigo em Inglês | MEDLINE | ID: mdl-28923461

RESUMO

Pollution by heavy metals and more recently by rare earth elements (REE) and other minor elements (ME) has increased due in part to their high use in technological and electronic devices. This contamination can become very relevant in those sites where e-waste is improperly processed, as it is the case in many countries of the African continent. Exposure to some toxic elements has been associated to certain hematological disorders, specifically anemia. In this study, the concentrations of 48 elements (including REE and other ME) were determined by ICP-MS in whole blood samples of sub-Saharan immigrants with anemia (n=63) and without anemia (n=78). We found that the levels of Fe, Cr, Cu, Mn, Mo, and Se were significantly higher in the control group than in the anemia group, suggesting that anemia was mainly due to nutritional deficiencies. However, since other authors have suggested that in addition to nutritional deficiency, exposure to some elements may influence hemoglobin levels, we wanted to explore the role of a broad panel of toxic and "emerging" elements in hemoglobin deficiency. We found that the levels of Ag, As, Ba, Bi, Ce, Eu, Er, Ga, La, Nb, Nd, Pb, Pr, Sm, Sn, Ta, Th, Tl, U and V were higher in anemic participants than in controls. For most of these elements an inverse correlation with hemoglobin concentration was found. Some of them also correlated inversely with blood iron levels, pointing to the possibility that a higher rate of intestinal uptake of these could exist in relation to a nutritional deficiency of iron. However, the higher levels of Pb, and the group of REE and other ME in anemic participants were independent of iron levels, pointing to the possibility that these elements could play a role in the development of anemia.


Assuntos
Anemia/sangue , Resíduo Eletrônico , Emigrantes e Imigrantes , Poluição Ambiental/efeitos adversos , Substâncias Perigosas/sangue , Metais Pesados/sangue , Metais Terras Raras/sangue , Adolescente , Adulto , África ao Sul do Saara/etnologia , Anemia/etnologia , Anemia/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Espanha , Adulto Jovem
20.
Vector Borne Zoonotic Dis ; 17(9): 630-634, 2017 09.
Artigo em Inglês | MEDLINE | ID: mdl-28759337

RESUMO

Coxiella burnetii, the etiological agent of human Q fever, can infect mammals, birds, and arthropods. The Canary Islands (Spain) are considered an endemic territory, with a high prevalence in both humans and livestock. Nonetheless, there is no epidemiological information about the wild and peridomestic cycles of C. burnetii. Tissue samples from rodents on farms (100) and wild rabbits (129) were collected and assessed by PCR to detect C. burnetii DNA. In parallel, ticks were also collected from vegetation (1169), livestock (335), domestic dogs (169), and wild animals (65). Globally, eight rodents (8%) and two rabbits (1.5%) were found to be positive, with the spleen being the most affected organ. Tick species identified were Hyalomma lusitanicum, Rhipicephalus turanicus, Rhipicephalus sanguineus, and Rhipicephalus pusillus. Hyalomma lusitanicum (80%) was the main species identified in vegetation, livestock, and wild animals, whereas Rhipicephalus sanguineus was the most prevalent in domestic dogs. Overall, C. burnetii DNA was detected in 6.1% of the processed ticks, distributed between those removed from livestock (11.3%), domestic dogs (6.9%), and from wild animals (6%). Ticks from vegetation were all negative. Results suggest that, in the Canary Islands, C. burnetii develops in a peridomestic rather than a wild cycle.


Assuntos
Animais Selvagens , Coxiella burnetii/isolamento & purificação , DNA Bacteriano/isolamento & purificação , Gado , Febre Q/veterinária , Animais , Doenças Endêmicas , Febre Q/epidemiologia , Espanha/epidemiologia , Zoonoses
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