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1.
Malar J ; 18(1): 242, 2019 Jul 17.
Artigo em Inglês | MEDLINE | ID: mdl-31315624

RESUMO

BACKGROUND: The importance of submicroscopic malaria infections in high-transmission areas could contribute to maintain the parasite cycle. Regarding non-endemic areas, its importance remains barely understood because parasitaemia in these afebrile patients is usually below the detection limits for microscopy, hence molecular techniques are often needed for its diagnosis. In addition to this, the lack of standardized protocols for the screening of submicroscopic malaria in immigrants from endemic areas may underestimate the infection with Plasmodium spp. The aim of this study was to assess the prevalence of submicroscopic malaria in afebrile immigrants living in a non-endemic area. METHODS: A prospective, observational, multicentre study was conducted. Afebrile immigrants were included, microscopic observation of Giemsa-stained thin and thick blood smears, and two different molecular techniques detecting Plasmodium spp. were performed. Patients with submicroscopic malaria were defined as patients with negative blood smears and detection of DNA of Plasmodium spp. with one or both molecular techniques. Demographic, clinical, analytical and microbiological features were recorded and univariate analysis by subgroups was carried out with STATA v15. RESULTS: A total of 244 afebrile immigrants were included in the study. Of them, 14 had a submicroscopic malaria infection, yielding a prevalence of 5.7% (95% confidence interval 3.45-9.40). In 71.4% of the positive PCR/negative microscopy cases, Plasmodium falciparum alone was the main detected species (10 out of the 14 patients) and in 4 cases (28.6%) Plasmodium vivax or Plasmodium ovale were detected. One patient had a mixed infection including three different species. CONCLUSIONS: The prevalence of submicroscopic malaria in afebrile immigrants was similar to that previously described in Spain. Plasmodium vivax and P. ovale were detected in almost a third of the submicroscopic infections. Screening protocols for afebrile immigrants with molecular techniques could be useful for a proper management of these patients.


Assuntos
Doenças Assintomáticas/epidemiologia , Malária/epidemiologia , Plasmodium falciparum/isolamento & purificação , Plasmodium ovale/isolamento & purificação , Plasmodium vivax/isolamento & purificação , Adulto , Coinfecção/epidemiologia , Coinfecção/parasitologia , Emigrantes e Imigrantes , Feminino , Humanos , Malária/parasitologia , Malária Falciparum/epidemiologia , Malária Falciparum/parasitologia , Malária Vivax/epidemiologia , Malária Vivax/parasitologia , Masculino , Microscopia , Pessoa de Meia-Idade , Prevalência , Espanha/epidemiologia
2.
Malar J ; 17(1): 399, 2018 Oct 30.
Artigo em Inglês | MEDLINE | ID: mdl-30376868

RESUMO

BACKGROUND: Few previous retrospective studies suggest that Plasmodium ovale wallikeri seems to have a longer latency period and produces deeper thrombocytopaenia than Plasmodium ovale curtisi. Prospective studies were warranted to better assess interspecies differences. METHODS: Patients with imported P. ovale spp. infection diagnosed by thick or thin film, rapid diagnostic test (RDT) or polymerase chain reaction (PCR) were recruited between March 2014 and May 2017. All were confirmed by DNA isolation and classified as P. o. curtisi or P. o. wallikeri using partial sequencing of the ssrRNA gene. Epidemiological, analytical and clinical differences were analysed by statistical methods. RESULTS: A total of 79 samples (35 P. o. curtisi and 44 P. o. wallikeri) were correctly genotyped. Males predominate in wallikeri group (72.7%), whereas were 48.6% in curtisi group. Conversely, 74.3% of curtisi group were from patients of African ethnicity, whilst 52.3% of Caucasians were infected by P. o. wallikeri. After performing a multivariate analysis, more thrombocytopaenic patients (p = 0.022), a lower number of platelets (p = 0.015), a higher INR value (p = 0.041), and shorter latency in Caucasians (p = 0.034) were significantly seen in P. o. wallikeri. RDT sensitivity was 26.1% in P. o. curtisi and 42.4% in P. o. wallikeri. Nearly 20% of both species were diagnosed only by PCR. Total bilirubin over 3 mg/dL was found in three wallikeri cases. Two patients with curtisi infection had haemoglobin under 7 g/dL, one of them also with icterus. A wallikeri patient suffered from haemophagocytosis. Chemoprophylaxis failed in 14.8% and 35% of curtisi and wallikeri patients, respectively. All treated patients with various anti-malarials which included artesunate recovered. Diabetes mellitus was described in 5 patients (6.32%), 4 patients of wallikeri group and 1 curtisi. CONCLUSIONS: Imported P. o. wallikeri infection may be more frequent in males and Caucasians. Malaria caused by P. o. wallikeri produces more thrombocytopaenia, a higher INR and shorter latency in Caucasians and suggests a more pathogenic species. Severe cases can be seen in both species. Chemoprophylaxis seems less effective in P. ovale spp. infection than in P. falciparum, but any anti-malarial drug is effective as initial treatment. Diabetes mellitus could be a risk factor for P. ovale spp. infection.


Assuntos
Doenças Transmissíveis Importadas/epidemiologia , Malária/epidemiologia , Plasmodium ovale/fisiologia , Adulto , África/etnologia , Doenças Transmissíveis Importadas/classificação , Doenças Transmissíveis Importadas/complicações , Doenças Transmissíveis Importadas/parasitologia , Europa (Continente)/epidemiologia , Europa (Continente)/etnologia , Feminino , Genótipo , Humanos , Incidência , Malária/classificação , Malária/complicações , Malária/parasitologia , Masculino , Pessoa de Meia-Idade , Plasmodium ovale/classificação , Plasmodium ovale/genética , Prevalência , Estudos Prospectivos , Fatores Sexuais , Especificidade da Espécie , Adulto Jovem
3.
PLoS Negl Trop Dis ; 12(11): e0006917, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30383753

RESUMO

BACKGROUND: Loa loa infection is endemic in limited areas of West-Central Africa. Loiasis has been associated with excess mortality, but clinical studies on its treatment are scant, particularly outside endemic areas, due to the rarity of cases diagnosed. METHODOLOGY/PRINCIPAL FINDINGS: With this retrospective TropNet (European Network for Tropical Medicine and Travel Health) study, we aimed at outlining the treatment schedules followed by different reference centers for tropical medicine across Europe. We gathered information about 238 cases of loiasis, 165 of which had follow up data. The regimens followed by the different centers were heterogeneous. The drugs most frequently administered were: diethylcarbamazine alone (74/165, 45.1%), ivermectin alone (41/165, 25%), albendazole + ivermectin (21/164, 11.6%), ivermectin + diethylcarbamazine (16/165, 9.7%). CONCLUSIONS/SIGNIFICANCE: The management of loiasis substantially differs across specialized travel clinics in Europe. These discrepancies could be due to different local protocols as well as to (un)availability of the drugs. An harmonization of clinical protocols for the treatment of loiasis would be suggested across reference centers for tropical medicine in Europe.


Assuntos
Filaricidas/uso terapêutico , Loa/efeitos dos fármacos , Loíase/tratamento farmacológico , Adulto , Albendazol/uso terapêutico , Animais , Dietilcarbamazina/uso terapêutico , Europa (Continente) , Humanos , Ivermectina/uso terapêutico , Loa/fisiologia , Loíase/parasitologia , Masculino , Estudos Retrospectivos , Viagem , Medicina Tropical , Adulto Jovem
4.
Malar J ; 17(1): 314, 2018 Aug 29.
Artigo em Inglês | MEDLINE | ID: mdl-30157862

RESUMO

BACKGROUND: Malaria is currently the most important human parasitic disease in the world responsible for high morbidity and mortality. Appropriate diagnostic methods are essential for early detection. Microscopy examination remains the gold standard, although molecular techniques have higher sensitivity and are very useful in cases of low parasitaemia and mixed infections. The objective of this study was to evaluate a new commercial molecular diagnostic technique. METHODS: A prospective, observational, multicentre study was performed between January 2015 and April 2017. All participants were immigrants from malaria-endemic areas, who were divided into two groups: asymptomatic group and symptomatic. Samples from both groups were evaluated by a rapid diagnostic test (ImmunoQuick® Malaria + 4 RDT), microscopy examination, and two commercial molecular malaria tests (FTD Malaria and FTD Malaria Differentiation), then compared against an in-house reference PCR technique. RESULTS: In all, 250 patients were included: 164 (65.6%) in the asymptomatic group, and 86 (34.4%) in the symptomatic group. There were seven cases of asymptomatic parasitaemia (prevalence = 2.8%) that were detected only by molecular methods. In the symptomatic group, there were seven cases of submicroscopic malaria. The main species detected was Plasmodium falciparum (96.6%). The commercial molecular technique had higher sensitivity than the other methods (S = 96%) and a high rate of concordance with the in-house reference PCR technique (Kappa score = 0.93). CONCLUSIONS: The molecular techniques, although slower than microscopy, have adequate diagnostic accuracy and are very useful for the detection of P. falciparum in cases with low parasitaemia.


Assuntos
Testes Diagnósticos de Rotina/métodos , Malária Falciparum/epidemiologia , Malária Vivax/epidemiologia , Malária/diagnóstico , Técnicas de Diagnóstico Molecular/métodos , Parasitemia/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Cidades , Emigrantes e Imigrantes , Humanos , Malária Falciparum/parasitologia , Malária Vivax/parasitologia , Pessoa de Meia-Idade , Parasitemia/parasitologia , Plasmodium falciparum/isolamento & purificação , Plasmodium vivax/isolamento & purificação , Valor Preditivo dos Testes , Prevalência , Estudos Prospectivos , Espanha/epidemiologia , Adulto Jovem
5.
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
6.
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
7.
Rev. esp. quimioter ; 30(1): 62-78, feb. 2017. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-159565

RESUMO

Los datos sobre prevalencia de la eosinofilia importada entre viajeros e inmigrantes la sitúan entre un 8%-28,5%. El estudio etiológico es en ocasiones complejo, y en función de lo exhaustivo del estudio y de la población analizada, se ha podido identificar una causa parasitaria en el 17%-75,9% de los individuos. Entre las dificultades que se encuentran para comparar los estudios están la heterogeneidad de las poblaciones estudiadas, el tipo de recogida (prospectiva/retrospectiva) y distintos protocolos diagnósticos. En este documento se detallan las recomendaciones del grupo de expertos de la Sociedad Española de Medicina Tropical y Salud Internacional (SEMTSI) para el diagnóstico y tratamiento de la eosinofilia importada (AU)


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 (AU)


Assuntos
Humanos , Masculino , Feminino , Eosinofilia/diagnóstico , Eosinofilia/terapia , Emigrantes e Imigrantes/estatística & dados numéricos , Conferências de Consenso como Assunto , Helmintíase/diagnóstico , Helmintos , Helmintos/isolamento & purificação , Imunoglobulina E/análise , Controle Sanitário de Viajantes , Sociedades Médicas/organização & administração , Sociedades Médicas/normas , Estudos Prospectivos , Saúde do Viajante , Helmintíase/epidemiologia , Estudos Retrospectivos , Eosinofilia/classificação , Ensaio de Imunoadsorção Enzimática/métodos , Western Blotting , Técnicas Imunoenzimáticas
8.
Malar J ; 16(1): 20, 2017 01 07.
Artigo em Inglês | MEDLINE | ID: mdl-28061871

RESUMO

BACKGROUND: Microscopy and rapid diagnosis tests have a limited sensitivity in diagnosis of malaria by Plasmodium ovale. The LAMP kit (LoopAMP®) can be used in the field without special equipment and could have an important role in malaria control programmes in endemic areas and for malaria diagnosis in returned travellers. The performance of the Pan primer of the kit in detecting malaria by P. ovale was compared with the results of standard nPCR in samples of patients returning from P. ovale endemic areas. METHODS: Plasmodium ovale positive samples (29, tested by PCR and/or microscopy) and malaria negative specimens (398, tested by microscopy and PCR) were collected in different hospitals of Europe from June 2014 to March 2016 and frozen at -20 °C. Boil and spin method was used to extract DNA from all samples and amplification was performed with LoopAMP® MALARIA kit (Eiken Chemical, Japan) in an automated turbidimeter (Eiken 500). The results of LAMP read by turbidimetry and with the naked eye were compared. RESULTS: The kit showed a sensitivity of 100% and a specificity of 97.24% with positive and negative predictive values of 72.5 and 100%, respectively. Naked eyed readings were in accordance with turbidimetry readings (sensitivity, 92.5%, specificity, 98.96% and positive and negative predictive values, respectively, 90.24 and 99.22%). The limit of detection of LAMP assay for P. ovale was between 0.8 and 2 parasites/µl. CONCLUSIONS: The Pan primer of the Malaria kit LoopAMP® can detect P. ovale at very low-levels and showed a predictive negative value of 100%. This tool can be useful in malaria control and elimination programmes and in returned travellers from P. ovale endemic areas. Naked eye readings are equivalent to automated turbidimeter readings in specimens obtained with EDTA.


Assuntos
Malária/diagnóstico , Malária/parasitologia , Técnicas de Diagnóstico Molecular/métodos , Técnicas de Amplificação de Ácido Nucleico/métodos , Plasmodium ovale/isolamento & purificação , Europa (Continente) , Humanos , Plasmodium ovale/genética , Valor Preditivo dos Testes , Sensibilidade e Especificidade
9.
Pediatr Infect Dis J ; 35(4): 392-5, 2016 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-26974746

RESUMO

BACKGROUND: Gastrointestinal symptoms are a common cause of consultation about children traveling to or coming from developing countries. The aim of this study was to identify the risk factors associated with gastrointestinal syndrome in children who travel. METHODS: A prospective observational analytical and multicenter study was performed within +Redivi, a Spanish Tropical Medicine network on imported infections, from January 2009 to December 2013. All participants aged 16 years and younger were included in the analysis. Ethical approval was obtained from all the participating centers. RESULTS: A total of 606 children ≤16 years of age were registered in the +Redivi database during the study period. Median age was 8.7 years (interquartile range, 4.4-12.4 years), 65.8% (399/606) were immigrants, 90% were >2 years old and 54% were male. Median travel duration, excluding immigrants, was 50 days (interquartile range, 30-150 days). Children with gastrointestinal symptoms represented 13.5% (82/606) of total consultations. A significant association was found in bivariate analysis between gastrointestinal disorder and age <2 years (P < 0.01) and travel duration (P = 0.046). Immigrants had less gastrointestinal disorders than tourists (P < 0.05). The most prevalent infection was protozoan in 23.4% (142/606), and Giardia intestinalis was the most common pathogen in 10.1% (61/606) of total children. Independent risk factors for gastrointestinal symptoms were tourist and traveler child visiting friends and relatives (P = 0.03), travel duration <90 days (P = 0.008) and bacterial cause (P < 0.001). CONCLUSIONS: Traveling children who developed a gastrointestinal syndrome represented 13.5% of the total pediatric consultations in +Redivi. Independent risk factors were tourist or traveler visiting friends and relatives, travel duration <90 days and bacterial infection. G. intestinalis was the most common infectious agent causing a gastrointestinal disorder in the traveler children.


Assuntos
Diarreia/epidemiologia , Diarreia/etiologia , Viagem , Criança , Pré-Escolar , Diarreia/diagnóstico , Feminino , Humanos , Masculino , Razão de Chances , Estudos Prospectivos , Fatores de Risco , Espanha/epidemiologia
10.
Enferm. infecc. microbiol. clín. (Ed. impr.) ; 34(3): 191-204, mar. 2016. tab
Artigo em Espanhol | IBECS | ID: ibc-150734

RESUMO

La malaria es potencialmente mortal y precisa un diagnóstico y un tratamiento urgentes. En zonas endémicas se está reduciendo su incidencia y mortalidad. La clínica es inespecífica, por lo que en malarias importadas es vital el antecedente de estancia en una zona malárica. La terapia de elección en Plasmodium falciparum son los tratamientos combinados con artemisininas, la cloroquina en la mayoría de los no P. falciparum y el artesunato intravenoso si existen criterios de gravedad. Las infecciones humanas por protozoos intestinales son de distribución mundial, con una alta morbimortalidad global. Producen diarrea y a veces enfermedad invasiva, aunque la mayoría son asintomáticas. En nuestro medio, las poblaciones de mayor riesgo son los niños —incluyendo adoptados en el extranjero—, inmunodeprimidos, viajeros, inmigrantes y personas en contacto con animales o que practican sexo oral-anal. El examen microscópico diagnóstico tiene baja sensibilidad, mejorando con métodos de detección de antígenos o moleculares. Recientemente están apareciendo resistencias a los antiparasitarios (AU)


Malaria is life threatening and requires urgent diagnosis and treatment. Incidence and mortality are being reduced in endemic areas. Clinical features are unspecific so in imported cases it is vital the history of staying in a malarious area. The first line treatments for Plasmodium falciparum are artemisinin combination therapies, chloroquine in most non-falciparum and intravenous artesunate if any severity criteria. Human infections with intestinal protozoa are distributed worldwide with a high global morbid-mortality. They cause diarrhea and sometimes invasive disease, although most are asymptomatic. In our environment populations at higher risk are children, including adopted abroad, immune-suppressed, travelers, immigrants, people in contact with animals or who engage in oral-anal sex. Diagnostic microscopic examination has low sensitivity improving with antigen detection or molecular methods. Antiparasitic resistances are emerging lately (AU)


Assuntos
Humanos , Malária/complicações , Infecções por Protozoários/complicações , Diarreia/microbiologia , Enteropatias Parasitárias/microbiologia , Antiprotozoários/uso terapêutico , Plasmodium falciparum/patogenicidade , Artemisininas/uso terapêutico
11.
Enferm Infecc Microbiol Clin ; 34(3): 191-204, 2016 Mar.
Artigo em Espanhol | MEDLINE | ID: mdl-26832999

RESUMO

Malaria is life threatening and requires urgent diagnosis and treatment. Incidence and mortality are being reduced in endemic areas. Clinical features are unspecific so in imported cases it is vital the history of staying in a malarious area. The first line treatments for Plasmodium falciparum are artemisinin combination therapies, chloroquine in most non-falciparum and intravenous artesunate if any severity criteria. Human infections with intestinal protozoa are distributed worldwide with a high global morbid-mortality. They cause diarrhea and sometimes invasive disease, although most are asymptomatic. In our environment populations at higher risk are children, including adopted abroad, immune-suppressed, travelers, immigrants, people in contact with animals or who engage in oral-anal sex. Diagnostic microscopic examination has low sensitivity improving with antigen detection or molecular methods. Antiparasitic resistances are emerging lately.


Assuntos
Intestinos/parasitologia , Malária Falciparum/epidemiologia , Animais , Antimaláricos/uso terapêutico , Cloroquina/uso terapêutico , Humanos , Incidência , Malária Falciparum/tratamento farmacológico
12.
Enferm. infecc. microbiol. clín. (Ed. impr.) ; 33(6): e1-e13, jun.-jul. 2015. tab, ilus
Artigo em Espanhol | IBECS | ID: ibc-142124

RESUMO

La malaria es una de las enfermedades tropicales importadas que con más frecuencia se diagnostican en nuestro país. La mortalidad en viajeros que adquieren la enfermedad oscila alrededor del 2-3%, siendo el principal factor asociado al mal pronóstico el retraso diagnóstico y del inicio del tratamiento antiparasitario. Los casos de malaria importada suelen presentarse con fiebre, cefalea y artromialgias, aunque pueden aparecer otros síntomas. El diagnóstico se debe realizar de forma urgente, a través de gota gruesa o pruebas de diagnóstico rápido, y extensión sanguínea. El tratamiento debe ser instaurado lo antes posible. En los casos de malaria grave, el uso de artemisininas intravenosas ha demostrado ser superior al uso de quinina intravenosa. En este documento se detallan las recomendaciones del grupo de expertos de la Sociedad Española de Medicina Tropical y Salud Internacional (SEMTSI) para el diagnóstico y tratamiento de la malaria importada (AU)


Malaria is a common parasitic disease diagnosed in the returned traveler. Mortality in travelers with imported malaria is around 2-3%, and one of the main factors associated with poor prognosis is the delay in the diagnosis and treatment. Imported malaria cases usually present with fever, headache and myalgia, but other symptoms may appear. The diagnosis should be performed as soon as possible, using thick smear or rapid diagnostic tests, and a blood smear. Treatment should be initiated urgently. In cases of severe malaria, the use of intravenous artemisinins has proved to be superior to intravenous quinine. This document reviews the recommendations of the expert group of the Spanish Society of Tropical Medicine and International Health (SEMTSI) for the diagnosis and treatment of imported malaria in Spain (AU)


Assuntos
Adulto , Criança , Feminino , Humanos , Recém-Nascido , Masculino , Gravidez , Malária/diagnóstico , Malária/tratamento farmacológico , Malária/epidemiologia , Malária/mortalidade , Antimaláricos/uso terapêutico , Malária Falciparum/tratamento farmacológico , Artemisininas/uso terapêutico , Quinina/uso terapêutico , Parasitemia/microbiologia , Monitoramento Epidemiológico/tendências , Técnicas e Procedimentos Diagnósticos , Artemisininas/administração & dosagem , Quinina/administração & dosagem , Complicações na Gravidez , Doenças do Recém-Nascido , Malária Vivax , Malária Cerebral , Plasmodium ovale , Plasmodium knowlesi , Espanha/epidemiologia
13.
Enferm Infecc Microbiol Clin ; 33(6): e1-e13, 2015.
Artigo em Espanhol | MEDLINE | ID: mdl-24656967

RESUMO

Malaria is a common parasitic disease diagnosed in the returned traveler. Mortality in travelers with imported malaria is around 2-3%, and one of the main factors associated with poor prognosis is the delay in the diagnosis and treatment. Imported malaria cases usually present with fever, headache and myalgia, but other symptoms may appear. The diagnosis should be performed as soon as possible, using thick smear or rapid diagnostic tests, and a blood smear. Treatment should be initiated urgently. In cases of severe malaria, the use of intravenous artemisinins has proved to be superior to intravenous quinine. This document reviews the recommendations of the expert group of the Spanish Society of Tropical Medicine and International Health (SEMTSI) for the diagnosis and treatment of imported malaria in Spain.


Assuntos
Antimaláricos/uso terapêutico , Malária/diagnóstico , Malária/terapia , Adulto , Algoritmos , Anticonvulsivantes/uso terapêutico , Antimaláricos/administração & dosagem , Transfusão de Sangue , Criança , Terapia Combinada , Comorbidade , Diagnóstico Precoce , Feminino , Hidratação , Humanos , Malária/epidemiologia , Malária/transmissão , Parasitemia/diagnóstico , Parasitologia/métodos , Gravidez , Complicações Infecciosas na Gravidez/diagnóstico , Complicações Infecciosas na Gravidez/terapia , Sociedades Médicas , Espanha/epidemiologia , Viagem , Medicina Tropical
14.
Emerg Infect Dis ; 20(3): 409-16, 2014 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-24572501

RESUMO

Sequencing data from Plasmodium ovale genotypes co-circulating in multiple countries support the hypothesis that P. ovale curtisi and P. ovale wallikeri are 2 separate species. We conducted a multicenter, retrospective, comparative study in Spain of 21 patients who had imported P. ovale curtisi infections and 14 who had imported P. ovale wallikeri infections confirmed by PCR and gene sequencing during June 2005-December 2011. The only significant finding was more severe thrombocytopenia among patients with P. ovale wallikeri infection than among those with P. ovale curtisi infection (p = 0.031). However, we also found nonsignificant trends showing that patients with P. ovale wallikeri infection had shorter time from arrival in Spain to onset of symptoms, lower level of albumin, higher median maximum core temperature, and more markers of hemolysis than did those with P. ovale curtisi infection. Larger, prospective studies are needed to confirm these findings.


Assuntos
Malária/epidemiologia , Malária/parasitologia , Plasmodium ovale/classificação , Adolescente , Adulto , Criança , Comorbidade , Feminino , História do Século XXI , Humanos , Malária/complicações , Malária/diagnóstico , Malária/história , Masculino , Pessoa de Meia-Idade , Plasmodium ovale/genética , Estudos Retrospectivos , Espanha/epidemiologia , Trombocitopenia/diagnóstico , Trombocitopenia/etiologia , Adulto Jovem
15.
Enferm. infecc. microbiol. clín. (Ed. impr.) ; 30(9): 528-534, nov. 2012. tab
Artigo em Espanhol | IBECS | ID: ibc-104169

RESUMO

Introducción: Las enfermedades importadas por viajeros e inmigrantes son un objeto prioritario en la prevención de la emergencia de las enfermedades infecciosas en el siglo xxi. Existen registros internacionales sobre patología importada, pero en España no hay un sistema similar. Material y métodos En 2009 se crea la red cooperativa +Redivi, formada por 14 centros sanitarios nacionales. +Redivi recoge datos demográficos, relativos al viaje/inmigración y al proceso infeccioso en formularios informatizados. Resultados Desde enero de 2009 a octubre de 2011 se registran 4.570 pacientes y se describen los principales datos demográficos (edad, sexo, presencia de inmunosupresión), relativos al viaje (destino, duración, tiempo en acudir a consulta desde la llegada del viaje) o al proceso migratorio (país de procedencia, tiempo en acudir a consulta desde la llegada a España), medidas preventivas realizadas (solicitud de consejo previaje, indicación de quimioprofilaxis antimalárica, fármaco utilizado y si se hizo correctamente), motivo de consulta y diagnósticos finales de viajeros, inmigrantes e inmigrantes que viajan. Así mismo, se describen en los 3 grupos los diagnósticos más frecuentes en los pacientes asintomáticos que acudieron a realizarse un examen de salud (..) (AU)


Introduction: Imported diseases by travellers and immigrants are a priority in the prevention of emerging infectious diseases in the 21st century. There are international records on imported diseases, but no such records are available in Spain. Material and methods: The cooperative network +Redivi was created in 2009 and consists of 11 national healthcare centres. +Redivi collects demographic data relating to travel/migration and infectious diseases in brief, computerised forms. Results: From January 2009 to October 2011, we collected 4,570 patients and recorded the main demographic data (age, sex, presence of immunosuppressant), travel data (destination, duration, time between the return trip and the consultation) and data regarding the migratory process (country of origin, time between the arrival in Spain and the first consultation), as well as preventive measures that have been taken (pre-travel advice, need for malaria chemoprophylaxis, drug that was used and whether it was correct), the reason for coming to the consultation, and (..) (AU)


Assuntos
Humanos , Doenças Transmissíveis/epidemiologia , /epidemiologia , Infecções Comunitárias Adquiridas/epidemiologia , Viagem/estatística & dados numéricos , Emigrantes e Imigrantes/estatística & dados numéricos , Medicina Tropical , Doenças Negligenciadas/epidemiologia
16.
Malar J ; 11: 112, 2012 Apr 11.
Artigo em Inglês | MEDLINE | ID: mdl-22494463

RESUMO

BACKGROUND: Malaria in pregnancy is associated with maternal and foetal morbidity and mortality in endemic areas, but information on imported cases to non-endemic areas is scarce.The aim of this study was to describe the clinical and epidemiological characteristics of malaria in pregnancy in two general hospitals in Madrid, Spain. METHODS: Retrospective descriptive study of laboratory-confirmed malaria in pregnant women at the Fuenlabrada University Hospital and the Príncipe de Asturias University Hospital, in Madrid, over a six- and 11-year period, respectively. Relevant epidemiological, clinical and laboratory data was obtained from medical records. RESULTS: There were 19 pregnant women among 346 malaria cases (5.4%). The average age was 27 years. The gestational age (trimester) was: 53% 3rd, 31% 1st, 16% 2nd. All but one were multigravidae. Three were HIV positive. All were sub-Saharan immigrants: two were recently arrived immigrants and seventeen (89%) had visited friends and relatives. None had taken prophylaxis nor seeked pre-travel advice. PRESENTATION: 16 symptomatic patients (fever in fourteen, asthenia in two), three asymptomatic. Median delay in diagnosis: 7.5 days. Laboratory tests: anaemia (cut off Hb level 11 g/dl) 78.9% (mild 31.6%, moderate 31.6%, severe 15.8%) thrombocytopaenia 73.7%, hypoglycaemia 10.5%. All cases were due to Plasmodium falciparum, one case of hyperparasitaemia. Quinine + clindamycin prescribed in 84%. OUTCOMES: no severe maternal complications or deaths, two abortions, fifteen term pregnancies, no low-birth-weight newborns, two patients were lost to follow-up. CONCLUSIONS: Though cases of malaria in pregnancy are uncommon, a most at risk group is clearly defined: young sub-Saharan mothers visiting friends and relatives without pre-travel counselling and recently-arrived immigrants. The most common adverse maternal and foetal effects were anaemia and stillbirth. Given that presentation can be asymptomatic, malaria should always be considered in patients with unexplained anaemia arriving from endemic areas. These findings could help Maternal Health programme planners and implementers to target preventive interventions in the immigrant population and should create awareness among clinicians.


Assuntos
Malária Falciparum/epidemiologia , Plasmodium falciparum/isolamento & purificação , Complicações Infecciosas na Gravidez/epidemiologia , Adulto , Anemia/epidemiologia , Anemia/etiologia , Emigração e Imigração , Feminino , Humanos , Malária Falciparum/complicações , Malária Falciparum/parasitologia , Malária Falciparum/patologia , Gravidez , Complicações Infecciosas na Gravidez/parasitologia , Complicações Infecciosas na Gravidez/patologia , Quinina , Estudos Retrospectivos , Fatores de Risco , Espanha/epidemiologia , Natimorto/epidemiologia , Viagem
17.
Enferm Infecc Microbiol Clin ; 30(9): 528-34, 2012 Nov.
Artigo em Espanhol | MEDLINE | ID: mdl-22409952

RESUMO

INTRODUCTION: Imported diseases by travellers and immigrants are a priority in the prevention of emerging infectious diseases in the 21st century. There are international records on imported diseases, but no such records are available in Spain. MATERIAL AND METHODS: The cooperative network +Redivi was created in 2009 and consists of 11 national healthcare centres. +Redivi collects demographic data relating to travel/migration and infectious diseases in brief, computerised forms. RESULTS: From January 2009 to October 2011, we collected 4,570 patients and recorded the main demographic data (age, sex, presence of immunosuppression), travel data (destination, duration, time between the return trip and the consultation) and data regarding the migratory process (country of origin, time between the arrival in Spain and the first consultation), as well as preventive measures that have been taken (pre-travel advice, need for malaria chemoprophylaxis, drug that was used and whether it was correct), the reason for coming to the consultation, and final diagnoses of the travellers, immigrants and immigrants-travellers. Likewise, the most frequent diagnoses of asymptomatic patients who came for a check-up are described for each of the three groups. CONCLUSIONS: The +Redivi network allows us to identify and quantify the geographical origin and the type of patients affected, as well as time pattern of infections imported by migrants and travellers. Preliminary data show the significant presence of transmissible diseases and the potential reintroduction in Spain, as well as the importance of systematic screening in patients that came from tropical areas. The objective of +Redivi is to evaluate the impact of imported diseases in Spain in order to contribute to improving the care of patients, to have an influence on prevention and treatment of the most prevalent imported diseases, and to detect possible outbreaks.


Assuntos
Doenças Transmissíveis/epidemiologia , Doenças Transmissíveis/transmissão , Emigrantes e Imigrantes , Sistema de Registros , Viagem , Adulto , Feminino , Humanos , Masculino , Estudos Prospectivos , Espanha
20.
Enferm. infecc. microbiol. clín. (Ed. impr.) ; 29(3): 204-208, mar. 2011. tab
Artigo em Espanhol | IBECS | ID: ibc-92650

RESUMO

Introducción Existe poca información sobre la malaria por Plasmodium ovale importada. Método Se estudiaron retrospectivamente 16 casos. Resultados La mayoría presentó un periodo de incubación de 2 a 53 meses y eran africanos inmigrantes o residentes en España que viajaron a África occidental; 10 presentaban enfermedades de base y 5 sufrieron una infección previa por P. falciparum; 3 pacientes presentaron complicaciones graves y 3 estaban asintomáticos. El test rápido fue positivo en 2 de 10 pacientes. A 5 se diagnosticó únicamente con PCR. Conclusiones La infección por P. ovale puede ser asintomática o producir complicaciones graves hasta 5 años después del regreso (AU)


Introduction: Information on imported malaria caused by Plasmodium ovale parasite is scarce. Methods: Sixteen cases were studied retrospectively.Results: Most cases had an incubation period ranging from 2 to 53 months and were African immigrantsrecently arrived or residents in Spain who had visited West Africa. Ten patients had underlying diseasesand 5 suffered from a previous P. falciparum infection. Three patients had severe complications and 3 were asymptomatic. Rapid malaria test was positive in 2 out of 10 patients. Five were diagnosed onlywith PCR. Conclusions: P. ovale infection can be asymptomatic or cause severe complications up to 5 years afterarriving (AU)


Assuntos
Humanos , Masculino , Feminino , Lactente , Pré-Escolar , Criança , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Antígenos de Protozoários/sangue , DNA de Protozoário/sangue , Malária/parasitologia , Malária/epidemiologia , Plasmodium ovale/isolamento & purificação , Reação em Cadeia da Polimerase , Estudos Retrospectivos , Sensibilidade e Especificidade
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