[Fever, diarrhoea and neurological syndrome in HIV-infected immigrants]. / Síndromes febril, diarreico y neurológico en pacientes inmigrantes infectados por el VIH.

Fever, diarrhoea and neurological symptoms are relatively common in immigrants, as well as in HIV-infected patients. The main febrile diseases in HIV-positive immigrants from the tropics are tuberculosis, bacteremia due to Salmonella spp. or Streptococcus pneumoniae and community-acquired pneumonia or pneumonia due to Pneumocystis jiroveci. The presence of diarrhoea should lead to suspicion of opportunistic infections caused by parasites and protozoa of the digestive tract such as Cryptosporidium parvum, Isospora belli, Cyclospora spp. and Microsporidium spp. The main diseases to be taken into account are those of the nervous system that affect immunosuppressed patients, such as cryptococcosis, tuberculosis, toxoplasmosis, and cytomegalovirus infections. Cerebral malaria as a complication of Plasmodium falciparum should be included in the differential diagnosis.

[Screening of microfilariasis in blood (Loa Loa) among the immigrant population in endemic areas]. / Cribaje de microfilariasis sanguínea (Loa loa) en la poblacion inmigrante de zonas endemicas.

BACKGROUND: Given the increasing flux of immigrant population from high-risk areas to our country, the need of screening for loasis arises, despite systematic screening being a debated and poorly evaluated practice to which there is no protocol. This study is aimed at identifying the population to which loasis screening would be most appropriate, by drawing a comparison among four alternatives. METHODS: Case and control group study, involving 30 cases (all those who came to our unit for treatment and who tested positive for Loa Loa in a microfilariae in the blood detection test) and 90 control cases (three controls per case from among the subjects having tested negative for microfiliariae in the blood chosen at random without any pairing criteria). RESULTS: Of the 1,638 subjects on whom the microfilariae blood test was performed, 30 tested positive (1.8%; 1.2-2.6%). Of these 30 cases of loasis, 76.7% (23; 57.7-90.1%) had eosinophilia (OR 8.8; 3.3-23.1; p<0.0001) and 30.0% (9; 14.7-49.4%) compatible clinical symptoms (OR 2.8; 1.0-7.5; p=0.04). If we were to apply the screening test to the entire immigrant population coming from endemic areas, we would have to perform 54.6 tests to detect one case. If we were to perform the test on patients showing eosinophilia and/or compatible clinical symptoms, we would have to perform a smaller number of tests for every case detected (NNS=29; IC=21-48), but there would be 16.7% (5; 5.7-34.7%) false negatives. CONCLUSIONS: Conducting a screening test with determination of microfiliariae in the blood on the immigrant population coming from Central and West Africa, independently of the presence of eosinophilia or compatible clinical symptoms, would be indicated, provided that the necessary resources are available.

Cribaje de microfilariasis sanguínea (Loa Loa) en la población inmigrante de zonas endémicas / Screening of microfilariasis in blood (Loa Loa) among the immigrant population in endemic areas

Fundamento: Dada la creciente afluencia de población inmigrante originaria de zonas de riesgo a nuestro país se plantea la necesidad de realizar cribaje para loasis, aunque el cribaje sistemático es una práctica discutida, poco evaluada y aún no protocolizada. El objetivo de este estudio es identificar la población en la que es más adecuado realizar el cribado de loasis, comparando 4 alternativas. Métodos: Estudio de casos y controles, con 30 casos (todos los que consultaron en nuestra Unidad y con un test de detección de microfilaremia positivo para Loa loa) y 90 controles (tres controles por caso de entre los sujetos con microfilaremia negativa, escogidos aleatoriamente y sin criterios de apareamiento). Resultados: De los 1.638 sujetos a los que se realizó la prueba de microfilaremia 30 (1,8%;1,2-2,6%) resultaron positivos. De estos 30 casos con loasis 76,7% (23;57,7-90,1%) presentaban eosinofilia (OR 8,8; 3,3-23,1; p<0,0001) y un 30,0% (9;14,7-49,4%) presentaba clínica (OR 2,8; 1,0-7,5; p=0,04). Si aplicáramos el test de cribado a toda la población inmigrante procedente de áreas endémicas deberíamos realizar 54,6 pruebas para detectar un caso. Si lo realizáramos en sujetos que presentan eosinofilia y/o clínica compatible, el número de pruebas que deberíamos realizar para cada caso detectado sería inferior (NNS=29; IC=21-48) pero habría un 16,7% (5;5,7-34,7%) de falsos negativos. Conclusiones: Estaría indicado practicar un test de cribado con determinación de microfilaremia a la población inmigrante procedente de Africa Central y Oeste, independientemente de la presencia de eosinofilia o clínica compatible, siempre que se disponga de los recursos necesarios (AU)

Background: Given the increasing flux of immigrant population from high-risk areas to our country, the need of screening for loasis arises, despite systematic screening being a debated and poorly evaluated practice to which there is no protocol. This study is aimed at identifying the population to which loasis screening would be most appropriate, by drawing a comparison among four alternatives. Methods: Case and control group study, involving 30 cases (all those who came to our unit for treatment and who tested positive for Loa Loa in a microfilariae in the blood detection test) and 90 control cases (three controls per case from among the subjects having tested negative for microfilariae in the blood chosen at random without any pairing criteria). Results: Of the 1,638 subjects on whom the microfilariae blood test was performed, 30 tested positive (1.8%; 1.2-2.6%). Of these 30 cases of loasis, 76.7% (23;57.7-90.1%) had eosinophylia (OR 8.8; 3.3-23.1; p<0.0001) and 30.0% (9;14.7-49.4%) compatible clinical symptoms (OR 2.8; 1.0-7.5; p=0.04). If we were to apply the screening test to the entire immigrant population coming from endemic areas, we would have to perform 54.6 tests to detect one case. It we were to perform the test on patients showing eosinophylia and/or compatible clinical symptoms, we would have to perform a smaller number of tests for every case detected (NNS=29; IC=21-48), but there would be 16.7% (5;5.7-34.7%) false negatives. Conclusions: Conducting a screening test with determination of microfilariae in the blood on the immigrant population coming from Central and West Africa, independently of the presence of eosinophylia or compatible clinical symptoms, would be indicated, provided that the necessary resources are available (AU)

Síndromes febril, diarreico y neurológico en pacientes inmigrantes infectados por el VIH / Fever, diarrhoea and neurological syndrome in HIV-infected immigrants

La fiebre, la diarrea y los síntomas neurológicos se observan con relativa frecuencia en la práctica diaria en pacientes inmigrantes, y también en pacientes infectados por el virus de la inmunodeficiencia humana (VIH). Las principales enfermedades que cursan con síndrome febril en pacientes inmigrantes originarios de zonas tropicales infectados por el VIH son la tuberculosis, la bacteriemia por Salmonella spp. o por Streptococcus pneumoniae, y la neumonía adquirida en la comunidad o por Pneumocystis jiroveci. En el contexto de un síndrome diarreico, hay que pensar en las infecciones oportunistas causadas por parásitos y protozoos del tubo digestivo, como Cryptosporidium parvum, Isospora belli, Cyclospora spp. y Microsporidium spp. Cabe destacar las enfermedades que afectan al sistema nervioso en estos pacientes inmunodeprimidos, fundamentalmente la criptococosis, la tuberculosis, la toxoplasmosis y la infección por citomegalovirus, sin olvidar el paludismo cerebral como complicación de Plasmodium falciparum

Fever, diarrhoea and neurological symptoms are relatively common in immigrants, as well as in HIV-infected patients. The main febrile diseases in HIV-positive immigrants from the tropics are tuberculosis, bacteremia due to Salmonella spp. or Streptococcus pneumoniae and community acquired pneumonia or pneumonia due to Pneumocystis jiroveci. The presence of diarrhoea should lead to suspicion of opportunistic infections caused by parasites and protozoa of the digestive tract such as Cryptosporidium parvum, Isospora belli, Cyclospora spp. and Microsporidium spp. The main diseases to be taken into account are those of the nervous system that affect immunosuppressed patients, such as cryptococcosis, tuberculosis, toxoplasmosis, and cytomegalovirus infections. Cerebral malaria as a complication of Plasmodium falciparum should be included in the differential diagnosis