Editorial:The Impact of Migration and Resettlement on Health

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Syndromic approach in migrant patients: Fever, diarrhea, anemia, eosinophilia and chronic cough

Paciente inmigrante; Fiebre; DiarreaPacient immigrant; Febre; DiarreaMigrant patient; Fever; DiarrheaLos pacientes inmigrantes comparten con los autóctonos las mismas enfermedades, pero diferencias biológicas o ambientales pueden hacer que la prevalencia y las manifestaciones de algunos síndromes sean distintas. Destacan ciertos cuadros frecuentes en atención primaria, como fiebre, diarrea, anemia, eosinofilia y tos crónica, donde es importante tener una consideración especial. La fiebre puede ser indicación de una enfermedad importada grave, y siempre se debe descartar la posibilidad de malaria. La diarrea generalmente es de origen infeccioso y en la mayoría de los casos el manejo es ambulatorio. La anemia, por su parte, puede ser indicativo de una malnutrición o malabsorción; y la eosinofilia puede indicar una infección parasitaria. Por último, la tos crónica puede ser un signo de tuberculosis, especialmente en inmigrantes provenientes de áreas endémicas. La medicina de familia ocupa una posición privilegiada para el abordaje integral, culturalmente sensible y centrado en la persona de estos cuadros.Migrant patients share the same diseases as natives, but biological or environmental differences may lead to distinct prevalence and manifestations of certain syndromes. Some common conditions in Primary Care stand out, such as fever, diarrhea, anemia, eosinophilia, and chronic cough, where it is important to have a special consideration. Fever may indicate a serious imported illness, and malaria should always be ruled out. Diarrhea is generally of infectious origin, and in most cases, management is outpatient. Anemia may indicate malnutrition or malabsorption, while eosinophilia may indicate a parasitic infection. Lastly, chronic cough may be a sign of tuberculosis, especially in immigrants from endemic areas. Family medicine holds a privileged position for the comprehensive, culturally sensitive, and person-centered approach to these conditions

Changes in the microbiological diagnosis and epidemiology of cutaneous leishmaniasis in real-time PCR era: A six-year experience in a referral center in Barcelona

Leishmania; Reacción en cadena de la polimerasa; EspañaLeishmania; Polymerase chain reaction; SpainLeishmania; Reacció en cadena de la polimerasa; EspanyaBackground Leishmaniasis is a neglected disease caused by different species of the protozoa Leishmania spp. Cutaneous lesions are the most common clinical manifestation. This disease is prevalent in tropical and subtropical areas, including the Mediterranean basin. In Spain, Leishmania (L.) infantum is the only endemic species, but imported cases are often diagnosed. Different classical parasitological methods can be performed for cutaneous leishmaniasis (CL) diagnosis; but currently molecular techniques serve as a relevant tool for the detection and characterization of Leishmania parasites. We aimed to evaluate clinical and epidemiological characteristics of CL diagnosed patients by real-time PCR in a tertiary hospital over a six-year period. Methodology/Principal findings Clinical, epidemiological and microbiological data were retrospectively collected and analyzed. In our study, CL was confirmed in 59 (31.4%) out of 188 patients by real-time PCR, showing an increase over recent years: 11 cases of CL between 2014 and 2016 and 48 between 2017 and 2019. Real-time PCR was performed on skin swabs and/or biopsies samples, with a positivity of 38.5% and 26.5%, respectively. Results were 100% concordant when biopsy and skin swab were performed simultaneously. L. (L.) infantum was the most frequent species detected (50%), followed by L. (L.) major (45%) and Viannia subgenus (5%), which were detected only in imported cases. L. (L.) major was almost entirely detected in travelers/migrants from Morocco. Multiple and atypical skin lesions were more common in imported cases than in autochthonous cases (44.4% vs. 21.8%). Conclusions/Significance An increase in both autochthonous and imported CL cases has been observed in past years in our hospital. Molecular techniques assist in improving CL diagnosis and characterization of the Leishmania species, mainly in imported cases.The author(s) received no specific funding for this work

Analytical Evaluation of Dried Blood Spot and Rapid Diagnostic Test as a New Strategy for Serological Community Screening for Chronic Chagas Disease

Trypanosoma cruzi; Mancha de sangre seca (DBS); Cribado serológicoTrypanosoma cruzi; Taca de sang seca (DBS); Cribratge serològicTrypanosoma cruzi; Dried blood spot (DBS); Serological screeningBackground: Chagas disease is a public health problem not only in Latin America, but also in other regions, including Spain, due to migration movements. Conventional serological diagnosis requires an invasive sample (plasma or serum) and a well-equipped laboratory. To circumvent those limitations, blood samples dried on filter paper (DBS) or Rapid Diagnostic Test (RDT) could be a practical alternative to reference protocol for serological screening in epidemiological studies. We evaluated the usefulness of dried blood sampling and a rapid diagnostic test (Trypanosoma Detect™) for the detection of antibodies against T. cruzi for their use in community-based screening. Methodology/Principal Findings: A total of 162 stored paired whole-blood and serum samples from Latin American migrants and 25 negative-control blood samples were included. Diagnosis of chronic Chagas disease was performed in serum according to WHO algorithms. Blood samples were retrospectively collected as dried spots and then analyzed using two different serological techniques, enzyme-linked immunosorbent assay (ELISA) and electrochemiluminescence immunoassay (E-CLIA). Whole-blood samples were also used to evaluate a rapid diagnostic test based on immunochromatography. A better correlation with conventional serum was observed in dried blood elutes using E-CLIA than ELISA (97% vs. 77% sensitivity, respectively). Both assays reported 100% specificity. The median cut-off index values of E-CLIA for dried blood were significantly lower than those for serum (138.1 vs. 243.3, P<0.05). The Trypanosoma Detect™ test presented a sensitivity and specificity of 89.6% and 100%, respectively. Conclusions: The detection of antibodies against T. cruzi in dried blood samples shows a higher sensitivity when using E-CLIA compared with ELISA. Trypanosoma Detect™ is easier to use but has a lower sensitivity. Hence, we propose a sequential strategy based on performing the rapid test first, and a negative result will be confirmed by DBS-ECLIA for use in community Chagas disease screening programs.This work has been supported by the Fundació la Marató TV3 (project number 20182610)

Opportunistic Community Screening of Chronic Chagas Disease Using a Rapid Diagnosis Test in Pharmacies in Barcelona (Catalonia, Spain): Study Protocol and Pilot Phase Results

Chagas disease; Community pharmacies; Rapid testEnfermedad de Chagas; Farmacias comunitarias; Test rapidoMalaltia de Chagas; Farmàcies comunitàries; Prova ràpidaObjectives: This study aimed to report the protocol and results from the pilot phase of an opportunistic CP-based CD screening program in Barcelona, Spain. Methods: Three strategies according to recruitment approach were designed: passive, active and active-community. The study process consisted of signing the informed consent form, recording the patient’s data in a web-based database system, and performing the rapid test and blood collection on dry paper. Results: Nineteen pharmacies participated and 64 patients were included during the pilot phase of the study. The rapid diagnostic test (RDT) was positive in 2/64 (3.13%) cases. Of the 49 DBS samples that arrived at the laboratory, 22 (45%) were collected incorrectly. After quantitative and qualitative assessment of the program, the dry paper sample and passive strategy were ruled out. Conclusion: DBS sampling and the passive strategy are not suitable for CD screening in community pharmacies. There is a need to expand the number of participating pharmacies and individuals to determine whether conducting a RDT in community pharmacies is an effective screening method to increase access to CD diagnosis in a non-endemic area.This work has been supported by the Fundació la Marató TV3 (project number 481/U/2018)

Associação entre distúrbios psíquicos e aspectos psicossociais do trabalho de professores

OBJECTIVE: To investigate the association between work-related psychosocial factors and the prevalence of mental disorders among pre-school and elementary school teachers. METHODS: This cross-sectional study was undertaken with 1,024 teachers from municipal public schools and from the ten largest private schools in Vitória da Conquista, Bahia State (Northeastern Brazil) in 2001. The main independent variable was based on the demand-control model, which classifies individuals according to their job pressures. The dependent variable was the incidence of mental disorders as evaluated by a self-reporting questionnaire. The measure of frequency was prevalence, and the measure of association was the prevalence ratio. A logistic regression model was used as the main statistical technique. RESULTS: There was a 44% prevalence of mental disorders among teachers. Evidence suggests that these were associated with work-related demands and control issues, after controlling for confounding variables such as sex, geographic region and social support. The prevalence of mental disorders among high-strain teachers was 1.5 times greater than that among low-strain teachers. CONCLUSIONS: The prevalence of mental disorders was high among teachers of the municipality. There was evidence that this was associated with job demands.OBJETIVO: Investigar a associação entre aspectos psicossociais do trabalho e prevalência de distúrbios psíquicos em professores da educação infantil e do ensino fundamental. MÉTODOS: Estudo de corte transversal realizado com 1.024 professores das escolas públicas municipais e das 10 maiores escolas particulares de Vitória da Conquista, Estado da Bahia, em 2001. A variável de exposição principal foi constituída pelo modelo de demanda-controle, que classifica os indivíduos de acordo com as exigências do trabalho. A variável de resposta representou distúrbios psíquicos medidos pelo Questionário de auto-resposta. A medida de freqüência foi a prevalência, e a medida de associação foi a razão de prevalências. A principal técnica estatística utilizada foi a análise de regressão logística. RESULTADOS: A prevalência de distúrbios psíquicos foi de 44%. Evidenciou-se associação entre sua presença e as condições de demanda e controle no trabalho, após o controle do confundimento introduzido pelas variáveis sexo, zona de trabalho e suporte social. Os professores com trabalho de alta exigência apresentaram prevalência 1,5 vez maior que os com trabalho de baixa exigência. CONCLUSÕES: A prevalência de distúrbios psíquicos foi elevada entre professores. Há evidências de que a prevalência estava associada com as exigências do trabalho

Imported strongyloidiasis : Data from 1245 cases registered in the +REDIVI Spanish collaborative network (2009-2017)

Background Imported strongyloidiasis is increasingly being diagnosed in non-endemic areas. The aim of this study was to describe the epidemiological, clinical and microbiological characteristics of patients with imported strongyloidiasis in Spain. Methodology This is an observational retrospective study that included all patients diagnosed of strongyloidiasis registered in the +REDIVI Collaborative Network from 2009 to 2017. Demographic, epidemiological and clinical information was collected from the +REDIVI database, and extra information regarding microbiological techniques, treatment and follow-up was requested to participant centers. Findings Overall, 1245 cases were included. Most of them were immigrants (66.9%), and South America was the most frequent area of origin. Detection of larvae in stool samples was observed in 21.9% of the patients, and serological tests allowed making the diagnosis in the rest of the cases. Eosinophilia was present in 82.2% of cases. Treatment with ivermectin (compared with albendazole) was the most strongly associated factor to achieve the cure (OR 2.34). Conclusions Given the long latency of the infection and the risk of developing a severe presentation, screening of S. stercoralis infection should be mandatory in patients coming from or had traveling to endemic areas, especially in those with immunosuppressant conditions

Adherence and Toxicity during the Treatment of Latent Tuberculous Infection in a Referral Center in Spain

Latent tuberculosis infection; Toxicity; Tuberculosis screeningInfecció tuberculosa latent; Toxicitat; Cribratge de tuberculosiInfección tuberculosa latente; Toxicidad; Cribado de tuberculosisThe screening and treatment of latent tuberculosis infection (LTBI) in countries with a low incidence of TB is a key strategy for the elimination of tuberculosis (TB). However, treatment can result in adverse events (AEs) and have poor adherence. This study aimed to describe treatment outcomes and AEs for LTBI patients at two departments in Vall d'Hebron University Hospital in Barcelona, Spain. A retrospective study was conducted on all persons treated for LTBI between January 2018 and December 2020. Variables collected included demographics, the reason for LTBI screening and treatment initiation, AEs related to treatment, and treatment outcome. Out of 261 persons who initiated LTBI treatment, 145 (55.6%) were men, with a median age of 42.1 years. The indications for LTBI screening were household contact of a TB case in 96 (36.8%) persons, immunosuppressive treatment in 84 (32.2%), and recently arrived migrants from a country with high TB incidence in 81 (31.0%). Sixty-three (24.1%) persons presented at least one AE during treatment, and seven (2.7%) required definitive discontinuation of treatment. In the multivariate analysis, AE development was more frequent in those who started LTBI treatment due to immunosuppression. Overall, 226 (86.6%) completed treatment successfully. We concluded that LTBI screening and treatment groups had different risks for adverse events and treatment outcomes. Persons receiving immunosuppressive treatment were at higher risk of developing AEs, and recently arrived immigrants from countries with a high incidence of TB had greater LTFU. A person-centered adherence and AE management plan is recommended.A.M.L. was supported by a postdoctoral grant “Juan Rodés” (JE21/00027) from the Instituto de Salud Carlos through the Ministry of Economy and Competitiveness, Spain

Sentinel surveillance of imported dengue via travellers to Europe 2012 to 2014: TropNet data from the DengueTools Research Initiative.

We describe the epidemiological pattern and genetic characteristics of 242 acute dengue infections imported to Europe by returning travellers from 2012 to 2014. The overall geographical pattern of imported dengue (South-east Asia &gt; Americas &gt; western Pacific region &gt; Africa) remained stable compared with 1999 to 2010. We isolated the majority of dengue virus genotypes and epidemic lineages causing outbreaks and epidemics in Asia, America and Africa during the study period. Travellers acted as sentinels for four unusual dengue outbreaks (Madeira, 2012-13; Luanda, 2013; Dar es Salaam, 2014; Tokyo, 2014). We were able to characterise dengue viruses imported from regions where currently no virological surveillance data are available. Up to 36% of travellers infected with dengue while travelling returned during the acute phase of the infection (up to 7 days after symptom onset) or became symptomatic after returning to Europe, and 58% of the patients with acute dengue infection were viraemic when seeking medical care. Epidemiological and virological data from dengue-infected international travellers can add an important layer to global surveillance efforts. A considerable number of dengue-infected travellers are viraemic after arrival back home, which poses a risk for dengue introduction and autochthonous transmission in European regions where suitable mosquito vectors are prevalent

Comparison of DNA extraction methods and real-time PCR assays for the molecular diagnostics of chronic Chagas disease

Fil: Ramírez, Juan C. ANLIS Dr.C.G.Malbrán. Instituto Nacional de Parasitología DR: Mario Fatala Chaben; Argentina.Fil: Silgado, Aroa. Universitat Autònoma de Barcelona, PROSICS. Hospital Universitari Vall d'Hebron. Departament de Microbiologia; Barcelona, España.Fil: Moure, Zaira. Universitat Autònoma de Barcelona, PROSICS. Hospital Universitari Vall d'Hebron. Departament de Microbiologia; España.Fil: de Oliveira, Maykon T. Universidade de São Paulo. Faculdade de Medicina de Ribeirão Preto. Unidade de Cardiologia. Departamento de Clínica Médica; Brasil.Fil: Serre-Delcor, Núria. Universitata Autònoma de Barcelona. Tropical Medicine Unit Vall d´Hebron-Drassanes; Barcelona, España.Fil: Salvador, Fernando. Universitat Autònoma de Barcelona. Department of Infectious Diseases, Vall d'Hebron University Hospital; Barcelona, España.Fil: Oliveira, Inés. Universitata Autònoma de Barcelona. Tropical Medicine Unit Vall d´Hebron-Drassanes; Barcelona, España.Fil: Molina, Israel. Universitat Autònoma de Barcelona. Department of Infectious Diseases, Vall d'Hebron University Hospital; Barcelona, España.Fil: Pumarola, Tomas. Universitat Autònoma de Barcelona, PROSICS. Hospital Universitari Vall d'Hebron. Departament de Microbiologia; España.Fil: Sulleiro, Elena. Universitat Autònoma de Barcelona, PROSICS. Hospital Universitari Vall d'Hebron. Departament de Microbiologia; España.Aim: This work aimed to compare the sensitivity of four protocols for the detection of Trypanosoma cruzi DNA in 98 blood samples from chronic Chagas disease patients. Materials & methods: Two DNA extraction (automated and manual) methods and two T. cruzi satellite DNA qPCRs (with a recent design and the usually used set of primers) were analyzed. Results: Both DNA extraction methods and qPCR assays tested in this work gave comparable qualitative results, although the lowest Ct values were obtained when samples were analyzed using the new set of primers for T. cruzi satellite DNA. Conclusion: Our results encourage the implementation of automated DNA extraction systems and the new T. cruzi qPCR for the molecular diagnostics and treatment response monitoring of chronic Chagas disease patients