Origen biogeogràfic i risc de varicel·la entre la població immigrant adulta de Catalunya

Es tracta de un estudi observacional longitudinal durant 2 anys naturals (07/2004 - 06/2006) i multicèntric (4 centres d'atenció primària) on es van monitoritzar i comparar les incidències de varicel·la registrades en les diferents poblacions ateses segons una classificació basada en el seu origen biogeogràfic. Les taxes d'incidència obtingudes, estandaritzades x 1000/any van ser, en ordre creixent: holoàrtics 2,17 (IC 95%: 1,95-2,39); autòctons 2,25 (IC 95%: 2,02-2,47); immigrants 3,59 (IC 95%: 2,92-4,26); neotropicals 4,50 (IC 95%: 3,28-5,71); no-holoàrtics 5,38 (IC 95%4,27-6,14); paleotropicals asiàtics 7,03 (IC 95%: 4,77-9,28) i paleotropicals etiòpics 7,05 (IC 95%: 1,12-23,58). Les diferències obtingudes en relació a la població autòctona es van centrar en los immigrants d'origen neotropical (raó d'incidència estandaritzada = 2,07; o un excés de 4,5 casos x 1000 habitants) i paleotropical asiàtica =3,24; o un excés de 9,6 casos x 1000 habitants) En conclusió, la població d'origen indostànic i, en menor grau, la d'origen sud-americà poden tenir una vulnerabilitat a la varicel·la superior al de la població autòctona

Approach to amoebic colitis: Epidemiological, clinical and diagnostic considerations in a non-endemic context (Barcelona, 2007-2017)

Amoebic colitis; Non-endemic; BarcelonaColitis amèbica; No-endèmic; BarcelonaColitis Amebiana; No-endémico; BarcelonaBACKGROUND: Amoebic colitis is the most frequent clinical manifestation of invasive intestinal infection due to Entamoeba histolytica and a common cause of diarrhoea worldwide. Since higher transmission rates are usually related to poor health and exposure to unhygienic conditions, cases reported in Europe usually involve immigrants and international travellers. The goal of this study was to characterise both the clinical and the epidemiological features of a European population diagnosed with amoebic colitis and then to evaluate the diagnostic tools and therapeutic options applied. METHODS AND RESULTS: This was a retrospective observational study in which data from all patients diagnosed with amoebic colitis attending at the International Health Units of two tertiary referral hospitals, Germans Trias i Pujol University Hospital (Badalona, North Barcelona Metropolitan Area) and Vall d'Hebron University Hospital (Barcelona city) between 2007 and 2017 were analysed. During the study period 50 patients were diagnosed with amoebic colitis. Thirty-six (72%) were men, and immigrants accounted for 46% of all cases. Antecedents of any international travel were reported for 28 (56%), the most frequent destinations having been the Indian subcontinent, South and Central America and sub-Saharan Africa. Preexisting pathological conditions or any kind of immunosuppression were identified in 29 (58%) patients; of these, 13 (26%) had HIV infection-all of them men who have sex with men-and 5 (10%) had inflammatory bowel disease. Diarrhoea, abdominal pain and dysentery were the most frequently recorded symptoms of invasive amoebae. Diagnosis was made through microbiological study in 45 (90%) and/or histological identification of amoebae in colon biopsies in 10 (20%). After treatment with metronidazole (82%) or tinidazole (8%), all patients had good outcomes. Post-acute intraluminal treatment was indicated in 28 (56%). CONCLUSIONS: Amoebic colitis should be suspected in patients with diarrhoea and compatible epidemiological risk factors (immigration, travelling abroad or men who have sex with men), especially if some degree of immunosuppression concurs. These risk factors must be taken into account in any diagnostic approach to inflammatory bowel disease (IBD), and active searches for stool parasites should be performed in such cases to rule out misdiagnosis or simultaneous amoebic infection. Treatment should include intraluminal anti-amoebic treatment in order to avoid relapse and prevent further spread of the disease

Risk of Trypanosoma cruzi infection among travellers visiting friends and relatives to continental Latin America

Chagas disease (CD) is regarded as a possible risk for travellers to endemic areas of continental Latin America (LA). The aim of the study is to determine the risk of Trypanosoma cruzi (TC) infection among travellers to CD endemic areas and to identify risk factors for acquiring TC infection. We designed a multicenter cross-sectional study among travellers in Spain (Badalona, Barcelona and Madrid). All available adults with laboratory confirmed proof of absence of TC infection from January 2012 to December 2015 were contacted. Participants referring a trip to LA after the negative TC screening were offered to participate. We performed a standardized questionnaire of travel related factors and measurement of TC antibodies in serum. A total of 971 participants with baseline negative TC serology were selected from the microbiology records. After excluding participants not meeting inclusion criteria, eighty participants were selected. Sixty three (78.8%) were female, and the median age was 38 (IQR 34-47) years. The reason to travel was visiting friends and relatives in 98.8% of the participants. The median duration of travel was 40 (IQR 30-60) days, with 4911 participants-day of exposure. Seventy seven cases (96.25%) participants had two negative TC serology tests after the travel, two cases (2.5%) had discordant serology results (considered false positive results) and one case was infected before travelling to LA. According to our data, the upper limit of the 95% confidence interval of the incidence rate of TC acquisition in travellers is 0.8 per 1000 participant-days. Among 79 non-CD travellers to TC endemic areas, we found no cases of newly acquired TC infection. The incidence rate of TC acquisition in travellers to endemic countries is less than or equal to 0.8 per 1000 traveller-days. Chagas disease is caused by the protozoan parasite T. cruzi. It is endemic in certain areas of continental Latin America. Few cases of T. cruzi infection have been described in travellers. However, there is little information regarding the incidence rate of T. cruzi infection during a trip to continental Latin America. In this study we aim to study the incidence of T. cruzi infection among migrants from Latin America living in Spain travelling to visit friends and relatives. In this study we found no cases of newly acquired T. cruzi infection among 79 previously uninfected travellers and calculate that the upper limit of the 95% CI of the incidence rate of T. cruzi acquisition in travellers is 0.8 per 1000 participants-da

Schistosomiasis Among Female Migrants in Non-endemic Countries : Neglected Among the Neglected? A Pilot Study

Schistosomiasis among migrant populations in Europe is an underdiagnosed infection, yet delayed treatment may have serious long-term consequences. In this study we aimed to characterize the clinical manifestations of Schistosoma infection among migrant women, and the degree of underdiagnosis. We carried out a prospective cross-sectional study among a migrant population living in the North Metropolitan Barcelona area and coming from schistosomiasis-endemic countries. We obtained clinical, laboratory and socio-demographic data from electronic clinical records, as well as information about years of residence and previous attendance at health services. Blood sample was obtained and schistosomiasis exposure was assessed using a specific ELISA serological test. Four hundred and five patients from schistosomiasis-endemic regions were screened, of whom 51 (12.6%) were female. Seropositivity prevalence was 54.8%, but considering women alone we found a prevalence of 58.8% (30 out of 51). The median age of the 51 women was 41.0 years [IQR (35-48)] and the median period of residence in the European Union was 13 years [IQR (10-16)]. Schistosoma -positive women (N = 30) showed a higher prevalence of gynecological signs and symptoms compared to the seronegative women (96.4 vs. 66.6%, p = 0.005). Among seropositive women, the median number of visits to Sexual and Reproductive Health unit prior to diagnosis of schistosomiasis was 41 [IQR (18-65)]. The high prevalence of signs and symptoms among seropositive women and number of previous visits suggest a high rate of underdiagnosis and/or delayed diagnosis of Schistosoma infection, particularly female genital schistosomiasis, among migrant females

A simple new screening tool for diagnosing imported schistosomiasis

We sought to test the sensitivity and feasibility of a Schistosoma infection screening process consisting of a scored patient consultation questionnaire and a serological diagnostic test. Prospective cross-sectional study. We collected from Schistosoma-exposed individuals a 14-point check list of clinical and laboratory data related to Schistosoma infection, alongside a serological test to detect Schistosoma spp infection. A check list score was created and compared with the risk of infection and clinical recovery through an agreement analysis. Two-hundred and fifty individuals were enrolled, of whom 220 (88%) were male and 30 (12%) female. The median age was 39 (range 18-78). One hundred-fifty (60%, 95% CI 54.9%-65.1%) had a check-list score ≥2. Serology test results were positive for 142 (56.8%, 95% CI 51.6%-62%). Chronic complications compatible with long-term Schistosoma infection were detected in 29 out of these 142 (20.4%, 95% CI 13.8%-27%).,. The median score value was 3, the area under the receiver operating characteristic (ROC) curve against serology results was 0.85 and the estimated intercept check-list questionnaire score value was 1.72 (95%, CI: 1.3-2.2). Participants with a positive serological test had a substantially higher check-list score (Cohen's kappa coefficient: 0.62, 95% CI: 0.54-0.70). Ninety four percent patients empirically treated showed a subsequent improvement in clinical and laboratory parameters. A two-component process consisting of a scored patient consultation questionnaire followed by serological assay can be a suitable strategy for screening populations at high risk of schistosomiasis infection

Vigilancia epidemiológica intensificada de arbovirosis : primer caso de dengue autóctono en Cataluña (España), zona Metropolitana Norte de Barcelona, 2018-2019

La Plataforma Integral para control de las arbovirosis en Cataluña (PICAT) es un proyecto realizado con el apoyo del Departamento de Salud de la Generalitat de Catalunya y ha sido financiada mediante una beca del Pla Estratègic de Recerca i Innovació en Salut (PERIS) 2016-2020, cod. exp. SLT002/16/00466Valorar los resultados obtenidos por una red de vigilancia epidemiológica y asistencial de arbovirosis compuesta por médicos y profesionales de enfermería de hospital y atención primaria (AP) formados en su identificación, confirmación diagnóstica y manejo clínico. Zona Sanitaria Metropolitana Norte de Barcelona (1.400.000 habitantes; Cataluña, España) durante un año natural. Diecisiete médicos (7 de AP y 10 hospitalarios) más 4 enfermeros/as de AP. Estudio observacional prospectivo. Se definieron variables demográficas, epidemiológicas (caso autóctono/importado, sospechoso/probable/confirmado) y asistenciales (síntomas, perfil serológico, periodo virémico). De los 34 pacientes identificados cumplían criterios de estudio 26 (76,5%) casos; de ellos, se confirmó alguna arbovirosis en 14 (53,8%): 13 fiebres dengues más 1 chikungunya. No se registraron casos de fiebre de zika. Existían antecedentes de viaje a zonas endémicas (23; 88,4%), pero no en 3 casos (11,6%), en los que se consideró la posibilidad de una transmisión autóctona; de ellos, se confirmó un caso de dengue. La incidencia estimada de arbovirosis fue de 0,4 (IC 95%: 0,33-0,51) casos × 10.000 hab./año, que, comparada con la incidencia estimada en la misma área geográfica durante el periodo 2009-2013 (0,19 casos × 10.000 hab./año; IC 95%: 0,07-0,31), mostró un incremento significativo (p = 0,044). Los pacientes en periodo de viremia al momento de la primera visita médica fueron 11 (42,3%). Un programa de vigilancia epidemiológica intensificada definido a nivel de AP y hospitalario es capaz de detectar significativamente más casos de arbovirosis importadas y transmitidas autóctonamente. Posiblemente asistimos a un aumento en la incidencia de arbovirosis importadas, por lo que las medidas encaminadas a su identificación y confirmación deben reforzarse

Epidemiological, clinical, diagnostic and economic features of an immigrant population of chronic schistosomiasis sufferers with long-term residence in a nonendemic country (North Metropolitan area of Barcelona, 2002-2016)

Background. Schistosomiasis, one of the neglected tropical diseases (NTD) listed by the WHO, is an acute and chronic parasitic disease caused by blood flukes (trematode worms) of the genus Schistosoma. Complications of long-term infestation include liver cirrhosis, bladder tumors and kidney failure. The objective of this study was to carry out a clinical and epidemiological characterization of a schistosomiasis-diagnosed immigrant population with long-term residencein the EU as well as to evaluate the diagnostic methods available to date. Methods and results. A total of 61 individuals with Schistosoma infection who received medical attention between June 2002 and June 2016 at the North Metropolitan International Health Unit in Barcelona (Catalonia, Spain), were included in the study. All patients were sub-Saharan African immigrants. The majority were male (91.8%) with a median age of 34 years. Symptoms attributable to infection such as haematuria, abdominal pain and dysuria were recorded in up to 90% of patients. The percentage of eosinophils decreased amongst older patients (p = 0.002) and those with symptoms associated with urinary tract infections (p = 0.017). Serology was used for diagnosis in 80.3% of the cases, with microscopic examination showingthe remaining 9.8% positive for parasite eggs. Direct microbiological diagnosis was more useful in patients with less than 5 years of residence in the EU (p = 0.05). Chronic complications were present in 22 (36%) of the patients, with renal failure affecting 20 (33%). Of these 20, 6(10%) developed terminal renal failure and required hemodialysis, while 3 (5%) received a renal transplantation. Conclusion. Morbidity associated with chronic long-term schistosomiasis is frequent among African immigrants in non-endemic countries. Better diagnostic tools and appropriate early treatment would prevent the development of visceral damage. Thorough screening in selected patients would also be useful to avoid chronic complications

Les malalties importades i la població immigrant Descripció i anàlisi de la situació a la zona Metropolitana nord de Barcelona (2002-2011)

La present tesi estudia i analitza dades sanitàries procedents de la població immigrant establerta a la zona Metropolitana Nord de la ciutat de Barcelona, majoritàriament de la comunitat resident a Santa Coloma de Gramenet i a Badalona, durant el període 2002-2011. Aquests 10 anys coincideixen amb el gran influx de població immigrant a Catalunya; abans ja havien tingut lloc migracions similars en quant en nombre de persones, però mai s’havia assistit a res de similar pel que fa a la varietat de l’origen dels nouvinguts. Per tant, i des del punt de vista epidemiològic, l’escenari en què han estat elaborats els articles que conformen la tesi és excepcional. A més, les dades poden posseir un interès suplementari pel fet d’haver estat recollides tant a nivell d’atenció primària (a la Unitat de Salut Internacional Metropolitana nord) com al tercer nivell hospitalari (a la Unitat de Malalties Infeccioses de l’Hospital Germans Trias i Pujol) així com pel fet d’haver comparat poblacions d’immigrants segons criteris d’origen biogeogràfic. Donada l’extensió dels objectius de la tesi, aquesta es va haver de dividir en tres grans apartats que intenten respondre a les següents preguntes: a) ¿quines malalties importen els immigrants nouvinguts?, b) ¿quin és el paper dels immigrants viatgers que retornen als seus països per a visitar les seves famílies com vehiculadors de patologia importada? I, c) ¿quin és l’eventual l’impacte de les malalties endèmiques europees en la població immigrant? Pel que fa a la presència de malalties importades endèmiques tropicals entre els immigrants recentment establerts, es pot concloure que es tracta d’un conjunt de problemes de salut que no és ni gaire freqüent ni gaire rellevant pel que fa a les seves repercussions en Salut Pública amb la possible excepció d’aquelles malalties que presenten períodes de portador sa molt perllongats, aquest seria el cas de les hepatitis víriques cròniques i de la infecció chagàsica. En respecte al segon punt, la resposta és categòrica: els immigrants que visiten les seves famílies després de residir a Europa durant anys són una població que acumula un nombre rellevant i en augment de malalties importades endèmiques tropicals potencialment greus. I, a més, els immigrants adults són comparativament més vulnerables a certes malalties freqüents a Europa en relació a la població adulta autòcton; ho exemplifica clarament l’excés de casos de varicel·la descrit entre els immigrants. Per tant, els cribats d’algunes malalties com les hepatitis cròniques víriques i la infecció chagàsica en immigrants nouvinguts sans segons criteris d’origen biogeogràfic i de la presència d’antecedents personals de risc podria ser útil i pertinent. Les activitats preventives prèvies als desplaçaments internacionals haurien de ser redirigides cap al col·lectiu immigrant en tant que presenten molts factors de risc per a contraure i importar malalties endèmiques tropicals potencialment greus. Algunes poblacions d’immigrants adults presenten una evident vulnerabilitat a certes malalties infeccioses transmissibles freqüents a Europa i, per tant, s’hauria de considerar la implementació de mesures preventives específiques.La presente tesis estudia y analiza datos sanitarios procedentes de la población inmigrante establecida en la zona Metropolitana Norte de la ciudad de Barcelona, mayoritariamente de la comunidad residente en los municipios de Santa Coloma de Gramenet y de Badalona, durante el período 2002-2011. Estos 10 años coinciden con la gran oleada de inmigración extranjera en Cataluña; antes ya habían tenido lugar migraciones similares en cuanto al número de personas, pero nunca se había asistido a nada similar en cuanto a la variedad del origen de los recién llegados. Por tanto, desde el punto de vista epidemiológico, el escenario del que proceden los datos descritos en los artículos que conforman la tesis es excepcional. Además, los datos pueden poseer un interés suplementario al haber sido recopilados tanto a nivel de atención primaria (en la Unidad de Salud Internacional Metropolitana Norte) como en el tercer nivel hospitalario (en la Unidad de Enfermedades Infecciosas del Hospital Germans Trias i Pujol) así como por haber comparado poblaciones de inmigrantes según criterios basados en su origen biogeográfico. Dada la extensión de los objetivos de la tesis, ésta tuvo que dividirse en tres grandes apartados que intentan responder a las preguntas siguientes: a) ¿qué enfermedades importan los inmigrantes recién llegados?, B) ¿cuál es el papel de los inmigrantes viajeros que retornan a sus países para visitar a sus familias como vehiculadores de patología importada? y, c) ¿cuál es la eventual el impacto de las enfermedades endémicas europeas en la población inmigrante? En cuanto a la presencia de enfermedades importadas endémicas tropicales entre los inmigrantes recientemente establecidos, se puede concluir que se trata de un conjunto de problemas de salud ni muy frecuentes ni muy relevantes en cuanto a sus repercusiones en Salud Pública con la posible excepción de aquellas enfermedades que presentan períodos de portador sano muy prolongados, este seria el caso de las hepatitis víricas crónicas y de la infección chagásica. En cuanto al segundo punto, la respuesta es categórica: los inmigrantes que visitan a sus familias después de residir en Europa durante años son una población que acumula un número relevante y en aumento de enfermedades importadas endémicas tropicales potencialmente graves. Y, además, los inmigrantes adultos son comparativamente más vulnerables a ciertas enfermedades europeas n comparación con la población adulta autóctona; ello lo ejemplifica el exceso de casos de varicela descrito entre los inmigrantes. Por tanto, los cribados de algunas enfermedades como las hepatitis crónicas víricas y la infección chagásica en inmigrantes recién llegados sanos según criterios basados en el origen biogeográfico y en la presencia de antecedentes personales de riesgo podría ser útil y pertinente. Las actividades preventivas previas a los desplazamientos internacionales deberían ser priorizadas, redirigidas, hacia el colectivo inmigrante en tanto que presentan muchos factores de riesgo para contraer e importar enfermedades endémicas tropicales potencialmente graves. Algunas poblaciones de inmigrantes adultos presentan una evidente vulnerabilidad a ciertas enfermedades infecciosas transmisibles frecuentes en Europa y, por lo tanto, debería considerarse la implementación de medidas preventivas específicas.This thesis examines and analyzes a ten years-long (2002-2011) health data from the established immigrant population within the Metropolitan Area north of the city of Barcelona, mostly from Santa Coloma de Gramenet and Badalona cities. These 10 years coincide with one of the larger immigrant influx ever received in Catalonia; formerly, other immigration waves had already taken place in comparable numbers but, however, the country had never seen anything similar with respect to the variety of newcomer’s origins. Therefore, and from the epidemiological point of view, the scenario reflected by the articles comprised in this thesis could be considered as exceptional. Furthermore, the studies can display an additional interest since the data have been collected both at primary care (the North Metropolitan International Health Unit) and at hospital third-level (the Infectious Diseases Unit at the Hospital Germans Trias i Pujol) and as the compared populations have been defined on the basis of their biogeographical origin. The general objective of the thesis is really an extensive one. Thus, it was divided into three main sections that attempt to answer the questions of: a) ¿what are the imported diseases diagnosed in the newly arrived immigrants?, b) ¿what is the role of Visiting Friends and Relatives immigrant travelers as potential carriers of imported diseases? and, c) ¿is the immigrant population more vulnerable to endemic European diseases than autochthonous? Regarding the presence of endemic tropical diseases imported from the newly established immigrants we can conclude that they do not set a main health problem in terms of frequency or Public Health impact with the possible exception of those diseases that have prolonged periods of healthy carrier, such as chronic viral hepatitis or Chagas infection. Regarding the second point, the answer is emphatic: immigrants who visit their families after years of residing in Europe are a population that has a significant and growing number of imported endemic tropical diseases, some of them potentially serious. Adult immigrants are comparatively more vulnerable to certain European diseases than adult European-born adults, as the case excess of varicella among immigrants exemplifies. Therefore, the screening of some infectious diseases among newly arrived healthy immigrants on the basis of their biogeographical origin and the presence personal risk factors could be pertinent and relevant. Pre-travel preventive activities should be redirected towards the travelling immigrant population since on them concur many risk factors for contracting and import tropical endemic diseases, sometimes serious. Some specific immigrant adult populations have a superior vulnerability to common transmissible infectious diseases in Europe, offering preventive measures should be considered

Origen biogeogràfic i risc de varicel.la entre la població immigrant adulta de Catalunya

Es tracta de un estudi observacional longitudinal durant 2 anys naturals (07/2004 - 06/2006) i multicèntric (4 centres d’atenció primària) on es van monitoritzar i comparar les incidències de varicel.la registrades en les diferents poblacions ateses segons una classificació basada en el seu origen biogeogràfic. Les taxes d’incidència obtingudes, estandaritzades x 1000/any van ser, en ordre creixent: holoàrtics 2,17 (IC 95%: 1,95-2,39); autòctons 2,25 (IC 95%: 2,02-2,47); immigrants 3,59 (IC 95%: 2,92-4,26); neotropicals 4,50 (IC 95%: 3,28-5,71); no-holoàrtics 5,38 (IC 95%4,27-6,14); paleotropicals asiàtics 7,03 (IC 95%: 4,77-9,28) i paleotropicals etiòpics 7,05 (IC 95%: 1,12-23,58). Les diferències obtingudes en relació a la població autòctona es van centrar en los immigrants d’origen neotropical (raó d’incidència estandaritzada = 2,07; o un excés de 4,5 casos x 1000 habitants) i paleotropical asiàtica =3,24; o un excés de 9,6 casos x 1000 habitants) En conclusió, la població d’origen indostànic i, en menor grau, la d’origen sud-americà poden tenir una vulnerabilitat a la varicel.la superior al de la població autòctona

Consejo sanitario previo a inmigrantes que viajan para visitar a familiares y amigos

Objetivo: Los inmigrantes que realizan o proyectan viajes para visitar a sus familiares en sus países de origen (inmigrantes-visiting friends and relatives [I-VFR]) tienen un riesgo superior a adquirir enfermedades relacionadas con el viaje que otros viajeros. El objetivo principal de este estudio es analizar los conocimientos de la población inmigrante sobre la necesidad de recibir consejo sanitario (CS) antes de realizar viajes internacionales en general y, específicamente, antes de viajar a sus países de origen. Diseño: Estudio observacional y multicéntrico. Emplazamiento: Participaron 10 médicos de familia de 10 Centros de Salud de Cataluña y Aragón. Participantes: Quinientos cincuenta y cinco inmigrantes ≥ 15 años de edad, que consultaron a su médico de familia y accedieron a responder un cuestionario. Se realizó un muestreo oportunista. Resultados: Consideraban necesario recibir CS antes de realizar un viaje internacional 389 (70,1%) personas; 406 (73,2%) eran I-VFR y 145 (35,7%) habían solicitado CS previamente al viaje, con mayor frecuencia a su médico de familia (n = 60; 41,1%). No habían solicitado CS 261 (65,2%) sujetos, siendo el motivo más frecuente por considerarlo innecesario 173 (42,6%). Conclusiones: Los I-VFR no suelen solicitar CS previo a viajar, fundamentalmente por considerarlo innecesario. Cuando lo solicitan, con gran frecuencia se dirigen en primera instancia a su médico de familia