Migration and Malaria in Europe

The proportion of imported malaria cases due to immigrants in Europe has increased during the lasts decades, with higher rates associated with settled immigrants who travel to visit friends and relatives (VFRs) in their country of origin. Cases are mainly due to P. falciparum and Sub-Saharan Africa is the most common origin. Clinically, malaria in immigrants is characterised by a mild clinical presentation including asymptomatic or delayed malaria cases and low parasitic levels. These characteristics may be explained by a semi-immunity acquired after long periods of time exposed to stable malaria transmission. Malaria cases among immigrants, even asymptomatic patients with sub-microscopic parasitemia, could increase the risk of transmission and cause the reintroduction of malaria in certain areas that have adequate vectors and climate conditions. Moreover, imported malaria cases in immigrants can also play an important role in the non-vector transmission out of endemic areas, through blood transfusions, organ transplantation or congenital transmission or occupational exposures. Consequently, outside of endemic areas, malaria screening should be carried out among recently arrived immigrants coming from malaria endemic countries. The aim of screening is to reduce the risk of clinical malaria in the individual as well as to prevent autochthonous transmission of malaria in areas where it has been eradicated

Listeriosis in Spain based on hospitalisation records, 1997 to 2015: need for greater awareness

Introduction Listeriosis is a food-borne disease of public health importance that has recently been involved in prolonged outbreaks. Despite its relevance, listeriosis is under-reported in many European countries.AimWe aimed to describe listeriosis epidemiology in Spain from 1997-2015.MethodsWe performed a retrospective study using the Spanish hospitalisation database. We calculated the mean number of hospitalisations per year and region. Pregnancy and neonatal-related listeriosis rates were computed. Relation between death and the presence of underlying health conditions was explored.ResultsBetween 1997-2015, 5,696 listeriosis hospitalisations occurred, showing a constantly increasing trend. Higher hospitalisation rates were located in the north of the country compared to southern regions. The age group ≥ 65 years old was the most represented (50%). Pregnant women and newborns accounted for 7% and 4% of hospitalisations, respectively. An underlying immunocompromising condition was present in 56.4% of patients: cancer (22.8%), diabetes mellitus (16.6%) and chronic liver disease (13.1%). Death occurred in 17% of patients, more frequently among those ≥ 65 years old (67.5%), with sepsis (39.9%) or with meningoencephalitis (19.2%).ConclusionListeriosis is an emergent public health problem in Spain that calls for targeted action. Further prevention strategies are urgently needed, including food safety education and messaging for all at-risk groups.We would like to thank the General Sub-direction of the Institute for Health Information, Spanish Ministry of Health, Consumer Affairs and Social Welfare, for providing the information on which this study is based. The corresponding author’s affiliation centre belongs to the ISCIII-Sub. Gral. Redes- Network Biomedical Research on Tropical Diseases (RICET in Spanish) grant RD16CIII/0003/0001, RD16/0027/0020, RD16CIII/0003/0001 and the European Regional Development Fund. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.S

Salud e inmigración en el contexto de esta crisis económica y de valores:el ejemplo de España

Los principales determinantes de la salud de las personas y de las comunidades son sociales y por tanto así deberán ser sus soluciones. En el caso de la población inmigración existe una excepción a esta regla ya que a su llegada por diversos motivos (que pueden resumirse en el 'healthy migration effect') suelen presentar una salud superior a la población que los acoge. No obstante, con el transcurso de los años está salud tiende a deteriorarse. Los Sistemas Sanitarios Públicos de cobertura Universal han demostrado su capacidad de reducir las desigualdades sanitarias. La Unión Europea en diversos documentos ha enfatizado la importancia de garantizar una adecuada atención sanitaria a toda la población incluyendo la inmigrante. España era un referente mundial en este sentido al garantizar la accesibilidad al Sistema Sanitario de todos los inmigrantes independientemente de su situación administrativa. No obstante, a raíz del Real Decreto Ley 12/2012, el Gobierno Español ha excluido a unas 900.000 de este Derecho provocando un grave problema humano, ético y sanitario ante el que distintos colectivos sociales y profesionales han manifestado su oposición

Visceral leishmaniasis and HIV coinfection in the Mediterranean region

Visceral leishmaniasis is hypoendemic in Mediterranean countries, where it is caused by the flagellate protozoan Leishmania infantum. VL cases in this area account for 5%-6% of the global burden. Cases of Leishmania/HIV coinfection have been reported in the Mediterranean region, mainly in France, Italy, Portugal, and Spain. Since highly active antiretroviral therapy was introduced in 1997, a marked decrease in the number of coinfected cases in this region has been reported. The development of new diagnostic methods to accurately identify level of parasitemia and the risk of relapse is one of the main challenges in improving the treatment of coinfected patients. Clinical trials in the Mediterranean region are needed to determine the most adequate therapeutic options for Leishmania/HIV patients as well as the indications and regimes for secondary prophylaxis. This article reviews the epidemiological, diagnostic, clinical, and therapeutic aspects of Leishmania/HIV coinfection in the Mediterranean region.S

Drug resistance and treatment failure in leishmaniasis: A 21st century challenge

Reevaluation of treatment guidelines for Old and New World leishmaniasis is urgently needed on a global basis because treatment failure is an increasing problem. Drug resistance is a fundamental determinant of treatment failure, although other factors also contribute to this phenomenon, including the global HIV/AIDS epidemic with its accompanying impact on the immune system. Pentavalent antimonials have been used successfully worldwide for the treatment of leishmaniasis since the first half of the 20th century, but the last 10 to 20 years have witnessed an increase in clinical resistance, e.g., in North Bihar in India. In this review, we discuss the meaning of “resistance” related to leishmaniasis and discuss its molecular epidemiology, particularly for Leishmania donovani that causes visceral leishmaniasis. We also discuss how resistance can affect drug combination therapies. Molecular mechanisms known to contribute to resistance to antimonials, amphotericin B, and miltefosine are also outlined

Application of an ELISA test using Schistosoma bovis adult worm antigens in travellers and immigrants from a schistosomiasis endemic area and its correlation with clinical findings

[EN] We have recently evaluated an ELISA for the diagnosis of human schistosomiasis using S. bovis adult worm antigens (AWA Sb), showing a sensitivity of 94% and a specificity of 97% for patients diagnosed by egg detection. Nevertheless, the comparison of this AWA Sb ELISA with direct parasitological findings as the gold standard could introduce a Selection bias, due to the well-known lack of sensitivity of direct methods in the detection of acute schistosomiasis and of low burden infections. The objective of the present work is to compare it with parasitological methods and commercial indirect haemagglutination test using S. mansoni antigens (WA Sm IHA) in 254 immigrants and travellers with different clinical settings; in addition, to find specific bands in the EITB of different phases of schistosomiasis. The AWA Sb ELISA showed 72% of seropositivity in patients with Katayama fever, while patients with eosinophilia and genito-urinary complaints showed 27% and 93%, respectively. The diagnosis yield was globally higher than direct egg detection or WA Sm IHA test with regard to the clinical setting. Finally, the utilization of EITB with S. bovis AWA permits the confirmation of diagnosis in chronic and acute phases of the disease

Visceral Larva Migrans in Immigrants from Latin America

To determine whether increased migration is associated with an increase in incidence of toxocariasis (visceral larva migrans), we analyzed clinical data obtained from immigrants from Latin America. Although infection with Toxocara sp. roundworm larvae is distributed worldwide, seroprevalence is highest in tropical and subtropical areas