Epidemiologic and biogeographic analysis of 542 VFR traveling children in Catalonia (Spain). A rising new population with specific needs.

BACKGROUND: Imported diseases recorded in the European Union (EU) increasingly involve traveling immigrants returning from visits to their relatives and friends (VFR). Children of these immigrant families can represent a population of extreme vulnerability. METHODS: A randomized cross-sectional study of 698 traveling children under the age of 15 was performed. VFR traveling children and non-VFR (or tourist) children groups were compared. RESULTS: A total of 698 individuals were analyzed: 354 males (50.7%) and 344 females (49.3%), with a median age (interquartile range) of 4 (2-9) years. Of these, 578 (82.8%) had been born in the EU with 542 (77.7%) being considered as VFR, whereas 156 (22.3%) were considered tourists. VFR children were younger (4.7 vs 8.2 yr; p < 0.001), they had more frequently been born in the EU (62.8% vs 20.1%; p < 0.01) and were more frequently lodged in private homes (76.6% vs 3.2%: p < 0.001) and rural areas (23.2% vs 1.6%; p < 0.001). Furthermore, VFR remained abroad longer (51.6 vs 16.6 d; p < 0.001), the visit/travel time interval was shorter (21.8 vs 32.2 d; p < 0.001) than tourists, and consultation was within 10 days prior to the departure (26.4% vs 2.7%; p < 0.001). The risk factor most differentiating VFR children from tourists was accommodation in a rural setting [odds ratio(OR) = 5.26;95%CI = 2.704-10.262;p < 0.001]. CONCLUSIONS: VFR traveling children showed a greater risk of exposure to infectious diseases compared with tourists. Immigrant families may represent a target group to prioritize international preventive activities.

Efficacy of three different valve systems of needle-free closed connectors in avoiding access of microorganisms to endovascular catheters after incorrect handling.

OBJECTIVE: Disinfectable needle-free closed connectors were designed to avoid needle-stick injuries and to be easily disinfected before handling. Workloads or lack of knowledge, however, could impede the correct handling of these devices, allowing endoluminal catheter colonization. The aim of our study was to assess the barrier effect of different disinfectable needle-free closed connectors during correct and incorrect handling using an experimental model. DESIGN: We used a model consisting of a blood culture bottle with a peripheral venous catheter inserted under sterile conditions. Three different disinfectable needle-free closed connectors with different valve designs (microClave, Bionector, and Smartsite plus) were used to close the catheters. The external surfaces of the disinfectable needle-free closed connectors were contaminated with different concentrations of a Staphylococcus epidermidis culture broth. After contamination, 10 units of each connector and each concentration were assigned to the correct handling group (cleaned with 70% ethylic alcohol before handling) and the same number to the incorrect handling group (handled without disinfection) with a total of 180 bottles. RESULTS: Increases in concentrations of external contamination and incorrect handling of the connectors resulted in an increase in connectors' permeability to the pass of microorganisms to the endoluminal way. MicroClave proved the best barrier in the experimental conditions described. CONCLUSION: The barrier effect of disinfectable needle-free closed connectors is adversely affected by incorrect handling, the quantity of external valve colonization, and the valve design.

Differences in the etiology of community-acquired pneumonia according to site of care: a population-based study.

BACKGROUND: A few population-based studies assessing the etiology of community-acquired pneumonia in both hospitalized and ambulatory patients, with special emphasis on the etiologic role of viral infections, have been reported. The purpose of this study was to assess microbiological differences according to initial site of care in patients with community-acquired pneumonia. METHODS: We studied 496 patients > 14 years of age collected from the study samples of three population-based studies carried out in the same geographical area ("Maresme" region in the Mediterranean coast in Barcelona, Spain) with the same methodology over an 8-year period (1987-1995). RESULTS: Fifty-six percent of patients were hospitalized and 44% were treated at home. Of the 474 patients with etiological evaluation, 195 patients had an identifiable etiology (overall diagnostic yield 41%). Streptococcus pneumoniae was the most common causative organism. Viral infection was diagnosed in 26.5% of hospitalized patients vs. 13.2% of ambulatory patients (P=0.03). Twenty-five percent of the 68 patients with documented etiology treated at home had Chlamydia pneumoniae infection compared with 14.3% of those treated in the hospital. Ten percent of hospitalized patients had pneumonia caused by two pathogens compared with 9.7% of ambulatory patients. The association of viruses and bacteria was the most frequent cause of dual infection (79% inpatients, 67% outpatients). CONCLUSIONS: This study has provided information on etiology of community-acquired pneumonia in hospitalized patients and in patients treated at home. A considerable proportion of patients had viral pneumonia, frequently requiring hospital admission for inpatient care.

Contribution of C-reactive protein to the diagnosis and assessment of severity of community-acquired pneumonia.

STUDY OBJECTIVE: To assess the usefulness of serum C-reactive protein (CRP) in the diagnosis and treatment approach of patients with community-acquired pneumonia (CAP). DESIGN: Population-based case-control study. SETTING: A mixed residential-industrial urban area of 74,368 adult inhabitants in the Maresme region (Barcelona, Spain). PATIENTS: From December 1993 to November 1995, all subjects who were > 14 years of age, were living in the area, and had received a diagnosis of CAP, which had been confirmed by chest radiographs and compatible clinical outcome, were registered. Patients from residential care facilities were excluded. Serum samples were assayed for CRP in the acute phase of the disease. Data from 201 patients with CAP were compared with 84 healthy control subjects matched by age, sex, and municipality, as well as with 25 patients with initially suspected pneumonia that was not confirmed at follow-up. Median CRP levels were 110.7, 1.9, and 31.9 mg/L, respectively. The thresholds of the test for discriminating among these three groups of subjects were 11.0 and 33.15 mg/L. RESULTS: Eighty-nine patients (44.8%) had an identifiable etiology. The most common pathogens were Streptococcus pneumoniae, viruses, and Chlamydia pneumoniae, followed by Mycoplasma pneumoniae, Legionella pneumophila, and Coxiella burnetii. There were statistically significant differences in the median CRP levels in pneumococcal (166.0 mg/L) and L pneumophila (178.0 mg/L) etiologies compared to other causative pathogens. Lower levels of CRP were found in pneumonia caused by viruses and C burnetii as well as in negative microbiological findings. The median CRP levels in hospitalized patients were significantly higher than in outpatients (132.0 vs 76.9 mg/L, respectively; p < 0.001). Considering a cut point of 106 mg/L in men and 110 mg/L in women for deciding about the appropriateness of inpatient care, CRP levels showed a sensitivity of 80.51% and a specificity of 80.72%. CONCLUSIONS: Serum CRP level is a useful marker for establishing the diagnosis of CAP in adult patients with lower respiratory tract infections. High CRP values are especially high in patients with pneumonias caused by S pneumoniae or L pneumophila. Moreover, high CRP values are suggestive of severity, which may be of value in deciding about the appropriateness of inpatient care.

Resistance to the migration of microorganisms of a needle-free disinfectable connector.

The aim of this study was to assess the efficacy of a disinfectable needle-free connector in reducing the pass of micro-organisms to the lumen of the catheter. A prospective, controlled, experimental trial was performed in which a laboratory model simulated the insertion of a peripheral venous catheter. Catheters inserted in sterile conditions in a hemoculture bottle were closed with the disinfectable needle-free connector (study group) or with a cap (control group). After 9 days of contamination and manipulation of the connector and cap external surfaces, 100% of bottles in the control group were contaminated whereas 60% remained sterile in the study group. The disinfectable needle-free connector showed more resistance to the pass of microorganisms than the conventional cap according to our experimental model.

[Imported hookworm infection in African immigrants in Spain: study of 285 patients]. / Uncinariasis importada por inmigrantes africanos: estudio de 285 casos.

BACKGROUND AND OBJECTIVE: Hookworm infection is a worldwide intestinal parasitic disease affecting more than one billion people. It represents an important public health problem in rural areas of developing countries. In our environment, it is generally considered an imported disease due to the immigration process. PATIENTS AND METHOD: Retrospective observational study of African immigrants diagnosed with hookworm infection at the Immigration and Tropical Medicine Unit of the Hospital of Mataró over the period 1984-1999. RESULTS: We identified 285 patients, mainly young males, from Gambia or Senegal, with a precarious job who had arrived in Spain 3 years earlier or less. Abdominal pain was the commonest reason for consultation (28.8%) cases. Non digestive symptoms were 35.6% and 4.6% remained assymptomatic. 60% had a concomitant infectious disease. Laboratory tests showed iron-deficiency anemia in 28.4% and eosinophilia in 52.3%. 70% of patients did not come to visit after treatment. CONCLUSIONS: Microbiologic stool examination is recommended as part of the health assessment of immigrants from countries where hookworm infection is highly prevalent, even in the absence of abdominal symptoms or abnormalities of the red and white blood series.

Uncinariasis importada por inmigrantes africanos:estudio de 285 casos / Imported hookworm infection in African immigrants in Spain: Study of 285 patients

FUNDAMENTO Y OBJETIVO: La uncinariasis es una parasitosis intestinal de amplia distribución mundial que afecta a más de mil millones de personas. Constituye un importante problema de salud pública en áreas rurales de los países con baja renta. En España es una enfermedad generalmente importada y, dado el fenómeno inmigratorio progresivo, conviene valorar su impacto. PACIENTES Y MÉTODO: Estudio observacional retrospectivo en una población de inmigrantes africanos diagnosticados de uncinariasis en la Unidad de Medicina de la Inmigración y Tropical del Hospital de Mataró, durante el período 1984-1999. RESULTADOS: Se diagnosticaron 285 pacientes, mayoritariamente varones, jóvenes, originarios de Gambia o Senegal, con inestabilidad laboral y con 3 o menos años de migración. Los motivos de consulta fueron variados. Entre los 10 más frecuentes el dolor abdominal fue el primero (28,8 por ciento), los síntomas no digestivos representaron el 35,6 por ciento y los pacientes asintomáticos supusieron el 4,6 por ciento. El 60 por ciento presentaba otras enfermedades infecciosas asociadas. En el estudio analítico se detectó anemia ferropénica en el 28,4 por ciento y eosinofilia en el 52,3 por ciento. Hubo un 70 por ciento de pérdidas en la visita de control postratamiento. CONCLUSIONES: Es recomendable realizar un análisis microbiológico de heces en los inmigrantes procedentes de países con alta prevalencia de uncinariasis, aunque no presenten sintomatología digestiva o alteración del hemograma (AU)

[Imported diseases in African immigrants in Spain: study of 1,321 patients]. / Enfermedades importadas en inmigrantes Africanos: estudio de 1.321 pacientes.

BACKGROUND: Immigrants can carry diseases characteristic from their countries of origin. These are known as imported diseases (ID) and can be classified into tropical diseases (TD) or cosmopolitan diseases (CD). The aim of this study was to analyse the ID in African immigrants and evaluate their repercussion in the Spanish Public Health. PATIENTS AND METHOD: Observational study, retrospective protocol, carried from 1984 to 1994 in African immigrants seen in a reference Hospital. Not infectious chronic ID were excluded. The repercussion in public health was divided in 3 categories according to transmission risk to the host population: a) ID without current risk; b) ID with potential risk and, c) ID of risk. RESULTS: 1,321 African immigrants were considered. Most of them were from Sub-Saharan Africa. The most frequent TD were helminthiases and among CD, tuberculosis, sexually transmitted diseases and parasitoses. ID without transmission risk were 26.7% (2.4% CD and 24.3% TD), ID with potential risk 35.2% (33.6% CD and 1.6% TD) and ID with risk 38% (all CD). CONCLUSIONS: The CD and their association with poverty suppose a higher risk of transmission to the host country population. Global policies of helping social and economic insertion of immigrant populations, combined with international health collaboration, will rebound positively in the general population's health.