Migration-associated malaria from Africa in southern Spain.

BACKGROUND: The western area of the province of Almeria, sited in southern Spain, has one of the highest immigrant population rates in Spain, mainly dedicated to agricultural work. In recent years, there has been a significant increase in the number of cases of imported malaria associated with migrants from countries belonging to sub-Saharan Africa. The objective of our study is to describe the epidemiological, clinical and analytical characteristics of malaria patients treated in a specialized tropical unit, paying special attention to the differences between VFR and non-VFR migrants and also to the peculiarities of microscopic malaria cases compared to submicroscopic ones. METHODS: Retrospective observational study of migrants over 14 years of age with imported malaria treated from October 2004 to May 2019. Characteristics of VFR and non-VFR migrants were compared. Malaria cases were divided into microscopic malaria (MM) and submicroscopic malaria (SMM). SMM was defined as the presence of a positive malaria PCR test together with a negative direct microscopic examination and a negative rapid diagnostic test (RDT). Microscopic malaria was defined as the presence of a positive RDT and/or a positive smear examination. RESULTS: Three hundred thirty-six cases of malaria were diagnosed, 329 in sub-Saharan immigrants. Of these, 78.1% were VFR migrants, in whom MM predominated (85.2% of cases). In non-VFR migrants, SMM represented 72.2% of the cases. Overall, 239 (72.6%) patients presented MM and 90 (27.4%) SMM. Fever was the most frequent clinical manifestation (64.4%), mainly in the MM group (MM: 81.1% vs SMM: 20.0%; p < 0.01). The most frequent species was P. falciparum. Patients with SMM presented fewer cytopenias and a greater number of coinfections due to soil-transmitted helminths, filarial and intestinal protozoa compared to patients with MM. CONCLUSIONS: Imported malaria in our area is closely related to sub-Saharan migration. VFR migrants are the main risk group, highlighting the need for actions aimed at improving disease prevention measures. On the other hand, almost a third of the cases are due to SMM. This fact could justify its systematic screening, at least for those travelers at greater risk.

Severe complications of imported schistosomiasis, Spain: A retrospective observational study.

BACKGROUND: Chronic schistosomiasis silently leads to severe organ-specific disorders, such as hydroureter, bladder cancer or portal hypertension in around 10% of infected people in endemic zones. However, in non-endemic areas, information on schistosomiasis' severe complications and their actual prevalence is scarce because diagnosis is usually reached when such complications are well established. METHODS: Retrospective observational study of data obtained from a screening protocol designed for sub-Saharan migrants including search for stool parasites and schistosoma serology. After screening 3090 sub-Saharans, 326 (10.5%) confirmed cases of schistosomiasis were found, based on detection of ova in feces, urine or in biopsy samples. Another 830 patients (26.9%) were diagnosed of probable schistosomiasis (positive serology and/or suggestive imaging findings). RESULTS: Only patients with confirmed schistosomiasis were included in the final analysis. Among them, 13 (4%) presented severe complications at the time of diagnosis. Depending on the location, they account for 5% of patients with hepatointestinal schistosomiasis and 3.5% of patients with urogenital infection. CONCLUSIONS: Targeted systematic screening could reduce the prevalence of severe complications by enabling early diagnosis and treatment. Having indigenous transmission been demonstrated in southern Europe, prevention of future cases in non-endemic countries might be another sound reason supporting such screening.

Utilidad de dos marcadores biológicos de infección bacteriana en niños menores de 2 años / Use of two bacterial infection biomarkers in children under 2 years old

Introducción. la procalcitonina (PCT) es una molécula que aumenta en infecciones bacterianas. La proteína C reactiva (PCR) se eleva en procesos inflamatorios independientemente de su origen. Debido a la vida media más corta y una elevación más rápida, la PCT ofrece potenciales ventajas sobre la PCR en el diagnóstico precoz de infección bacteriana. Objetivo. evaluar el rendimiento diagnóstico de la PCT y la PCR en infecciones bacterianas en niños menores de 2 años, usando como referencia el cultivo bacteriano positivo. Material y método. se estudió a 68 niños con síndrome febril y sospecha de infección bacteriana aguda. Al ingreso, se determinó su PCT y su PCR, además de cultivos bacteriológicos, virus respiratorio sincitial, rotavirus y adenovirus. Resultados. la PCT presentó una sensibilidad del 50%, una especificidad del 70,8%, un valor predictivo positivo (VPP) del 35% y un valor predictivo negativo (VPN) del 70,8%, todos ellos superiores a los de la PCR. Conclusiones. la PCT presenta una buena especificidad, y una sensibilidad mejorable si su determinación fuese cuantitativa y el valor umbral inferior. Así, se detectarían infecciones localizadas o una generalizada en sus etapas iniciales. En nuestro estudio, la determinación aislada de PCT ofrece más especificidad y sensibilidad que la PCR, si bien respecto a la sensibilidad hay trabajos que la igualan a la de la PCR y otros indican que esta última sería mayor y más practicable. No obstante, la implantación de la PCT como marcador de infección bacteriana en el laboratorio de urgencias nos permitiría descartar las infecciones generalizadas bacterianas en niños gracias a su buen VPN y, por lo tanto, racionalizar el uso de antibióticos, costes de tratamiento y estancias hospitalarias(AU)

Introduction. Procalcitonin (PCT) increases in bacterial infections. C reactive protein (CRP) rises in inflammatory processes regardless of origin. Due to its shorter half-life and a more rapid increase, PCT offers potential advantages over CRP in the early diagnosis of bacterial infection. Objective. To evaluate PCT and CRP diagnostic performance in children under 2 years old. We used positive bacterial culture as gold standard. Material and method. A total of 68 children with febrile syndrome and a suspected bacterial infection were studied. At admission, PCT and CRP were performed, along with microbiology cultures, respiratory syncytial virus, rotavirus and adenovirus. Results. PCT had a sensitivity of 50%, a specificity 70.8%, a predictive positive value (PPV) of 35% and a predictive negative value (PNV) of 70.8%. All of them higher than CRP. Conclusions. PCT had good specificity and an improvable sensitivity with a quantitative determination and a lower threshold value. Thus, we could detect local or generalised infections at initial stages. In our study, isolated PCT determination had a greater specificity and sensitivity than CRP. Although, there are studies that show that CRP is as sensitive as PCT, there are others that show CRP to have a higher and more practicable sensitivity. However, the introduction of PCT as bacterial infection marker at urgency laboratories could rule out generalised bacterial infections in children due to its better PNV, and therefore, could rationalise the use of antibiotics, and reduce treatment costs and hospital admissions(AU)