Fake imported tropical diseases: A retrospective study.

OBJECTIVE: When we evaluate a patient with a suspected imported disease we cannot forget to include any autochthonous causes that may mimic imported pathologies to avoid misdiagnosis and therapeutic delay. METHODS: A descriptive longitudinal retrospective study was designed with patients in whom an imported disease was suspected but who were finally diagnosed with autochthonous processes. The patients were selected from two internal medicine practices specializing in tropical diseases between 2008-2017 in Spain. RESULTS: We report 16 patients, 11 (68.7%) were males, and the mean age was 43.4 ± 13.7 years old. Thirteen patients (81.2%) were travellers. Half of the patients were from Latin America, 7 (43.5%) were from Africa, and 1 (6.2%) was from Asia. The time from trip to evaluation ranged between 1 week and 20 years (median, 4 weeks), and the mean time from evaluation to diagnosis was 58.4 ± 100.9 days. There were 5 (31.2%) cases of autochthonous infection, 5 (31.2%) cases of cancer, 2 (12.5%) cases of inflammatory disease, and 2 (12.5%) cases of vascular disease. CONCLUSIONS: Travel or migration by a patient can sometimes be a confusing factor if an imported disease is suspected and may cause delays in the diagnosis and treatment of an autochthonous disease. We highlight that 1/3 of the patients with autochthonous diseases in this study had cancer. The evaluation of imported diseases requires a comprehensive approach by the internist, especially if he specializes in infectious and/or tropical diseases and is, therefore, the best qualified to make an accurate diagnosis.

Is cystic echinoccocosis re-emerging in western Spain?

Cystic echinococcosis (CE) remains an important health problem in many areas of the world, including the Mediterranean region. We performed a retrospective study of cases reported from 1998 to 2012 in order to review and update the epidemiology of this disease in a highly endemic area situated in western Spain. A total of 471 patients were diagnosed with hydatid disease. Of these cases, 55·8% were male, with an average age of 62·3 ± 19·5 years. More importantly, 1·5% of patients were children, and 20·5% were aged <45 years. An active therapeutic approach was implemented for 92·6% of the CE patients with primary diagnoses; however, a 'watch and wait' strategy was used in 59·3% of all secondary CE diagnoses. The incidence rate of hydatid disease was significantly higher compared to the incidence described in the Notifiable Disease System in this area. Furthermore, a significant decrease in hydatid incidence during the years included in the study was observed (ß = -0·4357, P < 0·001). CE incidence has diminished in recent years, although active transmission remains in paediatric cases. Additionally, CE incidence remains high in our region despite public health plans for its control. The documented incidence of CE disease clearly underestimates the real numbers.