Risk factors for acquiring HCV at a healthcare center in Hidalgo, Mexico. / Factores de riesgo para adquirir VHC en una institución de salud en Hidalgo.

INTRODUCTION AND AIMS: The approach to HCV infection begins with the directed search for risk factors linked to its acquisition. Therefore, our primary aim was to identify the prevalence of risk factors associated with HCV infections in insured individuals seen at the Hidalgo delegation of the IMSS. MATERIALS AND METHODS: An observational, descriptive, cross-sectional study was conducted through validated surveys that identified major and minor risk factors. In cases of major risk factors, the Advanced Quality™ RAPID-ANTI-HCV TEST Accutrack® tests were applied to detect anti-HCV. Patients with positive tests were referred to the Hepatology service for the diagnostic-therapeutic approach. Statistical analysis was performed through measures of central tendency and percentages. RESULTS: A total of 528 insured individuals were surveyed (95%CI with a 5% margin of error). Two hundred eighty-two rapid tests were performed. Five of them were positive (0.94%) and belonged to the patients in the dialysis/hemodialysis group. A total of 71.2% persons had positive risk factors. The association of 2 or more factors varied from 2 to 8 factors present at the same time. Of the entire study population, 6.25% presented with 4 risk factors and 4.35% presented with 5 risk factors at the same time. CONCLUSIONS: Nearly three quarters of the individuals surveyed were exposed to HCV acquisition. The association of 2 or more risk factors in patients demonstrated their collective potentiality for acquiring HCV. We identified persons receiving treatment with dialysis/hemodialysis and those with high-risk sexual practices as vulnerable groups for HCV infection and suggest that they receive promotion and prevention activities, as well as public policy management.

Clinicoepidemiological study of imported malaria in travelers and immigrants to Madrid.

BACKGROUND: The number of Spanish travelers visiting malaria endemic areas, and the number of immigrants from malarial countries arriving in Spain are continuously increasing. However, little information about imported cases in Spain is available. METHODS: A prospective clinicoepidemiological study of imported cases of malaria diagnosed at a referral teaching hospital in Madrid, Spain. RESULTS: Of the 160 patients, sixty (37.5%) were immigrants and 100 (62.5%) Spanish nationals. Malaria was acquired in Africa by 98.3% of immigrants and in 83.0% of travelers. Falciparum malaria accounted for 71.8% of the cases, P. vivax for 11.9%, P. ovale for 10.6% and P. malarie for 5. 0%. Eleven (6.9%) patients, all immigrants, were asymptomatic. Severe complications were recorded in 17 (10.6%): 7, severe anemia; 3, cerebral malaria; 2, renal failure; 1, spontaneous splenic rupture; 1, acute pulmonary edema; 1, sepsis; 1, acute cerebrovascular accident; and 1, disseminated intravascular coagulation. There were no fatal cases. Among the 100 Spanish nationals, 44% did not follow any prophylaxis, 29% followed a correct prophylaxis, 27% were considered defaulters, and 39% took self-treatment without cure. CONCLUSIONS: There is a changing pattern of imported malaria in Madrid, with one third occurring in immigrants and two thirds in nationals. This data provides information about the reemergence of imported malaria to Europe.

Intestinal and extraintestinal cryptosporidiosis in AIDS patients.

In a prospective study in AIDS patients with chronic diarrhea, the overall prevalence of intestinal cryptosporidiosis was 15.6% (43/275). The prevalence was higher in homosexual patients (33.3%) than in intravenous drug abusers (10.6%) (p < 0.001). Extraintestinal infection was present in 30% (13/43) of the patients with known intestinal cryptosporidiosis. Eight of the 13 (61.5%) patients with extraintestinal cryptosporidiosis had Cryptosporidium in the bile and 7 of 13 (16.28%) had it in the sputum. Of the seven patients with Cryptosporidium in the sputum, four had respiratory symptoms and an abnormal chest radiograph, although another pulmonary pathogen was isolated simultaneously. Two other patients from whom Cryptosporidium was the sole respiratory pathogen isolated had no respiratory symptoms and normal chest radiographs. The seventh patient had pulmonary symptoms, interstitial infiltrate on chest radiograph and excessive activity on a pulmonary Gallium scan; Cryptosporidium was the only organism detected in induced sputum and bronchoalveolar lavage specimens. The mean CD4+ lymphocyte count in patients with extraintestinal cryptosporidiosis was 55 cells/mm3.

[Ocular toxocariasis or retinoblastoma?]. / Toxocariosis ocular o retinoblastoma?

BACKGROUND: Seroprevalence studies in Spain have shown that a high number of the population has been in contact with Toxocara canis although no cases of ocular involvement by this helminth have been described. The clinical and age of presentation makes differential diagnosis with retinoblastoma necessary, which is at time difficult, although essential since the treatment and prognosis are very different. METHODS: One case of ocular toxocariosis and the diagnostic keys based on the following are described: ophthalmologic exploration, imaging techniques (ECHO, TC, NMR), aqueous humor cytology, LDH quotient of aqueous/serum humor, and determination of specific anti-Toxocara antibodies by ELISA in serum and aqueous humor. CONCLUSIONS: Correct differential diagnosis between ocular toxocariosis and retinoblastoma is required.

[Dengue: an disease imported from the Indian subcontinent]. / Dengue: enfermedad importada del subcontinente indio.

BACKGROUND: The febrile syndrome is one of the most frequent diseases in travellers with transient clinical pictures, not being reported on many ocassions. In Spain no cases of dengue fever has been published so far. METHODS: A prospective clinical study was carried out in travellers from endemic zones with serologic diagnosis for dengue viruses being performed: IgM/IgG by hemagglutination inhibition and ELISA enhancement. RESULTS: Six cases of dengue are described in Spanish travellers (4 tourists and 2 workers) from the Indian subcontinent (1989-1992). Serologic diagnosis: IgM/IgG by hemagglutination inhibition and ELISA enhancement was carried out. Five cases presented with classical dengue fever picture and 1 with hemorrhagic dengue. In all cases, fever and thrombopenia were reported. The clinical picture was self-limited in 2 patients, complicated with post-dengue syndrome in 3 cases and with fatal outcome in 1. CONCLUSIONS: Dengue fever should be included in the differential diagnosis of febrile syndrome in travellers coming from endemic zones. The authors present the first cases of imported dengue in Spain.