Imported malaria in children in Madrid, Spain, 2007-2013.

BACKGROUND: The majority of malaria cases diagnosed in Europe in the last few years have occurred in people living in non-endemic areas travelling back to their home country to visit friends and relatives (VFRs). Children account for 15-20% of imported malaria, with known higher risk of severe disease. MATERIAL AND METHODS: A retrospective multicentre study was conducted in 24 hospitals in Madrid (Spain) including patients under 16 years diagnosed with malaria (2007-2013). RESULTS: A total of 149 episodes in 147 children were reported. Plasmodium falciparum was the species most commonly isolated. Twenty-five patients developed severe malaria and there was one death related to malaria. VFR accounted for 45.8% of our children. Only 17 VFRs had received prophylaxis, and 4 of them taken appropriately. They presented more frequently with fever (98% vs. 69%), a longer time with fever (55 vs. 26%), delay in diagnosis of more than three days (62 vs. 37%), and more thrombocytopenia (65 vs. 33%) than non-VFRs, and with significant differences (p<0.05). CONCLUSIONS: VFRs represent a large proportion of imported malaria cases in our study. They seldom took adequate prophylaxis, and delayed the visit to the physician, increasing the length of fever and subsequent delaying in diagnosis. Appropriate preventive measures, such as education and pre-travel advices should be taken in this population.

[Filarial infestation in patients emanating from endemic area. 14 cases series presentation]. / Filariosis en pacientes procedentes de área endémica. Presentación de una serie de 14 casos.

INTRODUCTION: The migration causes the emergence of new diseases in our environment. One of them is the filariosis which, due to the biologic cycle peculiarity, it's weird its appearance in pediatrics. This studio accomplishes a review of all the filariosis cases diagnosed the last years in an Unit specialized in Tropical Pediatrics Diseases. MATERIAL AND METHODS: Retrospective analysis comprising 14 patients than were diagnosed with filariosis from 1995 to 2007 in the Pediatrics Unit of Carlos III Hospital (Madrid). They have been analyzed several variables to cope with clinic-epidemiological, therapeutics and evolutional characteristics. RESULTS: All patients in the study came from Equatorial Guinea, their ages were between 3 and 15 years old. The isolated species were: 6 cases with O. volvulus, 8 with M. perstans and 2 with Loa-loa. The pruritus was the main symptom in the 71% of the cases. The eosinophilia was detected in the 78% of the patients, and the Loa-loa was the specie with higher figures. The 85% of the patients showed co-parasitation, being the intestinal the most frequent. The diagnostics was established by epidermic biopsy, microfilaremia detection, direct visualization and serology. The utilized drugs were: Mebendazole for the cases with M. perstans and Ivermectin or Dietylcarbamazine for the rest of the species. One child showed mixed filariosis. The cure was successful in the 8 cases that could be followed up. CONCLUSIONS: We consider essential to execute a filariosis screening to every patient emanating from endemic area, especially to those with eosinophilia. The diagnostic in the childhood, even though it's difficult, it allows the prevention of the disease development, serious complications as blindness and break the parasite life cycle.