Search

Background Prolonged or recurrent gastrointestinal symptoms may persist after acute traveller’s diarrhoea (TD), even after adequate treatment of the primary cause. This study aims to describe the epidemiological, clinical and microbiological characteristics of patients with post-infectious irritable bowel syndrome (PI-IBS) after returning from tropical or subtropical areas. Methods We conducted a retrospective study of patients presenting between 2009 and 2018 at the International Health referral centre in Barcelona with persistent gastrointestinal symptoms following a diagnosis of TD. PI-IBS was defined as the presence of persistent or recurrent gastrointestinal manifestations for at least 6 months after the diagnosis of TD, a negative stool culture for bacterial pathogens and a negative ova and parasite exam after targeted treatment. Epidemiological, clinical and microbiological variables were collected. Results We identified 669 travellers with a diagnosis of TD. Sixty-eight (10.2%) of these travellers, mean age 33 years and 36 (52.9%) women, developed PI-IBS. The most frequently visited geographical areas were Latin America (29.4%) and the Middle East (17.6%), with a median trip duration of 30 days (IQR 14–96). A microbiological diagnosis of TD was made in 32 of these 68 (47%) patients, 24 (75%) of whom had a parasitic infection, Giardia duodenalis being the most commonly detected parasite (n = 20, 83.3%). The symptoms persisted for a mean of 15 months after diagnosis and treatment of TD. The multivariate analysis revealed that parasitic infections were independent risk factors for PI-IBS (OR 3.0, 95%CI 1.2–7.8). Pre-travel counselling reduced the risk of PI-IBS (OR 0.4, 95%CI 0.2–0.9). Conclusions In our cohort, almost 10% of patients with travellers’ diarrhoea developed persistent symptoms compatible with PI-IBS. Parasitic infections, mainly giardiasis, seem to be associated with PI-IBS.

Unaccompanied and separated children (UASC) are a high-risk group for infectious diseases and information on their vaccination status is scarce. Different approaches are used to screen newly arrived minors in Europe. The aim of this study was to describe the health status and serological protection against different vaccine-preventable diseases among UASC to inform public health decision-making.Retrospective study of all UASC seen at an international health reference center in Barcelona (Spain) between January 2017 and February 2020. Screening results were analyzed using binary logistic regression with adjustment for symptoms, geographic origin, and time since arrival.We studied 289 UASC (88.9% males; median age, 17 years). At least one infection was diagnosed in 136 minors (47.1%). There was a high prevalence of intestinal parasites (22.8%), latent tuberculosis infection (22.5%), and hepatitis B (5.2%), even in asymptomatic individuals, and especially among UASC from sub-Saharan Africa (odds ratio, 2.5; 95% confidence interval, 1.5-4.0, Plt; 0.001). We did not observe a significant association between clinical symptoms and the presence of infection or differences in the prevalence of different infections according to number of months since arrival. Protection against hepatitis B virus (36%), measles (80%), and varicella (83%) was suboptimal.Our results highlight the importance of screening and vaccination programs for UASC arriving in Europe, especially border countries. Protocols should be adjusted according to geographic origin. Absence of symptoms does not necessarily rule out infection, highlighting the importance of screening in asymptomatic minors. These programs are a public health priority and should not be neglected during the current COVID-19 pandemic.

Resumen Introduccion La fase cronica de la enfermedad de Chagas se caracteriza por una parasitemia baja e intermitente. En esta fase la sensibilidad de la reaccion en cadena de la polimerasa (PCR) es muy variable, limitando su utilizacion como tecnica diagnostica. A pesar de ello, la realizacion de la PCR en pacientes no tratados puede aportar datos sobre el comportamiento del parasito y su presencia en sangre periferica. Metodos Se realizo PCR a tiempo real de forma puntual en una cohorte de 495 pacientes con enfermedad de Chagas cronica en ausencia de tratamiento. Tambien se realizo seguimiento de una subcohorte de 29 pacientes mediante PCR a tiempo real seriadas, entre 8 y 12 meses en los que no tuvieron acceso al tratamiento por falta de suministro. Resultados El porcentaje de positividad de PCR a tiempo real fue de 42%. Este porcentaje fue significativamente mayor en pacientes con 5 anos o menos de residencia en Espana (p = 0,041). La deteccion de ADN no se relaciono con la existencia de alteraciones cardiacas y/o digestivas. En el subgrupo de pacientes a los que se realizaron determinaciones seriadas, el resultado de PCR fue sostenidamente positivo en el 13,8% de los pacientes, negativo en el 31% e intermitente en el 55,2%. Conclusiones Las diferencias de resultados de PCR a tiempo real en funcion del tiempo de residencia apuntan que existen factores externos que pueden influir en la presencia del parasito en sangre periferica. Asi mismo, factores propios del hospedador parecen influir en la dinamica parasitaria a lo largo del tiempo.

Aim: This work aimed to compare the sensitivity of four protocols for the detection of Trypanosoma cruzi DNA in 98 blood samples from chronic Chagas disease patients. Materials & methods: Two DNA extraction (automated and manual) methods and two T. cruzi satellite DNA qPCRs (with a recent design and the usually used set of primers) were analyzed. Results: Both DNA extraction methods and qPCR assays tested in this work gave comparable qualitative results, although the lowest Ct values were obtained when samples were analyzed using the new set of primers for T. cruzi satellite DNA. Conclusion: Our results encourage the implementation of automated DNA extraction systems and the new T. cruzi qPCR for the molecular diagnostics and treatment response monitoring of chronic Chagas disease patients.

Most human hantavirus infections occur in Asia, but some cases have been described in Europe in travelers returning from Asia. We describe a case of hantavirus pulmonary syndrome in a previously healthy traveler occurring shortly after he returned to Spain from Nepal. Serologic tests suggested a Puumala virus-like infection. Sí

Background Leishmaniasis is a neglected disease caused by different species of the protozoa Leishmania spp. Cutaneous lesions are the most common clinical manifestation. This disease is prevalent in tropical and subtropical areas, including the Mediterranean basin. In Spain, Leishmania (L.) infantum is the only endemic species, but imported cases are often diagnosed. Different classical parasitological methods can be performed for cutaneous leishmaniasis (CL) diagnosis; but currently molecular techniques serve as a relevant tool for the detection and characterization of Leishmania parasites. We aimed to evaluate clinical and epidemiological characteristics of CL diagnosed patients by real-time PCR in a tertiary hospital over a six-year period. Methodology/Principal findings Clinical, epidemiological and microbiological data were retrospectively collected and analyzed. In our study, CL was confirmed in 59 (31.4%) out of 188 patients by real-time PCR, showing an increase over recent years: 11 cases of CL between 2014 and 2016 and 48 between 2017 and 2019. Real-time PCR was performed on skin swabs and/or biopsies samples, with a positivity of 38.5% and 26.5%, respectively. Results were 100% concordant when biopsy and skin swab were performed simultaneously. L. (L.) infantum was the most frequent species detected (50%), followed by L. (L.) major (45%) and Viannia subgenus (5%), which were detected only in imported cases. L. (L.) major was almost entirely detected in travelers/migrants from Morocco. Multiple and atypical skin lesions were more common in imported cases than in autochthonous cases (44.4% vs. 21.8%). Conclusions/Significance An increase in both autochthonous and imported CL cases has been observed in past years in our hospital. Molecular techniques assist in improving CL diagnosis and characterization of the Leishmania species, mainly in imported cases., Author summary Leishmaniasis is a neglected disease caused by different species of the genus Leishmania. This disease is prevalent in tropical and subtropical areas, including the Mediterranean basin. In Spain, the only endemic species is L. (L) infantum, although there are cases of imported leishmaniasis due to travel and migration of people from other endemic areas. Cutaneous lesions are the most common clinical form, but L. (L) infantum can also cause mucosal or visceral involvement. Although microscopic diagnosis and skin biopsy specimens are still used in routine diagnosis for cutaneous leishmaniasis, they are time-consuming and invasive, respectively. Currently, molecular techniques, such as real-time PCR, are very sensitive tools for the detection and identification of Leishmania parasites. In addition, the skin swab sample seems to be a non-invasive alternative for the diagnosis of cutaneous leishmaniasis. In the present work, we describe the clinical characteristics of 59 patients diagnosed by real-time PCR of cutaneous leishmaniasis, as well as the molecular epidemiology of the causative species. We show that there has been an increase in cutaneous leishmaniasis cases, both autochthonous and imported cases, over the study period. The presence of Leishmania species other than L. (L) infantum is also highlighted.

Background: to evaluate the real-life performance of direct microscopy techniques and ELISA serology for schistosomiasis screening in a high-risk population in a non-endemic setting. Methods: a retrospective cohort study was conducted in two out-patient Tropical Medicine units in Barcelona (Spain) from 2014 to 2017. Asymptomatic adults arriving from the Sub-Saharan region were included. Schistosomiasis screening was conducted according to clinical practice following a different strategy in each setting: A) feces and urine direct examination plus S. mansoni serology if non-explained eosinophilia was present, B) S.mansoni serology plus uroparasitological examination at second-step in case of a positive serology. Demographic, clinical and laboratory features were collected. Schistosomiasis cases, clinical management and 24 months follow-up were recorded for each group.Results: Four-hundred forty individuals were included: 399 in group A, 41 in group B. The majority of the cohort were male (250, 56.4%), mainly from West African countries. No differences in sex distribution (p=0.57), age (p=0.6) and baseline eosinophilia (p=0.17) were found between both groups. Fifty schistosomiasis cases were detected (11.5% group A vs 4 % group B, p=0.733). When both microscopic and serological techniques were performed, discordant results were recorded in 18.2% (16/88)). Eosinophilia was present in 50% cases. Schistosomiasis cases were younger (p. Conclusions: Similar results were achieved by serology and microscopy techniques -based strategies. Serology might be prioritized for schistosomiasis screening of asymptomatic adults from endemic areas, regardless peripheric eosinophil count or IgE levels.

Trypanosoma cruzi; Mancha de sangre seca (DBS); Cribado serológico Trypanosoma cruzi; Taca de sang seca (DBS); Cribratge serològic Trypanosoma cruzi; Dried blood spot (DBS); Serological screening Background: Chagas disease is a public health problem not only in Latin America, but also in other regions, including Spain, due to migration movements. Conventional serological diagnosis requires an invasive sample (plasma or serum) and a well-equipped laboratory. To circumvent those limitations, blood samples dried on filter paper (DBS) or Rapid Diagnostic Test (RDT) could be a practical alternative to reference protocol for serological screening in epidemiological studies. We evaluated the usefulness of dried blood sampling and a rapid diagnostic test (Trypanosoma Detect™) for the detection of antibodies against T. cruzi for their use in community-based screening. Methodology/Principal Findings: A total of 162 stored paired whole-blood and serum samples from Latin American migrants and 25 negative-control blood samples were included. Diagnosis of chronic Chagas disease was performed in serum according to WHO algorithms. Blood samples were retrospectively collected as dried spots and then analyzed using two different serological techniques, enzyme-linked immunosorbent assay (ELISA) and electrochemiluminescence immunoassay (E-CLIA). Whole-blood samples were also used to evaluate a rapid diagnostic test based on immunochromatography. A better correlation with conventional serum was observed in dried blood elutes using E-CLIA than ELISA (97% vs. 77% sensitivity, respectively). Both assays reported 100% specificity. The median cut-off index values of E-CLIA for dried blood were significantly lower than those for serum (138.1 vs. 243.3, P

Atención sanitaria; Migrante; Encuesta Atenció sanitària; Migrant; Enquesta Healthcare; Migrant; Survey Heightened conflicts and lack of safety due to reasons related to economic, social, ethnic, religious, sexual orientation, political, or nationality matters have increased migratory movements during the last, few decades. Unfortunately, when migrants arrive in new territories, they can face many barriers. For example, in Spain, some migrants have difficulties in accessing health services. The main objective of this study was to describe, from the perspective of social and healthcare professionals, health needs and barriers faced among migrants who recently arrived in Spain when accessing the health system. To accomplish this aim, we carried out a cross-sectional descriptive study using a newly created self-administered questionnaire. Statistical analysis was done using the SPSS 23.00® program. Survey collection was from April 2018 to October 2018, and the cohort comprised a total of 228 professionals. Most participants were females (76%), with an average age of 35 years [interquartile range (IQR) 29.8–43.0]. The most represented profession in the cohort was physician (48%), followed by social care professionals (32%), nursing (11%), and other (8%). Of these individuals, 61% stated having either little or limited knowledge of international migrant health rights, and 94% believed migrants must overcome barriers to receive health services. The four most reported barriers were as follows: language, cultural differences, administrative issues, and fear of being undocumented. Additionally, by order of importance, professionals viewed mental health disorders and infectious diseases as the most common contributors to disease burden in this group. The four most popular strategies implemented by professionals to improve healthcare access further for migrants included intercultural competency training for professionals; access to community health agents; access to translators; and development of health system navigation skills among those newly arrived. Study results suggest that governments should make greater efforts to provide social and healthcare professionals with more effective tools that overcome communication barriers and cultural competence training modules. Research reported in this publication was supported by co-funding from the Third EU Health Program (2014-2020) Project Grants (HP-PJ-2016) under Grant Agreement 738091 (MyHealth Consortium).

To provide information regarding the prevalence of strongyloidiasis among migrants coming from Strongyloides stercoralis-endemic areas who reside in Spain.Systematic review of the literature and meta-analysis of studies showing prevalence of S. stercoralis infection among migrants from Latin America, Africa, Eastern Europe, Asia and Oceania who reside in Spain. We included articles published until 30 April 2019 without language restriction. The keywords used for the search included 'Strongyloides stercoralis', 'strongyloidiasis', 'Spain', 'screening' and 'migrants'.Twenty-four studies were included in the review and meta-analysis, comprising 12 386 screened people. Eleven studies (7020 patients) evaluated the presence of S. stercoralis infection only through investigation of larvae in faeces, showing an overall prevalence of 1% (95%CI 1-1%). Thirteen studies (5366 patients) used a serological test, showing an overall prevalence of 14% (95%CI 11-17%). Strongyloidiasis seroprevalence was 20% (95%CI 15-24%) among migrants from sub-Saharan Africa, 14% (95%CI 10-18%) among those from Latin America and 8% (95%CI 5-11%) among migrants from North Africa.Migrants coming from strongyloidiasis-endemic areas living in Spain had a high S. stercoralis infection prevalence, particularly those from sub-Saharan Africa and Latin America. This population should be screened using serology as the most sensitive test for S. stercoralis infection. This could be easily implemented at primary care level.Fournir des informations sur la prévalence de la strongyloïdose parmi les migrants résidant en Espagne et provenant de zones endémiques pour Strongyloides stercoralis. MÉTHODES: Revue systématique de la littérature et méta-analyse des études montrant la prévalence de l'infection à S. stercoralis parmi les migrants d'Amérique latine, d'Afrique, d'Europe de l'Est, d'Asie et d'Océanie qui résident en Espagne. Nous avons inclus des articles publiés jusqu'au 30 avril e 2019 sans restriction de langue. Les mots clés utilisés pour la recherche comprenaient "Strongyloides stercoralis", "strongyloïdose", "Espagne", "dépistage" et "migrants". RÉSULTATS: Vingt-quatre études ont été incluses dans la revue et la méta-analyse, comprenant 12.386 personnes dépistées. Onze études (7.020 patients) ont évalué la présence d'une infection à S. stercoralis uniquement en examinant les larves dans les selles, montrant une prévalence globale de 1% (IC95%: 1-1%). Treize études (5.366 patients) ont utilisé un test sérologique, montrant une prévalence globale de 14% (IC95%: 11-17%). La séroprévalence de la strongyloïdose était de 20% (IC95%: 15-24%) chez les migrants d'Afrique subsaharienne, 14% (IC95%: 10-18%) chez ceux d'Amérique latine et 8% (IC95%: 5-11%) chez ceux d'Afrique du Nord.Les migrants en provenance de zones d'endémie pour la strongyloïdose vivant en Espagne avaient une prévalence élevée d'infection à S. stercoralis, en particulier ceux d'Afrique subsaharienne et d'Amérique latine. Cette population devrait être dépistée en utilisant la sérologie comme le test le plus sensible pour l' infection à S. stercoralis. Cela pourrait être facilement mis en œuvre au niveau des soins primaires.

Introduction Some studies indicate high prevalences of latent tuberculosis infection (LTBI) in the immigrant population, which is relevant because 5–10% of cases will develop active tuberculosis. The objective of this study is to describe the results of a sequential strategy in the newly-arrived immigrant population for the diagnosis of LTBI using the tuberculin skin test (TST) and IGRAs. Methods A retrospective descriptive study was carried out with immigrants between 6 and 35 years of age from shelters, referred to an international health unit between July 2013 and June 2016. The TST was performed and when it was ≥5 mm, IGRAs were conducted. LTBI was defined as an IGRA ≥0.35 IU/ml and normal chest X -ray. Results Of the 184 cases, 138 (75.0%) were men, 23.0 years of age. The most common geographical areas were: 63 (34.2%) from Asia, 42 (22.8%) from Eastern Europe and 41 (22.3%) from sub-Saharan Africa. The TST was ≥10 mm in 79 cases (42.9%). The prevalence of LTBI using the sequential strategy was 33/184 (17.9%). Cohen's Kappa index (between TST ≥ 10 mm and IGRAs) was 0.226. Conclusion Basing LTBI screening on the TST alone could give rise to an overestimation. Some studies show that sequential screening would be the most cost-effective; this seems most evident in BCG-vaccinated populations.

Resumen Introduccion Algunos estudios indican altas prevalencias de infeccion tuberculosa latente (ITBL) en poblacion inmigrante, lo que es relevante, pues el 5-10% de los casos desarrollaran una tuberculosis activa. El objetivo de este estudio es describir los resultados de una estrategia secuencial en poblacion inmigrante recien llegada para el diagnostico de ITBL usando la prueba de tuberculina (PT) e IGRAs. Metodos Se realizo un estudio descriptivo retrospectivo con inmigrantes entre 6 y 35 anos de edad de centros de acogida, derivados a una unidad de salud internacional entre julio de 2013 y junio de 2016. Se realizo la PT, y cuando fue ≥ 5 mm, se determinaron los IGRAs. La ITBL se definio como aquellos con IGRAs ≥ 0,35 UI/ml y radiografia de torax normal. Resultados De los 184 casos, 138 (75,0%) eran hombres, de 23,0 anos de edad. Las areas geograficas de origen mas frecuente fueron: 63 (34,2%) de Asia, 42 (22,8%) de Europa del Este y 41 (22,3%) del Africa subsahariana. La PT fue ≥ 10 mm en 79 (42,9%). La prevalencia de ITBL usando la estrategia secuencial fue de 33/184 (17,9%). El indice kappa de Cohen (entre PT ≥ 10 mm e IGRAs) fue de 0,226. Conclusion Basar el diagnostico de la ITBL tan solo en la PT puede representar una sobreestimacion. Algunos estudios demuestran que el cribado secuencial seria el mas coste-efectivo, y ello parece mas evidente en las poblaciones vacunadas con BCG.

[ES] Algunas enfermedades infecciosas han adquirido más relevancia por el aumento de los movimientos poblacionales. La eosinofilia es un hallazgo frecuente en inmigrantes y en viajeros. Una de las causas más frecuentes de eosinofilia es la infección por helmintos y algunos protozoos intestinales. El objetivo de este trabajo es describir las características epidemiológicas de los casos con eosinofilia y su asociación con la presencia de parásitos en la red de datos REDIVI. Se trata de un estudio observacional multicéntrico prospectivo, donde se incluyen los casos diagnosticados de eosinofilia registrados en la Red cooperativa para el estudio de las infecciones importadas por viajeros e inmigrantes (+REDIVI) desde enero de 2009 hasta diciembre de 2012. Se registraron en la red un total de 5.255 episodios durante el periodo de estudio, y la eosinofilia fue un hallazgo en el 8,1 al 31,3% de los casos (dependiendo del tipo migratorio). Fueron hombres el 60,2%, con una mediana de 31,0 años, inmigrantes el 72,4% y asintomáticos el 81,2%. Los parásitos más frecuentemente identificados fueron S. stercoralis (34,4%), Schistosoma sp. (11,0%) y uncinarias (8,6%). Existía asociación entre eosinofilia y presencia de parásitos para todos los helmintos (excepto para larva migrans cutánea). La sintomatología y la duración del viaje no determinaron significativamente la presencia de eosinofilia. Ante una eosinofilia en una persona que ha vivido en zonas endémicas de helmintiasis es aconsejable realizar estudios dirigidos para su diagnóstico, independientemente del tipo migratorio, la duración de la estancia o la presencia de sintomatología., [EN] The population movements during the last decades have resulted in a progressively increasing interest in certain infectious diseases. Eosinophilia is a common finding in immigrants and travellers. One of the most common causes of eosinophilia is helminth infection, and some intestinal protozoa. The aim of this paper is to describe the epidemiological characteristics of cases with eosinophilia and its association with the presence of parasites in the REDIVI data network. This is a multicentre prospective observational study that includes patients diagnosed with eosinophilia registered in the cooperative network for the study of infectious diseases in travellers and immigrants (+REDIVI) from January 2009 to December 2012. A total of 5,255 episodes were recorded in the network during the study period, and eosinophilia was observed in 8.1-31.3% of cases (depending on the immigration group). There were 60.2% men, with a median age of 31 years. There were 72.4% immigrants, and 81.2% were asymptomatic. The most commonly identified parasites were S. stercoralis (34.4%), Schistosoma sp. (11.0%), and hookworm (8.6%). The relationship between eosinophilia and parasite infection was significant for all helminths (except for cutaneous larva migrans). The symptoms and duration of the journey did not significantly determine the presence of eosinophilia. In the case of eosinophilia in a person who has lived in helminth endemic areas, it is advisable to carry out targeted studies to diagnose the infection, regardless of immigration type, length of stay, or the presence of symptoms.

Introduction The chronic phase of Chagas disease (CD) is characterised by a low and intermittent parasitaemia. The Polymerase Chain Reaction (PCR) presents a variable sensitivity in this stage limiting its use as a diagnostic tool. Despite this, the use of PCR in untreated patients can provide information on the parasite behavior and its presence in peripheral blood. Methods A timely real-time PCR determination was performed on a cohort of 495 untreated chronic CD patients. Also, a subcohort of 29 patients was followed-up by serial real-time PCR during a period from 8 to 12 months in which they could not have access to the treatment due to lack of supply. Results The positive percentage of real-time PCR in our series was 42%. Nevertheless, real-time PCR positive results were significantly higher in patients with five years or less of residence in Spain (P = .041). The detection of DNA was not related to the existence of cardiac and/or gastrointestinal abnormalities. In the follow-up subgroup, real-time PCR was consistently positive in 13.8% of patients, consistently negative in 31%, and intermittent in 55.2%. Conclusions The different real-time PCR results regarding the time of residence suggests the possible relationship of external factors in the parasite presence in peripheral blood. On the other hand, specific host factors may be involved in the behavior of parasitaemia over time.

Parasitic diseases suppose an important health problem in people from high endemic areas, so these must be discarded properly. Usually, these infections develop asymptomatically but, in propitious situations, are likely to reactivate themselves and can cause clinical symptoms and/or complications in the receiving country. Moreover, in some cases it is possible local transmission. Early diagnosis of these parasitic diseases made by appropriate parasitological techniques and its specific treatment will benefit both, the individual and the community. These techniques must be selected according to geoepidemiological criteria, patient's origin, migration route or time spent outside the endemic area; but other factors must also be considered as its sensitivity and specificity, implementation experience and availability. Given the high prevalence of intestinal parasites on asymptomatic immigrants, it is recommended to conduct a study by coproparasitological techniques. Because of its potential severity, the screening of asymptomatic malaria with sensitive techniques such as PCR (polymerase chain reaction) is also advisable. Serological screening for Chagas disease should be performed on all Latin American immigrants, except for people from the Caribbean islands. Other important parasites, which should be excluded, are filariasis and urinary schistosomiasis, by using microscopic examination. The aim of this paper is to review the different techniques for the screening of parasitic diseases and its advices within the care protocols for asymptomatic immigrants.

Finding Dicrocoelium dendriticum eggs in human feces is exceptional and there are few prevalence data available. True infection occurs after accidental ingestion of ants containing metacercariae and spurious infection through the consumption of infected animal liver. Differential diagnosis between true and pseudo-infections is performed through stool examination after a diet free of liver. In addition, microscopy can help to differentiate the type of infection. We report six cases, all from sub-Saharan Africa, detection of this fluke at the Tropical Medicine Unit Vall d'Hebron-Drassanes (Barcelona, Spain). Dicrocoelium dendriticum transit eggs were visualized in five cases and there were no subsequent visualizations after diet, which reinforces that all these cases were false parasitism. In one case, few embryonated eggs were observed and the patient was treated for a possible true parasitism. There is a need to investigate the prevalence of D. dendriticum in our country focusing on the distinction between true and spurious infections.

Background Imported malaria is a frequent diagnosis in travellers and migrants. The objective of this study was to describe the epidemiological and clinical characteristics of patients diagnosed with imported malaria within a Spanish collaborative network registering imported diseases (+REDIVI). In addition, the possible association between malaria and type of case, gender, age or area of exposure was explored. Methods Cases of imported malaria were identified among all cases registered in the +REDIVI database during the period October 2009–October 2016. Demographic, epidemiological and clinical characteristics were analysed. Results In total, 11,816 cases of imported infectious diseases were registered in +REDIVI’s database between October 2009 and October 2016. Immigrants seen for the first time after migration accounted for 60.2% of cases, 21.0% of patients were travellers, and 18.8% were travellers/immigrants visiting friends and relatives (VFRs). There were 850 cases of malaria (850/11,816, 7.2%). Malaria was significantly more frequent in men than in women (56.8% vs 43.2%) and in VFR-immigrants (52.6%) as compared to travellers (21.3%), immigrants (20.7%) and VFR-travellers (5.4%) (p

Dengue; Vigilància; Importació Dengue; Vigilancia; Importación Dengue; Surveillance; Importation We describe the epidemiological pattern and genetic characteristics of 242 acute dengue infections imported to Europe by returning travellers from 2012 to 2014. The overall geographical pattern of imported dengue (South-east Asia > Americas > western Pacific region > Africa) remained stable compared with 1999 to 2010. We isolated the majority of dengue virus genotypes and epidemic lineages causing outbreaks and epidemics in Asia, America and Africa during the study period. Travellers acted as sentinels for four unusual dengue outbreaks (Madeira, 2012–13; Luanda, 2013; Dar es Salaam, 2014; Tokyo, 2014). We were able to characterise dengue viruses imported from regions where currently no virological surveillance data are available. Up to 36% of travellers infected with dengue while travelling returned during the acute phase of the infection (up to 7 days after symptom onset) or became symptomatic after returning to Europe, and 58% of the patients with acute dengue infection were viraemic when seeking medical care. Epidemiological and virological data from dengue-infected international travellers can add an important layer to global surveillance efforts. A considerable number of dengue-infected travellers are viraemic after arrival back home, which poses a risk for dengue introduction and autochthonous transmission in European regions where suitable mosquito vectors are prevalent.

Parasitic diseases suppose an important health problem in people from high endemic areas, so these must be discarded properly. Usually, these infections develop asymptomatically but, in propitious situations, are likely to reactivate themselves and can cause clinical symptoms and/or complications in the receiving country. Moreover, in some cases it is possible local transmission. Early diagnosis of these parasitic diseases made by appropriate parasitological techniques and its specific treatment will benefit both, the individual and the community. These techniques must be selected according to geoepidemiological criteria, patient's origin, migration route or time spent outside the endemic area; but other factors must also be considered as its sensitivity and specificity, implementation experience and availability. Given the high prevalence of intestinal parasites on asymptomatic immigrants, it is recommended to conduct a study by coproparasitological techniques. Because of its potential severity, the screening of asymptomatic malaria with sensitive techniques such as PCR (polymerase chain reaction) is also advisable. Serological screening for Chagas disease should be performed on all Latin American immigrants, except for people from the Caribbean islands. Other important parasites, which should be excluded, are filariasis and urinary schistosomiasis, by using microscopic examination. The aim of this paper is to review the different techniques for the screening of parasitic diseases and its advices within the care protocols for asymptomatic immigrants.

Objectives Identifying pregnant women infected with Trypanosoma cruzi is one of the major challenges for preventing and controlling Chagas disease (CD) in non-endemic countries. The aim of this paper was to perform a policy evaluation of the current practices of congenital Chagas disease (CCD) control in non-endemic countries and to propose specific targets for enhanced interventions to tackle this emerging health problem outside the endemic areas of Latin America. Methods We conducted a mixed method review of CCD policy strategies by searching the literature in the PubMed, Google Scholar and the World Health Organization (WHO) databases using the key terms ‘CCD’, ‘paediatric Chagas disease’ and ‘non-endemic countries’; as free text and combined as one phrase to increase the search sensitivity. Reviews, recommendations, guidelines and control/surveillance programme reports were included. Results Of 427 CCD papers identified in non-endemic countries, 44 matched the inclusion. Although local programmes were launched in different countries with large numbers of Latin American immigrants, there were considerable disparities in terms of the programmes' distribution, delivery, integration and appropriated CCD control strategies. Moreover, Catalonia, Spain is the only region/country with an established systematic monitoring of CCD in pregnant women from Latin American countries. Conclusions Given the worldwide dissemination of CD, the nature of its vertical transmission, and the gaps of the current strategies in non-endemic countries, there is an urgent need to standardise, expand and reinforce the control measures against CCD transmission.

The population movements during the last decades have resulted in a progressively increasing interest in certain infectious diseases. Eosinophilia is a common finding in immigrants and travellers. One of the most common causes of eosinophilia is helminth infection, and some intestinal protozoa. The aim of this paper is to describe the epidemiological characteristics of cases with eosinophilia and its association with the presence of parasites in the REDIVI data network. This is a multicentre prospective observational study that includes patients diagnosed with eosinophilia registered in the cooperative network for the study of infectious diseases in travellers and immigrants (+REDIVI) from January 2009 to December 2012. A total of 5,255 episodes were recorded in the network during the study period, and eosinophilia was observed in 8.1-31.3% of cases (depending on the immigration group). There were 60.2% men, with a median age of 31years. There were 72.4% immigrants, and 81.2% were asymptomatic. The most commonly identified parasites were S.stercoralis (34.4%), Schistosoma sp. (11.0%), and hookworm (8.6%). The relationship between eosinophilia and parasite infection was significant for all helminths (except for cutaneous larva migrans). The symptoms and duration of the journey did not significantly determine the presence of eosinophilia. In the case of eosinophilia in a person who has lived in helminth endemic areas, it is advisable to carry out targeted studies to diagnose the infection, regardless of immigration type, length of stay, or the presence of symptoms.

OBJETIVO: Investigar a associação entre aspectos psicossociais do trabalho e prevalência de distúrbios psíquicos em professores da educação infantil e do ensino fundamental. MÉTODOS: Estudo de corte transversal realizado com 1.024 professores das escolas públicas municipais e das 10 maiores escolas particulares de Vitória da Conquista, Estado da Bahia, em 2001. A variável de exposição principal foi constituída pelo modelo de demanda-controle, que classifica os indivíduos de acordo com as exigências do trabalho. A variável de resposta representou distúrbios psíquicos medidos pelo Questionário de auto-resposta. A medida de freqüência foi a prevalência, e a medida de associação foi a razão de prevalências. A principal técnica estatística utilizada foi a análise de regressão logística. RESULTADOS: A prevalência de distúrbios psíquicos foi de 44%. Evidenciou-se associação entre sua presença e as condições de demanda e controle no trabalho, após o controle do confundimento introduzido pelas variáveis sexo, zona de trabalho e suporte social. Os professores com trabalho de alta exigência apresentaram prevalência 1,5 vez maior que os com trabalho de baixa exigência. CONCLUSÕES: A prevalência de distúrbios psíquicos foi elevada entre professores. Há evidências de que a prevalência estava associada com as exigências do trabalho.

A literatura científica sobre a saúde dos professores é escassa e recente, enfocando especialmente o desgaste e estresse. Este trabalho objetivou descrever as condições de trabalho e saúde dos professores da rede particular de ensino da cidade de Vitória da Conquista, Bahia, Brasil. Num questionário auto-aplicado foram coletadas informações de 250 professores de dez escolas. Entre as características do trabalho docente, avaliadas pelo Job Content Questionnaire, destacaram-se ritmo acelerado de trabalho, ser criativo e ter boas relações com as pessoas no trabalho. As queixas de saúde mais freqüentes estavam relacionadas à postura corporal, à saúde mental e a queixas relacionadas à voz. A prevalência de distúrbios psíquicos menores (DPM), medida pelo Self Reporting Questionnaire-20, foi de 41,5% e estava fortemente associada a longos períodos de intensa concentração em uma mesma tarefa e volume excessivo de trabalho. Os resultados sugerem relação entre a prevalência de DPM e algumas características do trabalho docente, evidenciando desgaste psicológico do educador.The scientific literature on teachers' health is scarce, recent, and focuses predominantly on stress and burnout. This study describes the labor conditions of private school teachers in Vitória da Conquista, Bahia State, Brazil. Information on 250 teachers from the ten largest schools in the municipality was collected through a self-applied questionnaire. The most relevant characteristics of teachers' work, evaluated by the Job Content Questionnaire were: speed of work, creativity at work, and relations with colleagues. The most frequent complaints related to posture, mental strain, and voice problems. Prevalence of minor psychological disorders according to the Self Reporting Questionnaire-20 was 41.5%, strongly associated with long periods of intense concentration on the same job and excessive work. Results suggest an association between the prevalence of minor psychological disorders and certain characteristics of teaching work, emphasizing teachers' exposure to stress.

To investigate the association between work-related psychosocial factors and the prevalence of mental disorders among pre-school and elementary school teachers.This cross-sectional study was undertaken with 1,024 teachers from municipal public schools and from the ten largest private schools in Vitória da Conquista, Bahia State (Northeastern Brazil) in 2001. The main independent variable was based on the demand-control model, which classifies individuals according to their job pressures. The dependent variable was the incidence of mental disorders as evaluated by a self-reporting questionnaire. The measure of frequency was prevalence, and the measure of association was the prevalence ratio. A logistic regression model was used as the main statistical technique.There was a 44% prevalence of mental disorders among teachers. Evidence suggests that these were associated with work-related demands and control issues, after controlling for confounding variables such as sex, geographic region and social support. The prevalence of mental disorders among high-strain teachers was 1.5 times greater than that among low-strain teachers.The prevalence of mental disorders was high among teachers of the municipality. There was evidence that this was associated with job demands.

The scientific literature on teachers' health is scarce, recent, and focuses predominantly on stress and burnout. This study describes the labor conditions of private school teachers in Vitória da Conquista, Bahia State, Brazil. Information on 250 teachers from the ten largest schools in the municipality was collected through a self-applied questionnaire. The most relevant characteristics of teachers' work, evaluated by the Job Content Questionnaire were: speed of work, creativity at work, and relations with colleagues. The most frequent complaints related to posture, mental strain, and voice problems. Prevalence of minor psychological disorders according to the Self Reporting Questionnaire-20 was 41.5%, strongly associated with long periods of intense concentration on the same job and excessive work. Results suggest an association between the prevalence of minor psychological disorders and certain characteristics of teaching work, emphasizing teachers' exposure to stress.

A literatura científica sobre a saúde dos professores é escassa e recente, enfocando especialmente o desgaste e estresse. Este trabalho objetivou descrever as condições de trabalho e saúde dos professores da rede particular de ensino da cidade de Vitória da Conquista, Bahia, Brasil. Num questionário auto-aplicado foram coletadas informações de 250 professores de dez escolas. Entre as características do trabalho docente, avaliadas pelo Job Content Questionnaire, destacaram-se ritmo acelerado de trabalho, ser criativo e ter boas relações com as pessoas no trabalho. As queixas de saúde mais freqüentes estavam relacionadas à postura corporal, à saúde mental e a queixas relacionadas à voz. A prevalência de distúrbios psíquicos menores (DPM), medida pelo Self Reporting Questionnaire-20, foi de 41,5% e estava fortemente associada a longos períodos de intensa concentração em uma mesma tarefa e volume excessivo de trabalho. Os resultados sugerem relação entre a prevalência de DPM e algumas características do trabalho docente, evidenciando desgaste psicológico do educador.