Hyperreactive malarial splenomegaly syndrome in a European patient.
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Biomedical subjects
Publications and source records attributed to M Corachán.
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OBJECTIVE: To evaluate the therapeutic guidelines used in evaluating taeniasis in primary care (mebendazole, pyrantel pamoate) and to show the low availability of first choice drugs (niclosamide, praziquantel). DESIGN: A retrospective, descriptive study. SETTING: A clinic for travellers abroad in the Tropical Medicine section (Infectious Diseases Service) of the Hospital Clínic, Barcelona. PARTICIPANTS: 68 medical histories of cases of Taeniasis seen at this clinic between 1984 and 1994. RESULTS: 72.3% had not travelled to the tropics (autochthonous Taeniasis). The most common symptoms were epigastralgia, anal pruritus, diarrhoea, weight loss and bulimia. 71.2% had previously attended other medical services and all had been correctly diagnosed. 91.8% had received ineffective treatment (the most common treatment was with mebendazole and pyrantel pamoate), sometimes on different occasions. Time elapsed between diagnosis and correct treatment varied from 1 day to 36 months. CONCLUSION: Taeniasis is an easily diagnosed infestation. Its treatment is comfortable and effective, with an average cure period of 24 hours. However, the particular medicines are not available in primary care, which hampers and delays treatment.
Amebian hepatic abscess (AHA) is the most frequent extraintestinal localization of infection by Entamoeba histolytica. Despite being a disease mainly of tropical zones, it is currently also observed with higher frequency in Spain. Thirteen cases of AHA diagnosed in the authors' hospital over the last 11 years were retrospectively analyzed comparing the data in this series with that of other published series and undertaking a review of this subject. The diagnosis of AHA was established on the basis of the clinical picture together with specific positive serology and compatible echographic imaging. The series was composed of 9 males and 4 females with a mean age of 38.7 years (range 25-55). Five were Spanish, and 8 were immigrants from tropical countries. In 61.5% of the cases echographically guided aspiration puncture was performed with placement of percutaneous drainage being carried out in 38%. Eighty-five percent of patients were treated with more than one amebicide drug (metronidazole or tinidazole together with chloroquine and dehydroemetine). Luminal amebicides were administered lastly. Laparotomy was required in 3 cases due to the presence of complications. No deaths were observed.
BACKGROUND: The increase in immigration and adventure travelling by tourists generates a population susceptible to have a type of helminthiasis which we are not familiar with. The clinical-epidemiologic characteristics of different groups of patients with this disease are presented. METHODS: A descriptive retrospective longitudinal study was carried out. The clinical-epidemiologic and imaging laboratory data of 56 patients with ankylostomiasis and strongyloidiasis observed in the Department of Tropical Medicine of the Hospital Clinic i Provincial, in Barcelona, Spain, were collected. RESULTS: Ankylostomiasis and strongyloidiasis represent 2% of the global diseases attended. The risk factor the "use of open footwear" was present in almost all the cases. Among the immigrants this parasitosis may become manifest up to 10 years after the last contact. The digestive form and the accidental finding were the most common forms of presentation among the tourists and immigrants, respectively, with diarrhoea being the most frequent manifestation among the tourists (p = 0.008). Forty-five percent of the patients presented polyparasitism, being more frequently observed among the immigrants (p = 0.025). Anemia was found among 44% of the immigrants while this was not observed in any of the tourists (p = 0.012). No clinical relapse was observed with treatment with mebendazol and thiabendazol. CONCLUSIONS: A clinically different behavior was observed between the two groups of travellers. Although infrequent, the clinical importance ot its diagnosis is based on avoiding severe complications in immunosuppressed individuals and preventing anemia in patients with several diseases.
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Podoconiosis or endemic non-filarial elephantiasis is produced by deposits of inorganic materials in the lymph node of the lower extremities. The presence of elephantiasis in São Tomé Island and its prevalence in two districts are documented. Epidemiological aspects of the disease as well as clinical and pathological data of some of the cases are illustrated. With all these data and the physical characteristics of the island we suggest that elephantiasis in São Tomé is of geological obstructive origin: podoconiosis. The importance of non-medical measures to eradicate this disease are underlined.
Among the immunizable diseases, viral hepatitis is the most frequently diagnosed in travellers. The epidemiology and the clinical presentation of the imported viral hepatitis among patients in the Tropical Medicine Unit of Hospital Clínic (Barcelona) are studied in this article. A retrospective review of 47 viral hepatitis in Spanish travellers seen during the period 1988-1991 is presented, representing 2.47% of all diagnosis. Only a third of the patients were hepatitis A cases. The duration of the trip was significantly shorter in those who acquired hepatitis of the A and non-A--non-B types. Africa (60% cases), India and South East Asia (17%) and Central America (16%) were considered areas of risk. The B, C and non-A--non-B hepatitis types had a more silent clinical and biological presentation. Gathered data confirm the importance of hepatitis as an imported disease, the partial protection of the Spanish population against hepatitis A and the need to introduce this infection among the advice to be given in a travellers clinic.
Two cases of relapsing malaria infection by Plasmodium vivax from Guatemala are presented in patients treated with current standard doses of chloroquine and primaquine. The difficulties in recognizing resistance to chloroquine versus poor response to standard primaquine schedules are discussed. The recent recommendations of adopting a schedule of 6 mg/kg as a total dose of primaquine proved in our cases to be effective in obtaining a radical cure of the infection.
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BACKGROUND: Travellers' diarrhea (TD) is the most frequent problem in travellers going to the developing countries. This paper analyses the prevalence of the syndrome by geographical areas as well as the risk factors in 2209 Spanish travellers to 3 continents. METHODS: Epidemiological data were gathered through a personnel interview filled by the travellers during their return trip. Those were introduce in a DbaseIII plus computer program and were evaluated through the Epi Info program. RESULTS: The overall prevalence of TD found was 41%. The Indian subcontinent, the Middle East and Moghreb countries showed a higher prevalence of TD. Trekkers and people on boat cruises (Nile and Amazon) had the highest prevalence of TD. The consumption of non-carbonic drinks and ice creams was significantly associated to TD. Travellers with previous gastrointestinal illnesses suffered more TD than others. CONCLUSIONS: Despite the fact that Spain in considered an area of intermediate risk for TD we found no significant differences in the prevalence of TD in Spanish travellers when compared with other published series from developed countries.
A cohort of 337 Spanish travellers to developing countries is presented. They all consulted us for traveller's diarrhea (TD). Bacteriological, parasitological and virological examinations were performed. A bacterial cause was found in 61.65% of travellers. Toxigenic and classical pathogenic Escherichia coli strains were the main bacterial agents. In comparison with other studies, Spanish travellers harboured Y. enterocolitica and EPEC organisms as a cause of TD. G. lamblia and E. histolytica were the most frequently isolated protozoa. Helminths were found in only 9 patients. No rotavirus infections were diagnosed. Previous antibiotic treatment had been taken by 161 patients. The percentage of isolated enteropathogens was similar in travellers who had previously taken antibiotic treatment and those who had not.
Paragonimiasis (infestation by the Paragonimus species) in Spain is a very infrequent entity within the group of imported infectious diseases. A native, resident of Equatorial Guinea who was affected by pulmonary and probably extrapulmonary paragonimiasis together with active pulmonary tuberculosis is described. This association is relatively common and may complicate the diagnostic process. The identification of the parasite was established from samples of pulmonary secretion obtained by natural expulsion and by fiber bronchoscopy in which Kinyoun carbonfucsine dye, Giemsa dye and argentic impregnation were used. The possibility of neurological disease existing (medullar and cerebral) produced by the same parasite is also discussed. Antituberculous treatment and the use of praziquantel satisfactorily control both infections.