Increasing incidence of imported schistosomiasis in Mallorca, Spain

Helminthosis and eosinophilia in Spain (1990-2015)

The finding of blood eosinophilia in a patient is a relatively frequent reason to refer him/her to a Clinical Department of Infectious Diseases. The doctor usually intends to rule out a parasitic disease in the autochthonous population, travelers or immigrants. It is uncommon for an eosinophilia to be produced by protozoa infection, whereas helminth parasites are more frequently associated with an increase of eosinophil counts in the infected patient. Eosinophilia can be the only abnormal finding, or it could be part of more complex clinical manifestations suffered by the patient. Furthermore, many, but not all, helminth infections are associated with eosinophilia, and the eosinophil level (low, high) differs according to parasite stages, helminth species, and worm co-infections. The purpose of the present article is to carry out a systematic review of cases and case series on helminth infections and eosinophilia reported in Spain from 1990 to 2015, making a distinction between autochthonous and imported (immigrants and travelers) cases, and studying their relationship with immunodepression situations.

[Imported and non-imported diseases in the immigrant population. A decade of experience from an infectious diseases unit]

INTRODUCTION

Immigration is an inexorable process. Immigrants may suffer infectious diseases commonly seen in our environment, or those more exotic or more prevalent in their own environment.

MATERIAL AND METHODS

A study was performed including all immigrants see in an Infectious Diseases Unit of a general hospital from June 2001 to May 2010.

RESULTS

We studied 1,071 patients from Latin America (n=405, 37.8%), Northern Africa (n=281, 26.2%), Eastern Europe (n=186, 17.4%), sub-Saharan Africa (n=178, 16.6%), and Asia (21, 2.0%). Transmissible infectious diseases were the leading cause of consultation (53.8%), and they were more common among people coming from Northern Africa (61.6%) and Eastern Europe (69.4%) (P=.001). The second reason for consultation was for common infectious diseases (29%). Tropical infectious diseases were diagnosed in 16.4% of the patients, particularly from sub-Saharan Africa (36%), and Latin America (25.9%) (P<.001). The most common diagnoses were latent tuberculous infection (20.8%) [most common in those from Eastern Europe (27.4%) (P=.004)], respiratory tract infection (12.5%), sexually transmitted infections (10.6%) [most common in patients from Northern Africa (17.1%) (P=.004)], chronic hepatitis (10.4%) [most common in patients from Eastern Europe (26.3%) (P<.001) and sub-Saharan Africa (16.9%) (P=.004)], and active tuberculosis (8.7%) [most common in sub-Saharan Africa patients (15.7%) (P=.001)].

CONCLUSIONS

The spectrum of infectious diseases in the immigrant population in our area is broad, and includes a wide variety of tropical and communicable diseases, but also of common infections. While communicable diseases are the leading cause of consultation, common infections constitute an important part of health care activity.

[Imported infectious diseases in Spain]

In Spain, owing to the rise of international travels and immigration, the number of patients with imported infectious diseases has increased, many of them from tropical or subtropical areas. In parallel, there has been a multiplication in the number of scientific papers with Spanish authors about imported infections due to parasites, fungus, mycobacteriae, bacteriae or viruses. The risk for public health is low, althought for their correct prevention and control it is important to ease an universal access to healthcare and fair socioeconomic conditions, along with maintaining an updated clinical and epidemiological training of the health personnel. These nationwide measures must be supplemented with worldwide initiatives of global control of these infections.