Epidemiology and clinical features of vivax malaria imported to Europe: sentinel surveillance data from TropNetEurop

BACKGROUND

Plasmodium vivax is the second most common species among malaria patients diagnosed in Europe, but epidemiological and clinical data on imported P. vivax malaria are limited. The TropNetEurop surveillance network has monitored the importation of vivax malaria into Europe since 1999.

OBJECTIVES

To present epidemiological and clinical data on imported P. vivax malaria collected at European level.

MATERIAL AND METHODS

Data of primary cases of P. vivax malaria reported between January 1999 and September 2003 were analysed, focusing on disease frequency, patient characteristics, place of infection, course of disease, treatment and differences between network-member countries.

RESULTS

Within the surveillance period 4,801 cases of imported malaria were reported. 618 (12.9%) were attributed to P. vivax. European travellers and immigrants were the largest patient groups, but their proportion varied among the reporting countries. The main regions of infection in descending order were the Indian subcontinent, Indonesia, South America and Western and Eastern Africa, as a group accounting for more than 60% of the cases. Regular use of malaria chemoprophylaxis was reported by 118 patients. With 86 (inter-quartile range 41-158) versus 31 days (inter-quartile range 4-133) the median symptom onset was significantly delayed in patients with chemoprophylaxis (p < 0.0001). Common complaints were fever, headache, fatigue, and musculo-skeletal symptoms. All patients survived and severe clinical complications were rare. Hospitalization was provided for 60% and primaquine treatment administered to 83.8% of the patients, but frequencies varied strongly among reporting countries.

CONCLUSIONS

TropNetEurop data can contribute to the harmonization of European treatment policies.

Imported schistosomiasis in Europe: sentinel surveillance data from TropNetEurop

BACKGROUND

Schistosomiasis is a major parasitic disease, increasingly imported into temperate climates by immigrants from and travelers to endemic areas.

METHOD

To generate valid data on imported infectious diseases to Europe and to recognize trends over time, the European Network on Imported Infectious Diseases Surveillance (TropNetEurop) was founded in 1999. Three hundred and thirty-three reports of schistosomiasis were analyzed for epidemiologic and clinical features.

RESULTS

Male patients accounted for 64% of all cases. The average age of all patients was 29.5 years. The majority of patients were of European origin (53%). Europeans traveled predominantly for tourism (52%). Main reasons for travel for people from endemic areas were immigration and refuge (51%) and visits to relatives and friends (28%). The majority of infections were acquired in Africa; 92 infections were clearly attributable to Schistosoma haematobium, 130 to Schistosoma mansoni, and 4 to Schistosoma intercalatum. Praziquantel was the only treatment used. No deaths were recorded.

CONCLUSION

TropNetEurop sentinel provides valuable epidemiologic and clinical data on imported schistosomiasis to Europe.

Epidemiology and clinical features of imported dengue fever in Europe: sentinel surveillance data from TropNetEurop

Travelers have the potential both to acquire and to spread dengue virus infection. The incidence of dengue fever (DF) among European travelers certainly is underestimated, because few centers use standardized diagnostic procedures for febrile patients. In addition, DF is currently not reported in most European public health systems. Surveillance has commenced within the framework of a European Network on Imported Infectious Disease Surveillance (TropNetEurop) to gain information on the quantity and severity of cases of dengue imported into Europe. Descriptions of 294 patients with DF were analyzed for epidemiological information and clinical features. By far the most infections were imported from Asia, which suggests a high risk of DF for travelers to that region. Dengue hemorrhagic fever occurred in 7 patients (2.4%) all of whom recovered. Data reported by member sites of the TropNetEurop can contribute to understanding the epidemiology and clinical characteristics of imported DF.

Imported Falciparum malaria in Europe: sentinel surveillance data from the European network on surveillance of imported infectious diseases

Malaria continues to have a high morbidity rate associated among European travelers. Thorough recording of epidemiological and clinical aspects of imported malaria has been helpful in the detection of new outbreaks and areas of developing drug resistance. Sentinel surveillance of data collected prospectively since 1999 has begun within TropNetEurop, a European network focusing on imported infectious diseases. TropNetEurop appears to cover approximately 10% of all patients with malaria seen in Europe. Reports of 1659 immigrants and European patients with Plasmodium falciparum malaria were analyzed for epidemiological information and data on clinical features. Regional data were quite diverse, reflecting local patterns of immigration and international travel. By far, the most infections were imported from West Africa. Europeans had more clinical complications; consequently, all deaths occurred in this group. Compared with European standards, the mortality rate was low (0.6% in Europeans). Data from TropNetEurop member sites can contribute to our understanding of the epidemiological and clinical findings regarding imported falciparum malaria.

[The determination of susceptibility to measles, rubella, mumps and chickenpox in students of health-related areas]

We present an epidemiological and serological study in 286 health care students. We found susceptibility for measles in 11.7% individuals (95% confidence interval (95% CI): 8.0-15%), for rubella: 6.7% (95% CI: 3.8-9.6%) for mumps: 12.7% (95% CI: 8.0-16.6%) and for varicella 8.5% (95% CI: 5.3-11.7%). Compared to a similar study, performed in 1992 in a population of health care workers, we found an increasing susceptibility to these diseases except for mumps, that had decreased. Among those who received one dose of measles vaccine we found 12.1% non immune. We found an high level of immunity (97.1%) for those who received rubella vaccination. We could not draw any conclusions for mumps because only seven had been vaccinated.

[The prevalence of measles, rubella, mumps and chickenpox antibodies in a population of health care workers]

We present an epidemiological and serological study in 409 health care workers randomly selected from the 4,103 workers of the University Hospital of Coimbra. A low level of susceptibility for measles (1.2%; 95% confidence interval (95% CI): 0.15-2.23%), rubella (2.4%; 95% CI: 0.9-3.9) and varicella (3.2%; 95% CI: 1.5-4.7%) and a very high one for mumps (17.3%; 95% CI: 13.7-21.1%), were found. Ineffectiveness of historical information in predicting immune status to all of these diseases was found. An economic analysis of preventive measures was done. A mumps vaccination policy for health care workers is recommended and the opportunity of measles and rubella vaccination is discussed, facing the results of this study. Continuous monitoring of these diseases is needed anticipating the changes in epidemiology that are expected to occur with childhood vaccination.

[Cerebral toxoplasmosis in a kidney transplant patient. A clinical case and review of the literature]

Infection caused by Toxoplasma gondii is a frequent event in Portugal. When this occurs in immunocompetent individuals it is rarely a matter of concern; the contrary occurs with immunosuppressed patients or in pregnancy. Transplant patients are treated with immunosuppressive drugs which mainly disturb their mechanisms of cellular immunity, and that opens the way to infections by opportunistic intracellular microorganisms. We recently treated a renal transplant patient who suffered from cerebral toxoplasmosis, and this provided an opportunity for a review of the other 20 patients reported in medical literature to date.

[Comparative study of various biological markers in HIV 1 infection]

A study was performed on 51 human immunodeficiency virus (HIV 1)-infected patients with a previous history of drug abuse. By the CDC staging system for HIV infection they were mainly in advanced stages of that infection, 67% were in IV-A and 8% in IV-C1. Patients were divided in two groups, one composed of 33 individuals who needed AZT therapy and the other of those who did not need that medication (18 patients). Between 3 and 18 months several parameters were assessed on 3 different occasions, according to standard techniques: red blood cells and platelet numeration, CD4 and CD8 cell counts, HIV antigen (p24 Ag), beta 2-microglobulin, high density serum lipoproteins (HDL), and anticardiolipin antibodies (ACA). In the patients treated with AZT the first bioserologic evaluation was performed before starting this therapy. Finally it was observed that p24 AG and ACA were present in 21% of the patients, all of them in advanced stages of HIV infection and under AZT therapy. A significant correlation was only found between CD4 counts and beta 2-microglobulin (R = 0.34; P = 0.0001).

[A metaplastic hypothesis of the histogenesis of ectopic salivary glands: apropos of two clinical cases]

We found in the literature a few cases reporting ectopic salivary glands occurring in the neck and in the mandible or in the maxila. We had two cases, one in the tongue, the other in the upper maxila retro incisal, and we have seen the coincidence of these locations and those of the embriogenic originated cysts. Even so the literature references also have almost all the cases reported with the same coincidence. Our hypothesis is that those ectopic salivary glands have their origin in embriogenic cysts and develop by a phenomenon of metaplasia.

[Physiology of autotransplants in the human species. Histological analysis of transplanted upper canine pulps]

10 canine pulps were examined after transplantation. The time of transplant life was not the same in all cases, so it was possible to record all the evolutive patterns during 2 months. Correlating our observations with literature and statistics, it was possible to draw the main aspects of transplant pulp physiology.