A study of eosinophilia and helminths in migrant subsaharan patients in a primary care center (Madrid, Spain)
DOI:
https://doi.org/10.37536/RIECS.2018.3.1.60Keywords:
Eosinophils, Migrants, Helminths, Primary Care HealthAbstract
Purposse: We determine the association between eosinophilia and certain parasites diagnosed by serology in patients of subsaharan origin of a Primary Care Center from Madrid region, Spain. Methods: It was implemented a complete protocol for migrant patient to study eosinophilia and realized serology tests for parasites detection. All variable and data were evaluated by statistical methods.
Results: A total of 184 patients with eosinophilia were included in the study, 115 patients (62.5%) were seronegative for helminths and 69 were seropositive. Strongyloides stercoralis (55.07%), Schistosoma spp (39.13%) and Toxocara canis (20.29%) were the most prevalent helminths immunodetected in the study. So, 49 patients (26.6%) had abdominal pain, 50 patients (27.17%) had problems related with skin conditions and 38 patients (20.65%) had respiratory disorder, symptoms not related with the helminth parasites detected. Regarding number of parasites by patient, one specie was identified in 49 patients (26.63%) and two or more was identified in 20 patients (10.86%). Eosinophilia was resolved in 91.4% of parasite serpositive patients after received one specific adequate antiparasitic treatment, but this was resolved in 98.3% after received two tratments, and 100% after the third.
Conclusions: The results obtained allow us to make some reflections on the difficulty of managing these patients in the Primary Care Center and on whether to diagnose and treat individuals from endemic areas, with or without eosinophilia and being asymptomatic or not, given the benefit it has for the individual and public health, as possible to minimize any chance of transmission.
References
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9 López-Vélez, R.; Navarro Beltrá, M.; Hernando Jerez, A.; del Amo Valero, J. HIV infection in immigrants. Enferm Infecc Microbiol Clin 2008, 5:12-21.
10 Saurina, C.; Vall-Llosera, L.; Saez, M. Factors determining access to and use of primary health care services in the Girona Health Region (Spain). Eur J Health Econ 2012, 13(4):419-27.
11 Ehmsen, BK.; Biswas, D.; Jensen, NK.; Krasnik, A. Norredam, M. Undocumented migrants have diverse health problems. Dan Med J 2014, 61(9): A4897.
12 Llop-Gironés, A.; Vargas Lorenzo, I.; Garcia-Subirats, I.; Aller, MB.; Vázquez Navarrete, ML. Immigrants' access to health care in Spain: a review. Rev Esp Salud Publica 2014, 88(6):715-34.
13 Norman, FF.; López-Vélez, R. Immigration, helminths and eosinophilia: A complex triad. Travel Med Infect Dis 2015, 13(4):283-4.
14 Meltzer, E.; Percik, R.; Shatzkes, J.; Sidi, Y.; Schwartz, E. Eosinophilia among returning travelers: a practical approach. Am J Trop Med Hyg 2008, 78(5):702-9.
15 Belhassen-García, M.; Pardo-Lledias, J.; Pérez Del Villar, L.; Muro, A.; Velasco-Tirado, V.; Muñoz Bellido, JL.; Vicente, B.; Blázquez de Castro, A.; Cordero-Sánchez, M. Should parasitic disease be investigated in immigrant children with relative eosinophilia from tropical and sub-tropical regions? Paediatr Int Child Health 2016, 9:1-4.
16 Sulzer, AL. Indirect fluorescent test for parasitic diseases. Preparation of a stable antigen from larvae of Trichinella spiralis. J. Parasitol 1965, 51: 717-721.
17 Muiño, L.; Perteguer, MJ.; Garate, T.; Martínez-Sernández, V.; Beltran, A.; Romaris, F.; Mezo, M.; Gonzalez-Warleta, M.; Ubeira, FM. Molecular and immunological characterization of Fasciola antigens recognized by the MM3 monoclonal antibody. Mol. Biochem. Parasitol 2011, 179(2): 80-90.
18 Lawrence, RA.; Denham, DA. Stage and isotype specific immune responses in a rat model of filariasis. Parasite Immunol 1993, 15 (8): 429-439.
19 Murdoch, ME.; Abiose, A.; Garate, T.; Hay, RJ.; Jones, BR.; Maizels, RM.; Parkhouse, RM. Human onchocerciasis in Nigeria: isotypic responses and antigen recognition in individuals with defined cutaneous pathology. Amm. Trop. Med. Hyg 1996, 54(6): 600-612.
20 Güerri, ML.; Davila, M.; Rodríguez, M.; Nieto, FJ.; Ladrón de Guevara, C. Utility of IgG subclases in the diagnosis and folow up of the hidatidosis. Enferm Infecc. Microbiol. Clin 2000, 18(6): 262-266.
21 Fleiss, JL. The design and analysis of clinical experiments. Wiley, New York, 1986.
22 Kirkwood, BR. Essentials of medical statistics. Oxford; Blackwell Scientific Publications, 1988.
23 Ehrhardt, S.; Burchard, GD. Eosinophilia in returning travelers and migrants. Dtsch Arztebl Int 2008, (46):801-7.
24 Checkley, AM.; Chiodini, PL.; Dockrell, DH.; Bates, I.; Thwaites, GE.; Booth, HL.; Brown, M.; Wright, SG.; Grant, AD.; Mabey, DC.; Whitty, CJ.; Sanderson, F. British Infection Society and Hospital for Tropical Diseases. Eosinophilia in returning travellers and migrants from the tropics: UK recommendations for investigation and initial management. J Infect 2010, 60(1):1-20.
25 Salas-Coronas, J.; Cabezas-Fernández, MT.; Vázquez-Villegas, J.; Soriano-Pérez, MJ.; Lozano-Serrano, AB.; Pérez-Camacho, I.; Cabeza-Barrera, MI.; Cobo, F. Evaluation of eosinophilia in immigrants in Southern Spain using tailored screening and treatment protocols: A prospective study. Travel Med Infect Dis 2015, 13(4):315-21.
26 Vilajeliu Balagué A, de Las Heras Prat P, Ortiz-Barreda G, Pinazo Delgado MJ, Gascón Brustenga J, Bardají Alonso, A. Imported parasitic diseases in the immigrant population in Spain. Rev Esp Salud Publica 2014, 88(6):783-802.
27 López-Vélez, R.; Huerga, H.; Turrientes, MC. Infectious diseases in immigrants from the perspective of a tropical medicine referral unit. Am J Trop Med Hyg 2003, 69(1):115-21.
28 Díaz, J.; Igual, R.; Alonso, MC.; Moreno, JM. Estudio del parasitismo intestinal en inmigrantes de la comarca de La Safor (Comunidad Valenciana). Rev Med Clin 2002, (119): 1.
29 López-Vélez, R.; Navarro Beltrán, M.; Jiménez Navarro, C. Estudio de Inmigración y Salud Pública: Enfermedades Infecciosas Importadas. Estudios, informe e investigación 2007. Ministerio de Sanidad y Consumo.
30 Martín Sánchez, AM.; Hernández García, A.; González Fernández, M.; Afonso Rodríguez, O.; Hernández Cabrera, M.; Pérez Arellano, JL. Intestinal parasitosis in the asymptomatic Subsaharian immigrant population. Gran Canaria 2000. Rev Clin Esp 2004, 204(1):14-7.
31 Roca, C.; Balanzó, X.; Fernández-Roure, JL.; Sauca, G.; Savall, R.; Gascón, J.; Corachán, M. Imported diseases in African immigrants in Spain: study of 1,321 patients. Med Clin (Barc) 2002, 119(16):616-9.
32 Monge-Maillo, B.; López-Vélez, R.; Norman, FF.; Ferrere-González, F.; Martínez-Pérez, Á.; Pérez-Molina, JA. Screening of imported infectious diseases among asymptomatic subsaharan African and Latin American immigrants: a public health challenge. Am J Trop Med Hyg 2015, 92(4):848-56.
33 Rodríguez Alvarez, E.; Lanborena Elordui, N.; Senhaji, M.; Pereda Riguera, C. Sociodemographic variables and lifestyle as predictors of self-perceived health in immigrants in the Basque Country [Spain]. Gac Sanit 2008, 22(5):404-12.
2 Mejia, R.; Nutman, TB. Evaluation and differential diagnosis of marked, persistent eosinophilia. Semin Hematol 2012, 49(2):149-59.
3 Leder, K.; Weller, PF. Eosinophilia and helminthic infections. Baillieres Best Pract Res Clin Haematol 2000, 13(2):301-17.
4 Valent, P.; Klio, AD.; Rosenwasser, LJ.; Arock, M.; Bochner, BS.; Butterfield, JH.; Gotlib, J.; Haferlach, T.; Hellmann, A.; Horny, HP.; Leiferman, KM.; Metzgeroth, G.; Matsumoto, K.; Reiter, A.; Roufosse, F.; Rothenberg, ME.; Simon, HU.; Sotlar, K.; Vandenberghe, P.; Weller, PF.; Gleich, GJ. ICON: Eosinophil Disorders. World Allergy Organ J 2012, 5(12):174-81.
5 Monge-Maillo, B.; Jiménez, BC.; Pérez-Molina, JA.; Norman, F.; Navarro, M.; Pérez-Ayala, A.; Herrero, JM.; Zamarrón, P.; López-Vélez, R. Imported infectious diseases in mobile populations, Spain. Emerg Infect Dis 2009, 15(11):1745-52.
6 Celestin, J.; Frieri, M. Eosinophilic disorders in various diseases. Curr Allergy Asthma Rep 2012, 12(1):18-24.
7 Valerio, L.; Roure, S.; Fernández-Rivas, G.; Basile, L.; Martínez-Cuevas, O.; Ballesteros, ÁL.; Ramos, X.; Sabrià, M.; North Metropolitan Working Group on Imported Diseases. Epidemiological and clinical characteristics of 70 cases diagnosed in the North Metropolitan Area of Barcelona, Spain, 2003-2012. Trans R Soc Trop Med Hyg 2013, 107(8):465-70. Strongyloides stercoralis, the hidden worm.
8 Ahonen, EQ.; Porthé, V.; Vázquez, ML.; García, AM.; López-Jacob, MJ.; Ruiz-Frutos, C.; Ronda-Pérez, E.; Benach, J.; Benavides, FG. ITSAL Project. A qualitative study about immigrant workers' perceptions of their working conditions in Spain. J Epidemiol Community Health 2009, 63(11):936-42.
9 López-Vélez, R.; Navarro Beltrá, M.; Hernando Jerez, A.; del Amo Valero, J. HIV infection in immigrants. Enferm Infecc Microbiol Clin 2008, 5:12-21.
10 Saurina, C.; Vall-Llosera, L.; Saez, M. Factors determining access to and use of primary health care services in the Girona Health Region (Spain). Eur J Health Econ 2012, 13(4):419-27.
11 Ehmsen, BK.; Biswas, D.; Jensen, NK.; Krasnik, A. Norredam, M. Undocumented migrants have diverse health problems. Dan Med J 2014, 61(9): A4897.
12 Llop-Gironés, A.; Vargas Lorenzo, I.; Garcia-Subirats, I.; Aller, MB.; Vázquez Navarrete, ML. Immigrants' access to health care in Spain: a review. Rev Esp Salud Publica 2014, 88(6):715-34.
13 Norman, FF.; López-Vélez, R. Immigration, helminths and eosinophilia: A complex triad. Travel Med Infect Dis 2015, 13(4):283-4.
14 Meltzer, E.; Percik, R.; Shatzkes, J.; Sidi, Y.; Schwartz, E. Eosinophilia among returning travelers: a practical approach. Am J Trop Med Hyg 2008, 78(5):702-9.
15 Belhassen-García, M.; Pardo-Lledias, J.; Pérez Del Villar, L.; Muro, A.; Velasco-Tirado, V.; Muñoz Bellido, JL.; Vicente, B.; Blázquez de Castro, A.; Cordero-Sánchez, M. Should parasitic disease be investigated in immigrant children with relative eosinophilia from tropical and sub-tropical regions? Paediatr Int Child Health 2016, 9:1-4.
16 Sulzer, AL. Indirect fluorescent test for parasitic diseases. Preparation of a stable antigen from larvae of Trichinella spiralis. J. Parasitol 1965, 51: 717-721.
17 Muiño, L.; Perteguer, MJ.; Garate, T.; Martínez-Sernández, V.; Beltran, A.; Romaris, F.; Mezo, M.; Gonzalez-Warleta, M.; Ubeira, FM. Molecular and immunological characterization of Fasciola antigens recognized by the MM3 monoclonal antibody. Mol. Biochem. Parasitol 2011, 179(2): 80-90.
18 Lawrence, RA.; Denham, DA. Stage and isotype specific immune responses in a rat model of filariasis. Parasite Immunol 1993, 15 (8): 429-439.
19 Murdoch, ME.; Abiose, A.; Garate, T.; Hay, RJ.; Jones, BR.; Maizels, RM.; Parkhouse, RM. Human onchocerciasis in Nigeria: isotypic responses and antigen recognition in individuals with defined cutaneous pathology. Amm. Trop. Med. Hyg 1996, 54(6): 600-612.
20 Güerri, ML.; Davila, M.; Rodríguez, M.; Nieto, FJ.; Ladrón de Guevara, C. Utility of IgG subclases in the diagnosis and folow up of the hidatidosis. Enferm Infecc. Microbiol. Clin 2000, 18(6): 262-266.
21 Fleiss, JL. The design and analysis of clinical experiments. Wiley, New York, 1986.
22 Kirkwood, BR. Essentials of medical statistics. Oxford; Blackwell Scientific Publications, 1988.
23 Ehrhardt, S.; Burchard, GD. Eosinophilia in returning travelers and migrants. Dtsch Arztebl Int 2008, (46):801-7.
24 Checkley, AM.; Chiodini, PL.; Dockrell, DH.; Bates, I.; Thwaites, GE.; Booth, HL.; Brown, M.; Wright, SG.; Grant, AD.; Mabey, DC.; Whitty, CJ.; Sanderson, F. British Infection Society and Hospital for Tropical Diseases. Eosinophilia in returning travellers and migrants from the tropics: UK recommendations for investigation and initial management. J Infect 2010, 60(1):1-20.
25 Salas-Coronas, J.; Cabezas-Fernández, MT.; Vázquez-Villegas, J.; Soriano-Pérez, MJ.; Lozano-Serrano, AB.; Pérez-Camacho, I.; Cabeza-Barrera, MI.; Cobo, F. Evaluation of eosinophilia in immigrants in Southern Spain using tailored screening and treatment protocols: A prospective study. Travel Med Infect Dis 2015, 13(4):315-21.
26 Vilajeliu Balagué A, de Las Heras Prat P, Ortiz-Barreda G, Pinazo Delgado MJ, Gascón Brustenga J, Bardají Alonso, A. Imported parasitic diseases in the immigrant population in Spain. Rev Esp Salud Publica 2014, 88(6):783-802.
27 López-Vélez, R.; Huerga, H.; Turrientes, MC. Infectious diseases in immigrants from the perspective of a tropical medicine referral unit. Am J Trop Med Hyg 2003, 69(1):115-21.
28 Díaz, J.; Igual, R.; Alonso, MC.; Moreno, JM. Estudio del parasitismo intestinal en inmigrantes de la comarca de La Safor (Comunidad Valenciana). Rev Med Clin 2002, (119): 1.
29 López-Vélez, R.; Navarro Beltrán, M.; Jiménez Navarro, C. Estudio de Inmigración y Salud Pública: Enfermedades Infecciosas Importadas. Estudios, informe e investigación 2007. Ministerio de Sanidad y Consumo.
30 Martín Sánchez, AM.; Hernández García, A.; González Fernández, M.; Afonso Rodríguez, O.; Hernández Cabrera, M.; Pérez Arellano, JL. Intestinal parasitosis in the asymptomatic Subsaharian immigrant population. Gran Canaria 2000. Rev Clin Esp 2004, 204(1):14-7.
31 Roca, C.; Balanzó, X.; Fernández-Roure, JL.; Sauca, G.; Savall, R.; Gascón, J.; Corachán, M. Imported diseases in African immigrants in Spain: study of 1,321 patients. Med Clin (Barc) 2002, 119(16):616-9.
32 Monge-Maillo, B.; López-Vélez, R.; Norman, FF.; Ferrere-González, F.; Martínez-Pérez, Á.; Pérez-Molina, JA. Screening of imported infectious diseases among asymptomatic subsaharan African and Latin American immigrants: a public health challenge. Am J Trop Med Hyg 2015, 92(4):848-56.
33 Rodríguez Alvarez, E.; Lanborena Elordui, N.; Senhaji, M.; Pereda Riguera, C. Sociodemographic variables and lifestyle as predictors of self-perceived health in immigrants in the Basque Country [Spain]. Gac Sanit 2008, 22(5):404-12.
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