Enfermedades infecciosas importadas en inmigrantes internacionales. Dos décadas de experiencia
- Autores: Begoña Monge Maillo
- Directores de la Tesis: Rogelio López-Vélez Pérez (dir. tes.)
- Lectura: En la Universidad de Alcalá ( España ) en 2011
- Idioma: español
- Tribunal Calificador de la Tesis: Joaquín Ortuño Mirete (presid.), Santiago Moreno Guillén (secret.), José Antonio Pérez Molina (voc.), Esteban Martín Echevarría (voc.), Teresa Garate Ormaechea (voc.)
- Materias:
- Enlaces
- Resumen
- español
Esta tesis recoge la experiencia acumulada durante más de veinte años por la Unidad de Medicina tropical del Servicio de Enfermedades Infecciosas del Hospital Ramón y Cajal de Madrid en la atención a pacientes inmigrantes con enfermedades infecciosas importadas. Se describen aspectos demográficos, motivos de consulta y diagnósticos de enfermedades infecciosas de una la cohorte de inmigrantes africanos sub-saharianos y latino americanos y de inmigrantes que viajan para visitar a familiares y amigos africanos sub-saharianos y latino americanos. Se analizan las frecuencias de los distintos síndromes de consulta y de los diagnósticos y se comparan según el área de procedencia. Del mismo modo, se cuantifica la cantidad de patología infecciosa silente en los inmigrantes asintomáticos atendidos, con lo que se establecen las bases de un cribado sistemático según procedencia. Se apuntan así las estrategias para la prevención de la emergencia de las enfermedades infecciosas importadas en nuestro medio
- English
Introduction: Immigration remains a growing phenomenon currently. In 2010, the number of international migrants worldwide was 214 million. The majority of immigrants come from less developed areas of Africa, Asia and Latin America, and countries of Europe and North America have become the main host countries (3). In the last 5 years Spain has been one of the main recipients of immigrants in Europe. The number of registered immigrants as of January 2011 was 5.7 million (12.2 % of the total population). The majority were from EU countries, mainly Romania, Great Britain and Germany, followed by the non-EU countries (mainly Morocco, Ecuador and Colombia). Migrants may have infectious diseases which may be endemic in their countries of origin, may be acquired during migration or in the country of resettlement and therefore presentation may be heterogeneous. Immigrants settled in the host country increasingly travel to their country of origin to visit friends and relatives (VFRs). This group accounts for an important proportion of all international travellers and several studies have identified them as a special risk group for certain travel-related preventable illnesses, especially infectious diseases, when compared with other types of travellers. Immigrants with certain infectious diseases may remain asymptomatic for long periods, this may lead to a late diagnosis and treatment and may favour transmission in the host country.
Objectives: To describe clinical and epidemiological characteristics and the imported infectious diseases of immigrants, immigrants who travel to visit friends and relatives and asymptomatic immigrants from sub-Saharan Africa and Latin America who were attended at the Tropical Medicine Unit of the Ramón y Cajal Hospital in Madrid.
Methods: An observational, retrospective, descriptive and analytical study was performed. Patients included in the study were: Latin American (LA) and sub-Saharan African (SSA) immigrants (INM) who attended the Tropical Medicine Unit (TMU) at the Ramón y Cajal Hospital from 1989 to June 2008; immigrants who traveled to SubSaharan Africa (SSA) and Latin America (LA) to visit friends and relatives (INM-VFRs) and attended the TMU after arrival from 1989 to June 2010; and asymptomatic SSA and LA immigrants (ASYM-IMM) attended at the TMU from January 2000 to January 2011 for a medical exam. Demographic variables included age, sex, country of origin, health coverage (defined as having Madrid’s social security health card) and pre-consultation period (defined as months elapsed from arrival in Spain to first consultation at the TMU.) For INM-VFRs duration of travel and country/area of travel were also included. Among INM and INM-VFRs the main reasons for seeking medical assistance at the TMU were grouped into syndromes: dermatological, febrile, gastrointestinal, respiratory, genitourinary, neurological, musculoskeletal, hematological-anemia, hematologicaleosinophilia, cardiovascular and asymptomatic. Diagnoses of infectious diseases were made using standard diagnostic techniques and grouped into 4 categories: Tropical infectious diseases, Transmissible Infectious diseases, Common infectious diseases and Infrequent infectious diseases. Among asymptomatic patients, screening included: HIV, HBV, HCV, rapid plasma reagin (RPR) serological analysis for syphilis, Mantoux skin test (PPD), stool parasites, PCR for malaria for SSA, Chagas serology for LA and schistosomiasis serology if risk factors.
Results: data for 2198 INM were analysed, 1564 SSA and 634 LA. Main countries of origin were: Equatorial Guinea, Nigeria, Senegal and Cameroon for SSA and Ecuador, Bolivia, Peru and Colombia for LA; 59.3% were male and median age was 29 years (IQR 22-36 years). The median pre-consultation period was 7 months. Pre-consultation period was significantly longer and proportion with a health card was significantly higher among LA. Hematological-eosinophilia, dermatological, febrile, hematological-anemia, genitourinary and musculoskeletal syndromes were more frequent among SSA; respiratory and neurological syndromes were more frequent among LA. LTI, filariasis, chronic infections with hepatitis viruses, malaria, STI and schistosomiasis were more frequent among SSA; TB, Chagas disease, respiratory infections, cysticercosis and leprosy were more frequent among LA. Data for 351 INM-VFRs were analysed, 209 SSA and 142 LA. Main countries visited were: Equatorial Guinea, Ecuador, Bolivia, Niger and Peru; 55.6% were females with a median age of 36 years (IQR 28-44 years). Median length of travel was: 1 month (IQR 0.6-2 months). Febrile and neurological syndromes were more frequent among SSA, chronic diarrhoea was more frequent among LA. Malaria, latent tuberculosis infection, filariasis and chronic viral hepatitis were more frequent among SSA, dengue, intestinal parasites and Chagas disease were more frequent among LA. Data for 633 ASYM-IMM were analysed, 283 SSA and 350 LA. Main countries of origin: were: Bolivia, Senegal, Niger, Ecuador and Cameroon; 54% were males and median age was 29 years (IQR 23-36 years). Median pre-consultation period was 32 months. LTI, chronic viral HBV hepatitis and schistosomiasis were more frequent among SSA; Chagas disease was more frequent among LA.
Conclusions: INM attended at the TMU were mainly young males, with an increasing proportion of LA. This is in accordance with recent official data on immigration in Spain. The diagnosis of infections varied according to the area of origin which may reflect that infectious diseases among immigrants are directly related to the geographical distribution and prevalence of infectious diseases in the world. INM-VFRs attended at the TMU were mainly young females. INM-VFRs travelled to less developed countries for longer periods of time, as described for INM-VFRs in general which may confer a higher risk for some travel-related diseases. Based on screening results for ASYM-INM, a targeted screening program for infectious disease in ASYM-IMM may include: In SSA: HIV, HBV, HCV, RPR, PPD ( if ≤ 5 years in the host country) , PCR for malaria (if ≤ 3 years in the host country), and schistosomiasis, if risk factors present/history of exposure; In LA: HIV, HBV, HCV (if risk factors), RPR, PPD (if ≤ 5 years in the host country) and Chagas disease. The low prevalence and clinical significance of intestinal parasites questions the need for performing routine stool analysis.
- español
