Estudio comparativo de la patología infecciosa en niños inmigrantes de distintas procedencias

doi:10.1016/S1695-4033(04)78212-0

Anales de Pediatría

Volume 60, Issue 1, 2004, Pages 16-21

https://doi.org/10.1016/S1695-4033(04)78212-0 Get rights and content

Introducción

Los inmigrantes tienen un mayor riesgo de presentar ciertas enfermedades infecciosas. El objetivo de este estudio es conocer y comparar el perfil de morbilidad de los niños inmigrantes según su procedencia

Material y métodos

Estudio descriptivo que incluye a todos los inmigrantes menores de 14 años que acudieron a la Unidad de Medicina Tropical del Hospital Ramón y Cajal de Madrid, entre 1989 y 2001

Resultados

Se han incluido 170 niños (73 % de África, 19 % de América latina y 5% de Asia). El 75 % padecían alguna enfermedad infecciosa (78 % de los africanos y 62 % de los americanos) y 27 % estaba coinfectado (> 2 patógenos). La frecuencia de niños sanos fue mayor (p < 0,05) en los americanos (21%) que en los africanos (9 %). Las enfermedades más frecuentes fueron: malaria (35 %), parasitosis intestinal (48 %), filariasis (23 %) y hepatitis virales (19 %). La malaria, la filariasis y la hepatitis fueron más frecuentes en los africanos que en los americanos (p < 0,05). Otras helmintiasis tisulares (15 %) fueron más frecuentes en estos últimos. En ambos fueron prevalentes las parasitosis intestinales y la tuberculosis (6 %)

De los 36 (21 %) niños asintomáticos, el 53 % padecía alguna enfermedad infecciosa. Las más diagnosticadas fueron: en africanos, parasitosis intestinal (35 %), malaria (7 %), hepatitis B curada (15 %), filariasis (12 %) micosis superficial (4 %); en americanos, parasitosis intestinal (38 %) y toxocariasis visceral (25 %)

Conclusiones

Las enfermedades infecciosas y las coinfecciones son frecuentes en los niños inmigrantes incluso en los que están asintomáticos. Los autores proponen el cribado de ciertas enfermedades infecciosas en función de la procedencia y del tiempo de estancia en España

Introduction

Immigrants have a higher risk of contracting some infectious diseases. The aim of this study was to determine and compare the morbidity profile of immigrant children according to their country of origin

Material and methods

We performed a descriptive study of all immigrants aged less than 14 years old who attended the Tropical Medicine Unit of the Ramon y Cajal Hospital in Madrid between 1989 and 2001

Results

A total of 170 children were included (73 % from Africa, 19 % from Latin America, and 5% from Asia). Seventy-five percent had at least one infectious disease (78 % of Africans and 62 % of Latin Americans) and 27 % were co-infected (> 2 pathogenic agents). The proportion of healthy children was higher (p < 0.05) among Latin Americans (21 %) than among Africans (9 %). The most frequent infectious diseases were malaria (35 %), intestinal parasites (48 %), filariasis (23 %), and viral hepatitis (19 %). Malaria, filariasis and hepatitis were more frequent in Africans than in Americans (p < 0.05). Other helminthic infections (15 %) were more frequent in Americans. In both groups intestinal parasites and tuberculosis (6 %) were prevalent

Of the 36 (21%) asymptomatic children, 53 % had at least one infectious disease. The most frequently diagnosed diseases in Africans were intestinal parasitosis (35 %), malaria (7 %), cured hepatitis B (15 %), filariasis (12 %) and superficial mycosis (4 %). The most frequent infectious diseases in Latin Americans were intestinal parasitosis (38 %) and visceral toxocariasis (25 %)

Conclusions

Infectious diseases and co-infections are frequent in immigrant children, even in those who are asymptomatic. We propose screening of certain infectious diseases in these children according to their country of origin and their length of residence in Spain

Bibliografía (23)

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Infectious diseases in sub-Saharan African immigrant children in Madrid, Spain
Ped Infect Dis J
(2002)

Cited by (33)

Hepatitis C prevalence among the migrant population in Spain: A systematic review and meta-analysis
2019, Enfermedades Infecciosas y Microbiologia Clinica
Citation Excerpt :
In our study, the highest prevalence of HCV was found among migrants from countries in Europe (7.1%) and from sub-Saharan Africa (3.6%). The HCV antibody prevalence of the general migrant population was consistent with previous findings11,54 and was found to be same as the estimated prevalence of the general population in Spain.23,55 We report an approximate 1.6% anti-HCV prevalence for the general Spanish population on the basis of evidence published by the European Centre for Disease Control and Prevention23 and similar prevalences reported in Hope et al.’s 2014 article.55
Spain, which has one of the largest migrant populations in Europe, has committed to eliminating the hepatitis C virus (HCV). The aim of this study was to estimate the prevalence of HCV among migrant groups in Spain, a country of 46 million people, with an estimated HCV-antibody prevalence of 1.7%.
Studies on HCV and migration in Spain were identified by systematically searching three databases from the first records to 30 November 2017, and consulting experts at the Ministry of Health and in the 17 Spanish autonomous communities. A meta-analysis was conducted to determine pooled HCV prevalence for the general migrant population. Prevalences were also calculated for high-risk migrant populations and populations who had undergone hospital screening, stratified by region of origin.
Out of 243 studies identified, 26 met the eligibility criteria. The meta-analysis of the general migrant population found HCV antibody prevalence to be 1.6%. Migrants originating from European countries, including those at high or moderate risk for HCV, had the highest pooled prevalence (7.1%). In the general migrant population, prevalence was highest among sub-Saharan African migrants (3.1%) and lowest among Latin American migrants (0.2%).
Based on the limited available data, the prevalence among the general migrant population was found to be the same as the general Spanish population. Further research is needed to more accurately determine HCV prevalence for the overall migrant population and specific migrant subpopulations with a higher risk in the country as a whole and in each of Spain's 17 autonomous communities.
España, con una de las mayores poblaciones de inmigrantes en Europa se ha comprometido en la tarea de eliminar el virus de la hepatitis C (VHC). El objetivo de este estudio fue estimar la prevalencia del VHC entre los grupos de migrantes en España, un país de 46 millones de personas, con una prevalencia estimada de anticuerpos contra el VHC del 1,7%.
Se identificaron los estudios sobre el VHC y la migración en España mediante la búsqueda sistemática de 3 bases de datos desde los primeros registros hasta el 30 de noviembre de 2017. Se consultaron expertos del Ministerio de Salud y de las 17 comunidades autónomas españolas. Se realizó un metaanálisis para determinar la prevalencia combinada del VHC para la población migrante general. También se calcularon las prevalencias para poblaciones migrantes de alto riesgo, y para aquellas poblaciones con cribado realizado a nivel hospitalario, estratificadas por región de origen.
De 243 estudios identificados, 26 cumplieron con los criterios de elegibilidad. El metaanálisis de la población migrante general encontró que la prevalencia de anticuerpos contra el VHC era del 1,6%. Los migrantes provenientes de países europeos, incluidos aquellos con alto o mediano riesgo del VHC, tuvieron la mayor prevalencia combinada (7,1%). En la población migrante general, la prevalencia fue más alta entre los migrantes del África subsahariana (3,1%) y más baja entre los migrantes de América Latina (0,2%).
En función de los datos disponibles que son limitados, el estudio muestra que la prevalencia entre la población general migrante en España es la misma que la de la población general española. Se necesitan más estudios para determinar con mayor precisión la prevalencia del VHC en la población general de migrantes y las subpoblaciones de población inmigrante con mayor riesgo específicas en el país en su conjunto y en las 17 comunidades autónomas de España.
Toxocariasis in humans in Africa – A systematic review
2017, Travel Medicine and Infectious Disease
Citation Excerpt :
In a retrospective analysis of immigrant children younger than 14 years of age presenting to a hospital in Spain, 127 were of African origin. Toxocariasis was diagnosed in one patient [36]. Contamination of soil, water and food has been reported from various regions.
Toxocariasis is a globally distributed zoonosis. The most important definitive hosts are dogs, whereas humans serve as paratenic hosts. Transmission to humans occurs by accidental ingestion of eggs, e.g. by consumption of contaminated fruits or vegetables. Although exposure to Toxocara is usually considered as relatively benign, it is implicated in a range of neurological, ophthalmologic and other organ-specific conditions, some of them with grave consequences. This review provides an overview on the epidemiology, presentation and risk factors of exposure to Toxocara in Africa.
A systematic search was performed for studies published after January 1st, 1990, in English, French, Portuguese, Spanish, Dutch or German. The review was prepared according to PRISMA guidelines. Studies on toxocariasis in human populations and contamination in human environments were included.
Sixty-five papers were included. Antibodies against Toxocara spp. in humans were found to be very common across Africa. Severe manifestations have been reported mainly from North Africa. Environmental contamination including soil, vegetables and fruits sold on markets was demonstrated in various locations in Africa.
Exposure to Toxocara is prevalent across the African continent. However, the complication frequency, the impact of the condition on the individual and the public health relevance of this zoonosis, and the economic impact have never been systematically evaluated.
Screening for parasite infections in immigrant children from low-income countries
2017, Enfermedades Infecciosas y Microbiologia Clinica
Citation Excerpt :
Intestinal parasites were detected in nearly 20% of the patients studied. This figure is less than was previously reported in other works, where the overall prevalence of intestinal parasitic diseases reached 75%.18–20,22 This reduced prevalence of intestinal parasitosis in our study may be explained because more than half of the children had not arrived recently (<6 months).
In Spain, minors represent approximately 20% of the immigration flow. Many of these immigrants come from countries in the tropics and sub-tropics where intestinal parasitic infections caused by helminths and protozoa are one of the major causes of human disease. The main objective of the present work was to describe parasite infections in a group of immigrant children.
A prospective evaluation was performed in 373 minors from Sub-Saharan Africa, North Africa, and Latin America. Details were collected from the medical records and physical examination. Urine, stool and peripheral blood samples were obtained for serological and routine laboratory tests. Direct and indirect parasitological tests were also performed.
At least 1 parasitic disease was diagnosed in 176 (47.1%) immigrant children, while 77 (20.6%) minors were infected with two or more parasites. The number of parasites was highest in children from Sub-Saharan Africa compared with the rest of the areas of origin (p < .001), and in children from urban areas compared with those from rural areas (OR 1.27 [1.059–1.552], p = .011). The most frequent causes of multiple parasite infection were filariasis plus strongyloidiasis and filariasis plus schistosomiasis. Intestinal parasite infection was diagnosed in 38 cases (13.8%). Logistic regression analysis revealed that for each month of stay, the probability of a positive finding in the stool sample decreased by 0.02% [β = −0.020, (p = .07)].
The high infection rates of parasite diseases in immigrant children point to the need for screening protocols for certain infectious diseases in these children according to their country of origin and their length of residence in Spain.
En España, los menores representan aproximadamente el 20% del flujo migratorio. Muchos de estos menores provienen de regiones tropicales y subtropicales donde las infecciones por helmintos y protozoos son una de las principales causas de morbilidad. El objetivo de este trabajo es describir las infecciones parasitarias presentes en un colectivo de menores inmigrantes.
Se evaluaron prospectivamente 373 menores procedentes de África subsahariana, África del Norte y Latinoamérica. Se realizó una historia clínica detallada. Se obtuvieron muestras de sangre periférica, orina y heces para la realización de los diferentes análisis bioquímicos, serológicos y parasitológicos directos e indirectos.
En 176 (47,1%) menores se diagnosticó al menos una enfermedad parasitaria. En 77 (20,6%) menores se detectaron 2 o más parásitos. En los niños de África subsahariana el número de parásitos fue mayor comparado el resto de orígenes (p < 0,001). Los menores de zonas urbanas tenían más parásitos comparado con los niños de zonas rurales (OR 1,27 [1059-1552], p = 0,011). Las causas más frecuentes de parasitación múltiple fueron filariosis más estrongiloidosis y filariosis más esquistosomiasis. Se diagnosticó parasitosis intestinal en 38 casos (13,8%). El análisis de regresión logística reveló que por cada mes de estancia, la probabilidad de un resultado positivo en las heces disminuía un 0,02% [β = −0,020 (p = 0,07)].
Las altas tasas de infección parasitaria en niños inmigrantes señala la necesidad de una detección protocolizada de estas enfermedades según el país de origen y el tiempo de residencia en España.
Imported transmissible diseases in minors coming to Spain from low-income areas
2015, Clinical Microbiology and Infection
Citation Excerpt :
HCV infection rate in our children was similar to rates previously described in adult immigrants. The reported prevalence in minors immigrating from Sub-Saharan Africa reached 1.7%, while it was 0% in minors coming from Latin America [17–19]. Three cases of HBV/HCV coinfection were found, which is extremely infrequent in other studies [5].
We prospectively studied the prevalence of imported transmissible diseases in 373 immigrant children and adolescents coming from Sub-Saharan Africa, North Africa and Latin America to Salamanca, Spain. The most frequent transmissible diseases in this group were latent tuberculosis (12.7%), chronic hepatitis B virus infection (4.2%), hepatitis C virus infection (2.3%), syphilis (1.5%) and human T-lymphotropic virus type 1 or 2 infections (1.4%). A total of 24.2% of patients had serologic profiles suggesting past hepatitis B virus infection. Anti–human immunodeficiency virus antibodies were not detected in any subject. Largely asymptomatic immigrant children show a high prevalence of communicable diseases. Thus, infectious disease screenings are highly advisable in immigrant children coming from low-income countries.
Imported infectious diseases in tertiary hospital
2014, Anales de Pediatria
En el año 2009 se crea en nuestro centro una Consulta de Patología Importada. El objetivo de este trabajo es conocer su aportación en cuanto a capacidad, calidad asistencial y docencia ofrecida.
Estudio retrospectivo entre 2009 y 2011 donde se analizan: a) desarrollo del conocimiento mediante la valoración de protocolos y publicaciones realizadas, así como la docencia impartida; y b) capacidad y calidad asistencial ofrecida mediante el análisis de los pacientes atendidos, la adecuación a los protocolos y la accesibilidad a la consulta. Se clasifican los pacientes atendidos en 3 grupos: grupo 1 cribado del paciente inmigrante; grupo 2 consulta tras viaje a zona tropical o subtropical; grupo 3 cribado de enfermedad importada de transmisión vertical.
Se han desarrollado y difundido en la web de la unidad 6 protocolos y 5 publicaciones científicas. Se han atendido 316 pacientes: 191 incluidos en el grupo 1 (29 adoptados y 162 inmigrantes); 57 en el grupo 2 (94,7% Visiting Friends and Relatives y 81,5% sin consulta previaje), que acudieron principalmente por clínica gastrointestinal (52,6%) y fiebre (43,8%); y 68 en el grupo 3 con riesgo de infección importada de transmisión vertical (62 Trypanosoma cruzi, 1 virus linfotrópico T humano y 5 Plasmodium spp.). La adecuación global a los protocolos disponibles fue del 77,1%.
Las unidades de patología infecciosa deben adaptarse a la realidad de la población que atienden, siendo flexibles en su estructura. Es imprescindible la valoración periódica de la calidad asistencial ofrecida, así como la valoración en la rentabilidad de los estudios complementarios a realizar.
An Imported Diseases Clinic was created in the hospital in 2009. The aim of this study was to asses its contribution in terms of capacity, quality of care and teaching offered.
A retrospective study was conducted from 2009 to 2011, analyzing: A) development of knowledge by means of protocols and publications created, and subject taught; B) capacity and quality of care offered by the analysis of patients seen, the adequacy of the protocols and accessibility.
The patients were classified into 3 groups. Group 1: immigrant patient screening, group 2: patient consultation after tropical or sub-tropical travel, group 3: screening of vertical transmission of imported disease.
Six protocols have been developed and disseminated on the unit website, as well as 5 scientific publications. A total of 316 patients were evaluated: 191 included in group 1 (29 Adopted and 162 Immigrants), 57 in group 2 (94.7% Visiting Friends and Relatives and 81.5% without a pre-travel consultation). They consulted due to, gastrointestinal symptoms (52.6%) and fever (43.8%), with 68 included in group 3 at risk of imported disease by vertical transmission (62 Trypanosoma cruzi, 1 Human T Lymphotropic Virus and 5 Plasmodium spp.). The overall adherence to the protocols was about 77.1%.
Infectious Diseases Units must adapt to the reality of the population and be flexible in its structure. Periodic assessment of the quality of care offered is essential, as well as an evaluation on the need for additional studies.
General and ambulatory management of patient with parasitosis
2010, Medicine

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Estudio comparativo de la patología infecciosa en niños inmigrantes de distintas procedenciasComparative study of infectious diseases in immigrant children from various countries

Introducción

Material y métodos

Resultados

Conclusiones

Introduction

Material and methods

Results

Conclusions

Soc Sci Med

An Esp Pediatr

Med Clin North Am

Arch Pediatr

Enfermedades infecciosas tropicales en el niño inmigrante

Rev Esp Pediatr

Infants of Mexican immi-grants. Health status of an emerging population

Med Care

Infectious diseases in sub-Saharan African immigrant children in Madrid, Spain

Ped Infect Dis J