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Objective To assess the outcomes of a contact-tracing programme to increase the diagnosis of tuberculosis in Cubal, Angola and offer preventive treatment to high-risk groups. Methods A health centre-based contact-tracing programme was launched in Hospital Nossa Senhora da Paz in March 2015 and we followed the programme until 2022. In that time, staffing and testing varied which we categorized as four periods: medical staff reinforcement, 2015-2017, with a doctor seconded from Vall d'Hebron University Hospital, Spain; routine staff, 2017-2021, with no external medical support; community directly observed treatment (DOT), 2018-2019 with community worker support; and enhanced contact tracing, 2021-2022, with funding that allowed free chest radiographs, molecular and gastric aspirate testing. We assessed differences in contacts seen each month, and testing and treatment offered across the four periods. Findings Overall, the programme evaluated 1978 contacts from 969 index cases. Participation in the programme was low, although it increased significantly during the community DOT period. Only 16.6% (329/1978) of contacts had a chest radiograph. Microbiological confirmation increased to 72.2% (26/36) after including molecular testing, and 10.1% (200/1978) of contacts received treatment for tuberculosis. Of 457 contacts younger than 5 years, 36 (7.9%) received preventive tuberculosis treatment. Half of the contacts were lost to follow-up before a final decision was taken on treatment. Conclusion Contact tracing increased the diagnosis of tuberculosis although engagement with the programme was low and loss to follow-up was high. Participation increased during community DOT. Community-based screening should be explored to improve participation and diagnosis. Objectif Evaluer l'efficacite d'un programme de suivi des contacts pour ameliorer le depistage de la tuberculose a Cubal, en Angola, et proposer un traitement preventif aux groupes a haut risque. Methodes Un programme de suivi des contacts en centre de sante a ete lance en mars 2015 a l'Hospital Nossa Senhora da Paz, et nous l'avons accompagne jusqu'en 2022. Comme les effectifs et le depistage ont evolue durant cette periode, nous l'avons divisee en quatre phases: renforcement de l'equipe medicale entre 2015 et 2017, avec un medecin detache de l'hopital universitaire Vall d'Hebron, en Espagne; personnel regulier entre 2017 et 2021, sans assistance medicale externe; traitement sous surveillance directe (TSD) au niveau communautaire entre 2018 et 2019, avec l'aide des agents communautaires; et enfin, suivi renforce des contacts entre 2021 et 2022, avec un financement permettant d'effectuer gratuitement des radiographies thoraciques, ainsi que des tests moleculaires et d'aspiration gastrique. Nous avons evalue les differences dans les contacts vus chaque mois, mais aussi dans les tests et traitements proposes durant les quatre phases. Resultats Au total, le programme a examine 1978 contacts Issus de 969 cas Indicateurs. La participation au programme etait faible, bien qu'elle ait considerablement augmente au cours de la phase de TSD au niveau communautaire. A peine 16,6% (329/1978) des contacts ont fait l'objet d'une radiographie thoracique. La confirmation microbiologique a atteint 72,2% (26/36) apres avoir inclus les tests moleculaires, tandis que 10,1% (200/1978) des contacts ont recu un traitement contre la tuberculose. Sur les 457 contacts ages de moins de 5 ans, 36 (7,9%) se sont vus administrer un traitement preventif contre la tuberculose. La moitie des contacts ont ete perdus de vue avant qu'une decision finale n'ait ete prise en matiere de traitement. Conclusion Le suivi a permis de mieux diagnostiquer la tuberculose, malgre la faible participation au programme et le nombre eleve de contacts perdus de vue. La participation a augmente pendant la phase de TSD au niveau communautaire. Le depistage au niveau communautaire devrait etre renforce afin d'accroitre le taux de participation et de diagnostic. Objetivo Evaluar los resultados de un programa de rastreo de contactos para aumentar el diagnostico de la tuberculosis en Cubal (Angola) y ofrecer tratamiento preventivo a los grupos de alto riesgo. Metodos En marzo de 2015, se inicio un programa de rastreo de contactos basado en centros sanitarios en el Hospital Nossa Senhora da Paz y se siguio hasta 2022. En ese tiempo, la dotacion de personal y las pruebas variaron, lo que clasificamos en cuatro periodos: refuerzo del personal medico, de 2015 a 2017, con un medico enviado en comision de servicios desde el Hospital Universitario Vall d'Hebron (Espana); personal de rutina, de 2017 a 2021, sin apoyo medico externo; tratamiento directamente observado (TDO) en la poblacion, de 2018 a 2019, con apoyo de trabajadores comunitarios; y rastreo de contactos mejorado, de 2021 a 2022, con financiacion que permitio realizar radiografias de torax y pruebas moleculares y de aspirado gastrico gratuitas. Se evaluaron las diferencias en los contactos atendidos al mes y las pruebas y el tratamiento ofrecidos en los cuatro periodos. Resultados En total, el programa evaluo 1978 contactos de 969 casos de referencia. La participacion en el programa fue baja, aunque aumento de manera significativa durante el periodo de TDO en la poblacion. Solo el 16,6% (329/1978) de los contactos se sometieron a una radiografia de torax. La confirmacion microbiologica aumento al 72,2% (26/36) tras incluir las pruebas moleculares y el 10,1% (200/1978) de los contactos recibieron tratamiento para la tuberculosis. De 457 contactos menores de 5 anos, 36 (7,9%) recibieron tratamiento preventivo contra la tuberculosis. Se perdio el seguimiento de la mitad de los contactos antes de que se tomara una decision final sobre el tratamiento. Conclusion El rastreo de contactos aumento el diagnostico de la tuberculosis, aunque el compromiso con el programa fue bajo y la perdida del seguimiento fue alta. La participacion aumento durante el TDO en la poblacion. Se debe explorar el cribado en la poblacion para mejorar la participacion y el diagnostico., Introduction Increasing testing and diagnosis of tuberculosis (TB) is one of the main pillars of the End TB Strategy, together with rapid initiation of effective therapy and follow-up programmes. 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Background: Hypereosinophilic syndrome can produce cardiac involvement and endomyocardial fibrosis, which have a poor prognosis. However, there is limited information regarding cardiac involvement among migrants from Latin America with eosinophilia related to helminthiasis. Methods: We conducted a pilot observational study where an echocardiography was performed on migrants from Latin America with both eosinophilia (>450 cells/μL) and a diagnosis of helminth infection, and on migrants from Latin America without eosinophilia or helminth infection. Microbiological techniques included a stool microscopic examination using the Ritchie's formalin-ether technique, and a specific serology to detect Strongyloides stercoralis antibodies. Results: 37 participants were included, 20 with eosinophilia and 17 without eosinophilia. Twenty (54.1%) were men with a mean age of 41.3 (SD 14.3) years. Helminthic infections diagnosed in the group with eosinophilia were: 17 cases of S. stercoralis infection, 1 case of hookworm infection, and 2 cases of S. stercoralis and hookworm coinfection. Among participants with eosinophilia, echocardiographic findings revealed a greater right ventricle thickness (p = 0.001) and left atrial area and volume index (p = 0.003 and p = 0.004, respectively), while showing a lower left atrial strain (p = 0.006) and E-wave deceleration time (p = 0.008). An increase was shown in both posterior and anterior mitral leaflet thickness (p = 0.0014 and p = 0.004, respectively) when compared with participants without eosinophilia. Conclusions: Migrants from Latin America with eosinophilia related to helminthic infections might present incipient echocardiographic alterations suggestive of early diastolic dysfunction, that could be related to eosinophilia-induced changes in the endomyocardium. Author summary: A recent study in migrants from Sub-Saharan Africa with eosinophilia related to helminth infection describes initial findings on cardiac ultrasound in the form of thickening of the posterior leaflet of the mitral valve, but with no clinical manifestations, representing the early stage of the endomyocardial fibrosis process. The aim of the present study is to evaluate the relationship between eosinophilia secondary to helminth infection and cardiac involvement in Latin American patients. In our cohort, eosinophilia in patients was mainly due to Strongyloides stercoralis infection. Among patients with eosinophilia, echocardiographic findings revealed a greater right ventricle thickness and left atrial area and volume index, while showing a lower left atrial strain and E-wave deceleration time when compared with patients without eosinophilia. These alterations are suggestive of early diastolic dysfunction that could be related to eosinophilia-induced changes in the endomyocardium. [ABSTRACT FROM AUTHOR]

Background People with pulmonary tuberculosis (PTB) are contagious, particularly to their household contacts. Their infectivity has been associated with the bacterial load in sputum samples. This study investigated if the bacterial load in sputum samples as quantified by Xpert MTB/RIF and Xpert Ultra is correlated with the extent that latent tuberculosis infection (LTBI) occurred in household contacts of people with PTB. Methods A retrospective study was performed including people with PTB presenting at Vall d'Hebron University Hospital, Barcelona, between 2011 and 2021. Their infection ratio, representing the proportion of household members found with LTBI in contact tracing investigation, was compared with the quantitative results of Xpert MTB/RIF and Xpert Ultra using ordinal regression analysis. Results A total of 107 people with PTB were included. Among their 398 household contacts, 126 (31.7%) cases of LTBI and 14 cases with active TB disease (3.5%) were reported. Higher bacterial load in Xpert MTB/RIF and Xpert Ultra baseline sputum was significantly associated with increased infection ratios, providing better estimates than conventional acid-fast bacilli (AFB) smear grading. Conclusions Xpert MTB/RIF and Xpert Ultra could serve as an alternative to AFB sputum-smear grading in determining contact tracing priorities. [ABSTRACT FROM AUTHOR]

Background Prolonged or recurrent gastrointestinal symptoms may persist after acute traveller's diarrhoea (TD), even after adequate treatment of the primary cause. This study aims to describe the epidemiological, clinical and microbiological characteristics of patients with post-infectious irritable bowel syndrome (PI-IBS) after returning from tropical or subtropical areas. Methods We conducted a retrospective study of patients presenting between 2009 and 2018 at the International Health referral centre in Barcelona with persistent gastrointestinal symptoms following a diagnosis of TD. PI-IBS was defined as the presence of persistent or recurrent gastrointestinal manifestations for at least 6 months after the diagnosis of TD, a negative stool culture for bacterial pathogens and a negative ova and parasite exam after targeted treatment. Epidemiological, clinical and microbiological variables were collected. Results We identified 669 travellers with a diagnosis of TD. Sixty-eight (10.2%) of these travellers, mean age 33 years and 36 (52.9%) women, developed PI-IBS. The most frequently visited geographical areas were Latin America (29.4%) and the Middle East (17.6%), with a median trip duration of 30 days (IQR 14–96). A microbiological diagnosis of TD was made in 32 of these 68 (47%) patients, 24 (75%) of whom had a parasitic infection, Giardia duodenalis being the most commonly detected parasite (n  = 20, 83.3%). The symptoms persisted for a mean of 15 months after diagnosis and treatment of TD. The multivariate analysis revealed that parasitic infections were independent risk factors for PI-IBS (OR 3.0, 95%CI 1.2–7.8). Pre-travel counselling reduced the risk of PI-IBS (OR 0.4, 95%CI 0.2–0.9). Conclusions In our cohort, almost 10% of patients with travellers' diarrhoea developed persistent symptoms compatible with PI-IBS. Parasitic infections, mainly giardiasis, seem to be associated with PI-IBS. [ABSTRACT FROM AUTHOR]

The aim of this study was to describe and compare the clinical characteristics of hospitalized patients with COVID-19 pneumonia according to their geographical origin. This is a retrospective case-control study of hospitalized patients with confirmed COVID-19 pneumonia treated at Vall d'Hebron University Hospital (Barcelona) during the first wave of the pandemic. Cases were defined as patients born in Latin America and controls were randomly selected among Spanish patients matched by age and gender. Demographic and clinical variables were collected, including comorbidities, symptoms, vital signs and analytical parameters, intensive care unit admission and outcome at 28 days after admission. Overall, 1080 hospitalized patients were registered: 774 (71.6%) from Spain, 142 (13.1%) from Latin America and the rest from other countries. Patients from Latin America were considered as cases and 558 Spanish patients were randomly selected as controls. Latin American patients had a higher proportion of anosmia, rhinorrhea and odynophagia, as well as higher mean levels of platelets and lower mean levels of ferritin than Spanish patients. No differences were found in oxygen requirement and mortality at 28 days after admission, but there was a higher proportion of ICU admissions (28.2% vs. 20.2%, p = 0.0310). An increased proportion of ICU admissions were found in patients from Latin America compared with native Spanish patients when adjusted by age and gender, with no significant differences in in-hospital mortality. [ABSTRACT FROM AUTHOR]

Introduction: Almost 281 million people were living in a foreign country in 2022, and more than 100 million were displaced because of war conflicts and human right violations. Vaccination coverage of infectious diseases in migrants from some disadvantaged settings could be lower than reception countries populations, consequently seroprevalence studies and better access to vaccination could contribute to reducing these differences., Methods: A descriptive retrospective cross-sectional study was conducted including migrants, living ≤5 years in the reception country and ≥16 years old, who requested a medical exam between January 1st, 2020 and January 31st, 2021. Seroprevalence assessment was performed, and vaccination was offered to those individuals without immunity to hepatitis B, hepatitis A, varicella, measles, mumps, and rubella., Results: A total of 315 migrants were attended during the study period. Immunity protection at arrival was 252/296 (85.1%) for measles, 274/295 (92.9%) for rubella, 257/296 (86.8%) for mumps, 264/295 (89.5%) for varicella, 267/313 (85.3%) for hepatitis A, and 104/300 (34.6%) for hepatitis B. The final immunity protection after full vaccination schedules was 278/296 (93.9%) for measles, 287/295 (97.3%) for rubella, 274/296 (92.6%) for mumps, 276/295 (93.6%) for varicella, 280/313 (89.5%) for hepatitis A, and 139/300 (46.3%) for hepatitis B., Conclusions: The vaccination intervention has increased immunity rates for the studied diseases in the attended migrants in our center, however, such interventions should be maintained to reach local population immunization levels. Moreover, the collaboration between shelter and reference specialized health centers is fundamental to implement such vaccination programs., (Copyright © 2024 Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. Published by Elsevier España, S.L.U. All rights reserved.)