从非洲到西班牙南部的与移民相关的疟疾。

Migration-associated malaria from Africa in southern Spain.

机构信息

Tropical Medicine Unit. Hospital de Poniente, El Ejido, Almería, Spain.

Tropical Medicine Unit. Distrito Poniente, Almería, Spain.

出版信息

Parasit Vectors. 2021 May 7;14(1):240. doi: 10.1186/s13071-021-04727-0.

DOI:10.1186/s13071-021-04727-0

PMID:33962647

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8103587/

Abstract

BACKGROUND

The western area of the province of Almeria, sited in southern Spain, has one of the highest immigrant population rates in Spain, mainly dedicated to agricultural work. In recent years, there has been a significant increase in the number of cases of imported malaria associated with migrants from countries belonging to sub-Saharan Africa. The objective of our study is to describe the epidemiological, clinical and analytical characteristics of malaria patients treated in a specialized tropical unit, paying special attention to the differences between VFR and non-VFR migrants and also to the peculiarities of microscopic malaria cases compared to submicroscopic ones.

METHODS

Retrospective observational study of migrants over 14 years of age with imported malaria treated from October 2004 to May 2019. Characteristics of VFR and non-VFR migrants were compared. Malaria cases were divided into microscopic malaria (MM) and submicroscopic malaria (SMM). SMM was defined as the presence of a positive malaria PCR test together with a negative direct microscopic examination and a negative rapid diagnostic test (RDT). Microscopic malaria was defined as the presence of a positive RDT and/or a positive smear examination.

RESULTS

Three hundred thirty-six cases of malaria were diagnosed, 329 in sub-Saharan immigrants. Of these, 78.1% were VFR migrants, in whom MM predominated (85.2% of cases). In non-VFR migrants, SMM represented 72.2% of the cases. Overall, 239 (72.6%) patients presented MM and 90 (27.4%) SMM. Fever was the most frequent clinical manifestation (64.4%), mainly in the MM group (MM: 81.1% vs SMM: 20.0%; p < 0.01). The most frequent species was P. falciparum. Patients with SMM presented fewer cytopenias and a greater number of coinfections due to soil-transmitted helminths, filarial and intestinal protozoa compared to patients with MM.

CONCLUSIONS

Imported malaria in our area is closely related to sub-Saharan migration. VFR migrants are the main risk group, highlighting the need for actions aimed at improving disease prevention measures. On the other hand, almost a third of the cases are due to SMM. This fact could justify its systematic screening, at least for those travelers at greater risk.

摘要

背景

西班牙南部的阿尔梅里亚省西部地区是西班牙移民人口比例最高的地区之一，这些移民主要从事农业工作。近年来，与来自撒哈拉以南非洲国家的移民相关的输入性疟疾病例数量显著增加。我们的研究目的是描述在一个专门的热带病单位治疗的疟疾患者的流行病学、临床和分析特征，特别关注 VFR 和非 VFR 移民之间的差异，以及与亚微观疟疾相比，微观疟疾病例的特点。

方法

回顾性观察性研究 2004 年 10 月至 2019 年 5 月期间年龄在 14 岁以上的输入性疟疾移民患者。比较 VFR 和非 VFR 移民的特征。将疟疾病例分为微观疟疾（MM）和亚微观疟疾（SMM）。SMM 定义为疟原虫 PCR 检测阳性，直接镜检阴性，快速诊断检测（RDT）阴性。微观疟疾定义为 RDT 和/或涂片检查阳性。

结果

诊断出 336 例疟疾，其中 329 例来自撒哈拉以南地区的移民。其中，78.1%为 VFR 移民，其中 MM 占主导地位（85.2%的病例）。在非 VFR 移民中，SMM 占病例的 72.2%。总体而言，239 例（72.6%）患者为 MM，90 例（27.4%）为 SMM。发热是最常见的临床表现（64.4%），主要发生在 MM 组（MM：81.1%比 SMM：20.0%；p<0.01）。最常见的疟原虫是恶性疟原虫。与 MM 患者相比，SMM 患者的细胞减少症和土壤传播性蠕虫、丝虫和肠道原虫的合并感染较少。