Imported sparganosis in Canada

The first case of human sparganosis in Canada is reported in a 23-year-old woman who emigrated from Greece in 1969. Examination of a ribbon-like worm removed from a painful swelling in the neighbourhood of her right biceps muscle revealed a single larva, about 110 mm. long and 2.5 mm. wide, subsequently identified as the plerocercoid larva or sparganum of a member of the genus Spirometra. The source of this infection, acquired in Greece, may have been undercooked pork.     

Imported submicroscopic malaria in Madrid

ABSTRACT: BACKGROUND: Submicroscopic malaria (SMM) can be defined as low-density infections of Plasmodium that are unlikely to be detected by conventional microscopy. Such submicroscopic infections only occasionally cause acute disease, but they are capable of infecting mosquitoes and contributing to transmission. This entity is frequent in endemic countries; however, little is known about imported SMM. The goals of this study were two-fold: a) to know the frequency of imported SMM, and b) to describe epidemiological, laboratorial and clinical features of imported SMM. METHODS: A retrospective study based on review of medical records was performed. The study population consisted of patients older than 15 years attended at the Tropical Medicine Unit of Hospital Carlos III, between January 1, 2002 and December 31, 2007. Routinely detection techniques for Plasmodium included Field staining and microscopic examination through thick and thin blood smear. A semi-nested multiplex malaria PCR was used to diagnose or to confirm cases with low parasitaemia. RESULTS: SMM was diagnosed in 104 cases, representing 35.5% of all malaria cases. Mean age (IC95%) was 40.38 years (37.41-43.34), and sex distribution was similar. Most cases were in immigrants, but some cases were found in travellers. Equatorial Guinea was the main country where infection was acquired (81.7%). Symptoms were present only in 28.8% of all SMM cases, mainly asthenia (73.3% of symptomatic patients), fever (60%) and arthromialgias (53.3%). The associated laboratory abnormalities were anaemia (27.9%), leukopaenia (15.4%) and thrombopaenia (15.4%). Co-morbidity was described in 75 cases (72.1%). CONCLUSIONS: Results from this study suggest that imported SMM should be considered in some patients attended at Tropical Medicine Units. Although it is usually asymptomatic, it may be responsible of fever, or laboratory abnormalities in patients coming from endemic areas. The possibility of transmission in SMM has been previously described in endemic zones, and presence of vector in Europe has also been reported. Implementation of molecular tests in all asymptomatic individuals coming from endemic area is not economically feasible. So reemergence of malaria (Plasmodium vivax) in Europe may be speculated.     

Blood Protozoa of Imported Birds

SYNOPSIS. Large numbers of birds, until recently, were brought into the United States each year. Countries of origin were varied, and included those of Australasia, Africa, South America, and the Caribbean Islands, as well as other places. With them of course come their parasites, some of which may be potential pathogens to domestic avifauna. In part for this reason, a survey was undertaken of blood parasites of birds from pet shops and importers. So far a total of 1234 birds belonging to 186 species has been examined. Several new species and subspecies of avian Plasmodium have been found in the course of this study, including P. octamerium Manwell, 1968 in a Pintail Whydah, Vidua macoura , from Africa; P. paranucleophilum Manwell & Sessler, 1971 in a South American tanager, Tachyphonus sp.; and P. nucleophilum toucani Manwell & Sessler 1971 in a Swainson's Toucan, Ramphastos s. swainsonii. Plasmodium huffi Muniz, Soares & Battista is undoubtedly a synonym pro parte for the last. Plasmodium tenue Laveran & Marullaz, long thought to be a synonym of Plasmodium vaughani Novy & MacNeal, was rediscovered and found to be a valid species. Plasmodium nucleophilum , infrequently seen in the New World, occurred in many Asian and African birds, and especially in starlings. Infections with other species of Plasmodium were common. Haemoproteus was the commonest blood parasite; Leucocytozoon was very rare as was Atoxoplasma (Lankesterella). The 2 families of birds best represented were the Fringillidae and the Psittacidae, but no blood parasites were seen in the latter. It is clear that imported birds are often infected with blood protozoa, some of which are unknown from native birds.     

Imported Amoebic Liver Abscess in France

Background

Worldwide, amoebic liver abscess (ALA) can be found in individuals in non-endemic areas, especially in foreign-born travelers.

Methods

We performed a retrospective analysis of ALA in patients admitted to French hospitals between 2002 and 2006. We compared imported ALA cases in European and foreign-born patients and assessed the factors associated with abscess size using a logistic regression model.

Results

We investigated 90 ALA cases. Patient median age was 41. The male:female ratio was 3.5∶1. We were able to determine the origin for 75 patients: 38 were European-born and 37 foreign-born. With respect to clinical characteristics, no significant difference was observed between European and foreign-born patients except a longer lag time between the return to France after traveling abroad and the onset of symptoms for foreign-born. Factors associated with an abscess size of more than 69 mm were being male (OR = 11.25, p<0.01), aged more than 41 years old (OR = 3.63, p = 0.02) and being an immigrant (OR = 11.56, p = 0.03). Percutaneous aspiration was not based on initial abscess size but was carried out significantly more often on patients who were admitted to surgical units (OR = 10, p<0.01). The median time to abscess disappearance for 24 ALA was 7.5 months.

Conclusions/Significance

In this study on imported ALA was one of the largest worldwide in terms of the number of cases included males, older patients and foreign-born patients presented with larger abscesses, suggesting that hormonal and immunological factors may be involved in ALA physiopathology. The long lag time before developing ALA after returning to a non-endemic area must be highlighted to clinicians so that they will consider Entamoeba histolytica as a possible pathogen of liver abscesses more often.     

Imported Malaria in the United Kingdom

Over 2,000 cases of imported malaria have been confirmed by blood examination. Ninety percent. of cases from tropical Africa were infected with P. falciparum. Most of the patients were Caucasians and had primary infections. All developed fever within a month after arrival and most of them within two weeks of arrival. In some patients malaria parasites were seen in routine blood films.Developing forms of P. falciparum were always present in the peripheral blood of patients suffering from a primary attack which was not diagnosed or treated until a week or more after the onset of fever.All deaths investigated were caused by P. falciparum and were primary infections.In not one of the P. falciparum infections did the victim continue taking prophylactic drugs for more than a few days after leaving the endemic area. Had drugs been continued for one month probably not a single overt case of P. falciparum would have occurred.A primary attack of P. falciparum malaria is seldom, if ever, classical in that the fever is never tertian and may resemble clinically many other diseases.Children in boarding-schools returning from the tropics should be supplied with prophylactic tablets and instructions to the matron. If there is an epidemic of a fever any students who have recently returned from the tropics should have a blood film examined for malaria.The risk of contracting malaria among drug addicts is considerable, especially with P. falciparum.     

Imported and autochthonous kala-azar in France.

OBJECTIVE--To study the epidemiological, clinical, and biological features of imported and autochthonous kala-azar in France. DESIGN--Prospective survey of all patients in France with kala-azar diagnosed over the two years 1986-7. Information was obtained from parasitology laboratories in regional hospitals and all hospital laboratories and haematology departments capable of diagnosing leishmaniasis in the south of France. SETTING--107 public hospitals in France. PATIENTS--89 patients with kala-azar. INTERVENTIONS--All patients were treated with drugs. In the first instance meglumine antimonate was given to all but two patients. MAIN OUTCOME MEASURES--Prevalence of the various clinical and biological features of kala-azar; proportion of patients with HIV infection. RESULTS--Half (44) of the patients were children under 8 years old. Seventy patients acquired the disease in France. Imported kala-azar was acquired mainly in Mediterranean countries (9/18 cases). Only 46 (52%) of the patients had all three of the classic associated clinical features of fever, splenomegaly, and hepatomegaly. Anaemia was the commonest biological sign, and the association of the four usual biological signs--anaemia, leucopenia, thrombocytopenia, and hypergammaglobulinaemia--was present in only 14 (33%) of the children under 8 and 26 (60%) adults. Fourteen of the patients over 8 years old were infected with HIV. CONCLUSION--Doctors must be aware of kala-azar in Mediterranean areas, especially as patients often present without the characteristic features and the disease affects young children preferentially.     

Imported diseases: an assessment of trends

Increasing travel, migration and other forms of international exchange have given a new importance to imported diseases in Canada. This is reflected in the maintenance of an immigration medical screening program, the development of specialized clinics in major cities, increasing interest in tropical medicine and international health, and the designation of a national reference centre for parasitology.The introduction of a point system for immigration selection in 1967 gave rise to a burgeoning influx of people from developing countries that may have plateaued only within the past year. While tuberculosis is probably the single most important health problem in immigration, parasitic infections are of increasing concern. The popularity of overseas travel among Canadians is now also a major factor in the introduction of exotic diseases into Canada. Importation of disease by international trade is far less common than by travel and immigration.On a community health scale a system of monitoring trends of immigration to Canada and travel of Canadians to and from countries with a known risk would likely provide the best indicator of trends in disease importation. Thus, there was an increase of almost threefold (11.6% to 31.1%) between 1965 and 1975 in the proportion of immigration to Canada from countries with a malaria risk and a 2.78-fold increase between 1967 and 1974 in the overall amount of Canadian travel to such countries from which statistics were available.