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Valerio L.,Autonomous University of Barcelona | Roure S.,Autonomous University of Barcelona | Fernandez-Rivas G.,Autonomous University of Barcelona | Basile L.,Generalitat of Catalonia | And 4 more authors.
Transactions of the Royal Society of Tropical Medicine and Hygiene | Year: 2013

Background: The nematode Strongyloides stercoralis has a very particular autoinfection life-cycle which leads to chronic infections remaining undetected for decades. However, hyperinfection can occur in patients receiving immunotherapy resulting in high mortality rates. The main objective of this study was to assess the results of a 10-year multicenter surveillance program performed in an area with dense immigration in Barcelona, Spain. Methods: From January 2003 to December 2012, all individuals with Strongyloides stercoralis infection attending the four centers with diagnostic capability in the North Metropolitan area of Barcelona were recorded. Results: The annual detection rate was 0.2 new diagnosed cases x10 000 inhabitants/year and 1 case x10 000 immigrants/year. Many patients were immigrants (63; 90.0%), asymptomatic (45; 64.3%) and with a high eosinophil count (63; 90.0%). Immunosuppression was present in 11 (15.7%) patients, among whom two (2.8%) cases of disseminated hyperinfection were recorded. Ivermectin was prescribed in 45 (76.3%) and albendazole in 14 (23.7%). Following treatment seven patients (11.9%) receiving albendazole presented relapse, that is, albendazole failed to clear the parasite in 50% of these drug-treated patients (p < 0.001). Conclusions: During the study period, 90% of the cases of Strongyloides stercoralis diagnosed could be considered as imported by immigrants, most being asymptomatic and with eosinophilia. The infection is probably largely underestimated and population-based studies are needed to determine its true prevalence. Meanwhile, diagnosis must be based on active investigation of the helminth (serology and feces culture), especially in immunocompromised patients. The implementation of pre-immunosuppression protocols with the aim of identifying Strongyloides stercoralis is encouraged with empirical treatment with ivermectin being recommended in sites without diagnostic facilities. © Royal Society of Tropical Medicine and Hygiene 2013. All rights reserved.


Broner S.,CIBER ISCIII | Torner N.,CIBER ISCIII | Dominguez A.,CIBER ISCIII | Dominguez A.,University of Barcelona | And 2 more authors.
Food Control | Year: 2010

Reducing disparities in health is a significant health policy goal and so improving knowledge on differences in the distribution of health problems is needed. The aim of this study is to evaluate the relationship between the incidence of foodborne disease outbreaks (FBDO) and demographic-socioeconomic characteristics. Association between outbreak incidence rate (IR) and demographic and socioeconomic features such as age >65 and gender, income, higher education, unemployment, household tasks and mean household size were studied. A total of 181 FBDO (IR: 2.59 outbreaks per million inhabitants) were recorded in Catalonia, 43.6% in food-services and 42.5% in household. Unemployment, female, ≥65y, higher education and household tasks were associated to lower FBDO risk. Educational programmes addressed at the increasing number of elderly and less favoured populations could avoid incorrect practices that facilitate community cases of FBD and may contribute to reduce disparities in health. © 2009 Elsevier Ltd. All rights reserved.


Costi M.,Eli Lilly and Company | Dilla T.,Eli Lilly and Company | Reviriego J.,Eli Lilly and Company | Castell C.,Generalitat of Catalonia | Goday A.,Autonomous University of Barcelona
Acta Diabetologica | Year: 2010

Little information is available on the management of patients with type 2 diabetes mellitus (DM2) in regular clinical practice, prior to and at the point of initiating treatment with insulin. The INSTIGATE study provides a description of the clinical profile of the patient with DM2 who begins treatment with insulin in both primary and secondary care. A total of 224 patients who had been diagnosed with DM2, were not responding to oral treatment, and began receiving insulin were included in the INSTIGATE study in Spain. Demographic data were collected, as well as data on macro- and microvascular complications of diabetes and comorbidities, past medical history of diabetes and oral treatment administered, the clinical severity of diabetes (HbA1c concentration) and insulin treatment initiated. Mean age of the sample was 65.4 years and 56.7% were men. There were 87% of patients who had a diagnosis of at least one significant comorbidity, notably hypertension and hyperlipidemia. The patient profile for metabolic syndrome was met by 75.1% of the patients. There was a higher incidence of macrovascular complications (38.4%) than microvascular complications (16.1%). Prior to insulin initiation, the most recent mean HbA1c was 9.2%. The majority of patients had been treated in the last 12 months with sulfonylureas and/or metformin (69.6 and 57.6%). The most common treatment prior to insulinization was the co-administration of two oral antidiabetics (OADs) (37.5%). Patients with DM2 observed in the study presented with elevated mean HbA1c and body mass index levels, comorbidities and complications related to diabetes at the time of insulin initiation. Changes and adjustments in treatment from diagnosis of diabetes occur when HbA1c levels are far above those recommended by the IDF (International Diabetes Federation), a factor which could be contributing to the development of both macrovascular and microvascular complications in the patient profile described in the study. © 2009 The Author(s).


Dominguez A.,University of Barcelona | Dominguez A.,CIBER ISCIII | Izquierdo C.,Generalitat of Catalonia | Ruiz L.,Generalitat of Catalonia | And 5 more authors.
Clinical Microbiology and Infection | Year: 2013

The number of elderly patients in the community with immunosuppressive conditions has increased progressively over recent decades. We sought to determine the incidence, causative organisms and outcome of community-acquired pneumonia (CAP) occurring in immunocompromised older patients. We prospectively compared cases of CAP in immunocompromised and non-immunocompromised patients admitted to five public hospitals in three Spanish regions. Of 320 cases studied, 115 (36%) occurred in immunocompromised patients, including: solid or hematological malignancy (97), corticosteroids or other immunosuppressive drugs (44), solid organ or stem cell transplant (five), and other conditions (eight). The etiology was established in 44% of immunocompromised patients vs. 32% of non-immunocompromised patients (p0.03). Streptococcus pneumoniae was the most common causative organism in both groups (29% vs. 21%; p0.08), followed by Legionella pneumophila (3% vs. 6%; p0.01). Gram-negative bacilli were more frequent among immunocompromised patients (5% vs. 0.5%; p<0.01), particularly Pseudomonas aeruginosa (3% vs. 0%; p0.04). Nocardiosis was only observed in immunocompromised patients (two cases). Bacteremia occurred similarly in the two groups. No significant differences were found with respect to ICU admission (8%, in both groups) or the length of stay (12.5 vs. 10.4days). The early (<48h) (3.5 vs. 0.5%; p0.04) and overall case-fatality rates (12% vs. 3%; p<0.01) were higher in immunocompromised patients. In conclusion, a substantial number of older patients hospitalized for CAP are immunocompromised. Although relatively uncommon, CAP due to gram-negative bacilli, including P. aeruginosa, is more frequent among these patients. CAP occurring in immunocompromised patients causes significant morbidity and mortality. © 2012 The Authors. Clinical Microbiology and Infection © 2012 European Society of Clinical Microbiology and Infectious Diseases.


Arias C.,Epidemiological Surveillance Unit of the Central Region of Catalonia | Sala M.R.,Epidemiological Surveillance Unit of the Central Region of Catalonia | Dominguez A.,University of Barcelona | Dominguez A.,CIBER ISCIII | And 6 more authors.
Clinical Microbiology and Infection | Year: 2010

Noroviruses are the most frequent cause of acute gastroenteritis in the community. In Catalonia, it is not clear how this type of viral gastroenteritis is evolving, and the objective of this prospective population-based study was to describe the incidence and epidemiological and clinical features of outbreaks of acute gastroenteritis due to norovirus in Catalonia between October 2004 and October 2005. Incidence rates were calculated using the estimated population of Catalonia in 2005. For each outbreak, the mode of transmission, the number of persons affected, demographic variables, clinical presentation, the date and time of onset of symptoms and the duration of symptoms, physician visits and hospitalizations were collected. Sixty viral outbreaks affecting 1791 people were identified, with no distinct seasonality. The mean number of outbreaks per month was 4.6. The global incidence was 24.6 per 100 000 person-years. The incidence was higher in women (25.7 per 100 000 person-years) and in the 5-11 years (52.4 per 100 000 person-years) and ≥65 years (42.4 per 100 000 person-years) age groups. The prevalence of vomiting, abdominal pain and general malaise was higher in children and adolescents, whereas the prevalence of diarrhoea and myalgia was higher in adults. These results suggest that norovirus infection has an important public health impact in Catalonia and that prevention strategies should be designed and implemented. © 2009 The Authors. Journal Compilation © 2009 European Society of Clinical Microbiology and Infectious Diseases.

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