Disseminated infection due to Mycobacterium bovis after intravesical BCG instillation

Intravesical bacillus Calmette-Guerin(BCG) instillation has been adopted for the treatment of patients with superficial bladder cancer. Severe adverse events due to local instillation of BCG are uncommon, with an overall rate of serious complications of less than 5%. We report the case of an immunocompetent adult patient with multi-system effects, namely pneumonitis, granulomatous hepatitis and meningitis, who responded well to standard treatment for Mycobacterium bovis. This case highlights the importance of a thorough assessment of this type of patient.

<i>Angiostrongylus costaricensis</i>: Systematic Review of Case Reports

Introduction: Abdominal angiostrongyliasis is an infrequently diagnosed disease because it is little known and is usually well tolerated. Methods: We carried out a systematic review with PubMed as a search engine for the MedLine database, and we analysed the clinical, epidemiological and analytical parameters of this disease. Results: In total, reports of 27 case have been found, together with a series of 116 patients, which were later augmented up to 194 patients. In the results, we have observed a predominance of male patients, and Costa Rica, Brazil and the United States as the main countries of origin. Typical symptoms include abdominal pain on the right iliac fossa, with leukocytosis and eosinophilia. Discussion: There are some serological diagnostic methods, although lack of standardization leads to most of the diagnoses being reached via pathology. Surgery is the usual treatment approach. Although there are medical options, this is a controversial subject because of the low number of cases published in the literature, which implies an absence of solid studies.

Loiasis in sub-Saharan migrants living in Spain with emphasis of cases from Equatorial Guinea

Background:Loiasis is an uncommon and poorly understood parasitic disease outside endemic areas of Africa.The aim of this study was to describe the clinical and biological patterns and treatment of imported loiasis by sub-Saharan migrants diagnosed in Madrid,Spain.Methods:A retrospective study was conducted with sub-Saharan immigrants seen at the Tropical Medicine Unit of the Carlos III Hospital in Madrid,Spain,a reference center,over 19 years.Categorical variables were expressed as frequency counts and percentages.Continuous variables were expressed as the mean and standard deviation(SD)or median and interquartile range(IQR:Q3–Q1).Chi-square tests were used to assess the association between categorical variables.The measured outcomes were expressed as the odds ratio(OR)with a 95%confidential interval.Continuous variables were compared by Student’s t-tests or Mann-Whitney U tests.Binary logistic regression models were used.P<0.05 was considered a statistically significant difference.Results:One hundred thirty-one migrants from tropical and subtropical areas with loiasis were identified.Forty-nine patients were male(37.4%).The migrants’mean age(±SD)was 42.3±17.3 years,and 124(94.7%)were from Equatorial Guinea.The median time(IQR)between arrival in Spain and the first consultation was 2(1–7)months.One hundred fifteen migrants had eosinophilia,and one hundred thirteen had hyper-IgE syndrome.Fifty-seven patients had pruritus(43.5%),and thirty patients had Calabar swelling(22.9%).Seventy-three patients had coinfections with other filarial nematodes(54.2%),and 58 migrants had only Loa loa infections(45.8%).One hundred two patients(77.9%)were treated;45.1%(46/102)patients were treated with one drug,and 54.9%(56/102)patients were treated with combined therapy.Adverse reactions were described in 14(10.7%)migrants.Conclusions:Our patients presented early clinical manifestations and few atypical features.Thus,physicians should systematically consider loiasis in migrants with a typical presentation.However,considering that 72.5%of the patients had only positive microfilaremia without any symptoms,we suggest searching for microfilaremia in every migrant from endemic countries for loiasis presenting with eosinophilia.

Imported Mansonella perstans infection in Spain

Background Mansonella perstans infection can be considered one of the most neglected tropical infectious diseases.Very few studies have reported on the clinical picture caused by infection with this nematode.Therefore,our study was aimed to describe the clinical patterns and treatment of imported M.perstans infection by migrants from Africa.Methods The present study evaluated a large cohort of migrants who have been diagnosed,examined and treated for imported M.perstans infection at a Spanish reference center(Hospital Carlos III Tropical Medicine Unit,Madrid,Spain)over a 19-year period.Most patients voluntarily attend the emergency unit or are referred from primary care or general hospitals in Madrid.Chi-square test was used to compare the association between categorical variables.The continuous variables were compared by Student’s t-test or the Mann–Whitney test.The corresponding regression models were used for multivariate analysis.Results Five hundred three cases of migrants from tropical and subtropical areas with M.perstans infection were identified.Two hundred sixty-four patients were female(52.5%).The mean age(±SD)was 44.6±18.2 years(range:16–93 years).The mean time(±SD)between the arrival in Spain and the first consultation was 8.6±18.0 months.The major origin of the patients was Equatorial Guinea(97.6%).Regarding the clinical picture,257 patients were asymptomatic(54.7%)and 228 were symptomatic(45.3%);190 patients had pruritus(37.8%),50(9.9%)had arthralgia,18 patients had Calabar-like swelling(3.6%),and 15(3%)had abdominal pain.Four hundred forty-two(87.9%)migrants had hyper-IgE,and 340(67.6%)had eosinophilia.One hundred ninety-five patients had coinfections with other filarial nematodes(38.8%),and 308 migrants had only M.perstans infection(61.2%).Four hundred thirty-seven cases(86.9%)had been treated with anti-filarial drugs;292 cases were treated with one anti-filarial drug,and 145 cases were treated with combined anti-filarial therapy.Additionally,20(4%)cases received steroids and 38(7.6%)cases received antihistamines.Conclusions A long series of M.perstans infections is presented in sub-Saharan immigrants whose data indicate that it should be included in the differential diagnosis in patients with pruritus or analytical alterations such as eosinophilia or hyper-IgE presentation,and they also have a high number of coinfections with other microorganisms whose treatment needs to be protocolized.