Hepatitis B, C, and D and HIV infections among immigrants from Equatorial Guinea living in Spain

A total of 1,220 subjects from Equatorial Guinea living in Spain (median age = 41 years; 453 male and 767 female) was examined for antibodies to human immunodeficiency virus (HIV) and Hepatitis B (HBV), C (HCV), and D (HDV) viruses. Extracted RNA and DNA from the positive samples were used to quantify viral load. The prevalence of HIV antibodies, HCV RNA, and HBV surface antigen (HBsAg) was 10.8% (N = 132), 11.6% (N = 141), and 7.9% (N = 96), respectively. The most prevalent HIV variant was CRF02_AG (38.5%; N = 40). HCV genotype 4 (60%; N = 36) and HBV genotype A3 (32%; N = 8) were the hepatitis variants most frequently found. Superinfection with HDV was seen in 20.9% (N = 24) of HBsAg carriers. A control group of 276 immigrants from other sub-Saharan countries showed similar rates of HIV and HBsAg, although no HCV cases were found. Immigrants constitute a major source of HIV and hepatitis viruses in Spain; therefore, it is important that control measures are intensified.

[Cesarean section in a woman with acute blood-stage malaria]

Malaria infection during pregnancy is a serious health problem in most of the world's tropical regions. The disease has also been imported into Western countries, however, as an increasing number of infected women, who may become pregnant, emigrate from areas where malaria is endemic. Infection during pregnancy can have serious repercussions for both mother and fetus. Early diagnosis and multidisciplinary management are essential. We report the case of a woman from Guinea who debuted with severe, acute blood-stage malaria in the 32nd week of pregnancy and was admitted to the recovery care unit.

Usual diet in Bubis, a rural immigrant population of African origin in Madrid

OBJECTIVE

To assess the usual diet of an immigrant Bubis population living in Madrid, the main ethnic group from the Island of Bioco, Equatorial Guinea, and explore how different it is from the predominant diet in West Africa and from the adult population of Madrid.

DESIGN

Cross-sectional study. We randomly selected a sample of 213 Bubis aged 18-84 years, 83 men and 130 women, who were born in Bioco, emigrated and now live in the Madrid area. Participants were interviewed about their usual diet with the use of a food frequency questionnaire. Height and weight were also measured during interviews and prevalence of obesity was estimated as a body mass index (kg m(-2)).

SETTING

The urban area of Madrid in 2001.

RESULTS

The diet of the Bubis living in the metropolitan area of Madrid resembles more the urban diet observed among Spanish people than the traditional rural diet observed among people of West Africa. The percentage of calories from fat, protein and carbohydrates was 33.9, 18.3 and 47.7%, respectively. The Bubi diet presented a much higher protein intake and much lower fat intake than the usual diet in Cameroon. The usual Bubi diet also contained more protein and less fat and alcohol than the predominant diet of adult population living in the Madrid area. Women presented higher prevalence of obesity (23.2%) than men (11.0%), and even higher than that observed among Spanish women.

CONCLUSIONS

The first immigrant generation of Bubis in Madrid showed food and nutrient intakes closer to the prevalent diet in Madrid than to the diet of their native land. The impact of this westernization of the diet of this and other immigrant populations in Spain needs to be monitored in the future.

Strong association between HLA-Cw*0706 and HLA-B*44032 in the Bubi population from Equatorial Guinea

Unrelated Bubi, native to the island of Bioko (Equatorial Guinea), were previously typed by low-resolution polymerase chain reaction using sequence-specific primers (PCR-SSP) and serology for HLA-A, -B and -C. HLA-B*44 was found frequently and associated with Cw*07. We have studied the HLA subtypes of 20 B*44pos/Cw*07pos Bubi individuals. HLA-B and -C were typed by sequencing exons 2 and 3. To distinguish the alleles Cw*1701/02/03, Cw*07011/012/06 and Cw*1801/02 additional sequencing of exon 1 or 5 was performed. All 20 B*44pos/Cw*07pos individuals of the Bubi population were typed Cw*0706 positive. Nineteen of them carried the B*44032 allele and one B*4407. In addition, 19 B*44neg/ Cw*07pos Bubi individuals were typed for HLA-C and none of them proved Cw*0706 positive. To determine whether the association between Cw*0706 and B*44032 was limited to the Bubi, 19 individuals from Dutch Caucasian families were typed in which B44 and Cw7 segregated on one haplotype. None of these individuals showed the presence of B*44032 or Cw*0706. The haplotypes found in the Dutch Caucasians were B*4402-Cw*0704, B*44031-Cw*07011 and B*44031-Cw*0702. The present observation indicates a strong association between B*44032 and Cw*0706 in the Bubi population.

Sub-Saharan influence on the Canary Islands population deduced from G6PD gene sequence analysis

In a screening of glucose-6-phosphate dehydrogenase (G6PD) A variants in the Canary Islands and northwest African populations by electrophoresis and posterior gene sequencing, the common A+ 376G and A- 202A/376G and the rare A- 376G/968C mutations were found. In addition, three new silent C-->T transitions have been detected at nucleotides 759 (exon 7), 1338 (exon 11), and 1573 (exon 13). Canary Island and North African samples share sub-Saharan haplotypes with Equatorial Guineans. The slave trade seems the most probable origin of the African haplotypes found in the Canary Islands.

[The halofantrine treatment of Plasmodium falciparum malaria. Clinical experience]

The objective of this study was to evaluate the efficacy of halofantrine in the treatment of malaria caused by Plasmodium falciparum since the resistance of these plasmodium to chloroquine is increasing in countries of Western Africa.

MATERIAL AND METHOD

Between January 1991 and June 1994 we studied 50 children from Equatorial Guinea. All of them were black and between the ages of 8 months and 13 years. They were treated with 3 doses of halofantrine (8 mg/kg every 6 hours). The definitive diagnosis was made by the demonstration of the parasites on thick and thin blood smears, stained by standard methods, repeated every 24-72 yours after therapy. We considered the disappearance of fever and the clearance of plasmodium from the red blood cells as signs of response to the treatment. We also monitored the tolerance and the adverse side effects of the drug.

RESULTS

All of the patients responded favorably with the disappearance of the fever after 24 hours and after 72 hours no parasites were seen in red blood cells. Only one patient had a recurrence, which occurred on the 10th day. All patient satisfactorily tolerated the drug and only 3 children showed an increase of aminotransferases that was spontaneously cured.

CONCLUSIONS

We conclude that halofantrine is a safe and efficient drug for the treatment of children diagnosed with malaria caused by Plasmodium falciparum.

[Acute thoracic syndrome]

The acute chest syndrome is a clinical entity appearing in patients suffering from sickle cell anaemia. It presents with pleuritic pain, fever, leucocytosis and pulmonary infiltrates in the thoracic radiology. The etiological diagnosis is difficult, and it is necessary to distinguish between pneumonia and pulmonary infarction. This syndrome is quite frequent among the patients at risk, and can be lethal according to the severity and the etiology of the event. A case of acute chest syndrome due to a S. pneumoniae sepsis is presented. The interest of the case lies in the rareness of this disease in our population and the peculiar evolutive clinical features of this case, with the development of intracranial hypertension and death.

[Histamine liberation and specific IgE against Dermatophagoides pteronyssinus in parasitized patients]

We studied 98 patients with different parasitosis, without clinical symptoms of mite sensitization, most of them coming from Guinea. Histamine release to Dermatophagoides pteronyssinus was performed using whole blood. Specific IgE to the same antigen was measured by EAST, as well as by an immunodot with the same antigen extract employed for the histamine release test. Finally, the EAST positive sera were studied by immunoblotting. The presence of specific IgE by EAST could be proved in 31 patients, but these antibodies were nor detected by dot, blot and histamine release. On the other hand, only two patients showed a positive histamine release test to D. pteronyssinus and in these two cases the EAST to mites was negative. There was no relation between total IgE levels and specific IgE to mites. The presence of mite-specific IgE showed a significative association to the parasite Trichuris trichiura (odds ratio 3.09). This fact suggest that the specific IgE values found in this population can reflect some cross-reaction between parasites and allergens. It is the author's opinion that the same study should be performed in european patients in order to test the relationship between mite-specific antibodies and the presence of parasites, specially of Trichuris trichiura.

[Paragonimiasis and pulmonary tuberculosis]

Paragonimiasis (infestation by the Paragonimus species) in Spain is a very infrequent entity within the group of imported infectious diseases. A native, resident of Equatorial Guinea who was affected by pulmonary and probably extrapulmonary paragonimiasis together with active pulmonary tuberculosis is described. This association is relatively common and may complicate the diagnostic process. The identification of the parasite was established from samples of pulmonary secretion obtained by natural expulsion and by fiber bronchoscopy in which Kinyoun carbonfucsine dye, Giemsa dye and argentic impregnation were used. The possibility of neurological disease existing (medullar and cerebral) produced by the same parasite is also discussed. Antituberculous treatment and the use of praziquantel satisfactorily control both infections.