R Igual Adell

Hospital Francesc De Borja De Gandia, Gandía, Valencia, Spain

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Publications (13)20.24 Total impact

  • Rafael Igual Adell · Victoria Domínguez Márquez
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    ABSTRACT: Strongyloides stercoralis is an intestinal nematode with a singular life cycle, capable of producing persistent parasitization for decades because of an autoinfestation process. In the last 15 years, more than a thousand autochthonous cases have been diagnosed at the Hospital Francesc de Borja, Gandía (Valencia), thus confirming the endemicity of the area served by this hospital. Acute and chronic strongyloidiasis usually cause asymptomatic or mild infestations, characterized by moderate gastrointestinal, cutaneous and respiratory disturbances. However, in cases of impaired host immunity, especially cell-related immunity, accelerated autoinfection can develop that can eventually lead to a “hyperinfection syndrome”, a serious and life-threatening complication. In our laboratory, direct etiologic diagnosis based on the agar plate culture method has achieved a diagnostic efficacy similar to that of the Baermann technique, considered as the gold standard diagnostic method. However, in the autochthonous population, serologic tests might be useful for screening patients with risk factors, since crossreactions with other parasites specific to our environment have not been observed. The drug of choice for strongyloidosis is ivermectin, but because this drug is not always available, albenzole is frequently used as an alternative. We strongly recommend that all individuals from endemic areas or with epidemiological risk for strongyloidiasis be carefully screened before initiating any immunosuppressive therapy.
    Enfermedades Infecciosas y Microbiología Clínica 10/2007; 25:38-44. DOI:10.1157/13111836 · 1.88 Impact Factor
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    ABSTRACT: This study describes the epidemiological characteristics of all cases of strongyloidiasis diagnosed in the period 1995-1999 (both years included) in Area 11 of the Valencian Community (Spain) and their possible correlation to certain geographical and environmental conditions. This is a retrospective, descriptive study. Information was collected using a telephone survey. A total of 473 cases of strongyloidiasis were diagnosed. Of the total patients, 282 (60%) answered to the survey. There were 342 males (72%) and 131 females (28%). Ninety-four percent of the patients were in the 51-91 years age interval. Only three patients had been born abroad, while 15 had been on brief holidays to countries where the disease is endemic. The largest concentration of cases was found in zones 1 (0.49%) and 6 (0.9%), both having similar geomorphic characteristics. The professional activity of patients was recorded in 215 cases. The most frequent occupation was agriculture, with 124 cases (58%). Risk activities were recorded in 184 cases, the growing of rice in 145 patients (79%) being the most important. Strongyloides stercoralis infestation is endemic and possibly related to agricultural activities performed in previous years, and to the geographical characteristics of some parts of the area.
    Journal of Infection 09/2004; 49(2):152-8. DOI:10.1016/j.jinf.2004.01.016 · 4.02 Impact Factor
  • Revista Clínica Española 12/2003; 203(11):563-563. DOI:10.1157/13052594 · 1.31 Impact Factor
  • Revista Clínica Española 12/2003; 203(11):563; author reply 564-5. · 1.31 Impact Factor
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    ABSTRACT: In the last few years, Strongyloides stercoralis has been repeatedly recovered from indigenous farmers in the Safor area (Valencia Community). The relationship between the different occupational activities, mainly farming, and the presence of strongyloidiasis was investigated. A paired case-control study was designed. The investigation was conducted at Oliva Centro de Salud, from October 1997 to October 1999. Diagnosis was established when Strongyloides stercoralis was observed in any of the three serial fecal samples requested when eosinophilia was observed in the hemogram. Controls were persons matched by sex and age (+/- 5) years, with no eosinophilia in the hemogram and in whom the presence of the parasite was excluded in fecal samples. Participants in the study were 47 cases and their respective controls. Each group included 39 (83%) men and 8 (17%) women. Forty-five cases (95%) and 42 controls (89%) had been born in Safor. Only two cases had travelled to endemic areas. Farming was the main activity in 32 (68%) cases and 31 (66%) controls. The only occupational activity which showed influence on strongyloidiasis was working in ricefields, with an OR of 2.97 (95% CI: 1.16-7.71). Dermatologic symptoms were significant for pruritus, OR 7.39 (95% CI: 2.29-27.60). One case with hyperinfection and another with larva currens were diagnosed. In our area, working in ricefields and chronic pruritus are associated with chronic strongylodiasis.
    Revista Clínica Española 03/2001; 201(2):81-4. · 1.31 Impact Factor
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    ABSTRACT: Background In the last few years, Strongyloides stercoralis has been repeatedly recovered from indigenous farmers in the Safor area (Valencia Community). The relationship between the different occupational activities, mainly farming, and the presence of strongyloidiasis was investigated. Patients and Methods A paired case-control study was designed. The investigation was conducted at Oliva Centro de Salud, from October 1997 to October 1999. Diagnosis was established when Strongyloides stercoralis was observed in any of the three serial fecal samples requested when eosinophilia was observed in the hemogram. Controls were persons matched by sex and age (± 5) years, with no eosinophilia in the hemogram and in whom the presence of the parasite was excluded in fecal samples. Results Participants in the study were 47 cases and their respective controls. Each group included 39 (83%) men and 8 (17%) women. Forty-five cases (95%) and 42 controls (89%) had been born in Safor. Only two cases had travelled to endemic areas. Farming was the main activitiy in 32 (68%) cases and 31 (66%) controls. The only occupational activity which showed influence on strongyloidiasis was working in ricefields, with an OR of 2.97 (95% CI: 1.16-7.71). Dermatologic symptoms were significant for pruritus, OR 7.39 (95% CI: 2.29-27.60). One case with hyperinfection and another with larva currens were diagnosed. Conclusion In our area, working in ricefields and chronic pruritus are associated with chronic strongylodiasis.
    Revista Clínica Española 01/2001; 201(2):81–84. DOI:10.1016/S0014-2565(01)70755-2 · 1.31 Impact Factor
  • Revista Clínica Española 07/2000; 200(6):341-3. · 1.31 Impact Factor
  • Revista Clínica Española 01/2000; 200(6):341-343. DOI:10.1016/S0014-2565(00)70653-9 · 1.31 Impact Factor
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    ABSTRACT: To study the characteristics of the Strongyloides stercoralis infestation in our area. A 30-case series. Survey of workplace behaviour and hygienic conditions in the home. Review of clinical histories to check for factors putting subjects at risk of severe self-infection. 21,000 inhabitants covered by the Oliva Health Centre. All the cases diagnosed between January 1994 and June 1997. The diagnosis was carried out by observing under the microscope both fresh Strongyloides stercoralis larvae and cultures of three serial faecal samples. We found 19 men (63.3%) and 11 women (36.7%), with an average age of 65 (SD, 11.5 years). 28 had been born in the area (93.4%). 15 had never travelled abroad (50%). Of the 19 men, 18 (94%) had done agricultural work barefoot, but none of the women. Clinically, 17 (56.6%) had chronic symptoms; cough was the most common, in 12 (40%). Incidence in our area of Strongyloidiasis, although diagnosed infrequently, has increased considerably with the systematic discarding of the infection in non-attributable cases of Eosinophilia.
    Atención Primaria 04/1998; 21(5):271-4. · 0.89 Impact Factor
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    ABSTRACT: Objective To determine as accurately as possible the incidence of pulmonary tuberculosis within Health Area 15 of the Community of Valencia during the period 1990-1993, using the capture-recapture method. Method Descriptive study on the popularion of Health Area 15 (population: -139.903) divided into 4 large groups according to age (0-14, 15-34, 34-54 and 55+). Data was obtained from the statutory notification system of infectious disease (SNSID) and from the registry of the said area's Hospital Microbiology Service. The main variable under study was the number of cases of pulmonary tuberculosis, both as notified under the SNSID and in terms of cases in the microbiology register in which M. tuberculosis was isolated. The incidence rates were calculated by age and year of study for both registries employing the capture-recapture method. Results The mean annual incidence obtained for the SNSID register during the study period was 15.85 cases × 10-5, and for the microbiology registry it was 23.29 × 10-5. When the capture-recapture method was employed the mean annual incidence for the study period was 34.81 × 10-5 (Cl 95%: 31.82 -39.92). In each of the years studied the number of cases identified was greater for the microbiology register than for the SNSID. Around half the cases of tuberculosis are below 34 years of age, with the larger section, and that having the highest incidence of tuberculosis being the 15 to 34 years age-group. There is no apparent upward trend in incidence rates calculated for this period. Conclusions The data from the SNSID system on incidence of pulmonary tuberculosis within Health Area 15 of the Community of Valencia tends to underestimate the true incidence rate. The factual resources of the Hospital Microbiology Service are underutilised, considering the quantity and quality of information it can provide. The capture-recapture method is a good choice of method for measuring tuberculosis incidence. This method merits greater use within the field of epidemiology as much in order to assess the representativeness and thoroughness of surveillance systems as to identify inadequacies in their reporting and localisation of disease outbreaks.
    Gaceta Sanitaria 12/1997; 11(3):115–121. DOI:10.1016/S0213-9111(97)71286-X · 1.25 Impact Factor
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    ABSTRACT: Strongyloides stercoralis infection was hardly seen in Spain until a few years ago but has recently been shown to be fairly common in some geographic areas. In the respiratory tract this germ can cause acute bronchospasms that make diagnosis difficult, particularly in patients with underlying bronchial disease. To determine if curing S. stercoralis infection is accompanied by clinical and functional improvement in patients with bronchial obstruction, we studied the evolution of 22 infected patients: 11 with no bronchopulmonary disease and 11 with chronic airway obstruction or asthma. The following variables were assessed in both groups at the moment of diagnosis of infection and four months after cure: levels of eosinophils and total serum IgE, respiratory symptoms, steroid doses and spirometric parameters. After four months we observed a significant decrease in eosinophil (16 versus 5%) and IgE (1,600 versus 770 IU/ml) levels in both groups. The number of bronchospasms and daily steroid doses required decreased in the group with bronchial disease. No significant differences were seen in spirometric parameters, however. The improvement in respiratory symptoms, blood parameters and need for medication leads us to believe that airway inflammation decreases after the infection has been eradicated, in spite of the lack of improvement in bronchial obstruction.
    Archivos de Bronconeumología 10/1997; 33(8):384-8. · 1.82 Impact Factor
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    ABSTRACT: Strongyloides stercoralis is an endemic nematode in tropical and subtropical regions, but almost unknown in Spain. In order to know some epidemiological, clinical and analytic features of this infection in our area (La Safor, Valencia), we performed a prospective study for 19 months. Through the search for the parasite in feces of patients with eosinophilia, we identified 37 subjects who were studied at diagnosis and 4 months later. Thirty-three patients (89%) were currently, or had been agricultural workers, and thirty had worked barefooted and/or had drunk contaminated irrigation water. Twenty-three patients (62%) had a chronic or immunosuppressive diseases, and two of them on steroid treatment, developed a disseminated strongyloidiasis. Thirteen patients (35%) were asymptomatic; the rest had clinical manifestations attributed S. stercoralis, mainly digestive. Two of the patients with disseminated strongyloidiasis also had concomitant bacterial infections by Streptococcus bovis, Streptococcus faecalis and Enterobacter sp. At diagnosis, besides eosinophilia, 86.5% had raised levels of IgE. Four months later treatment, the number of eosinophils was normal and IgE levels significantly decreased. The diagnostic yield of parasitic study of feces was increased with the number of samples examined. Thiabendazole achieved erradication of the parasite in 35 patients, and the other two died because of disseminated strongyloidiasis. The presence of eosinophilia in patients from rural areas with subtropical climate should raise suspicion about infection by S. stercoralis, which, although sometimes is asymptomatic, may cause systemic bacterial infections in cases of hyperinfestation, specially when glucocorticoid treatment is given.
    Medicina Clínica 08/1997; 109(6):212-5. · 1.25 Impact Factor
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    ABSTRACT: To determine as accurately as possible the incidence of pulmonary tuberculosis within Health Area 15 of the Community of Valencia during the period 1990-1993, using the capture-recapture method. Descriptive study on the population of Health Area 15 (population: -139.903) divided into 4 large groups according to age (0-14, 15-34, 34-54 and 55+). Data was obtained from the statutory notification system of infectious disease (SNSID) and from the registry of the said area's Hospital Microbiology SERVICE: The main variable under study was the number of cases of pulmonary tuberculosis, both as notified under the SNSID and in terms of cases in the microbiology register in which M. tuberculosis was isolated. The incidence-rates were calculated by age and year of study for both registries employing the capture-recapture method. The mean annual incidence obtained for the SNSID register during the study period was 15.85 cases x 10(-5), and for the microbiology registry it was 23.29 x 10(-5). When the capture-recapture method was employed the mean annual incidence for the study period was 34.81 x 10(-5) (CI 95%: 31.82-39.92). In each of the years studied the number of cases identified was greater for the microbiology register than for the SNSID. Around half the cases of tuberculosis are below 34 years of age, with the larger section, and that having the highest incidence of tuberculosis being the 15 to 34 years age-group. There is no apparent upward trend in incidence rates calculated for this period. The data from the SNSID system on incidence of pulmonary tuberculosis within Health Area 15 of the Community of Valencia tends to underestimate the true incidence rate. The factual resources of the Hospital Microbiology Service are underutilized, considering the quantity and quality of information it can provide. The capture-recapture method is a good choice of method for measuring tuberculosis incidence. This method merits greater use within the field of epidemiology as much in order to assess the representativeness and thoroughness of surveillance systems as to identify inadequacies in their reporting and localisation of disease outbreaks.
    Gaceta Sanitaria 01/1997; 11(3):115-21. · 1.25 Impact Factor