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La tripanosomiasis americana o enfermedad de Chagas es una enfermedad infecciosa endémica en América Latina continental, causada por el protozoo Trypanosomacruzi. En las últimas décadas, debido a los movimientos poblacionales, se ha expandido más allá de las zonas endémicas, siendo España el país europeo con más inmigrantes latinoamericanos. Durante años puede permanecer asintomática, pero cuando se manifiesta clínicamente puede ser grave (miocardiopatía dilatada, megacolon, megaesófago). Así como, debido a su transmisión vertical, la detección en embarazadas es una alta prioridad. Se han elaborado guías de detección de Trypanosomacruzi en circunstancias específicas (bancos de sangre, maternidades, coinfección con VIH, trasplante de órganos); pero detectamos falta de información dirigida a los profesionales de atención primaria. Para facilitar la detección y manejo de esta enfermedad se consideró la necesidad de realizar este documento, redactado y consensuado por médicos de familia, pediatras de Atención Primaria y especialistas en Salud Internacional (AU)

Chagas disease is caused by the protozoan Trypanosoma cruzi. Although it is commonly transmitted by an insect vector in continental Latin-America, in recent decades, due migration, it has been diagnosed in other countries such as Spain, the European country with a largest immigrant population of Latin Americans. For a long time, the patient remains asymptomatic, but some years after this stage, the symptoms can be serious (dilated cardiomyopathy, megacolon, megaesophagus). In addition, detection in pregnant women has a high priority because of the route of vertical transmission. Several specific guidelines about Chagas disease have been developed (blood banks, maternal hospitals, HIV co-infection, organ transplant). But lack of information to primary care professionals has been detected. We consider this document written and agreed by family physicians, pediatricians and specialists in International Health will be useful (AU)

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OBJECTIVE: To find whether the prophylactic measures against malaria used by travellers to the WHO-defined endemic zones are adequate and what role the General Practitioner plays in their prescription. DESIGN: Descriptive study. SETTING: El Prat de Llobregat (Barcelona) airport and four Primary Care practices in Barcelona province. PARTICIPANTS: Susceptible travellers coming from zones with effective transmission of the disease. MEASUREMENTS AND RESULTS: 142 people satisfied the inclusion criteria, average age 32.8 and 52.1% women. 25.4% had visited type A transmission zones; 23.2%, type B; and 48.6%, type C. Trips which were not formally organised made up 61.3% of the total. 75.4% of travellers received health advice before leaving, but only 3.8% asked their G.P.. Indication of prophylactic measures was correct in 108 people (74.6%); there was under-dosage in 4 (2.8%) and incorrect medication in 32 (22.5%). 85.5% of travellers complied with prescribed amounts. 15.6% had pharmacological side-effects. CONCLUSIONS: At present, there is a hole in primary prophylaxis for malaria for travellers to the WHO's zone A. General Practitioners can and must prefer advice to the traveller on this question.

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OBJECTIVE: To find the frequency and seasonal variability of the infectious diseases detected over a year. DESIGN: Observational prospective study. SETTING: Primary care centre. PATIENTS: Simple multi-stage random sampling of the patients over 14 seen on demand at general medical clinics and the Casualty department between June 1991 and May 1992. MEASUREMENTS AND MAIN RESULTS: Out of 49,193 attendances during the study period, the attendance sample was 2,523, of which 474 (18.8%; CI: 17.3-20.3%) were for infectious conditions. Average age of these 474 was 39 (SD: 19.17); 55% were women. Frequency of respiratory infections was 64.1% (CI: 59.8-68.5%). The correlation coefficient between respiratory infections and the total number of infections was 0.94 (R2 = 0.89). The frequency of infections oscillated between 29% (CI: 23-35%) in February and 10% (CI: 5.8-14.5%) in May. CONCLUSIONS: Infectious conditions account for a considerable percentage of the total number of primary care attendances. There is a seasonal variation in infections, which is mainly due to respiratory infections.

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OBJECTIVE: To identify the antibiotic prescriptions and evaluate their suitability for the infectious conditions treated at a Primary Care Centre. DESIGN: A prospective observation study. SETTING: La Mina Primary Care Centre. Sant Adrià de Besòs (Barcelona). PATIENTS AND OTHER PARTICIPANTS: The on-demand visits of patients over 14 to the General Medicine and Emergency clinics between June 1991 and May 1992 provided the data through a simple multi-stage random sample. MEASUREMENTS AND MAIN RESULTS: On the basis of the clinical notes, these variables were recorded: age, gender, diagnosis, the antibiotic prescribed and its manner of administration. The indication and choice of treatment was assessed in line with previously established criteria, as well as whether the antibiotic was first-choice in Primary Care. Infections treated in hospital or by specialists, non-bacterial cutaneous infections and Conjunctivitis were excluded. Out of 2,523 people examined, 474 presented infectious conditions (18.8%); the most common of these were infections of the upper respiratory tract (46.4%) and acute Bronchitis (17.3%). An antibiotic was prescribed in 206 cases (43.3%). The most used antibiotics were: Amoxicillin (41.5%), Penicillin (19.0%), Cloxacillin (11.2%), Erythromycin (10.2%) and Pipemidic Acid (7.8%). They were orally taken in 89.4% of cases. 92.3% of the antibiotics were first-choice. Overall fitness of treatment was 86.3% (56.5% unnecessary and non-prescribed treatment; and 29.7% necessary and using the recommended antibiotic). The least suitable treatment was observed for cases of acute Bronchitis without any risk factors. CONCLUSIONS: Prescriptions are adjusted to the recommendations on antibiotic policy in Primary Care, although less suitable treatment was observed for acute Bronchitis. The importance of applying a methodology based on objective criteria, in order to make a qualitative analysis in studies on the use of medication, is highlighted.

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