Factors associated with malaria and arboviral disease in patients with imported febrile syndrome: a retrospective cohort study. / Factores asociados con malaria y arboviriasis en pacientes con síndrome febril importado: estudio de cohortes retrospectivo.

OBJECTIVES: To identify predictors of malaria and arboviral disease in patients with febrile syndrome who seek care after traveling from tropical or subtropical locations. MATERIAL AND METHODS: Observational retrospective cohort study. We collected demographic, epidemiologic, and clinical data; laboratory findings; and the clinical and final microbiologic diagnoses. Multivariate analysis was used to calculate indices of diagnostic accuracy (sensitivity, specificity, and predictive values) and coefficients of probability of combinations of variables. RESULTS: Data for 291 patients with febrile syndrome were included; 108 had malaria (37.1%), 28 had an arboviral disease (9.6%), and 155 had other causes of fever (53.3%). Multivariate analysis showed patients most likely to have malaria were those from sub-Saharan Africa, adjusted odds ratio (aOR) of 45.85 (95% CI, 9.45-222.49); immigrants who returned to visit friends and relatives (VFR), aOR of 3.55 (95% CI, 1.21-10.46); or had platelet concentrations 150 000/mm3, aORa of 16.47 (95% CI, 5.46-49.70) or headache, aOR of 10.62 (95% CI, 3.20-35.28). The combination of these 4 variables gave a positive probability coefficient (PPC) of 23.72 (95% CI, 5.76-97.62). Patients with febrile syndrome most likely to have an arboviral disease were those from Central or South America, OR 5.07 (95% CI, 1.73-14.92), and those who had exanthems, OR 5.10 (95% CI, 1.72-17.02) or joint pain, OR 14.50 (95% CI, 3.05-68.80). The combination of these 3 variables gave a PPC of 20.66 (95% CI, 7.74-55.21). CONCLUSION: Patients with febrile syndrome with the greatest probability of having malaria are those from sub-Saharan Africa, those who are VFR, and those with platelet concentrations under 150.000/µL or headache. Arboviral disease was more likely in patients from Central and South America who had exanthems or joint pain.

OBJETIVO: Definir variables predictoras de malaria y arboviriasis en pacientes que consultan por síndrome febril tras la vuelta de un viaje a zonas tropicales/subtropicales. METODO: Estudio de cohortes retrospectivo. Se incluyeron variables demográficas, epidemiológicas, clínicas, analíticas y el diagnóstico final clínico y microbiológico. Se realizó un análisis multivariante y se calcularon los índices de exactitud diagnóstica (sensibilidad, especificidad, valores predictivos) y cocientes de probabilidad de la combinación de dichasvariables. RESULTADOS: Se incluyeron 291 pacientes con síndrome febril, 108 tenían malaria (37,1%), 28 arboviriasis (9,6%) y 155 otras causas de fiebre (53,3%). En el análisis multivariante, los pacientes con síndrome febril con más riesgo de padecer malaria fueron los que procedían de África subsahariana [odds ratio ajustado (ORa): 45,85; IC 95%: 9,45- 222,49], eran inmigrantes que visitan a familiares y amigos (VFA) (ORa = 3,55; IC 95%: 1,21-10,46), presentaban cifras de plaquetas 150.000/mm3 (ORa = 16,47; IC 95%: 5,46-49,70) o cefalea (ORa = 10,62; IC 95%: 3,20-35,28). La combinación de estas cuatro variables tiene un cociente de probabilidad positivo (CPP) de 23,72 (IC 95%: 5,76- 97,62). Los pacientes con síndrome febril que tienen más riesgo de padecer arboviriasis eran los que procedían de Centroamérica y Sudamérica (OR = 5,07; IC 95%: 1,73-14,92), presentaban exantema (OR = 5,10; IC 95%: 1,72- 17,02) o artromialgias (OR = 14,50; IC 95%: 3,05-68,80). La combinación de estas tres variables tiene un CPP de 20,66 (IC 95%: 7,74-55,21). CONCLUSIONES: Los pacientes con síndrome febril que tienen más riesgo de padecer malaria son los que procedían de África subsahariana, eran VFA, presentaban cifras de plaquetas 150.000/µl o cefalea, y tenían mayor riesgo de padecer arboviriasis si procedían de Centroamérica y Sudamérica, presentaban exantema o artromialgias.

[Association between inflammatory markers and microbial translocation in patients with human immunodeficiency virus infection taking antiretroviral treatment]. / Asociación entre marcadores inflamatorios y traslocación bacteriana en pacientes con infección por el virus de la inmunodeficiencia humana en tratamiento antirretroviral.

BACKGROUND AND OBJECTIVE: Inflammatory biomarkers are increased in patients with human immunodeficiency virus (HIV) infection. Antiretroviral treatment (ART) improves some parameters but do not normalize them. The aim of this study is to determine those factors (including microbial translocation) associated with higher inflammation in HIV treated patients. PATIENTS AND METHODS: Transversal observational study. INCLUSION CRITERIA: HIV patients receiving ART with an HIV viral load (VL)<400 copies/mL. Selection of patients: consecutively between November 2011 and January 2012. Main variable: plasma levels of interleukin 6 (IL-6) and tumour necrosis factor α (TNF-α). Main explanatory variable: microbial translocation markers (16S ribosomal DNA and sCD14). Patients with IL-6 or TNF-α levels above percentile 75 (group 1) were compared with the rest of patients (group 2). Odds ratio (OR) were determined. RESULTS: Eighty-one patients were included (73% male, median age 45 years, 48% stage C). Twenty-six percent had chronic hepatitis C. Median CD4 cell was 493/mm(3) and 30% had detectable HIV VL. 16S ribosomal DNA was detected in 21% of patients. Factors associated with the higher levels of inflammatory markers were 16S ribosomal DNA (OR 77, P<.0001), sCD14 levels (P<.0001) and history of cardiovascular disease (OR 15, P<.01). In multivariate analysis, associations remained for 16S ribosomal DNA (OR 62, P<.0001) and previous cardiovascular disease (OR 25, P<.01). CONCLUSIONS: In patients with HIV infection receiving treatment, the higher levels of inflammatory markers are associated with microbial translocation and past cardiovascular events.

[Expert recommendations for the diagnosis and treatment of chronic hepatitis C infection in the prison setting]. / Recomendaciones de expertos sobre el diagnóstico y tratamiento de la hepatitis C crónica en el medio penitenciario.

The prevalence of HCV infection in Spanish prisons is very high (38.5%). The characteristics of the infected patients, particularly the high rate of HIV coinfection, makes it very likely that the morbidity and mortality produced by serious liver disease secondary to this infection will increase considerably in the coming years. A group of Spanish experts with experience in patients who are inmates has been invited to establish a series of recommendations for the diagnosis and treatment of chronic hepatitis C infection in Spanish prisons.

[Expert recommendations for the diagnosis and treatment of chronic hepatitis C infection in the prison setting]. / Recomendaciones de expertos sobre el diagnóstico y tratamiento de la hepatitis C crónica en el medio penitenciario.

The prevalence of HCV infection in Spanish prisons is very high (38.5%). The characteristics of the infected patients, particularly the high rate of HIV coinfection, makes it very likely that the morbidity and mortality produced by serious liver disease secondary to this infection will increase considerably in the coming years. A group of Spanish experts with experience in patients who are inmates has been invited to establish a series of recommendations for the diagnosis and treatment of chronic hepatitis C infection in Spanish prisons.