RESUMEN
The purpose of this guideline is to provide evidence-based guidance for the most effective strategies for the diagnosis and management of babesiosis. The diagnosis and treatment of co-infection with babesiosis and Lyme disease will be addressed in a separate Infectious Diseases Society of America (IDSA), American Academy of Neurology (AAN), and American College of Rheumatology (ACR) guideline [1]. Recommendations for the diagnosis and treatment of human granulocytic anaplasmosis can be found in the recent rickettsial disease guideline developed by the Centers for Disease Control and Prevention [2]. The target audience for the babesiosis guideline includes primary care physicians and specialists caring for this condition, such as infectious diseases specialists, emergency physicians, intensivists, internists, pediatricians, hematologists, and transfusion medicine specialists.
Asunto(s)
Babesiosis , Enfermedades Transmisibles , Enfermedad de Lyme , Animales , Babesiosis/diagnóstico , Babesiosis/terapia , Humanos , Sociedades , Estados UnidosRESUMEN
The purpose of this guideline is to provide evidence-based guidance for the most effective strategies for the diagnosis and management of babesiosis. The diagnosis and treatment of co-infection with babesiosis and Lyme disease will be addressed in a separate Infectious Diseases Society of America (IDSA), American Academy of Neurology (AAN), and American College of Rheumatology (ACR) guideline [1]. Recommendations for the diagnosis and treatment of human granulocytic anaplasmosis can be found in the recent rickettsial disease guideline developed by the Centers for Disease Control and Prevention [2]. The target audience for the babesiosis guideline includes primary care physicians and specialists caring for this condition, such as infectious diseases specialists, emergency physicians, intensivists, internists, pediatricians, hematologists, and transfusion medicine specialists.
Asunto(s)
Babesiosis , Enfermedades Transmisibles , Enfermedad de Lyme , Animales , Babesiosis/diagnóstico , Babesiosis/terapia , Humanos , Sociedades , Estados UnidosRESUMEN
This evidence-based clinical practice guideline for the prevention, diagnosis, and treatment of Lyme disease was developed by a multidisciplinary panel representing the Infectious Diseases Society of America (IDSA), the American Academy of Neurology (AAN), and the American College of Rheumatology (ACR). The scope of this guideline includes prevention of Lyme disease, and the diagnosis and treatment of Lyme disease presenting as erythema migrans, Lyme disease complicated by neurologic, cardiac, and rheumatologic manifestations, Eurasian manifestations of Lyme disease, and Lyme disease complicated by coinfection with other tick-borne pathogens. This guideline does not include comprehensive recommendations for babesiosis and tick-borne rickettsial infections, which are published in separate guidelines. The target audience for this guideline includes primary care physicians and specialists caring for this condition such as infectious diseases specialists, emergency physicians, internists, pediatricians, family physicians, neurologists, rheumatologists, cardiologists and dermatologists in North America.
Asunto(s)
Enfermedades Transmisibles , Enfermedad de Lyme , Neurología , Reumatología , Animales , Humanos , Enfermedad de Lyme/diagnóstico , Enfermedad de Lyme/tratamiento farmacológico , Enfermedad de Lyme/prevención & control , América del Norte , Estados UnidosRESUMEN
This evidence-based clinical practice guideline for the prevention, diagnosis, and treatment of Lyme disease was developed by a multidisciplinary panel representing the Infectious Diseases Society of America (IDSA), the American Academy of Neurology (AAN), and the American College of Rheumatology (ACR). The scope of this guideline includes prevention of Lyme disease, and the diagnosis and treatment of Lyme disease presenting as erythema migrans, Lyme disease complicated by neurologic, cardiac, and rheumatologic manifestations, Eurasian manifestations of Lyme disease, and Lyme disease complicated by coinfection with other tick-borne pathogens. This guideline does not include comprehensive recommendations for babesiosis and tick-borne rickettsial infections, which are published in separate guidelines. The target audience for this guideline includes primary care physicians and specialists caring for this condition such as infectious diseases specialists, emergency physicians, internists, pediatricians, family physicians, neurologists, rheumatologists, cardiologists and dermatologists in North America.
Asunto(s)
Enfermedades Transmisibles , Enfermedad de Lyme , Neurología , Reumatología , Animales , Humanos , Enfermedad de Lyme/diagnóstico , Enfermedad de Lyme/tratamiento farmacológico , Enfermedad de Lyme/prevención & control , América del Norte , Estados UnidosRESUMEN
Eosinophilic esophagitis (EoE) is a chronic inflammatory condition of the esophagus. Many new studies have been reported recently that describe EoE management. An expert panel was convened by the American Gastroenterological Association Institute and the Joint Task Force on Allergy-Immunology Practice Parameters to provide a technical review to be used as the basis for an updated clinical guideline. This technical review was developed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework. Eighteen focused EoE management questions were considered, with 15 answered using the GRADE framework and 3 with a narrative summary. There is moderate certainty in the evidence that topical glucocorticosteroids effectively reduce esophageal eosinophil counts to <15 per high-power field over a short-term treatment period of 4-12 weeks, but very low certainty about the effects of using topical glucocorticosteroids as maintenance therapy. Multiple dietary strategies may be effective in reducing esophageal eosinophil counts to <15 per high-power field over a short-term treatment period, with moderate certainty for elemental diets, low certainty for empiric 2-, 4-, and 6-food elimination diets, and very low certainty that allergy-based testing dietary eliminations have a higher failure rate compared to empiric diet elimination. There is very low certainty for the effect of proton pump inhibitors in patients with esophageal eosinophilia. Although esophageal dilation appears to be relatively safe, there is no evidence that it reduces esophageal eosinophil counts. There is very low certainty in the effects of multiple other medical treatments for EoE: anti-interleukin-5 therapy, anti-interleukin-13 therapy, anti-IgE therapy, montelukast, cromolyn, and anti-TNF therapy.
Asunto(s)
Esofagitis Eosinofílica/terapia , Medicina Basada en la Evidencia/normas , Hipersensibilidad a los Alimentos/diagnóstico , Administración Tópica , Adulto , Comités Consultivos/normas , Factores de Edad , Alergia e Inmunología/organización & administración , Alergia e Inmunología/normas , Niño , Dilatación/efectos adversos , Dilatación/normas , Esofagitis Eosinofílica/diagnóstico , Esofagitis Eosinofílica/inmunología , Eosinófilos/efectos de los fármacos , Eosinófilos/inmunología , Esofagoscopía/efectos adversos , Esofagoscopía/normas , Medicina Basada en la Evidencia/métodos , Hipersensibilidad a los Alimentos/complicaciones , Hipersensibilidad a los Alimentos/dietoterapia , Hipersensibilidad a los Alimentos/inmunología , Alimentos Formulados , Gastroenterología/métodos , Gastroenterología/organización & administración , Gastroenterología/normas , Glucocorticoides/administración & dosificación , Humanos , Inhibidores de la Bomba de Protones/uso terapéutico , Sociedades Médicas/organización & administración , Sociedades Médicas/normas , Resultado del Tratamiento , Estados UnidosRESUMEN
Eosinophilic esophagitis (EoE) is a chronic inflammatory condition of the esophagus. Many new studies have been reported recently that describe EoE management. An expert panel was convened by the American Gastroenterological Association Institute and the Joint Task Force on Allergy-Immunology Practice Parameters to provide a technical review to be used as the basis for an updated clinical guideline. This technical review was developed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework. Eighteen focused EoE management questions were considered, with 15 answered using the GRADE framework and 3 with a narrative summary. There is moderate certainty in the evidence that topical glucocorticosteroids effectively reduce esophageal eosinophil counts to <15 per high-power field over a short-term treatment period of 4-12 weeks, but very low certainty about the effects of using topical glucocorticosteroids as maintenance therapy. Multiple dietary strategies may be effective in reducing esophageal eosinophil counts to <15 per high-power field over a short-term treatment period, with moderate certainty for elemental diets, low certainty for empiric 2-, 4-, and 6-food elimination diets, and very low certainty that allergy-based testing dietary eliminations have a higher failure rate compared to empiric diet elimination. There is very low certainty for the effect of proton pump inhibitors in patients with esophageal eosinophilia. Although esophageal dilation appears to be relatively safe, there is no evidence that it reduces esophageal eosinophil counts. There is very low certainty in the effects of multiple other medical treatments for EoE: anti-interleukin-5 therapy, anti-interleukin-13 therapy, anti-IgE therapy, montelukast, cromolyn, and anti-TNF therapy.
Asunto(s)
Dieta , Esofagitis Eosinofílica/terapia , Glucocorticoides/uso terapéutico , Inmunoterapia/métodos , Comités Consultivos , Alérgenos/inmunología , Alergia e Inmunología , Esofagitis Eosinofílica/epidemiología , Testimonio de Experto , Humanos , Comunicación Interdisciplinaria , Guías de Práctica Clínica como Asunto , Inhibidores de la Bomba de Protones/uso terapéuticoRESUMEN
BACKGROUND & AIMS: We performed a systematic review and meta-analysis to estimate the decrease in liver stiffness, measured by vibration-controlled transient elastrography (VCTE), in patients with hepatitis C virus infection who achieved a sustained virologic response (SVR). METHODS: We searched the literature through October 2016 for observational studies or randomized controlled trials of adults with hepatitis C virus infection who received antiviral therapy (either direct-acting antiviral agents or interferon-based therapies), underwent liver stiffness measurement using VCTE before starting therapy, and had at least 1 follow-up VCTE after completion of therapy; studies also provided data on mean or median liver stiffness measurements for patients who did and did not achieve an SVR. We identified 24 studies, and estimated weighted mean difference (and 95% confidence interval) in liver stiffness in patients with versus without SVR using random-effects meta-analysis. RESULTS: In patients who achieved SVR, liver stiffness decreased by 2.4 kPa at the end of therapy (95% CI, -1.7 to -3.0), by 3.1 kPa 1-6 months after therapy (95% CI, -1.6 to -4.7), by 3.2 kPa 6-12 months after therapy (90% CI, -2.6 to -3.9), and 4.1 kPa 12 months or more after therapy (95% CI, -3.3 to -4.9) (median decrease, 28.2%; interquartile range, 21.8-34.8). In contrast, there was no significant change in liver stiffness in patients who did not achieve an SVR (at 6-12 months after therapy, decrease of 0.6 kPa; 95% CI, -1.7 to 0.5). Decreases in liver stiffness were significantly greater in patients treated with direct-acting antiviral agents than with interferon-based therapy (decrease of 4.5 kPa vs decrease of 2.6 kPa; P = .03), cirrhosis at baseline (decrease of 5.1 kPa vs decrease of 2.8 kPa in patients with no cirrhosis; P = .02), or high pretreatment levels of alanine aminotransferase (P < .01). Among patients with baseline liver stiffness >9.5 kPa, 47% (95% CI, 27%-68%) achieved posttreatment liver stiffness of <9.5 kPa. CONCLUSIONS: In a systematic review and meta-analysis, we associated eradication of hepatitis C virus infection (SVR) with significant decreases in liver stiffness, particularly in patients with high baseline level of inflammation or patients who received direct-acting antiviral agents. Almost half the patients considered to have advanced fibrosis, based on VCTE, before therapy achieved posttreatment liver stiffness levels <9.5 kPa. Clinical Trial Registration no: CRD42016051034.
Asunto(s)
Antivirales/administración & dosificación , Hepatitis C Crónica/tratamiento farmacológico , Hepatitis C Crónica/patología , Hígado/patología , Diagnóstico por Imagen de Elasticidad , Hepatitis C Crónica/diagnóstico por imagen , Humanos , Hígado/diagnóstico por imagen , Respuesta Virológica Sostenida , Factores de Tiempo , Resultado del TratamientoRESUMEN
Chronic liver diseases (CLDs), due to chronic hepatitis C; hepatitis B; nonalcoholic fatty liver diseases (NAFLD); and alcoholic liver disease, are a leading cause of morbidity and mortality globally. Early identification of patients with cirrhosis at high risk of progression to liver-related complications may facilitate timely care and improve outcomes. With risks and misclassification associated with invasive tests, such as liver biopsy, noninvasive imaging modalities for liver fibrosis assessment have gained popularity. Therefore, the American Gastroenterological Association prioritized clinical guidelines on the role of elastography in CLDs, focusing on vibration-controlled transient elastography (VCTE) and magnetic resonance elastography (MRE). To inform these clinical guidelines, the current technical review was developed in accordance with the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework for diagnostic accuracy studies. This technical review addresses focused questions related to: (1) comparative diagnostic performance of VCTE and MRE relative to nonproprietary, serum-based fibrosis markers for detection of cirrhosis in patients with hepatitis C virus (HCV), hepatitis B virus (HBV), NAFLD, and alcoholic liver diseases; (2) performance of specific VCTE-defined liver stiffness cutoffs as a test replacement strategy (to replace liver biopsy) in making key decisions in the management of patients with CLDs; and (3) performance of specific VCTE-defined liver stiffness cutoffs as a triage test to identify patients with low likelihood of harboring high-risk esophageal varices (EVs) or having clinically significant portal hypertension (for presurgical risk stratification). This technical review does not address performance of other noninvasive modalities for assessing fibrosis (eg, acoustic radiation force pulse imaging or shear wave elastography) or steatosis (controlled attenuation parameter or magnetic resonance imaging-estimated proton density fat fraction).
Asunto(s)
Diagnóstico por Imagen de Elasticidad/métodos , Elasticidad , Cirrosis Hepática/diagnóstico por imagen , Cirrosis Hepática/patología , Biopsia , Toma de Decisiones Clínicas , Várices Esofágicas y Gástricas/etiología , Medicina Basada en la Evidencia , Hepatitis B Crónica/complicaciones , Hepatitis C Crónica/complicaciones , Humanos , Hígado/patología , Cirrosis Hepática/sangre , Cirrosis Hepática/etiología , Hepatopatías Alcohólicas/complicaciones , Enfermedad del Hígado Graso no Alcohólico/complicaciones , Medición de RiesgoAsunto(s)
Anticoagulantes/uso terapéutico , Trastornos de la Coagulación Sanguínea/tratamiento farmacológico , Coagulación Sanguínea/efectos de los fármacos , Gastroenterología/normas , Cirrosis Hepática/tratamiento farmacológico , Anticoagulantes/efectos adversos , Trastornos de la Coagulación Sanguínea/sangre , Trastornos de la Coagulación Sanguínea/diagnóstico , Pruebas de Coagulación Sanguínea , Consenso , Medicina Basada en la Evidencia , Hemorragia/inducido químicamente , Humanos , Cirrosis Hepática/sangre , Cirrosis Hepática/diagnóstico , Seguridad del Paciente , Valor Predictivo de las Pruebas , Medición de Riesgo , Factores de Riesgo , Resultado del TratamientoRESUMEN
Evidence-based guidelines for implementation and measurement of antibiotic stewardship interventions in inpatient populations including long-term care were prepared by a multidisciplinary expert panel of the Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America. The panel included clinicians and investigators representing internal medicine, emergency medicine, microbiology, critical care, surgery, epidemiology, pharmacy, and adult and pediatric infectious diseases specialties. These recommendations address the best approaches for antibiotic stewardship programs to influence the optimal use of antibiotics.
Asunto(s)
Antiinfecciosos , Revisión de la Utilización de Medicamentos , Control de Medicamentos y Narcóticos , Antiinfecciosos/administración & dosificación , Antiinfecciosos/uso terapéutico , Epidemiología/organización & administración , Humanos , Infectología/organización & administración , Evaluación de Programas y Proyectos de Salud , Estados UnidosRESUMEN
Evidence-based guidelines for implementation and measurement of antibiotic stewardship interventions in inpatient populations including long-term care were prepared by a multidisciplinary expert panel of the Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America. The panel included clinicians and investigators representing internal medicine, emergency medicine, microbiology, critical care, surgery, epidemiology, pharmacy, and adult and pediatric infectious diseases specialties. These recommendations address the best approaches for antibiotic stewardship programs to influence the optimal use of antibiotics.
Asunto(s)
Antiinfecciosos , Revisión de la Utilización de Medicamentos , Control de Medicamentos y Narcóticos , Antiinfecciosos/administración & dosificación , Antiinfecciosos/uso terapéutico , Epidemiología/organización & administración , Humanos , Infectología/organización & administración , Estados UnidosAsunto(s)
Alergia e Inmunología/normas , Esofagitis Eosinofílica/terapia , Gastroenterología/normas , Comités Consultivos/normas , Alergia e Inmunología/organización & administración , Esofagitis Eosinofílica/inmunología , Gastroenterología/métodos , Gastroenterología/organización & administración , Humanos , Sociedades Médicas/organización & administración , Sociedades Médicas/normas , Estados UnidosAsunto(s)
Corticoesteroides/uso terapéutico , Alergia e Inmunología , Esofagitis Eosinofílica/tratamiento farmacológico , Inhibidores de la Bomba de Protones/uso terapéutico , Administración Tópica , Comités Consultivos , Progresión de la Enfermedad , Esofagitis Eosinofílica/diagnóstico , Testimonio de Experto , Humanos , Fenotipo , Guías de Práctica Clínica como Asunto , Estados UnidosAsunto(s)
Diagnóstico por Imagen de Elasticidad/normas , Gastroenterología/normas , Cirrosis Hepática/diagnóstico por imagen , Sociedades Médicas/normas , Consenso , Medicina Basada en la Evidencia/normas , Humanos , Cirrosis Hepática/terapia , Valor Predictivo de las Pruebas , Pronóstico , Estados UnidosAsunto(s)
Gastroenterología/normas , Fallo Hepático Agudo/diagnóstico , Fallo Hepático Agudo/terapia , Sociedades Médicas/normas , Consenso , Medicina Basada en la Evidencia/normas , Humanos , Fallo Hepático Agudo/etiología , Valor Predictivo de las Pruebas , Factores de Riesgo , Resultado del Tratamiento , Estados UnidosAsunto(s)
Antivirales/uso terapéutico , Virus de la Hepatitis B/efectos de los fármacos , Hepatitis B/tratamiento farmacológico , Hepatitis B/prevención & control , Inmunosupresores/efectos adversos , Activación Viral/efectos de los fármacos , Biomarcadores/sangre , ADN Viral/sangre , Gastroenterología , Hepatitis B/diagnóstico , Hepatitis B/inmunología , Hepatitis B/virología , Anticuerpos contra la Hepatitis B/sangre , Antígenos de Superficie de la Hepatitis B/sangre , Virus de la Hepatitis B/genética , Virus de la Hepatitis B/inmunología , Virus de la Hepatitis B/patogenicidad , Humanos , Recurrencia , Factores de Riesgo , Sociedades Médicas , Resultado del Tratamiento , Carga ViralAsunto(s)
Toma de Decisiones , Medicina Basada en la Evidencia/tendencias , Gastroenterología/tendencias , Adhesión a Directriz , Objetivos Organizacionales , Práctica Profesional/organización & administración , Medicina Basada en la Evidencia/métodos , Gastroenterología/organización & administración , Humanos , Guías de Práctica Clínica como Asunto/normas , Sociedades Médicas/organización & administración , Sociedades Médicas/tendenciasAsunto(s)
Antivirales/uso terapéutico , Virus de la Hepatitis B/efectos de los fármacos , Hepatitis B/tratamiento farmacológico , Hepatitis B/prevención & control , Inmunosupresores/efectos adversos , Activación Viral/efectos de los fármacos , Biomarcadores/sangre , ADN Viral/sangre , Hepatitis B/diagnóstico , Hepatitis B/inmunología , Hepatitis B/virología , Anticuerpos contra la Hepatitis B/sangre , Antígenos de Superficie de la Hepatitis B/sangre , Virus de la Hepatitis B/genética , Virus de la Hepatitis B/inmunología , Virus de la Hepatitis B/patogenicidad , Humanos , Recurrencia , Resultado del Tratamiento , Carga ViralRESUMEN
This evidence-based clinical practice guideline for the prevention, diagnosis, and treatment of Lyme disease was developed by a multidisciplinary panel representing the Infectious Diseases Society of America (IDSA), the American Academy of Neurology (AAN), and the American College of Rheumatology (ACR). The scope of this guideline includes prevention of Lyme disease, and the diagnosis and treatment of Lyme disease presenting as erythema migrans, Lyme disease complicated by neurologic, cardiac, and rheumatologic manifestations, Eurasian manifestations of Lyme disease, and Lyme disease complicated by coinfection with other tick-borne pathogens. This guideline does not include comprehensive recommendations for babesiosis and tick-borne rickettsial infections, which are published in separate guidelines. The target audience for this guideline includes primary care physicians and specialists caring for this condition such as infectious diseases specialists, emergency physicians, internists, pediatricians, family physicians, neurologists, rheumatologists, cardiologists and dermatologists in North America.