RESUMEN
OBJECTIVE: Hemophagocytic syndrome (HPS) is characterized by various clinical and biological data derived from cytokine hyperproduction and cell proliferation. The objectives of this study were to evaluate the epidemiological, etiological, clinical and evolutionary characteristics of patients diagnosed with hemophagocytic syndrome and HIV infection, as well as their comparison with data from the literature. METHODS: A retrospective descriptive observational study was performed, including all adult patients with a diagnosis of HPS and HIV infection treated in the Infectious Diseases and Tropical Medicine Unit of the Hospital Universitario Insular, Las Palmas, Gran Canaria from June 1, 1998 to December 31, 2018. RESULTS: An analysis of this series of case reports of 15 patients showed a higher percentage of males than females, with a mean age of 42 years. With respect to the diagnostic criteria for HPS, presence of fever, cytopenias and hyperferritinemia were a constant in all patients. Clinical neurological manifestations were frequent and clinical respiratory signs and symptoms absent. HPS was confirmed in some patients who were not severely immune-depressed and had undetectable viral loads. Furthermore, 40% of cases were not receiving ART. The most frequent triggering causes of HPS were viral, especially HHV-8. In addition, two new HPS triggers were identified: Blastocystis dermatitidis and Mycobacterium chelonae. CONCLUSIONS: Administration of treatment in HPS is arbitrary. This, together with the high mortality rate and the fact that it is underdiagnosed, indicates the importance of conducting future studies.
Asunto(s)
Infecciones por VIH/complicaciones , Linfohistiocitosis Hemofagocítica/etiología , Adulto , Femenino , Humanos , Linfohistiocitosis Hemofagocítica/diagnóstico , Linfohistiocitosis Hemofagocítica/epidemiología , Linfohistiocitosis Hemofagocítica/terapia , Masculino , Persona de Mediana Edad , Estudios RetrospectivosAsunto(s)
Eosinofilia/etiología , Intestinos/parasitología , Miasis/complicaciones , Animales , Eosinofilia/diagnóstico , Femenino , Humanos , Larva/crecimiento & desarrollo , Larva/patogenicidad , Persona de Mediana Edad , Muscidae/crecimiento & desarrollo , Muscidae/patogenicidad , Miasis/diagnóstico , ViajeAsunto(s)
Absceso/tratamiento farmacológico , Bacillus cereus , Infecciones por Bacterias Grampositivas/tratamiento farmacológico , Absceso/microbiología , Antibacterianos/uso terapéutico , Traumatismos en Atletas/complicaciones , Fiebre/etiología , Infecciones por Bacterias Grampositivas/microbiología , Humanos , Levofloxacino/uso terapéutico , Masculino , Adulto JovenRESUMEN
OBJECTIVE: When we evaluate a patient with a suspected imported disease we cannot forget to include any autochthonous causes that may mimic imported pathologies to avoid misdiagnosis and therapeutic delay. METHODS: A descriptive longitudinal retrospective study was designed with patients in whom an imported disease was suspected but who were finally diagnosed with autochthonous processes. The patients were selected from two internal medicine practices specializing in tropical diseases between 2008-2017 in Spain. RESULTS: We report 16 patients, 11 (68.7%) were males, and the mean age was 43.4 ± 13.7 years old. Thirteen patients (81.2%) were travellers. Half of the patients were from Latin America, 7 (43.5%) were from Africa, and 1 (6.2%) was from Asia. The time from trip to evaluation ranged between 1 week and 20 years (median, 4 weeks), and the mean time from evaluation to diagnosis was 58.4 ± 100.9 days. There were 5 (31.2%) cases of autochthonous infection, 5 (31.2%) cases of cancer, 2 (12.5%) cases of inflammatory disease, and 2 (12.5%) cases of vascular disease. CONCLUSIONS: Travel or migration by a patient can sometimes be a confusing factor if an imported disease is suspected and may cause delays in the diagnosis and treatment of an autochthonous disease. We highlight that 1/3 of the patients with autochthonous diseases in this study had cancer. The evaluation of imported diseases requires a comprehensive approach by the internist, especially if he specializes in infectious and/or tropical diseases and is, therefore, the best qualified to make an accurate diagnosis.
Asunto(s)
Enfermedades Transmisibles/diagnóstico , Errores Diagnósticos , Medicina Tropical , Adulto , Emigrantes e Inmigrantes , Femenino , Migración Humana , Humanos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , España , Viaje , Adulto JovenRESUMEN
Q fever is an anthropozoonosis whose causative agent is Coxiella burnetii, which has an important impact from the human and animal health point of view. In this review, a brief historical reference of the infection by C. burnetii and Q fever has been made initially. In a second section the basic epidemiological aspects of this infection are described (reservoirs/ sources of infection, form of transmission and epidemiological forms). Subsequently, the data of the infection by C. burnetii in Spain will be are indicated, particularly the clinical series, the seroepidemiological studies in humans, the affectation of different types of mammals and the participation of the ticks in the biological cycle. In addition, basic data on C. burnetii infection/ disease in other regions of the world will be are also included. Finally, and taking into account the previous data will indicate the main epidemiological characteristics of Q fever at present.
Asunto(s)
Fiebre Q/epidemiología , Coxiella burnetii , Humanos , Fiebre Q/microbiología , Estudios Seroepidemiológicos , España/epidemiología , Enfermedades por Picaduras de Garrapatas/epidemiologíaRESUMEN
OBJECTIVE: The aim was to analyse those syndromes with fever in travellers who return from tropical regions evaluated at our Department of Infectology and Tropical Medicine. Clarifying these conditions intends to reach earlier diagnoses and, perhaps, to avoid the emergence and spread of imported diseases, as well as to establish appropriate preventive measures. METHODS: An observational descriptive transversal study was performed, selecting those patients who returned from tropical regions with fever, amongst all travellers evaluated in our department between 1998 and 2013. We analysed demographic features, information related to the trip, as well as the presenting complaints and the diagnoses. RESULTS: A total of 247 international travellers presenting with fever were analysed. The most common diagnoses were self-limiting fever (29.1%), malaria (25.1%), invasive gastroenteritis (15.4%), other bacterial infections (7.4%) and genitourinary parenchymal infections (4.5%). Of all the cases, only 8.5% required hospitalization, and no case of mortality was recorded. CONCLUSIONS: In the series presented, there are common data with other published data (malaria as a fundamental disease, difficulties in diagnosis) and different ones (less number of pre-trip consultations and admissions, higher incidence of prostatitis and fewer dengue cases).
Asunto(s)
Fiebre/microbiología , Viaje , Adulto , Infecciones Bacterianas/epidemiología , Infecciones Bacterianas/etiología , Infecciones Bacterianas/microbiología , Femenino , Fiebre/epidemiología , Fiebre/etiología , Hospitalización/estadística & datos numéricos , Humanos , Incidencia , Malaria/epidemiología , Malaria/etiología , Malaria/parasitología , Masculino , Persona de Mediana Edad , Síndrome , Medicina TropicalRESUMEN
OBJECTIVE: The aim was to analyse those syndromes without fever in travellers who return from tropical regions evaluated at our Department of Infectology and Tropical Medicine. Clarifying these conditions intends to reach earlier diagnoses and, perhaps, to avoid the emergence and spread of imported diseases, as well as to establish appropriate preventive measures. METHODS: An observational descriptive transversal study was performed, selecting those patients who returned from tropical regions without fever (n = 281), amongst all travellers evaluated in our department between 1998 and 2013. We analysed demographic features, information related to the trip, as well as the presenting complaints and the diagnoses. RESULTS: A total of 281 international travellers presenting without fever were analysed. Only 39% had received health counsel prior to travelling. The most visited regions were Lat-in America (38.8%), Africa (37.8%) and Asia (13.6%). 15% of patients were asymptomatic or suffered from non-infectious conditions. Among the rest, most had either gastrointestinal (46%) or cutaneous (34%) syndromes. The main gastrointestinal condition was diarrhoea, with a microbiological diagnosis reached in almost 50% of cases. Regarding cutaneous syndromes, arthropods bites (31%) and different bacterial lesions (20%) were most common. CONCLUSIONS: Approximately 10% of patients in Travel Medicine are international travellers returning from tropical regions, half of them with no fever. Most are diagnosed with infectious diseases, mainly gastrointestinal or cutaneous syn-dromes. Eosinophilia is the third problem in frequency among this group of patients, and sexually transmitted infections are rare in our cohort. It is important to emphasize in preventive activities.
Asunto(s)
Enfermedades Transmisibles/epidemiología , Viaje , Medicina Tropical , Adulto , Infecciones Bacterianas/epidemiología , Infecciones Bacterianas/microbiología , Enfermedades Transmisibles/microbiología , Femenino , Humanos , Masculino , Factores de Riesgo , Síndrome , Virosis/epidemiología , Virosis/microbiologíaRESUMEN
According to published data, prevalence of imported eosinophilia among travellers and immigrants is set between 8% and 28.5%. Etiological diagnosis is often troublesome, and depending on the depth of the study and on the population analyzed, a parasitic cause is identified in 17% to 75.9% of the individuals. Among the difficulties encountered to compare studies are the heterogeneity of the studied populations, the type of data collection (prospective/retrospective) and different diagnostic protocols. In this document the recommendations of the expert group of the Spanish Society of Tropical Medicine and International Health (SEMTSI) for the diagnosis and treatment of imported eosinophilia are detailed.
Asunto(s)
Emigrantes e Inmigrantes , Eosinofilia/diagnóstico , Eosinofilia/terapia , Viaje , Medicina Tropical , Consenso , Eosinofilia/parasitología , Helmintiasis/sangre , Helmintiasis/tratamiento farmacológico , Helmintiasis/parasitología , Humanos , Sociedades Médicas , EspañaRESUMEN
OBJECTIVE: The objective of this paper was to determine the demographic characteristics and the evolution of international travelers treated at the Unit of Infectious and Tropical Medicine in order to improve precautions prior to travel and, thus reduce the occurrence of these diseases. METHODS: A retrospective study of all international travelers served in UEIMT (Las Palmas de Gran Canaria) during the period 1998-2013 was performed. The following variables were collected using a standardized protocol were analyzed: age, gender, date of consultation, type of traveler, countries of destination and preventive measures undertaken (malaria chemoprophylaxis and vaccines). RESULTS: A total of 6,783 international travelers of which 52% were women were analyzed. The average age was 36 years (SD 13). The most frequent destination continent was Africa (39%) followed by Asia (36%) and Latin America (23%). The most common country of destination was India 13% (882), followed by Senegal 7.5% (509) and Thailand 6.3% (429). The most frequently recommended vaccines were typhoid fever (82.9%) and hepatitis A (66.9%). As for malaria prophylaxis, the indicated drugs were atovaquone-proguanil (56.5%), mefloquine (36.7%), in regard to travelers returning to visit relatives and friends with a 26.81% were children (0-9 years).. CONCLUSIONS: The overall profile of the traveler is a young man who chooses holiday destination Africa followed by Asia and Latin America. Over 50% of travelers received vaccination against typhoid and hepatitis A. The most commonly used malaria chemoprophylaxis was atovaquone / proguanil followed by mefloquine.
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Antimaláricos/uso terapéutico , Vacunas contra la Malaria/uso terapéutico , Malaria/epidemiología , Malaria/prevención & control , Vacunación/estadística & datos numéricos , Adolescente , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Estaciones del Año , Factores Sexuales , Factores Socioeconómicos , España/epidemiología , Viaje , Adulto JovenRESUMEN
According to the literature, prostatitis is a rare cause of prolonged fever without an apparent origin. However, this syndrome can be easily diagnosed using specific tests, either two-glass pre- and post-prostatic massage or the Meares-Stamey four-glass test. A retrospective study over a 5-year period (between August 1st 2006 and July 31st 2011) was performed. All patients who met the criteria for microbiological prostatitis were included and assigned to one of two groups, either a study group [paucisymptomatic infectious prostatitis (PIP)] or a control group [classic infectious prostatitis (CIP)]. Epidemiological, clinical, microbiological, and treatment-related variables were collected. A comparative study between both groups was performed. Thirty-nine patients were diagnosed with prostatitis. The main risk factors were unprotected anal intercourse, human immunodeficiency virus (HIV) infection, recent travel, and recurrent urinary tract infections. The most significant differences between the PIP (19 patients) and CIP (20 patients) groups were higher frequency of elevated inflammatory markers, higher frequency of monomicrobial etiology, and longer treatment. In monomicrobial prostatitis, the most common causative agents were coagulase-negative Staphylococcus spp., Escherichia coli, and Corynebacterium glucuronolyticum. According to the findings of this study, we believe that prostatitis should be included as a possible diagnosis in a man who complains of prolonged fever without an apparent origin and having at least one of the following risk factors: unprotected anal intercourse, HIV infection, recent travel, and recurrent urinary tract infections.
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Infecciones Bacterianas/microbiología , Infecciones Bacterianas/patología , Fiebre/etiología , Prostatitis/microbiología , Prostatitis/patología , Adulto , Antibacterianos/uso terapéutico , Bacterias/clasificación , Bacterias/aislamiento & purificación , Infecciones Bacterianas/tratamiento farmacológico , Infecciones Bacterianas/epidemiología , Humanos , Masculino , Persona de Mediana Edad , Prostatitis/tratamiento farmacológico , Prostatitis/epidemiología , Estudios Retrospectivos , Factores de RiesgoRESUMEN
Schistosomiasis is one disease produced by helminths, which affect many people in tropical areas. Granuloma formation is the main mechanism involved in the pathogenesis of this disease. Experimental studies have demonstrated angiogenesis (blood vessels formation from pre-existing vessels) in the initial phase of granuloma formation. In the present work, VEGF (vascular endothelial growth factor) levels were analyzed in sera from people diagnosed with different helminthic infections. Patients with schistosomiasis and filariasis had significantly high VEGF levels in compared with healthy people and patients diagnosed with hookworms. In addition, the effects of angiogenesis inhibition using anti-angiogenic factors (endostatin) were evaluated in a schistosomiasis murine model. A lesion decrease was observed in mice infected with Schistosoma mansoni and treated with endostatin. Finally, mechanisms of angiogenesis induction were studied and observed that cercariae antigens stimulated the angiogenic factors by host alveolar macrophages.
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Proteínas Angiogénicas/fisiología , Esquistosomiasis Urinaria/etiología , Esquistosomiasis mansoni/etiología , Adolescente , Adulto , África del Sur del Sahara/etnología , Inhibidores de la Angiogénesis/farmacología , Proteínas Angiogénicas/sangre , Animales , Antígenos Helmínticos/inmunología , Biomphalaria/parasitología , Endostatinas/farmacología , Eosinófilos/citología , Femenino , Factores de Crecimiento de Fibroblastos/biosíntesis , Humanos , Recuento de Leucocitos , Macrófagos Alveolares/inmunología , Macrófagos Alveolares/metabolismo , Masculino , Ratones , Ratones Endogámicos BALB C , Ratas , Ratas Wistar , Schistosoma mansoni/inmunología , Esquistosomiasis Urinaria/etnología , Esquistosomiasis Urinaria/patología , Esquistosomiasis mansoni/etnología , Esquistosomiasis mansoni/patología , España , Factor A de Crecimiento Endotelial Vascular/biosíntesis , Factor A de Crecimiento Endotelial Vascular/sangre , Adulto JovenRESUMEN
Coxiella burnetii is the causative agent of Q fever, a zoonosis with worldwide occurrence. In the Canary Islands, the overall seroprevalence in humans has been estimated to be 21.5%. Gran Canaria island concentrates the highest ruminant population in the archipelago and the prevalence of the human infection is 23.5%. To evaluate the seroprevalence in livestock and the affected areas in Gran Canaria island, a total of 1249 ruminants were randomly selected for this study (733 goats, 369 sheep and 147 cattle). The samples were evaluated using an indirect ELISA Kit. The results showed seroprevalences of 60.4%, 31.7% and 12.2% in goats, sheep and cattle, respectively. Based on these results, Q fever could be considered as endemic in Gran Canaria island. Sanitary measures should be taken at the farm level to minimize the risk of exposure of C. burnetii to humans.
Asunto(s)
Enfermedades de los Bovinos/epidemiología , Coxiella burnetii/aislamiento & purificación , Enfermedades de las Cabras/epidemiología , Fiebre Q/veterinaria , Enfermedades de las Ovejas/epidemiología , Animales , Bovinos , Enfermedades de los Bovinos/sangre , Geografía , Enfermedades de las Cabras/sangre , Cabras , Fiebre Q/epidemiología , Estudios Seroepidemiológicos , Ovinos , Enfermedades de las Ovejas/sangre , España/epidemiologíaRESUMEN
This study aims to investigate the role of angiogenic factors in the pathogenesis of experimental strongyloidiasis. Two complementary approaches were used: Firstly, CD1 mice were treated with endostatin, an angiogenesis inhibitor, and infected with Strongyloides venezuelensis. Also, the mechanisms involved in this process were studied. Parasitological examination revealed a significant decrease in egg per gram of faeces, number of collected larvae from lung tissue and number of collected adult females in mice treated with endostatin. Direct mechanisms with diminution of angiogenesis factors and an indirect mechanism with increase of eosinophil perhaps produced their effect. Secondly, the effect of the antigens responsible for stimulation of angiogenic factors [vascular endothelial growth factor (VEGF) and fibroblast growth factor 2 (FGF2)] from alveolar macrophages and the mechanisms involved in their production were investigated. Alveolar macrophage cells obtained by bronchoalveolar lavage were incubated at different concentrations of somatic and excretory/secretory antigens of S. venezuelensis. Also, mRNA levels of VEGF and FGF2 in macrophage cells were detected by RT-PCR. L3-PBS larvae antigens induced angiogenic factors. The relationship between angiogenesis factors and nitric oxide has been observed using nitric oxide synthase inhibitors.
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Inductores de la Angiogénesis/metabolismo , Strongyloides/patogenicidad , Estrongiloidiasis/patología , Inductores de la Angiogénesis/antagonistas & inhibidores , Animales , Endostatinas/administración & dosificación , Heces/parasitología , Femenino , Factor 2 de Crecimiento de Fibroblastos/biosíntesis , Perfilación de la Expresión Génica , Pulmón/parasitología , Macrófagos Alveolares/inmunología , Masculino , Ratones , Recuento de Huevos de Parásitos , Ratas , Ratas Wistar , Reacción en Cadena de la Polimerasa de Transcriptasa Inversa , Factor A de Crecimiento Endotelial Vascular/biosíntesisRESUMEN
The newborn larval stage of Trichinella spiralis enters the host striated skeletal muscle cell resulting in the formation of the nurse cell. Vascular Endothelial Growth Factor (VEGF) was detected in cells in the area immediately surrounding the nurse cells. However, no data are available on the antigens involved, the role of other angiogenic factors or the relationship of angiogenesis with Nitric Oxide (NO) production. Using macrophage cell culture we study the effect of different Trichinella L1 antigens from one encapsulated (T. spiralis) and one non-encapsulated (Trichinellapseudospiralis) on the expression of VEGF and basic Fibroblast Growth Factor (FGF2). Also, we investigate the relationship between the production of NO and angiogenic mediators. The results show that encapsulated and non-encapsulated Trichinella species are different in their capacity to stimulate the expression of VEGF and FGF2 from host macrophages. Finally, there is no relationship between angiogenic factors and NO production by T. spiralis antigen.