Tratamiento y prevención de la viruela del mono / Treatment and prevention of monkeypox

La viruela del mono es una zoonosis que se contagia principalmente a través del contacto directo con los fluidos y las lesiones cutáneas de personas contagiadas con vesículas aun activas. Aunque el virus fue aislado por primera vez en 1958, y el primer caso humano se identificó en un niño en 1970, en la República Democrática del Congo, la enfermedad ha aumentado progresivamente su incidencia en África, alcanzando en mayo de 2022 transmisión sostenida fuera de este continente. Al ser un virus de nueva introducción en nuestro entorno sanitario, es necesario aprender el patrón epidemiológico en un medio diferente al de las zonas tradicionalmente endémicas y conocer los tratamientos antivirales a nuestro alcance, así como las medidas profilácticas que podrían plantearse, sabiendo que como virus emergente en nuestras regiones las evidencias científicas aun son limitadas. Existen antivirales que han demostrado en modelos animales combatir eficazmente la enfermedad con muy buena tolerancia clínica. Esta enfermedad también ha obligado a revisar las características de las vacunas frente a la viruela, ya que han demostrado un efecto protector frente a la viruela del mono. Por ello, es importante disponer de un documento que recopile toda la información científica publicada a este respecto.(AU)

Monkeypox is a zoonosis that is spread mainly through direct contact with fluids and skin lesions of infected people with vesicles still active. Although the virus was isolated for the first time in 1958 and the first human case was identified in a child in 1970, in the Democratic Republic of the Congo, the disease has progressively increased its incidence in Africa reaching in May 2022 sustained transmission outside this continent. As it is a newly introduced virus in our health system, it is necessary to learn the epidemiological pattern in a different environment from that of traditionally endemic areas and to know the available antiviral treatments, as well as the prophylactic measures that could be considered, knowing that as a virus emerging in our regions, scientific evidence is still limited. There are antivirals that have been shown, in animal models, to effectively combat the disease with very good clinical tolerance. This disease has also forced us to review the characteristics of smallpox vaccines, because they have shown a protective effect against monkeypox. For this reason, it is important to have a document that compiles all the scientific information published in this regard.(AU)

The Impact of Antibiotic Prophylaxis on a Retrospective Cohort of Hospitalized Patients with COVID-19 Treated with a Combination of Steroids and Tocilizumab.

OBJECTIVES: In the context of COVID-19, patients with a severe or critical illness may be more susceptible to developing secondary bacterial infections. This study aims to investigate the relationship between the use of prophylactic antibiotic therapy and the occurrence of bacterial or fungal isolates following the administration of tocilizumab in hospitalized COVID-19 patients who had previously received steroids during the first and second waves of the pandemic in Spain. METHODS: This retrospective observational study included 70 patients hospitalized with COVID-19 who received tocilizumab and steroids between January and December 2020. Data on demographics, comorbidities, laboratory tests, microbiologic results, treatment, and outcomes were collected from electronic health records. The patients were divided into two groups based on the use of antibiotic prophylaxis, and the incidence of bacterial and fungal colonizations/infections was analyzed. RESULTS: Among the included patients, 45 patients received antibiotic prophylaxis. No significant clinical differences were observed between the patients based on prophylaxis use regarding the number of clinically diagnosed infections, ICU admissions, or mortality rates. However, the patients who received antibiotic prophylaxis showed a higher incidence of colonization by multidrug-resistant bacteria compared to that of the subgroup that did not receive prophylaxis. The most commonly isolated microorganisms were Candida albicans, Enterococcus faecalis, Staphylococcus aureus, and Staphylococcus epidermidis. Conclusions: In this cohort of hospitalized COVID-19 patients treated with tocilizumab and steroids, the use of antibiotic prophylaxis did not reduce the incidence of secondary bacterial infections. However, it was associated with an increased incidence of colonization by multidrug-resistant bacteria.

Treatment and prevention of monkeypox.

Monkeypox is a zoonosis that is spread mainly through direct contact with fluids and skin lesions of infected people with vesicles still active. Although the virus was isolated for the first time in 1958 and the first human case was identified in a child in 1970, in the Democratic Republic of the Congo, the disease has progressively increased its incidence in Africa reaching in May 2022 sustained transmission outside this continent. As it is a newly introduced virus in our health system, it is necessary to learn the epidemiological pattern in a different environment from that of traditionally endemic areas and to know the available antiviral treatments, as well as the prophylactic measures that could be considered, knowing that as a virus emerging in our regions, scientific evidence is still limited. There are antivirals that have been shown, in animal models, to effectively combat the disease with very good clinical tolerance. This disease has also forced us to review the characteristics of smallpox vaccines, because they have shown a protective effect against monkeypox. For this reason, it is important to have a document that compiles all the scientific information published in this regard.

[Treatment and prevention of monkeypox]. / Tratamiento y prevención de la viruela del mono.

Monkeypox is a zoonosis that is spread mainly through direct contact with fluids and skin lesions of infected people with vesicles still active. Although the virus was isolated for the first time in 1958 and the first human case was identified in a child in 1970, in the Democratic Republic of the Congo, the disease has progressively increased its incidence in Africa reaching in May 2022 sustained transmission outside this continent. As it is a newly introduced virus in our health system, it is necessary to learn the epidemiological pattern in a different environment from that of traditionally endemic areas and to know the available antiviral treatments, as well as the prophylactic measures that could be considered, knowing that as a virus emerging in our regions, scientific evidence is still limited. There are antivirals that have been shown, in animal models, to effectively combat the disease with very good clinical tolerance. This disease has also forced us to review the characteristics of smallpox vaccines, because they have shown a protective effect against monkeypox. For this reason, it is important to have a document that compiles all the scientific information published in this regard.

Motivos de consulta de pacientes con enfermedades autoinmunes sistémicas en el servicio de urgencias de un hospital terciario / Causes for consultation in the emergency room among patients with systemic autoimmune diseases

Background: The causes of acute decompensations of patients with systemic autoimmune diseases are not well known. Aim: To describe the causes for consultation in an emergency room of patients with systemic autoimmune diseases. Material and Methods: Review of medical records of patients with systemic autoimmune diseases, aged over 14 years, consulting in an emergency room of a general hospital during three months. Results: In the study period, 166 patients with systemic autoimmune diseases consulted in the emergency room, of a total of 18,153 consultations (0.9%). Patients with rheumatoid arthritis were those that consulted with higher frequency (37%) followed by patients with systemic lupus erythematosus (21%). The most common causes for consultation were cardiovascular diseases in 25%, followed by digestive disorders in 15%. The most common diagnosis was chest pain with suspected ischemic heart disease in 36%. No differences in cardiovascular risk factors were observed between those patients consulting for cardiovascular diseases and those consulting for other causes. Conclusions: The most common cause of consultation in the emergency room of patients with systemic autoimmune diseases is cardiovascular.

[Causes for consultation in the emergency room among patients with systemic autoimmune diseases]. / Motivos de consulta de pacientes con enfermedades autoinmunes sistémicas en el servicio de urgencias de un hospital terciario.

BACKGROUND: The causes of acute decompensations of patients with systemic autoimmune diseases are not well known. AIM: To describe the causes for consultation in an emergency room of patients with systemic autoimmune diseases. MATERIAL AND METHODS: Review of medical records of patients with systemic autoimmune diseases, aged over 14 years, consulting in an emergency room of a general hospital during three months. RESULTS: In the study period, 166 patients with systemic autoimmune diseases consulted in the emergency room, of a total of 18,153 consultations (0.9%). Patients with rheumatoid arthritis were those that consulted with higher frequency (37%) followed by patients with systemic lupus erythematosus (21%). The most common causes for consultation were cardiovascular diseases in 25%, followed by digestive disorders in 15%. The most common diagnosis was chest pain with suspected ischemic heart disease in 36%. No differences in cardiovascular risk factors were observed between those patients consulting for cardiovascular diseases and those consulting for other causes. CONCLUSIONS: The most common cause of consultation in the emergency room of patients with systemic autoimmune diseases is cardiovascular.

Absceso del músculo iliopsoas: tratamiento y evolución en una serie de 35 pacientes / Iliopsoas abscess: therapeutic approach and outcome in a series of 35 patients

Introducción El presente estudio pretende revisar el absceso del músculo iliopsoas (AMI) desde una perspectiva contemporánea, partiendo de la experiencia acumulada en dos centros de tercer nivel. Material y Métodos Análisis retrospectivo de 35 pacientes con diagnóstico de AMI entre 1998 y 2009. Revisamos sus variables clínico-microbiológicas y su evolución en función del tipo de tratamiento definitivo: médico [antibioterapia (10 pacientes)] o intervencionista [antibioterapia más drenaje percutáneo y/o quirúrgico (25 pacientes)]. Resultados El absceso fue de naturaleza primaria en 8 casos y secundaria en los restantes, con predominio de las formas asociadas a espondilodiscitis. La tríada clínica clásica (fiebre, dolor y dificultad para la de ambulación) estuvo presente en 10 pacientes, con una mediana de duración de los síntomas hasta el diagnóstico de 12 días. Staphylococcus aureus fue el microorganismo más frecuente. Tras una mediana de seguimiento de 454 días, el riesgo de evolución desfavorable (muerte relacionada y/o recidiva) fue mayor en pacientes con diabetes mellitus (44,4 vs. 7,7%; p=0,027), sin diferencias significativas entre los grupos sometidos a tratamiento médico o intervencionista (20,0 vs. 28,0%).Conclusiones En nuestra serie predominaron las formas de AMI por S. aureus secundarias a un foco osteoarticular. El tratamiento exclusivamente médico parece eficaz a largo plazo, si bien los pacientes diabéticos presentaron mayor riesgo de recidiva (AU)

Introduction: The present study was aimed at reviewing the iliopsoas abscess (IPA) from a contemporary perspective, on the basis of experience from two tertiary referral centres. Material and methods: We performed a retrospective analysis of 35 cases of IPA diagnosed between1998 and 2009. Their clinical and microbiological features were recorded, as well as their long-term outcome according to the type of treatment: antibiotics alone (10 patients), or antibiotics plus percutaneous drainage or surgery (25 patients).Results: Primary abscess occurred in 8 patients. The most frequent source of secondary abscesses was spondylodiscitis. The classic clinical triad (fever, pain and functional impairment) was present in10 patients, with a median duration of symptoms before diagnosis of 12 days. Staphylococcus aureus was the most frequently isolated microorganism. At the end of a median follow-up of 454 days, the risk of poor outcome (related death and/or relapse) was higher among patients with diabetes mellitus (44.4% vs.7.7%; P=.027), with no (..) (AU)

Infección por el virus de la inmunodeficiencia humana tipo 1 e inflamación persistente: ¿es la traslocación bacteriana la causa oculta? / HIV infection and chronic inflammation: Is the bacterial translocation the underlying cause?

En la actualidad, las comorbilidades no-sida (enfermedad cardiovascular, tumores no diagnósticos de sida, enfermedad hepática u osteoporosis) son una causa importante de morbimortalidad en los pacientes con infección por el virus de la inmunodeficiencia humana tipo 1 (VIH-1). La elevación de los marcadores plasmáticos de inflamación se ha asociado al desarrollo de enfermedad cardiovascular y muerte por todas las causas. Por tanto, existe gran interés en conocer cuáles son las causas asociadas a la infección crónica por VIH-1 que mantienen el estímulo inflamatorio persistente. La alteración de la barrera intestinal asociada a la infección por VIH-1 puede favorecer el paso de productos microbianos a la sangre desde la luz intestinal, con el consiguiente estímulo inmunológico. En este artículo se revisará la patogenia de la traslocación bacteriana y su relevancia en la infección por el VIH-1 (AU)

Currently, non-AIDS comorbidities (cardiovascular disease, non-AIDS-related cancers, liver disease, osteoporosis, etc.) have become an important cause of morbimortality in patients with human immunodeficiency virus type 1 (HIV-1) infection. The elevation of plasma markers of inflammation has been associated with the development of cardiovascular disease and death from all causes. Therefore, there is great interest in elucidating the underlying causes responsible for this persistent inflammatory status. The intestinal barrier disruption associated with HIV-1 infection may favor the passage of gut microbial products into the blood, resulting in immune stimulation. In this article we review the pathogenesis of bacterial translocation and its relevance to HIV-1 infection (AU)

Actualización en la patología pulmonar relacionada con la infección VIH / Updating Our Understanding of Pulmonary Disease Associated With HIV Infection

La introducción del tratamiento antirretroviral de gran actividad (TARGA) ha supuesto una disminución de las infecciones oportunistas asociada a la inmunodepresión celular y humoral. Sin embargo, no está claro el impacto del TARGA en el desarrollo de otras patologías no asociadas a sida, como el cáncer de pulmón y la enfermedad pulmonar obstructiva crónica (EPOC). El objetivo del presente artículo es revisar los aspectos más novedosos y relevantes de la patología pulmonar en pacientes infectados por el virus de la inmunodeficiencia humana (VIH)(AU)

The introduction of highly active antiretroviral therapy (HAART) has resulted in a reduction of opportunistic infections associated with cellular and humoral immunosuppression. However, what is still unclear is the impact of HAART on the development of other diseases not associated with AIDS, such as lung cancer and COPD. The aim of this paper is to review the most innovative and relevant aspects of lung pathology in patients infected with HIV(AU)

[HIV infection and chronic inflammation: is the bacterial translocation the underlying cause?]. / Infección por el virus de la inmunodeficiencia humana tipo 1 e inflamación persistente: ¿es la traslocación bacteriana la causa oculta?

Currently, non-AIDS comorbidities (cardiovascular disease, non-AIDS-related cancers, liver disease, osteoporosis, etc.) have become an important cause of morbimortality in patients with human immunodeficiency virus type 1 (HIV-1) infection. The elevation of plasma markers of inflammation has been associated with the development of cardiovascular disease and death from all causes. Therefore, there is great interest in elucidating the underlying causes responsible for this persistent inflammatory status. The intestinal barrier disruption associated with HIV-1 infection may favor the passage of gut microbial products into the blood, resulting in immune stimulation. In this article we review the pathogenesis of bacterial translocation and its relevance to HIV-1 infection.

Updating our understanding of pulmonary disease associated with HIV infection.

The introduction of highly active antiretroviral therapy (HAART) has resulted in a reduction of opportunistic infections associated with cellular and humoral immunosuppression. However, what is still unclear is the impact of HAART on the development of other diseases not associated with AIDS, such as lung cancer and COPD. The aim of this paper is to review the most innovative and relevant aspects of lung pathology in patients infected with HIV.

[Iliopsoas abscess: therapeutic approach and outcome in a series of 35 patients]. / Absceso del músculo iliopsoas: tratamiento y evolución en una serie de 35 pacientes.

INTRODUCTION: The present study was aimed at reviewing the iliopsoas abscess (IPA) from a contemporary perspective, on the basis of experience from two tertiary referral centres. MATERIAL AND METHODS: We performed a retrospective analysis of 35 cases of IPA diagnosed between 1998 and 2009. Their clinical and microbiological features were recorded, as well as their long-term outcome according to the type of treatment: antibiotics alone (10 patients), or antibiotics plus percutaneous drainage or surgery (25 patients). RESULTS: Primary abscess occurred in 8 patients. The most frequent source of secondary abscesses was spondylodiscitis. The classic clinical triad (fever, pain and functional impairment) was present in 10 patients, with a median duration of symptoms before diagnosis of 12 days. Staphylococcus aureus was the most frequently isolated microorganism. At the end of a median follow-up of 454 days, the risk of poor outcome (related death and/or relapse) was higher among patients with diabetes mellitus (44.4% vs. 7.7%; P=.027), with no significant differences according to the therapeutic approach (20.0% in the group of antibiotics alone vs. 28.0% in the group with drainage or surgery). CONCLUSIONS: In our series, most cases of IPA were due to S. aureus and secondary to a skeletal source. Antibiotic therapy seems effective in the long-term, although diabetic patients had a higher risk of relapse.

Enfermedad desmielinizante en pacientes infectados por el virus de la inmunodeficiencia humana sin inmunodepresión severa / Demyelinating disease in human immunodeficiency virus-infected patients without severe immunodepression

Objetivo Se analizaron los casos de lesiones desmielinizantes múltiples en pacientes con infección VIH sin inmunodepresión grave. Métodos Se realizó una búsqueda a través de una base de datos informatizada y se seleccionaron aquellos pacientes con linfocitos CD4 superior a 200 (..) (AU)

Objective Human immunodeficiency virus (HIV) infected patients who did not have severe immunodepression were analysed for multiple demyelinating lesions. Methods Patients with a CD4 greater than (..) AU)

[Demyelinating disease in human immunodeficiency virus-infected patients without severe immunodepression]. / Enfermedad desmielinizante en pacientes infectados por el virus de la inmunodeficiencia humana sin inmunodepresión severa.

OBJECTIVE: Human immunodeficiency virus (HIV) infected patients who did not have severe immunodepression were analysed for multiple demyelinating lesions. METHODS: Patients with a CD4 greater than 200/µL were selected after a search was made in a computerised data base. RESULTS: Four patients were found, three were co-infected with hepatitis C virus (HCV), with one of them on treatment with peg-interferón α-2b and ribavirin. CONCLUSION: HIV infected patients can develop demyelinating disease without having severe immunodepression, probably favoured by other factors, such as co-infection wIth HCV.