Patología dermatológica y medicina tropical. Resultados de un estudio prospectivo (2004-2007) / Skin diseases and tropical medicine. Results from a prospective study (2004-2007)

Introducción. En los últimos años se ha producido un incremento de los viajes internacionales, siendo España uno de los principales países emisores de turismo internacional. La patología dermatológica al regreso de regiones tropicales es un motivo frecuente de consulta médica, producida por diferentes agentes etiológicos. Objetivo. Los objetivos del presente estudio son evaluar la importancia de la patología dermatológica en pacientes que acuden a una consulta de medicina tropical, analizar la influencia que tienen en su aparición la duración, el motivo y el destino del viaje y describirlas entidades más frecuentes. Material y métodos. Se realizó un estudio observacional longitudinal prospectivo en el que se incluyó a todos los españoles mayores de edad que acudieron a una consulta de medicina tropical, durante el período comprendido entre el 1 de enero de 2004 y el31 de diciembre de 2007. Se recogieron datos epidemiológicos y clínicos del grupo de pacientes con patología dermatológica. Resultados. Se atendió un total de 3.351 consultas nuevas, con 660 casos de dermopatía. La patología infecciosa constituyó casi la mitad (48,5%) de la patología dermatológica(320 casos). Las lesiones más frecuentemente descritas fueron reacciones a picaduras de insectos (113 casos), larva migrans cutánea (LMC) (84 casos), micosis (52 casos) yurticaria (43 casos).Conclusiones. La aparición de dermatosis en los viajeros parece estar determinada por el motivo, la duración y el destino del mismo. Dada la heterogeneidad de la patología, el reconocimiento de las lesiones es fundamental para iniciar el tratamiento adecuado (AU)

Introduction. An increase of international trips has been taken place in recent years, being Spain one of the principal issuing countries of international tourism. Dermatological diseases returning from tropical areas are frequent causes of medical consultation. Etiology is varied. Objective. The aims of the present study are: to evaluate the importance of dermatological pathology in patients who come to a consultation of Tropical Medicine; to analyze the influence of duration, motive and the destination of the trip; and to describe the most frequent entities. Materials and methods. An observational prospective study was realized, including all Spanish people older than 18 years-old who came to a consultation of Tropical Medicine. The period of study was between January 1st, 2004 and December 31st, 2007. Epidemiological and clinical items were collected from the group of patients with dermatological pathology. Results. There were attended 3,351 new consultations, with 660 cases of skin diseases. The infectious pathology constituted an almost the half (48.5%) of the dermatological pathology (320 cases). The injuries more frequently described were associated with stings arthropods (113 cases) and cutaneous larva migrants (CLM) (84), mycoses (52) andurticaria (43).Conclusions. The appearance of dermatosis in the travelers seems to be determined by the motive, the duration and the destination. Given the heterogeneity of the pathology, the recognition of the injuries is fundamental to initiate the suitable treatment (AU)

[Skin diseases and tropical medicine. Results from a prospective study (2004-2007)]. / Patología dermatológica y medicina tropical. Resultados de un estudio prospectivo (2004-2007).

INTRODUCTION: An increase of international trips has been taken place in recent years, being Spain one of the principal issuing countries of internationl tourism. Dermatological diseases returning from tropical areas are frequent causes of medical consultation. Etiology is varied. OBJECTIVE. The aims of the present study are: to evaluate the importance of dermatological pathology in patients who come to a consultation of Tropical Medicine; to analyze the influence of duration, motive and the destination of the trip; and to describe the most frequent entities. MATERIALS AND METHODS: An observational prospective study was realized, including all Spanish people older than 18 years-old who came to a consultation of Tropical Medicine. The period of study was between January 1st, 2004 and December 31st, 2007. Epidemiological and clinical items were collected from the group of patients with dermatological pathology. RESULTS: There were attended 3,351 new consultations, with 660 cases of skin diseases. The infectious pathology constituted an almost the half (48.5%) of the dermatological pathology (320 cases). The injuries more frequently described were associated with stings arthropods (113 cases) and cutaneous larva migrans (CLM) (84), mycoses (52) and urticaria (43). CONCLUSIONS: The appearance of dermatosis in the travelers seems to be determined by the motive, the duration and the destination. Given the heterogeneity of the pathology, the recognition of the injuries is fundamental to initiate the suitable treatment.

[Clinical and subclinical neuropathy in patients with human immunodeficiency virus receiving antiretroviral therapy]. / Neuropatía clínica y subclínica de pacientes con virus de inmunodeficiencia humana en tratamiento antirretroviral.

INTRODUCTION: There is a clear association between human immunodeficiency virus (HIV) and peripheral neuropathy. Peripheral polyneuropathy (PPN) is the most frequent neurological complication due to both the infection itself and the neurotoxicity deriving from highly active antiretroviral therapies (HAART). AIMS: The aim of this study was to determine the incidence of symptomatic PPN associated to HAART and to find out the true prevalence rate of subclinical neuropathy following over several years' treatment. PATIENTS AND METHODS: In order to evaluate the incidence of symptomatic PPN we conducted a study of patients undergoing treatment with HAART with a combination of didanosine (ddI), lamivudine (3TC) and efavirenz, and its presence was confirmed both clinically and electromyographically. Moreover, to study the prevalence rate of asymptomatic or subclinical PPN we chose patients without PPN who had been receiving this treatment for more than two years, with a viral load that had remained undetectable for over a year and with no further risk factors for PPN, and submitted them to a voluntary electromyographic study for PPN. RESULTS: Of the 108 patients studied, only two cases of symptomatic PPN were found. CONCLUSIONS: The incidence rate of clinical neuropathy following the administration of HAART is low (1.85%); PPN is a rare cause of withdrawal. Nevertheless, the prevalence rate found for subclinical PPN in patients undergoing prolonged therapy is high (66%). We therefore find ourselves with a problem that is little known, rarely suspected and more common than is believed.

Neuropatía clínica y subclínica de pacientes con virus de inmunodeficiencia humana en tratamiento antirretroviral / Clinical and subclinical neuropathy in patients with human immunodeficiency virus receiving antiretroviral therapy

Introducción. Existe una clara asociación entre el virus de inmunodeficiencia humana y la neuropatía periférica. La polineuropatía periférica (PNP) es la complicación neurológica más frecuente, debido tanto a la propia infección como a la neurotoxicidad derivada de las terapias antirretrovirales de gran actividad(TARGA). Objetivo. Esclarecer la incidencia de la PNP sintomática asociada a las TARGA y conocer la verdadera prevalencia de neuropatía subclínica tras un tratamiento prolongado de varios años. Pacientes y métodos. Para valorar la incidencia de la PNP sintomática se realizó un estudio de los pacientes en tratamiento con TARGA con la combinación de didanosina (ddI), la mivudina (3TC) y efavirenz, y se definió su presencia a la confirmación clínica y electromiográfica. Por otra parte, con la finalidad de estudiarla prevalencia de la PNP asintomática o subclínica se escogieron pacientes sin PNP que llevaban más de dos años con dicho tratamiento, con una carga viral indetectable durante más de un año y sin otros factores de riesgo de padecer PNP, y se les realizó de forma voluntaria un estudio electromiográfico para PNP. Resultados. De los 108 pacientes estudiados, tan sólo se objetivaron dos casos de PNP sintomática. Conclusiones. La incidencia de neuropatía clínica tras la administración de TARGA es baja (1,85%); la PNP es una causa poco frecuente de suspensión. Sin embargo, la prevalencia encontrada de PNP subclínica en pacientes con terapia prolongada es alta (66%), con lo que nos encontramos con un problema poco conocido, poco sospechado y más frecuente de lo que se cree (AU)

Introduction. There is a clear association between human immunodeficiency virus (HIV) and peripheral neuropathy. Peripheral polyneuropathy (PPN) is the most frequent neurological complication due to both the infection itself and the neurotoxicity deriving from highly active antiretroviral therapies (HAART). Aims. The aim of this study was to determine the incidence of symptomatic PPN associated to HAART and to find out the true prevalence rate of subclinical neuropathy following over several years’ treatment. Patients and methods. In order to evaluate the incidence of symptomatic PPN we conducted a study of patients undergoing treatment with HAART with a combination of didanosine (ddI), lamivudine(3TC) and efavirenz, and its presence was confirmed both clinically and electromyographically. Moreover, to study the prevalence rate of asymptomatic or subclinical PPN we chose patients without PPN who had been receiving this treatment for more than two years, with a viral load that had remained undetectable for over a year and with no further risk factors for PPN, and submitted them to a voluntary electromyography study for PPN. Results. Of the 108 patients studied, only two cases of symptomatic PPN were found. Conclusions. The incidence rate of clinical neuropathy following the administration of HAART is low (1.85%); PPN is a rare cause of withdrawal. Nevertheless, the prevalence rate found for subclinical PPN in patients undergoing prolonged therapy is high (66%). We therefore find ourselves with a problem that is little known, rarely suspected and more common than is believed (AU)

Mujer de 39 años con eosinofilia y edema subcutáneo tras estancia en áreas tropicales / 39 year old woman with eosinophilia and subcutaneous edema after stay in tropical areas

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[Central nervous system infections in HIV patients in the era of high activity antiretroviral treatment]. / Las infecciones del sistema nervioso central en pacientes con virus de la inmunodeficiencia humana en la era del tratamiento antirretroviral de gran actividad.

Although the incidence of most central nervous system infections in HIV+ patients has decreased after the introduction of the modern antiretroviral treatments, they are still a major cause of morbidity and mortality. New technologies in molecular biology and neuroradiology establish the diagnosis in many cases and have decreased the need for cerebral biopsy. Prognosis has improved substantially after the introduction of high activity antiretroviral treatment; more active treatments are needed, however, for infections as PML or citomegalovirus encephalitis because of their still unacceptably high mortality.

Las infecciones del sistema nervioso central en pacientes con virus de la inmunodeficiencia humana en la era del tratamiento antirretroviral de gran actividad / Central nervous system infections in HIV patients in the era of high activity antiretroviral treatment

Aunque la incidencia de la mayoría de las infecciones del sistema nervioso central en los pacientes infectados por el virus de la inmunodeficiencia humana ha disminuido tras la introducción de los modernos tratamientos antirretrovirales, aún siguen siendo una causa importante de morbilidad y mortalidad. Las nuevas tecnologías en biología molecular y neurorradiología permiten el diagnóstico en muchos casos y han disminuido la necesidad de la biopsia cerebral. El pronóstico ha mejorado sustancialmente tras la introducción de la terapia antirretroviral de alta eficacia, pero, sin embargo, se precisan tratamientos más activos para infecciones como la LMP o la encefalitis por citomegalovirus donde la mortalidad sigue siendo inaceptablemente alta

Although the incidence of most central nervous system infections in HIV+ patients has decreased after the introduction of the modern antiretroviral treatments, they are still a major cause of morbidity and mortality. New technologies in molecular biology and neuroradiology establish the diagnosis in many cases and have decreased the need for cerebral biopsy. Prognosis has improved substantially after the introduction of high activity antiretroviral treatment; more active treatments are needed, however, for infections as PML or citomegalovirus encephalitis because of their still unacceptably high mortality

Pseudomigraña con pleocitosis. Un nuevo caso / Pseudomigraine with pleocytosis. A new case

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Síndrome de hipersensibilidad al alopurinol

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