Clinical and Epidemiological Characteristics of the 2022 Mpox Outbreak in Spain (CEME-22 Study).

Background: We conducted a multicentric national study (SEIMC-CEME-22), to describe the clinical and epidemiological profile of the mpox outbreak in Spain, including the management of the disease. Methods: This was a retrospective national observational study conducted by Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica (SEIMC) and Foundation SEIMC-GESIDA. We included patients with a confirmed mpox diagnosis before 13 July 2022, and attended at the Spanish health network (the early phase of the outbreak). Epidemiological, clinical, and therapeutic data were collected. Results: Of a total of 1472 patients from 52 centers included, 99% of them were cisgender men, mostly middle-aged, and 98.6% were residents in Spain. The main suspected route of transmission was sexual exposure, primarily among MSM. Occupational exposure was reported in 6 patients. Immunosuppression was present in 40% of patients, mainly due to human immunodeficiency virus (HIV). Only 6.5% of patients had been vaccinated against orthopoxvirus. Virus sequencing was performed in 147 patients (all B.1 lineage). Rash was the most frequent symptom (95.7%), followed by fever (48.2%), adenopathies (44.4%) myalgias (20.7%), proctitis (17%), and headache (14.7%). Simultaneously diagnosed sexually transmitted infections included syphilis (n = 129), gonococcal infection (n = 91), HIV (n = 67), chlamydia (n = 56), hepatitis B (n = 14), and hepatitis C (n = 11). No therapy was used in 479 patients (33%). Symptomatic therapies and antibiotics were used in 50% of cases. The most used therapy regimens were systemic corticoids (90 patients), tecovirimat (6 patients), and cidofovir (13 patients). Smallpox immunoglobulins were used in 1 patient. Fifty-eight patients were hospitalized, and 1 patient died. Conclusions: Mpox outbreak in Spain affected primarily middle-aged men who were sexually active and showed a high rate of HIV infection. A range of heterogeneous therapeutics options was performed.

Prevalencia de alteraciones digestivas asociadas a Chagas importado (estudio PADChI): un estudio observacional / Prevalence of digestive disorders associated with imported Chagas disease (PADChI study): an observational study

Background Chagas disease (CD) is a parasitic disease caused by Trypanosoma cruzi, in which up to 10–20% of those affected may suffer digestive disorders. Multiple studies have been carried out on CD in non-endemic countries, mainly related to cardiological involvement. However, digestive disorders have not been analyzed in such depth. The objective of the study was to determine the prevalence of digestive disorders in imported CD at the time of first care. Methods An observational cross-sectional descriptive analysis of imported CD was performed. Chagasic structural damage and infectious digestive comorbidity were evaluated. The association between Chagasic structural damage and heart disease in Chagas patients was also investigated. Results After reviewing a total of 1,216 medical records, those of 464 patients were selected for analysis. Globally, the prevalence of digestive disorders in imported Chagas was 57.76%, 95% CI (53.25–62.27). The prevalence of comorbidity of infectious diseases was 40.73% CI 95% (36.25–45.22). Colonic abnormalities were found in 84 of 378 barium enema patients. CD-related esophageal abnormalities were present in 63 of 380 patients studied with esophagogram. Conclusions The prevalence of digestive disorders associated with CD is high, so the presence of infectious diseases (mainly parasitic and H. pylori infection) should be ruled out. It is important to exclude structural involvement in all symptomatic patients, and asymptomatic patients should also be considered and offered (AU)

Antecedentes La enfermedad de Chagas (EC) es una enfermedad parasitaria causada por Trypanosoma cruzi, en la que hasta un 10–20% de los afectados pueden sufrir trastornos digestivos. Se han realizado múltiples estudios sobre la EC en países no endémicos, principalmente relacionados con el compromiso cardiológico. Sin embargo, los trastornos digestivos no se han analizado con tanta profundidad. El objetivo del estudio fue determinar la prevalencia de los trastornos digestivos en la EC importada en el momento de la primera atención. Métodos Se realizó un análisis descriptivo transversal observacional de la EC importada. Se evaluó el daño estructural chagásico y la comorbilidad digestiva infecciosa. También se investigó la asociación entre el daño estructural chagásico y la enfermedad cardíaca en pacientes con Chagas. Resultado Tras la revisión de un total de 1.216 historias clínicas, se seleccionaron para el análisis las de 464 pacientes. A nivel global, la prevalencia de trastornos digestivos en Chagas importado fue del 57,76% IC95% (53,25–62,27). La prevalencia de comorbilidad de enfermedades infecciosas fue de 40,73% IC95% (36,25–45,22). Se encontraron anomalías colónicas en 84 de 378 pacientes con enema de bario. Las anomalías esofágicas relacionadas con la EC estuvieron presentes en 63 de 380 pacientes estudiados con esofagograma. Conclusiones La prevalencia de trastornos digestivos asociados a EC es alta, por lo que conviene descartar la presencia de enfermedades infecciosas (principalmente parasitarias e infección por H. pylori). Es importante excluir afectación estructural en todos los pacientes sintomáticos, y también se debería considerar y ofrecer a pacientes asintomáticos (AU)

Prevalence of digestive disorders associated with imported Chagas disease (PADChI study): an observational study.

BACKGROUND: Chagas disease (CD) is a parasitic disease caused by Trypanosoma cruzi, in which up to 10-20% of those affected may suffer digestive disorders. Multiple studies have been carried out on CD in non-endemic countries, mainly related to cardiological involvement. However, digestive disorders have not been analyzed in such depth. The objective of the study was to determine the prevalence of digestive disorders in imported CD at the time of first care. METHODS: An observational cross-sectional descriptive analysis of imported CD was performed. Chagasic structural damage and infectious digestive comorbidity were evaluated. The association between Chagasic structural damage and heart disease in Chagas patients was also investigated. RESULTS: After reviewing a total of 1,216 medical records, those of 464 patients were selected for analysis. Globally, the prevalence of digestive disorders in imported Chagas was 57.76%, 95% CI (53.25-62.27). The prevalence of comorbidity of infectious diseases was 40.73% CI 95% (36.25-45.22). Colonic abnormalities were found in 84 of 378 barium enema patients. CD-related esophageal abnormalities were present in 63 of 380 patients studied with esophagogram. CONCLUSIONS: The prevalence of digestive disorders associated with CD is high, so the presence of infectious diseases (mainly parasitic and H. pylori infection) should be ruled out. It is important to exclude structural involvement in all symptomatic patients, and asymptomatic patients should also be considered and offered.

Aspergilosis pulmonar invasiva / Invasive pulmonary aspergillosis

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Review of effectiveness criteria in the application of Telemedicine

Telemedicine is a very useful tool and resource for medical diagnosis and treatment. Since its inception in the 70s it has developed progressively, demonstrating the clinical benefit it brings to patients and being increasingly present in the daily activities of clinicians. Different studies have tried to define and limit its effectiveness at the time of application versus face-to-face assistance, this being an important variable to clarify. This article reviews the different variables that have been coined to define the effectiveness when trying to demonstrate the cost-effectiveness of including telemedicine in daily healthcare activity

La telemedicina es una herramienta y recurso de gran utilidad para el diagnóstico y tratamiento médico. Desde su inicio en la década de los 70 se ha desarrollado de forma progresiva, demostrando el beneficio clínico que aporta a los pacientes y estando cada vez más presente en la actividad diaria de los clínicos. Diferentes estudios han tratado de definir y acotar su efectividad a la hora de aplicarse versus la asistencia presencial, siendo esta una variable importante a despejar. Este artículo realiza una revisión de las diferentes variables que se han acuñado para definir efectividad a la hora de tratar de demostrar la rentabilidad de incluir la telemedicina en la actividad asistencial diaria

Organización de la cuarentena hospitalaria en los evacuados de Wuhan al inicio de la pandemia de COVID-19 / Hospital organization quarantine in Wuhan evacuees at the start of the COVID-19 pandemic

INTRODUCCIÓN: El 31 de diciembre de 2019, la Organización Mundial de la Salud fue informada de un grupo de casos de neumonía de etiología desconocida detectados en la ciudad de Wuhan (China). El 30 de enero de 2020, se declaró el brote de nCoV-2019 (posteriormente SARS-CoV-2) como una emergencia de salud pública de preocupación internacional. En este contexto, algunos países occidentales, decidieron evacuar a sus ciudadanos. OBJETIVOS: En este artículo se describe el planteamiento llevado a cabo en el caso de las personas evacuadas desde Wuhan a su llegada a España. MATERIAL Y MÉTODO: Se recopiló información sobre los criterios para seleccionar las instalaciones y el personal, el número de casos en cuarentena, la estrategia de control de infección, la duración de la cuarentena, la monitorización clínica y otros aspectos relevantes. RESULTADOS: Las autoridades sanitarias españolas seleccionaron el Hospital Central de Defensa Gómez Ulla para realizar una cuarentena hospitalaria. Veintiuna personas fueron trasladadas de Wuhan a Madrid, incluidos dos niños. Los médicos de medicina preventiva y enfermedades infecciosas fueron seleccionados para dirigir y asistir la vigilancia. Las visitas fueron autorizadas siguiendo un protocolo establecido. CONCLUSIONES: Este es el primer informe sobre cuarentena hospitalaria para SARS-CoV-2, diseñado específicamente para repatriados. La cuarentena hospitalaria podría ser un método útil para casos seleccionados de enfermedades altamente contagiosas. Sin embargo, se necesita un buen soporte de recursos e instalaciones, selección de personal experimentado y protocolos revisados

INTRODUCTION: On December 31, 2019, the World Health Organization was informed of a group of cases of pneumonia of unknown etiology detected in the city of Wuhan (China). On January 30, 2020, the nCoV-2019 outbreak (later SARS-CoV-2) was declared a public health emergency of international concern. In this context, some western countries decided to evacuate their citizens. AIM: This article describes the approach taken in the case of people evacuated from Wuhan upon arrival in Spain. METHODS: Information was collected on the criteria for selecting facilities and personnel, the number of quarantine cases, the infection control strategy, the duration of quarantine, clinical monitoring, and other relevant aspects. RESULTS: The Spanish health authorities selected the Gómez Ulla Central Defense Hospital to carry out a hospital quarantine. Twenty-one people were transferred from Wuhan to Madrid, including two children. Preventive medicine and infectious disease physicians were selected to direct and assist surveillance. The visits were authorized following an established protocol. CONCLUSIONS: This is the first hospital quarantine report for SARS-CoV-2, designed specifically for returnees. Hospitalarian quarantine could be a useful method for selected cases of highly contagious diseases. However, good resource and facility support, selection of experienced staff, and revised protocols are required

[Diagnosis and treatment of imported eosinophilia in travellers and immigrants: Recommendations of the Spanish Society of Tropical Medicine and International Health (SEMTSI)]. / Diagnóstico y tratamiento de la eosinofilia importada en viajeros e inmigrantes: recomendaciones de la Sociedad Española de Medicina Tropical y Salud Internacional (SEMTSI).

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.

Paludismo importado en adultos. Perfil clínico, epidemiológico y analítico / Imported malaria in adults. Clinical, epidemiological and analytical features

Introducción. Las características epidemiológicas y clínicas de los casos de paludismo importado en España se han descrito hasta ahora en pequeñas series hospitalarias. En casi todas ellas el diagnóstico se ha realizado a partir de episodios sintomáticos. El objetivo del presente estudio es conocer las características epidemiológicas, clínicas y analíticas del paludismo importado en una Unidad de Referencia para Enfermedades Tropicales. Pacientes y métodos. . Se realiza un estudio observacional de corte transversal retrospectivo. La serie está constituida por los enfermos diagnosticados de malaria en el Hospital Carlos III entre el 1 de enero de 2002 y el 31 de diciembre de 2007. Resultados. Se identificaron 484 episodios de paludismo, incluyéndose en el análisis 398 casos. Casi la mitad de los pacientes eran nativos de zonas endémicas, mientras que la otra mitad eran viajeros o nativos-viajeros. En la mayoría de los viajes a zonas endémicas (88-98% según los grupos) no se había realizado quimioprofilaxis antipalúdica de forma correcta. El 30,4% de los pacientes se encontraban asintomáticos en el momento del diagnóstico. El 28,1% de los asintomáticos tenían anemia, el 19,8% trombopenia, el 14% leucopenia, el 5% hipocolesterolemia, el 5% insuficiencia renal y el 4,1% hipoglucemia. El 97,5% de los individuos asintomáticos tenían parasitemia baja, frente al 80,5% de los sintomáticos (p<0,001). Discusión. La mayoría de los pacientes que viajan a zonas endémicas en los que se diagnostica paludismo no realizan una quimioprofilaxis correcta. Se debe descartar la existencia de malaria en individuos procedentes de regiones tropicales con síntomas compatibles, así como también en algunos individuos asintomáticos con alteraciones analíticas(AU)

Introduction. Up to now, the epidemiological and clinical features of imported malaria in Spain have been described in small series from general hospitals. Almost all diagnosis had been made based on symptomatic patients. The aim of this study has been to determine the epidemiological, clinical and laboratorial characteristics of imported malaria in a Reference Unit for Tropical Diseases. Patients and methods. We performed a cross-sectional, observational and retrospective study. The series consisted of patients diagnosed of malaria who had been attended at the Hospital Carlos III from January 1, 2002 to December 31, 2007. Results. We identified 484 episodes of malaria, of which 398 cases were included in the analysis. Almost 50% of the patients were natives of endemic areas, while the rest were native-travelers or travelers. Most cases (88-98% according to the group) had not taken malaria chemoprophylaxis correctly when indicated. At the time of diagnosis, 30.4% of patients were asymptomatic and 28.1% of asymptomatic patients had anemia, 19.8% thrombocytopenia, 14% leukopenia, 5% hypocholesterolemia, 5% renal failure and 4.1% hypoglycemia. Low parasitemia was present in 97.5% of asymptomatic individuals compared to 80.5% of the symptomatic patients (P<0.001). Discussion. Absence of chemoprophylaxis (or poor compliance) is the main reason for malaria in individuals traveling to endemic areas. Malaria must be ruled out in individuals coming from tropical countries with compatible symptoms, and it also should be suspected in certain groups of asymptomatic individuals with abnormal laboratorial parameters(AU)

Paludismo importado e infección por VIH en Madrid. Perfil clínico y epidemiológico / Imported malaria and HIV infection in Madrid. Clinical and epidemiological features

Introducción. En España disponemos de pocos datos referentes a pacientes con paludismo coinfectados por el virus de inmunodeficiencia humana (VIH). Este estudio pretende precisar las características epidemiológicas y clínicas del paludismo importado en pacientes coinfectados por el VIH en nuestro medio. Pacientes y métodos. Serie de casos retrospectiva, a partir de las historias clínicas. La población de estudio está constituida por los enfermos diagnosticados de malaria en nuestro centro entre el 1 de enero de 2002 y el 31 de diciembre de 2007. Resultados. Se identificaron 484 episodios de paludismo, incluyéndose en el estudio 398 casos. La coinfección con el VIH se describió en 32 casos. Todos ellos ocurrieron en individuos en los que presumiblemente existía algún grado de semiinmunidad. En el grupo de los coinfectados se encontraban asintomáticos 13 casos (40,6%), mientras que esta circunstancia se produjo en 99 casos de los pacientes no coinfectados (37,2%) (p=0,707). Destacó la mayor presencia de anemia en los pacientes coinfectados (62,5% en pacientes VIH frente a 32,3% en los no coinfectados [p=0,001]). Conclusiones. Las formas de presentación clínica del paludismo no parecen variar en función de la coexistencia con infección por el VIH. Si bien la población estudiada no reproduce todos los escenarios posibles de infección por VIH, señala la realidad de los pacientes que llegan a la Comunidad Autónoma de Madrid(AU)

Introduction. Few data are available in Spain data on human immunodeficiency virus (HIV) patients coinfected with malaria. This study has aimed to determine the epidemiological and clinical characteristics of imported malaria in patients coinfected with HIV. Patients and methods. A case-series retrospective study was performed using the patient's medical records. The study population consisted on patients diagnosed with malaria attended in our center from january 1, 2002 to december 31, 2007. Results. A total of 484 episodes of malaria, 398 of which were included in this study, were identified. Co-infection with HIV was described in 32 cases. All of them occurred in individuals presumably with some degree of semi-immunity. In the coinfected group, there were 13 cases (40.6%) asymptomatic, whereas this event occurred in 99 cases of patients not coinfected (37.2%) (P=0.707). The greater presence of anemia in co-infected patients (62.5% vs 32.3% in non-coinfected [P=0.001]) stands out. Conclusions. In present study, the clinical presentation forms were similar, regardless of the presence or absence of HIV infection. Although the study population does not reflect all possible scenarios of malaria and HIV coinfection, our results indicate the reality of patients attended in the Autonomous Community of Madrid(AU)

[Imported malaria and HIV infection in Madrid. Clinical and epidemiological features]. / Paludismo importado e infección por VIH en Madrid. Perfil clínico y epidemiológico.

INTRODUCTION: Few data are available in Spain data on human immunodeficiency virus (HIV) patients coinfected with malaria. This study has aimed to determine the epidemiological and clinical characteristics of imported malaria in patients coinfected with HIV. PATIENTS AND METHODS: A case-series retrospective study was performed using the patient's medical records. The study population consisted on patients diagnosed with malaria attended in our center from january 1, 2002 to december 31, 2007. RESULTS: A total of 484 episodes of malaria, 398 of which were included in this study, were identified. Co-infection with HIV was described in 32 cases. All of them occurred in individuals presumably with some degree of semi-immunity. In the coinfected group, there were 13 cases (40.6%) asymptomatic, whereas this event occurred in 99 cases of patients not coinfected (37.2%) (P=0.707). The greater presence of anemia in co-infected patients (62.5% vs 32.3% in non-coinfected [P=0.001]) stands out. CONCLUSIONS: In present study, the clinical presentation forms were similar, regardless of the presence or absence of HIV infection. Although the study population does not reflect all possible scenarios of malaria and HIV coinfection, our results indicate the reality of patients attended in the Autonomous Community of Madrid.

[Imported malaria in adults. Clinical, epidemiological and analytical features]. / Paludismo importado en adultos. Perfil clínico, epidemiológico y analítico.

INTRODUCTION: Up to now, the epidemiological and clinical features of imported malaria in Spain have been described in small series from general hospitals. Almost all diagnosis had been made based on symptomatic patients. The aim of this study has been to determine the epidemiological, clinical and laboratorial characteristics of imported malaria in a Reference Unit for Tropical Diseases. PATIENTS AND METHODS: We performed a cross-sectional, observational and retrospective study. The series consisted of patients diagnosed of malaria who had been attended at the Hospital Carlos III from January 1, 2002 to December 31, 2007. RESULTS: We identified 484 episodes of malaria, of which 398 cases were included in the analysis. Almost 50% of the patients were natives of endemic areas, while the rest were native-travelers or travelers. Most cases (88-98% according to the group) had not taken malaria chemoprophylaxis correctly when indicated. At the time of diagnosis, 30.4% of patients were asymptomatic and 28.1% of asymptomatic patients had anemia, 19.8% thrombocytopenia, 14% leukopenia, 5% hypocholesterolemia, 5% renal failure and 4.1% hypoglycemia. Low parasitemia was present in 97.5% of asymptomatic individuals compared to 80.5% of the symptomatic patients (P<0.001). DISCUSSION: Absence of chemoprophylaxis (or poor compliance) is the main reason for malaria in individuals traveling to endemic areas. Malaria must be ruled out in individuals coming from tropical countries with compatible symptoms, and it also should be suspected in certain groups of asymptomatic individuals with abnormal laboratorial parameters.

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.

Tromboflebitis y neumonía en paciente VIH / Thrombophlebitis and pneumonia in HIV patient

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