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1.
Transplant Rev (Orlando) ; : 100528, 2020 Jan 13.
Artigo em Inglês | MEDLINE | ID: mdl-32001103

RESUMO

The immunosuppressive treatment that recipients receive from a solid organ transplantation hinders the defensive response to infection. Its transmission from the donor can cause dysfunction or loss of the graft and even death of the recipient if proper preventive measures are not established. This potential risk should be thoroughly evaluated to minimise the risk of infection transmission from donor to recipient, especially with organ transplantation from donors with infections, without increasing graft dysfunction and morbidity and mortality in the recipient. This document aims to review current knowledge about infection screening in potential donors and offer clinical and microbiological recommendations about the use of organs from donors with infection based on available scientific evidence.

2.
Future Microbiol ; 2020 Feb 17.
Artigo em Inglês | MEDLINE | ID: mdl-32065535

RESUMO

Globalization has contributed to the emergence of specific parasitic diseases in novel geographical areas, and in these regions, these infections in travelers and immigrants may cause a considerable burden of disease. Timely diagnosis and treatment of protozoan infections to decrease mortality and prevent associated complications are essential. In this respect, the increased availability of specific DNA-detection procedures has improved the diagnosis of many imported parasitic infections. Travelers and immigrants with associated comorbidities or immunosuppression may pose a special challenge regarding management. An updated review of the main protozoan infections in mobile populations (malaria, Chagas disease, leishmaniasis, enteric protozoan infections) is provided, focusing on the changing epidemiology of these diseases, recent developments in diagnosis and management and the possibility of local transmission of imported infections.

3.
Expert Rev Anti Infect Ther ; 18(2): 127-143, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31914335

RESUMO

Introduction: Recent increases in population movements have created novel health challenges in many areas of the World, and health policies have been adapted accordingly in several countries. However, screening guidelines for infectious diseases are not standardized and generally do not include comprehensive screening for parasitic infections.Areas covered: Malaria, Chagas disease, leishmaniasis, amebiasis, filariases, strongyloidiasis, and schistosomiasis are reviewed, focusing on the challenges posed for their diagnosis and management in vulnerable populations such as migrants. The methodology included literature searches in public databases such as PubMed.gov and Google Scholar and search of the US National Library of Medicine online database of privately and publicly funded clinical studies (ClinicalTrials.gov) until November 2019.Expert opinion: Parasitic infections which may remain asymptomatic for prolonged periods, leading to chronic infection and complications, and/or may be transmitted in non-endemic areas are ideal candidates for screening. Proposed strategies to improve diagnosis in vulnerable groups such as migrants include facilitating access to healthcare in a multi-dimensional manner considering location, individual characteristics, and timing. Limitations and availability of specific diagnostic techniques should be addressed and focus on drug and vaccine development for these neglected infections should be prioritized through collaborative initiatives with public disclosure of results.

4.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-31870646

RESUMO

The immunosuppressive treatment that recipients receive from a solid organ transplantation hinders the defensive response to infection. Its transmission from the donor can cause dysfunction or loss of the graft and even death of the recipient if proper preventive measures are not established. This potential risk should be thoroughly evaluated to minimise the risk of infection transmission from donor to recipient, especially with organ transplantation from donors with infections, without increasing graft dysfunction and morbidity and mortality in the recipient. This document aims to review current knowledge about infection screening in potential donors and offer clinical and microbiological recommendations about the use of organs from donors with infection based on available scientific evidence.

5.
J Travel Med ; 26(7)2019 Oct 14.
Artigo em Inglês | MEDLINE | ID: mdl-31407784

RESUMO

BACKGROUND: Chagas disease, or American trypanosomiasis, is a protozoan infectious disease endemic throughout most of the Americas, caused by the trypanosome, Trypanosoma cruzi, and mainly transmitted to humans by reduviid or kissing bugs. Some progress has been achieved in control of the disease mainly in endemic areas, but migration flows have acted as drivers for the emergence of the disease mainly in non-endemic areas of Europe and North America. Most imported cases of Chagas disease in Europe are reported in migrants from highly endemic areas of countries such as Bolivia and Paraguay, and reports of Chagas disease in travellers are extremely rare. METHODS: Pan American Health Organization (PAHO) recently updated their guidelines on the diagnosis and management of Chagas. These guidelines and their applicability to migrants and travellers are reviewed. RESULTS: PAHO recommends the use of two serological tests for diagnosis of chronic infection (allowing for the use of a single sensitive test followed by confirmation in special settings such as the screening of potential blood donors). The indication for specific trypanocidal treatment of acute infections, children and women of child-bearing age remains as before, with either benznidazole or nifurtimox being the treatment of choice. For chronic infection with/without organ damage, treatment recommendations are less well defined. Although treatment is generally not recommended in patients with visceral involvement, decisions regarding treatment need to be tailored to the individual. Either benznidazole or nifurtimox may be used for initial treatment. CONCLUSIONS: The recent PAHO Guidelines provide a framework to aid the diagnosis and management of this infection, but several aspects such as the underdiagnosis of infections, the multidisciplinary approach to patient management, the investigation of novel biomarkers of disease progression/response to treatment and the development of new treatment strategies are areas which should be further strengthened.

6.
Travel Med Infect Dis ; : 101460, 2019 Jul 29.
Artigo em Inglês | MEDLINE | ID: mdl-31369899

RESUMO

BACKGROUND: Tuberculosis (TB) is the leading cause of infectious disease mortality worldwide. We analysed active and latent TB infections (LTBI) from the Spanish Network for the Study of Imported Infectious Diseases by Travellers and Immigrants (+REDIVI). METHODS: Observational, retrospective, multicentre study of TB and LTBI registered in the +REDIVI network from October 2009 to December 2016. RESULTS: Of 1008 cases of LTBI, 884 (87.7%) were immigrants; 93 (4.5%), immigrants visiting friends and relatives (VFR); 2 (0.9%), VFR-travellers; and 29 (1.1%), travellers. Absolute (N = 157 vs. N = 75) and relative (12.5% vs. 5.9%) frequency decreased over the study period (p = 0.003). Median time to diagnosis was 24.6 months (females 50.3 vs males 11.9; p < 0.001). Of 448 TB cases, 405 (90.4%) were in immigrants; 30 (6.7%), VFR-immigrants; 6 (1.3%), VFR-travellers; and 7 (1.6%), travellers. Median time to diagnosis was 62.5 months (females 86.6 vs males 70.1; p = 0.0075). There were 8 multidrug resistant TB cases and 1 extensively drug resistant case of TB, all in immigrants. CONCLUSION: TB was frequently diagnosed more than 5 years after arrival in Spain. Screening programmes for TB and LTBI in immigrants should be considered beyond this time point. Women showed a higher diagnostic delay for both latent and active TB.

7.
Travel Med Infect Dis ; 29: 51-57, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30738196

RESUMO

BACKGROUND: Continuous growth of mobile populations has influenced the global epidemiology of infectious diseases, including chronic and acute viral hepatitis. METHOD: A prospective observational multicentre study was performed in a Spanish network of imported infections. Viral hepatitis cases from January 2009 to September 2017 were included. RESULTS: Of 14,546 records, 723 (4.97%) had imported viral hepatitis, including 48 (6.64%) acute cases and 675 (93.36%) chronic cases. Of the 48 acute cases, 31 were travellers and immigrants returning from visiting friends or relatives (VFR), while 19 (61%) were acute Hepatitis A or Hepatitis B. Only 18.2% of VFR immigrants and 35% of travellers received pre-travel advice. Acute hepatitis was more frequent in VFR immigrants (AOR 2.59, CI95% 1.20-5.60) and travellers (AOR 2.83, CI95% 1.46-5.50) than immigrants. Of the 675 Chronic cases, 570 were immigrants, and 439 (77%) had chronic Hepatitis B. Chronic hepatitis was more frequent in immigrants (AOR 20.22, CI95% 11.64-35.13) and VFR immigrants (AOR 11.12, CI95% 6.20-19.94) than travellers. CONCLUSIONS: Chronic viral hepatitis was typical of immigrants, acute viral hepatitis was common among travellers, and VFR immigrants had mixed risk. Improving pre-travel consultation and screening of immigrants may contribute to preventing new cases of viral hepatitis and avoiding community transmission.


Assuntos
Hepatite Viral Humana/epidemiologia , Migrantes/estatística & dados numéricos , Viagem/estatística & dados numéricos , Adolescente , Adulto , Doenças Transmissíveis Importadas/epidemiologia , Feminino , Humanos , Imunossupressão/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Risco , Espanha/epidemiologia
8.
PLoS Negl Trop Dis ; 13(2): e0007006, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30779741

RESUMO

BACKGROUND: Cystic echinococcosis (CE) is present in all continents, except for the Antarctica. Characteristically, CE lesions are found in the liver and the lungs, but virtually any part of the body may be affected (the spleen, kidneys, heart, central nervous system, bones, among others). It is estimated that the incidence of bone involvement in CE is 0.5% to 4%. METHODOLOGY: A retrospective study was performed of patients with osseous CE treated at the National Reference Unit of Tropical Diseases of the Ramon y Cajal Hospital, Madrid, Spain, between 1989 and December 2017. Epidemiological, clinical, diagnostic and therapeutic data of patients with long-term follow-up were collected. MAIN FINDINGS: During the study period, of the 104 patients with CE, 27 exhibited bone involvement (26%). The bones most frequently affected were the spine, followed by the ribs, pelvis, femur, tibia and the scapula. The most common symptom was pain followed by medullar syndrome and pathologic fracture. In total, 81.5% of patients underwent surgery for osseous CE at least once. As many as 96% received albendazol either in (mostly long-term) monotherapy or in combination with praziquantel. CONCLUSIONS: The diagnosis and management of osseous CE is challenging. In many cases osseous CE should be considered a chronic disease and should be managed on a case-by-case basis. Lifelong follow-up should be performed for potential recurrence and sequels.


Assuntos
Doenças Ósseas/patologia , Doenças Ósseas/parasitologia , Equinococose/patologia , Equinococose/parasitologia , Anti-Helmínticos/administração & dosagem , Anti-Helmínticos/uso terapêutico , Doenças Ósseas/epidemiologia , Doenças Ósseas/terapia , Equinococose/epidemiologia , Equinococose/terapia , Humanos , Recidiva , Estudos Retrospectivos , Espanha/epidemiologia
9.
Drug Saf ; 41(11): 1035-1048, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30006773

RESUMO

INTRODUCTION: Benznidazole is the preferred drug for treatment of Chagas disease. However, it is toxic and of limited value in chronic infection. OBJECTIVE: We aimed to estimate the rates of and factors related to adverse reactions (ARs) to benznidazole and treatment discontinuations (TDs). METHODS: A meta-analysis was performed using an electronic search of the published literature with no language restrictions until June 2017. Prospective studies were included of chronically infected patients in which at least one treatment arm included benznidazole. Data were added from a prospective cohort of patients with Chagas disease at our centre (January 2007-June 2017). Weighted rates of ARs and TDs were estimated, and potentially related factors were analysed. RESULTS: Some 413 studies were found, from which we chose 42 (nine clinical trials and 33 observational studies, including ours), comprising data for 7822 patients. The weighted rate of ARs to benznidazole was 44.1% (95% confidence interval [CI] 37.2-51.2). ARs were more frequent in adults than in children (51.6 vs. 24.5%), with the most common being skin reactions (34%), gastrointestinal complaints (12.6%) and neurological symptoms (11.5%). Grade 4 ARs were recorded in 3% of cases. The weighted rate of TDs was 11.4% (95% CI 8.5-14.5); TDs were more frequent in adults than in children (14.2 vs. 3.8%). In our cohort, only female sex was related to an increased rate of ARs but not to TDs. CONCLUSION: Benznidazole had a poor tolerability profile, with a high incidence of TDs, especially in adult patients and women. Optimised dosing schedules and/or new drugs are urgently needed.


Assuntos
Doença de Chagas/tratamento farmacológico , Nitroimidazóis/uso terapêutico , Tripanossomicidas/uso terapêutico , Fatores Etários , Doença Crônica , Relação Dose-Resposta a Droga , Esquema de Medicação , Humanos , Nitroimidazóis/administração & dosagem , Nitroimidazóis/efeitos adversos , Estudos Prospectivos , Fatores Sexuais , Tripanossomicidas/administração & dosagem , Tripanossomicidas/efeitos adversos
10.
Transpl Infect Dis ; 20(5): e12938, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-29863799

RESUMO

A 57-year-old man was admitted with fever and thrombocytopenia 1 month after renal transplantation. He had never received a blood transfusion or travelled outside Spain. A peripheral blood smear revealed Plasmodium malariae and P. ovale parasites, diagnosis confirmed later by malaria PCR. The donor, from Equatorial Guinea, had negative thick and thin blood smears and rapid malaria antigen test prior to organ donation. Peripheral blood malaria PCR was not performed during donor screening. The second renal recipient and the liver recipient were evaluated and were found to be asymptomatic. Thick and thin films and rapid malaria diagnostic tests were negative for both patients and blood for malaria PCR was sent to the referral laboratory. The index patient was treated with oral chloroquine diphosphate, with a favorable outcome and was considered cured. Malaria PCR was negative for the other renal recipient and positive for P. malariae and P. ovale curtisi for the liver transplant patient. Both were treated with oral chloroquine and the liver recipient also completed treatment with primaquine phosphate. This reported case of multiorgan transmission of mixed malaria infection highlights the importance of PCR-based tests for Plasmodium in the screening of donors from endemic areas.


Assuntos
Internacionalidade , Transplante de Rim/efeitos adversos , Transplante de Fígado/efeitos adversos , Malária/transmissão , Antígenos de Protozoários/isolamento & purificação , Antimaláricos/uso terapêutico , Guiné Equatorial , Feminino , Humanos , Malária/sangue , Malária/tratamento farmacológico , Malária/microbiologia , Masculino , Pessoa de Meia-Idade , Plasmodium malariae/imunologia , Plasmodium malariae/isolamento & purificação , Plasmodium ovale/imunologia , Plasmodium ovale/isolamento & purificação , Espanha , Doadores de Tecidos , Obtenção de Tecidos e Órgãos/métodos
11.
BMJ Case Rep ; 20182018 Mar 27.
Artigo em Inglês | MEDLINE | ID: mdl-29588298

RESUMO

Chagas disease is a parasitic disease that mostly affects Latin American countries, but it has currently become a worldwide epidemic due to migration. Both drugs marketed for its treatment (benznidazole and nifurtimox) are associated with a high rate of adverse reactions. Benznidazole is preferred initially because of its more favourable toxicity profile and perceived greater efficacy. Hypersensitivity dermatological reactions, gastrointestinal and neurological disturbances represent the most common drug-related adverse events. General symptoms such as fever, arthralgia, myalgia or bone marrow depression (leucopaenia) are seen less frequently. We describe the case of a 33-year-old woman with chronic Chagas disease who presented with acute gingival bleeding and severe thrombocytopaenia, probably related to benznidazole treatment. Temporal association with drug initiation and recovery after treatment withdrawal were demonstrated. Clinicians should be aware of the possible association between immune thrombocytopaenia and benznidazole, even though the pathogenesis remains unclear at present.


Assuntos
Doença de Chagas/tratamento farmacológico , Imunossupressores/efeitos adversos , Nitroimidazóis/efeitos adversos , Trombocitopenia/induzido quimicamente , Adulto , Doença Crônica , Feminino , Humanos , Imunossupressores/uso terapêutico , Nitroimidazóis/uso terapêutico
12.
Artigo em Inglês | IBECS | ID: ibc-171416

RESUMO

In a global world, knowledge of imported infectious diseases is essential in daily practice, both for the microbiologist-parasitologist and the clinician who diagnoses and treats infectious diseases in returned travelers. Tropical and subtropical countries where there is a greater risk of contracting an infectious disease are among the most frequently visited tourist destinations. The SEIMC considers it appropriate to produce a consensus document that will be useful to primary care physicians as well as specialists in internal medicine, infectious diseases and tropical medicine who help treat travelers returning from tropical and sub-tropical areas with infections. Preventive aspects of infectious diseases and infections imported by immigrants are explicitly excluded here, since they have been dealt with in other SEIMC documents. Various types of professionals (clinicians, microbiologists, and parasitologists) have helped produce this consensus document by evaluating the available evidence-based data in order to propose a series of key facts about individual aspects of the topic. The first section of the document is a summary of some of the general aspects concerning the general assessment of travelers who return home with potential infections. The main second section contains the key facts (causative agents, diagnostic procedures and therapeutic measures) associated with the major infectious syndromes affecting returned travelers [gastrointestinal syndrome (acute or persistent diarrhea); febrile syndrome with no obvious source of infection; localized cutaneous lesions; and respiratory infections]. Finally, the characteristics of special traveler subtypes, such as pregnant women and immunocompromised travelers, are described (AU)


En el mundo global, el conocimiento de las enfermedades infecciosas importadas es esencial en la práctica diaria, tanto para el microbiólogo-parasitólogo como para el clínico en enfermedades infecciosas que atiende a viajeros internacionales. Entre los destinos turísticos más visitados se encuentran muchos países tropicales o subtropicales, donde el riesgo de contraer una enfermedad infecciosa es más elevado. La SEIMC ha considerado pertinente la elaboración de un documento de consenso que sirva de ayuda tanto a médicos de Atención Primaria como a especialistas en Medicina Interna, Enfermedades Infecciosas y Medicina Tropical que atienden a viajeros que regresan con infecciones tras un viaje a zonas tropicales y subtropicales. Se han excluido de forma explícita los aspectos de prevención de estas y las infecciones importadas por inmigrantes, objeto de otros documentos de la SEIMC. Varios tipos de profesionales (clínicos, microbiólogos y parasitólogos) han desarrollado este documento de consenso tras evaluar los datos disponibles basados en la evidencia para proponer una serie de datos clave acerca de este aspecto. Inicialmente se revisan los aspectos generales acerca de la evaluación general del viajero que regresa con una potencial infección. En un segundo bloque se señalan los datos clave (agentes causales, procedimientos diagnósticos y medidas terapéuticas) de los síndromes infecciosos principales en el viajero que regresa (síndrome gastrointestinal (diarrea aguda o persistente), síndrome febril sin foco aparente, lesiones cutáneas localizadas e infecciones respiratorias). Finalmente se describen las características en viajeros especiales como la viajera embarazada y el viajero inmunodeprimido (AU)


Assuntos
Humanos , Masculino , Feminino , Doenças Transmissíveis/epidemiologia , Doenças Transmissíveis/microbiologia , Consenso , Eosinofilia/epidemiologia , Doenças do Sistema Nervoso/epidemiologia , Sociedades Médicas/organização & administração , Sociedades Médicas/normas , Microbiologia , Microbiologia/organização & administração , Saúde do Viajante , Medicina de Viagem/organização & administração
13.
Enferm Infecc Microbiol Clin ; 36(3): 187-193, 2018 03.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-28396090

RESUMO

In a global world, knowledge of imported infectious diseases is essential in daily practice, both for the microbiologist-parasitologist and the clinician who diagnoses and treats infectious diseases in returned travelers. Tropical and subtropical countries where there is a greater risk of contracting an infectious disease are among the most frequently visited tourist destinations. The SEIMC considers it appropriate to produce a consensus document that will be useful to primary care physicians as well as specialists in internal medicine, infectious diseases and tropical medicine who help treat travelers returning from tropical and sub-tropical areas with infections. Preventive aspects of infectious diseases and infections imported by immigrants are explicitly excluded here, since they have been dealt with in other SEIMC documents. Various types of professionals (clinicians, microbiologists, and parasitologists) have helped produce this consensus document by evaluating the available evidence-based data in order to propose a series of key facts about individual aspects of the topic. The first section of the document is a summary of some of the general aspects concerning the general assessment of travelers who return home with potential infections. The main second section contains the key facts (causative agents, diagnostic procedures and therapeutic measures) associated with the major infectious syndromes affecting returned travelers [gastrointestinal syndrome (acute or persistent diarrhea); febrile syndrome with no obvious source of infection; localized cutaneous lesions; and respiratory infections]. Finally, the characteristics of special traveler subtypes, such as pregnant women and immunocompromised travelers, are described.


Assuntos
Doenças Transmissíveis Importadas/diagnóstico , Doenças Transmissíveis Importadas/terapia , Humanos , Viagem
14.
Malar J ; 16(1): 407, 2017 10 10.
Artigo em Inglês | MEDLINE | ID: mdl-29017499

RESUMO

BACKGROUND: Imported malaria is a frequent diagnosis in travellers and migrants. The objective of this study was to describe the epidemiological and clinical characteristics of patients diagnosed with imported malaria within a Spanish collaborative network registering imported diseases (+REDIVI). In addition, the possible association between malaria and type of case, gender, age or area of exposure was explored. METHODS: Cases of imported malaria were identified among all cases registered in the +REDIVI database during the period October 2009-October 2016. Demographic, epidemiological and clinical characteristics were analysed. RESULTS: In total, 11,816 cases of imported infectious diseases were registered in +REDIVI's database between October 2009 and October 2016. Immigrants seen for the first time after migration accounted for 60.2% of cases, 21.0% of patients were travellers, and 18.8% were travellers/immigrants visiting friends and relatives (VFRs). There were 850 cases of malaria (850/11,816, 7.2%). Malaria was significantly more frequent in men than in women (56.8% vs 43.2%) and in VFR-immigrants (52.6%) as compared to travellers (21.3%), immigrants (20.7%) and VFR-travellers (5.4%) (p < 0.001). Although this data was not available for most patients with malaria, only a minority (29/217, 13.4%) mentioned correct anti-malarial prophylaxis. Sub-Saharan Africa was found to be the most common region of acquisition of malaria. Most common reason for consultation after travel was a febrile syndrome although an important proportion of immigrants were asymptomatic and presented only for health screening (27.3%). Around 5% of travellers presented with severe malaria. The most prevalent species of Plasmodium diagnosed was Plasmodium falciparum (81.5%). Malaria due to Plasmodium ovale/Plasmodium vivax was frequent among travellers (17%) and nearly 5% of all malaria cases in immigrants were caused by Plasmodium malariae. CONCLUSIONS: Malaria was among the five most frequent diagnoses registered in +REDIVI's database. Some significant differences were found in the distribution of malaria according to gender, type of case, species. Among all malaria cases, the most frequent diagnosis was P. falciparum infection in VFR-immigrant men.


Assuntos
Doenças Transmissíveis Importadas/epidemiologia , Malária/epidemiologia , Adulto , Fatores Etários , Antimaláricos/uso terapêutico , Doenças Transmissíveis Importadas/diagnóstico , Doenças Transmissíveis Importadas/parasitologia , Emigrantes e Imigrantes/estatística & dados numéricos , Feminino , Humanos , Malária/diagnóstico , Malária/parasitologia , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores Sexuais , Espanha/epidemiologia , Viagem
15.
Rev. esp. quimioter ; 30(1): 62-78, feb. 2017. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-159565

RESUMO

Los datos sobre prevalencia de la eosinofilia importada entre viajeros e inmigrantes la sitúan entre un 8%-28,5%. El estudio etiológico es en ocasiones complejo, y en función de lo exhaustivo del estudio y de la población analizada, se ha podido identificar una causa parasitaria en el 17%-75,9% de los individuos. Entre las dificultades que se encuentran para comparar los estudios están la heterogeneidad de las poblaciones estudiadas, el tipo de recogida (prospectiva/retrospectiva) y distintos protocolos diagnósticos. En este documento se detallan las recomendaciones del grupo de expertos de la Sociedad Española de Medicina Tropical y Salud Internacional (SEMTSI) para el diagnóstico y tratamiento de la eosinofilia importada (AU)


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 (AU)


Assuntos
Humanos , Masculino , Feminino , Eosinofilia/diagnóstico , Eosinofilia/terapia , Emigrantes e Imigrantes/estatística & dados numéricos , Conferências de Consenso como Assunto , Helmintíase/diagnóstico , Helmintos , Helmintos/isolamento & purificação , Imunoglobulina E/análise , Controle Sanitário de Viajantes , Sociedades Médicas/organização & administração , Sociedades Médicas/normas , Estudos Prospectivos , Saúde do Viajante , Helmintíase/epidemiologia , Estudos Retrospectivos , Eosinofilia/classificação , Ensaio de Imunoadsorção Enzimática/métodos , Western Blotting , Técnicas Imunoenzimáticas
16.
Euro Surveill ; 22(1)2017 Jan 05.
Artigo em Inglês | MEDLINE | ID: mdl-28080959

RESUMO

We describe the epidemiological pattern and genetic characteristics of 242 acute dengue infections imported to Europe by returning travellers from 2012 to 2014. The overall geographical pattern of imported dengue (South-east Asia > Americas > western Pacific region > Africa) remained stable compared with 1999 to 2010. We isolated the majority of dengue virus genotypes and epidemic lineages causing outbreaks and epidemics in Asia, America and Africa during the study period. Travellers acted as sentinels for four unusual dengue outbreaks (Madeira, 2012-13; Luanda, 2013; Dar es Salaam, 2014; Tokyo, 2014). We were able to characterise dengue viruses imported from regions where currently no virological surveillance data are available. Up to 36% of travellers infected with dengue while travelling returned during the acute phase of the infection (up to 7 days after symptom onset) or became symptomatic after returning to Europe, and 58% of the patients with acute dengue infection were viraemic when seeking medical care. Epidemiological and virological data from dengue-infected international travellers can add an important layer to global surveillance efforts. A considerable number of dengue-infected travellers are viraemic after arrival back home, which poses a risk for dengue introduction and autochthonous transmission in European regions where suitable mosquito vectors are prevalent.


Assuntos
Vírus da Dengue/isolamento & purificação , Dengue/epidemiologia , Dengue/transmissão , Surtos de Doenças , Vigilância de Evento Sentinela , Viagem , África/epidemiologia , Américas/epidemiologia , Ásia Sudeste/epidemiologia , Dengue/diagnóstico , Vírus da Dengue/genética , Europa (Continente)/epidemiologia , Genótipo , Humanos , Incidência , Filogenia , Reação em Cadeia da Polimerase Via Transcriptase Reversa/métodos , Medicina de Viagem/métodos
17.
Travel Med Infect Dis ; 15: 52-56, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-27818359

RESUMO

BACKGROUND: Post-artesunate delayed haemolysis is described as hemolytic anemia presenting days after malaria treatment in hyperparasitemic patients. Physiopathological mechanisms and clinical manifestations have not been thoroughly characterised. METHODS: We conducted a retrospective study of hospitalised malaria patients who received artemisinin derivatives from January 1, 2010 to December 31, 2015. RESULTS: 21 patients were included in the study: 11 travellers, 8 travellers visiting friends and relatives and 2 immigrants. Median age was 35.5 years (IQR: 25.7-44.8) and 11 were men. Eight patients received oral and 13 received intravenous (IV) artemisinin-based drugs. Follow-up after the malaria episode was available for 15 patients (12 with IV treatment). Four patients presented with delayed haemolysis 9-14 days after artesunate treatment; all had been admitted with severe malaria, were treated IV and had hyperparasitaemia (17%-33%). Other than hyperparasitaemia, no other factors were associated with artesunate haemolysis. Patients' outcomes were favourable and the only additional therapeutic measure needed was a blood transfusion. CONCLUSIONS: Delayed haemolysis is a frequent complication in hyperparasitemic malaria treated with IV artesunate. Follow-up is mandatory for at least 2 weeks after treatment initiation. This condition is potentially severe but does not appear to be life threatening.


Assuntos
Anemia Hemolítica/induzido quimicamente , Antimaláricos/efeitos adversos , Artemisininas/efeitos adversos , Hemólise , Malária/complicações , Malária/tratamento farmacológico , Administração Intravenosa , Adulto , Antimaláricos/administração & dosagem , Artemisininas/administração & dosagem , Artesunato , Feminino , Hospitalização , Humanos , Malária/parasitologia , Masculino , Pessoa de Meia-Idade , Encaminhamento e Consulta/estatística & dados numéricos , Estudos Retrospectivos , Espanha , Viagem
18.
Am J Trop Med Hyg ; 95(5): 1166-1168, 2016 Nov 02.
Artigo em Inglês | MEDLINE | ID: mdl-27601517

RESUMO

Zika virus (ZIKV) and chikungunya virus (CHIKV) are currently circulating in overlapping areas in the American continents and may both be transmitted by Aedes spp. mosquitoes. The first documented case, to the authors' knowledge, of sequential CHIKV and ZIKV infections diagnosed in a nonendemic area in a returning traveler is reported. The implications for heightened clinical surveillance for these infections and specific patient recommendations are emphasized.


Assuntos
Febre de Chikungunya/diagnóstico , Infecção por Zika virus/diagnóstico , Adulto , Aspartato Aminotransferases/sangue , Proteína C-Reativa/metabolismo , Febre de Chikungunya/complicações , Febre de Chikungunya/virologia , Vírus Chikungunya , Feminino , Honduras , Humanos , Zika virus , Infecção por Zika virus/complicações
19.
Acta Trop ; 164: 117-124, 2016 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-27619190

RESUMO

Symptomatic chronic Chagas disease affects up to 40% of patients infected with Trypanosoma cruzi. The lack of reliable early markers of cure after therapy hinders disease management and clinical trials with new drugs. We performed a study with 18 months of follow-up to compare changes in immune parameters and T. cruzi-specific immune responses as surrogate markers of response to therapy between patients treated with benznidazole and untreated patients. This was a pilot, open-label, randomised clinical trial of treatment with benznidazole versus no treatment in patients with indeterminate chronic T. cruzi infection. In both groups we investigated changes in T-cell activation, T-cell subpopulations, regulatory T-cell counts, IL6, and sCD14 levels, and T. cruzi-specific immune responses (Th1, Th2, and Th17 responses). Fourteen patients were included in the study (seven in each group). Median age was 35 years (P25-75 31-43), 57% were female, and 93% were Bolivian. Benznidazole was administered at 5mg/kg/day for 60days. Three patients discontinued benznidazole owing to adverse reactions and were not evaluated. At the end of the follow-up period, treated patients showed significantly less immune activation and lower regulatory T-cell counts, with an increased Th17 and Th1 response. This randomised pilot clinical trial administering benznidazole to patients with indeterminate chronic Chagas disease brings about changes in the adaptive immunity, leading to a general decrease in inflammatory status. This apparently beneficial response could act as the basis for monitoring new antiparasitic drugs.


Assuntos
Doença de Chagas/tratamento farmacológico , Nitroimidazóis/uso terapêutico , Tripanossomicidas/uso terapêutico , Trypanosoma cruzi/imunologia , Adulto , Idoso , Biomarcadores , Doença de Chagas/imunologia , Doença Crônica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento
20.
Euro Surveill ; 21(36)2016 Sep 08.
Artigo em Inglês | MEDLINE | ID: mdl-27631156

RESUMO

Since the first documented autochthonous transmission of chikungunya virus in the Caribbean island of Saint Martin in 2013, the infection has been reported within the Caribbean region as well as North, Central and South America. The risk of autochthonous transmission of chikungunya virus becoming established in Spain may be elevated due to the large numbers of travellers returning to Spain from countries affected by the 2013 epidemic in the Caribbean and South America, as well as the existence of the Aedes albopictus vector in certain parts of Spain. We retrospectively analysed the laboratory diagnostic database of the National Centre for Microbiology, Institute of Health Carlos III (CNM-ISCIII) from 2008 to 2014. During the study period, 264 confirmed cases, of 1,371 suspected cases, were diagnosed at the CNM-ISCIII. In 2014 alone, there were 234 confirmed cases. The highest number of confirmed cases were reported from the Dominican Republic (n = 136), Venezuela (n = 30) and Haiti (n = 11). Six cases were viraemic in areas of Spain where the vector is present. This report highlights the need for integrated active case and vector surveillance in Spain and other parts of Europe where chikungunya virus may be introduced by returning travellers.


Assuntos
Febre de Chikungunya/diagnóstico , Vírus Chikungunya/isolamento & purificação , Febre/etiologia , Viagem , Aedes/virologia , Animais , Febre de Chikungunya/epidemiologia , Febre de Chikungunya/virologia , Vírus Chikungunya/genética , Surtos de Doenças , República Dominicana , Feminino , Haiti , Humanos , Insetos Vetores/virologia , Masculino , RNA Viral , Estudos Retrospectivos , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Vigilância de Evento Sentinela , Espanha/epidemiologia , Venezuela
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