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1.
Infect Dis Poverty ; 9(1): 16, 2020 Feb 07.
Artigo em Inglês | MEDLINE | ID: mdl-32029005

RESUMO

BACKGROUND: Loiasis is an uncommon and poorly understood parasitic disease outside endemic areas of Africa. The aim of this study was to describe the clinical and biological patterns and treatment of imported loiasis by sub-Saharan migrants diagnosed in Madrid, Spain. METHODS: A retrospective study was conducted with sub-Saharan immigrants seen at the Tropical Medicine Unit of the Carlos III Hospital in Madrid, Spain, a reference center, over 19 years. Categorical variables were expressed as frequency counts and percentages. Continuous variables were expressed as the mean and standard deviation (SD) or median and interquartile range (IQR: Q3-Q1). Chi-square tests were used to assess the association between categorical variables. The measured outcomes were expressed as the odds ratio (OR) with a 95% confidential interval. Continuous variables were compared by Student's t-tests or Mann-Whitney U tests. Binary logistic regression models were used. P <  0.05 was considered a statistically significant difference. RESULTS: One hundred thirty-one migrants from tropical and subtropical areas with loiasis were identified. Forty-nine patients were male (37.4%). The migrants' mean age (±SD) was 42.3 ± 17.3 years, and 124 (94.7%) were from Equatorial Guinea. The median time (IQR) between arrival in Spain and the first consultation was 2 (1-7) months. One hundred fifteen migrants had eosinophilia, and one hundred thirteen had hyper-IgE syndrome. Fifty-seven patients had pruritus (43.5%), and thirty patients had Calabar swelling (22.9%). Seventy-three patients had coinfections with other filarial nematodes (54.2%), and 58 migrants had only Loa loa infections (45.8%). One hundred two patients (77.9%) were treated; 45.1% (46/102) patients were treated with one drug, and 54.9% (56/102) patients were treated with combined therapy. Adverse reactions were described in 14 (10.7%) migrants. CONCLUSIONS: Our patients presented early clinical manifestations and few atypical features. Thus, physicians should systematically consider loiasis in migrants with a typical presentation. However, considering that 72.5% of the patients had only positive microfilaremia without any symptoms, we suggest searching for microfilaremia in every migrant from endemic countries for loiasis presenting with eosinophilia.

2.
Enferm Infecc Microbiol Clin ; 37(9): 602-608, 2019 Nov.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-29907366

RESUMO

Ribavirin is a molecule with antiviral activity against different viruses. In clinical practice, it has made its niche almost exclusively for the treatment of the hepatitisC virus. However, there are other diseases in which it could be of benefit and it has the advantage of being suitable for oral, intravenous and inhaled administration. We conducted a review of the indications of the main drug agencies (Spanish, European and American) and other possible indications, mainly haemorrhagic fevers and coronavirus.

3.
Enferm. infecc. microbiol. clín. (Ed. impr.) ; 36(10): 633-639, dic. 2018. tab, ilus, graf
Artigo em Espanhol | IBECS | ID: ibc-176928

RESUMO

Introduction: Onchocerciasis is caused by Onchocerca volvulus and mainly leads to pruritus and skin and visual disorders, including blindness. Seventeen million people are infected in 38 countries; 31 of these are in sub-Saharan Africa, six in Latin America and one on the Arabian Peninsula. More than 99% of cases occur in sub-Saharan Africa where 120 million people are at risk of infection. Eye disorders have been well-documented; however, skin disorders have not been described accurately. The objective of our study was to describe the epidemiology, main skin manifestations and treatment of imported onchocerciasis. Material and methods: A retrospective study was thus conducted by analysing the main demographic, clinical and treatment data regarding a cohort of 400 patients attending a reference clinical unit over a 17-year period. Results: Most patients were female (55%) with mean age 37.5 ± 16.7 years. All the migrants came from sub-Saharan countries. The most frequently occurring dermatological symptom was pruritus. Ivermectin had been used as first-line therapy and adverse reactions had been described in 11 patients (3.2%). Conclusions: The results indicate the fact that there should be a clinical suspicion of onchocerciasis regarding immigrants from endemic areas having skin lesions compatible with the disease's profile or asymptomatic patients having eosinophilia or unexplained high IgE. Moreover, skin snips from the buttocks region were very fruitful and treatment with ivermectin was seen to be safe. This is the largest case series regarding imported onchocerciasis described up to the present time


Introducción: La oncocercosis está causada por Onchocerca volvulus que produce fundamentalmente trastornos cutáneos, prurito y alteraciones visuales. Diecisiete millones de personas están infectadas en 38 países; 31 de ellos en África subsahariana, 6 en América Latina y uno en la península arábiga. Más del 99% de los casos se producen en el África subsahariana, donde 120 millones de personas están en riesgo de infección. Mientras los trastornos oculares han sido bien documentados, los trastornos cutáneos no se han descrito con precisión. El objetivo de nuestro estudio es describir la epidemiología, las principales manifestaciones cutáneas y el tratamiento de la oncocercosis importada. Material y métodos: Estudio retrospectivo de una cohorte de 400 pacientes atendidos en una unidad de referencia a lo largo de un período de 17 años con los principales datos demográficos, clínicos y de tratamiento. Resultados: La mayoría de pacientes eran mujeres (55%) con una edad media de 37,5 ± 16,7 años. Todos los migrantes procedían de países subsaharianos. El síntoma dermatológico más frecuente fue el prurito. La ivermectina fue el fármaco de elección, describiéndose reacciones adversas en 11 pacientes (3,2%). Conclusiones: Los resultados señalan de que se debe mantener una sospecha clínica de oncocercosis en inmigrantes procedentes de áreas endémicas y lesiones cutáneas sugerentes o en pacientes asintomáticos con eosinofilia o IgE inexplicada. Además, los pellizcos cutáneos de glúteos fueron altamente rentables. El tratamiento con ivermectina es seguro. Esta es la mayor serie de casos de oncocercosis importada descrita hasta la fecha


Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Onchocerca volvulus/isolamento & purificação , Oncocercose/diagnóstico , Oncocercose/tratamento farmacológico , Doenças Negligenciadas , Dermatopatias/parasitologia , Estudos Retrospectivos , Estudos de Coortes , Emigração e Imigração , Dermatopatias/diagnóstico , Dermatopatias/tratamento farmacológico
4.
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
5.
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
6.
Enferm Infecc Microbiol Clin ; 36(10): 633-639, 2018 12.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-29275076

RESUMO

INTRODUCTION: Onchocerciasis is caused by Onchocerca volvulus and mainly leads to pruritus and skin and visual disorders, including blindness. Seventeen million people are infected in 38 countries; 31 of these are in sub-Saharan Africa, six in Latin America and one on the Arabian Peninsula. More than 99% of cases occur in sub-Saharan Africa where 120 million people are at risk of infection. Eye disorders have been well-documented; however, skin disorders have not been described accurately. The objective of our study was to describe the epidemiology, main skin manifestations and treatment of imported onchocerciasis. MATERIAL AND METHODS: A retrospective study was thus conducted by analysing the main demographic, clinical and treatment data regarding a cohort of 400 patients attending a reference clinical unit over a 17-year period. RESULTS: Most patients were female (55%) with mean age 37.5±16.7 years. All the migrants came from sub-Saharan countries. The most frequently occurring dermatological symptom was pruritus. Ivermectin had been used as first-line therapy and adverse reactions had been described in 11 patients (3.2%). CONCLUSIONS: The results indicate the fact that there should be a clinical suspicion of onchocerciasis regarding immigrants from endemic areas having skin lesions compatible with the disease's profile or asymptomatic patients having eosinophilia or unexplained high IgE. Moreover, skin snips from the buttocks region were very fruitful and treatment with ivermectin was seen to be safe. This is the largest case series regarding imported onchocerciasis described up to the present time.


Assuntos
Doenças Transmissíveis Importadas , Oncocercose , Dermatopatias Parasitárias , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Doenças Transmissíveis Importadas/diagnóstico , Doenças Transmissíveis Importadas/tratamento farmacológico , Doenças Transmissíveis Importadas/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Oncocercose/diagnóstico , Oncocercose/tratamento farmacológico , Oncocercose/epidemiologia , Estudos Retrospectivos , Dermatopatias Parasitárias/diagnóstico , Dermatopatias Parasitárias/tratamento farmacológico , Dermatopatias Parasitárias/epidemiologia , Adulto Jovem
7.
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
8.
Lancet Respir Med ; 3(7): 554-62, 2015 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-26041403

RESUMO

BACKGROUND: In the current epidemic of Ebola virus disease, health-care workers have been transferred to Europe and the USA for optimised supportive care and experimental treatments. We describe the clinical course of the first case of Ebola virus disease contracted outside of Africa, in Madrid, Spain. METHODS: Herein we report clinical, laboratory, and virological findings of the treatment of a female nurse assistant aged 44 years who was infected with Ebola virus around Sept 25-26, 2014, while caring for a Spanish missionary with confirmed Ebola virus disease who had been medically evacuated from Sierra Leone to La Paz-Carlos III University Hospital, Madrid. We also describe the use of experimental treatments for Ebola virus disease in this patient. FINDINGS: The patient was symptomatic for 1 week before first hospital admission on Oct 6, 2014. We used supportive treatment with intravenous fluids, broad-spectrum antibiotics, and experimental treatments with convalescent plasma from two survivors of Ebola virus disease and high-dose favipiravir. On day 10 of illness, she had acute respiratory distress syndrome, possibly caused by transfusion-related acute lung injury, which was managed without mechanical ventilation. Discharge was delayed because of the detection of viral RNA in several bodily fluids despite clearance of viraemia. The patient was discharged on day 34 of illness. At the time of discharge, the patient had possible subacute post-viral thyroiditis. None of the people who had contact with the patient before and after admission became infected with Ebola virus. INTERPRETATION: This report emphasises the uncertainties about the efficacy of experimental treatments for Ebola virus disease. Clinicians should be aware of the possibility of transfusion-related acute lung injury when using convalescent plasma for the treatment of Ebola virus disease. FUNDING: La Paz-Carlos III University Hospital.


Assuntos
Doença pelo Vírus Ebola/terapia , Assistentes de Enfermagem , Doenças Profissionais/etiologia , Plasma , Síndrome do Desconforto Respiratório do Adulto/etiologia , Lesão Pulmonar Aguda/etiologia , Adulto , Amidas/uso terapêutico , Antivirais/uso terapêutico , Feminino , Humanos , Doenças Profissionais/terapia , Isolamento de Pacientes , Pirazinas/uso terapêutico , Síndrome do Desconforto Respiratório do Adulto/terapia , Espanha , Superinfecção/etiologia , Reação Transfusional , Carga Viral
9.
Enferm. infecc. microbiol. clín. (Ed. impr.) ; 33(6): e1-e13, jun.-jul. 2015. tab, ilus
Artigo em Espanhol | IBECS | ID: ibc-142124

RESUMO

La malaria es una de las enfermedades tropicales importadas que con más frecuencia se diagnostican en nuestro país. La mortalidad en viajeros que adquieren la enfermedad oscila alrededor del 2-3%, siendo el principal factor asociado al mal pronóstico el retraso diagnóstico y del inicio del tratamiento antiparasitario. Los casos de malaria importada suelen presentarse con fiebre, cefalea y artromialgias, aunque pueden aparecer otros síntomas. El diagnóstico se debe realizar de forma urgente, a través de gota gruesa o pruebas de diagnóstico rápido, y extensión sanguínea. El tratamiento debe ser instaurado lo antes posible. En los casos de malaria grave, el uso de artemisininas intravenosas ha demostrado ser superior al uso de quinina intravenosa. 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 malaria importada (AU)


Malaria is a common parasitic disease diagnosed in the returned traveler. Mortality in travelers with imported malaria is around 2-3%, and one of the main factors associated with poor prognosis is the delay in the diagnosis and treatment. Imported malaria cases usually present with fever, headache and myalgia, but other symptoms may appear. The diagnosis should be performed as soon as possible, using thick smear or rapid diagnostic tests, and a blood smear. Treatment should be initiated urgently. In cases of severe malaria, the use of intravenous artemisinins has proved to be superior to intravenous quinine. This document reviews the recommendations of the expert group of the Spanish Society of Tropical Medicine and International Health (SEMTSI) for the diagnosis and treatment of imported malaria in Spain (AU)


Assuntos
Adulto , Criança , Feminino , Humanos , Recém-Nascido , Masculino , Gravidez , Malária/diagnóstico , Malária/tratamento farmacológico , Malária/epidemiologia , Malária/mortalidade , Antimaláricos/uso terapêutico , Malária Falciparum/tratamento farmacológico , Artemisininas/uso terapêutico , Quinina/uso terapêutico , Parasitemia/microbiologia , Monitoramento Epidemiológico/tendências , Técnicas e Procedimentos Diagnósticos , Artemisininas/administração & dosagem , Quinina/administração & dosagem , Complicações na Gravidez , Doenças do Recém-Nascido , Malária Vivax , Malária Cerebral , Plasmodium ovale , Plasmodium knowlesi , Espanha/epidemiologia
10.
Enferm Infecc Microbiol Clin ; 33(6): e1-e13, 2015.
Artigo em Espanhol | MEDLINE | ID: mdl-24656967

RESUMO

Malaria is a common parasitic disease diagnosed in the returned traveler. Mortality in travelers with imported malaria is around 2-3%, and one of the main factors associated with poor prognosis is the delay in the diagnosis and treatment. Imported malaria cases usually present with fever, headache and myalgia, but other symptoms may appear. The diagnosis should be performed as soon as possible, using thick smear or rapid diagnostic tests, and a blood smear. Treatment should be initiated urgently. In cases of severe malaria, the use of intravenous artemisinins has proved to be superior to intravenous quinine. This document reviews the recommendations of the expert group of the Spanish Society of Tropical Medicine and International Health (SEMTSI) for the diagnosis and treatment of imported malaria in Spain.


Assuntos
Antimaláricos/uso terapêutico , Malária/diagnóstico , Malária/terapia , Adulto , Algoritmos , Anticonvulsivantes/uso terapêutico , Antimaláricos/administração & dosagem , Transfusão de Sangue , Criança , Terapia Combinada , Comorbidade , Diagnóstico Precoce , Feminino , Hidratação , Humanos , Malária/epidemiologia , Malária/transmissão , Parasitemia/diagnóstico , Parasitologia/métodos , Gravidez , Complicações Infecciosas na Gravidez/diagnóstico , Complicações Infecciosas na Gravidez/terapia , Sociedades Médicas , Espanha/epidemiologia , Viagem , Medicina Tropical
11.
Parasitol Res ; 113(7): 2587-91, 2014 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-24770719

RESUMO

Microscopy and rapid diagnostic tests (RDTs) are the techniques commonly used for malaria diagnosis but they are usually insensitive at very low levels of parasitemia. Nested PCR is commonly used as a reference technique in the diagnosis of malaria due to its high sensitivity and specificity. However, it is a cumbersome assay only available in reference centers. We evaluated a new nested PCR-based assay, BIOMALAR kit (Biotools B&M Labs, Madrid, Spain) which employs ready-to-use gelled reagents and allows the identification of the main four species of Plasmodium. Blood samples were obtained from patients with clinical suspicion of malaria. A total of 94 subjects were studied. Fifty-two (55.3%) of them were malaria-infected subjects corresponding to 48 cases of Plasmodium falciparum, 1 Plasmodium malariae, 2 Plasmodium vivax, and 1 Plasmodium ovale. The performance of the BIOMALAR test was compared with microscopy, rapid diagnostic test (RDT) (BinaxNOW® Malaria) and real-time quantitative PCR (qPCR). The BIOMALAR test showed a sensitivity of 98.1% (95% confidence interval [CI], 89.7-100), superior to microscopy (82.7% [95% CI, 69.7-91.8]) and RDT (94.2% [95% CI, 84.1-98.8]) and similar to qPCR (100% [95% CI, 93.2-100]). In terms of specificity, the BIOMALAR assay showed the same value as microscopy and qPCR (100% [95% CI, 93.2-100]). Nine subjects were submicroscopic carriers of malaria. The BIOMALAR test identified almost all of them (8/9) in comparison with RDT (6/9) and microscopy (0/9). In conclusion, the BIOMALAR is a PCR-based assay easy to use with an excellent performance and especially useful for diagnosis submicroscopic malaria.


Assuntos
Malária/diagnóstico , Plasmodium falciparum/genética , Plasmodium malariae/genética , Plasmodium ovale/genética , Plasmodium vivax/genética , Reação em Cadeia da Polimerase/métodos , Adulto , Estudos de Casos e Controles , Testes Diagnósticos de Rotina , Feminino , Genes de RNAr , Humanos , Malária/parasitologia , Masculino , Microscopia , Pessoa de Meia-Idade , Plasmodium falciparum/isolamento & purificação , Plasmodium malariae/isolamento & purificação , Plasmodium ovale/isolamento & purificação , Plasmodium vivax/isolamento & purificação , RNA Ribossômico 18S/genética , Sensibilidade e Especificidade , Viagem
12.
Emerg Infect Dis ; 20(3): 409-16, 2014 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-24572501

RESUMO

Sequencing data from Plasmodium ovale genotypes co-circulating in multiple countries support the hypothesis that P. ovale curtisi and P. ovale wallikeri are 2 separate species. We conducted a multicenter, retrospective, comparative study in Spain of 21 patients who had imported P. ovale curtisi infections and 14 who had imported P. ovale wallikeri infections confirmed by PCR and gene sequencing during June 2005-December 2011. The only significant finding was more severe thrombocytopenia among patients with P. ovale wallikeri infection than among those with P. ovale curtisi infection (p = 0.031). However, we also found nonsignificant trends showing that patients with P. ovale wallikeri infection had shorter time from arrival in Spain to onset of symptoms, lower level of albumin, higher median maximum core temperature, and more markers of hemolysis than did those with P. ovale curtisi infection. Larger, prospective studies are needed to confirm these findings.


Assuntos
Malária/epidemiologia , Malária/parasitologia , Plasmodium ovale/classificação , Adolescente , Adulto , Criança , Comorbidade , Feminino , História do Século XXI , Humanos , Malária/complicações , Malária/diagnóstico , Malária/história , Masculino , Pessoa de Meia-Idade , Plasmodium ovale/genética , Estudos Retrospectivos , Espanha/epidemiologia , Trombocitopenia/diagnóstico , Trombocitopenia/etiologia , Adulto Jovem
13.
Int J Infect Dis ; 18: 32-7, 2014 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-24211226

RESUMO

OBJECTIVES: The objective of this study was to assess the epidemiological, laboratory, and clinical features of imported strongyloidiasis in a tropical medicine referral unit in Madrid, Spain. METHODS: This was a retrospective study based on a review of medical records. A patient was diagnosed with strongyloidiasis when the infection could be detected by conventional stool analysis and/or serology against Strongyloides stercoralis, regardless of the presence of symptoms. RESULTS: One hundred and seventy-eight cases of strongyloidiasis were included in the study. Stool tests were performed in all patients, and serology in 160 patients (89.9%). The diagnosis of strongyloidiasis was based on serology only in four patients; 21 patients only had positive stool tests. A third of the total strongyloidiasis cases in this study were travel-related, mainly associated with short trips (<2 months). Only 47.8% of total cases were symptomatic. We found no differences in clinical presentation between immigrants and travelers with strongyloidiasis. CONCLUSIONS: Not only should strongyloidiasis be suspected in symptomatic travelers and immigrants, but it should also be ruled out when elevated IgE levels or eosinophilia are present. Strongyloidiasis can be asymptomatic in HIV patients, but it should be diagnosed and treated before a possible hyperinfection develops.


Assuntos
Estrongiloidíase/diagnóstico , Estrongiloidíase/tratamento farmacológico , Estrongiloidíase/epidemiologia , Adulto , Animais , Doenças Assintomáticas , Emigração e Imigração , Eosinofilia/patologia , Fezes/parasitologia , Feminino , Humanos , Imunoglobulina E/sangue , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Espanha/epidemiologia , Strongyloides stercoralis/isolamento & purificação , Viagem
14.
Enferm. infecc. microbiol. clín. (Ed. impr.) ; 31(10): 669-671, dic. 2013. tab
Artigo em Espanhol | IBECS | ID: ibc-118185

RESUMO

Fundamento: Existen pocos datos sobre la eficacia de etravirina (ETV) en la práctica clínica. Métodos Estudio observacional retrospectivo para evaluar su uso, su eficacia y su tolerabilidad. Resultados Los principales motivos de uso de ETV en 151 pacientes pretratrados fueron toxicidad y fracaso virológico. La tolerancia fue buena, y tras 16 meses, el 76,16% tienen carga viral indetectable. Los pacientes con carga viral detectable al inicio tuvieron mayor riesgo de fracaso (31,7% vs 18%; p = 0,05).Conclusiones ETV puede considerarse un fármaco seguro, eficaz y duradero (AU)


Background: There are limited data on etravirine (ETV) use in routine clinical practice. Methods: The reasons, efficacy and tolerability of its use are retrospectively reviewed. Results: Overall, 151 patients started a regimen containing ETV. The main reasons for prescription were toxicity and virological failure. After a median follow-up of 16 months 76.2% of the patients had an undetectable viral load. Patients with detectable HIV-RNA at baseline had a greater risk of failure (31.7% vs18%; P = .05).Conclusion: ETV is safe, effective and durable (AU)


Assuntos
Humanos , Inibidores da Transcriptase Reversa/farmacocinética , Infecções por HIV/tratamento farmacológico , HIV-1/patogenicidade , Antirretrovirais/farmacocinética , Carga Viral , Estudos Retrospectivos , Terapia Antirretroviral de Alta Atividade
15.
Enferm Infecc Microbiol Clin ; 31(10): 669-71, 2013 Dec.
Artigo em Espanhol | MEDLINE | ID: mdl-24128390

RESUMO

BACKGROUND: There are limited data on etravirine (ETV) use in routine clinical practice. METHODS: The reasons, efficacy and tolerability of its use are retrospectively reviewed. RESULTS: Overall, 151patients started a regimen containing ETV. The main reasons for prescription were toxicity and virological failure. After a median follow-up of 16months 76.2% of the patients had an undetectable viral load. Patients with detectable HIV-RNA at baseline had a greater risk of failure (31.7% vs 18%; P=.05). CONCLUSION: ETV is safe, effective and durable.


Assuntos
Infecções por HIV/tratamento farmacológico , Piridazinas/uso terapêutico , Inibidores da Transcriptase Reversa/uso terapêutico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
16.
Malar J ; 11: 324, 2012 Sep 12.
Artigo em Inglês | MEDLINE | ID: mdl-22970903

RESUMO

BACKGROUND: Submicroscopic malaria (SMM) can be defined as low-density infections of Plasmodium that are unlikely to be detected by conventional microscopy. Such submicroscopic infections only occasionally cause acute disease, but they are capable of infecting mosquitoes and contributing to transmission. This entity is frequent in endemic countries; however, little is known about imported SMM.The goals of this study were two-fold: a) to know the frequency of imported SMM, and b) to describe epidemiological, laboratorial and clinical features of imported SMM. METHODS: A retrospective study based on review of medical records was performed. The study population consisted of patients older than 15 years attended at the Tropical Medicine Unit of Hospital Carlos III, between January 1, 2002 and December 31, 2007. Routinely detection techniques for Plasmodium included Field staining and microscopic examination through thick and thin blood smear. A semi-nested multiplex malaria PCR was used to diagnose or to confirm cases with low parasitaemia. RESULTS: SMM was diagnosed in 104 cases, representing 35.5% of all malaria cases. Mean age (IC95%) was 40.38 years (37.41-43.34), and sex distribution was similar. Most cases were in immigrants, but some cases were found in travellers. Equatorial Guinea was the main country where infection was acquired (81.7%). Symptoms were present only in 28.8% of all SMM cases, mainly asthenia (73.3% of symptomatic patients), fever (60%) and arthromialgias (53.3%). The associated laboratory abnormalities were anaemia (27.9%), leukopaenia (15.4%) and thrombopaenia (15.4%). Co-morbidity was described in 75 cases (72.1%). CONCLUSIONS: Results from this study suggest that imported SMM should be considered in some patients attended at Tropical Medicine Units. Although it is usually asymptomatic, it may be responsible of fever, or laboratory abnormalities in patients coming from endemic areas. The possibility of transmission in SMM has been previously described in endemic zones, and presence of vector in Europe has also been reported. Implementation of molecular tests in all asymptomatic individuals coming from endemic area is not economically feasible. So re-emergence of malaria (Plasmodium vivax) in Europe may be speculated.


Assuntos
Doenças Assintomáticas/epidemiologia , Malária/diagnóstico , Malária/epidemiologia , Plasmodium/isolamento & purificação , Adulto , Idoso , Técnicas de Laboratório Clínico/métodos , Emigração e Imigração , Feminino , Humanos , Malária/parasitologia , Malária/patologia , Masculino , Microscopia/métodos , Pessoa de Meia-Idade , Reação em Cadeia da Polimerase Multiplex/métodos , Parasitologia/métodos , Reação em Cadeia da Polimerase/métodos , Estudos Retrospectivos , Espanha , Viagem
20.
J Travel Med ; 17(2): 139-40, 2010.
Artigo em Inglês | MEDLINE | ID: mdl-20412183

RESUMO

Paracoccidioidomycosis is the most important systemic mycosis in South America. In Europe the disease is very rare and only found in returning travelers. Here we report on a 56-year-old Spanish missionary with respiratory symptoms but no other affected systems. Diagnosis was made based on serology and PCR for Paracoccidioides brasiliensis.


Assuntos
Paracoccidioidomicose/diagnóstico , Missões Religiosas , Antifúngicos/uso terapêutico , Diagnóstico Diferencial , Humanos , Masculino , Pessoa de Meia-Idade , Missionários , Paracoccidioidomicose/tratamento farmacológico , Espanha , Venezuela
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