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1.
Emerg Infect Dis ; 27(4)2021 02 04.
Artigo em Inglês | MEDLINE | ID: mdl-33539721

RESUMO

Pneumonia caused by severe acute respiratory syndrome coronavirus 2 emerged in China at the end of 2019. Because of the severe immunomodulation and lymphocyte depletion caused by this virus and the subsequent administration of drugs directed at the immune system, we anticipated that patients might experience fungal superinfection. We collected data from 186 patients who had coronavirus disease-associated pulmonary aspergillosis (CAPA) worldwide during March-August 2020. Overall, 182 patients were admitted to the intensive care unit (ICU), including 180 with acute respiratory distress syndrome and 175 who received mechanical ventilation. CAPA was diagnosed a median of 10 days after coronavirus disease diagnosis. Aspergillus fumigatus was identified in 80.3% of patient cultures, 4 of which were azole-resistant. Most (52.7%) patients received voriconazole. In total, 52.2% of patients died; of the deaths, 33.0% were attributed to CAPA. We found that the cumulative incidence of CAPA in the ICU ranged from 1.0% to 39.1%.

2.
Pathog Glob Health ; : 1-4, 2020 Dec 30.
Artigo em Inglês | MEDLINE | ID: mdl-33380280

RESUMO

The aim of this study was to describe the clinical and epidemiological profile of immunosuppressed patients with imported strongyloidiasis in a non-endemic setting, and to compare these results with non-immunosuppressed patients. This is a case-control substudy from a larger observational retrospective study that included all patients with strongyloidiasis registered in the +REDIVI Spanish Collaborative Network. Overall, 1245 patients with imported strongyloidiasis were included. From these, 80 (6.4%) patients had some kind of immunosuppression. Three (3.8%) patients had a hyperinfection syndrome, and 34 (52.3%) patients had eosinophilia. The percentages of positive results of the formalin-ether technique, the fecal culture and serology were 12.3%, 21.1% and 95.4%, respectively. When comparing the main characteristics, immunosuppressed patients had higher proportion of severe clinical manifestations and lower proportion of eosinophilia. No differences were found regarding yield of microbiological techniques and treatment response. These results stress the importance of strongyloidiasis screening among immunosuppressed patients coming from endemic areas. Serological tests have an acceptable sensitivity to be used as a screening tool.

3.
Infect Dis (Lond) ; 52(11): 808-815, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32648796

RESUMO

BACKGROUND: Linezolid has good penetration to the meninges and could be an alternative for treatment of Staphylococcus aureus meningitis. We assessed the efficacy and safety of linezolid therapy for this infection. METHODS: Retrospective multicenter cohort study of 26 adults treated with linezolid, derived from a cohort of 350 cases of S. aureus meningitis diagnosed at 11 university hospitals in Spain (1981-2015). RESULTS: There were 15 males (58%) and mean age was 47.3 years. Meningitis was postoperative in 21 (81%) patients. The infection was nosocomial in 23 (88%) cases, and caused by methicillin-resistant S. aureus in 15 cases and methicillin-susceptible S. aureus in 11. Linezolid was given as empirical therapy in 10 cases, as directed therapy in 10, and due to failure of vancomycin in 6. Monotherapy was given to 16 (62%) patients. Median duration of linezolid therapy was 17 days (IQR 12-22 days) with a daily dose of 1,200 mg in all cases. The clinical response rate to linezolid was 69% (18/26) and microbiological response was observed in 14 of 15 cases evaluated (93%). Overall 30-day mortality was 23% and was directly associated with infection in most cases. When compared with the patients of the cohort, no significant difference in mortality was observed between patients receiving linezolid or vancomycin for therapy of methicillin-resistant S. aureus meningitis (9% vs. 20%; p = .16) nor between patients receiving linezolid or cloxacillin for therapy of methicillin-susceptible S. aureus meningitis (20% vs 14%; p = .68). Adverse events appeared in 14% (3/22) of patients, but linezolid was discontinued in only one patient. CONCLUSIONS: Linezolid appears to be effective and safe for therapy of S. aureus meningitis. Our findings showed that linezolid may be considered an adequate alternative to other antimicrobials in meningitis caused by S. aureus.

4.
Enferm. infecc. microbiol. clín. (Ed. impr.) ; 38(6): 283-288, jun.-jul. 2020.
Artigo em Inglês | IBECS-Express | IBECS | ID: ibc-ET5-1773

RESUMO

The Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC), the Spanish Society of Tropical Medicine and International Health (SEMTSI), the Spanish Association of Surgeons (AEC), the Spanish Society of Pneumology and Thoracic Surgery (SEPAR), the Spanish Society of Thoracic Surgery (SECT), the Spanish Society of Vascular and Interventional Radiology (SERVEI), and the Spanish Society of Paediatric Infectious Diseases (SEIP) considered it pertinent to issue a consensus statement on the management of cystic echinococcosis (CE) to guide healthcare professionals in the care of patients with CE. Specialists from several fields (clinicians, surgeons, radiologists, microbiologists, and parasitologists) identified the most clinically relevant questions and developed this Consensus Statement, evaluating the available evidence-based data to propose a series of recommendations on the management of this disease. This Consensus Statement is accompanied by the corresponding references on which these recommendations are based. Prior to publication, the manuscript was open for comments and suggestions from the members of the SEIMC and the scientific committees and boards of the various societies involved


La Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica (SEIMC), la Sociedad Española de Medicina Tropical y Salud Internacional (SEMTSI), la Asociación Española de Cirujanos (AEC), la Sociedad Española de Neumología y Cirugía Torácica (SEPAR), la Sociedad Española de Cirugía Torácica (SECT), la Sociedad Española de Radiología Vascular e Intervencionista (SERVEI) y la Sociedad Española de Infectología Pediátrica (SEIP) han considerado pertinente la elaboración de una declaración de consenso sobre el tratamiento de la equinococosis quística (EQ) que sirva de ayuda al personal sanitario en la atención de pacientes con EQ. Varios tipos de profesionales (médicos, cirujanos, radiólogos, microbiólogos y parasitólogos) han seleccionado las preguntas más clínicamente relevantes y han desarrollado esta Declaración de consenso, en la que evalúan los datos basados en la evidencia disponibles para proponer una serie de recomendaciones sobre el tratamiento de esta enfermedad. Esta Declaración de consenso se acompaña de la bibliografía correspondiente que fundamenta estas recomendaciones. Antes de su publicación, el manuscrito estuvo abierto a comentarios y sugerencias de los miembros de la SEIMC y de los comités científicos y juntas directivas de las diferentes sociedades implicadas

5.
Am J Trop Med Hyg ; 103(1): 303-307, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32394885

RESUMO

The aim of the study was to evaluate the availability of different procedures, diagnostic tests, and treatments, as well as the procedures and techniques used in the management of cystic echinococcosis (CE) in Spain. This was a cross-sectional study performed from September to December 2018 in Spain. A survey directed to CE-treating clinicians was conducted to collect information regarding the center characteristics and the different protocols of management followed. Thirty-nine centers among 76 contacted centers participated in the survey, most of them belonging to the public health system and attending both adult and children. The median number of patients with CE attended during the last three years per center was 15. Percutaneous techniques were used only in seven centers, and surgery was the most frequently used therapeutic approach. Drugs and duration of treatment (both when administered exclusively or when combined with surgery/puncture, aspiration, injection, and reaspiration) were very variable depending on the centers. There is a high variability in the management of CE among Spanish centers. These results stress the importance of promoting the diffusion of existing knowledge, adapting the WHO recommendations to our setting, and referring patients to referral centers at a national level.


Assuntos
Equinococose/diagnóstico , Adulto , Fatores Etários , Criança , Estudos Transversais , Equinococose/epidemiologia , Equinococose/terapia , Emigrantes e Imigrantes/estatística & dados numéricos , Inquéritos Epidemiológicos , Humanos , Espanha/epidemiologia
6.
Am J Trop Med Hyg ; 103(1): 480-484, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32342844

RESUMO

The female immigrant population is especially vulnerable to imported diseases. We describe the results of a prospective screening program for imported diseases performed in immigrant female patients. The protocol included tests for HIV, hepatitis B virus (HBV), hepatitis C virus (HCV), Treponema pallidum, Trypanosoma cruzi, Strongyloides stercoralis and Schistosoma spp., intestinal parasites, malaria, and the detection of microfilaremia, according to the patient's origin. Six hundred eleven patients were studied. The most frequent imported diseases were intestinal parasitosis (39.4%), followed by syphilis (14.6%), HIV infection (9%), chronic HCV (5%), and HBV (3.3%). Most of the cases of HIV (78%) and HBV (85%) were diagnosed in patients aged between 16 and 45 years. Hepatitis C virus appeared mostly in patients in the 46- to 65-year range (P = 0.001; odds ratio [OD]: 3.667 [1.741-7.724]) or older than 65 years (P = 0.0001; OR: 26.350 [7.509-92.463]). Syphilis was diagnosed more frequently in patients older than 46 years (P = 0.0001; OR: 4.273 [2.649-6.893]). Multivariate analysis confirmed a greater presence of HCV infection (P = 0.049) and syphilis (P = 0.0001) in patients aged between 46 and 65 years. In 15.4% of patients, screening did not find any pathology. These data show a high prevalence of imported diseases in the female immigrant population, which may have serious consequences in terms of morbimortality and vertical transmission. Our results encourage the establishment of policies of active screening both in women of childbearing age and within the specific pregnancy screening programs.


Assuntos
Doenças Transmissíveis Importadas/diagnóstico , Emigrantes e Imigrantes/estatística & dados numéricos , Mulheres , Adolescente , Adulto , África/etnologia , Idoso , América Central/etnologia , Doença de Chagas/diagnóstico , Doença de Chagas/epidemiologia , Doenças Transmissíveis Importadas/epidemiologia , Feminino , Filariose/diagnóstico , Filariose/epidemiologia , Infecções por HIV/diagnóstico , Infecções por HIV/epidemiologia , Hepatite B Crônica/diagnóstico , Hepatite B Crônica/epidemiologia , Hepatite C Crônica/diagnóstico , Hepatite C Crônica/epidemiologia , Humanos , Transmissão Vertical de Doença Infecciosa , Enteropatias Parasitárias/diagnóstico , Enteropatias Parasitárias/epidemiologia , Malária/diagnóstico , Malária/epidemiologia , Programas de Rastreamento , Pessoa de Meia-Idade , Prevalência , Esquistossomose/diagnóstico , Esquistossomose/epidemiologia , América do Sul/etnologia , Espanha/epidemiologia , Estrongiloidíase/diagnóstico , Estrongiloidíase/epidemiologia , Sífilis/diagnóstico , Sífilis/epidemiologia , Tuberculose/diagnóstico , Tuberculose/epidemiologia , Adulto Jovem
7.
Travel Med Infect Dis ; 37: 101683, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32335208

RESUMO

BACKGROUND: Neurocysticercosis (NCC) is the most common parasitic neurological disease worldwide and a major cause of epilepsy. Spain is the country reporting the highest number of NCC imported cases in Europe. METHODOLOGY: Retrospective case series of NCC patients registered in the +REDIVI Network from October 1, 2009 to July 2018. A specific questionnaire, including clinical and diagnostic characteristics, was created and sent to the collaborator centers. RESULTS: 46 cases were included in the analysis. 55% were male, mean age of 40 years. 95.6% were migrants. The median duration since migration from an endemic area was 10 years. Predominant nationalities were Ecuadorians (50%) and Bolivians (30.4%). Frequent locations were parenchymal (87%), subarachnoid (26.1%) and intraventricular cysts (10.9%). Serological analysis was performed in 91.3%, being 54.8% positive. Most prevalent clinical manifestations were persistent headache (60.9%), epilepsy (43.5%) and visual changes (13%). Patients were mainly treated with albendazole (76.1%), corticosteroids (67.4%), and anticonvulsionants (52.2%). 82.5% had a favorable clinical outcome. CONCLUSIONS: Most NCC cases were long-standing migrants. Few clinical differences were observed depending on the cysticerci location. The treatment was often not according to current recommendations, and no uniform criteria were followed when it came to the therapeutic regimen. NCC case management in Spain (including clinician awareness and laboratory capacity improvements) needs to be strengthened.

8.
Emerg Infect Dis ; 26(4): 658-666, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32186486

RESUMO

To determine the epidemiologic and clinical characteristics of patients in Spain with imported arbovirus infections, we analyzed 22,655 records from a collaborative network for January 2009-December 2018. Among 861 arbovirus infections, 845 were monoinfections (456 [53%] dengue, 280 [32.5%] chikungunya, 109 [12.7%] Zika) and 16 (1.8%) were co-infections. Most patients were travelers (56.3%) or immigrants returning to Spain after visiting friends or relatives (31.3%). Median patient age was 37 years; most (62.3%) were women and some (28.6%) had received pretravel advice. Only 12 patients were immunosuppressed. Six cases (all dengue monoinfections, none in immunosuppressed patients) were severe. Since 2014, nondengue arbovirus infections increased; until 2016, chikungunya and Zika were most common. Imported arbovirus infections (mostly dengue) were frequently diagnosed, although increased chikungunya and Zika virus infections coincided with their introduction and spread in the Americas. A large proportion of cases occurred in women of childbearing age, some despite receipt of pretravel advice.

9.
Artigo em Inglês | IBECS-Express | IBECS | ID: ibc-ET5-1707

RESUMO

BACKGROUND: Pseudomonas aeruginosa neurosurgical meningitis is a rare entity, usually related with intraventricular catheters and associated with high mortality rates. We describe the clinical characteristics, treatment and outcomes of a series of neurosurgical meningitis caused by P. aeruginosa along 1990-2016. METHODS: Descriptive, retrospective study of all postsurgical meningitis due to P. aeruginosa related to intraventricular catheters in Hospital Universitario Central de Asturias, between 1990 and 2016. Clinical features, therapeutic approaches and prognostic factors were analyzed statistically. A binary logistic regression analysis was performed to determine the factors influencing the infection mortality. RESULT: 51 episodes from 51 different patients with CSF culture positive for P. aeruginosa were reviewed. Seventeen patients (33.3%) died as a direct consequence of the infection. Univariate analysis showed that mortality was higher in the group of patients treated with ceftazidime (12 vs. 15, p = 0.068, OR 3.040 [0.877-10.544]) and lower in patients whom had received intrathecal therapy (2 vs. 13, p = 0.050, OR 4.64 [0.80-34.93]), without differences observed between those patients treated with aminoglycosides or with colistin. Any patient treated with colistin died (0 vs. 6, p = 0.067, OR: not defined). In the multivariate analysis mortality was only significant higher for patients without catheter withdrawal (p = 0.014) and lower for those patients who received intrathecal therapy (p = 0.05) or adequate empirical treatment (p = 0.006). CONCLUSIONS: The mortality of P. aeruginosa meningitis is high especially in infections without catheter withdrawal and in patients for whom the intrathecal route of administration was not used. Catheter withdrawal was an independent factor of good outcome in our series


ANTECEDENTES: La meningitis nosocomial por Pseudomonas aeruginosa es una entidad poco frecuente, generalmente relacionada con catéteres intraventriculares y asociada con altas tasas de mortalidad. Se describen las características clínicas, con especial hincapié en su tratamiento, de una serie de meningitis neuroquirúrgicas por P. aeruginosa entre 1990 y 2016. MÉTODOS: Estudio descriptivo, retrospectivo, de todas las meningitis posquirúrgicas por P. aeruginosa relacionadas con catéteres intraventriculares en el Hospital Universitario Central de Asturias entre 1990 y 2016, con especial hincapié en los enfoques terapéuticos y factores pronósticos. Los factores asociados con mortalidad se analizaron mediante regresión logística binaria. RESULTADOS: Se revisaron 51 episodios de 51 pacientes diferentes con cultivos de LCR positivos para P. aeruginosa. Diecisiete pacientes (33,3%) murieron como consecuencia directa de la infección. La mortalidad fue mayor en el grupo de pacientes tratados con ceftazidima (12 vs. 15, p = 0,068, OR 3,040 [0,877-10,544]) y menor en los pacientes que habían recibido terapia intratecal (2 vs. 13, p = 0,050, OR 4,64 [0,80-34,93]), sin diferencias en estos últimos entre los tratados con aminoglucósidos o con colistina. Ningún paciente tratado con colistina falleció (0 vs. 6, p = 0,067, OR no definida). El análisis multivariable únicamente confirmó la asociación con la ausencia de terapia intratecal (p = 0,05) o tratamiento empírico adecuado (p = 0,006). CONCLUSIONES: La mortalidad de la meningitis por P. aeruginosa es elevada, especialmente en pacientes en quienes no se utilizó la vía de administración intratecal. La retirada del catéter fue un factor independiente de buena evolución en nuestra serie

11.
Enferm Infecc Microbiol Clin ; 38(2): 54-58, 2020 02.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-31126690

RESUMO

BACKGROUND: Pseudomonas aeruginosa neurosurgical meningitis is a rare entity, usually related with intraventricular catheters and associated with high mortality rates. We describe the clinical characteristics, treatment and outcomes of a series of neurosurgical meningitis caused by P. aeruginosa along 1990-2016. METHODS: Descriptive, retrospective study of all postsurgical meningitis due to P. aeruginosa related to intraventricular catheters in Hospital Universitario Central de Asturias, between 1990 and 2016. Clinical features, therapeutic approaches and prognostic factors were analyzed statistically. A binary logistic regression analysis was performed to determine the factors influencing the infection mortality. RESULT: 51 episodes from 51 different patients with CSF culture positive for P. aeruginosa were reviewed. Seventeen patients (33.3%) died as a direct consequence of the infection. Univariate analysis showed that mortality was higher in the group of patients treated with ceftazidime (12 vs. 15, p=0.068, OR 3.040 [0.877-10.544]) and lower in patients whom had received intrathecal therapy (2 vs. 13, p=0.050, OR 4.64 [0.80-34.93]), without differences observed between those patients treated with aminoglycosides or with colistin. Any patient treated with colistin died (0 vs. 6, p=0.067, OR: not defined). In the multivariate analysis mortality was only significant higher for patients without catheter withdrawal (p=0.014) and lower for those patients who received intrathecal therapy (p=0.05) or adequate empirical treatment (p=0.006). CONCLUSIONS: The mortality of P. aeruginosa meningitis is high especially in infections without catheter withdrawal and in patients for whom the intrathecal route of administration was not used. Catheter withdrawal was an independent factor of good outcome in our series.

12.
Enferm Infecc Microbiol Clin ; 38(6): 283-288, 2020.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-31866064

RESUMO

The Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC), the Spanish Society of Tropical Medicine and International Health (SEMTSI), the Spanish Association of Surgeons (AEC), the Spanish Society of Pneumology and Thoracic Surgery (SEPAR), the Spanish Society of Thoracic Surgery (SECT), the Spanish Society of Vascular and Interventional Radiology (SERVEI), and the Spanish Society of Paediatric Infectious Diseases (SEIP) considered it pertinent to issue a consensus statement on the management of cystic echinococcosis (CE) to guide healthcare professionals in the care of patients with CE. Specialists from several fields (clinicians, surgeons, radiologists, microbiologists, and parasitologists) identified the most clinically relevant questions and developed this Consensus Statement, evaluating the available evidence-based data to propose a series of recommendations on the management of this disease. This Consensus Statement is accompanied by the corresponding references on which these recommendations are based. Prior to publication, the manuscript was open for comments and suggestions from the members of the SEIMC and the scientific committees and boards of the various societies involved.

13.
PLoS Negl Trop Dis ; 13(5): e0007399, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-31095570

RESUMO

BACKGROUND: Imported strongyloidiasis is increasingly being diagnosed in non-endemic areas. The aim of this study was to describe the epidemiological, clinical and microbiological characteristics of patients with imported strongyloidiasis in Spain. METHODOLOGY: This is an observational retrospective study that included all patients diagnosed of strongyloidiasis registered in the +REDIVI Collaborative Network from 2009 to 2017. Demographic, epidemiological and clinical information was collected from the +REDIVI database, and extra information regarding microbiological techniques, treatment and follow-up was requested to participant centers. FINDINGS: Overall, 1245 cases were included. Most of them were immigrants (66.9%), and South America was the most frequent area of origin. Detection of larvae in stool samples was observed in 21.9% of the patients, and serological tests allowed making the diagnosis in the rest of the cases. Eosinophilia was present in 82.2% of cases. Treatment with ivermectin (compared with albendazole) was the most strongly associated factor to achieve the cure (OR 2.34). CONCLUSIONS: Given the long latency of the infection and the risk of developing a severe presentation, screening of S. stercoralis infection should be mandatory in patients coming from or had traveling to endemic areas, especially in those with immunosuppressant conditions.


Assuntos
Anti-Helmínticos/uso terapêutico , Estrongiloidíase/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Albendazol/uso terapêutico , Animais , Criança , Pré-Escolar , Emigrantes e Imigrantes/estatística & dados numéricos , Eosinofilia/etiologia , Feminino , Humanos , Lactente , Ivermectina/uso terapêutico , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , América do Sul , Espanha/epidemiologia , Strongyloides stercoralis/efeitos dos fármacos , Strongyloides stercoralis/isolamento & purificação , Strongyloides stercoralis/fisiologia , Estrongiloidíase/complicações , Estrongiloidíase/diagnóstico , Estrongiloidíase/parasitologia , Viagem , Adulto Jovem
14.
Enferm. infecc. microbiol. clín. (Ed. impr.) ; 37(5): 290-295, mayo 2019. tab, graf
Artigo em Inglês | IBECS | ID: ibc-189216

RESUMO

INTRODUCTION: The characteristics of D. fragilis infection are described, with special focus on the clinical and epidemiological aspects. MATERIALS AND METHODS: A retrospective and descriptive study was performed, including all the patients with Dientamoeba fragilis infection who attended a specialized unit between January 2012 and December 2017. PCR was used to diagnose D. fragilis. Patients were treated with metronidazole or paromomycin and reviewed at four and eight weeks post-treatment. Cure was defined as the negativization of all parasitological tests, in absence of symptoms. RESULTS: 163 patients were diagnosed. The most frequent symptoms were abdominal pain (36.2%), chronic diarrhoea (12.3%), anal itching (10.4%), abdominal discomfort (9.2%), skin disease (8%), acute diarrhoea (4.3%) and vomiting (4.3%). Fifty patients were asymptomatic. Forty-two patients had eosinophilia in blood. Thirty-eight cases (23.3%) had a coinfection by Enterobius vermicularis. One hundred and seven patients received treatment, sixty-one of them with metronidazole and the rest with paromomycin. Ninety-nine patients (91%) were cured. The rate of cure was 100% in the paromomycin group versus 86.8% in the metronidazole group (p = 0.005; OR: 1.173 [1.057-1.302]). The absence of cure was associated with E. vermicularis coinfection (p = 0.014; OR: 6.167 [1.432-26.563] and with longer duration of the symptoms (175 [± 159SD]) versus 84 [± 88SD] days, p = 0.014) but multivariable analysis did not confirm these associations. CONCLUSION: Dientamoeba fragilis is an important and underestimated cause of gastrointestinal disease in both the autochthonous and immigrant or traveller population. More studies are needed to clarify its optimal treatment and the role played by E. vermicularis in its transmission and maintenance


INTRODUCCIÓN: Se describen las características clínicas y epidemiológicas de la infección por Dientamoeba fragilis. MATERIAL Y MÉTODOS: Se realizó un estudio retrospectivo y descriptivo de los pacientes diagnosticados de infección por D. fragilis en una unidad especializada entre 2012-2017. El diagnóstico de D. fragilis se realizó mediante PCR. Los pacientes fueron tratados con metronidazol o paromomicina y revisados a las 4 y 8 semanas tras tratamiento. Se consideró a los pacientes curados tras negativización microbiológica en ausencia de síntomas. RESULTADOS: Se analizaron 163 pacientes. Los síntomas más frecuentes fueron: dolor abdominal (36,2%), diarrea crónica (12,3%), prurito anal (10,4%), malestar abdominal (9,2%), síntomas cutáneos (8%), diarrea aguda y vómitos (4,3%, respectivamente). Cincuenta pacientes estaban asintomáticos. Cuarenta y dos pacientes presentaron eosinofilia. En 38 pacientes se observó coinfección por Enterobius vermicularis. Ciento siete pacientes recibieron tratamiento, 61 con metronidazol y el resto con paromomicina, con una curación del 91%. La tasa de curación fue del 100% en los pacientes tratados con paromomicina y del 86,8% en el grupo del metronidazol (p = 0,005; OR: 1,173 [1,057-1,302]). La no curación se asoció a la coinfección por E. vermicularis (p = 0,014; OR: 6,167 [1,432-26,563]) y con la mayor duración de los síntomas (175 [± 159 DE] versus 84 [± 88 DE] días; p = 0,014), pero el análisis multivariable no confirmó dichas asociaciones. CONCLUSIÓN: D. fragilis es causa importante y subestimada de enfermedad gastrointestinal tanto en poblaciones autóctonas como inmigrantes o viajeros. Se necesitan más estudios para aclarar su tratamiento óptimo y el papel desempeñado por E. vermicularis en su tratamiento


Assuntos
Humanos , Masculino , Feminino , Criança , Adolescente , Adulto , Dientamebíase/epidemiologia , Enterobius/microbiologia , Doenças Parasitárias/microbiologia , Estudos Retrospectivos , Dientamebíase/tratamento farmacológico , Metronidazol/uso terapêutico , Coinfecção/microbiologia
15.
Enferm Infecc Microbiol Clin ; 37(5): 290-295, 2019 May.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-30274823

RESUMO

INTRODUCTION: The characteristics of D. fragilis infection are described, with special focus on the clinical and epidemiological aspects. MATERIALS AND METHODS: A retrospective and descriptive study was performed, including all the patients with Dientamoeba fragilis infection who attended a specialized unit between January 2012 and December 2017. PCR was used to diagnose D. fragilis. Patients were treated with metronidazole or paromomycin and reviewed at four and eight weeks post-treatment. Cure was defined as the negativization of all parasitological tests, in absence of symptoms. RESULTS: 163 patients were diagnosed. The most frequent symptoms were abdominal pain (36.2%), chronic diarrhoea (12.3%), anal itching (10.4%), abdominal discomfort (9.2%), skin disease (8%), acute diarrhoea (4.3%) and vomiting (4.3%). Fifty patients were asymptomatic. Forty-two patients had eosinophilia in blood. Thirty-eight cases (23.3%) had a coinfection by Enterobius vermicularis. One hundred and seven patients received treatment, sixty-one of them with metronidazole and the rest with paromomycin. Ninety-nine patients (91%) were cured. The rate of cure was 100% in the paromomycin group versus 86.8% in the metronidazole group (p=0.005; OR: 1.173 [1.057-1.302]). The absence of cure was associated with E. vermicularis coinfection (p=0.014; OR: 6.167 [1.432-26.563] and with longer duration of the symptoms (175 [±159SD]) versus 84 [±88SD] days, p=0.014) but multivariable analysis did not confirm these associations. CONCLUSION: Dientamoeba fragilis is an important and underestimated cause of gastrointestinal disease in both the autochthonous and immigrant or traveller population. More studies are needed to clarify its optimal treatment and the role played by E. vermicularis in its transmission and maintenance.


Assuntos
Dientamebíase , Adulto , Antiprotozoários/uso terapêutico , Dientamebíase/diagnóstico , Dientamebíase/tratamento farmacológico , Dientamebíase/epidemiologia , Feminino , Humanos , Masculino , Metronidazol/uso terapêutico , Pessoa de Meia-Idade , Paromomicina/uso terapêutico , Estudos Retrospectivos , Adulto Jovem
16.
Enferm. infecc. microbiol. clín. (Ed. impr.) ; 36(7): 423-427, ago.-sept. 2018. graf, tab
Artigo em Inglês | IBECS | ID: ibc-176723

RESUMO

INTRODUCTION: The results of a study on the household contacts of patients with D. fragilis infection are presented. METHODS: A prospective, descriptive study was carried out on all Dientamoeba fragilis-infected patients treated at the Tropical Medicine Unit of Hospital Universitario Central de Asturias between 2012- 2017 and their household contacts. Three stool samples per patient and three stool samples from each of their household contacts were concentrated and analysed. Polymerase chain reaction (PCR) was used to detect the presence of D. fragilis in all stool samples. Co-infection with E. vermicularis was studied in both groups. Patients and contacts who failed to deliver one or more samples for diagnosis and patients without household contacts were excluded. RESULTS: 44 Patients infected with D. fragilis, as well as their 97 household contacts were enrolled. 50.5% of household contacts had a positive PCR for D. fragilis. 20 were also coinfected with E. vermicularis. The presence of infection was significantly more frequent in patients with children (34/15 versus 24/24; p= 0.064; OR: 2.267 [0.988-5.199]), E. vermicularis infection in the children being 20/29 versus 0/48 (p = 0.0001), and in another family member being 29/20 versus 15/33 (p = 0.008; OR: 3.190 [1.384-7.352]). CONCLUSIONS: The prevalence of D. fragilis infection in household contacts was high. It was associated with the presence of children in the family nucleus and coinfection with E. vermicularis irrespective of gender, age, rural area or contact with animals


INTRODUCCIÓN: Los informes de sensibilidad acumulada son una herramienta valiosa para guiar el tratamiento empírico de infecciones urinarias, sobre todo en el contexto actual de crecientes tasas de resistencia. Nuestro objetivo es analizar la sensibilidad antimicrobiana de bacterias aisladas de urocultivos de pacientes pediátricos durante un período de 5 años. MÉTODOS: Estudio retrospectivo de los urocultivos del período 2011-2015. La identificación y estudios de sensibilidad se realizaron con el sistema Vitek-2 (BioMérieux(R)) y se interpretaron según los criterios de EUCAST. Se analizaron los datos de sensibilidad antimicrobiana según sexo y tramos de edad (neonatos, 1 mes-5 años, 5-15 años) y se compararon con los datos de mayores de 15 años. RESULTADOS: En el período analizado se procesaron 17.164 urocultivos de 7.924 pacientes menores de 16 años. Los porcentajes de sensibilidad en estos pacientes fueron: ampicilina 36,3%; amoxicilina/clavulánico 75,3%; cefuroxima 83,2%; cotrimoxazol 68,9%; ciprofloxacino 85,3%; fosfomicina 85,5%; nitrofurantoína 84,4%, y cefalosporinas de tercera generación 89-91%. Aminoglucósidos (>92%) y carbapenemas (95%) mantienen las mayores tasas de sensibilidad. La prevalencia de aislamientos productores de BLEE fue significativamente menor en niños menores de 16 años (1,5% vs. 4,1%). En menores de 16 años, los aislamientos de Escherichia coli procedentes de mujeres fueron significativamente (p < 0,0001) más sensibles a ampicilina (41% vs. 30%) y amoxicilina-clavulánico (82% vs. 72%) que en varones. CONCLUSIONES: La elaboración de informes de sensibilidad acumulados desglosados por edad o sexo permite detectar importantes diferencias. En nuestra área, cefuroxima puede considerarse como primera opción de tratamiento empírico en pacientes pediátricos


Assuntos
Humanos , Masculino , Feminino , Pré-Escolar , Criança , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Bacteroides fragilis/genética , Infecções por Bacteroides/diagnóstico , Infecções por Bacteroides/epidemiologia , Busca de Comunicante , Infecções por Bacteroides/transmissão , Reação em Cadeia da Polimerase , Estudos Prospectivos , Prevalência
17.
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
18.
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
19.
Enferm Infecc Microbiol Clin ; 36(7): 423-427, 2018.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-29078992

RESUMO

INTRODUCTION: The results of a study on the household contacts of patients with D. fragilis infection are presented. METHODS: A prospective, descriptive study was carried out on all Dientamoeba fragilis-infected patients treated at the Tropical Medicine Unit of Hospital Universitario Central de Asturias between 2012- 2017 and their household contacts. Three stool samples per patient and three stool samples from each of their household contacts were concentrated and analysed. Polymerase chain reaction (PCR) was used to detect the presence of D. fragilis in all stool samples. Co-infection with E. vermicularis was studied in both groups. Patients and contacts who failed to deliver one or more samples for diagnosis and patients without household contacts were excluded. RESULTS: 44 Patients infected with D. fragilis, as well as their 97 household contacts were enrolled. 50.5% of household contacts had a positive PCR for D. fragilis. 20 were also coinfected with E. vermicularis. The presence of infection was significantly more frequent in patients with children (34/15 versus 24/24; p= 0.064; OR: 2.267 [0.988-5.199]), E. vermicularis infection in the children being 20/29 versus 0/48 (p=0.0001), and in another family member being 29/20 versus 15/33 (p=0.008; OR: 3.190 [1.384-7.352]). CONCLUSIONS: The prevalence of D. fragilis infection in household contacts was high. It was associated with the presence of children in the family nucleus and coinfection with E. vermicularis irrespective of gender, age, rural area or contact with animals.


Assuntos
Dientamoeba/isolamento & purificação , Dientamebíase/epidemiologia , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Coinfecção/epidemiologia , Coinfecção/parasitologia , Busca de Comunicante , Dientamebíase/parasitologia , Dientamebíase/transmissão , Disenteria Amebiana/epidemiologia , Entamoeba/isolamento & purificação , Características da Família , Fezes/parasitologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Prospectivos , Espanha/epidemiologia , Adulto Jovem
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