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2.
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.

3.
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
4.
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.

5.
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.

6.
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: Se presentan los resultados de un estudio de contactos domiciliarios de pacientes con infección por Dientamoeba fragilis (D. fragilis). Métodos: Estudio prospectivo descriptivo realizado en todos los pacientes diagnosticados de infección por D. fragilis atendidos en la Unidad de Medicina Tropical del Hospital Universitario Central de Asturias entre 2012-2017 y sus contactos domiciliarios. Se analizaron 3 muestras de heces concentradas tanto para los casos como para sus contactos. La presencia de D. fragilis se confirmó mediante reacción en cadena de la polimerasa (PCR). En ambos grupos se estudió la presencia de coinfección por Enterobius vermicularis (E. vermicularis). Se excluyeron los pacientes y los contactos que no entregaron una o más muestras para el diagnóstico, así como los pacientes sin contactos domésticos. Resultados: Se incluyeron 44 pacientes infectados por D. fragilis, así como sus 97 contactos domiciliarios. El 50,5% de los contactos tuvo PCR positiva para D. fragilis. Veinte además estaban coinfectados por E. vermicularis. La presencia de infección fue significativamente más frecuente en pacientes con niños (34/15 versus 24/24, p = 0,064; OR: 2,267 [0,988-5,199]), infección por E. vermicularis en ellos (20/29 versus 0/48, p = 0,0001) o en otro miembro de la familia (29/20 frente a 15/33, p = 0,008; OR: 3,190 [1,384-7,352]). Conclusiones: La prevalencia de infección por D. fragilis en los contactos domiciliarios fue elevada y se asoció con la presencia de niños en el núcleo familiar y la coinfección con E. vermicularis independiente del sexo, edad, zonas rurales o contacto con animales


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
7.
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
8.
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
9.
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
12.
Int J Infect Dis ; 49: 59-61, 2016 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-27263118

RESUMO

OBJECTIVES: Dientamoeba fragilis is a pathogenic protozoan of the human gastrointestinal tract with a worldwide distribution, which has emerged as an important and misdiagnosed cause of chronic gastrointestinal illnesses such as diarrhea and 'irritable-bowel-like' gastrointestinal disease. Very little research has been conducted on the use of suitable antimicrobial compounds. Furthermore, higher rates of co-infection with Enterobius vermicularis have been described, suggesting that E. vermicularis could influence the treatment of D. fragilis-infected patients. To study this, the treatment of E. vermicularis and D. fragilis co-infected patients was evaluated. METHODS: Forty-nine patients with a D. fragilis infection, including 25 (51.0%) patients co-infected with E. vermicularis, were studied. All of them were treated with metronidazole. Patients with E. vermicularis co-infection and/or an E. vermicularis-positive case in the family were treated with mebendazole. RESULTS: Metronidazole treatment failure was significantly more frequent in patients with E. vermicularis co-infection and in patients with children in the family. CONCLUSIONS: Co-infection with E. vermicularis may act as a factor favoring D. fragilis infection by preventing eradication measures. This suggests that both parasites should be treated simultaneously.


Assuntos
Coinfecção/tratamento farmacológico , Dientamoeba/efeitos dos fármacos , Dientamebíase/tratamento farmacológico , Enterobíase/tratamento farmacológico , Enterobius/efeitos dos fármacos , Adolescente , Adulto , Idoso , Animais , Anti-Helmínticos/administração & dosagem , Antiprotozoários , Criança , Pré-Escolar , Coinfecção/parasitologia , Dientamoeba/fisiologia , Dientamebíase/parasitologia , Enterobíase/parasitologia , Enterobius/parasitologia , Fezes/parasitologia , Feminino , Humanos , Masculino , Mebendazol/administração & dosagem , Metronidazol/administração & dosagem , Pessoa de Meia-Idade , Adulto Jovem
14.
Medicine (Baltimore) ; 91(1): 10-7, 2012 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-22198499

RESUMO

Methicillin-resistant Staphylococcus aureus (MRSA) meningitis is an uncommon disease, and little is known about its epidemiology, clinical features, therapy, and outcome. We performed a multicenter retrospective study of MRSA meningitis in adults. Eighty-six adult patients were included and the following data were obtained: underlying diseases, clinical presentation, analytical and microbiologic data, response to therapy, and outcome.There were 56 men (65%) and the mean age was 51.5 years; 54 of them (63%) had severe comorbidities. There were 78 cases of postoperative meningitis and 8 of spontaneous meningitis. The infection was nosocomial in 93% (80/86) of the cases. Among the 78 patients with postoperative meningitis, the most common predisposing conditions were cerebrospinal fluid (CSF) devices (74%), neurosurgery (45%), CSF leakage (17%), and head trauma (12%). Most patients had fever (89%), altered mental status (68%), headache (40%), and meningeal signs (29%). The most common CSF findings were pleocytosis (90%), elevated protein level (77%), and hypoglycorrhachia (30%). CSF Gram stain and blood cultures were positive in 49% (32/65) and 36% (16/45) of cases, respectively. An associated MRSA infection and polymicrobial meningitis appeared in 33% (28/86) and 23% (20/86) of cases, respectively. Antimicrobial therapy was given to 84 patients. Most of them received vancomycin (92%) either as monotherapy (64%) or in combination with other antibiotics (28%), for a median of 18 days. Overall 30-day mortality was 31% (27/86). Multivariate study identified 2 independent factors associated with mortality: spontaneous meningitis (odds ratio [OR], 21.4; 95% confidence interval [CI], 2.3-195.4; p = 0.007), and coma (OR, 9.7; 95% CI, 2.2-42.3; p = 0.002).In conclusion, MRSA is a relatively uncommon but serious disease. Although most cases are nosocomial infections appearing in neurosurgical patients, spontaneous meningitis may present as a community-onset infection in patients with severe comorbidities requiring frequent contact with the health care system. Most patients have a favorable response to vancomycin, but the beneficial effect of combined and intraventricular therapy, or alternative drugs, remains unclear. MRSA meningitis is associated with a high mortality, and the presence of spontaneous infection and coma are the most important prognostic factors.


Assuntos
Meningites Bacterianas/tratamento farmacológico , Staphylococcus aureus Resistente à Meticilina , Infecções Estafilocócicas/tratamento farmacológico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/uso terapêutico , Infecção Hospitalar/tratamento farmacológico , Infecção Hospitalar/microbiologia , Infecção Hospitalar/mortalidade , Feminino , Humanos , Masculino , Meningites Bacterianas/microbiologia , Meningites Bacterianas/mortalidade , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Infecções Estafilocócicas/microbiologia , Infecções Estafilocócicas/mortalidade , Resultado do Tratamento , Adulto Jovem
15.
HIV Clin Trials ; 12(6): 287-98, 2011.
Artigo em Inglês | MEDLINE | ID: mdl-22189148

RESUMO

As a result of population migration, Chagas disease is no longer limited to the North and South American continents. In HIV-infected patients, chronic infection by Trypanosoma cruzi behaves as an opportunistic infection in severely immunosuppressed patients and is responsible for high morbidity and mortality. Unlike other opportunistic infections, information on the natural history, diagnosis, treatment, and prevention of Chagas disease is scarce. Spain has the highest number of cases of Chagas disease outside the North and South American continents, and coinfection with HIV is increasingly prevalent. In this article, the Spanish Society for Tropical Medicine and International Health (Sociedad Española de Medicina Tropical y Salud Internacional) reviews the current situation of coinfection with HIV and T. cruzi infection and provides guidelines on the diagnosis, treatment, and prevention in areas where Chagas disease is not endemic. It also identifies areas of uncertainty where additional research is necessary.


Assuntos
Fármacos Anti-HIV/uso terapêutico , Doença de Chagas/complicações , Infecções por HIV/complicações , Tripanossomicidas/uso terapêutico , Infecções Oportunistas Relacionadas com a AIDS/diagnóstico , Infecções Oportunistas Relacionadas com a AIDS/tratamento farmacológico , Infecções Oportunistas Relacionadas com a AIDS/transmissão , Doença de Chagas/tratamento farmacológico , Doença de Chagas/prevenção & controle , Doença de Chagas/transmissão , Doença Crônica , Coinfecção , Doenças Endêmicas , Feminino , Infecções por HIV/tratamento farmacológico , Humanos , Lactente , Transmissão Vertical de Doença Infecciosa , Gravidez , Complicações Parasitárias na Gravidez/diagnóstico , Complicações Parasitárias na Gravidez/tratamento farmacológico , Recidiva
17.
Antivir Ther ; 16(1): 27-35, 2011.
Artigo em Inglês | MEDLINE | ID: mdl-21311106

RESUMO

BACKGROUND: Reliable non-invasive methods for the evaluation of liver fibrosis are desirable, and the risk factors associated with fibrosis are not fully identified. METHODS: A cross-sectional study of a cohort of 805 HIV-HCV-coinfected patients with active HCV replication, most (95.2%) of whom were intravenous drug users, was conducted. Liver fibrosis was measured by transient elastometry with cutoff values of 7.2 kPa (significant fibrosis), 9.4 kPa (advanced fibrosis) and 14.0 kPa (cirrhosis), and by liver fibrosis indexes (LFI; APRI, Forns and FIB-4). Available liver biopsies were also evaluated. RESULTS: The prevalences of significant fibrosis, advanced fibrosis and cirrhosis were 55.8%, 38.4% and 23.5%, respectively. A number of parameters were associated both in the univariate and multivariate analyses with each of the diverse fibrosis groups; however, only six of them were predictive of all stages of fibrosis: heavy alcohol intake (odds ratio [OR] 3.37, 95% confidence interval [CI] 2.02-5.59; P < 0.001), duration of HCV infection (OR 1.13, 95% CI 1.07-1.19; P < 0.001), CDC category C3 (OR 1.80, 95% CI 1.07-3.02; P=0.026), anti-HCV treatment failure (OR 4.37, 95% CI 2.24-8.55; P < 0.001), thrombocytopaenia (OR 1.015, 95% CI 1.011-1.019; P < 0.001) and increased aspartate aminotransferase (1.006, 95% CI 1.0021-1.010; P = 0.004). Furthermore, 53%, 68% and 80% of patients with significant fibrosis, advanced fibrosis and cirrhosis, respectively, had increased measures on at least one of the LFI, with the Forns index being the most sensitive. Area under the receiver operating characteristic curves of elastometry to predict histological fibrosis was 0.83 (95% CI 0.76-0.90), 0.89 (95% CI 0.83-0.95) and 0.87 (95% CI 0.80-0.94) for Metavir score ≥ F2, ≥ F3 and F4, respectively. CONCLUSIONS: Elastometry constitutes a useful tool in the diagnosis and follow-up of HIV-HCV-coinfected patients. Fibrosis is associated with diverse factors, some of them treatable or preventable, which need to be addressed considering the high prevalence and course of fibrosis in these patients.


Assuntos
Antivirais/efeitos adversos , Fibrose/diagnóstico , Fibrose/etiologia , Infecções por HIV/complicações , Hepatite C Crônica/complicações , Cirrose Hepática/diagnóstico , Cirrose Hepática/etiologia , Adulto , Alcoolismo/complicações , Antivirais/administração & dosagem , Área Sob a Curva , Aspartato Aminotransferases/análise , Estudos de Coortes , Estudos Transversais , Usuários de Drogas , Feminino , Fibrose/epidemiologia , Fibrose/patologia , HIV , Infecções por HIV/tratamento farmacológico , Infecções por HIV/patologia , Hepacivirus , Hepatite C Crônica/tratamento farmacológico , Hepatite C Crônica/patologia , Humanos , Cirrose Hepática/epidemiologia , Cirrose Hepática/patologia , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Índice de Gravidade de Doença , Abuso de Substâncias por Via Intravenosa/complicações , Trombocitopenia/complicações , Falha de Tratamento
18.
Med Clin (Barc) ; 137(6): 278-9, 2011 Sep 10.
Artigo em Espanhol | MEDLINE | ID: mdl-20980024

Assuntos
Fármacos Anti-HIV/uso terapêutico , Doença de Chagas/tratamento farmacológico , Infecções por HIV/tratamento farmacológico , Nitroimidazóis/uso terapêutico , Pirrolidinonas/uso terapêutico , Tripanossomicidas/uso terapêutico , Adenina/administração & dosagem , Adenina/análogos & derivados , Adenina/farmacocinética , Adenina/uso terapêutico , Adulto , Fármacos Anti-HIV/administração & dosagem , Fármacos Anti-HIV/farmacocinética , Terapia Antirretroviral de Alta Atividade , Sulfato de Atazanavir , Doença de Chagas/complicações , Interações de Medicamentos , Quimioterapia Combinada , Feminino , Infecções por HIV/complicações , Humanos , Lamivudina/administração & dosagem , Lamivudina/farmacocinética , Lamivudina/uso terapêutico , Nitroimidazóis/administração & dosagem , Nitroimidazóis/farmacocinética , Oligopeptídeos/administração & dosagem , Oligopeptídeos/farmacocinética , Oligopeptídeos/uso terapêutico , Organofosfonatos/administração & dosagem , Organofosfonatos/farmacocinética , Organofosfonatos/uso terapêutico , Paraguai/etnologia , Piridinas/administração & dosagem , Piridinas/farmacocinética , Piridinas/uso terapêutico , Pirrolidinonas/administração & dosagem , Pirrolidinonas/farmacocinética , Raltegravir Potássico , Ritonavir/administração & dosagem , Ritonavir/farmacocinética , Ritonavir/uso terapêutico , Espanha , Tenofovir , Tripanossomicidas/administração & dosagem , Tripanossomicidas/farmacocinética , Zidovudina/administração & dosagem , Zidovudina/farmacocinética , Zidovudina/uso terapêutico
19.
Trans R Soc Trop Med Hyg ; 104(6): 443-5, 2010 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-20338608

RESUMO

Schistosomiasis polyps induced by Schistosoma mansoni and S. japonicum have been reported from pathological observations but this is not the case for colonic schistosomiasis infection by S. intercalatum which has always been associated with mild clinical presentations. We report the case of a 17-year-old man, native from Equatorial Guinea, with colonic polyposis associated with infection by S. intercalatum.


Assuntos
Pólipos do Colo/parasitologia , Schistosoma/isolamento & purificação , Esquistossomose/complicações , Adolescente , Animais , Pólipos do Colo/patologia , Humanos , Masculino , Contagem de Ovos de Parasitas , Esquistossomose/patologia
20.
Scand J Infect Dis ; 41(10): 774-6, 2009.
Artigo em Inglês | MEDLINE | ID: mdl-19685377

RESUMO

Population movements from Chagas disease-endemic areas to non-endemic countries due to immigration make the occurrence of this disease in these latter areas possible. We describe the results of a screening programme conducted in an immigrant population from endemic areas, attending the Tropical Medicine Unit of the Hospital Central de Asturias between June 2006 and June 2008. The ID-Chagas antibody test (particle gel immunoassay (PaGIA); DiaMed-ID) was used as a screening assay. We analysed 64 patients, 9 of whom (14%) tested positive for Chagas disease antibodies, a diagnosis that was confirmed in all cases. Six patients came from Bolivia, 2 from Paraguay and 1 from Brazil. Chagas disease is of increasing importance, even in areas with low migratory flows; hence screening programmes for this population group are especially important.


Assuntos
Doença de Chagas/diagnóstico , Emigrantes e Imigrantes/estatística & dados numéricos , Adulto , Anticorpos Antiprotozoários/sangue , Doença de Chagas/epidemiologia , Doença de Chagas/imunologia , Doenças Endêmicas , Feminino , Humanos , Masculino , Programas de Rastreamento , Pessoa de Meia-Idade , Reação em Cadeia da Polimerase , América do Sul/etnologia , Espanha/epidemiologia , Trypanosoma cruzi/genética
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