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1.
Lancet Infect Dis ; 2020 Feb 18.
Artigo em Inglês | MEDLINE | ID: mdl-32085848

RESUMO

Our understanding of congenital infections is based on prospective studies of women infected during pregnancy. The EU has funded three consortia to study Zika virus, each including a prospective study of pregnant women. Another multi-centre study has been funded by the US National Institutes of Health. This Personal View describes the study designs required to research Zika virus, and questions whether funding academics in the EU and USA to work with collaborators in outbreak areas is an effective strategy. 3 years after the 2015-16 Zika virus outbreaks, these collaborations have taught us little about vertical transmission of the virus. In the time taken to approve funding, agree contracts, secure ethics approval, and equip laboratories, Zika virus had largely disappeared. By contrast, prospective studies based on local surveillance and standard-of-care protocols have already provided valuable data. Threats to fetal and child health pose new challenges for global preparedness requiring support for the design and implementation of locally appropriate protocols. These protocols can answer the key questions earlier than externally designed studies and at lower cost. Local protocols can also provide a framework for recruitment of unexposed controls that are required to study less specific outcomes. Other priorities include accelerated development of non-invasive tests, and longer-term storage of neonatal and antenatal samples to facilitate retrospective reconstruction of cohort studies.

2.
Pediatr Infect Dis J ; 39(2): e22-e25, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31738322

RESUMO

We investigated the impact of baseline tuberculin skin tests (TSTs) and preventive isoniazid chemoprophylaxis on subsequent QuantiFERON-TB Gold In-Tube (QFT-GIT) assays performed after a 10- to 12-week window period in 114 children <5 years of age. Previous TSTs and chemoprophylaxis had no impact on the magnitude of subsequent antigen-induced responses in QFT-GIT. Furthermore, previous TSTs did not induce conversion from a negative to a positive QFT-GIT result.

5.
Front Pediatr ; 7: 238, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31245340

RESUMO

Introduction: Children younger than 2 years have an increased risk of complications associated with tuberculosis (TB) due to the immaturity of the innate and adaptive immune response. We aimed to identify TB clinical presentations and outcomes as well as risk factors for complications in this age group. Materials and Methods: Multicenter, retrospective, cross-sectional study of TB cases in children aged <2 years in Catalonia (2005-2013). Epidemiological and clinical data were collected from the hospital medical records. TB complications, sequelae included, were defined as any tissue damage generating functional or anatomical impairment after being diagnosed or after TB treatment being completed. Statistical analyses were based on bivariate chi-square and multivariate logistic regression, and it was carried out with Stata® version 13.1. Odds ratios (OR) and its 95% confidence intervals were calculated (CI). Results: A total of 134 patients were included, 50.7% were male, the median [IQR] age was 13[8-18] months, and 18.7% (25/134) showed TB-associated complications. Pulmonary TB was diagnosed in 94.0% (126/134) of children, and the most common complications were lobar collapse (6/126). TB meningitis was diagnosed in 14/134 (10.4%), and hydrocephalus and mental impairment occurred in 1 and 2 patients, respectively. Two patients with spinal TB developed vertebral destruction and paraplegia, respectively. Only one of the patients died. At multivariate level, tachypnea (OR = 4.24; 95% CI 1.17-15.35) and meningeal (OR = 52.21; 95% CI 10.05-271.2) or combined/extrapulmonary forms (OR = 11.3; 95% CI 2.85-45.1) were associated with the development of TB complications. Discussion: TB complications are common in children under 2 years old. Extrapulmonary TB forms in this pediatric age remain a challenge and require prompt diagnosis and treatment in order to prevent them. The presence of tachypnea at the time of TB diagnosis is an independent associated factor to the development of TB complications in infants. This clinical sign should be closely monitored in patients in this age group. It is necessary to perform further studies in this age group in a prospective design in order to understand whether there are other factors associated to TB complications.

6.
BMJ Open ; 9(6): e026092, 2019 06 18.
Artigo em Inglês | MEDLINE | ID: mdl-31217315

RESUMO

INTRODUCTION: Zika virus (ZIKV) infection during pregnancy is a known cause of microcephaly and other congenital and developmental anomalies. In the absence of a ZIKV vaccine or prophylactics, principal investigators (PIs) and international leaders in ZIKV research have formed the ZIKV Individual Participant Data (IPD) Consortium to identify, collect and synthesise IPD from longitudinal studies of pregnant women that measure ZIKV infection during pregnancy and fetal, infant or child outcomes. METHODS AND ANALYSIS: We will identify eligible studies through the ZIKV IPD Consortium membership and a systematic review and invite study PIs to participate in the IPD meta-analysis (IPD-MA). We will use the combined dataset to estimate the relative and absolute risk of congenital Zika syndrome (CZS), including microcephaly and late symptomatic congenital infections; identify and explore sources of heterogeneity in those estimates and develop and validate a risk prediction model to identify the pregnancies at the highest risk of CZS or adverse developmental outcomes. The variable accuracy of diagnostic assays and differences in exposure and outcome definitions means that included studies will have a higher level of systematic variability, a component of measurement error, than an IPD-MA of studies of an established pathogen. We will use expert testimony, existing internal and external diagnostic accuracy validation studies and laboratory external quality assessments to inform the distribution of measurement error in our models. We will apply both Bayesian and frequentist methods to directly account for these and other sources of uncertainty. ETHICS AND DISSEMINATION: The IPD-MA was deemed exempt from ethical review. We will convene a group of patient advocates to evaluate the ethical implications and utility of the risk stratification tool. Findings from these analyses will be shared via national and international conferences and through publication in open access, peer-reviewed journals. TRIAL REGISTRATION NUMBER: PROSPERO International prospective register of systematic reviews (CRD42017068915).

7.
Am J Case Rep ; 20: 723-725, 2019 May 21.
Artigo em Inglês | MEDLINE | ID: mdl-31110169

RESUMO

BACKGROUND The Zika virus is an arbovirus that has as main source of transmission the bite of infected insects of the genus Aedes and has been associated with cases of congenital malformation and microcephaly in neonates. However, other sources of transmission have been identified since the emergence of this virus in the world population, such as vertical transmission by semen and possibly other body fluids such as vaginal secretion and breast milk. CASE REPORT An infant, born to a mother whose previous delivery was a baby with severe microcephaly, was normal and was negative for Zika virus at birth but developed secondary microcephaly 1 month later, that persisted. The baby was exclusively breast-fed and Zika virus was present in the mother's milk. CONCLUSIONS We report the detection of Zika virus exclusively in the breast milk of a woman after her second delivery of an infant, who later developed microcephaly. This case is consistent with possible vertical transmission.


Assuntos
Aleitamento Materno , Transmissão Vertical de Doença Infecciosa , Microcefalia/etiologia , Leite Humano , Infecção por Zika virus/diagnóstico , Infecção por Zika virus/transmissão , Feminino , Humanos , Recém-Nascido , Microcefalia/diagnóstico
8.
Medicine (Baltimore) ; 98(20): e15532, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31096455

RESUMO

INTRODUCTION: Zika virus (ZIKV) has caused one of the most challenging global infectious epidemics in recent years because of its causal association with severe microcephaly and other congenital malformations. The diagnosis of viral infections usually relies on the detection of virus proteins or genetic material in clinical samples as well as on the infected host immune responses. Serial serologic testing is required for the diagnosis of congenital infection when diagnostic molecular biology is not possible. PATIENT CONCERNS: A 2-year-old girl, born to a mother with confirmed ZIKV infection during pregnancy, with a confirmed ZIKV infection in utero, showed at birth a severe microcephaly and clinical characteristics of fetal brain disruption sequence compatible with a congenital ZIKV syndrome (CZS). DIAGNOSIS: ZIKV-RNA and ZIKV-IgM serological response performed at birth and during the follow-up time tested always negative. Serial serologic ZIKV-IgG tests were performed to assess the laboratory ZIKV diagnosis, ZIKV-IgG seroreversion was observed at 21 months of age. ZIKV diagnosis of this baby had to be relied on her clinical and radiological characteristics that were compatible with a CZS. INTERVENTIONS: The patient was followed-up as per protocol at approximately 1, 4, 9, 12, 18-21, and 24 months of age. Neurological, radiological, audiological, and ophthalmological assessment were performed during this period of time. Prompt rehabilitation was initiated to prevent potential adverse long-term neurological outcomes. OUTCOMES: The growth of this girl showed a great restriction at 24 months of age with a weight of 8.5 kg (-2.5 z-score) and a head circumference of 40.5 cm (-4.8 z-score). She also had a great neurodevelopmental delay at the time of this report. CONCLUSION: We presume that as a consequence of prenatal ZIKV infection, the fetal brain and other organs are damaged before birth through direct injury. Following this, active infection ends during intrauterine life, and as a consequence the immune system of the infant is unable to build up a consistent immune response thereafter. Further understanding of the mechanisms taking part in the pathogenesis of ZIKV congenital infection is needed. This finding might change our paradigm regarding serological response in the ZIKV congenital infection.


Assuntos
Complicações Infecciosas na Gravidez/diagnóstico , Infecção por Zika virus/diagnóstico , Encéfalo/anormalidades , Pré-Escolar , Feminino , Humanos , Microcefalia/etiologia , Gravidez , Testes Sorológicos , Espanha , Infecção por Zika virus/complicações
10.
Pediatr Infect Dis J ; 37(12): 1235-1241, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30408005

RESUMO

BACKGROUND: Available data to assess the optimal diagnostic approach in infants and preschool children at risk of tuberculosis (TB) are limited. METHODS: We conducted a prospective observational study in children younger than 5 years undergoing assessment with both tuberculin skin tests (TST) and QuantiFERON-TB Gold In-Tube (QFT-GIT) assays at 2 tertiary TB units in Barcelona, Spain. RESULTS: A total of 383 children were included. One of 304 participants considered uninfected developed active TB during follow-up {median [interquartile range (IQR)]: 47 [30; 48] months}, compared with none of 40 participants with latent TB infection [follow-up since completion of anti-TB treatment: 42 (32; 45) months]. Overall test agreement between TST and QFT-GIT was moderate (κ = 0.551), but very good in children screened after TB contact (κ = 0.801) and in Bacillus Calmette-Guérin (BCG)-unvaccinated children (κ = 0.816). Discordant results (16.8%, all TST+/QFT-GIT-) were mainly observed in new-entrant screening and in BCG-vaccinated children. Children with indeterminate QFT-GIT results were on average younger than those with determinate results (median age: 12 vs. 30 months; P < 0.001). The sensitivity of TSTs and QFT-GIT assays in children with confirmed active TB was 100% (95% confidence interval: 79.4%-100%) and 93.7% (95% confidence interval: 69.8%-99.8%), respectively. In patients with latent TB infection or active TB, there was no correlation between age and antigen-stimulated interferon-γ responses (r = -0.044; P = 0.714). CONCLUSIONS: In young BCG-unvaccinated children with recent TB contact, a dual testing strategy using TST and QFT-GIT in parallel may not be necessary. However, TST+/QFT-GIT- discordance is common, and it remains uncertain if this constellation indicates TB infection or not. In active TB, QFT-GIT assays do not perform better than TSTs.


Assuntos
Testes de Liberação de Interferon-gama/métodos , Teste Tuberculínico/métodos , Tuberculose/diagnóstico , Pré-Escolar , Feminino , Seguimentos , Humanos , Lactente , Masculino , Estudos Prospectivos , Sensibilidade e Especificidade , Espanha
11.
Enferm. infecc. microbiol. clín. (Ed. impr.) ; 36(9): 550-554, nov. 2018. tab
Artigo em Espanhol | IBECS | ID: ibc-176831

RESUMO

Introducción: Algunos estudios indican altas prevalencias de infección tuberculosa latente (ITBL) en población inmigrante, lo que es relevante, pues el 5-10% de los casos desarrollaran una tuberculosis activa. El objetivo de este estudio es describir los resultados de una estrategia secuencial en población inmigrante recién llegada para el diagnóstico de ITBL usando la prueba de tuberculina (PT) e IGRAs. Métodos: Se realizó un estudio descriptivo retrospectivo con inmigrantes entre 6 y 35años de edad de centros de acogida, derivados a una unidad de salud internacional entre julio de 2013 y junio de 2016. Se realizó la PT, y cuando fue ≥ 5 mm, se determinaron los IGRAs. La ITBL se definió como aquellos con IGRAs ≥ 0,35 UI/ml y radiografía de tórax normal. Resultados: De los 184 casos, 138 (75,0%) eran hombres, de 23,0años de edad. Las áreas geográficas de origen más frecuente fueron: 63 (34,2%) de Asia, 42 (22,8%) de Europa del Este y 41 (22,3%) del África subsahariana. La PT fue ≥10mm en 79 (42,9%). La prevalencia de ITBL usando la estrategia secuencial fue de 33/184 (17,9%). El índice kappa de Cohen (entre PT ≥ 10mm e IGRAs) fue de 0,226. Conclusión: Basar el diagnóstico de la ITBL tan solo en la PT puede representar una sobreestimación. Algunos estudios demuestran que el cribado secuencial sería el más coste-efectivo, y ello parece más evidente en las poblaciones vacunadas con BCG


Introduction: Some studies indicate high prevalences of latent tuberculosis infection (LTBI) in the immigrant population, which is relevant because 5-10% of cases will develop active tuberculosis. The objective of this study is to describe the results of a sequential strategy in the newly-arrived immigrant population for the diagnosis of LTBI using the tuberculin skin test (TST) and IGRAs. Methods: A retrospective descriptive study was carried out with immigrants between 6 and 35years of age from shelters, referred to an international health unit between July 2013 and June 2016. The TST was performed and when it was ≥ 5mm, IGRAs were conducted. LTBI was defined as an IGRA ≥ 0.35IU/ml and normal chest X-ray. Results: Of the 184 cases, 138 (75.0%) were men, 23.0 years of age. The most common geographical areas were: 63 (34.2%) from Asia, 42 (22.8%) from Eastern Europe and 41 (22.3%) from sub-Saharan Africa. The TST was ≥ 10mm in 79 cases (42.9%). The prevalence of LTBI using the sequential strategy was 33/184 (17.9%). Cohen's Kappa index (between TST ≥ 10mm and IGRAs) was 0.226. Conclusion: Basing LTBI screening on the TST alone could give rise to an overestimation. Some studies show that sequential screening would be the most cost-effective; this seems most evident in BCG-vaccinated populations


Assuntos
Humanos , Masculino , Feminino , Adulto Jovem , Adulto , Emigrantes e Imigrantes/estatística & dados numéricos , Populações Vulneráveis/estatística & dados numéricos , Tuberculose Latente/etnologia , Tuberculose Latente/epidemiologia , Estudos Retrospectivos
12.
Am J Trop Med Hyg ; 99(4): 1011-1017, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-30141396

RESUMO

Urinary schistosomiasis causes damage to the urological system. Ultrasound is a method that detects the burden of secondary disease, individually and in epidemiological studies. In this study, the Schistosoma haematobium-associated urinary tract pathology is analyzed before and after treatment in a short period of time. Seventy children who had previously participated in an epidemiological study on schistosomiasis in the city of Cubal, Angola, and had also performed urinary ultrasound between August 2013 and February 2014 were cited 6-8 months later to assess the possible reinfection and repeat new urinary ultrasound, analyzing changes at the level of urinary pathology. The presence of hematuria and proteinuria was also analyzed. Of the 70 children analyzed, 29 (41.4%) were girls, with an average age of 10.4 years (standard deviation 2.3). Fifty-three (75.7%) had an improvement in their bladder and/or kidney scores, whereas 12 (17.1%) had no change and five (7.1%) had progression of the disease. None of the parameters analyzed completely disappeared. After one single course of treatment with praziquantel, all the analyzed parameters showed regression. Improvement was greater in the urinary bladder than in the upper urinary tract, though these lesions also reversed; the reversion of all parameters was greater among children older than 10 years old than the younger ones. Proteinuria was the parameter with a smaller reduction. Ultrasound should be a usual tool for diagnosis and follow-up in urinary schistosomiasis, particularly in children; more accurate recommendations about follow-up in the case of children whose lesions do not reverse should be established.


Assuntos
Anti-Helmínticos/uso terapêutico , Doenças Endêmicas , Rim/diagnóstico por imagem , Praziquantel/uso terapêutico , Proteinúria/diagnóstico por imagem , Esquistossomose Urinária/diagnóstico por imagem , Bexiga Urinária/diagnóstico por imagem , Adolescente , Angola , Animais , Criança , Estudos Transversais , Feminino , Humanos , Rim/efeitos dos fármacos , Rim/parasitologia , Rim/patologia , Masculino , Contagem de Ovos de Parasitas , Proteinúria/tratamento farmacológico , Proteinúria/epidemiologia , Proteinúria/patologia , Schistosoma haematobium/efeitos dos fármacos , Schistosoma haematobium/fisiologia , Esquistossomose Urinária/tratamento farmacológico , Esquistossomose Urinária/epidemiologia , Esquistossomose Urinária/patologia , Ultrassonografia , Bexiga Urinária/efeitos dos fármacos , Bexiga Urinária/parasitologia , Bexiga Urinária/patologia
13.
PLoS Med ; 15(7): e1002591, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-29995958

RESUMO

BACKGROUND: An estimated 32,000 children develop multidrug-resistant tuberculosis (MDR-TB; Mycobacterium tuberculosis resistant to isoniazid and rifampin) each year. Little is known about the optimal treatment for these children. METHODS AND FINDINGS: To inform the pediatric aspects of the revised World Health Organization (WHO) MDR-TB treatment guidelines, we performed a systematic review and individual patient data (IPD) meta-analysis, describing treatment outcomes in children treated for MDR-TB. To identify eligible reports we searched PubMed, LILACS, Embase, The Cochrane Library, PsychINFO, and BioMedCentral databases through 1 October 2014. To identify unpublished data, we reviewed conference abstracts, contacted experts in the field, and requested data through other routes, including at national and international conferences and through organizations working in pediatric MDR-TB. A cohort was eligible for inclusion if it included a minimum of three children (aged <15 years) who were treated for bacteriologically confirmed or clinically diagnosed MDR-TB, and if treatment outcomes were reported. The search yielded 2,772 reports; after review, 33 studies were eligible for inclusion, with IPD provided for 28 of these. All data were from published or unpublished observational cohorts. We analyzed demographic, clinical, and treatment factors as predictors of treatment outcome. In order to obtain adjusted estimates, we used a random-effects multivariable logistic regression (random intercept and random slope, unless specified otherwise) adjusted for the following covariates: age, sex, HIV infection, malnutrition, severe extrapulmonary disease, or the presence of severe disease on chest radiograph. We analyzed data from 975 children from 18 countries; 731 (75%) had bacteriologically confirmed and 244 (25%) had clinically diagnosed MDR-TB. The median age was 7.1 years. Of 910 (93%) children with documented HIV status, 359 (39%) were infected with HIV. When compared to clinically diagnosed patients, children with confirmed MDR-TB were more likely to be older, to be infected with HIV, to be malnourished, and to have severe tuberculosis (TB) on chest radiograph (p < 0.001 for all characteristics). Overall, 764 of 975 (78%) had a successful treatment outcome at the conclusion of therapy: 548/731 (75%) of confirmed and 216/244 (89%) of clinically diagnosed children (absolute difference 14%, 95% confidence interval [CI] 8%-19%, p < 0.001). Treatment was successful in only 56% of children with bacteriologically confirmed TB who were infected with HIV who did not receive any antiretroviral treatment (ART) during MDR-TB therapy, compared to 82% in children infected with HIV who received ART during MDR-TB therapy (absolute difference 26%, 95% CI 5%-48%, p = 0.006). In children with confirmed MDR-TB, the use of second-line injectable agents and high-dose isoniazid (15-20 mg/kg/day) were associated with treatment success (adjusted odds ratio [aOR] 2.9, 95% CI 1.0-8.3, p = 0.041 and aOR 5.9, 95% CI 1.7-20.5, p = 0.007, respectively). These findings for high-dose isoniazid may have been affected by site effect, as the majority of patients came from Cape Town. Limitations of this study include the difficulty of estimating the treatment effects of individual drugs within multidrug regimens, only observational cohort studies were available for inclusion, and treatment decisions were based on the clinician's perception of illness, with resulting potential for bias. CONCLUSIONS: This study suggests that children respond favorably to MDR-TB treatment. The low success rate in children infected with HIV who did not receive ART during their MDR-TB treatment highlights the need for ART in these children. Our findings of individual drug effects on treatment outcome should be further evaluated.


Assuntos
Antituberculosos/uso terapêutico , Tuberculose Resistente a Múltiplos Medicamentos/tratamento farmacológico , Adolescente , Idade de Início , Fármacos Anti-HIV/uso terapêutico , Antituberculosos/efeitos adversos , Criança , Transtornos da Nutrição Infantil/epidemiologia , Transtornos da Nutrição Infantil/fisiopatologia , Fenômenos Fisiológicos da Nutrição Infantil , Pré-Escolar , Coinfecção , Comorbidade , Feminino , Infecções por HIV/tratamento farmacológico , Infecções por HIV/epidemiologia , Humanos , Masculino , Desnutrição/epidemiologia , Desnutrição/fisiopatologia , Estado Nutricional , Medição de Risco , Fatores de Risco , Índice de Gravidade de Doença , Resultado do Tratamento , Tuberculose Resistente a Múltiplos Medicamentos/diagnóstico , Tuberculose Resistente a Múltiplos Medicamentos/epidemiologia , Tuberculose Resistente a Múltiplos Medicamentos/microbiologia
14.
Expert Rev Anti Infect Ther ; 16(3): 243-254, 2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-29415586

RESUMO

INTRODUCTION: Zika virus (ZIKV) infection has caused the most challenging worldwide infectious epidemic outbreak in recent months. ZIKV causes microcephaly and other congenital malformations. There is a need to perform updated systematic reviews on ZIKV infection periodically because this epidemic is bringing up new evidence with extraordinary speed. Areas covered: Evidence related to ZIKV infection in the gestational, perinatal, and early infant periods covering epidemiology, virology, pathogenesis, risk factors, time of infection during pregnancy, newborn symptoms, treatment, and vaccines. To this end, a search was performed using terms ['Zika'] AND ['Perinatal Infection'] OR ['Congenital Infection'] in the PubMed® international electronic database. Out of a total of 1,538 articles published until 30 November 2017, we finally assessed 106 articles articles that were relevant to the research areas included in this study. Expert commentary: ZIKV is a new teratogenic/neurotropic virus affecting fetuses. Many challenges are still far from being solved regarding the epidemiology, case definition, clinical and laboratory diagnosis, and preventive measures. An approach using 'omics' and new biomarkers for diagnosis, and a ZIKV-vaccine for treatment, might finally give us the tools to solve these challenges.


Assuntos
Transmissão Vertical de Doença Infecciosa/prevenção & controle , Complicações Infecciosas na Gravidez/prevenção & controle , Infecção por Zika virus/complicações , Animais , Surtos de Doenças , Feminino , Humanos , Recém-Nascido , Microcefalia/prevenção & controle , Microcefalia/virologia , Gravidez , Complicações Infecciosas na Gravidez/virologia , Fatores de Risco , Vacinas Virais/administração & dosagem , Infecção por Zika virus/epidemiologia , Infecção por Zika virus/prevenção & controle
15.
Enferm. infecc. microbiol. clín. (Ed. impr.) ; 36(1): 9-15, ene. 2018. ^graf, tab
Artigo em Espanhol | IBECS | ID: ibc-170108

RESUMO

Introducción: La transmisión vertical (TV) es relevante en la epidemiología global del virus de la inmunodeficiencia humana (VIH), representando la principal vía de infección en la edad pediátrica. Los objetivos del estudio fueron determinar la tasa de TV del VIH y su tendencia epidemiológica entre la población autóctona e inmigrante en Catalunya entre 2000-2014. Métodos: Estudio observacional prospectivo de parejas madre-hijo expuestas al VIH atendidas en 12 hospitales de Catalunya en 2000-2014. Se estimó la tasa de TV del VIH aplicando un modelo bayesiano de regresión logística. Se utilizó el software estadístico R y WinBUGS. Resultados: Se analizaron 909 gestantes, 1.009 embarazos y 1.032 niños; datos de origen materno en el 79,4% de las mujeres, el 32,7% inmigrantes y de estas el 53,0% de África subsahariana. La tasa de TV del VIH fue del 1,4% (14/1.023; IC95% 0,8-2,3). El riesgo de TV del VIH fue 10 veces menor en mujeres con buen control virológico (p=0,01), al que llegaron 2 tercios de ellas. No hubo diferencias en la tasa de TV del VIH entre mujeres autóctonas e inmigrantes (p=0,6). La proporción de mujeres inmigrantes fue significativamente mayor en el período 2008-2014 (p<0,0001), en relación con el diagnóstico de la infección por VIH (p<0,0001) y la administración de antirretrovirales (p=0,02) durante el embarazo, y con la viremia indetectable próxima al parto (p<0,001). Conclusiones: Existe un aumento progresivo de gestantes inmigrantes con VIH en Catalunya. Aun siendo la mayoría diagnosticadas durante el embarazo, la tasa de TV del VIH no fue diferente a la hallada en las mujeres autóctonas (AU)


Introduction: Mother-to-child transmission (MTCT) is relevant in the global epidemiology of human-immunodeficiency virus (HIV), as it represents the main route of infection in children. The study objectives were to determine the rate of HIV-MTCT and its epidemiological trend between the Spanish-born and immigrant population in Catalonia in the period 2000-2014. Methods: A prospective observational study of mother-child pairs exposed to HIV, treated in 12 hospitals in Catalonia in the period 2000-2014. HIV-MTCT rate was estimated using a Bayesian logistic regression model. R and WinBUGS statistical software were used. Results: The analysis included 909 pregnant women, 1,009 pregnancies, and 1,032 children. Data on maternal origin was obtained in 79.4% of women, of whom 32.7% were immigrants, with 53.0% of these from sub-Saharan Africa. The overall HIV-MTCT rate was 1.4% (14/1,023; 95% CI; 0.8-2.3). The risk of MTCT-HIV was 10-fold lower in women with good virological control (P=.01), which was achieved by two-thirds of them. The proportion of immigrants was significantly higher in the period 2008-2014 (P<.0001), for the HIV-diagnosis (P<.0001), and antiretroviral administration (P=.02) during pregnancy, and for undetectable viral load next to delivery (P<.001). There were no differences in the rate of MTCT-HIV among Spanish-born and immigrant women (P=.6). Conclusions: There is a gradual increase in HIV pregnant immigrants in Catalonia. Although most immigrant women were diagnosed during pregnancy, the rate of MTCT-HIV was no different from the Spanish-born women (AU)


Assuntos
Humanos , Masculino , Feminino , Gravidez , Síndrome de Imunodeficiência Adquirida/epidemiologia , HIV/isolamento & purificação , Emigrantes e Imigrantes/estatística & dados numéricos , Transmissão Vertical de Doença Infecciosa/estatística & dados numéricos , Complicações na Gravidez/epidemiologia , Síndrome de Imunodeficiência Adquirida/microbiologia , Estudos Prospectivos , Estudos de Coortes , Teorema de Bayes , Complicações na Gravidez/microbiologia
16.
Enferm Infecc Microbiol Clin ; 36(9): 550-554, 2018 11.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-29223317

RESUMO

INTRODUCTION: Some studies indicate high prevalences of latent tuberculosis infection (LTBI) in the immigrant population, which is relevant because 5-10% of cases will develop active tuberculosis. The objective of this study is to describe the results of a sequential strategy in the newly-arrived immigrant population for the diagnosis of LTBI using the tuberculin skin test (TST) and IGRAs. METHODS: A retrospective descriptive study was carried out with immigrants between 6 and 35years of age from shelters, referred to an international health unit between July 2013 and June 2016. The TST was performed and when it was ≥5mm, IGRAs were conducted. LTBI was defined as an IGRA ≥0.35IU/ml and normal chest X-ray. RESULTS: Of the 184 cases, 138 (75.0%) were men, 23.0 years of age. The most common geographical areas were: 63 (34.2%) from Asia, 42 (22.8%) from Eastern Europe and 41 (22.3%) from sub-Saharan Africa. The TST was ≥10mm in 79 cases (42.9%). The prevalence of LTBI using the sequential strategy was 33/184 (17.9%). Cohen's Kappa index (between TST≥10mm and IGRAs) was 0.226. CONCLUSION: Basing LTBI screening on the TST alone could give rise to an overestimation. Some studies show that sequential screening would be the most cost-effective; this seems most evident in BCG-vaccinated populations.


Assuntos
Emigrantes e Imigrantes , Tuberculose Latente/diagnóstico , Programas de Rastreamento/métodos , Populações Vulneráveis , Adolescente , Adulto , África ao Sul do Saara/etnologia , Ásia/etnologia , Vacina BCG , Análise Custo-Benefício , Europa Oriental/etnologia , Feminino , Humanos , Testes de Liberação de Interferon-gama/economia , Tuberculose Latente/etnologia , América Latina/etnologia , Masculino , Programas de Rastreamento/economia , Prevalência , Estudos Retrospectivos , Determinantes Sociais da Saúde , Espanha/epidemiologia , Teste Tuberculínico/economia , Vacinação/estatística & dados numéricos , Adulto Jovem
17.
Trop Med Int Health ; 23(2): 221-228, 2018 02.
Artigo em Inglês | MEDLINE | ID: mdl-29205689

RESUMO

OBJECTIVE: To evaluate the usefulness of the WHO classification of ultrasound pathological changes and to establish risk factors for morbidity in a highly endemic setting. METHODS: One hundred and fifty-seven ultrasounds were performed on school-aged children previously diagnosed with urinary schistosomiasis in Cubal, Angola. The findings were analysed according to the WHO guidelines. Factors for morbidity were studied. RESULTS: Mean age of the children was 8.7 (SD 3.2) years. Pathological changes were found in 85.3% (84.7% in the bladder, 34.4% the ureter and 6.3% kidney lesions). The global score according to the WHO classification was 5.74. Male gender [OR 2.61 (1.04-6.58); P 0.043] and older age [OR 2.96 (1.17-7.46); P 0.023] were associated with a higher risk of developing any kind of urinary abnormality. Proteinuria was present in 61.7% of the children. Macroscopic haematuria [OR 2.48 (1.11-5.58); P = 0.02)] and a high level of proteinuria > 300 mg/dl [OR 5.70 (2.17-14.94); P 300 mg/dl)] were associated with abnormalities of the upper urinary tract and showed good positive and negative predictive values for the detection of pathology in the upper urinary tract (65.5% and 71.1%, respectively). CONCLUSIONS: Severe urinary tract pathology was found in a high percentage of the children in our setting. Microhaematuria and proteinuria were good markers of morbidity, proteinuria being more precise for severe alterations of the upper urinary tract. We suggest initial and evolutive ultrasound in children diagnosed with schistosomiasis, and close monitoring including periodic controls. As schistosomiasis control efforts are currently focused on reducing morbidity, tests that detect the presence or degree of morbidity are essential for targeting treatment and tracking the progress of control campaigns.


Assuntos
Esquistossomose Urinária/complicações , Esquistossomose Urinária/diagnóstico por imagem , Doenças da Bexiga Urinária/diagnóstico por imagem , Doenças da Bexiga Urinária/patologia , Sistema Urinário/diagnóstico por imagem , Sistema Urinário/patologia , Angola , Criança , Feminino , Humanos , Masculino , Medição de Risco , Ultrassonografia , Doenças da Bexiga Urinária/parasitologia , Sistema Urinário/parasitologia
18.
Enferm Infecc Microbiol Clin ; 36(1): 9-15, 2018 01.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-27609632

RESUMO

INTRODUCTION: Mother-to-child transmission (MTCT) is relevant in the global epidemiology of human-immunodeficiency virus (HIV), as it represents the main route of infection in children. The study objectives were to determine the rate of HIV-MTCT and its epidemiological trend between the Spanish-born and immigrant population in Catalonia in the period 2000-2014. METHODS: A prospective observational study of mother-child pairs exposed to HIV, treated in 12 hospitals in Catalonia in the period 2000-2014. HIV-MTCT rate was estimated using a Bayesian logistic regression model. R and WinBUGS statistical software were used. RESULTS: The analysis included 909 pregnant women, 1,009 pregnancies, and 1,032 children. Data on maternal origin was obtained in 79.4% of women, of whom 32.7% were immigrants, with 53.0% of these from sub-Saharan Africa. The overall HIV-MTCT rate was 1.4% (14/1,023; 95% CI; 0.8-2.3). The risk of MTCT-HIV was 10-fold lower in women with good virological control (P=.01), which was achieved by two-thirds of them. The proportion of immigrants was significantly higher in the period 2008-2014 (P<.0001), for the HIV-diagnosis (P<.0001), and antiretroviral administration (P=.02) during pregnancy, and for undetectable viral load next to delivery (P<.001). There were no differences in the rate of MTCT-HIV among Spanish-born and immigrant women (P=.6). CONCLUSIONS: There is a gradual increase in HIV pregnant immigrants in Catalonia. Although most immigrant women were diagnosed during pregnancy, the rate of MTCT-HIV was no different from the Spanish-born women.


Assuntos
Emigrantes e Imigrantes , Infecções por HIV/diagnóstico , Infecções por HIV/epidemiologia , Transmissão Vertical de Doença Infecciosa/estatística & dados numéricos , Complicações Infecciosas na Gravidez/diagnóstico , Complicações Infecciosas na Gravidez/epidemiologia , Adulto , Criança , Feminino , Humanos , Gravidez , Estudos Prospectivos , Espanha/epidemiologia , Fatores de Tempo
19.
Am J Trop Med Hyg ; 98(1): 300-307, 2018 01.
Artigo em Inglês | MEDLINE | ID: mdl-29165223

RESUMO

The rising rate of conflicts and the unsafe situation caused by reasons of ethnicity, religion, gender, sexual orientation, political opinion, or nationality entail an increase in the number of migratory movements. The goal of this article is to describe the health status of asylum seekers visited in an international health center. We conducted a retrospective study of the asylum seekers visited between July 2013 and June 2016. A total of 303 cases were included. The median age was 28.0 years (interquartile range [IQR]: 21-35), and 203 (67.0%) were men. Of the total, 128 cases (42.2%) were from Asia, 82 (27.1%) from Eastern Europe, 42 (13.9%) from sub-Saharan Africa, 34 (11.2%) from America, and 17 (5.6%) from Maghreb. The majority, 287 (94.7%), were asymptomatic. Seventy of the 303 (23.1%) cases were diagnosed with at least one infection, this being more prevalent in men; migrants from sub-Saharan Africa; and in those who took a land-maritime migratory route. Eight of the 303 (2.6%) cases were referred to the transcultural psychiatric department. Two important challenges of the study were the communication barriers and the legal or social situation that condition the psychological symptoms. In 48 of the 303 (15.8%) cases, there was diagnosed a noncommunicable diseases. The process of care was completed by 82.5%; although 21.9% completed the vaccination for hepatitis B. The asylum seekers in this study were in general healthy young men, although special attention was given to infectious diseases with certain geoepidemiological backgrounds. Unstable living arrangements, linguistic, and cultural barriers could account for the failure of the course of care.


Assuntos
Nível de Saúde , Refugiados/estatística & dados numéricos , Adolescente , Adulto , África ao Sul do Saara/etnologia , Ásia/etnologia , Europa Oriental/etnologia , Feminino , Humanos , Masculino , Transtornos Mentais/epidemiologia , Doenças não Transmissíveis/epidemiologia , Estudos Retrospectivos , Espanha/epidemiologia , Adulto Jovem
20.
Enferm. infecc. microbiol. clín. (Ed. impr.) ; 35(10): 617-623, dic. 2017. tab
Artigo em Espanhol | IBECS | ID: ibc-169560

RESUMO

Algunas enfermedades infecciosas han adquirido más relevancia por el aumento de los movimientos poblacionales. La eosinofilia es un hallazgo frecuente en inmigrantes y en viajeros. Una de las causas más frecuentes de eosinofilia es la infección por helmintos y algunos protozoos intestinales. El objetivo de este trabajo es describir las características epidemiológicas de los casos con eosinofilia y su asociación con la presencia de parásitos en la red de datos REDIVI. Se trata de un estudio observacional multicéntrico prospectivo, donde se incluyen los casos diagnosticados de eosinofilia registrados en la Red cooperativa para el estudio de las infecciones importadas por viajeros e inmigrantes (+REDIVI) desde enero de 2009 hasta diciembre de 2012. Se registraron en la red un total de 5.255 episodios durante el periodo de estudio, y la eosinofilia fue un hallazgo en el 8,1 al 31,3% de los casos (dependiendo del tipo migratorio). Fueron hombres el 60,2%, con una mediana de 31,0años, inmigrantes el 72,4% y asintomáticos el 81,2%. Los parásitos más frecuentemente identificados fueron S.stercoralis(34,4%), Schistosoma sp. (11,0%) y uncinarias (8,6%). Existía asociación entre eosinofilia y presencia de parásitos para todos los helmintos (excepto para larva migrans cutánea). La sintomatología y la duración del viaje no determinaron significativamente la presencia de eosinofilia. Ante una eosinofilia en una persona que ha vivido en zonas endémicas de helmintiasis es aconsejable realizar estudios dirigidos para su diagnóstico, independientemente del tipo migratorio, la duración de la estancia o la presencia de sintomatología (AU)


The population movements during the last decades have resulted in a progressively increasing interest in certain infectious diseases. Eosinophilia is a common finding in immigrants and travelers. One of the most common causes of eosinophilia is helminth infection, and some intestinal protozoa. The aim of this paper is to describe the epidemiological characteristics of cases with eosinophilia and its association with the presence of parasites in the REDIVI data network. This is a multicenter prospective observational study that includes patients diagnosed with eosinophilia registered in the cooperative network for the study of infectious diseases in travelers and immigrants (+REDIVI) from January 2009 to December 2012. A total of 5,255 episodes were recorded in the network during the study period, and eosinophilia was observed in 8.1-31.3% of cases (depending on the immigration group). There were 60.2% men, with a median age of 31years. There were 72.4% immigrants, and 81.2% were asymptomatic. The most commonly identified parasites were S.stercoralis (34.4%), Schistosoma sp. (11.0%), and hookworm (8.6%). The relationship between eosinophilia and parasite infection was significant for all helminths (except for cutaneous larva migrans). The symptoms and duration of the journey did not significantly determine the presence of eosinophilia. In the case of eosinophilia in a person who has lived in helminth endemic areas, it is advisable to carry out targeted studies to diagnose the infection, regardless of immigration type, length of stay, or the presence of symptoms (AU)


Assuntos
Humanos , Eosinofilia/epidemiologia , Eosinofilia/prevenção & controle , Saúde do Viajante , Fatores de Risco , Emigrantes e Imigrantes , Protocolos Clínicos , Doenças Transmissíveis/epidemiologia , Estudos Prospectivos , Eosinofilia/microbiologia , Medicina de Viagem/normas , Eosinofilia/parasitologia
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