Posts filed under ‘Infecciones en seniles’

Impact of postherpetic neuralgia: A six year population-based analysis on people aged 50 years or older

Journal of Infection August 2018 V.76 N.8 P.131–136

Cintia Muñoz-Quiles, Mónica López-Lacort, Alejandro Orrico-Sánchez, Javier Díez-Domingo

Highlights

  • This population-based study shows that 15.7% of HZ cases develop PHN.
  • Incidence rate of PHN was 1.19/1000 persons (≥50)-year and it was double in women.
  • The adjusted risk of developing PHN increased sharply with age and comorbidities.
  • About 32% of people will develop a HZ between ages 50–90 years.
  • About 7% of people will develop PHN between ages 50–90 years.

Objectives

To estimate the incidence and burden of postherpetic neuralgia (PHN) and to investigate risk factors for PHN in the Valencia Region of Spain.

Methods

Data were extracted from population and healthcare databases from the Valencia Region (2009–2014). Herpes zoster (HZ) and PHN were defined using ICD-9 codes and drug prescriptions in people aged ≥50 years. The risk of HZ patients for developing PHN and potential risk factors (diabetes mellitus, COPD and heart failure) were investigated. A survival analysis was developed to estimate the cumulative hazard of developing HZ and PHN between ages 50–90 years.

Results

From a total of 2,289,485 subjects, 87,086 cases of HZ were registered, 13,658 (15.7%) of whom developed PHN. PHN risk was higher in women and increased sharply with age and comorbidities as diabetes mellitus, COPD and heart failure. The cumulative risk of developing HZ between ages 50–90 years was 31.7% (95% CI: 31.3-32.1) and 6.9 (95% CI: 6.7–7.1) for PHN.

Conclusions

PHN risk was higher in women and increased with age and comorbidities. At least 32% and 7% of people will develop HZ and PHN, respectively, between ages 50–90 years. These results should be considered for vaccine policy implementation.

FULL TEXT

https://www.journalofinfection.com/article/S0163-4453(18)30107-5/fulltext

PDF

https://www.journalofinfection.com/article/S0163-4453(18)30107-5/pdf

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July 28, 2018 at 7:32 pm

Incidence and costs of herpes zoster and postherpetic neuralgia in German adults aged ≥50 years: A prospective study

Journal of Infection May 2018 V.76 N.5 P.475–482

Ruprecht Schmidt-Ott, Ulf Schutter, Jörg Simon, Barbara Poulsen Nautrup, Alfred von Krempelhuber, Kusuma Gopala, Anastassia Anastassopoulou, Adrienne Guignard, Desmond Curran, Sean Matthews, Emmanuelle Espié

Objectives

Herpes zoster (HZ) mainly affects elderly people and immunocompromised individuals. HZ is usually characterized by a unilateral painful skin rash. Its most common complication, postherpetic neuralgia (PHN), may cause chronic debilitating pain. This study aimed to estimate the HZ incidence in individuals aged ≥50 years in Germany, the proportion of PHN and the economic burden.

Methods

From 2010 to 2014, HZ patients were recruited when consulting physicians in physician networks covering about 157,000 persons aged ≥50 years. PHN was defined as “worst pain” rated ≥3 on the zoster brief pain inventory persisting or appearing over 90 days after rash onset. Costs were calculated based on medical resource utilization and lost working time.

Results

HZ incidence was estimated as 6.7/1000 person-years, increasing with age to 9.4/1000 in ≥80 year-olds. Among 513 HZ patients enrolled, the proportion of PHN was 11.9%, rising with age to 14.3% in HZ patients ≥80 years. Estimated total cost per HZ patient was €156 from the healthcare system perspective and €311 from the societal perspective.

Conclusions

The study confirmed previous findings that HZ causes a substantial clinical and economic burden in older German adults. It also confirmed the age-related increasing risk of HZ and PHN.

FULL TEXT

https://www.journalofinfection.com/article/S0163-4453(18)30053-7/fulltext

PDF

https://www.journalofinfection.com/article/S0163-4453(18)30053-7/pdf

July 28, 2018 at 7:27 pm

Scabies outbreaks in ten care homes for elderly people: a prospective study of clinical features, epidemiology, and treatment outcomes

LANCET INFECTIOUS DISEASES August 2018 V.18 N.8 P.894–902

Background

Scabies outbreaks in residential and nursing care homes for elderly people are common, subject to diagnostic delay, and hard to control. We studied clinical features, epidemiology, and outcomes of outbreaks in the UK between 2014 and 2015.

Methods

We did a prospective observational study in residential care homes for elderly people in southeast England that reported scabies outbreaks to Public Health England health protection teams. An outbreak was defined as two or more cases of scabies (in either residents or staff) at a single care home. All patients who provided informed consent were included; patients with dementia were included if a personal or nominated consultee (ie, a family member or nominated staff member) endorsed participation. Dermatology-trained physicians examined residents at initial clinical visits, which were followed by two mass treatments with topical scabicide as per local health protection team guidance. Follow-up clinical visits were held 6 weeks after initial visits. Scabies was diagnosed through pre-defined case definitions as definite, probable, or possible with dermatoscopy and microscopy as appropriate.

Findings

230 residents were examined in ten outbreaks between Jan 23, 2014, and April 13, 2015. Median age was 86·9 years (IQR 81·5–92·3), 174 (76%) were female, and 157 (68%) had dementia. 61 (27%) residents were diagnosed with definite, probable, or possible scabies, of whom three had crusted scabies. Physical signs differed substantially from classic presentations. 31 (51%) of the 61 people diagnosed with scabies were asymptomatic, and only 25 (41%) had burrows. Mites were visualised with dermatoscopy in seven (11%) patients, and further confirmed by microscopy in three (5%). 35 (57%) cases had signs of scabies only on areas of the body that would normally be covered. Dementia was the only risk factor for a scabies diagnosis that we identified (odds ratio 2·37 [95% CI 1·38–4·07]). At clinical follow-up, 50 people who were initially diagnosed with scabies were examined. No new cases of scabies were detected, but infestation persisted in ten people.

Interpretation

Clinical presentation of scabies in elderly residents of care homes differs from classic descriptions familiar to clinicians. This difference probably contributes to delayed recognition and suboptimal management in this vulnerable group. Dermatoscopy and microscopy were of little value. Health-care workers should be aware of the different presentation of scabies in elderly people, and should do thorough examinations, particularly in people with dementia.

Funding

Public Health England and British Skin Foundation.

FULL TEXT

https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(18)30347-5/fulltext?dgcid=raven_jbs_etoc_email

PDF

https://www.thelancet.com/pdfs/journals/laninf/PIIS1473-3099(18)30347-5.pdf

July 26, 2018 at 12:40 pm

Sexually transmitted infections in older populations

Current Opinion in Infectious Diseases. 26(1):80-85, February 2013.

Poynten, I. Mary; Grulich, Andrew E.; Templeton, David J.

Purpose of review

People are living longer and healthier lives. In recent years, there has been a focus on recognition of ongoing sexual activity among older adults and leading from this, the potential for an increase in diagnoses of sexually transmitted infections (STIs). Data on STI rates, sexual behaviour and factors affecting susceptibility to STIs are discussed.

Recent findings

There is limited published literature in this field and few recent longitudinal studies of STI acquisition in people older than 50 years. Although there is evidence of an increase in incidence, STIs remain rare in older compared with younger populations. Compared with their heterosexual counterparts, older men who have sex with men are at higher risk of incident HIV and some other STIs. The HIV epidemic is ageing as a result of increasing life span and acquisition of HIV at older ages. Improved longevity, evolving societal norms and physiological changes may place older people at risk of HIV and other STIs.

Summary

Routine STI screening is not warranted in all older people. Education and prevention strategies for all people at greater risk of HIV, regardless of age are required. Age-appropriate interventions designed to impart knowledge and provide the requisite skills needed to reduce STI risk in older age would be beneficial.

FULL TEXT

https://journals.lww.com/co-infectiousdiseases/Fulltext/2013/02000/Sexually_transmitted_infections_in_older.12.aspx?WT.mc_id=HPxADx20100319xMP

PDF (CLIC en ARTICLE as PDF)

June 30, 2018 at 10:49 am

Is it safe to go back into the water? A systematic review and meta-analysis of the risk of acquiring infections from recreational exposure to seawater

International Journal of Epidemiology February 26, 2018

Anne F C Leonard  Andrew Singer  Obioha C Ukoumunne  William H Gaze  Ruth Garside

Abstract

Background

Numerous illnesses are associated with bathing in natural waters, although it is assumed that the risk of illness among bathers exposed to relatively clean waters found in high-income countries is negligible. A systematic review was carried out to quantify the increased risk of experiencing a range of adverse health outcomes among bathers exposed to coastal water compared with non-bathers.

Methods

In all 6919 potentially relevant titles and abstracts were screened, and from these 40 studies were eligible for inclusion in the review. Odds ratios (OR) were extracted from 19 of these reports and combined in random-effect meta-analyses for the following adverse health outcomes: incident cases of any illness, ear infections, gastrointestinal illness and infections caused by specific microorganisms.

Results

There is an increased risk of experiencing symptoms of any illness [OR = 1.86, 95% confidence interval (CI): 1.31 to 2.64, P = 0.001] and ear ailments (OR = 2.05, 95% CI: 1.49 to 2.82, P < 0.001) in bathers compared with non-bathers. There is also an increased risk of experiencing gastrointestinal ailments (OR = 1.29, 95% CI: 1.12 to 1.49, P < 0.001).

Conclusions

This is the first systematic review to evaluate evidence on the increased risk of acquiring illnesses from bathing in seawater compared with non-bathers. Our results support the notion that infections are acquired from bathing in coastal waters, and that bathers have a greater risk of experiencing a variety of illnesses compared with non-bathers.

FULL TEXT

https://academic.oup.com/ije/advance-article/doi/10.1093/ije/dyx281/4911079

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March 23, 2018 at 7:55 am

A systems biology approach to the effect of aging, immunosenescence and vaccine response.

Current Opinion in Immunology August 2014 V.29 P.62-8.

Poland GA1, Ovsyannikova IG2, Kennedy RB2, Lambert ND2, Kirkland JL3.

Author information

1 Mayo Clinic Vaccine Research Group, Mayo Clinic, Rochester, MN, USA. Electronic address: poland.gregory@mayo.edu.

2 Mayo Clinic Vaccine Research Group, Mayo Clinic, Rochester, MN, USA.

3 Robert & Arlene Kogod Center on Aging, Mayo Clinic, Rochester, MN, USA.

Abstract

Aging can lead to immunosenescence, which dramatically impairs the hosts’ ability to develop protective immune responses to vaccine antigens. Reasons for this are not well understood.

This topic’s importance is reflected in the increases in morbidity and mortality due to infectious diseases among elderly persons, a population growing in size globally, and the significantly lower adaptive immune responses generated to vaccines in this population.

Here, we endeavor to summarize the existing data on the genetic and immunologic correlates of immunosenescence with respect to vaccine response.

We cover how the application of systems biology can advance our understanding of vaccine immunosenescence, with a view toward how such information could lead to strategies to overcome the lower immunogenicity of vaccines in the elderly.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4119552/pdf/nihms589246.pdf

February 19, 2018 at 9:12 am

The microbiota and microbiome in aging: potential implications in health and age-related diseases.

J Am Geriatr Soc. April 2015 V.63 N.4 P.776-81.

Zapata HJ1, Quagliarello VJ.

Author information

1 Infectious Diseases Section, Department of Internal Medicine, School of Medicine, Yale University, New Haven, Connecticut.

Abstract

Advances in bacterial deoxyribonucleic acid sequencing allow for characterization of the human commensal bacterial community (microbiota) and its corresponding genome (microbiome).

Surveys of healthy adults reveal that a signature composite of bacteria characterizes each unique body habitat (e.g., gut, skin, oral cavity, vagina).

A myriad of clinical changes, including a basal proinflammatory state (inflamm-aging), that directly interface with the microbiota of older adults and enhance susceptibility to disease accompany aging.

Studies in older adults demonstrate that the gut microbiota correlates with diet, location of residence (e.g., community dwelling, long-term care settings), and basal level of inflammation.

Links exist between the microbiota and a variety of clinical problems plaguing older adults, including physical frailty, Clostridium difficile colitis, vulvovaginal atrophy, colorectal carcinoma, and atherosclerotic disease.

Manipulation of the microbiota and microbiome of older adults holds promise as an innovative strategy to influence the development of comorbidities associated with aging.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4406803/pdf/nihms-644813.pdf

February 19, 2018 at 9:11 am

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