Posts filed under ‘Infecciones en seniles’

Case Reports – Altered Mental Status as a Novel Initial Clinical Presentation for COVID-19 Infection in the Elderly

Am J Geriatr Psychiatry. 2020 Aug;28(8):808-811. 

COVID-19 se identificó por primera vez en la provincia de Hubei en China en noviembre 2019 y se propagó rápidamente para convertirse en una pandemia mundial.

El SARS-CoV-2 es particularmente virulento en los ancianos que pueden desarrollar síntomas y enfermarse mortalmente a los pocos días de contraer la infección.

El SARS-CoV-2 se transmite fácilmente por gotitas (p. ej. estornudos, tos, al hablar o cantar) y los entornos de vida comunitaria, como los hogares de cuidado personal, pueden ser vulnerables a la propagación del virus.

Identificar a los pacientes temprano en el proceso de la enfermedad es importante para proporcionar intervenciones médicas apropiadas.

Hasta la fecha, la mayoría de la literatura médica, incluidas las pautas de los CDC se ha basado en tres síntomas necesarios para hacer el diagnóstico de COVID-19: fiebre, tos y disnea.

Presentan 4 casos de adultos mayores que desarrollaron un estado mental alterado como síntoma de presentación sin fiebre asociada o síntomas respiratorios.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7227566/pdf/main.pdf

August 6, 2020 at 4:33 pm

Prevalence and Etiology of Community-acquired Pneumonia in Immunocompromised Patients

Clin Infect Dis. April 24, 2019 V.68 N.9 P.1482-1493. 

Background

The correct management of immunocompromised patients with pneumonia is debated. We evaluated the prevalence, risk factors, and characteristics of immunocompromised patients coming from the community with pneumonia.

Methods

We conducted a secondary analysis of an international, multicenter study enrolling adult patients coming from the community with pneumonia and hospitalized in 222 hospitals in 54 countries worldwide. Risk factors for immunocompromise included AIDS, aplastic anemia, asplenia, hematological cancer, chemotherapy, neutropenia, biological drug use, lung transplantation, chronic steroid use, and solid tumor.

Results

At least 1 risk factor for immunocompromise was recorded in 18% of the 3702 patients enrolled. The prevalences of risk factors significantly differed across continents and countries, with chronic steroid use (45%), hematological cancer (25%), and chemotherapy (22%) the most common. Among immunocompromised patients, community-acquired pneumonia (CAP) pathogens were the most frequently identified, and prevalences did not differ from those in immunocompetent patients. Risk factors for immunocompromise were independently associated with neither Pseudomonas aeruginosa nor non-community-acquired bacteria. Specific risk factors were independently associated with fungal infections (odds ratio for AIDS and hematological cancer, 15.10 and 4.65, respectively; both P = .001), mycobacterial infections (AIDS; P = .006), and viral infections other than influenza (hematological cancer, 5.49; P < .001).

Conclusions

Our findings could be considered by clinicians in prescribing empiric antibiotic therapy for CAP in immunocompromised patients. Patients with AIDS and hematological cancer admitted with CAP may have higher prevalences of fungi, mycobacteria, and noninfluenza viruses.

FULL TEXT

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6481991/

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6481991/pdf/ciy723.pdf

 

July 13, 2020 at 3:53 pm

REVIEW SARS-CoV-2 and COVID-19 in Older Adults: What We May Expect Regarding Pathogenesis, Immune Responses, and Outcomes

Geroscience April 2020 V.42 N.2 P.:505-514.

El SARS-CoV-2, el agente causante de COVID-19, está arrasando el mundo, llegando a 500,000 casos confirmados y más de 21,000 muertes al 25/03/20.

Mientras está bajo control en algunos, en los países asiáticos afectados (Taiwán, Singapur, Vietnam), el virus demostró una fase exponencial de infectividad en varios países grandes (China a fines de enero y febrero y muchos países europeos y Estados Unidos en marzo), con casos que explotaron en 30-50,000 / día en la tercera y cuarta semana de marzo 2020.

El SARS-CoV-2 ha demostrado ser particularmente mortal para los adultos mayores y aquellos con ciertas afecciones médicas subyacentes, muchos de los cuales son de edad avanzada.

En esta revisión revisan brevemente el virus, su estructura y evolución, epidemiología y patogénesis, inmunogenicidad e inmunidad y respuesta clínica en adultos mayores, utilizando el conocimiento disponible sobre SARS-CoV-2 y sus parientes altamente patógenos MERS-CoV y SARS-CoV- 1

Concluyen la necesidad de discutir enfoques de ciencia clínica y básica para proteger a los adultos mayores contra esta enfermedad.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7145538/pdf/11357_2020_Article_186.pdf

June 12, 2020 at 6:30 pm

REVIEW COVID-19 and Older Adults – What We Know

J Am Geriatr Soc. May 2020 V.68 N.5 P.926-929.

El SARS-CoV-2, un nuevo virus que causa la infección por COVID-19, ha surgido recientemente y ha causado una pandemia mortal. Los estudios han demostrado que este virus causa peores resultados y una mayor tasa de mortalidad en adultos mayores y aquellos con comorbilidades como hipertensión, enfermedad cardiovascular, diabetes, enfermedad respiratoria crónica y enfermedad renal crónica (ERC).

Un porcentaje significativo de adultos estadounidenses mayores tienen estas enfermedades, lo que los pone en mayor riesgo de infección. Además, muchos adultos con hipertensión, diabetes y ERC reciben antihipertensivos inhibidores de la enzima convertidora de angiotensina (ECA) y bloqueadores de los receptores de angiotensina II.

Los estudios han demostrado que estos medicamentos regulan al alza el receptor ACE-2, el mismo receptor que utiliza el virus SARS-CoV-2 para ingresar a las células huésped.

Aunque se ha planteado la hipótesis de que esto puede causar un mayor riesgo de infección, se necesitan más estudios sobre el papel de estos medicamentos en las infecciones por COVID-19.

En esta revisión, discuten la transmisión, la sintomatología y la mortalidad de COVID-19 en su relación con los adultos mayores, y los posibles tratamientos que están actualmente bajo investigación.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7262251/pdf/JGS-68-926.pdf

June 12, 2020 at 6:29 pm

Community-acquired pneumonia in critically ill very old patients – a growing problem

European Respiratory Review March 2020

Los adultos ≥ 80 años constituyen una proporción creciente de la población mundial.

Actualmente, este subgrupo de pacientes representa un porcentaje importante de pacientes ingresados en  UCI.

La neumonía adquirida en la comunidad (NAC) con frecuencia afecta a adultos muy mayores, sin embargo, no hay recomendaciones específicas para el manejo de pacientes crónicamente enfermos con NAC > 80 años.

La morbilidad múltiple, la polifarmacia, la inmunosenescencia y la fragilidad contribuyen a un mayor riesgo de NAC en esta población.

La NAC en pacientes críticos > 80 años se asocia con una mayor mortalidad a corto y largo plazo, sin embargo, debido a su presentación poco común, el diagnóstico puede ser muy difícil.

El manejo de pacientes con NAC críticamente enfermos debe guiarse por sus características basales, presentación clínica y factores de riesgo para patógenos resistentes a múltiples antimicrobianos.

La hospitalización en cuidados intermedios puede ser una buena opción para pacientes > 80 años críticamente enfermos que no requieren procedimientos invasivos y para quienes las UCI son cuestionables en términos de beneficio.

FULL TEXT

https://err.ersjournals.com/content/29/155/190126

PDF

https://err.ersjournals.com/content/errev/29/155/190126.full.pdf

 

April 10, 2020 at 7:45 pm

Use of 13-Valent Pneumococcal Conjugate Vaccine and 23-Valent Pneumococcal Polysaccharide Vaccine Among Adults Aged ≥ 65 Years: Updated Recommendations of the Advisory Committee on Immunization Practices.

MMWR Morb Mortal Wkly Rep. November 22, 2019 V.68 N.46 P.1069-1075.

Matanock A, Lee G, Gierke R, Kobayashi M, Leidner A, Pilishvili T.

Abstract

Two pneumococcal vaccines are currently licensed for use in adults in the United States: a 13-valent pneumococcal conjugate vaccine (PCV13 [Prevnar 13, Pfizer, Inc.]) and a 23-valent pneumococcal polysaccharide vaccine (PPSV23 [Pneumovax 23, Merck and Co., Inc.]).

In 2014, the Advisory Committee on Immunization Practices (ACIP)* recommended routine use of PCV13 in series with PPSV23 for all adults aged ≥65 years based on demonstrated PCV13 safety and efficacy against PCV13-type pneumonia among adults aged ≥65 years (1).

At that time, ACIP recognized that there would be a need to reevaluate this recommendation because it was anticipated that PCV13 use in children would continue to reduce disease burden among adults through reduced carriage and transmission of vaccine serotypes from vaccinated children (i.e., PCV13 indirect effects).

On June 26, 2019, after having reviewed the evidence accrued during the preceding 3 years (https://www.cdc.gov/vaccines/acip/recs/grade/PCV13.html), ACIP voted to remove the recommendation for routine PCV13 use among adults aged ≥65 years and to recommend administration of PCV13 based on shared clinical decision-making for adults aged ≥65 years who do not have an immunocompromising condition,† cerebrospinal fluid (CSF) leak, or cochlear implant, and who have not previously received PCV13.

ACIP recognized that some adults aged ≥65 years are potentially at increased risk for exposure to PCV13 serotypes, such as persons residing in nursing homes or other long-term care facilities and persons residing in settings with low pediatric PCV13 uptake or traveling to settings with no pediatric PCV13 program, and might attain higher than average benefit from PCV13 vaccination.

When patients and vaccine providers§ engage in shared clinical decision-making for PCV13 use to determine whether PCV13 is right for a particular person, considerations might include both the person’s risk for exposure to PCV13 serotypes and their risk for developing pneumococcal disease as a result of underlying medical conditions.

All adults aged ≥65 years should continue to receive 1 dose of PPSV23. If the decision is made to administer PCV13, it should be given at least 1 year before PPSV23.

ACIP continues to recommend PCV13 in series with PPSV23 for adults aged ≥19 years with an immunocompromising condition, CSF leak, or cochlear implant (2).

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6871896/pdf/mm6846a5.pdf

 

 

December 19, 2019 at 7:46 am

Emergent Invasive Group A Streptococcus dysgalactiae subsp. equisimilis, US 2015–2018

Emerging Infectious Diseases July 2019

The term group A Streptococcus is considered synonymous for the species Streptococcus pyogenes. We describe an emergent invasive S. dysgalactiae subspecies equisimilis lineage that obtained the group A antigen through a single ancestral recombination event between a group C S. dysgalactiae subsp. equisimilis strain and a group A S. pyogenes strain.

FULL TEXT

https://wwwnc.cdc.gov/eid/article/25/8/18-1758_article?deliveryName=DM4767

PDF (CLIC en DOWNLOAD ARTICLE)

July 21, 2019 at 7:43 pm

Listeriosis in Spain based on hospitalisation records, 1997 to 2015: need for greater awareness

Eurosuveillance

Listeriosis is an infectious disease caused by bacteria of the genus Listeria spp. L. monocytogenes is the major pathogenic species in both animals and humans. L. monocytogenes is a Gram-positive, rod-shaped organism that can grow in aerobic and anaerobic conditions [1], is widely distributed in the environment and is able to contaminate a wide variety of foods or beverages (soft cheese, deli meats, unpasteurised milk, refrigerated smoked seafood, etc.) [2]. The bacteria can multiply at refrigerator temperatures [3]; therefore, contaminated products are often kept for several days or even weeks, e.g. in the household/restaurants, and may be eaten on multiple occasions, which can complicate the identification of the incriminated food source [4].

The clinical syndromes of listeriosis include: febrile gastroenteritis, sepsis, central nervous system (CNS) involvement in the form of encephalitis, meningoencephalitis and focal infections such as pneumonia myo-endocarditis and septic arthritis, etc [5]. Invasive listeriosis most commonly affects pregnant women, neonates, elderly people and people with chronic conditions or weakened immune response [6]. Listeriosis has one of the highest case fatality rates among all food-borne infections; when it affects the CNS, the mortality rate is above 50% and neurological sequelae are present in more than 60% of survivors [2]. Listeriosis is also associated with fetal and neonatal death.

Worldwide, listeriosis is an emerging infection of public health concern [7]. In Europe, human listeriosis peaked in incidence during the 1980s, showed a general decline during the 1990s and stabilised in the 2000s [8]. More recent data show an increasing trend since 2008 [9]. This increase seems to be related to the ageing of the population and the increase in life expectancy of immunocompromised patients, but also to changes in the ways food is produced, stored, distributed and consumed around the world [10]. Although listeriosis is often a sporadic disease [11], large food-borne outbreaks have occurred during the last decade in Europe and the United States (US) [12]. In South Africa, an outbreak with more than 1,024 laboratory-confirmed listeriosis cases, as at 2 May 2018, has been ongoing since the start of 2017, with a 28.6% case fatality rate [13].

In Spain, food safety criteria (FSC) for L. monocytogenes follow European Commission (EC) regulations [14,15]. Before 2015, when it was added to the list of mandatory notifiable diseases, regions could voluntarily report listeriosis to the Microbiological Information System (Sistema de Información Microbiológica, SIM) [16]. Using the centralised hospital discharge database (Conjunto Mínimo Básico de Datos, CMBD), we aimed to describe the epidemiology of listeriosis in Spain from 1997–2015.

FULL TEXT

https://www.eurosurveillance.org/content/10.2807/1560-7917.ES.2019.24.21.1800271

PDF (CLIC en DOWNLOAD PDF)

June 21, 2019 at 7:49 am

Diagnostic value of symptoms and signs for identifying urinary tract infection in older adult outpatients: Systematic review and meta-analysis

Journal of Infection November 2018 V.77 N.5 P.379–390

Oghenekome A. Gbinigie, José M. Ordóñez-Mena, Thomas R. Fanshawe, Annette Plüddemann, Carl Heneghan

Highlights

  • Older adults may present atypically with UTI and making a diagnosis can be difficult.
  • There is limited authoritative guidance on how older adult outpatients present with UTI.
  • Symptoms and signs traditionally associated with UTI (e.g. nocturia, urgency and abnormal vital signs) may have limited utility in diagnosing these infections in older adult outpatients.
  • Disability in performing a number of acts of daily living may be better predictors of UTI; high quality studies should be conducted in this area to confirm this

Objectives

To critically appraise and evaluate the diagnostic value of symptoms and signs in identifying UTI in older adult outpatients, using evidence from observational studies.

Methods

We searched Medline and Medline in process, Embase and Web of Science, from inception up to September 2017. We included studies assessing the diagnostic accuracy of symptoms and/or signs in predicting UTI in outpatients aged 65 years and above. Study quality was assessed using the QUADAS-2 tool.

Results

We identified 15 eligible studies of variable quality, with a total of 12,039 participants (range 65–4259), and assessed the diagnostic accuracy of 66 different symptoms and signs in predicting UTI. A number of symptoms and signs typically associated with UTI, such as nocturia, urgency and abnormal vital signs, were of limited use in older adult outpatients. Inability to perform a number of acts of daily living were predictors of UTI: For example, disability in feeding oneself, + ve LR: 11.8 (95% CI 5.51–25.2) and disability in washing one’s hands and face, + ve LR: 6.84 (95% CI 4.08–11.5).

Conclusions

The limited evidence of varying quality shows that a number of symptoms and signs traditionally associated with UTI may have limited diagnostic value in older adult outpatients.

FULL TEXT

https://www.journalofinfection.com/article/S0163-4453(18)30190-7/fulltext

PDF

https://www.journalofinfection.com/article/S0163-4453(18)30190-7/pdf

January 12, 2019 at 9:59 am

Managing community acquired pneumonia in the elderly – the next generation of pharmacotherapy on the horizon.

Expert Opin Pharmacother. 2017 Aug;18(11):1039-1048.

Amalakuhan B1,2, Echevarria KL1,2, Restrepo MI1,2.

Abstract

Community acquired pneumonia (CAP) is associated with high rates of morbidity and mortality, especially among the elderly.

Antibiotic treatment for CAP in the elderly is particularly challenging for many reasons, including compliance issues, immunosuppression, polypharmacy and antimicrobial resistance.

There are few available antibiotics that are able to address these concerns.

Areas covered: After a systematic review of the current literature, we describe seven novel antibiotics that are currently in advanced stages of development (phase 3 and beyond) and show promise for the treatment of CAP in those over the age of 65.

These antibiotics are: Solithromycin, Pristinamycin, Nemonaxacin, Lefamulin, Omadacycline, Ceftobiprole and Delafloxacin.

Using a novel conceptual framework designed by the present authors, known as the ‘San Antonio NIPS model‘, we evaluate their strengths and weaknesses based on their ability to address the unique challenges that face the elderly.

Expert opinion: All seven antibiotics have potential value for effective utilization in the elderly, but to varying degrees based on their NIPS model score.

The goal of this model is to reorganize a clinician’s focus on antibiotic choices in the elderly and bring attention to a seldom discussed topic that may potentially become a health-care crisis in the next decade

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6092187/pdf/nihms-1500383.pdf

November 18, 2018 at 11:47 am

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