Posts filed under ‘Medicina del viajero’

Clinical Practice Guidelines by the Infectious Diseases Society of America: 2018 Update on Diagnosis, Treatment, Chemoprophylaxis, and Institutional Outbreak Management of Seasonal Influenza.

Clinical Infectious Diseases March 5, 2019 V.68 N.6 P.e1-e47.   

Clinical Practice Guidelines by the Infectious Diseases Society of America: 2018 Update on Diagnosis, Treatment, Chemoprophylaxis, and Institutional Outbreak Management of Seasonal Influenza.

Uyeki TM1, Bernstein HH2, Bradley JS3,4, Englund JA5, File TM6, Fry AM1, Gravenstein S7, Hayden FG8, Harper SA9, Hirshon JM10, Ison MG11, Johnston BL12, Knight SL13, McGeer A14, Riley LE15, Wolfe CR16, Alexander PE17,18, Pavia AT19.

Abstract

These clinical practice guidelines are an update of the guidelines published by the Infectious Diseases Society of America (IDSA) in 2009, prior to the 2009 H1N1 influenza pandemic. This document addresses new information regarding diagnostic testing, treatment and chemoprophylaxis with antiviral medications, and issues related to institutional outbreak management for seasonal influenza. It is intended for use by primary care clinicians, obstetricians, emergency medicine providers, hospitalists, laboratorians, and infectious disease specialists, as well as other clinicians managing patients with suspected or laboratory-confirmed influenza. The guidelines consider the care of children and adults, including special populations such as pregnant and postpartum women and immunocompromised patients.

Published by Oxford University Press for the Infectious Diseases Society of America 2018.

FULL TEXT

https://academic.oup.com/cid/article/68/6/e1/5251935

PDF (CLIC en PDF)

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May 1, 2019 at 6:23 pm

Imported toxin-producing cutaneous diphtheria— Minnesota, Washington, and New Mexico, 2015–2018.

MMWR Morb Mortal Wkly Rep March 29, 2019 V.68 N.12 P.281-284

Griffith J et al.

Summary

What is already known about this topic?

Cutaneous diphtheria has not been notifiable in the United States since 1980, and U.S. disease incidence data are limited.

What is added by this report?

Toxin-producing Corynebacterium diphtheriae was identified in cutaneous wounds from four U.S. residents after return from international travel. Public health response for toxin-producing diphtheria includes treating patients, providing chemoprophylaxis to close contacts, testing patients and close contacts for C. diphtheriae carriage, and providing diphtheria toxoid–containing vaccine to incompletely immunized patients and close contacts.

What are the implications for public health practice?

Cutaneous toxin-producing diphtheria should be considered in travelers with wound infections who have returned from countries with endemic disease to permit prompt public health response and prevent disease transmission.

 

From September 2015 to March 2018, CDC confirmed four cases of cutaneous diphtheria caused by toxin-producing Corynebacterium diphtheriae in patients from Minnesota (two), Washington (one), and New Mexico (one). All patients had recently returned to the United States after travel to countries where diphtheria is endemic. C. diphtheriae infection was not clinically suspected in any of the patients; treating institutions detected the organism through matrix-assisted laser desorption/ionization–time-of-flight mass spectrometry (MALDI-TOF) testing of wound-derived coryneform isolates. MALDI-TOF is a rapid screening platform that uses mass spectrometry to identify bacterial pathogens. State public health laboratories confirmed C. diphtheriae through culture and sent isolates to CDC’s Pertussis and Diphtheria Laboratory for biotyping, polymerase chain reaction (PCR) testing, and toxin production testing. All isolates were identified as toxin-producing C. diphtheriae. The recommended public health response for cutaneous diphtheria is similar to that for respiratory diphtheria and includes treating the index patient with antibiotics, identifying close contacts and observing them for development of diphtheria, providing chemoprophylaxis to close contacts, testing patients and close contacts for C. diphtheriae carriage in the nose and throat, and providing diphtheria toxoid–containing vaccine to incompletely immunized patients and close contacts. This report summarizes the patient clinical information and response efforts conducted by the Minnesota, Washington, and New Mexico state health departments and CDC and emphasizes that health care providers should consider cutaneous diphtheria as a diagnosis in travelers with wound infections who have returned from countries with endemic diphtheria.

FULL TEXT

https://www.cdc.gov/mmwr/volumes/68/wr/mm6812a2.htm?s_cid=mm6812a2_w

PDF

https://www.cdc.gov/mmwr/volumes/68/wr/pdfs/mm6812a2-H.pdf

April 18, 2019 at 9:57 am

Increased risk of chikungunya infection in travellers to Thailand during ongoing outbreak in tourist areas: cases imported to Europe and the Middle East, early 2019.

EuroSurveillance  March 07, 2019 V.24 N.10

Rapid communication

Emilie Javelle1,2,3, Simin-Aysel Florescu4, Hilmir Asgeirsson5,6, Shilan Jmor7, Gilles Eperon8, Eyal Leshem9, Johannes Blum10, Israel Molina11, Vanessa Field7,12, Nancy Pietroski13, Carole Eldin2, Victoria Johnston7, Ioana Ani Cotar14, Corneliu Popescu4, Davidson H Hamer15,16, Philippe Gautret2,3

Since the start of 2019, the EuroTravNet/GeoSentinel and TropNet data collection networks for the surveillance of travel-related morbidity have identified nine patients with chikungunya virus (CHIKV) infection imported from Thailand to Sweden, Switzerland, the United Kingdom (UK), Romania, Israel and France.

In comparison, the last CHIKV infection reported to EuroTravNet/GeoSentinel in travellers from Thailand was a suspected case in Romania in January 2018.

Only three other cases were reported to this network during the past 3 years from Thailand, and none in travellers returning to Europe.

Here, we present the clinical and travel data of eight travellers notified to EuroTravNet/GeoSentinel and one notified to TropNet with confirmed chikungunya disease imported from Thailand within 2 months.

FULL TEXT

https://www.eurosurveillance.org/content/10.2807/1560-7917.ES.2019.24.10.1900146

PDF (CLIC DOWNLOAD)

April 7, 2019 at 12:53 pm

Prior dengue virus infection and risk of Zika: A pediatric cohort in Nicaragua

Public Library of Science – Medicine PLOS Medicine

Background

Zika virus (ZIKV) emerged in northeast Brazil in 2015 and spread rapidly across the Americas, in populations that have been largely exposed to dengue virus (DENV). The impact of prior DENV infection on ZIKV infection outcome remains unclear. To study this potential impact, we analyzed the large 2016 Zika epidemic in Managua, Nicaragua, in a pediatric cohort with well-characterized DENV infection histories.

Methods and findings

Symptomatic ZIKV infections (Zika cases) were identified by real-time reverse transcription PCR and serology in a community-based cohort study that follows approximately 3,700 children aged 2–14 years old. Annual blood samples were used to identify clinically inapparent ZIKV infections using a novel, well-characterized serological assay. Multivariable Poisson regression was used to examine the relation between prior DENV infection and incidence of symptomatic and inapparent ZIKV infection. The generalized-growth method was used to estimate the effective reproduction number. From January 1, 2016, to February 28, 2017, 560 symptomatic ZIKV infections and 1,356 total ZIKV infections (symptomatic and inapparent) were identified, for an overall incidence of 14.0 symptomatic infections (95% CI: 12.9, 15.2) and 36.5 total infections (95% CI: 34.7, 38.6) per 100 person-years. Effective reproduction number estimates ranged from 3.3 to 3.4, depending on the ascending wave period. Incidence of symptomatic and total ZIKV infections was higher in females and older children. Analysis of the effect of prior DENV infection was performed on 3,027 participants with documented DENV infection histories, of which 743 (24.5%) had experienced at least 1 prior DENV infection during cohort follow-up. Prior DENV infection was inversely associated with risk of symptomatic ZIKV infection in the total cohort population (incidence rate ratio [IRR]: 0.63; 95% CI: 0.48, 0.81; p < 0.005) and with risk of symptomatic presentation given ZIKV infection (IRR: 0.62; 95% CI: 0.44, 0.86) when adjusted for age, sex, and recent DENV infection (1–2 years before ZIKV infection). Recent DENV infection was significantly associated with decreased risk of symptomatic ZIKV infection when adjusted for age and sex, but not when adjusted for prior DENV infection. Prior or recent DENV infection did not affect the rate of total ZIKV infections. Our findings are limited to a pediatric population and constrained by the epidemiology of the site.

Conclusions

These findings support that prior DENV infection may protect individuals from symptomatic Zika. More research is needed to address the possible immunological mechanism(s) of cross-protection between ZIKV and DENV and whether DENV immunity also modulates other ZIKV infection outcomes such as neurological or congenital syndromes.

FULL TEXT

https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1002726

PDF

https://journals.plos.org/plosmedicine/article/file?id=10.1371/journal.pmed.1002726&type=printable

February 13, 2019 at 10:09 pm

Human Rabies — Virginia, 2017

MMWR January 4, 2019  V.67 N.5152 P.1410–1414

Julia Murphy, DVM1; Costi D. Sifri, MD2; Rhonda Pruitt3; Marcia Hornberger4; Denise Bonds4; Jesse Blanton, DrPH5; James Ellison, PhD5; R. Elaine Cagnina2; Kyle B. Enfield2; Miriam Shiferaw, MD5; Crystal Gigante, PhD5; Edgar Condori5; Karen Gruszynski, PhD1,6; Ryan M. Wallace, DVM5

On May 9, 2017, the Virginia Department of Health was notified regarding a patient with suspected rabies. The patient had sustained a dog bite 6 weeks before symptom onset while traveling in India.

On May 11, CDC confirmed that the patient was infected with a rabies virus that circulates in dogs in India.

Despite aggressive treatment, the patient died, becoming the ninth person exposed to rabies abroad who has died from rabies in the United States since 2008.

A total of 250 health care workers were assessed for exposure to the patient, 72 (29%) of whom were advised to initiate postexposure prophylaxis (PEP). The total pharmaceutical cost for PEP (rabies immunoglobulin and rabies vaccine) was approximately $235,000.

International travelers should consider a pretravel consultation with travel health specialists; rabies preexposure prophylaxis is warranted for travelers who will be in rabies endemic countries for long durations, in remote areas, or who plan activities that might put them at risk for a rabies exposures.

PDF

https://www.cdc.gov/mmwr/volumes/67/wr/pdfs/mm675152a2-H.pdf

More information for international travelers about rabies considerations can be found on the CDC’s rabies webpage.

FULL TEXT

https://www.cdc.gov/rabies/index.html

January 26, 2019 at 12:41 pm

Correlación entre criterios clínicos y de laboratorio de casos notificados por sospecha de hantavirosis y el resultado de la técnica de referencia.

Rev. Chil. Infectol. Junio 2016 V.33 N.3 P.275-281

Actualmente en Chile, debido a la elevada sospecha clínica de enfermedad por hantavirus y el alto impacto en salud pública que esto provoca, se hace necesario reforzar al equipo de salud, los criterios de sospecha clínica y epidemiológica de hantavirosis.

Objetivo:

Analizar la información contenida en las notificaciones de sospecha de infección por hantavirus versus la técnica de referencia para el diagnóstico confirmatorio de casos sospechosos, ELISA IgM de captura anti-hantavirus.

Material y Método:

Mediante cálculo de precisión diagnóstica se analizó la correlación que existe entre la información entregada en las notificaciones versus el resultado de la confirmación mediante la técnica de referencia.

Resultados:

De 1.566 pacientes estudiados 3,4% (53 casos) fue confirmado para SCPH. De las notificaciones analizadas 58,6% estaban con datos incompletos. Los porcentajes de positividad de la técnica de referencia asociada a fiebre, mialgia y cefalea, fueron de 80-85%. Destaca que la presencia de inmunoblastos (> 10%), presenta: S: 25%, E: 98%, VPP: 37%, VPN: 97%. Paratrombocitopenia se obtuvo: S: 98%, E: 74%, VPP: 16%, VPN: 100%.

Conclusión:

Se hace necesario reiterar a nivel del sistema sanitario chileno la importancia de contar con datos completos en los formularios de notificación. La presencia de trombocitopenia e inmunoblastos (> 10%) fue altamente sensible y especifica, respectivamente, en la detección de pacientes con SCPH. Con el fin de optimizar la sospecha de infección por hantavirus, según la definición de caso sospechoso, se plantea la necesidad de desarrollar programas de capacitación para la sospecha clínica y lectura de parámetros de laboratorio, tales como presencia de inmunoblastos en el hemograma, así como incluir un algoritmo con el fin de optimizar la sospecha y el uso adecuado de los recursos sanitarios.

PDF

https://scielo.conicyt.cl/pdf/rci/v33n3/art04.pdf

 

January 20, 2019 at 8:05 pm

1er caso de SCPH diagnosticado en la Región de Antofagasta, Chile. 

Rev. Chil. Infectol. Agosto 2012 V.29 N.4 P.477-477

En Chile, desde 1995 se han confirmado casos del SCPH desde Valparaíso hasta Aysén, correspondiendo la mayor incidencia a las regiones de Aysén, Los Lagos, Araucanía y Bío Bío. El agente etiológico del SCPH es un virus ARN del género hantavirus, familia Bunyaviridae, variedad Andes.

El reservorio es el “ratón de cola larga” (Oligoryzomis longicaudatus) el cual se distribuye desde la Región de Atacama hasta la Región de Magallanes (XII°). El virus es eliminado por el ratón a través de sus secreciones (saliva, orina y heces) e ingresa al hombre por vía digestiva, cutánea o aérea, siendo esta última la más frecuente1. La transmisión de persona a persona está documentada, pero se considera excepcional.

El SCPH es un cuadro agudo grave con alta letalidad (30-55%) y sin tratamiento específico. El período de incubación puede durar hasta 45 días. Los primeros síntomas son fiebre, mialgias, cefalea y ocasionalmente diarrea; días después aparece la fase de compromiso respiratorio, con disnea progresiva e insuficiencia respiratoria grave. Es indispensable la terapia de soporte hemodinámico y manejo de la falla respiratoria en una UCI.

PDF

https://scielo.conicyt.cl/pdf/rci/v29n4/art22.pdf

January 20, 2019 at 8:02 pm

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