Hidatidosis: aspectos clínicos y morbimortalidad

[ES] La hidatidosis es la artropozoonosis más importante en España. Cuatro especies son las que infectan al ser humanos siendo E. granulosus y E. multilocularis, agentes causales de la equinococosis quística y equinococosis alveolar respectivamente, los más importantes desde el punto de vista de salud pública por su distribución geográfica e impacto económico a nivel mundial. Estuvo incluida en el grupo de enfermedades de declaración obligatoria hasta 1996 y posteriormente cada comunidad autónoma decidió su estrategia de control, incluyéndose, en el caso de Castilla y León, dentro de la red de vigilancia epidemiológica. Muy recientemente y a consecuencia de los datos epidemiológicos en marzo de 2015, se ha reintroducido la hidatidosis como Enfermedad de Declaración Obligatoria en España. No obstante, nuestro grupo ha demostrado una importante discrepancia de los datos oficiales publicados con respecto a los datos reales, siendo claramente infradeclarados y persistiendo como una zona de alta prevalencia de esta enfermedad. El hombre actúa como huésped intermediario, adquiriendo la infección mediante ingesta o contacto con productos contaminados por los excrementos. La infección da lugar a formación de quistes que pueden llegar a crecer a una velocidad de 1-5 cm/año. Generalmente se ubican en el hígado y en el pulmón, pero hasta un quinto de los casos se pueden localizar en otros tejidos como bazo, riñones, corazón, huesos o sistema nervioso central. Así las manifestaciones clínicas son variables, pudiendo permanecer asintomáticos o dando lugar a cuadros clínicos graves con riesgo de fallecimiento del paciente cuando existe alguna complicación. En la actualidad no existe un consenso en el tratamiento de la hidatidosis a pesar de la recomendación de la OMS en este sentido, además existen diferencias sustanciales en el manejo según las posibilidades técnicas de que disponga el centro sanitario A esto hay que añadir un elevado coste. Análisis recientes han demostrado que la hidatidosis no solo es una enfermedad reemergente, como hemos comentado previamente, sino que presenta un gran impacto en cuanto a pérdidas económicas e incapacidad ajustada por años de vida (DAYLs disability adjusted life years). Este trabajo doctoral pretende esclarecer ciertos aspectos epidemiológicos, clínicos y de manejo a través del análisis de una cohorte de pacientes con hidatidosis atendidos en el Complejo Asistencial Universitario de Salamanca (CAUSA) durante los últimos 17 año

Is babesiosis a rare zoonosis in Spain? Its impact on the Spanish Health System over 23 years

Background: Babesiosis is a zoonosis caused by an intraerythrocytic protozoan of the genus Babesia and transmitted mainly by ticks of the Ixodes spp. complex. There is no comprehensive global incidence in the literature, although the United States, Europe and Asia are considered to be endemic areas. In Europe, the percentage of ticks infected with Babesia spp. ranges from 0.78% to 51.78%. The incidence of babesiosis in hospitalized patients in Spain is 2.35 cases per 10,000,000 inhabitants/year. The mortality rate is estimated to be approximately 9% in hospitalized patients but can reach 20% if the disease is transmitted by transfusion. Objective: To analyze the epidemiological impact of inpatients diagnosed with babesiosis on the National Health System (NHS) of Spain between 1997 and 2019. Methodology: A retrospective longitudinal descriptive study that included inpatients diagnosed with babesiosis [ICD-9-CM code 088.82, ICD-10 code B60.0, cases ap2016-2019] in public Spanish NHS hospitals between 1 January 1997 and 31 December 2019 was developed. Data were obtained from the minimum basic dataset (CMBD in Spanish), which was provided by the Ministerio de Sanidad, Servicios Sociales e Igualdad after the receipt of a duly substantiated request and the signing of a confidentiality agreement. Main findings: Twenty-nine inpatients diagnosed with babesiosis were identified in Spain between 1997 and 2019 (IR: 0.28 cases/10,000,000 person-years). A total of 82.8% of the cases were men from urban areas who were approximately 46 years old. The rate of primary diagnoses was 55.2% and the number of readmissions was 79.3%. The mean hospital stay was 20.3±19.2 days, with an estimated cost of €186,925.66. Two patients, both with secondary diagnoses of babesiosis, died in our study. Conclusions: Human babesiosis is still a rare zoonosis in Spain, with an incidence rate that has been increasing over the years. Most cases occurred in middle-aged men from urban areas between summer and autumn. The Castilla-La-Mancha and Extremadura regions recorded the highest number of cases. Given the low rate of primary diagnoses (55.2%) and the high number of readmissions (79.3%), a low clinical suspicion is likely. There was a 6.9% mortality in our study. Both patients who died were patients with secondary diagnoses of the disease

Falsas enfermedades tropicales: un estudio retrospectivo

Background. When we evaluate a patient with a suspected imported disease we cannot forget to include any autochthonous causes that may mimic imported pathologies to avoid misdiagnosis and therapeutic delay. Methods. A descriptive longitudinal retrospective study was designed with patients in whom an imported disease was suspected but who were finally diagnosed with autochthonous processes. The patients were selected from two internal medicine practices specializing in tropical diseases between 2008-2017 in Spain. Results. We report 16 patients, 11 (68.7%) were males, and the mean age was 43.4 ± 13.7 years old. Thirteen patients (81.2%) were travellers. Half of the patients were from Latin America, 7 (43.5%) were from Africa, and 1 (6.2%) was from Asia. The time from trip to evaluation ranged between 1 week and 20 years (me-dian, 4 weeks), and the mean time from evaluation to diagnosis was 58.4 ± 100.9 days. There were 5 (31.2%) cases of autochthonous infection, 5 (31.2%) cases of cancer, 2 (12.5%) cases of inflammatory disease, and 2 (12.5%) cases of vascular disease. Conclusions. Travel or migration by a patient can sometimes be a confusing factor if an imported disease is suspected and may cause delays in the diagnosis and treatment of an autochthonous disease. We highlight that 1/3 of the patients with autochthonous diseases in this study had cancer. The evaluation of imported diseases requires a comprehensive approach by the internist, especially if he specializes in infectious and/or tropical diseases and is, therefore, the best qualified to make an accurate diagnosis.Introducción. La evaluación de un enfermo con sospecha de patología importada debe incluir las causas autóctonas que puedan simular enfermedades importadas, para evitar un diagnóstico erróneo y un retraso terapéutico. Métodos. Estudio retrospectivo longitudinal descriptivo de pacientes con sospecha de patología importada con diagnóstico final de proceso autóctono. Los pacientes fueron seleccionados en dos consultas especializadas en enfermedades tropicales de dos hospitales españoles entre 2008-2017. Resultados. Se obtuvieron 16 pacientes, 11 (68,7%) hombres. La edad media fue de 43,4 ± 13,7 años. Trece pacientes (81,2%) eran viajeros. Ocho (50%) pacientes eran latinoamericanos, 7 (43,5%) africanos y un paciente asiático (6,2%). El tiempo desde el viaje hasta la evaluación osciló entre 1 semana y 20 años. El tiempo medio desde la evaluación hasta el diagnóstico fue de 58,4 ± 100,9 días. Hubo 5 (31,2%) casos de infección autóctona, 5 (31,2%) casos de cáncer, 2 (12,5%) casos de enfermedad inflamatoria y 2 (12,5%) casos de patología vascular. Conclusiones. El origen del paciente o el antecedente de un viaje pueden ser factores de confusión durante el proceso clínico y causar un retraso diagnóstico y terapéutico. Por lo tanto, es aconsejable una visión amplia al evaluar estas enfermedades. Destacamos que un tercio de los pacientes presentó un diagnóstico final de neoplasia

Complications Associated With Initial Clinical Presentation of Cystic Echinococcosis: A 20-year Cohort Analysis

Cystic echinococcosis (CE) is a chronic, complex, and overlooked zoonotic disease caused by Echinococcus granulosus. In humans, it may result in a wide spectrum of clinical manifestations depending on the type of complications, ranging from asymptomatic infection to fatal disease. The primary complications and risk factors associated with CE are not well defined. We performed a retrospective, observational study of inpatients diagnosed with CE from January 1998 to December 2017 in the public health-care system of western Spain. Five hundred and six cases were analyzed. More than half of the patients (302 [59.7%]) were asymptomatic, and the diagnoses were made incidentally. A total of 204 (40.3%) patients had complications associated with CE; 97 (47.5%) were mechanical, 62 (30.4%) were infectious, 15 (7.3%) were immunoallergic, and 30 (14.7%) involved a combination of complications. Mortality was higher in patients with mechanical complications (9.4%) than in patients with infectious complications (5.6%) and in patients with allergic complications (0%) (odds ratio = 19.7, 95% CI, 4.3-89.1, P < 0.001). In summary, CE frequently results in complications, especially in the liver in younger patients and, regardless of other variables, such as size or stage of cyst. Mechanical problems and superinfection are the most frequent complications. CE is an obligatory diagnosis in patients with urticarial or anaphylactoid reactions of unknown cause in endemic areas

Epidemiological assessment of 5598 brucellosis inpatients in Spain (1997-2015)

Brucellosis remains one of the main zoonoses worldwide. Epidemiological data on human brucellosis in Spain are scarce. The objective of this study was to assess the epidemiological characteristics of inpatient brucellosis in Spain between 1997 and 2015. A retrospective longitudinal descriptive study was performed. Data were requested from the Health Information Institute of the Ministry of Health and Equality, which provided us with the Minimum Basic Data Set of patients admitted to the National Health System. We also obtained data published in the System of Obligatory Notifiable Diseases. A total of 5598 cases were registered. The period incidence rate was 0.67 (95% CI 0.65?0.68) cases per 100 000 person-years. We observed a progressive decrease in the number of cases and annual incidence rates. A total of 3187 cases (56.9%) came from urban areas. The group most at risk comprised men around the fifth decade of life. The average (±S.D.) hospital stay was 12.6 days (±13.1). The overall lethality rate of the cohort was 1.5%. The number of inpatients diagnosed with brucellosis decreased exponentially. The group of patients with the highest risk of brucellosis in our study was males under 45 years of age and of urban origin. The lethality rate has reduced to minimum values. It is probable that hospital discharge records could be a good database for the epidemiological analysis of the hospital management of brucellosis and offer a better information collection system than the notifiable diseases system (EDO in Spanish)

Portal hypertension as a complication of cystic echinococcosis: a 20-year cohort analysis

Cystic echinococcosis (CE) is a parasitic disease caused by the larval forms of species of the tapeworm Echinococcus. The most common location is the liver. To assess the frequency and clinical characteristics of portal hypertension (PH) and the risk factors for PH development, we performed a retrospective observational study of inpatients diagnosed with hepatic CE and PH from January 1998 to December 2018, at Complejo Asistencial Universitario de Salamanca, Spain. Of 362 patients analyzed with hepatic CE, 15 inpatients (4.1%) had a portal vein diameter ≥ 14 mm, and the mean diameter of the portal vein was 16.9 (standard deviation [SD] ±2.1) mm. Twelve patients were men. The mean age was 59.5 years (SD ± 17.8 years). Four patients had ascites (26.6%), four had collateral circulation (26.6%), 14 had hepatosplenomegaly (93.3%), five had esophageal varices (33.3%), four had hematemesis, and three had jaundice. Other causes of PH included hepatitis B virus (1 patient) and hepatitis C virus (1 patient) infections and alcohol abuse (1 patient). The host variables associated with PH development were male sex (odds ratio, 4.6; 95% confidence interval, 1.1-20.9; P = 0.030) and larger cyst size (10.8 ± 6.3 versus 7.6 ± 4.1; P = 0.004). Hepatic CE is an infrequent cause of PH that usually occurs without indications of liver failure. Larger cyst size and male sex were the main risk factors associated with this complication. Mortality was higher for patients with hepatic CE with PH than for patients with hepatic CE without PH

How Has the Aspergillosis Case Fatality Rate Changed over the Last Two Decades in Spain?

Background: Aspergillus produces high morbidity and mortality, especially in at-risk populations. In Spain, the evolution of mortality in recent years due to this fungus is not well established. The aim of this study was to estimate the case fatality rate of aspergillosis in inpatients from 1997 to 2017 in Spain. (2) Methodology: A retrospective descriptive study was conducted with records of inpatients admitted to the National Health System with a diagnosis of aspergillosis. (3) Principal findings: Of 32,960 aspergillosis inpatients, 24.5% of deaths were registered, and 71% of the patients who died were men. The percentage of deaths increased progressively with age. The case fatality rate progressively decreased over the period, from 25.4 and 27.8% in 1997–1998 to values of 20.6 and 20.8% in 2016 and 2017. Influenza and pneumonia occurrence/association significantly increased case fatality rates in all cases. (4) Conclusions: Our study shows that lethality significantly decreased in the last two decades despite the increase in cases. This highlights the fact that patients with solid and/or hematological cancer do not have a much higher mortality rate than the group of patients with pneumonia or influenza alone, these two factors being the ones that cause the highest CFRs. We also need studies that analyze the causes of mortality to decrease it and studies that evaluate the impact of COVID-19.Peer reviewe

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Memoria ID-0264. Ayudas de la Universidad de Salamanca para la innovación docente, curso 2015-2016