Tratamiento de la equinococosis quística

Tesis por compendio de publicaciones[ES] La hidatidosis humana o equinococosis quística (EQ) es una zoonosis causada por el Echinococcus granulosus, un céstodo cuyo hospedador definitivo es el perro, y en la que el hombre constituye un hospedador intermediario accidental. Debido al impacto en términos de morbilidad, la especial afectación en áreas desfavorecidas y la escasa inversión en investigación, esta enfermedad está incluida en el listado de “Enfermedades Tropicales Desatendidas” de la Organización Mundial de la Salud (OMS).A pesar de la recomendación de la OMS, no existe un consenso en el tratamiento de la hidatidosis en este momento, de forma que su manejo es enormemente complejo. A modo de resumen, existen fundamentalmente tres tipos de tratamientos, en muchas ocasiones complementarios entre sí: i) la cirugía, ii) las técnicas percutáneas y, iii) los antiparasitarios. Además, existen enormes diferencias en el manejo según medios disponibles, centro sanitario, características del paciente y del quiste.Por lo descrito, el tratamiento de la EQ es un problema vigente y sustancial, condicionando un intenso debate parar decidir cual es el tratamiento óptimo. El objetivo general de esta tesis es la evaluación del tratamiento actual frente a la equinococosis quística. Los objetivos específicos son los siguientes: Valoración de la eficacia y seguridad del tratamiento con antihelmínticos en la equinococosis quística; Evaluación del tratamiento aplicado a los pacientes con equinococosis quística atendidos en el Complejo Asistencial Universitario de Salamanca (CAUSA) durante el periodo de 1998 al 2015;Evaluación de las recurrencias postquirúrgicas en los pacientes atendidos en el CAUSA con equinococosis quística desde 1998 al 2015; Valoración de la mortalidad en la equinococosis quística en la cohorte CAUSA. La tesis es un compendio de artículos originales elaborados a partir de un meta-análisis y revisión sistematica, tres estudios retrospectivos longitudinales y tres casos clínicos. Los artículos originales de los que consta esta tesis doctoral, para responder a los diferentes objetivos planteados son los siguientes: i) “Medical treatment of Cystic Echinococcosis: systematic review and meta-analysis“. BMC 2018, en prensa. ii) “Safety of the Combined Use of Praziquantel and Albendazole in the Treatment of Human Hydatid Disease”. doi: 10.4269/ajtmh.13-0059. iii) “Dysgeusia as an adverse reaction to praziquantel”. doi: 10.3109/01480545.2011.584065. iv) “Management of Cystic Echinococcosis in the last two decades: what have we learned?” doi: 10.1093/trstmh/try050 v) “Cutaneous Disease as the First Manifestation of Cystic Echinococcosis”. doi: 10.4269/ajtmh.15-0855. vi) ”Recurrence of Cystic Echinococcosis in an Endemic Area: A Retrospective Study”. doi: 10.1186/s12879-017-2556-9. vii) ”Recurrent spinal echinococcosis”. doi: 10.1016/j.ijid.2011.03.002. Las conclusiones son: Primera. El tratamiento con antiparasitarios de la equinococosis quística mejora los resultados en pacientes que van a ser intervenidos. El tratamiento combinado con albendazol mas praziquantel frente a la monoterapia con albendazol presenta una mayor actividad escolicida. Segunda. Los efectos secundarios a la quimioterapia antihelmíntica con albendazol y praziquantel suelen ser infrecuentes, leves y reversibles, lo que sugiere que el tratamiento combinado es seguro. Tercero. Los principales factores implicados en la selección de la estrategia terapéutica son las características de los pacientes y de los quistes . Cuarta. Las recurrencias son un problema frecuente en la equinococosis quística. Pueden ocurrir décadas después del tratamiento y la localización del quiste primario es el principal factor asociado. Quinta. Una de las principales causas de mortalidad entre los pacientes con equinococosis quística son las complicaciones del quiste. El tamaño, la localización el número de quistes y la estrategia expectante de tratamiento “Watch & Wait” son los principales factores implicados

Clinical Spectrum of Schistosomiasis: An Update

Schistosomiasis is a helminthic infection and one of the neglected tropical diseases (NTDs). It is caused by blood flukes of the genus Schistosoma. It is an important public health problem, particularly in poverty-stricken areas, especially those within the tropics and subtropics. It is estimated that at least 236 million people worldwide are infected, 90% of them in sub-Saharan Africa, and that this disease causes approximately 300,000 deaths annually. The clinical manifestations are varied and affect practically all organs. There are substantial differences in the clinical presentation, depending on the phase and clinical form of schistosomiasis in which it occurs. Schistosomiasis can remain undiagnosed for a long period of time, with secondary clinical lesion. Here, we review the clinical profile of schistosomiasis. This information may aid in the development of more efficacious treatments and improved disease prognosis

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

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)

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 Scenario of Q Fever Hospitalized Patients in the Spanish Health System: What's New

Objectives: The objective of this study was to assess the epidemiology and burden of Q fever (QF) in Spain. Methods: We designed a retrospective descriptive study using the minimum basic data set in patients admitted to hospitals of the National Health System between 1998 and 2015 with a diagnosis of Q fever (ICD-9: 083.0.). Results: We found 4214 hospitalized patients with a mean age (±SD) of 50.9±19.3 years. The male/female ratio was 3:1. The incidence rate was between 0.41 and 0.65 cases per 100,000 person-years over the 18-year period. The highest incidence of cases was from March to August (p=0.024). 21.1% patients had pneumonia, 17.5% had liver disease, and only 3.2% had endocarditis. The average hospital stay was 13.8 days (±12.8). A total of 117 (2.8%) patients died. The total mean cost of QF is approximately €154,232,779 (€36,600±139,422 per patient). Conclusions: QF is an important zoonosis in Spain with a stable incidence rate and high cost for hospitalization. Older patients have a more severe clinical picture and higher mortality, which can be decreased with early clinical suspicion

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