Síndrome constitucional y pancitopenia a estudio. Un diagnóstico inesperado

[spa] Mujer de 85 años con polimialgia reumática que ingresa para estudio de síndrome constitucional y pancitopenia. Tras plantear diferentes opciones diagnósticas, se llega a la confirmación de leishmaniasis visceral. Con la instauración de tratamiento específico, la evolución de la paciente es favorable hasta la curación

Effectiveness of Modified Vaccinia Ankara-Bavaria Nordic Vaccination in a Population at High Risk of Mpox: A Spanish Cohort Study

Background: With over 7,500 cases notified since April 2022, Spain has experienced the highest incidence of mpox in Europe. From July 12th onwards, the Modified Vaccinia Ankara-Bavaria Nordic (MVA-BN) smallpox vaccine was offered as pre-exposure prophylaxis for individuals at high-risk of mpox, including those receiving pre-exposure prophylaxis for HIV (HIV-PrEP). Our aim was to assess the effectiveness of one dose of MVA-BN vaccine as pre-exposure against mpox virus (MPXV) infection in persons on HIV-PrEP. Methods: We conducted a national retrospective cohort study between July 12 and December 12, 2022. Individuals ≥18 years, receiving HIV-PrEP as of July 12 and with no previous MPXV infection or vaccination were eligible. Each day, we matched individuals receiving a first dose of MVA-BN vaccine and unvaccinated controls of the same age group and region. We used a Kaplan-Meier estimator and calculate risk ratios (RR) and vaccine effectiveness (VE = 1-RR). Results: We included 5,660 matched pairs, with a median follow-up of 62 days (interquartile range 24-97). Mpox cumulative incidence was 5.6 per 1,000 (25 cases) in unvaccinated and 3.5 per 1,000 (18 cases) in vaccinated. No effect was found during days 0-6 post-vaccination (VE -38.3; 95% confidence interval (95%CI): -332.7; 46.4), but VE was 65% in ≥7 days (95%CI 22.9; 88.0) and 79% in ≥14 days (95%CI 33.3; 100.0) post-vaccination. Conclusions: One dose of MVA-BN vaccine offered protection against mpox in a most-at-risk population shortly after the vaccination. Further studies need to assess the VE of a second dose and the duration of protection over time.S

Síndrome constitucional y pancitopenia a estudio: un diagnóstico inesperado

An 85-year-old woman with polymyalgia rheumatica was admitted in our hospital because of constitutional symptoms and pancytopenia. We proposed several diagnostic options and finally visceral leishmaniasis was confirmed. With the correct treatment, the patient evolved favourably and was cured.Mujer de 85 años con polimialgia reumática que ingresa para estudio de síndrome constitucional y pancitopenia. Tras plantear diferentes opciones diagnósticas, se llega a la confirmación de leishmaniasis visceral. Con la instauración de tratamiento específico, la evolución de la paciente es favorable hasta la curación

Lesión cerebral y respiratoria en estudio

A 76-year-old man with benign prostatic hyperplasia and depressive syndrome presenting cerebral cystic imaging, possible hemangioblastoma, and respiratory insufficiency with rapidly growing lung mass.Varón de 76 años con hiperplasia benigna de próstata y síndrome depresivo que presenta imagen quística cerebral, posible hemangioblastoma, y afectación respiratoria con masa pulmonar de rápido crecimiento

Epidemiological and clinical characteristics of community-acquired and nosocomial influenza cases and risk factors associated with complications: a four season analysis of all adult patients admitted in a tertiary hospital.

[eng] Background: Information on the characteristics of patients with nosocomial influenza and associated complications is scarce. This study compared epidemiological and clinical characteristics of patients admitted with hospital-acquired influenza (HAI) to those with community-acquired influenza (CAI) and analyzed risk factors associated with complications. Methods: This retrospective, observational study included all adult patients with confirmed influenza virus infection admitted to Son Espases University Hospital during the influenza season in Spain (October to May) from 2012-2013 to 2015-2016. Symptom onset before admission was included as CAI, and 2 days after admission or within 48 hours after previous discharge were considered as HAI. Results: Overall, 666 patients with laboratory-confirmed influenza were included; 590 (88.6%) and 76 (11.4%) had CAI and HAI, respectively. Baseline characteristics and vaccination rates were similar in both groups. Patients with HAI had significantly fewer symptoms, less radiological alterations, and earlier microbiological diagnosis than those with CAI. Eighty-five (14.4%) and 20 (27.6%) CAI and HAI patients, respectively, experienced at least one complication, including septic shock, admission to the intensive care unit, mechanical ventilation or evolution to death (any one, P = .003). Univariate and multivariate binary logistic regression was performed to assess independent risk factors associated with the occurrence of complications: nosocomial infection, diabetes, oseltamivir treatment, having received no vaccination, microbiological delay, dyspnea, and the state of confusion were the most important significant factors. Conclusions: Our study shows the need to implement microbiological diagnostic measures in the first 48 hours to reduce HAI frequency and associated complications