Germán Ramírez Olivencia - Academia.edu (original) (raw)
Papers by Germán Ramírez Olivencia
Antibiotics
Objectives: In the context of COVID-19, patients with a severe or critical illness may be more su... more Objectives: In the context of COVID-19, patients with a severe or critical illness may be more susceptible to developing secondary bacterial infections. This study aims to investigate the relationship between the use of prophylactic antibiotic therapy and the occurrence of bacterial or fungal isolates following the administration of tocilizumab in hospitalized COVID-19 patients who had previously received steroids during the first and second waves of the pandemic in Spain. Methods: This retrospective observational study included 70 patients hospitalized with COVID-19 who received tocilizumab and steroids between January and December 2020. Data on demographics, comorbidities, laboratory tests, microbiologic results, treatment, and outcomes were collected from electronic health records. The patients were divided into two groups based on the use of antibiotic prophylaxis, and the incidence of bacterial and fungal colonizations/infections was analyzed. Results: Among the included patien...
Medicina Clinica, Feb 1, 2007
Sanidad militar: revista de sanidad de las Fuerzas Armadas de España, 2020
Revista Clinica Espanola, 2004
Revista Clínica Española (English Edition)
Sanidad militar: revista de sanidad de las Fuerzas Armadas de España, 2020
Revista Clínica Española, 2019
Revista Clínica Española, 2006
Enfermedades infecciosas y microbiologia clinica (English ed.)
INTRODUCTION Infectious pathologies can benefit from the application of Telemedicine (TM). This s... more INTRODUCTION Infectious pathologies can benefit from the application of Telemedicine (TM). This study provides a description of the infectious pathology treated by the Telemedicine Service of the Hospital Central de la Defensa Gómez Ulla (STM-HCDGU). METHODS Analysis of the e-consultations made by members of the Armed Forces of Spain displaced to the area of operations in the period between 01/1/2015 and 31/12/2018 who developed symptoms of infectious diseases. RESULTS 127 infectious diseases were diagnosed, the most frequent being those of respiratory etiology and later malaria. Geographically Africa and embarked contingents were the most significant. It was necessary to evacuate 18 patients to the HCDGU, being the diagnosis of malaria the most frequent reason for evacuation, cause of the only fatal case. CONCLUSIONS infectious diseases benefit from the application of TM, being an important tool for the diagnosis and treatment of these, constituting an opportunity to expand to other displaced or remote populations.
Revista Espanola De Quimioterapia, 2017
espanolLos datos sobre prevalencia de la eosinofilia importada entre viajeros e inmigrantes la si... more espanolLos datos sobre prevalencia de la eosinofilia importada entre viajeros e inmigrantes la situan entre un 8%-28,5%. El estudio etiologico es en ocasiones complejo, y en funcion de lo exhaustivo del estudio y de la poblacion analizada, se ha podido identificar una causa parasitaria en el 17%-75,9% de los individuos. Entre las dificultades que se encuentran para comparar los estudios estan la heterogeneidad de las poblaciones estudiadas, el tipo de recogida (prospectiva/retrospectiva) y distintos protocolos diagnosticos. En este documento se detallan las recomendaciones del grupo de expertos de la Sociedad Espanola de Medicina Tropical y Salud Internacional (SEMTSI) para el diagnostico y tratamiento de la eosinofilia importada. EnglishAccording to published data, prevalence of imported eosinophilia among travellers and immigrants is set between 8% and 28.5%. Etiological diagnosis is often troublesome, and depending on the depth of the study and on the population analyzed, a paras...
The Lancet Infectious Diseases, 2021
Background The clinical presentation of COVID-19 in patients admitted to hospital is heterogeneou... more Background The clinical presentation of COVID-19 in patients admitted to hospital is heterogeneous. We aimed to determine whether clinical phenotypes of patients with COVID-19 can be derived from clinical data, to assess the reproducibility of these phenotypes and correlation with prognosis, and to derive and validate a simplified probabilistic model for phenotype assignment. Phenotype identification was not primarily intended as a predictive tool for mortality. Methods In this study, we used data from two cohorts: the COVID-19@Spain cohort, a retrospective cohort including 4035 consecutive adult patients admitted to 127 hospitals in Spain with COVID-19 between Feb 2 and March 17, 2020, and the COVID-19@HULP cohort, including 2226 consecutive adult patients admitted to a teaching hospital in Madrid between Feb 25 and April 19, 2020. The COVID-19@Spain cohort was divided into a derivation cohort, comprising 2667 randomly selected patients, and an internal validation cohort, comprising the remaining 1368 patients. The COVID-19@HULP cohort was used as an external validation cohort. A probabilistic model for phenotype assignment was derived in the derivation cohort using multinomial logistic regression and validated in the internal validation cohort. The model was also applied to the external validation cohort. 30-day mortality and other prognostic variables were assessed in the derived phenotypes and in the phenotypes assigned by the probabilistic model. Findings Three distinct phenotypes were derived in the derivation cohort (n=2667)-phenotype A (516 [19%] patients), phenotype B (1955 [73%]) and phenotype C (196 [7%])-and reproduced in the internal validation cohort (n=1368)phenotype A (233 [17%] patients), phenotype B (1019 [74%]), and phenotype C (116 [8%]). Patients with phenotype A were younger, were less frequently male, had mild viral symptoms, and had normal inflammatory parameters. Patients with phenotype B included more patients with obesity, lymphocytopenia, and moderately elevated inflammatory parameters. Patients with phenotype C included older patients with more comorbidities and even higher inflammatory parameters than phenotype B. We developed a simplified probabilistic model (validated in the internal validation cohort) for phenotype assignment, including 16 variables. In the derivation cohort, 30-day mortality rates were 2•5% (95% CI 1•4-4•3) for patients with phenotype A, 30•5% (28•5-32•6) for patients with phenotype B, and 60•7% (53•7-67•2) for patients with phenotype C (log-rank test p<0•0001). The predicted phenotypes in the internal validation cohort and external validation cohort showed similar mortality rates to the assigned phenotypes (internal validation cohort: 5•3% [95% CI 3•4-8•1] for phenotype A, 31•3% [28•5-34•2] for phenotype B, and 59•5% [48•8-69•3] for phenotype C; external validation cohort: 3•7% [2•0-6•4] for phenotype A, 23•7% [21•8-25•7] for phenotype B, and 51•4% [41•9-60•7] for phenotype C). Interpretation Patients admitted to hospital with COVID-19 can be classified into three phenotypes that correlate with mortality. We developed and validated a simplified tool for the probabilistic assignment of patients into phenotypes. These results might help to better classify patients for clinical management, but the pathophysiological mechanisms of the phenotypes must be investigated.
SSRN Electronic Journal, 2020
Background: On 31 December 2019, WHO was informed of a cluster of cases of pneumonia of unknown e... more Background: On 31 December 2019, WHO was informed of a cluster of cases of pneumonia of unknown etiology detected in Wuhan, China. A new type of coronavirus, SARS-CoV-2, was isolated on 7 January 2020. On January 30th, WHO declared a Public Health Emergency of International Concern. In this context, some western countries, including Spain, decided to evacuate its nationals from Hubei, China. Spaniards evacuated were put into quarantine for 14 days in a military hospital in Madrid. Methods: A review of bibliography using the terms “quarantine and (MERS or coronavirus or SARS)” was conducted in Pubmed on January 31st, 2020. We collected information about criteria for selecting installations and staff, number of quarantine cases, strategy of infection control, duration of quarantine, clinical monitoring, supports, viral screening, resources, epidemiological survey, and organization of daily assessment. We describe the design of our hospital quarantine. Findings: We identified 271 potentially relevant studies, of which 21 were full papers. 14 papers were finally selected to be reviewed. We didn’t find previous reports about hospital quarantine of nationals evacuated during a coronavirus outbreak, nor previous reports about quarantine during COVID-19 outbreak. Interpretation: The decision to promote quarantine and isolation is usually not supported by evidence, and there is little evidence of its impact on public health. Previous quarantines for coronavirus had a larger size, but mainly quarantine was performed at home. When performed at a health care facility, quarantine cases were patients and/or staff members from hospital with SARS or MERS cases. Our findings of the systematic review, and our description of the design of the quarantine, could be used as a guide for further similar situations, not only with SARS-CoV-2 contacts but with other viral infections transmitted by droplets. Funding Statement: No funding was received for this study. Declaration of Interests: We declare that we know of no conflicts of interest associated with this publication, and there has been no significant financial support for this work that could have influenced its outcome. Ethics Approval Statement: Our research is exempted of ethics approval because there are no clinical data. Ethical approval requirement is not applicable for a review of bibliography nor a description of action guidelines performed during a disease outbreak.
Background: There is no treatment proven effective against COVID-19. Several drugs with in vitro ... more Background: There is no treatment proven effective against COVID-19. Several drugs with in vitro potential against SARS-CoV-2 virus have been proposed. Hydroxychloroquine has in vitro anti-viral and immunomodulatory activity, but there is no current clinical evidence of its effectiveness changing the outcome of the disease. Methods: We enrolled all 18-85 years old inpatients from Central Defense Hospital “Gómez Ulla”, Madrid, Spain, who were hospitalised for COVID-19 and had a definitive outcome (dead or discharged). We used a statistical survival analysis to detect treatment differences associated with in-hospital death. Results: We analysed first 220 medical records. 166 patients met the inclusion criteria. 48,8 % of patients not treated with HCQ died, 22% of those treated with hydroxychloroquine (p=0,002). According to clinical picture at admission, hydroxychloroquine increased the mean cumulative survival in all groups from 1,4 to 1,8 times. This difference was statistically sig...
Enfermedades Infecciosas y Microbiología Clínica, 2018
La ribavirina es una molécula con actividad antiviral sobre diferentes virus. Ha encontrado su hu... more La ribavirina es una molécula con actividad antiviral sobre diferentes virus. Ha encontrado su hueco en la práctica clínica de forma casi exclusiva para el tratamiento del virus de la hepatitis C, pero existen otras enfermedades que podrían beneficiarse de su empleo. Su disponibilidad para administración por vía oral, por vía intravenosa e inhalada es una característica beneficiosa. En este trabajo se realiza una revisión de las indicaciones en las principales agencias del medicamento (española, europea y americana), así como de otras posibles indicaciones, principalmente sobre fiebres hemorrágicas y coronavirus.
Enfermedades infecciosas y microbiologia clinica (English ed.), 2019
Ribavirin is a molecule with antiviral activity against different viruses. In clinical practice, ... more Ribavirin is a molecule with antiviral activity against different viruses. In clinical practice, it has made its niche almost exclusively for the treatment of the hepatitis C virus. However, there are other diseases in which it could be of benefit and it has the advantage of being suitable for oral, intravenous and inhaled administration. We conducted a review of the indications of the main drug agencies (Spanish, European and American) and other possible indications, mainly haemorrhagic fevers and coronavirus.
Enfermedades infecciosas y microbiologia clinica, Mar 7, 2017
In a global world, knowledge of imported infectious diseases is essential in daily practice, both... more In a global world, knowledge of imported infectious diseases is essential in daily practice, both for the microbiologist-parasitologist and the clinician who diagnoses and treats infectious diseases in returned travelers. Tropical and subtropical countries where there is a greater risk of contracting an infectious disease are among the most frequently visited tourist destinations. The SEIMC considers it appropriate to produce a consensus document that will be useful to primary care physicians as well as specialists in internal medicine, infectious diseases and tropical medicine who help treat travelers returning from tropical and sub-tropical areas with infections. Preventive aspects of infectious diseases and infections imported by immigrants are explicitly excluded here, since they have been dealt with in other SEIMC documents. Various types of professionals (clinicians, microbiologists, and parasitologists) have helped produce this consensus document by evaluating the available e...
The Lancet Respiratory Medicine, 2015
Background In the current epidemic of Ebola virus disease, health-care workers have been transfer... more Background In the current epidemic of Ebola virus disease, health-care workers have been transferred to Europe and the USA for optimised supportive care and experimental treatments. We describe the clinical course of the fi rst case of Ebola virus disease contracted outside of Africa, in Madrid, Spain. Methods Herein we report clinical, laboratory, and virological fi ndings of the treatment of a female nurse assistant aged 44 years who was infected with Ebola virus around Sept 25-26, 2014, while caring for a Spanish missionary with confi rmed Ebola virus disease who had been medically evacuated from Sierra Leone to La Paz-Carlos III University Hospital, Madrid. We also describe the use of experimental treatments for Ebola virus disease in this patient. Findings The patient was symptomatic for 1 week before fi rst hospital admission on Oct 6, 2014. We used supportive treatment with intravenous fl uids, broad-spectrum antibiotics, and experimental treatments with convalescent plasma from two survivors of Ebola virus disease and high-dose favipiravir. On day 10 of illness, she had acute respiratory distress syndrome, possibly caused by transfusion-related acute lung injury, which was managed without mechanical ventilation. Discharge was delayed because of the detection of viral RNA in several bodily fl uids despite clearance of viraemia. The patient was discharged on day 34 of illness. At the time of discharge, the patient had possible subacute post-viral thyroiditis. None of the people who had contact with the patient before and after admission became infected with Ebola virus. Interpretation This report emphasises the uncertainties about the effi cacy of experimental treatments for Ebola virus disease. Clinicians should be aware of the possibility of transfusion-related acute lung injury when using convalescent plasma for the treatment of Ebola virus disease.
Medicina clínica, Jan 10, 2007
AIDS reviews
Malaria and HIV infection are both prevalent in the areas of the world where these diseases have ... more Malaria and HIV infection are both prevalent in the areas of the world where these diseases have the largest burden. Both diseases interact with one another and this interaction is especially important in areas with non-continuous malaria transmission, in pregnant women, and in patients with more severe immunodeficiency. Malaria has been implicated in transitory higher viral load and in low CD4 counts, so it could have an influence on higher transmission rates of HIV and perhaps in the course of HIV infection. Infection with HIV has been shown to cause more clinical malaria and higher parasitemia in patients living in perennial transmission areas, and higher rates of severe malaria episodes and mortality in areas where malaria is transmitted with seasonal frequency. The HIV-infected patients have also higher rates of malaria treatment failures. Co-trimoxazole prophylaxis has been shown to be effective in the prevention of some opportunistic infections in HIV-infected patients, but a...
Antibiotics
Objectives: In the context of COVID-19, patients with a severe or critical illness may be more su... more Objectives: In the context of COVID-19, patients with a severe or critical illness may be more susceptible to developing secondary bacterial infections. This study aims to investigate the relationship between the use of prophylactic antibiotic therapy and the occurrence of bacterial or fungal isolates following the administration of tocilizumab in hospitalized COVID-19 patients who had previously received steroids during the first and second waves of the pandemic in Spain. Methods: This retrospective observational study included 70 patients hospitalized with COVID-19 who received tocilizumab and steroids between January and December 2020. Data on demographics, comorbidities, laboratory tests, microbiologic results, treatment, and outcomes were collected from electronic health records. The patients were divided into two groups based on the use of antibiotic prophylaxis, and the incidence of bacterial and fungal colonizations/infections was analyzed. Results: Among the included patien...
Medicina Clinica, Feb 1, 2007
Sanidad militar: revista de sanidad de las Fuerzas Armadas de España, 2020
Revista Clinica Espanola, 2004
Revista Clínica Española (English Edition)
Sanidad militar: revista de sanidad de las Fuerzas Armadas de España, 2020
Revista Clínica Española, 2019
Revista Clínica Española, 2006
Enfermedades infecciosas y microbiologia clinica (English ed.)
INTRODUCTION Infectious pathologies can benefit from the application of Telemedicine (TM). This s... more INTRODUCTION Infectious pathologies can benefit from the application of Telemedicine (TM). This study provides a description of the infectious pathology treated by the Telemedicine Service of the Hospital Central de la Defensa Gómez Ulla (STM-HCDGU). METHODS Analysis of the e-consultations made by members of the Armed Forces of Spain displaced to the area of operations in the period between 01/1/2015 and 31/12/2018 who developed symptoms of infectious diseases. RESULTS 127 infectious diseases were diagnosed, the most frequent being those of respiratory etiology and later malaria. Geographically Africa and embarked contingents were the most significant. It was necessary to evacuate 18 patients to the HCDGU, being the diagnosis of malaria the most frequent reason for evacuation, cause of the only fatal case. CONCLUSIONS infectious diseases benefit from the application of TM, being an important tool for the diagnosis and treatment of these, constituting an opportunity to expand to other displaced or remote populations.
Revista Espanola De Quimioterapia, 2017
espanolLos datos sobre prevalencia de la eosinofilia importada entre viajeros e inmigrantes la si... more espanolLos datos sobre prevalencia de la eosinofilia importada entre viajeros e inmigrantes la situan entre un 8%-28,5%. El estudio etiologico es en ocasiones complejo, y en funcion de lo exhaustivo del estudio y de la poblacion analizada, se ha podido identificar una causa parasitaria en el 17%-75,9% de los individuos. Entre las dificultades que se encuentran para comparar los estudios estan la heterogeneidad de las poblaciones estudiadas, el tipo de recogida (prospectiva/retrospectiva) y distintos protocolos diagnosticos. En este documento se detallan las recomendaciones del grupo de expertos de la Sociedad Espanola de Medicina Tropical y Salud Internacional (SEMTSI) para el diagnostico y tratamiento de la eosinofilia importada. EnglishAccording to published data, prevalence of imported eosinophilia among travellers and immigrants is set between 8% and 28.5%. Etiological diagnosis is often troublesome, and depending on the depth of the study and on the population analyzed, a paras...
The Lancet Infectious Diseases, 2021
Background The clinical presentation of COVID-19 in patients admitted to hospital is heterogeneou... more Background The clinical presentation of COVID-19 in patients admitted to hospital is heterogeneous. We aimed to determine whether clinical phenotypes of patients with COVID-19 can be derived from clinical data, to assess the reproducibility of these phenotypes and correlation with prognosis, and to derive and validate a simplified probabilistic model for phenotype assignment. Phenotype identification was not primarily intended as a predictive tool for mortality. Methods In this study, we used data from two cohorts: the COVID-19@Spain cohort, a retrospective cohort including 4035 consecutive adult patients admitted to 127 hospitals in Spain with COVID-19 between Feb 2 and March 17, 2020, and the COVID-19@HULP cohort, including 2226 consecutive adult patients admitted to a teaching hospital in Madrid between Feb 25 and April 19, 2020. The COVID-19@Spain cohort was divided into a derivation cohort, comprising 2667 randomly selected patients, and an internal validation cohort, comprising the remaining 1368 patients. The COVID-19@HULP cohort was used as an external validation cohort. A probabilistic model for phenotype assignment was derived in the derivation cohort using multinomial logistic regression and validated in the internal validation cohort. The model was also applied to the external validation cohort. 30-day mortality and other prognostic variables were assessed in the derived phenotypes and in the phenotypes assigned by the probabilistic model. Findings Three distinct phenotypes were derived in the derivation cohort (n=2667)-phenotype A (516 [19%] patients), phenotype B (1955 [73%]) and phenotype C (196 [7%])-and reproduced in the internal validation cohort (n=1368)phenotype A (233 [17%] patients), phenotype B (1019 [74%]), and phenotype C (116 [8%]). Patients with phenotype A were younger, were less frequently male, had mild viral symptoms, and had normal inflammatory parameters. Patients with phenotype B included more patients with obesity, lymphocytopenia, and moderately elevated inflammatory parameters. Patients with phenotype C included older patients with more comorbidities and even higher inflammatory parameters than phenotype B. We developed a simplified probabilistic model (validated in the internal validation cohort) for phenotype assignment, including 16 variables. In the derivation cohort, 30-day mortality rates were 2•5% (95% CI 1•4-4•3) for patients with phenotype A, 30•5% (28•5-32•6) for patients with phenotype B, and 60•7% (53•7-67•2) for patients with phenotype C (log-rank test p<0•0001). The predicted phenotypes in the internal validation cohort and external validation cohort showed similar mortality rates to the assigned phenotypes (internal validation cohort: 5•3% [95% CI 3•4-8•1] for phenotype A, 31•3% [28•5-34•2] for phenotype B, and 59•5% [48•8-69•3] for phenotype C; external validation cohort: 3•7% [2•0-6•4] for phenotype A, 23•7% [21•8-25•7] for phenotype B, and 51•4% [41•9-60•7] for phenotype C). Interpretation Patients admitted to hospital with COVID-19 can be classified into three phenotypes that correlate with mortality. We developed and validated a simplified tool for the probabilistic assignment of patients into phenotypes. These results might help to better classify patients for clinical management, but the pathophysiological mechanisms of the phenotypes must be investigated.
SSRN Electronic Journal, 2020
Background: On 31 December 2019, WHO was informed of a cluster of cases of pneumonia of unknown e... more Background: On 31 December 2019, WHO was informed of a cluster of cases of pneumonia of unknown etiology detected in Wuhan, China. A new type of coronavirus, SARS-CoV-2, was isolated on 7 January 2020. On January 30th, WHO declared a Public Health Emergency of International Concern. In this context, some western countries, including Spain, decided to evacuate its nationals from Hubei, China. Spaniards evacuated were put into quarantine for 14 days in a military hospital in Madrid. Methods: A review of bibliography using the terms “quarantine and (MERS or coronavirus or SARS)” was conducted in Pubmed on January 31st, 2020. We collected information about criteria for selecting installations and staff, number of quarantine cases, strategy of infection control, duration of quarantine, clinical monitoring, supports, viral screening, resources, epidemiological survey, and organization of daily assessment. We describe the design of our hospital quarantine. Findings: We identified 271 potentially relevant studies, of which 21 were full papers. 14 papers were finally selected to be reviewed. We didn’t find previous reports about hospital quarantine of nationals evacuated during a coronavirus outbreak, nor previous reports about quarantine during COVID-19 outbreak. Interpretation: The decision to promote quarantine and isolation is usually not supported by evidence, and there is little evidence of its impact on public health. Previous quarantines for coronavirus had a larger size, but mainly quarantine was performed at home. When performed at a health care facility, quarantine cases were patients and/or staff members from hospital with SARS or MERS cases. Our findings of the systematic review, and our description of the design of the quarantine, could be used as a guide for further similar situations, not only with SARS-CoV-2 contacts but with other viral infections transmitted by droplets. Funding Statement: No funding was received for this study. Declaration of Interests: We declare that we know of no conflicts of interest associated with this publication, and there has been no significant financial support for this work that could have influenced its outcome. Ethics Approval Statement: Our research is exempted of ethics approval because there are no clinical data. Ethical approval requirement is not applicable for a review of bibliography nor a description of action guidelines performed during a disease outbreak.
Background: There is no treatment proven effective against COVID-19. Several drugs with in vitro ... more Background: There is no treatment proven effective against COVID-19. Several drugs with in vitro potential against SARS-CoV-2 virus have been proposed. Hydroxychloroquine has in vitro anti-viral and immunomodulatory activity, but there is no current clinical evidence of its effectiveness changing the outcome of the disease. Methods: We enrolled all 18-85 years old inpatients from Central Defense Hospital “Gómez Ulla”, Madrid, Spain, who were hospitalised for COVID-19 and had a definitive outcome (dead or discharged). We used a statistical survival analysis to detect treatment differences associated with in-hospital death. Results: We analysed first 220 medical records. 166 patients met the inclusion criteria. 48,8 % of patients not treated with HCQ died, 22% of those treated with hydroxychloroquine (p=0,002). According to clinical picture at admission, hydroxychloroquine increased the mean cumulative survival in all groups from 1,4 to 1,8 times. This difference was statistically sig...
Enfermedades Infecciosas y Microbiología Clínica, 2018
La ribavirina es una molécula con actividad antiviral sobre diferentes virus. Ha encontrado su hu... more La ribavirina es una molécula con actividad antiviral sobre diferentes virus. Ha encontrado su hueco en la práctica clínica de forma casi exclusiva para el tratamiento del virus de la hepatitis C, pero existen otras enfermedades que podrían beneficiarse de su empleo. Su disponibilidad para administración por vía oral, por vía intravenosa e inhalada es una característica beneficiosa. En este trabajo se realiza una revisión de las indicaciones en las principales agencias del medicamento (española, europea y americana), así como de otras posibles indicaciones, principalmente sobre fiebres hemorrágicas y coronavirus.
Enfermedades infecciosas y microbiologia clinica (English ed.), 2019
Ribavirin is a molecule with antiviral activity against different viruses. In clinical practice, ... more Ribavirin is a molecule with antiviral activity against different viruses. In clinical practice, it has made its niche almost exclusively for the treatment of the hepatitis C virus. However, there are other diseases in which it could be of benefit and it has the advantage of being suitable for oral, intravenous and inhaled administration. We conducted a review of the indications of the main drug agencies (Spanish, European and American) and other possible indications, mainly haemorrhagic fevers and coronavirus.
Enfermedades infecciosas y microbiologia clinica, Mar 7, 2017
In a global world, knowledge of imported infectious diseases is essential in daily practice, both... more In a global world, knowledge of imported infectious diseases is essential in daily practice, both for the microbiologist-parasitologist and the clinician who diagnoses and treats infectious diseases in returned travelers. Tropical and subtropical countries where there is a greater risk of contracting an infectious disease are among the most frequently visited tourist destinations. The SEIMC considers it appropriate to produce a consensus document that will be useful to primary care physicians as well as specialists in internal medicine, infectious diseases and tropical medicine who help treat travelers returning from tropical and sub-tropical areas with infections. Preventive aspects of infectious diseases and infections imported by immigrants are explicitly excluded here, since they have been dealt with in other SEIMC documents. Various types of professionals (clinicians, microbiologists, and parasitologists) have helped produce this consensus document by evaluating the available e...
The Lancet Respiratory Medicine, 2015
Background In the current epidemic of Ebola virus disease, health-care workers have been transfer... more Background In the current epidemic of Ebola virus disease, health-care workers have been transferred to Europe and the USA for optimised supportive care and experimental treatments. We describe the clinical course of the fi rst case of Ebola virus disease contracted outside of Africa, in Madrid, Spain. Methods Herein we report clinical, laboratory, and virological fi ndings of the treatment of a female nurse assistant aged 44 years who was infected with Ebola virus around Sept 25-26, 2014, while caring for a Spanish missionary with confi rmed Ebola virus disease who had been medically evacuated from Sierra Leone to La Paz-Carlos III University Hospital, Madrid. We also describe the use of experimental treatments for Ebola virus disease in this patient. Findings The patient was symptomatic for 1 week before fi rst hospital admission on Oct 6, 2014. We used supportive treatment with intravenous fl uids, broad-spectrum antibiotics, and experimental treatments with convalescent plasma from two survivors of Ebola virus disease and high-dose favipiravir. On day 10 of illness, she had acute respiratory distress syndrome, possibly caused by transfusion-related acute lung injury, which was managed without mechanical ventilation. Discharge was delayed because of the detection of viral RNA in several bodily fl uids despite clearance of viraemia. The patient was discharged on day 34 of illness. At the time of discharge, the patient had possible subacute post-viral thyroiditis. None of the people who had contact with the patient before and after admission became infected with Ebola virus. Interpretation This report emphasises the uncertainties about the effi cacy of experimental treatments for Ebola virus disease. Clinicians should be aware of the possibility of transfusion-related acute lung injury when using convalescent plasma for the treatment of Ebola virus disease.
Medicina clínica, Jan 10, 2007
AIDS reviews
Malaria and HIV infection are both prevalent in the areas of the world where these diseases have ... more Malaria and HIV infection are both prevalent in the areas of the world where these diseases have the largest burden. Both diseases interact with one another and this interaction is especially important in areas with non-continuous malaria transmission, in pregnant women, and in patients with more severe immunodeficiency. Malaria has been implicated in transitory higher viral load and in low CD4 counts, so it could have an influence on higher transmission rates of HIV and perhaps in the course of HIV infection. Infection with HIV has been shown to cause more clinical malaria and higher parasitemia in patients living in perennial transmission areas, and higher rates of severe malaria episodes and mortality in areas where malaria is transmitted with seasonal frequency. The HIV-infected patients have also higher rates of malaria treatment failures. Co-trimoxazole prophylaxis has been shown to be effective in the prevention of some opportunistic infections in HIV-infected patients, but a...