Dolores Folgueira

Hospital Universitario 12 de Octubre, Madrid, Madrid, Spain

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Publications (20)39.61 Total impact

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    ABSTRACT: IntroductionCytomegalovirus (CMV) infection is the most common congenital infection in Europe. Symptoms are present at birth in 10% of infected children, and up to 30-40% have some degree of hearing loss after the newborn period.MethodsA retrospective study was performed over a period of 4 years and included all patients with congenital CMV infection diagnosed after the neonatal period using the dried blood spots from neonatal metabolic screening.ResultsWe present 5 patients diagnosed with congenital CMV infection outside the neonatal period. The main reasons for consultation were hearing loss and/or neurological impairment in the first few months of life.DiscussionCongenital CMV infection may be mildly symptomatic at birth, and present as hearing loss and/or neurological impairment in infancy. Therefore, a high degree of suspicion is necessary in order to make an accurate diagnosis and start specific treatment to improve the outcome.
    Enfermedades Infecciosas y Microbiología Clínica 02/2013; 31(2):93–96. · 1.48 Impact Factor
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    ABSTRACT: BACKGROUND: The strength of the assumed association of CMV and long term deleterious events in solid organ transplant recipients (SOT) is controversial. OBJECTIVES: The aim of the present study was to evaluate whether viral replication dynamics during CMV infection or CMV disease may correlate not only with graft dysfunction and survival, but also with other potentially related late events in a long-term followed cohort of kidney (KT) and liver (LT) transplant recipients. STUDY DESIGN: 162 SOT (104 kidney, 58 liver) at our institution (2003-2005) with survival over 180 days and a median follow-up of 71 months (9-86) were analyzed. Using a Cox proportional hazard model, CMV infection (including area under the curve of DNAemia[AUC]) and CMV disease in the first 180 days were evaluated as potential predictors of the following late events (>180 days): mortality, graft dysfunction (GD), graft loss (GL), cardiovascular events (CVE), malignant tumors (MT). RESULTS: CMV infection occurred in 59% and CMV disease in 8%. Late death occurred in 17%, GD in 45.6%, GL in 14.2%, CVE in 10.5% and MT in 9.9%. We found no significant association between the intensity or duration of CMV viremia (AUC, persistent viremia or untreated CMV viremia) or CMV disease and the development of evaluated late events. According multivariate analysis neither CMV infection (hazard ratio [HR] 2.18 95% CI 0.949-5 p=0.066) nor CMV disease (HR: 1.72; 95% CI 0.59-5 p=0.31) were significantly correlated with late mortality. CONCLUSIONS: Our data do not support that CMV infection or CMV disease contribute significantly to long-term deleterious events in SOT.
    Journal of clinical virology: the official publication of the Pan American Society for Clinical Virology 01/2013; · 3.12 Impact Factor
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    ABSTRACT: INTRODUCTION: Cytomegalovirus (CMV) infection is the most common congenital infection in Europe. Symptoms are present at birth in 10% of infected children, and up to 30-40% have some degree of hearing loss after the newborn period. METHODS: A retrospective study was performed over a period of 4 years and included all patients with congenital CMV infection diagnosed after the neonatal period using the dried blood spots from neonatal metabolic screening. RESULTS: We present 5 patients diagnosed with congenital CMV infection outside the neonatal period. The main reasons for consultation were hearing loss and/or neurological impairment in the first few months of life. DISCUSSION: Congenital CMV infection may be mildly symptomatic at birth, and present as hearing loss and/or neurological impairment in infancy. Therefore, a high degree of suspicion is necessary in order to make an accurate diagnosis and start specific treatment to improve the outcome.
    Enfermedades Infecciosas y Microbiología Clínica 08/2012; · 1.48 Impact Factor
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    ABSTRACT: Accuracy of rapid BD Directigen(®) EZ Flu A+B diagnostic test against Influenza A (H1N1) Virus in children. A descriptive retrospective study was performed. One hundred and forty children underwent the rapid influenza test and the RT-PCR against Influenza A (H1N1) Virus. The sensitivity was 70.4% (95% CI: 58.9-79.7), specificity 100 % (95% CI: 94.7-100), NPV 76.6% (95% CI: 66.9-84,2) and PPV 100% (95% CI: 92.8-100). This test showed high sensitivity and specificity, very similar to the seasonal influenza, in children.
    Enfermedades Infecciosas y Microbiología Clínica 12/2010; 28(10):698-700. · 1.48 Impact Factor
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    ABSTRACT: IntroductionAccuracy of rapid BD Directigen® EZ Flu A+B diagnostic test against Influenza A (H1N1) Virus in children.
    Enfermedades Infecciosas Y Microbiologia Clinica - ENFERM INFEC MICROBIOL CLIN. 01/2010; 28(10):698-700.
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    ABSTRACT: Cytomegalovirus (CMV) remains the most common viral infection after pancreas-kidney transplantation (PKT). Comparative studies about CMV prophylaxis in PKT have not been developed. We analyzed CMV disease in a cohort of 84 PKT recipients. All received intravenous ganciclovir during treatment with anti-thymocyte globulin and later one of the following options for pre-transplant CMV-seropositive recipients: (a) no prophylaxis (n=10 patients), (b) preemptive therapy (PT) (n=13), or (c) continuous prophylaxis (CP) for 12 weeks (n=29). Pre-transplant CMV-seronegative recipients received CP (n=21). Eleven patients were excluded because of organ explantation in the first 15 days. Incidence of CMV disease in seropositive recipients was 30% under no prophylaxis, 23% under PT, and 6.9% under CP. Incidence of CMV disease under CP was 33.3% in seronegative recipients. Six of 9 episodes of CMV disease under CP occurred after finishing prophylaxis. Under CP, the incidence of CMV disease was significantly higher in seronegative than in seropositive recipients (P<0.05). According to the results of our study, for CMV-seropositive PKT recipients, CP is a better strategy than PT. For CMV-seronegative recipients, 3 months of CP is an inadequate strategy.
    Transplant Infectious Disease 07/2009; 11(5):400-4. · 1.98 Impact Factor
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    ABSTRACT: There is limited information about clinical consequences of respiratory virus infections (RVI) in solid organ transplant recipients. No prospective epidemiological study has been published previously. We selected a cohort of 152 transplant recipients (cardiac, hepatic and renal transplant recipients). Median time from transplantation was 17 months (range 1-50). They were prospectively followed-up for RVI during 7 months (October to April). Clinical and microbiological evaluation (cell culture, shell vial and polymerase chain reaction technique) of each RVI episode was made. We detected 81 RVI (0.91 episodes/patient/year). Complications were detected in 15/81 episodes (18.5%): acute bronchitis (10 cases), pneumonia (three cases; 3.7% of RVI episodes) and bacterial sinusitis (2 cases). In 4 of 81 episodes (5%), patients needed hospitalization. A respiratory virus was isolated in 17 of 68 nasopharyngeal samples (six respiratory syncytial virus, six influenza, four picornavirus, one adenovirus). Fever presented an 83% positive predictive value for the diagnosis of influenza virus infection among those with a positive microbiological isolation. There were no episodes of acute rejection coincidentally with RVI. Only 54% of the subjects had been previously vaccinated against influenza. Incidence of RVI among solid organ transplant recipients is similar to general population but complications are higher. A relationship between RVI and rejection was not detected. The rate of influenza vaccination was lower than expected. The presence of fever in a transplant recipient with RVI strongly suggests influenza infection.
    Transplantation 11/2007; 84(7):851-6. · 3.78 Impact Factor
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    ABSTRACT: The aim of the study was to assess the utility of the polymerase chain reaction (PCR) assay in blood and urine for the diagnosis of tuberculosis (TB). We prospectively evaluated the usefulness of PCR performed in blood and urine samples from patients with proved or probable TB compared with a control group of patients. The PCR technique was performed using IS6110 primers. We included in the study 57 patients (43 with definite TB and 14 with probable TB) and 26 controls. Blood and urine samples were drawn at the time of microbiologic diagnosis and 3, 6, 9, and 12 months later. Cultures were positive in the early period (<1 month after treatment) in 11 of 57 patients (19%) with probable or definite TB, in comparison with 42% of patients (24/57) who yielded a positive PCR (P = 0.02). Urine samples increased the sensitivity of PCR determination in blood samples by 10%. The PCR in blood and/or urine was positive in 41% of patients with pulmonary TB, in 36% of patients with extrapulmonary TB, and in 50% of patients with disseminated TB. Mycobacterium tuberculosis was still detectable by PCR in 5 of 13 patients with cured TB after 1 or more months of antituberculous treatment. The PCR detection of M. tuberculosis in blood and urine samples is useful for the diagnosis of different clinical forms of TB, mostly in those patients in which sample extraction is difficult or requires aggressive techniques. The sensitivity of this technique could be improved studying more than 1 sample in each patient, even after initiating an antituberculous treatment.
    Diagnostic Microbiology and Infectious Disease 11/2006; 56(2):141-6. · 2.26 Impact Factor
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    ABSTRACT: To assess the utility of interferon gamma (INF-gamma) levels in cerebrospinal fluid (CSF), for the diagnosis of tuberculous meningitis (TBM), and compare these results with aPCR technique. We studied CSF samples from patients with proven or probable TBM and a control group, composed by patients with other causes of meningitis and without meningitis. INFgamma levels were measured by radioimmunoassay. A PCR technique was performed using IS6110 primers. Of the 127 patients studied, 20 (15.6%) had TBM, 59 (46%) had meningitis of another aetiology and 49 (38.4%) had were HIV and non-HIV patients with normal CSF. The area below the ROC curve for interferon gamma levels in the diagnosis of TBM was 0.94. A cut-off of 6.4 IU/mL yielded a sensitivity of 70% and a specificity of 94%. False positive results were observed in 7 of the 59 patients (11.8%) with non-TB meningitis, (patients with herpetic meningoencephalitis and meningitis due to intracellular microorganisms). INF-gamma sensitivity was higher than PCR (70% vs. 65%). Both tests performed together showed higher sensitivity (80%) and specificity (92.6%). CSF INF-gamma levels (> 6.4 IU/mL) are very valuable in TBM diagnosis. PCR and INF-gamma could be simultaneously used to increase the diagnostic yield.
    Journal of Neurology 10/2006; 253(10):1323-30. · 3.58 Impact Factor
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    ABSTRACT: The role of valganciclovir in the prevention of cytomegalovirus (CMV) disease in high-risk seropositive transplant patients is not known. We prospectively followed 301 seropositive solid organ transplant recipients to assess the efficacy and safety of valganciclovir (VGCV) in the prevention of CMV disease in high-risk patients. Asymptomatic patients with an antigenemia test >or=25 positive cells/2x10(5) polymorphonuclear cells received valganciclovir 900 mg twice a day as preemptive therapy until resolution of antigenemia (minimum 14 days). Additionally, patients treated with antilymphocytic drugs for more than 6 days received prophylaxis with VGCV 900 mg once a day during 90 days. Mean follow-up was 14 months (range 6-20 months). Thirty-eight patients received VGCV; 24 as preemptive therapy and 14 due to the use of antilymphocytic drugs. No patient developed CMV disease during the follow-up. Viral load (antigenemia) decreased a mean of 78% from baseline after 7 days of VGCV therapy (P=0.024) and 98% at day 14 (P=0.029). Two patients showed a relapse of the antigenemia test >or=25 positive cells and were successfully treated with a repeated course of VGCV. Leukopenia (<2500/mm3) developed in 3/24 (12.5%) recipients in the preemptive therapy group and required to discontinuing the drug in one of them. VGCV is safe and highly efficacious in the prevention of CMV disease in high-risk seropositive organ transplant recipients.
    Transplantation 07/2006; 82(1):30-5. · 3.78 Impact Factor
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    ABSTRACT: Most studies focusing on respiratory infections in immunocompromised children have been addressed to bacterial etiology. However, respiratory virus infections in this population can also lead to severe disease. The objective of this study is to evaluate the clinical significance of respiratory virus infections in children with cancer or human immunodeficiency virus (HIV) infection. Retrospective study conducted in a teaching hospital in Madrid. Medical records from children <or=14 years diagnosed with cancer or with HIV infection were reviewed. We analyzed demographic characteristics, clinical syndromes associated with the infection, need for hospitalization, treatment prescribed, and outcome. Fifty-three respiratory viral infections were identified: 26 (20%) in 129 HIV-infected children and 27 (12%) in 218 children with cancer. Twenty (38%) of the respiratory infections were nosocomial. Causal viruses were: respiratory syncytial virus, 43%; influenza A, 26%; adenovirus, 13%; parainfluenza virus, 13%; and influenza B, 4%. Thirty-three children were hospitalized: 14 (54%) with HIV infection and 19 (70%) receiving anticancer chemotherapy. Pneumonia occurred in 11 (34%) of the 33 hospitalized children. Four (21%) of the 19 hospitalized children with cancer, but none of the HIV-infected children, were admitted to the Pediatric Intensive Care Unit (P=0.096). Two children with cancer died. Common respiratory virus infections in children with cancer or HIV infection have a relevant morbidity. The fact that 40% of these infections are hospital-acquired emphasizes the need for isolation and preventive measures.
    Journal of Pediatric Hematology/Oncology 04/2006; 28(3):154-9. · 0.97 Impact Factor
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    ABSTRACT: This study describes a nosocomial outbreak of influenza in high-risk-hematological patients, and the usefulness of epidemiological measures and zanamivir administration for its control. Fifteen patients who had been in contact with a patient with influenza A were included in the study. Viral culture of nasopharyngeal exudate was performed and the epidemiological data, risk factors and clinical outcome were evaluated. The efficacy of early therapy and preventive use of zanamivir was also assessed. Seven out of 15 patients (46.6%) developed symptoms and in 5 of these 7 cases (71.4%), influenza A virus was isolated. Eight patients did not develop symptoms and viral culture was sterile. All symptomatic patients were isolated, and treatment with inhaled zanamivir (10 mg/12 h, 5 days) was initiated as soon as possible; only one patient developed respiratory failure; the remaining cases had self-limited upper respiratory tract symptoms. There was no associated mortality. Zanamivir prophylaxis was used in three non-symptomatic patients considered to be at high risk. Tolerance to zanamivir was excellent. No new cases were observed after initiation of the preventive measures and use of zanamivir. The attack rate in a nosocomial influenza outbreak can be very high in immunocompromised patients. Prompt initiation of preventive measures, early treatment and prophylaxis with zanamivir may help to limit the extension of these outbreaks.
    Enfermedades Infecciosas y Microbiología Clínica 02/2006; 24(1):10-3. · 1.48 Impact Factor
  • Enfermedades Infecciosas y Microbiología Clínica 02/2006; 24(1):61-3. · 1.48 Impact Factor
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    ABSTRACT: Introduction This study describes a nosocomial outbreak of influenza in high-risk-hematological patients, and the usefulness of epidemiological measures and zanamivir administration for its control. Methods Fifteen patients who had been in contact with a patient with influenza A were included in the study. Viral culture of nasopharyngeal exudate was performed and the epidemiological data, risk factors and clinical outcome were evaluated. The efficacy of early therapy and preventive use of zanamivir was also assessed. Results Seven out of 15 patients (46.6%) developed symptoms and in 5 of these 7 cases (71.4%), influenza A virus was isolated. Eight patients did not develop symptoms and viral culture was sterile. All symptomatic patients were isolated, and treatment with inhaled zanamivir (10 mg/12 h, 5 days) was initiated as soon as possible; only one patient developed respiratory failure; the remaining cases had self-limited upper respiratory tract symptoms. There was no associated mortality. Zanamivir prophylaxis was used in three non-symptomatic patients considered to be at high risk. Tolerance to zanamivir was excellent. No new cases were observed after initiation of the preventive measures and use of zanamivir. Conclusion The attack rate in a nosocomial influenza outbreak can be very high in immunocompromised patients. Prompt initiation of preventive measures, early treatment and prophylaxis with zanamivir may help to limit the extension of these outbreaks.
    Enfermedades Infecciosas y Microbiología Clínica 01/2006; 24(1):10–13. · 1.48 Impact Factor
  • Enfermedades infecciosas y microbiología clínica, ISSN 0213-005X, Vol. 24, Nº. 1, 2006, pags. 61-63. 01/2006;
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    ABSTRACT: We prospectively followed 70 CMV-seropositive solid organ transplant recipients to evaluate the efficacy and safety of valganciclovir (VGCV) as preemptive therapy based on antigenemia test to prevent cytomegalovirus (CMV) disease. From December 2003 to May 2004, 12 of 70 (17%) asymptomatic patients who showed an antigenemia value > or =25 positive cells per 2 x 10(5) polymorphonuclear (PMN) were treated with VGCV (900 mg twice a day adjusted to renal function) until resolution of CMV antigenemia, a minimum of 14 days. No patient developed CMV disease during follow-up. Only one who showed an asymptomatic relapse of the antigenemia test > or =25 positive cells was successfully treated with a repeated course of VGCV. Mean duration of VGCV therapy was 18 days (range, 14 to 28). Antigenemia was negative in 7 of 12 (58%) patients after 14 days and negative in all patients 4 weeks after the administration of VGCV. No significant side effects were associated with the use of VGCV therapy. Preemptive VGCV therapy is safe and effective in the prevention of CMV disease in seropositive solid organ transplant recipients.
    Transplantation Proceedings 11/2005; 37(9):3766-7. · 0.95 Impact Factor
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    ABSTRACT: We describe the clinical characteristics of 209 children younger than 15 years of age with positive pharyngeal cultures for adenovirus. The mean age of the children was 37 +/- 33 months, and the mean peak temperature was 39.2 +/- 0.76 degrees C. On physical examination, tonsillitis was found for 88% of children; 52% of them had exudative tonsillitis. Forty-eight percent of the patients who had a white blood cell count performed had >15,000 leukocytes per mm, and 25% had >20,000 leukocytes per mm. C-reactive protein concentrations were >7 mg/dL for 22.5% of the patients. Adenovirus pharyngeal infections in young children mimic severe bacterial infections.
    The Pediatric Infectious Disease Journal 08/2005; 24(8):733-4. · 3.57 Impact Factor
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    ABSTRACT: In liver transplant recipients the most frequent infection is that produced by cytomegalovirus (CMV). One of the methods to reduce the incidence of that infection is the CMV pp65 antigenemia-guided preemptive therapy with intravenous ganciclovir. Liver transplant recipients were tested for CMV antigenemia at days 14, 28, 45, 60, 90 and 180 postransplantation and when clinically indicated. Patients showing > 50/200.000 leukocytes received ganciclovir 5 mg/kg/12 h for 14 days. Risk factors for active CMV disease where studied. 182 CMV seropositive patients where included in the study. 16 patients with > 50/200.000 leukocytes received ganciclovir as preemptive therapy. CMV disease appeared in 9/182 patients (4.9%): 2/16 who received PT and 7/166 among those who did not receive preemptive therapy. The only factor associated with increased incidence of CMV disease was to have missing samples for CMV antigenemia during the follow up (p < 0.0042; OR = 8,17; 95% CI, 1.94-34.36). Ganciclovir antigenemia-guided preemptive therapy is associated with a low incidence of CMV disease. Bad adherence to the protocol of antigenemia samples increases the risk for CMV disease.
    Medicina Clínica 01/2004; 122(2):41-5. · 1.40 Impact Factor
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    ABSTRACT: This study evaluated the susceptibility of Escherichia coli to quinolones in 72 stool samples collected from 31 patients with solid tumours who had undergone high dose chemotherapy (HDC) and peripheral blood stem-cell (PBSC) rescue with ciprofloxacin prophylaxis. Samples were obtained at admission, after completing prophylaxis and three months later. All E. coli strains isolated from baseline samples were susceptible to quinolones. Fluoroquinolone-resistant E. coli strains were isolated in 10 (32%) patients in the second sample. In eight of these patients isolates were susceptible 3 months later. No patient developed infection due to fluorquinolone-resistant E. coli. No differences were observed in outcome between patients with susceptible and resistant flora.
    Journal of Antimicrobial Chemotherapy 08/1999; 44(1):117-20. · 5.34 Impact Factor
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    ABSTRACT: Background and objective In liver transplant recipients the most frequent infection is that produced by cytomegalovirus (CMV). One of the methods to reduce the incidence of that infection is the CMV pp65 antigenemia-guided preemptive therapy with intravenous ganciclovir. Patients and method Liver transplant recipients were tested for CMV antigenemia at days 14, 28, 45, 60, 90 and 180 postransplantation and when clinically indicated. Patients showing > 50/200.000 leukocytes received ganciclovir 5 mg/kg/12 h for 14 days. Risk factors for active CMV disease where studied. Results 182 CMV seropositive patients where included in the study. 16 patients with > 50/200.000 leukocytes received ganciclovir as preemptive therapy. CMV disease appeared in 9/182 patients (4.9%): 2/16 who received PT and 7/166 among those who did not receive preemptive therapy. The only factor associated with increased incidence of CMV disease was to have missing samples for CMV antigenemia during the follow up (p < 0.0042; OR = 8,17; 95% CI, 1.94–34.36). Conclusions Ganciclovir antigenemia-guided preemptive therapy is associated with a low incidence of CMV disease. Bad adherence to the protocol of antigenemia samples increases the risk for CMV disease.
    Medicina Clínica. 122(2):41–45.