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ABSTRACT: Currently, only two drugs are approved for treating T. cruzi infection: benznidazole and nifurtimox. Adverse reactions are frequent with both drugs: they have chemical similarities and common metabolic pathways making cross reactions a possibility. Our objective was to describe the safety/tolerability profile of nifurtimox in patients who had previously discontinued benznidazole due to hypersensitivity reactions. We performed a prospective observational study from September 2009 to December 2011. Patients who discontinued benznidazole therapy due to hypersensitivity reactions (HR) and were later treated with nifurtimox were included. HR to benznidazole were defined as presence of a rash with or without mucosal involvement, fever or laboratory abnormalities (such as eosinophilia, leucopaenia or impaired liver function tests). The drugs were prescribed for 60 days (benznidazol) or 60 to 90 days (nifurtimox). The National Cancer Institute criteria (CTCAE, Version 3.0; year 2006) were used for grading and reporting of adverse reactions (AR). Eighteen patients (16 females, two males, median age 35.5 years, range 15-50 years) with asymptomatic late chronic infection, were included. Median time between benznidazole interruption and start of therapy with nifurtimox was 121.5 days (IQR 72-223 days). Fifteen patients (83.3%) developed an AR to nifurtimox, gastrointestinal complaints and anorexia being the most common, and 13 patients (72%) completed the treatment schedule. Five patients interrupted therapy (27.8%) mainly because of gastrointestinal intolerance and/or nervous system toxicity. Only one patient developed skin lesions, a mild maculopapular rash not requiring specific therapy or treatment withdrawal. There were no severe AR. Nifurtimox as second line therapy in patients who discontinued benznidazole specifically due to HR appears to be safe and does not seem to be associated with a higher incidence of AR.
Acta tropica 04/2013; · 2.22 Impact Factor
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PLoS Neglected Tropical Diseases 12/2012; 6(12):e1962. · 4.69 Impact Factor
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Journal of Immigrant and Minority Health 08/2012; · 1.16 Impact Factor
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ABSTRACT: Chagas disease is a neglected tropical disease endemic in Latin America. The first-line treatment option is benznidazole, but stocks are expected to run out in the coming months. Spain would need around 5 million benznidazole tablets. This drug shortage could make Chagas disease a neglected tropical disease also in developed countries.
The American journal of tropical medicine and hygiene 07/2012; 87(3):489-90. · 2.59 Impact Factor
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ABSTRACT: Trypanosoma cruzi infection is an imported parasitic disease in Spain, and the majority of infected individuals are in the chronic phase of the disease. This study evaluated the sensitivity and specificity of the Operon immunochromatographic test (ICT-Operon; Simple Stick Chagas and Simple Chagas WB [whole blood]; Operon S.A., Spain) for different biological samples. Well-characterized serum samples were obtained from chagasic patients (n = 63), nonchagasic individuals (n = 95), visceral leishmaniasis patients (n = 38), and malaria patients (n = 55). Noncharacterized specimens were obtained from Latin American immigrants and individuals at risk with a clinical and/or epidemiological background: these specimens were recovered serum or plasma samples (n = 450), whole peripheral blood (n = 94), and capillary blood (n = 282). The concordance of the results by enzyme-linked immunosorbent assay and indirect immunofluorescence test was considered to be the "gold standard" for diagnosis. Serum and plasma samples were analyzed by Stick Chagas, and whole blood was analyzed by Simple Chagas WB. The sensitivity and specificity of the ICT-Operon in well-characterized samples were 100% and 97.9%, respectively. No cross-reactivity was found with samples obtained from visceral leishmaniasis patients. In contrast, a false-positive result was obtained in 27.3% of samples from malaria patients. The sensitivities of the rapid test in noncharacterized serum or plasma, peripheral blood, and capillary blood samples were 100%, 92.1%, and 86.4%, respectively, while the specificities were 91.6%, 93.6%, and 95% in each case. ICT-Operon showed variable sensitivity, depending on the kind of sample, performing better when serum or plasma samples were used. It could therefore be used for serological screening combined with any other conventional test.
Clinical and vaccine immunology: CVI 07/2012; 19(9):1353-9. · 2.37 Impact Factor
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Journal of global infectious diseases 07/2012; 4(3):182-3.
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ABSTRACT: VFRs are at a greater risk of contracting travel-related illnesses such as malaria, and their knowledge about travel health tends to be poor. Since 2009, community-based activities targeting potential and impending VFRs were performed by a multidisciplinary team in Madrid, Spain. The design and distribution of multilingual and culturally-sensitive material following a qualitative research, and intercultural mediators were key tools of the health education programme.
Travel Medicine and Infectious Disease 05/2012; 10(3):152-6. · 1.50 Impact Factor
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ABSTRACT: Imported Chagas disease (Trypanosoma cruzi infection) is increasingly recognized as an emerging problem in the USA and Europe due to immigration from Latin America. Most migrants from endemic countries will have been infected during childhood. Based on the natural history of the disease, up to 35 % of those infected may develop cardiac and/or gastrointestinal manifestations during the third or fourth decade of life. This disease was described more than 100 years ago, yet many challenges still remain such as the identification of risk factors for visceral involvement, effective treatment for chronic cases, and reliable markers of cure following treatment. Transmission of the infection may occur even in non-endemic areas through non-vectorial routes and many countries are therefore currently facing the challenge of this emerging public health problem.
Current Infectious Disease Reports 04/2012; 14(3):263-74.
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Emerging Infectious Diseases 02/2012; 18(2):356-7. · 6.79 Impact Factor
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ABSTRACT: The proportion of imported malaria cases due to immigrants in Europe has increased during the lasts decades, with higher rates associated with settled immigrants who travel to visit friends and relatives (VFRs) in their country of origin. Cases are mainly due to P. falciparum and Sub-Saharan Africa is the most common origin. Clinically, malaria in immigrants is characterised by a mild clinical presentation including asymptomatic or delayed malaria cases and low parasitic levels. These characteristics may be explained by a semi-immunity acquired after long periods of time exposed to stable malaria transmission. Malaria cases among immigrants, even asymptomatic patients with sub-microscopic parasitemia, could increase the risk of transmission and cause the reintroduction of malaria in certain areas that have adequate vectors and climate conditions. Moreover, imported malaria cases in immigrants can also play an important role in the non-vector transmission out of endemic areas, through blood transfusions, organ transplantation or congenital transmission or occupational exposures. Consequently, outside of endemic areas, malaria screening should be carried out among recently arrived immigrants coming from malaria endemic countries. The aim of screening is to reduce the risk of clinical malaria in the individual as well as to prevent autochthonous transmission of malaria in areas where it has been eradicated.
Mediterranean Journal of Hematology and Infectious Diseases 01/2012; 4(1):e2012014.
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ABSTRACT: Cystic echinococcosis (CE) can affect the heart and the vena cava but few cases are reported.
A retrospective case series of 11 patients with cardiac and/or endovascular CE, followed-up over a period of 15 years (1995-2009) is reported.
Main clinical manifestations included thoracic pain or dyspnea, although 2 patients were asymptomatic. Cysts were located mostly in the right atrium and inferior vena cava. Nine patients were previously diagnosed with disseminated CE. Echocardiography was the diagnostic method of choice, although serology, electrocardiogram, chest X-ray, computed tomography/magnetic resonance imaging and histology aided with diagnosis and follow-up. Nine patients underwent cardiac surgery and nine received long-term antiparasitic treatment for a median duration of 25 months (range 4-93 months). One patient died intra-operatively due to cyst rupture and endovascular dissemination. Two patients died 10 and 14 years after diagnosis, due to pulmonary embolism (PE) and cardiac failure, respectively. One patient was lost to follow-up. Patients who had cardiac involvement exclusively did not have complications after surgery and were considered cured. There was only one recurrence requiring a second operation. Patients with vena cava involvement developed PEs and presented multiple complications.
Cardiovascular CE is associated with a high risk of potentially lethal complications. Clinical manifestations and complications vary according to cyst location. Isolated cardiac CE may be cured after surgery, while endovascular extracardiac involvement is associated with severe chronic complications. CE should be included in the differential diagnosis of cardiovascular disease in patients from endemic areas.
PLoS Neglected Tropical Diseases 01/2012; 6(1):e1437. · 4.69 Impact Factor
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ABSTRACT: Filariases are infections caused by distinct species of nematodes. These infections are transmitted through insect bites and primarily affect lymph nodes and skin. Filariases are classified as neglected diseases and affect millions, producing severe disability and social stigma. This type of infection is rarely diagnosed in travellers, as prolonged stays in endemic areas are usually required acquire infection. Infections may be asymptomatic, and clinical manifestations depend on the host immune response to the infection and the parasite burden. Diagnosis is based on the demonstration of microfilariae in blood or skin, but there are other methods that support the diagnosis. Individual treatment is effective, but community interventions, mostly mass drug administration, have helped to diminish the incidence of filariases.
Enfermedades Infecciosas y Microbiología Clínica 12/2011; 29 Suppl 5:27-37. · 1.49 Impact Factor
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ABSTRACT: Initiation of highly active antiretroviral therapy (HAART) with low CD4 lymphocyte counts is associated with AIDS-related and non-AIDS-related events and increased mortality. However, no clear association has been found with an increased rate of treatment failure.
We conducted a meta-analysis including randomized clinical trials of currently recommended HAART in naive patients to evaluate treatment response in very late starters (VLSs). Studies with information on response in at least one of the two strata (≤ 50 versus >50 CD4 cells/mm(3) and/or ≤ 200 versus >200 CD4 cells/mm(3)) and follow-up of at least 48 weeks were analysed. A pooled odds ratio of the effect of starting HAART with ≤ 50 versus >50 or ≤ 200 versus >200 CD4 cells/mm(3) for each arm by fitting a random-effect logistic regression model was computed. Sources of heterogeneity [sex, age, year of study initiation, nucleos(-t)ide pair and third drug] were investigated.
We included 25 treatment arms from 13 randomized clinical trials. Being a VLS consistently impairs treatment outcomes at 48 and 96 weeks. Only hepatitis C virus (HCV)/hepatitis B virus (HBV) coinfection was associated with a reduced impact of late initiation of HAART; at 48 weeks for 50 and 200 cells/mm(3) thresholds (P = 0.013 and P = 0.032, respectively). None of the remaining sources of heterogeneity explored was significantly associated with the impact of being a VLS.
We found that initiation of antiretroviral therapy with very low CD4 lymphocyte counts is consistently associated with poorer outcomes of HAART. This effect could be modulated by HBV/HCV coinfection, but not by the individual components of the HAART regimen.
Journal of Antimicrobial Chemotherapy 11/2011; 67(2):312-21. · 5.07 Impact Factor
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Enfermedades Infecciosas y Microbiología Clínica 07/2011; 29(9):714; author reply 715. · 1.49 Impact Factor
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Enfermedades Infecciosas y Microbiología Clínica 06/2011; 29(9):712-3. · 1.49 Impact Factor
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Jesús Fortún,
Pilar Martín-Dávila,
Enrique Navas, Rogelio López-Vélez,
Vicente Pintado,
Javier Cobo,
Andrés González,
María Bonilla,
Victoria Aneiros,
Enrique Gómez-Mampaso,
Santiago Moreno
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ABSTRACT: The epidemiological characteristics of patients with tuberculosis (TB) in European hospitals have changed in recent years.
A prospective study of patients with culture-proven pulmonary TB admitted to our institution from 1997 to 2008 is shown.
We analyzed 661 patients with pulmonary TB. An increase in the incidence of TB was confirmed during the study period (P<.001). The proportion of patients with HIV infection decreased from 26% during 1997-2000 to 12% during 2005-2008. However, the proportions of older (>40 years old) and foreign-born patients increased significantly, from 37% to 59% and from 12% to 35%, respectively. Multivariate analysis confirmed previous antituberculous therapy and immigration as factors associated with resistance to isoniazid and to isoniazid+rifampin. After the year 2000, mortality was independently associated with extrapulmonary TB (OR: 3.1; CI 95%: 1.4-7.2), hepatitis C virus infection (OR: 6.0; CI 95%: 2.2-16.3), and diabetes (OR: 6.4; CI 95%: 2.4-16.8).
Immigration from countries with high rates of TB infection has replaced HIV infection as the most relevant risk factor associated with TB. The increase in the number of older patients with TB and the presence of specific comorbid conditions, especially chronic liver dysfunction, could explain the more difficult management and increased mortality.
Enfermedades Infecciosas y Microbiología Clínica 06/2011; 29(9):654-9. · 1.49 Impact Factor
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ABSTRACT: Malaria is endemic throughout most of the tropics mainly due to Plasmodium falciparum. Outside the tropics, cases have been described among mobile population groups, such as travellers, immigrants and refugees. Malaria prevalence among refugees ranges from 3% to more than 60%, many of them being asymptomatic. This article assesses the findings of a recent study performed in Canada where malaria prevalence among recently arrived asymptomatic refugees was measured. A total of 324 refugees were screened for malaria, obtaining a global prevalence of 3.1% by PCR. Identifying imported, asymptomatic cases of malaria may have an important impact both for the individual concerned and for public health.
Expert Review of Anticancer Therapy 05/2011; 9(5):521-4. · 3.28 Impact Factor
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Cristina Domingo PhD,
Matthias Niedrig PhD,
Joaquim Gascón PhD,
Gustavo Palacios PhD,
Noelia Reyes TA,
María José Malo TA,
Ole Wichmann MD, MCTM, DTM&H,
Joaquim Ruiz PhD,
MSc Detlev Schultze MD,
MPH Mirjam Schunk MD, [......],
Joaquim Ruiz,
Detlev Schultze,
Mirjam Schunk,
Sabino Puente,
Lasse Vinner,
Marjan Van Esbroeck,
Isabelle Schuffenecker,
Marc Grandadam, Rogelio López‐Vélez,
Antonio Tenorio
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ABSTRACT: Background. Dengue viruses (DENV) are the most widespread arthropod-borne viruses, which have shown an unexpected geographic expansion, as well as an increase in number and severity of outbreaks in the last decades. Although the emergence of dengue is considered to be due to a number of complex factors, epidemiological studies have shown that some strains of dengue might be associated with increased severity and higher transmission rates than others. In this context, surveillance and identification of the appearance or introduction of more virulent strains, along with fluctuation of DENV among endemic areas are now considered essential public health activities.Methods. Samples from travelers returning from the tropics with acute dengue infections were analyzed to obtain up-dated information on circulating dengue strains. A short nucleotide fragment located in the carboxyl terminus of the dengue E gene was used for the characterization of DENV strains and the identification of their sero- and genotype.Results. One hundred eighty-six new dengue strains have been classified into 12 distinct genotype groups within the four dengue serotypes. The identification of the emergence of different sero- and genotypes, the appearance of new clades correlating with outbreaks, and the identification of a dengue-4 genotype not previously reported have been achieved. Interestingly, African strains characterized in this study have provided valuable data on dengue circulation on the continent.Conclusions. This work demonstrates the convenience of routine application of molecular epidemiology analyses in dengue diagnosis laboratories. The use of molecular epidemiology tools on the analysis of imported dengue infections strengthens data acquisition on dengue strain movements correlating with epidemiological changes. The importance of surveillance of imported diseases contributing data for the epidemiological knowledge of infectious diseases in endemic areas has been once more demonstrated.
Journal of Travel Medicine 04/2011; 18(3):183 - 190. · 1.75 Impact Factor
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ABSTRACT: We aimed to evaluate the effectiveness of nitazoxanide in disseminated cystic echinococcosis (DCE) that failed to respond to surgical and antiparasitic therapy. We report on seven patients (five of them with bony involvement): two cases from the literature and five patients who were included in a compassionate trial of nitazoxanide therapy in our hospital. Median follow-up time until nitazoxanide therapy was 12 years and all patients had received prior medical treatment and extensive surgery. Nitazoxanide (500 mg/12 h) in combination with albendazole, with/without praziquantel, was administered for 3-24 months. Three patients improved: one with muscle involvement (clinico-radiological response), one with lung involvement (radiological response), and another with soft tissue and bony involvement (clinico-radiological response of soft tissue cysts). There was one discontinuation after 15 days of starting therapy. Nitazoxanide combination therapy could have a role in the treatment of DCE when there is no bony involvement. Long-term safety profile seems to be favorable.
The American journal of tropical medicine and hygiene 02/2011; 84(2):351-6. · 2.59 Impact Factor
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ABSTRACT: This study investigates the reasons why sub-Saharan African migrants (SSAM) living in Spain may be unwilling to have their blood tested. A qualitative study was developed for 3 years (2006-2009) with the participation of 1338 SSAM. Cultural differences along with lack of information about Spanish health care system and health-related rights produced a feeling of mistrust towards medical staff. Reluctance to do blood testing may prevent SSAM from having a prompt HIV diagnosis and an appropriate health care. Linguistically and culturally adapted information is essential to overcome these barriers and achieve an equal access to health care services and HIV testing.
AIDS and Behavior 01/2011; 16(1):30-5. · 3.49 Impact Factor
