RESUMEN
OBJECTIVE: The diagnosis of SARS-CoV-2 infection presents some limitations. RT-PCR in nasopharyngeal swabs is considered the gold standard for the diagnosis, although it can have false negative results. We aimed to analyze the accuracy of repeating nasopharyngeal swabs based on different clinical probabilities. METHODS: Retrospective observational study of the first patients admitted to a two COVID Internal Medicine wards at the University Hospital Marqués de Valdecilla, Santander, from March to April 2020. RT-PCR targering E, N, RdRP and ORFab1 genes and antibody tests detecting IgG. RESULTS: A total of 145 hospitalized patients with suspected SARS-Cov2 infection were admitted and in 98 (67.5%) diagnosis was confirmed. The independent predictive variables for SARS-CoV-2 infection were: epidemiological contact, clinical presentation as pneumonia, absence of pneumonia in the last year, onset of symptoms > 7 days, two or more of the following symptoms -dyspnea, cough or fever- and serum lactate dehydrogenase levels >350 U/L (p<0.05). A score based on these variables yielded an AUC-ROC of 0.89 (CI95%, 0.831-0.946; p<0.001). The accuracy of the first nasopharyngeal swabs was 54.9%. Repeating nasopharyngeal swabs two or three times allows to detect an additional 16% of positive cases. The overall accuracy of successive RT-PCR tests in patients with low pre-test probability was <5%. CONCLUSIONS: We have defined a pre-test probability score based on epidemiological and clinical data with a high accuracy for diagnosis of SARS-CoV-2. Repeating nasopharyngeal swabs avoids sampling errors, but only in medium of high probability pre-test clinical scenarios.
Asunto(s)
Prueba de COVID-19/métodos , COVID-19/diagnóstico , Reacción en Cadena de la Polimerasa de Transcriptasa Inversa/métodos , SARS-CoV-2/aislamiento & purificación , Anciano , Anticuerpos Antivirales/análisis , Área Bajo la Curva , Prueba de Ácido Nucleico para COVID-19/métodos , Prueba de Ácido Nucleico para COVID-19/estadística & datos numéricos , Prueba Serológica para COVID-19/métodos , Prueba Serológica para COVID-19/estadística & datos numéricos , Prueba de COVID-19/estadística & datos numéricos , Distribución de Chi-Cuadrado , Femenino , Genes Virales , Humanos , Masculino , Nasofaringe/virología , Probabilidad , Curva ROC , Reproducibilidad de los Resultados , Estudios Retrospectivos , Reacción en Cadena de la Polimerasa de Transcriptasa Inversa/estadística & datos numéricos , SARS-CoV-2/genética , SARS-CoV-2/inmunologíaRESUMEN
BACKGROUND: WU and KI polyomaviruses were discovered in 2007 in samples of respiratory secretions of children with acute respiratory symptoms. Seroepidemiologic studies have shown that these viruses are widely distributed throughout the world, but their incidence in Spain has not been determined. In transplant patients, early detection and treatment of viral infections may influence prognosis and survival, because they are associated with increased morbidity and mortality, including graft failure. METHODS: We aimed to determine the prevalence and clinical characteristics of WU and KI polyomaviruses among patients undergoing hematologic or solid organ transplant in the Hospital Marqués de Valdecilla (Santander, Spain). An in-house polymerase chain reaction with the use of specific primers was carried out in invasive lower respiratory samples from hospitalized patients with suspected respiratory infection and/or graft dysfunction and compared with asymptomatic transplant patients. RESULTS: Overall, we obtained 5.5% KI-positive samples and 1.4% WU-positive samples, with a higher prevalence of WU and KI polyomaviruses in the symptomatic population compared with the control group. Although the data suggest that their detection in respiratory samples is sporadic and often associated with other microorganisms, we should pay special attention to their association with cases of graft failure. Studies are needed with a larger number of samples to explore the potential clinical impact of these emerging polyomaviruses in transplant recipients.
Asunto(s)
Trasplante de Órganos , Infecciones por Polyomavirus/epidemiología , Poliomavirus , Infecciones del Sistema Respiratorio/epidemiología , Trasplante de Células Madre , Infecciones Tumorales por Virus/epidemiología , Adulto , Anciano , Cartilla de ADN , Femenino , Humanos , Masculino , Persona de Mediana Edad , Reacción en Cadena de la Polimerasa , Infecciones por Polyomavirus/diagnóstico , Prevalencia , Estudios Prospectivos , Infecciones del Sistema Respiratorio/diagnóstico , Infecciones del Sistema Respiratorio/virología , España , Infecciones Tumorales por Virus/diagnósticoRESUMEN
BACKGROUND: Monitoring the emergence of drug-resistant influenza variants is crucial in influenza surveillance programs. OBJECTIVES: Influenza A kinetics and the emergence of drug-resistant strains in hospitalized patients treated with oseltamivir were investigated. STUDY DESIGN: Sequential samples from oseltamivir-treated and -untreated hospitalized patients in the period November 2011 through April 2012 were analyzed. NA gene was sequenced in samples from oseltamivir treated patients. Clonal analysis of the viral population was performed in patients unresponsive to treatment. Viral kinetics was determined in 24 (14 immunocompromised and 10 immunocompetent) A(H3N2)-positive patients treated and 24 (10 immunocompromised and 14 immunocompetent) untreated patients. RESULTS: Viral shedding was significantly reduced in treated vs untreated immunocompromised patients (7 vs 22 days, p<0.05, respectively). Viral load decreased significantly in immunocompromised and immunocompetent treated patients as compared with immunocompromised and immunocompetent untreated patients (0.73 and 0.93 vs 0.47 and 0.45 log10/day, p<0.05). In two (8.3%) treated patients with prolonged virus shedding, the oseltamivir resistance R292K mutation was revealed. In these patients, clonal analysis of the virus population showed the presence of additional oseltamivir-resistant mutants (E119V, N294S and deletion Del247-250). CONCLUSIONS: Oseltamivir resistance is reported for the first time in A(H3N2) virus strains during the 2011-2012 influenza season. Different drug-resistant viruses emerged in hospitalized immunocompromised patients showing prolonged virus shedding.
Asunto(s)
Antivirales/uso terapéutico , Farmacorresistencia Viral , Subtipo H3N2 del Virus de la Influenza A/genética , Gripe Humana/tratamiento farmacológico , Gripe Humana/virología , Mutación Missense , Oseltamivir/uso terapéutico , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Femenino , Humanos , Huésped Inmunocomprometido , Lactante , Subtipo H3N2 del Virus de la Influenza A/clasificación , Subtipo H3N2 del Virus de la Influenza A/aislamiento & purificación , Italia , Masculino , Persona de Mediana Edad , Datos de Secuencia Molecular , Neuraminidasa/genética , Estudios Prospectivos , ARN Viral/genética , Análisis de Secuencia de ADN , Proteínas Virales/genética , Adulto JovenRESUMEN
Las infecciones parasitarias intestinales constituyen un problema de salud pública en diversas regiones del mundo, especialmente en áreas tropicales y subtropicales. Se calcula que un tercio de la población mundial está infectada por parásitos intestinales, siendo comunes las poliparasitosis, lo cual es causa de trastornos tales como malnutrición, anemia por déficit de hierro, obstrucción intestinal o retraso de crecimiento. Sin embargo, en adultos lo habitual es que esta patología sea asintomática. Algunos parásitos, como Schistosoma o Strongyloides, persisten durante años, siendo necesario su tratamiento para evitar el desarrollo de complicaciones más serias en estadios avanzados. El cribado de parásitos importados en inmigrantes aparentemente sanos es una prioridad en los centros de atención primaria, especialmente en aquellos que provienen de áreas endémicas. La investigación debe ir dirigida hacia aquellos parásitos prevalentes en el área de procedencia de cada paciente. En este artículo presentamos el caso de un paciente subsahariano que es diagnosticado de un cuadro de poliparasitosis en el contexto de una enfermedad aguda que motiva la asistencia sanitaria (AU)
Intestinal parasitic diseases pose a public health problem in many countries of the world, especially in tropical and subtropical areas. It is estimated that one third of the world's population may be infected with intestinal worms, polyparasitosis being common. This is the cause of a variety of conditions including malnutrition, iron-deficiency anemia, intestinal obstruction or physical growth retardation. Nevertheless, this condition is usually asymptomatic in adults. Some parasites such as Schistosoma and Strongyloides persist for many years and must be treated to prevent the development of serious complications at later stages. Screening for imported parasites in apparently healthy immigrants remains a public health priority in health care settings that attend immigrants, most of whom may have emigrated from countries where intestinal parasitic diseases are endemic. Research must focus on parasites prevalent in the area where the person has lived. In this article, we present the case of a sub-Saharan patient who was diagnosed of polyparasitosis in the context of an acute disease that required health care assistance (AU)
Asunto(s)
Humanos , Masculino , Adolescente , Enfermedades Parasitarias/diagnóstico , Eosinofilia/diagnóstico , Enfermedades Parasitarias/epidemiología , Emigrantes e Inmigrantes , Tamizaje Masivo , Embolia Pulmonar/complicaciones , Anticoagulantes/uso terapéutico , Antiparasitarios/uso terapéuticoRESUMEN
Las infecciones parasitarias intestinales constituyen un problema de salud pública en diversas regiones del mundo, especialmente en áreas tropicales y subtropicales. Se calcula que un tercio de la población mundial está infectada por parásitos intestinales, siendo comunes las poliparasitosis, lo cual es causa de trastornos tales como malnutrición, anemia por déficit de hierro, obstrucción intestinal o retraso de crecimiento. Sin embargo, en adultos lo habitual es que esta patología sea asintomática. Algunos parásitos, como Schistosoma o Strongyloides, persisten durante años, siendo necesario su tratamiento para evitar el desarrollo de complicaciones más serias en estadios avanzados. El cribado de parásitos importados en inmigrantes aparentemente sanos es una prioridad en los centros de atención primaria, especialmente en aquellos que provienen de áreas endémicas. La investigación debe ir dirigida hacia aquellos parásitos prevalentes en el área de procedencia de cada paciente. En este artículo presentamos el caso de un paciente subsahariano que es diagnosticado de un cuadro de poliparasitosis en el contexto de una enfermedad aguda que motiva la asistencia sanitaria(AU)
Intestinal parasitic diseases pose a public health problem in many countries of the world, especially in tropical and subtropical areas. It is estimated that one third of the world's population may be infected with intestinal worms, polyparasitosis being common. This is the cause of a variety of conditions including malnutrition, iron-deficiency anemia, intestinal obstruction or physical growth retardation. Nevertheless, this condition is usually asymptomatic in adults. Some parasites such as Schistosoma and Strongyloides persist for many years and must be treated to prevent the development of serious complications at later stages. Screening for imported parasites in apparently healthy immigrants remains a public health priority in health care settings that attend immigrants, most of whom may have emigrated from countries where intestinal parasitic diseases are endemic. Research must focus on parasites prevalent in the area where the person has lived. In this article, we present the case of a sub-Saharan patient who was diagnosed of polyparasitosis in the context of an acute disease that required health care assistance(AU)