Evaluation of a HIV screening strategy in the hospital setting to reduce undiagnosed infection.

INTRODUCTION: In Spain, half of new HIV diagnoses are late and a significant proportion of people living with HIV have not yet been diagnosed. Our aim was to evaluate the effectiveness of an automated opportunistic HIV screening strategy in the hospital setting. METHODS: Between April 2022 and September 2023, HIV testing was performed on all patients in whom a hospital admission analytical profile, a pre-surgical profile and several pre-designed serological profiles (fever of unknown origin, pneumonia, mononucleosis, hepatitis, infection of sexual transmission, rash, endocarditis and myopericarditis) was requested. A circuit was started to refer patients the specialists. RESULTS: 6407 HIV tests included in the profiles were performed and 18 (0.3%) new cases were diagnosed (26.4% of diagnoses in the health area). Five patients were diagnosed by hospital admission and pre-surgery profile and 13 by a serological profile requested for indicator entities (fever of unknown origin, sexually transmitted infection, mononucleosis) or possibly associated (pneumonia) with HIV occult infection. Recent infection was documented in 5 (27.8%) patients and late diagnosis in 9 (50.0%), of whom 5 (55.5%) had previously missed the opportunity to be diagnosed. CONCLUSIONS: This opportunistic screening was profitable since the positive rate of 0.3% is cost-effective and allowed a quarter of new diagnoses to be made, so it seems a good strategy that contributes to reducing hidden infection and late diagnosis.

Infección aguda por el virus de la hepatitis C: ¿en qué personas se está produciendo la transmisión? / Acute hepatitis due to the hepatitisC virus: Where are the transmission occurring?

Objetivo: Conocer los patrones de transmisión de la infección aguda por el virus de la hepatitisC (VHC) en un momento en que estamos próximos a su eliminación.Pacientes y métodos: Se realizó un estudio clínico-epidemiológico descriptivo prospectivo de los casos de infección aguda por VHC diagnosticados entre los años 2016 y 2020 en un hospital de referencia de la isla de Gran Canaria.Resultados: Se diagnosticaron 22 casos de infección aguda (10 primarios y 12 reinfecciones), observándose un incremento de incidencia de 0,6 en 2016 a 2,3 casos/100.000 habitantes en el año 2020. La mediana de edad fue de 46años. El 77,3% eran hombres y el 68,2% eran VIH-positivos. El 54,5% mantenían relaciones sexuales de riesgo; el 83,3% eran hombres que mantenían sexo con hombres (el 70% con otra infección de transmisión sexual concomitante); el 31,8% eran consumidores de drogas, el 9,1% tenían trastornos neuropsiquiátricos y una mujer (4,5%) tuvo una intervención quirúrgica previa. El 40,9% de pacientes presentaron síntomas, y de los 13 asintomáticos, el 84,6% eran VIH-positivos.Conclusiones: Observamos un aumento de incidencia en los últimos años del estudio, y la principal vía de contagio fue tener relaciones sexuales de riesgo, principalmente en hombres que mantienen sexo con hombres y que son VIH-positivo. Los casos en personas no-VIH con relaciones sexuales no protegidas están, probablemente, infradiagnosticados. Las estrategias de microeliminación podrían ser insuficientes para diagnosticar estos casos, por lo que para conseguir la eliminación del VHC la mejor estrategia podría ser el cribado poblacional.(AU)

Objective: To know the transmission patterns of the acute infection by the hepatitisC virus at a time when we are close to its elimination.Patients and methods: A prospective descriptive clinical-epidemiological study of cases of acute HCV infection diagnosed between 2016 and 2020 was carried out in a reference hospital in the island of Gran Canaria.Results: Twenty-two cases of acute HCV were diagnosed (10 primary infections and 12 reinfections). There was an increase in the incidence from 0.6 in 2016 and 2017 to 2.3 cases per 100,000 inhabitants in 2020. The median age was 46years. From these, 77.3% were men and 68.2% were HIV-positive. According to the risk factors, 54.5% had high-risk sexual practices, 83.3% were men who had sex with men (70% with a concomitant STI), 31.8% were drug users, 9.1% were women with neuropsychiatric disorders, and one woman (4.5%) had a previous surgical intervention. There were thirteen patients (40.9%) who presented symptoms and eleven out of the thirteen patients who were asymptomatic were HIV-positive.Conclusions: An increase in incidence was observed in the last years of the study and the main route of infection was high-risk sexual practice, mainly in men who have sex with men and who are HIV positive. Cases related to unsafe sex in other non-HIV groups are probably under-diagnosed. Microelimination strategies may not be sufficient to diagnose these cases, so in order to achieve elimination of the HCV the best strategy would be a population-based screening.(AU)

Acute hepatitis due to the hepatitisC virus: Where are the transmission occurring? / Infección aguda por el virus de la hepatitisC: ¿en qué personas se está produciendo la transmisión?

OBJECTIVE: To know the transmission patterns of the acute infection by the hepatitisC virus at a time when we are close to its elimination. PATIENTS AND METHODS: A prospective descriptive clinical-epidemiological study of cases of acute HCV infection diagnosed between 2016 and 2020 was carried out in a reference hospital in the island of Gran Canaria. RESULTS: Twenty-two cases of acute HCV were diagnosed (10 primary infections and 12 reinfections). There was an increase in the incidence from 0.6 in 2016 and 2017 to 2.3 cases per 100,000 inhabitants in 2020. The median age was 46years. From these, 77.3% were men and 68.2% were HIV-positive. According to the risk factors, 54.5% had high-risk sexual practices, 83.3% were men who had sex with men (70% with a concomitant STI), 31.8% were drug users, 9.1% were women with neuropsychiatric disorders, and one woman (4.5%) had a previous surgical intervention. There were thirteen patients (40.9%) who presented symptoms and eleven out of the thirteen patients who were asymptomatic were HIV-positive. CONCLUSIONS: An increase in incidence was observed in the last years of the study and the main route of infection was high-risk sexual practice, mainly in men who have sex with men and who are HIV positive. Cases related to unsafe sex in other non-HIV groups are probably under-diagnosed. Microelimination strategies may not be sufficient to diagnose these cases, so in order to achieve elimination of the HCV the best strategy would be a population-based screening.

Estudio clínico-epidemiológico de la infección por Bordetella pertussis en la isla de Gran Canaria en el período 2008-2016 / Evaluation of sensitization to Der p 1 and Der p 2 in a pediatric population of the North of Portugal

OBJETIVO: Describir el patrón epidemiológico y clínico de la infección por Bordetella pertussis (tosferina) en niños menores de un año hospitalizados en un hospital pediátrico de Gran Canaria. PACIENTES Y MÉTODOS: Se revisaron retrospectivamente las historias clínicas de los pacientes con diagnóstico microbiológico de infección por B. pertussis mediante reacción en cadena de la polimerasa, de enero de 2008 a diciembre de 2016. RESULTADOS: Se identificaron 110 pacientes, de los cuales 105 (95,4%) fueron menores de 6 meses y el 59,1% eran varones. La incidencia anual de hospitalización se estimó entre 13,7 y 425,0 casos por cada 100.000 lactantes menores de 12 meses, con 2picos en 2011 y 2015. Los familiares cercanos fueron las principales fuentes de contagio potenciales. Las principales manifestaciones fueron la tos pertusoide asociada con signos catarrales, cianosis y linfocitosis. El 15,4% de los pacientes presentaron complicaciones (principalmente neumonía), pero la evolución fue favorable en todos los casos. La menor edad y la no vacunación se asociaron con un mayor riesgo de desarrollar complicaciones (p < 0,05). La coinfección viral ocurrió en el 31,6% de los pacientes diagnosticados de infección por B. pertussis. CONCLUSIONES: La incidencia de infección por B. pertussis ha aumentado en los últimos años en nuestra área, con un menor desarrollo de complicaciones y con tasas de mortalidad inferiores al período anterior. La menor edad y la no vacunación previa se consideran factores de riesgo para el desarrollo de complicaciones. La vacunación en mujeres embarazadas probablemente disminuirá la incidencia en el futuro, sobre todo en niños menores de 6 meses

OBJECTIVE: Describe the epidemiological and clinical pattern of Bordetella pertussis infection (whooping cough) among hospitalised infants less than one year-old in a paediatric hospital in Gran Canaria. PATIENTS AND METHODS: A retrospective review of the patient hospital records was performed, and recording only those with a microbiological diagnosis of pertussis infection detected using polymerase chain reaction, from January 2008 to December 2016. RESULTS: A total of 110 patients were identified, of which 105 (95.4%) were less than 6 months-old, and 59.1% were males. The annual incidence of hospital admissions was estimated between 13.7 to 425.0 cases per 100,000 infants <12 months old, with 2peaks in 2011 and 2015. Household members were the main potential sources of infection. Main clinical features were pertussis cough associated with signs of catarrh, cyanosis, and lymphocytosis. Complications occurred in 15.4% of the patients (mainly pneumonia), but the outcome was favourable in all the cases. A lower age and non-vaccination were associated with an increased risk of developing complications (P<.05). Viral co-infection occurred in 31.6% of infants diagnosed with pertussis. CONCLUSIONS: The incidence of pertussis has increased in the last years in Gran Canaria, with a lower development of complications and mortality rates compared with the previous period. Lower age and non-vaccination status are considered risk factors for developing complications. Vaccination in pregnant women will probably lead to a decline in the incidence in the future, especially in infants younger than 6 months

Clinical-epidemiological study of Bordetella pertussis infection in the Gran Canaria island in the period, 2008-2016.

OBJECTIVE: Describe the epidemiological and clinical pattern of Bordetella pertussis infection (whooping cough) among hospitalised infants less than one year-old in a paediatric hospital in Gran Canaria. PATIENTS AND METHODS: A retrospective review of the patient hospital records was performed, and recording only those with a microbiological diagnosis of pertussis infection detected using polymerase chain reaction, from January 2008 to December 2016. RESULTS: A total of 110 patients were identified, of which 105 (95.4%) were less than 6 months old, and 59.1% were males. The annual incidence of hospital admissions was estimated between 13.7 and 425.0 cases per 100 000 infants <12 months old, with 2 peaks in 2011 and 2015. Household members were the main potential sources of infection. Main clinical features were pertussis cough associated with signs of catarrh, cyanosis, and lymphocytosis. Complications occurred in 15.4% of the patients (mainly pneumonia), but the outcome was favourable in all the cases. A lower age and non-vaccination were associated with an increased risk of developing complications (p < .05). Viral co-infection occurred in 31.6% of infants diagnosed with pertussis. CONCLUSIONS: The incidence of pertussis has increased in the last years in Gran Canaria, with a lower development of complications and mortality rates compared with the previous period. Lower age and non-vaccination status are considered risk factors for developing complications. Vaccination in pregnant women will probably lead to a decline in the incidence in the future, especially in infants younger than 6 months.

OBJETIVO: Describir el patrón epidemiológico y clínico de la infección por Bordetella pertussis (tosferina) en niños menores de un año hospitalizados en un hospital pediátrico de Gran Canaria. PACIENTES Y MÉTODOS: Se revisaron retrospectivamente las historias clínicas de los pacientes con diagnóstico microbiológico de infección por B. pertussis mediante reacción en cadena de la polimerasa, de enero de 2008 a diciembre de 2016. RESULTADOS: Se identificaron 110 pacientes, de los cuales 105 (95,4%) fueron menores de 6 meses y el 59,1% eran varones. La incidencia anual de hospitalización se estimó entre 13,7 y 425,0 casos por cada 100.000 lactantes menores de 12 meses, con 2 picos en 2011 y 2015. Los familiares cercanos fueron las principales fuentes de contagio potenciales. Las principales manifestaciones fueron la tos pertusoide asociada con signos catarrales, cianosis y linfocitosis. El 15,4% de los pacientes presentaron complicaciones (principalmente neumonía), pero la evolución fue favorable en todos los casos. La menor edad y la no vacunación se asociaron con un mayor riesgo de desarrollar complicaciones (p < 0,05). La coinfección viral ocurrió en el 31,6% de los pacientes diagnosticados de infección por B. pertussis. CONCLUSIONES: La incidencia de infección por B. pertussis ha aumentado en los últimos años en nuestra área, con un menor desarrollo de complicaciones y con tasas de mortalidad inferiores al período anterior. La menor edad y la no vacunación previa se consideran factores de riesgo para el desarrollo de complicaciones. La vacunación en mujeres embarazadas probablemente disminuirá la incidencia en el futuro, sobre todo en niños menores de 6 meses.

[Clinical-epidemiological study of Bordetella pertussis infection in the Gran Canaria island in the period, 2008-2016]. / Estudio clínico-epidemiológico de la infección por Bordetella pertussis en la isla de Gran Canaria en el período 2008-2016.

OBJECTIVE: Describe the epidemiological and clinical pattern of Bordetella pertussis infection (whooping cough) among hospitalised infants less than one year-old in a paediatric hospital in Gran Canaria. PATIENTS AND METHODS: A retrospective review of the patient hospital records was performed, and recording only those with a microbiological diagnosis of pertussis infection detected using polymerase chain reaction, from January 2008 to December 2016. RESULTS: A total of 110 patients were identified, of which 105 (95.4%) were less than 6 months-old, and 59.1% were males. The annual incidence of hospital admissions was estimated between 13.7 to 425.0 cases per 100,000 infants <12 months old, with 2peaks in 2011 and 2015. Household members were the main potential sources of infection. Main clinical features were pertussis cough associated with signs of catarrh, cyanosis, and lymphocytosis. Complications occurred in 15.4% of the patients (mainly pneumonia), but the outcome was favourable in all the cases. A lower age and non-vaccination were associated with an increased risk of developing complications (P<.05). Viral co-infection occurred in 31.6% of infants diagnosed with pertussis. CONCLUSIONS: The incidence of pertussis has increased in the last years in Gran Canaria, with a lower development of complications and mortality rates compared with the previous period. Lower age and non-vaccination status are considered risk factors for developing complications. Vaccination in pregnant women will probably lead to a decline in the incidence in the future, especially in infants younger than 6 months.

Meningoencefalitis viral en pacientes inmunocompetentes: papel del VIH / Viral meningoencephalitis in inmunocompetent patients: Relevance of HIV infection

No disponible

Evolución de la transmisión de cepas con resistencia a fármacos antirretrovirales en pacientes diagnosticados de infección por el virus de la inmunodeficiencia humana en Gran Canaria en el período 2009-2012 / Transmission of antiretroviral drug resistant strains in patients diagnosed with human immunodeficiency virus infection in Gran Canaria in the period 2009-2012

No disponible

Tratamiento de la infección crónica por el virus de la hepatitis C. Factores predictores de respuesta / Treatment of chronic hepatitis C virus infection. A study of best predictors for response

Objetivo: Evaluar la respuesta virológica sostenida (RVS) y los factores predictores de la misma en los pacientes con infección crónica por el virus de la hepatitis C (VHC) tratados con peginterferón alfa-2a y ribavirina. Pacientes: Estudio retrospectivo de 272 pacientes naïve con infección crónica por el VHC tratados durante 24 ó 48 semanas y con seguimiento durante 24 semanas después de retirar el tratamiento. Resultados: De los 272 pacientes, 243 completaron el tratamiento. La RVS en el análisis por intención de tratar fue del 66,5%, y en pacientes tratados 74,5%. En el análisis univariado, la RVS fue mayor en menores de 40 años (84,4%), con carga viral pretratamiento <500.000 UI/ml (86,9%), genotipo no-1 (86,4%), no cirróticos ni precirróticos (76,5%), con respuesta virológica rápida (RVR) (91,4%) y con respuesta virológica precoz (RVP) (83,8%) (p<0.01). El análisis multivariado mostró que solo el genotipo y la RVP influyeron en la RVS. La RVR y el grado de lesión hepática no se incluyeron en el análisis multivariado porque no se dispuso de estas variables en un alto número de pacientes. Los VPP y VPN de la RVR fueron 91,5% y 48,7% respectivamente, de la RVP 83,8% y 95,8% y de la RVP completa 91,3% y 78,7% respectivamente. Conclusiones: La RVS en nuestra serie fue mayor que en otros estudios. Los factores predictores de RVS fueron el genotipo y la RVP. La RVP presentó un alto VPN y la RVP completa un alto VPP(AU)

Objective: The aim of this study was evaluate the rate of sustained viral response (SVR) and the influence of different factors on the SVR in patients with chronic hepatitis C virus (HCV) infection treated with pegylated interferon alfa 2a and ribavirin. Methods: We retrospectively analysed 272 naïve patients with chronic hepatitis C who had been treated for 24 weeks or 48 weeks and had been followed for an additional 6 months thereafter. Results: Out of 272 patients, 243 completed the entire treatment. The overall SVR rate in intent-to-treat analysis was 66.5% and in treated patients was 74.5%. In an univariate analysis, the SVR was associated with age <40 years (84.4%), pre-treatment viral load <500.000 IU/ml (86.9%), non-1 genotype HCV (86.4%), non cirrhosis or pre-cirrhosis (76.5%), rapid virologic response (RVR) (91.4%) and early virologic response (EVR) (83.8%). In the multivariate logistic regression analysis, the presence of an infection caused by a non-1 genotype and to achieve ERV were independent predictors of SVR. The RVR and histological stage of liver disease were not included in the multivariate analysis because these data were not available in most of the patients. The PPV and NVP of RVR were 91.5% and 48.7% respectively, of EVR were 83.8% and 95.8% respectively and of complete EVR were 91.3% and 78.7%, respectively. Conclusions: The SVR was higher than in other studies. The genotype and EVR were independent factors to predict the effect of antiviral therapy. The EVR had a high NPV and the complete EVR a high PPV(AU)

Malaria in paradise: characterization of imported cases in Gran Canaria Island (1993-2006).

BACKGROUND: Spain obtained the official certificate of malaria eradication in 1964. However, imported malaria cases have been increasing during the last few decades in this country. This study aims to describe the clinical and epidemiological features of patients diagnosed with malaria on Gran Canaria Island. METHODS: A retrospective study was conducted based on case review of all patients diagnosed with malaria microbiologically confirmed from 1993 to 2006, at the three referral teaching hospitals on Gran Canaria Island. RESULTS: One hundred eighty-four episodes in 181 patients were diagnosed, 170 of them were analyzed. Most of them (82%) were travelers. Nearly 15% (14.7%) declared having had some chemoprophylaxis, but only half of them completed the treatment. Twenty cases (10.9%) were diagnosed who had just arrived as immigrants, mainly children. Malaria was acquired in Africa by 94.7% of the cases and Plasmodium falciparum was responsible for the majority of the cases (84.1%). Clinical and epidemiological differences were observed among different groups of patients formed by their origin and travel purposes. At least one indicator of severe malaria was established in 22.9% of the cases. However, global mortality was 3.8%. CONCLUSIONS: Malaria in Gran Canaria Island is imported from endemic areas, mainly from African countries, observed mostly among young adult males, but clinical and epidemiological features may change among different groups of patients. The number of immigrants diagnosed with malaria is increasing in this area nowadays.

Hepatitis aguda por el virus de la hepatitis C en la población adulta / Acute hepatitis due to hepatitis C virus infection in the adult population

Introducción El conocimiento de la infección aguda por el virus de la hepatitis C (VHC) es importante para diseñar estrategias de prevención y tratamiento efectivas. El objetivo del estudio fue conocer las características clinicoepidemiológicas y la evolución de los pacientes diagnosticados de infección aguda por VHC.MétodosEstudio clinicoepidemiológico descriptivo retrospectivo de los pacientes adultos con infección aguda por VHC diagnosticados entre los años 2000-2008 en nuestro hospital.ResultadosSe diagnosticó a 16 pacientes. La fuente probable de transmisión fue la adicción a drogas por vía parenteral (ADVP) en 4 casos, un accidente sanitario por pinchazo en 3 casos, un procedimiento médico en 3 casos y la vía sexual en 2 casos. En 4 casos la fuente de infección fue desconocida. Ocho pacientes se diagnosticaron por un cuadro clínico sintomático, (3 en los controles por accidente sanitario y en 5 la detección fue casual). Nueve pacientes presentaron síntomas francos y 7 fueron asintomáticos o tuvieron síntomas leves. Los 4 pacientes que recibieron tratamiento se curaron y de los 12 pacientes que no recibieron tratamiento, el 58,3% cronificó. Se observó una mayor tendencia a la cronificación en los pacientes que no presentaron ictericia frente a los que la presentaron (el 85,7 vs. el 16,7%).ConclusionesLos procedimientos médicos siguen siendo un factor de riesgo de adquisición de la infección por el VHC, por lo que es necesaria la búsqueda activa así como insistir en el cumplimiento de las medidas de prevención de transmisión parenteral. Debido al bajo porcentaje de pacientes con ictericia que cronifican, el inicio del tratamiento en estos pacientes podría retrasarse en función de su evolución (AU)

Introduction Knowledge of acute hepatitis C infection (AHC) is important to design effective prevention and treatment strategies. The aim of this study was to determine the clinical and epidemiological features and outcomes of patients diagnosed with AHC.MethodsA retrospective clinical-epidemiological study was carried out in adult patients diagnosed with AHC between 2000 and 2008 in our hospital.ResultsSixteen patients were diagnosed. The most probable source of transmission was intravenous drug abuse in four patients, a percutaneous injury in three healthcare workers, a medical procedure in three patients and sexual contact in two patients. The source of infection was unknown in four patients. Diagnosis was based on acute clinical symptoms in eight patients, follow-up of healthcare injury in three patients and was fortuitous in five patients. Nine patients showed severe symptoms, while seven patients were asymptomatic or had mild symptoms. The four patients who received treatment were cured. Of the 12 patients that did not receive treatment, the disease became chronic in 58.3%. Progression to chronic disease was more frequent in patients without jaundice than in those with jaundice (85.7% vs 16.7%).ConclusionsBecause medical procedures are still a risk factor for hepatitis C infection, active surveillance is required as well as compliance with prevention measures against parenteral transmission. The percentage of patients with jaundice who progress to chronic disease is low and consequently the start of treatment in these patients could be delayed according to their clinical course (AU)

[Acute hepatitis due to hepatitis C virus infection in the adult population]. / Hepatitis aguda por el virus de la hepatitis C en la población adulta.

INTRODUCTION: Knowledge of acute hepatitis C infection (AHC) is important to design effective prevention and treatment strategies. The aim of this study was to determine the clinical and epidemiological features and outcomes of patients diagnosed with AHC. METHODS: A retrospective clinical-epidemiological study was carried out in adult patients diagnosed with AHC between 2000 and 2008 in our hospital. RESULTS: Sixteen patients were diagnosed. The most probable source of transmission was intravenous drug abuse in four patients, a percutaneous injury in three healthcare workers, a medical procedure in three patients and sexual contact in two patients. The source of infection was unknown in four patients. Diagnosis was based on acute clinical symptoms in eight patients, follow-up of healthcare injury in three patients and was fortuitous in five patients. Nine patients showed severe symptoms, while seven patients were asymptomatic or had mild symptoms. The four patients who received treatment were cured. Of the 12 patients that did not receive treatment, the disease became chronic in 58.3%. Progression to chronic disease was more frequent in patients without jaundice than in those with jaundice (85.7% vs 16.7%). CONCLUSIONS: Because medical procedures are still a risk factor for hepatitis C infection, active surveillance is required as well as compliance with prevention measures against parenteral transmission. The percentage of patients with jaundice who progress to chronic disease is low and consequently the start of treatment in these patients could be delayed according to their clinical course.