Admissions for imported and non-imported parasitic diseases at a General Hospital in Spain: A retrospective analysis.

OBJECTIVE: To analyze imported and non-imported parasitic diseases as a cause of admission to a general hospital. METHODS: A retrospective analysis of hospital admissions for parasitic diseases between 2004 and 2013 performed by means of hospital information systems at a public hospital in the city of Castellón (Spain). RESULTS: During the period covered in this study, there were 204,349 admissions, 213 of which were for parasitic diseases (prevalence: 1.04/1000 admission). 129 were neglected parasitic tropical diseases and 61 were imported parasitic diseases. The main parasitic diseases were hydatidosis (24.9%), visceral leishmaniasis (22.5%) and malaria (12.2%). There was a decrease in admissions for visceral leishmaniasis in the 2004-2008 period from 27.7% to 15.9% in the 2009-2013 period (p < 0.001), and an increase in admissions for malaria from 5.0% to 21.3% (p < 0.001). 38 (20.3%) of the 187 patients with parasitic diseases were HIV infected. HIV infection was more common in patients with toxoplasmosis (94.1%; p < 0.001), cryptosporidiosis (66.7%; p < 0.02) and visceral leishmaniasis (46.4%; p = 0.003). There were 34 (18.2%) children with parasitic diseases. Twelve of the 28 patients with visceral leishmaniasis (42.9%; p < 0.001), and 11 of the 17 patients with soil-transmitted diseases were children (64.7%; p < 0.001). The cause of death in eight patients was parasitic disease related (mortality rate: 4.3%). The mortality rate for visceral leishmaniasis was significantly higher (14.3%; p = 0.01). CONCLUSION: The main cause is endemic parasitic diseases such as hydatidosis. Visceral leishmaniasis decreased during the period covered by the study, but malaria increased.

Respuesta de los autores: Nocardiosis cutánea primaria por Nocardia brasiliensis en España / Author’s reply: Primary nocardiosis by Nocardia brasiliensis in Spain

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[Predictors of progression and death in patients with advanced HIV infection in the era of highly active antiretroviral therapy]. / Predictores de progresión y muerte en pacientes con infección avanzada por el VIH en la era de los tratamientos antirretrovirales de gran actividad.

INTRODUCTION: To assess the factors associated with progression of infection and death in HIV-positive patients with severe immunodepression in the era of highly active antiretroviral therapy (HAART). METHODS: We studied 146 HIV-infected patients with < 100 x 10(6)/L CD4+ lymphocytes and positive cytomegalovirus (CMV) serology enrolled between December 1997 and October 1998 and prospectively followed a median of 12.1 months. The main outcome measures were progression of HIV infection, defined as the appearance of a new AIDS-defining disease (CDC category C) or death. HIV viral load, lymphocyte count (CD4+ and CD8+), HAART administration and other clinical variables were evaluated at baseline. CMV viremia (determined by PCR) and HAART efficacy were recorded during follow-up. RESULTS: Progression was observed in 40% of patients and 17% died. Factors associated with progression or death were CD4+ lymphocyte count less than 50 x 10(6)/L, CD8+ lymphocyte count less than 500 x 10(6)/L, HIV viral load more than 300,000 copies RNA/mL, CMV viremia, and absence or inefficacy of HAART. In the multivariate model, absence of HAART and low CD4+ and CD8+ counts remained statistically associated with progression, but the only variable associated with death was CMV viremia. CONCLUSIONS: In patients with advanced HIV infection, CD4+ and CD8+ cell count and HAART were the most important factors related to progression, and CMV viremia was the strongest predictor of death.

Endocarditis por micrococcus luteus / Endocarditis due to Micrococcus luteus

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