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R López-Vélez

Publications and source records attributed to R López-Vélez.

At least 19 recordsLinked to original sources
PubMed2004

[Comparative study of infectious diseases in immigrant children from various countries].

INTRODUCTION: Immigrants have a higher risk of contracting some infectious diseases. The aim of this study was to determine and compare the morbidity profile of immigrant children according to their country of origin. MATERIAL AND METHODS: We performed a descriptive study of all immigrants aged less than 14 years old who attended the Tropical Medicine Unit of the Ramon y Cajal Hospital in Madrid between 1989 and 2001. RESULTS: A total of 170 children were included (73 % from Africa, 19 % from Latin America, and 5 % from Asia). Seventy-five percent had at least one infectious disease (78 % of Africans and 62 % of Latin Americans) and 27 % were co-infected (> 2 pathogenic agents). The proportion of healthy children was higher (p < 0.05) among Latin Americans (21 %) than among Africans (9 %). The most frequent infectious diseases were malaria (35 %), intestinal parasites (48 %), filariasis (23 %), and viral hepatitis (19 %). Malaria, filariasis and hepatitis were more frequent in Africans than in Americans (p < 0.05). Other helminthic infections (15 %) were more frequent in Americans. In both groups intestinal parasites and tuberculosis (6 %) were prevalent. Of the 36 (21 %) asymptomatic children, 53 % had at least one infectious disease. The most frequently diagnosed diseases in Africans were intestinal parasitosis (35 %), malaria (7 %), cured hepatitis B (15 %), filariasis (12 %) and superficial mycosis (4 %). The most frequent infectious diseases in Latin Americans were intestinal parasitosis (38 %) and visceral toxocariasis (25 %). CONCLUSIONS: Infectious diseases and co-infections are frequent in immigrant children, even in those who are asymptomatic. We propose screening of certain infectious diseases in these children according to their country of origin and their length of residence in Spain.

Adolescent↗
PubMed2003

Visceral leishmaniasis in those infected with HIV: clinical aspects and other opportunistic infections.

Cases of visceral leishmaniasis (VL) in HIV-positive individuals have been reported from most areas of the world where the geographical distributions of the two infections overlap. The majority of the co-infected cases that have been recorded, however, live around the Mediterranean basin. In these subjects, the length of the incubation period of VL is presumably very short, particularly in those who have severe immunodepression. At diagnosis, almost all cases of VL/HIV co-infection have been found to have fewer than 200 CD4+ cells/microl blood, and about 50% meet the AIDS-defining criteria during their first episode of VL. The clinical manifestations of VL in HIV-infected individuals may be similar to those seen in HIV-negative cases; fever, pancytopenia and hepato-splenomegaly, for example, are found in 75% of all the HIV-positive cases. Following the dissemination of the parasites, however, the HIV-positive cases may develop unusual, multi-organ pathology. Almost all the cases of co-infection are very prone to VL relapses, even after carefully managed antileishmanial treatment. The opportunistic infections that are often seen in HIV-positives frequently develop during VL episodes, the signs and symptoms of the leishmaniasis then confusingly overlapping with those of the other infections.

AIDS-Related Opportunistic Infections↗
PubMed2003

The impact of highly active antiretroviral therapy (HAART) on visceral leishmaniasis in Spanish patients who are co-infected with HIV.

Clinicians in Madrid have been observing and treating HIV-positive patients with visceral leishmaniasis (VL) for over a decade. As their records cover some of the co-infection cases that occurred before and after highly active antiretroviral therapy (HAART) was introduced into Spain, retrospective analysis of the records has allowed some of the effects of HAART on local VL to be determined. Encouragingly, HAART appears to have decreased the annual incidence of VL among local AIDS cases, from 4.81 cases/100 to just 0.8 case/100 (P <0.0005), a first episode of VL now appearing only when there is obvious HAART failure. Unfortunately, it does not seem to be very good at preventing VL relapses; within 24 months of antileishmanial treatment, 70% of patients who were receiving HAART had such relapses. The mean time between antileishmanial treatment and VL relapse was, however, longer when HAART was used than when it was not (20 v. 13 months). In those receiving HAART, relapses of the VL often occurred despite increasing CD4+ cell counts and undetectable HIV loads, indicating that successful treatment of the viral infection is insufficient to prevent the relapse of the leishmaniasis. These results are in general agreement with other observations made in Spain. VL relapses are possible and even frequent in HIV-positives who have no more than 200 CD4+ cells/microl, but secondary prophylaxis to prevent VL relapses may be safely suspended if a CD4+ count of >200 cells/microl can be maintained using HAART. VL also seems to hamper the immunological recovery of the HIV-positive, although HAART appears to have little effect on the clinical manifestations of VL.

AIDS-Related Opportunistic Infections↗
PubMed2003

Infectious diseases in immigrants from the perspective of a tropical medicine referral unit.

Immigrants from less developed countries to Europe are growing in number and could contribute to the emergence of some infectious diseases. To address this issue, we conducted a descriptive study of 988 immigrants, of whom 79.9% were sub-Saharan Africans and 72% were of undocumented origin. Fever, pruritus, eosinophilia, visceromegaly, and anemia were more frequent in Africans, while a cough was more common Latin Americans (P < 0.005). The most frequent diagnoses were previous hepatitis B (46.5%), latent tuberculosis (44.2%), filariasis (24.8%), infection with intestinal helminths (15.4%), malaria (15.1%), infection with intestinal protozoa (10%), hepatitis C (8.8%), other non-parasitic infections (7.8%), active hepatitis B (7.6%), sexually transmitted diseases (7.5%), active tuberculosis (5.8%), and infection with human immunodeficiency virus (HIV) (5.2%). Past and active hepatitis B and C, active tuberculosis, infection with HIV, malaria, and filariasis were more frequent in Africans (P < 0.005). Thirty-two other tropical diseases were also diagnosed.

Adult↗
PubMed2000

Prevalence of hepatitis E antibodies in immigrants from developing countries.

The aim of the present study was to investigate the prevalence of anti-hepatitis E virus (HEV) antibodies among indigenous Spanish blood donors and immigrants from developing countries in order to determine whether immigrants pose a significant risk for the transmission of HEV to the healthy Spanish population. The seroprevalence of HEV was determined in a cohort of 90 asymptomatic immigrants (mostly from countries in sub-Saharan Africa) who had recently arrived in Madrid, Spain, and in 863 blood donors, who represented the healthy Spanish population. The results showed that the prevalence of HEV antibodies was 1.9 times higher in the immigrants than in the blood donors (5.5% in immigrants, 95% CI 1.8-12.4; 2.9% in blood donors, 95% CI 1.9-4.2). Combined with the estimated population figures of 300,000 undocumented immigrants versus 39,000,000 Spaniards, these results indicate that sub-Saharan immigrants cannot currently be considered a major risk source for the transmission of HEV in Spain.

Adolescent↗
PubMed1999

Treatment of visceral leishmaniasis in HIV-infected patients: a randomized trial comparing meglumine antimoniate with amphotericin B. Spanish HIV-Leishmania Study Group.

BACKGROUND: Visceral leishmaniasis is common in patients with HIV infection living in endemic areas, but the most effective and safe treatment remains unknown. OBJECTIVE: To compare the efficacy and safety of meglumine antimoniate versus amphotericin B in HIV-infected patients with first episodes of visceral leishmaniasis (VL). DESIGN: An open, multicentre, prospective and randomized trial. SETTING: Twelve tertiary hospitals. PATIENTS: Eighty-nine consecutive HIV-infected patients diagnosed with VL. Patients were randomly assigned to treatment with either meglumine antimoniate (20 mg pentavalent antimony per kilogram of body weight per day) or amphotericin B (0.7 mg/kg per day) both for 28 days. Treatment was considered successful if a bone marrow aspirate performed 1 month after the end of therapy did not detect parasites. Relapse was defined as the reappearance of parasites after an initial cure. RESULTS: An initial cure was attained in 29 of 44 patients (65.9%) randomly assigned to treatment with meglumine antimoniate and 28 of 45 (62.2%) randomly assigned to treatment with amphotericin B. The incidence of moderate to severe adverse events was similar in both groups. The patients treated with meglumine antimoniate had higher incidences of cardiotoxicity (14 versus 0%, P = 0.02) and chemical pancreatitis (30 versus 0%, P < 0.01). However, in the amphotericin B group, nephrotoxicity was more frequent (36 versus 5%, P < 0.01). There was no difference in survival or relapse-free interval according to the allocated group of therapy. CONCLUSION: Treatment of VL with meglumine antimoniate or amphotericin B was shown to have similar efficacy and toxicity rates in Spanish HIV-infected patients. The differences in the toxicity patterns could be useful in choosing one of these agents as first-line treatment.

AIDS-Related Opportunistic Infections↗