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Respiratory syncytial virus-associated acute respiratory infection (RSV-ARI) constitutes an emerging cause of morbidity in the adult population. The present retrospective study was aimed at identifying factors predictive of poor outcome that may be assessed at the first evaluation in the Emergency Department (ED). We included 275 adult patients with laboratory-confirmed RSV-ARI that required hospital admission from the ED between January 2018 and December 2019. Poor outcome (composite of progression to high-flow oxygen therapy, non-invasive or invasive mechanical ventilation, or intensive care unit admission, and/or 30-day all-cause mortality) occurred in 31 patients (11.2%). Immunosuppression was present in 59 patients (21.5%). Although bacterial co-infection was rare, antibiotic therapy was commonly initiated. Ribavirin was administered in 10 patients. Cognitive impairment (odds ratio [OR]: 2.452; 95% confidence interval [CI]: 0.990-6.072), concurrent oral anticoagulation (OR: 3.099; 95 CI: 1.287-7.464) and a pulse oximetry oxygen saturation to fraction of inspired oxygen ratio (SpO 2 /FiO 2 ) ratio <382 at ED admission (OR: 3.013; 95 CI: 1.306-6.950) were independent risk factors for poor outcome, whereas influenza vaccination in the current season was protective (OR: 0.324; 95% CI: 0.138-0.763). Various factors easily available at the ED are useful for early risk stratification in adult patients with RSV-ARI., (© 2024 Wiley Periodicals LLC.)

Objective: There is a high rate of occult infection and late diagnosis in HIV. Hospital emergency departments (ED) are an important point of health care. The present work aims to know the number of missed opportunities for HIV diagnosis occurring in the ED., Method: Retrospective multicenter cohort study that included all patients diagnosed with HIV infection in 2019 in 27 Spanish hospitals in 7 different autonomous communities. All ED consultation episodes in the 5 years prior to diagnosis were reviewed to find out the reason for consultation and whether this represented a missed opportunity for HIV diagnosis., Result: Seven hundred twenty-three patients were included, and 352 (48.7%, 95%CI: 45.1%-52.3%) had at least one ED visit during the 5 years prior to diagnosis (median 2, p25-p75: 1-4). One hundred and eighteen patients (16.3%, 95%CI: 13.8%-19.2%) had a missed diagnostic opportunity. The main consultations were drug use [145 (15%)], sexually transmitted infections [91 (9.4%)] and request for post-exposure HIV prophylaxis [39 (4%)]. One hundred and fifty-five (42.9%) of the 352 had less than 350 CD4/mm 3 when the HIV diagnosis was established. In patients with previous ED visits, the mean time to diagnosis from this visit was 580 (SD 647) days., Conclusions: Sixteen percent of patients diagnosed with HIV missed the opportunity to be diagnosed in the 5 years prior to diagnosis, highlighting the need to implement ED screening measures different from current ones to improve these outcomes., (Copyright © 2022 Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. Published by Elsevier España, S.L.U. All rights reserved.)

Objective: To determine the predictive factors of pulmonary thromboembolic (PTE) in patients with SARS-CoV-2 infection (COVID-19) assessed in the emergency department at a tertiary hospital during the first pandemic wave., Methods: Observational single-center study conducted in a retrospective cohort of patients with confirmed SARS-CoV-2 infection (or high clinical-radiological suspicion) who underwent PTE screening by computed tomography pulmonary angiography (CTPA). Predictive factors of PTE were explored using logistic regression, creating two predictive models (without or with D-dimer values)., Results: Out of a total of 274 CTPA performed, 70 procedures presented diagnostic findings of PTE, representing a cumulative incidence of 25.54% (95% confidence interval [CI]: 20.49-31.14). In the non-D-dimer based model, respiratory rate >22 bpm (odds ratio [OR]: 3.162; 95% CI: 1.627-6.148; p = 0.001) and the absence of findings suggestive of COVID-19 in plain chest X-ray (OR: 3.869; 95% CI: 0.869-17.225; p = 0.076) were predictors of PTE. In the D-dimer-based model, tachypnea remained as a predictive factor (OR: 4.967; 95% CI: 2.053-12.018; p < 0.001), as well as D-dimers > 3000 ng/mL (OR: 7.494; 95% CI: 3.038-18.485; p < 0.001)., Conclusions: The presence of tachypnea (>22 bpm) and the absence of radiological findings suggestive of SARS-CoV-2 infection in the chest X-ray, in addition to D-dimer values >3000 ng/mL, were identified as predictive factors of PTE in patients with COVID-19., (© 2021 Elsevier España, S.L.U. All rights reserved.)

Background: The aim of this study is to determine the current status of Spanish Hospital Emergency Services (HES) in diagnosing and treating the most prevalent tropical diseases (TD) in Spain., Methods: A cross-sectional descriptive study was carried out, using a questionnaire in Google Forms® sent to members of the INFURG-SEMES group. The following variables were analyzed: the size of the hospital in terms of number of beds, number of tropical disease emergencies, existence of tropical medicine protocols, urgent diagnostic tests or antimalarial treatment., Results: The form was sent to 75 hospitals. Responses were obtained from 42 emergency services (55%) in 10 Autonomous Communities. Twenty-four (57.1%) had >500 beds. Only five hospitals (11.9%) have the facilities to diagnose malaria and dengue 24 hours a day. There was no tropical disease protocol in 19 (45.3%) hospitals. Seven (16.7%) hospitals had =?10 attendances/day. Larger hospitals were more likely to have an infectious disease unit independent from Internal Medicine service, along with a tropical medicine unit, and an on-call infectious disease specialist and microbiologist. There are no statistically significant differences between larger and smaller hospitals in terms of their capacity to carry out appropri-ate diagnoses or treatments in 24 hours., Conclusion: Care and treatment of emerging diseases are now a sizeable percentage of the consultations at an HES. Such units generally lack specific protocols, particularly for malaria. Urgent diagnostic testing for malaria is also needed.

The increase in international travel, the growing presence of arbovirus vectors in our country, and notifications of haemorrhagic fever such as the current outbreak of Ebola in D.R. Congo and the cases of Crimea-Congo haemorrhagic fever in our country have again cast the spotlight on tropical diseases Isolating suspected cases of highly contagious and lethal diseases must be a priority (Haemorrhagic fever, MERS-CoV). Assessing the patient, taking a careful medical history based on epidemiological aspects of the area of origin, activities they have carried out, their length of stay in the area and the onset of symptoms, will eventually help us, if not to make a definitive diagnosis, at least to exclude diseases that pose a threat to these patients. Malaria should be ruled out because of its frequency, without forgetting other common causes of fever familiar to emergency doctors., (Copyright © 2019 Elsevier España, S.L.U. All rights reserved.)

Background: Cutaneous larva migrans may be diagnosed by the typical clinical presentation, consisting on a pruritic serpiginous lesion that advances in a patient with a history of sunbathing, walking barefoot on the beach, or similar activity in a tropical location., Case Presentation: We describe the case of a Mediterranean 32-year-old man, recently returned from a trip to a Brazilian beach, which presented with a 2-week history of pruritic cutaneous lesions that had not resolved after treatment with oral antihistamines and topical fluocinolone ointment. Physical examination showed a serpiginous, erythematous and slightly elevated lesion of 2-mm wide and 7-cm long located on the posterior aspect of his left knee. Patient affirmed that the lesion advanced progressively. Laboratory analyses only revealed an elevated absolute eosinophil count. Albendazole 400 mg/d 3 days was administered to the patient with complete resolution of symptoms within 1 week., Conclusion: Cutaneous larva migrans is common among travelers returning from tropical countries. We review epidemiology, clinical, diagnosis and therapeutic options of cutaneous larva migrans.