We are the combination of four hospitals: the General Hospital, the Children’s Hospital, the Women’s Hospital and the Traumatology, Rehabilitation and Burns Hospital. We are part of the Vall d’Hebron Barcelona Hospital Campus: a world-leading health park where healthcare plays a crucial role.
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Infectious endocarditis involves the presence of a microbial infection in the endocardial surface (internal surface of the heart). It is the most frequent cardiovascular infection and it is very important because of its potential severity and its different forms of presentation.
Infectious endocarditis mainly affects cardiac valves, whether natural or artificial, although sometimes it can occur in other structures of the heart.
It is classified according to the time the infection has been established (days, weeks or months) and according to the bacteria or microorganism (yeast, fungus) that causes it.
The characteristic lesion of infectious endocarditis is endocardial vegetation. It is made up of the completely abnormal presence of an aggregate of platelets, fibrin, bacteria and inflammatory cells that adhere to the internal surface of the heart, usually on the surface of a cardiac valve, and which is susceptible to breaking off, causing an infectious embolism at a distance in another organ (skin, nervous system, limb).
It is considered a serious illness and although in most cases it is cured, it also has significant complications and mortality despite treatment. In many cases, patients must be subjected to surgical intervention in order for it to be definitively cured, eliminating the affected tissue and inserting a new artificial heart valve.
In its most acute form infectious endocarditis can produce high fever, chills, prostration and severally affect the patient's general condition in a short time period (hours-days). In subacute forms it may evolve over weeks or months, with a clinical presentation of tiredness, lack of appetite and low-grade fever. In these cases, infectious skin manifestations may also occur as nodules or characteristic spots, which do not always appear.
In patients with severe cardiac valve involvement, the valves themselves may not function correctly, which may result in symptoms of heart failure such as severe shortness of breath and swelling of the lower limbs
Infectious endocarditis has a global incidence of 2-3 cases per 100,000 population per year, and so it is estimated that in Catalonia around 200 cases are diagnosed every year. Its incidence increases greatly with age, reaching 15-30 cases/per 100,000 population/year in over 65s, or 10 times higher than that of the younger population.
The cause of infectious endocarditis has changed a lot in recent decades. In recent years the most frequent causal bacterium has been streptococcus, especially a species called viridans. There is currently a great variety of causal agents, although staphylococci are the most frequent, followed by streptococci and enterococci. It is, however, advisable to note that any microorganism that circulates through the blood can adhere to a heart valve, especially if it has previous injuries or is an artificial valve.
The diagnosis of endocarditis is based essentially on:
- blood cultures to identify the bacterium that causes the infection and allow the most suitable specific antibiotic treatment to be chosen.
- echocardiogram that allows the endocardial vegetations typical of the disease to be located. It also informs doctors about the function of the valve affected and contributes significantly to assessing the need for surgical treatment in some patients.
- in some cases it is necessary to carry out other explorations (such as CAT or scintigraphy) to rule out the existence of peripheral embolisms, which are very common at the time of diagnosis or during the course of treatment of the disease.
The treatment of infectious endocarditis is antibiotic, but specifically targeting the microorganism that causes it. The doses are high and prolonged over time because the vegetations typical of the disease are not very vascularised and antibiotics must penetrate through diffusion from circulating blood. In patients who do not respond adequately to this antibiotic treatment or who have major valve damage as a consequence of the infection, it is necessary to assess the need for valve replacement surgery.
Blood cultures and echocardiogram, both at the time of diagnosis and to monitor the evolution of the illness.
When an alteration of a person's heart valve is recognised, antibiotic prevention must be administered before any dental or gum treatment is given, following specialised consultation.
Preventive measures must also be taken in the case of endoscopes, especially of the upper gastrointestinal tract (gastroscopy), with the antibiotic and guidelines indicated by the doctor.
This prevention is very important because the presence of bacteria in the blood, as a result of the intervention or exploration, carries a significant risk of infectious endocarditis.
The Drassanes Vall d'Hebron Centre for International Health and Infectious Diseases is a clinic specialising in communicable diseases.
How to get there
Located in the heart of Barcelona, the Centre for International Health and Infectious Diseases of Drassanes- Vall d’Hebron, integrates different types of services that collaborate; pioneering the healthcare structure within the Catalan Institute of Health (ICS).
The department is divided into different units: sexually transmitted infections, tuberculosis, international health and travel medicine, community health, transcultural psychiatry, and the microbiology laboratory that aids all the units. Prevention, rapid diagnosis, and early treatment are key features of the Drassanes- Vall d’Hebron Center for International Health and Communicable Diseases, where administrative staff, nursing staff, community health agents, and medical staff from the pulmonology, paediatrics, infectious diseases, psychiatry, and microbiology department work together to provide the best care.
Professionals work with culturally competent care, adapted to each patient, guaranteeing compliance with visits and adherence to treatment. The centre supports care and teaching for Primary Care and other hospitals promoting multidisciplinary innovation and research programs both in its own and other multicentre (nationally and internationally), collaborating in a network with third-sector entities.
For any questions or queries, please email: ccee.drassanes@vallhebron.cat
This unit treats all patients who present with symptoms compatible with a sexually transmitted infection (STI), those who have had contact with an STI, or those who want to be screened.
An immediate care consultation can be requested by appointment, where a quick diagnosis and specific treatment are provided (most of the time administered in the same centre during the visit), and specialised advice to provide prevention according to sexual habits. This program is also known as the Drassanes Exprés.
The unit also provides pre-exposure prophylaxis (PrEP). PrEP consists of a program for comprehensive sexuality care aimed at people vulnerable to contracting HIV based on the administration of antiretroviral medication.
The centre also specialises in rapid diagnosis, personalized treatment, and prevention of tuberculosis. In any person with long-standing respiratory symptoms, this disease must be ruled out. The risk factors include alcoholism, drug addiction, economic difficulties, and homelessness, all increasing the risk of suffering from tuberculosis.
The professionals in this area are dedicated to the care of patients with suspected or confirmed diagnoses of tuberculosis, especially with pulmonary involvement, as well as monitor them throughout their therapy until the patient is in remission. The centre also works with individuals who have been in contact with an active case of the disease, informing them of proper treatments and preventative measures.
In the case of migrants from other countries with high incidence or high social vulnerability, early detection and treatment of a latent tuberculosis infection as well as an active tuberculosis case is offered in coordination with other agencies, including the Barcelona Public Health Agency. The Vall d’Hebron- Drassanes Tuberculosis Unit is a leader in its research and is currently collaborating with other centres. It is the reference point for Clinical units by the Primary Care department in the city of Barcelona.
This unit specialises in the prevention, early diagnosis, and treatment of any individual, whether traveller or migrant, before their trip or upon coming back if they present any symptoms or have some clinical suspicion of an infectious pathology related to their trip. To offer the best, fastest, response, we coordinate closely with the other units in the centre. This unit is part of the Health Program for International Health of the Catalan Institute of Health, as an assistant program.
A personalized consultation includes the administration of vaccines, preventative measures for malaria, and a review of the different risks of the patient’s trip to preserve their full health. You can schedule an appointment online, by calling, or in person. It is recommended that you schedule an appointment at least one month before your trip. This service has been partially subsidized by CatSalud. In the case of children under 5 years of age, the service is free, except when the patient exhibits yellow fever, in which an additional fee is involved.
The team of Public and Community Health at Drassanes-Vall d’Hebron Hospital works in the field of international health and immigration, especially with vulnerable groups, in an integrated manner with different hospital services, in connection with other primary care teams including Public health institutions and civil society entities for more comprehensive and equitable care. The team has expert health personnel specialized in public and community health, including agents from different cultures.
We carry out the following actions:
The Paediatric Infectious Pathology and Immunodeficiency Unit is responsible for caring for the entire paediatric population that requires it in any of the institution’s areas of specialization. That is, international health and travel medicine, diagnosis, prevention and treatment of tuberculosis, and more recently, sexually transmitted infections, including preventative measures such as PrEP and HPV vaccination. In many cases, the care of this population requires coordination of care with professionals who care for other adult family members in the same centre.
The current trend, followed by most countries that have experienced an evolution towards multiculturalism, is to create programs of transcultural psychiatry referencing current frameworks from existing psychiatric services. The HUVH Transcultural Psychiatry Program (PPT) stems from an initiative supported by the Catalan Institute of Health and the Department of Health of the Generalitat of Catalonia. This program aims to offer mental health care services of the same quality to all patients, regardless of their ethnic or cultural origin. In 2014, the Transcultural Psychiatry Program began to collaborate with PROSICS, which resulted in the addition of the unit to the Tropical Medicine and International Health Unit of Drassanes-Vall d’Hebron.
PPT professionals offer psychiatric and psychological care, on a supra-sector basis, to all people in the community who, due to their cultural characteristics, cannot be adequately cared for in their reference mental health centers and offer additional support to programs in Cataluña that do not have those resources.
The centre has a Microbiology laboratory, an extension of the current lab at the University Hospital of Vall d’Hebron, that consists of different workspaces and is perfectly equipped with cutting-edge technology. Its location and organization model allows for quick diagnosis of the main diseases treated at the centre, creating fluid communication between professionals and clinical units. This differential feature has a direct impact on the efficiency of patient care and therefore improves it overall.
Thanks to their experience, they are referent in highly complex parasitological diagnoses. Additionally, the laboratory coordinates the rapid diagnosis program for sexually transmitted diseases in the asymptomatic high-risk population known as the Drassanes Express and the international primary health care working group for the city of Barcelona.
For any emergency, schedule an appointment or email us at ccee.drassanes@vallhebron.cat or call 934 894 408
Meningococcal disease (meningitis) is a serious infectious illness caused by a bacterium called “meningococcus”, which is transmitted through pharyngeal and nasal secretions.
The risk of contracting meningitis increases if you come into close contact with someone who has it (if you sleep in the same room, live in the same house, kiss on the cheek, etc.), but there is no need to disinfect objects or areas because meningococcus bacteria do not live long outside of the human body.
The measures to prevent this illness are:
With meningitis, the appropriate measure is to administer antibiotics to the family and other people who live with the affected person.
If the illness was caused by meningococcal group B, the only preventive measure, and the most common in Spain, is chemoprophylaxis, which aims to eliminate the microorganism from the pharynx. This stops it from spreading, in the space of a few days, between the people who have taken the medication.
If the illness was caused by meningococcal group C, as well as administering chemoprophylaxis, people close to the affected person will be vaccinated if they have not already been so.
If there is evidence that someone has had intimate contact with the patient in the ten days prior to the occurrence of the disease and they have not been administered chemoprophylaxis, healthcare staff must be informed.
The only way of effectively curing tuberculosis and preventing others from catching it is through treatment based on combining different antibiotics for a minimum of six months. The symptoms of tuberculosis often disappear quickly, but the disease may come back if medication is not taken correctly and for the time indicated.
Currently, tuberculosis (TB) drugs are safe and effective, and the majority of people take them without any problems. In some cases side effects may appear, so it is important to follow the treatment plan under supervision and see a doctor in case of doubt.
Once treatment begins, and to make sure it has the desired result, follow the instructions below:
Urine, faeces, sweat and tears may be red/orange in colour. This change is normal and will disappear when the treatment comes to an end.
CDC - Preguntes i respostes sobre la tuberculosis
Educating patients with resistant osteoarticular infections is key to avoiding contamination of utensils and possible complications resulting from the infection. Healthcare professionals will therefore emphasise the importance of hygiene in the infected area and will give instructions on dressing the area (if required) and on taking medication correctly for the duration prescribed.
When the patient is discharged, nursing staff will give them all the support and information they need to be able to look after the wound themselves. Most patients will be fitted with an external fixator that needs daily care, so healthcare staff will emphasise the importance of hygiene in the affected area, which should be cleaned daily and the correct dressing applied.
If patients are not independent and do not have a relative or carer to look after them, the local health authority will be contacted (through the PREALT discharge preparation unit), so that they may be provided with nursing care. If patients are being treated with intravenous medication, the Hospital at Home Unit will be contacted to follow up and provide the relevant treatment.
It is also necessary to explain the importance of taking the medication prescribed. On being discharged, most patients will receive long-term oral antibiotics (prescribed by the Infectious Diseases Unit) and they are reminded of the importance of maintaining a fixed schedule and not forgetting to take their medication.
They are also reminded of the need to maintain healthy habits, such as:
Currently, Zika virus mainly affects some countries in Latin America. In order to avoid the risk of being infected, therefore, we advise travellers not to visit those countries during pregnancy. As there is still no vaccine to prevent the virus, prevention measures are fundamental to avoiding infection.
The advice to prevent infection with Zika virus is particularly aimed at pregnant women or those thinking of becoming pregnant in the short to medium term. The possibility of transmitting the infection to the foetus means that pregnant women are the most vulnerable group. For this reason, you are advised to:
Another way of preventing mosquito bites is to avoid proliferation of mosquitoes, which you can do by finding out and periodically checking the areas where these insects reproduce. Once breeding points are located, the measures should focus, as appropriate, on:
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