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People with chronic Chagas disease should maintain regular medical follow-ups, recognize warning signs, maintain a healthy lifestyle, follow medical advice, and participate in peer education. These measures help prevent complications, manage psychological stress, and improve quality of life.
Chagas disease is an infectious, usually chronic, tropical disease caused by the parasite Trypanosoma cruzi. People can become infected through the faeces of an infected insect, a triatomine, also known as conenose bugs, kissing bugs, assassin bugs or vampire bugs, depending on the country.
It can also be transmitted in other ways:
Transmission caused by the insect only takes places in Central and South America, but the other ways, due to the migratory movements of infected people, may occur in other corners of the planet. The illness can be prevented.
Although Chagas disease affects between eight and ten million people around the world, today it is not very well known. According to the World Health Organization, it is one of 17 forgotten and neglected diseases.
In somewhere like Spain this illness has different health education needs than in countries where it is endemic. Familiarity, awareness, removing stigmas and visibility of the illness are therefore essential instruments in health education about Chagas disease.
It is calculated that currently less than 10% of infected people know that they have the disease.
Who can be infected?
How do you know if you are infected?
What do you need to do?
Chagas disease is characterised, first of all, by an acute phase during which treatment is effective, and it can be cured. In most cases, however, it evolves to become a chronic disease and, as such, requires control and monitoring for life.
More than half of infected people show no symptoms, but three out of ten will suffer heart problems and one in every ten digestive problems (years after having contracted the infection). In these cases, the process is initially asymptomatic, so that without sufficient treatment or monitoring the illness could manifest itself suddenly and cause irreversible damage or even sudden death.
What effects does the disease have?
What are the warning signs?
Chagas disease is often accompanied by emotions and feelings of guilt, impotence and fear. Questions such as: “Why me?”, “What do I do now?” and “Does Chagas mean I’m going to die?” are common in people who have been diagnosed.
What do you need to know?
There are no drugs (vaccinations or medicine) to prevent Chagas disease. People without the disease are at risk of becoming infected and people who are already affected are at risk of being re-infected.
The preventive measure we have is education.
Chagas disease has psychological, social and cultural characteristics and determinants for the people affected, their families and society. In fact, a diagnosis of Chagas disease can have significant repercussions from a psychological and social point of view.
Often, the people affected do not want to know if they are affected or not for fear of the disease and its imagined consequences: often these are based on popular beliefs and/or previous experience with relatives, friends or acquaintances who have died in an unfavourable social environment. Sometimes, they hide the disease for fear of being excluded at work.
Syphilis is a sexually transmitted infection caused by a bacterium called T. pallidum. It can have very serious complications if left untreated, but, fortunately, it is easily cured with the right treatment.
You can catch it by having unprotected oral, vaginal, and/or anal sex with someone who has syphilis. In pregnant women, it can be transmitted to the baby through the placenta.
Syphilis manifests in different stages.
In the first stage, a chancre (an ulcerated lesion that is painless and thus can go unnoticed) appears in the area of first contact with the bacterium, such as the mouth, penis, vulva/vagina, or anus/rectum.
If not treated, it will progress to the second stage, known as secondary syphilis. At this stage, skin lesions are the most common sign, with erythematous lesions that affect the palms of the hands and the soles of the feet. However, it can cause many other symptoms, such as fatigue, sore throat, and even eye problems.
If left untreated, the infection can enter a latent period that can last for years, in which there are no symptoms and the only way to diagnose it is by doing a blood test.
The latent stage of syphilis has two phases: the early stage, during the first year, and the late stage, which occurs after a year of being infected. Long-term, 20 to 40 years later, a certain percentage of patients will exhibit neurological symptoms (cognitive impairment or neuropathic pain in the lower extremities) or heart issues (aneurysm). However, if these patients receive treatment with the right antibiotics, the syphilis infection can be cured at any stage. Nowadays, it is very rare for this disease to reach late stages.
In pregnant women, it can be transmitted to the foetus, which can trigger a miscarriage or a serious disease like congenital syphilis in the newborn. Thus, every pregnant woman should be screened for syphilis and treated if the test comes up positive.
The diagnosis is often done with a blood test, which looks for the antibodies generated in response to the infection. If there is a lesion, direct tests can be carried out on it to detect the presence of the bacteria.
The treatment of choice is still the intramuscular injection of penicillin. The number of injections required can vary depending on the stage of the disease, ranging from a single injection to three (one per week). If there are symptoms, the patient may run a fever during the first 24 hours following the injection.
The treatment is considered a definitive cure, but follow-up blood tests should be done periodically to confirm that the infection is gone.
Even though antibodies can be detected in the blood after treatment, if the individual comes into contact with T. pallidum again, they can be reinfected and experience a new bout of the disease.
If you are diagnosed with syphilis, you need to notify the people you have had sexual contact with in the past months. The number of months will depend on the stage the disease is in when it is diagnosed. If it is diagnosed during the first stage, you should contact the people you have had sexual relations with in the past 3 months. If this diagnosis occurs during the second stage, this time frame needs to be extended to 6 months.
Gonorrhoea is one of the most common sexually transmitted infections worldwide. Detection and treatment of this disease is carried out by an expert medical team.
Gonorrhoea is a curable infection caused by a bacteria that is transmitted from person to person via sexual contact, whether this involves the genitals, anus, or mouth. Depending on the sexual practices engaged in, the infection can also be located in the anus and the throat.
In many cases, gonorrhoea causes no symptoms.
In men, it produces a burning sensation and discharge from the urethra a few days after the infection is transmitted; it can also lead to complications and affect the testicles.
In women it can cause:
In women, gonorrhoea can lead to complications and affect the fallopian tubes and the pelvis area, possibly causing infertility. Other complications are uncommon.
A newborn baby can also acquire the infection if a pregnant woman has gonorrhoea and does not receive the proper prophylaxis. To avoid this, a preventative treatment is applied at the time of the birth.
Gonorrhoea affects people who have unprotected sex (without a condom) with someone who has this sexually transmitted disease.
To make a diagnosis, samples of the genital secretions must be collected using a swab and sent to a lab to carry out tests that can confirm the infection. To diagnose the infection in the throat or anus, samples must be taken from these areas.
The typical treatment consists of administering a single dose of an antibiotic derived from penicillin via a gluteal injection, if there are no allergies or other contraindications.
Sexual partners should also be evaluated and treated as needed, even if they do not have any symptoms.
To prevent gonorrhoea, you must use a condom when you have sexual relations with someone who is not a stable, healthy partner.
Human immunodeficiency virus (HIV) is a retrovirus, made up of two copies of single-chain RNA enclosed within a capsid.
It is transmitted by blood and genital secretions (unprotected sex) and from mother to foetus during pregnancy or birth or through breast-feeding (where the mother does not have her infection controlled).
HIV infects a particular type of the body’s defences, CD4+ lymphocytes. It reduces the number of its host's lymphocytes, thereby increasing the latter’s risk of suffering certain infections from micro-organisms (bacteria, viruses, fungi and parasites) that normally do not cause problems when the immune system is working correctly; these are known as opportunistic infections. In addition, the virus infects the body’s other cells and remains in a latent state in areas such as lymphatic ganglia and intestinal mucus. This latent virus is known as a viral reservoir and is one of the main obstacles to curing this infection.
HIV is NOT transmitted through other channels, such as objects, insects or physical contact without sharing blood or secretions. HIV can be prevented by using condoms during sex and by not sharing any materials that may contain infected blood.
Acquired immunodeficiency syndrome (AIDS) is diagnosed where the number of CD4+ lymphocytes drop below 200/μl or one of the syndrome's defining diseases (infections or neoplasia) appears. It is for this reason, and for the sake of preventing new infections, that early diagnosis of the infection is very important. Anyone who has been in a risk situation should be tested for HIV (and other STDs), irrespective of the presence or absence of symptoms. Having any other STD raises the risk of acquiring and transmitting HIV.
Acute infection with HIV can manifest itself non-specifically, like any other viral infection such as the flu (fever, general malaise, skin rash, swollen lymph glands, pain in the joints or in swallowing, fatigue etc.,) or may be completely asymptomatic.
Once the infection has become chronic, a variable period of time passes during which patients may be completely without symptoms but can transmit their infection. As the (CD4+) defences drop, clinical symptoms may appear with the associated pathologies, whether infections or neoplasias, which can affect several organs/systems.
Anyone who is sexually active runs the risk of being infected by HIV if they do not know the state of health of the person they are having sexual relations with and do not take the following precautions: use of condoms or pre-exposure prophylaxis (PrEP: taking a combination of two anti-retroviral medicines without being infected with HIV, to prevent such infection in the event of coming into contact with the virus). Fortunately, the risk of transmission through other channels, such as blood or mother to foetus, has dropped significantly in our environment, thanks to harm-reduction and HIV-screening programmes for pregnant women and blood and organ donors, among other measures.
HIV is diagnosed in the laboratory by detecting antibodies the patient creates against the virus (but which are not used for neutralising the virus and curing the infection and which remain positive for life as a marker of the infection) and the direct detection of parts of HIV, whether the virus’ antigens or by determining the number if HIV particles that are circulating through the bloody (viral load). Note that there is a period of time between the virus’ entry into the body and the detection of these antigens/antibodies during which all tests are negative, known as the window period. Today’s new techniques have reduced this period to 2-3 weeks after infection.
The recommendation these days is for all patients infected with HIV to start anti-retroviral treatment irrespective of the number of CD4+ lymphocytes or viral load. The only exception would be elite controllers, that is, people whose viral load remains undetectable without treatment. For all other infected individuals, treatment is started with patients as soon as they are ready to receive it and have the necessary information for choosing the best option possible in each case. An effective treatment makes the viral load undetectable, although it does not eliminate HIV from the body. The immune system can therefore remain intact/recover, reducing the possibility of new infections. In fact, when the virus is undetectable in the blood thanks to this anti-retroviral treatment, the infection is not transmitted to other people (undetectable=untransmittable).
There are various families of medicines that act at several points in the HIV life cycle, halting its replication within the body. So we now have analogue and non-analogue nucleoside reverse transcriptase inhibitors, integrase inhibitors, protease inhibitors and entry inhibitors.
Anti-retroviral treatment is currently administered in pills or in the form of long-acting injectable medicines. Standard treatment involves a combination of 2 or 3 different medicines, which can often be combined in two pills or a single tablet. Today's anti-retroviral treatment is for life, given that, if patients stop their treatment, their latent HIV reservoir will re-activate and replicate. Depending on the drugs patients are taking, the possibility of interactions with any other medications they may receive needs to be monitored and a follow-up analysis or specific explorations may be necessary for certain drugs.
Today, HIV infection has become a chronic illness and, with the current treatment, people diagnosed with it now have a life expectancy similar to that of the general population. If someone infected with HIV performs their controls correctly and takes their anti-retroviral medication they can lead a completely normal life, and that includes having children without transmitting their infection to them. Routine visits are made to monitor the infection, usually every 3 to 6 months, during which the number of defence cells (CD4+ lymphocytes) and viral load are measured.
That analysis also measures other parameters to monitor any other pathologies which patients may have (blood count, renal function, liver function, lipids). In addition, a series of specific complementary explorations may also be performed, such as early detection of STDs, screening certain neoplasias (cervix, anus), osseous pathology and so on. People living with HIV can also be given advice on certain preventive measures, such as taking vaccinations against influenza and invasive pneumococcal disease.
The inflammation that the virus’ replication in the body causes also increases the risk of suffering diseases we find in the general population, such as cardiovascular, liver, renal and neurological pathologies and certain cancers, which may appear more severely or at younger ages. That is why it is very important for people living with HIV to control conventional risk factors and adopt healthy life habits.
As an STD, HIV infection can be better treated through early detection and prevented through the use of barrier methods during sex, basically male or female condoms. As mentioned above, the last few years have seen studies on the use of PrEPs as a prevention strategy. This strategy has proven to be highly effective in preventing HIV infection, although it has the disadvantage, unlike using condoms, that it does not protect users from other kinds of STDs.
A person who has been exposed to HIV can also undergo post-exposure prophylaxis (PEP), which involves being administered 3 anti-retroviral drugs for 28 days, although this will have to start within the first 72 hours after exposure to the virus.
A urinary tract infection is the presence of bacteria in the urinary tract, which is normally sterile. It can affect the lower urinary tract (bladder or urethra) or the kidneys, known as pyelonephritis. Common symptoms include pain during urination, frequent urination, or fever. Treatment usually involves antibiotics.
Infections of the lower urinary tract are characterised by localised pain, which increases when urinating, and sometimes by cloudy or dark urine, usually without high temperatures.
Kidney infections (pyelonephritis) are characterised by high temperatures, acute local pain in the lower back, and pain or irritation when urinating.
Urinary tract infection is characterised by the presence of local pain (lower abdomen or lumbar region), which increases when urinating. The urine is often cloudy, or dark if it contains blood. There may be high fever, especially in the case of pyelonephritis (an infection of the upper urinary tract).
It can affect people at any age, from early childhood to old age. It is more frequent among women and there are factors that make people vulnerable to it (pregnancy for women and enlarged prostate for men) as well as urological anomalies (pre-existing malformation or presence of kidney stones).
Urinary infections are diagnosed by examining urine under the microscope (sediment) to see whether it contains white blood cells and/or bacteria, and by cultivating the bacteria in a microbiological culture to identify the strain and determine the most appropriate antibiotic for treatment (antibiotic susceptibility testing).
Urinary tract infections are usually treated with antibiotics. Treatment is oral in the case of lower-tract infection.
For upper-tract infections (pyelonephritis) it is usually intravenous, although in some cases outpatient oral treatment may be administered.
The standard tests are urine sediment and culture (urine culture with antibiotic susceptibility testing). An ultrasound scan may be indicated for examining the kidney and urinary tract and identifying obstructions or kidney stones that may have brought about the infection.
Ultrasounds are also used to assess the state of the kidneys. A general analysis may also be indicated to see how the urinary tract infection is affecting the rest of the body, and specifically the renal function.
Urinary tract infection can be prevented by frequent urination (every 2 to 3 hours) and, above all, by avoiding the habit of holding in urine, and by going to the toilet whenever the bladder feels full, without waiting too long.
Pneumonia is an infection of the lung tissue. It can be caused by many different microorganisms, although the most common causes are S. pneumoniae (pneumococcus) and Mycoplasma. Other microorganisms that can also cause pneumonia include Haemophilus, Klebsiella, Staphylococcus aureus, Legionella pneumophila, Chlamydia pneumoniae and some viruses.
Characterised by high fever, coughing, with or without sputum, and often chest pain, which may increase with respiratory movements. Sometimes, sputum has a brownish or rusty appearance, which points to pneumonia caused by pneumococcus.
The so-called atypical pneumonia, caused by Mycoplasma or Chlamydia among others, is often characterised by fever with very few respiratory symptoms.
Depending on the extent of pneumonia in the respiratory tract, different types are identified:
Pneumonia is a very common disease (350,000 cases/year in Spain) and is a significant cause of mortality in the general population. It can affect all age groups.
In previously healthy people it is a disease of mild or moderate severity. It can even be treated at home or in outpatient care, but in patients with previous pathology (immunocompromised, heart failure, previous respiratory failure), it is generally serious.
The appropriate use of antibiotics, together with occasional respiratory support measures (oxygen therapy or even intubation), contributes significantly to improving the chances of cure in the most severe cases.
It is performed based on the patient's clinical history (age, previous pathology, evolution time and type of symptoms), auscultation, chest radiography and blood and sputum cultures to identify the causative organism.
Antigens can also be detected in urine for pneumococcus and Legionella.
The treatment is antibiotic, based on a clinical estimate of the possibility of it being caused by one germ or another (in many cases treatment is started immediately without knowing the causal organism). Treatment is later maintained or changed according to the cultures and the patient's evolution.
The criterion for inpatient or outpatient treatment depends on the estimation of the risks that may occur (older age, previous pathology, impairment of respiratory function).
In a previously healthy patient, treatment may be in outpatient care.
Chest x-ray, blood and sputum or respiratory secretion cultures and determination of antigens in urine.
Infective endocarditis is the presence of a microbial infection on the endocardial surface (the inner surface of the heart). It is the most common cardiovascular infection and is highly significant due to its potential severity and the fact that it can present in different clinical forms.
Infective endocarditis primarily affects the heart valves, whether natural or artificial, although it can sometimes involve other structures of the heart. It is classified according to the duration of the infection (days, weeks, or months) and the type of causative microorganism (bacteria, yeast, or fungi).
The characteristic lesion of infective endocarditis is the endocardial vegetation. This consists of an abnormal aggregate of platelets, fibrin, bacteria, and inflammatory cells that adheres to the inner surface of the heart—typically a heart valve—and can detach, causing infectious emboli in distant organs such as the skin, nervous system, or extremities.
It is considered a serious disease. Although most cases are curable, it carries significant complications and mortality even with treatment. In many cases, achieving a definitive cure requires surgical intervention to remove affected tissue and replace the valve with an artificial one.
In the acute form, infective endocarditis may cause high fever, chills, prostration, and rapid deterioration of general condition over hours or days.
In subacute forms, with progression over weeks or months, the main symptoms are fatigue, loss of appetite, and mild fever. In these cases, characteristic skin lesions, such as nodules or spots, may also occur, although not always.
In patients with severe valve involvement, valvular dysfunction may develop, resulting in heart failure symptoms, such as significant shortness of breath and edema in the lower limbs.
Infective endocarditis has a global incidence of 2–3 cases per 100,000 people per year. In Catalonia, around 200 new cases are diagnosed annually. Its incidence increases significantly with age, reaching 15–30 cases per 100,000 people per year in individuals over 65—about 10 times higher than in younger populations.
The causative agents have changed over recent decades. Previously, streptococci, particularly viridans streptococci, were the most common. Currently, the most frequent pathogens are staphylococci, followed by streptococci and enterococci. However, any microorganism present in the blood can adhere to a heart valve, especially if it is previously damaged or artificial.
Diagnosis is primarily based on:
-blood cultures: to identify the causative microorganism and guide selection of the appropriate antibiotic therapy.
-echocardiography: to locate endocardial vegetations, assess valve function, and determine the need for surgery in certain patients.
In some cases, additional imaging (CT scans, nuclear medicine scans) is necessary to detect peripheral emboli, which are common at diagnosis or during treatment.
Treatment of infective endocarditis is antibiotic therapy, specifically targeted at the causative microorganism. Doses are high and prolonged, because vegetations are poorly vascularized and the antibiotic must penetrate by diffusion from circulating blood.
Patients who do not respond adequately to antibiotic therapy, or who develop significant valvular damage, may require valve replacement surgery.
Blood cultures and echocardiography, both at diagnosis and during follow-up, to monitor disease progression.
In individuals with known valvular abnormalities, antibiotic prophylaxis is recommended before dental procedures or gum surgery, following specialist guidance.
Preventive measures should also be taken during endoscopic procedures, especially upper gastrointestinal endoscopy (gastroscopy), according to the prescribed antibiotic regimen.
This prevention is crucial because the presence of bacteria in the bloodstream during such procedures significantly increases the risk of infective endocarditis.
Tuberculosis is an infection caused by the bacterium Mycobacterium tuberculosis, mainly affecting the lungs and transmitted through the air. Common symptoms include cough, fever, night sweats, and weight loss. Diagnosis uses clinical, imaging, and microbiological tests. Treatment is long (at least six months) with a drug combination and is curable if properly followed.
Infectious disease caused by the microorganism Mycobacterium tuberculosis, which mainly affects the respiratory system and requires prolonged and uninterrupted treatment to cure. If treatment is interrupted, it can become resistant to drugs, which makes it harder to cure.
The reservoir of Mycobacterium tuberculosis is humans and it is usually an airborne disease. Transmission is caused by living in close proximity to someone with pulmonary tuberculosis. It is important to be aware that we are talking about a disease that can be treated, cured and eradicated, which means that it could disappear from the human population.
At the moment, however, it is the primary cause of death from infectious disease on the planet. Factors such as resistance to first-line drugs or coinfection make it difficult to treat the disease and increase its mortality rate.
The symptoms of tuberculosis depend on the organ that is infected. In the case of pulmonary tuberculosis, the most common symptoms are chesty cough, fever, weight loss and sweating at night. A diagnosis of tuberculosis should be considered when these symptoms last for more than 3-4 weeks.
It can affect anyone who has been in contact with infected patients.
Tuberculosis is diagnosed according to the patient’s symptomatology, the findings of a physical examination and the results of complementary testing. Microbiological tests constitute an essential pillar for diagnosis. Some tests include micobacteria cultures, microscopic techniques and evidence of molecular biology.
Patients have a confirmed diagnosis when the microbiological tests are positive. If they are not positive, they are said to have a probable diagnosis.
Conducted by means of several drugs to avoid resistance. The length of treatment is prolonged (minimum six months) because many drugs acts on the dividing bacteria and this microorganism is slow growing. Where possible, all tablets are administered in one single sitting per day to make following the treatment plan easier.
Chest x-rays, general tests, cultures of biological samples.
There are no specific prevention measures to avoid infection.
Oral herpes is an infection in the lips, mouth and gums caused by the herpes simplex virus (HSV-1) and which shows up as small painful blisters called herpes labialis, commonly known as cold sores.The herpes simplex infection is very contagious, common and endemic throughout the world. It is normally acquired in childhood and lasts a lifetime.
Herpes caused by the HVS-1 virus is spread by mouth-to-mouth or skin contact with ulcers or saliva and the area around the mouth and lips. It can also be spread to the genitals, resulting in genital herpes.
Although uncommon, it can be transmitted from an infected mother to her baby during birth.
Usually, herpes labialis (or the cold sore virus) is asymptomatic and most people infected do not realise. When it appears, it does so as painful blisters or ulcers on or around the mouth. People with this condition notice a feeling of stinging, tingling or burning in the affected area.
After the first infection, the blisters may periodically reappear, varying from person to person.
According to the WHO, 67 % of the population is infected with HSV-1.
Diagnosis is done in a medical centre, in other words, through examination of the patient. If there is any doubt, the specialist may request virological culture tests on the blisters during the initial stages of the disease to confirm it.
Antiviral medications such as aciclovir, famciclovir and valaciclovir are the most effective to treat those infected with HSV-1. However, despite reducing the intensity and frequency of symptoms, they do not cure the infection.
The concept of resistant osteoarticular infections encompasses all procedures on patients with infections that have not responded to previous medical and surgical treatment.
These procedures may be changing prostheses or treatment for chronic osteomyelitis or septic pseudoarthrosis among others.
The different types of resistant osteoarticular infections treated are:
Osteomyelitis/osteitis of haematogenous origin and which are resistant to medical and surgical treatment:
Chronic osteomyelitis or septic pseudoarthrosis derived from trauma or surgical interventions. Those resulting from open fractures, typically in the tibia, are often accompanied by loss of bone or the cutaneous covering. Exact incidence rates are not known, but the more exposed the bone has been, the higher the chances of chronic infection.
Periprosthetic infections. This type of infection occurs in 1-3% of primary arthroplasty procedures. In some cases, the only obvious symptom may be pain. The presence of a fistula or the isolation of a pathogen microorganism in different samples is used to confirm diagnosis. The most common treatment is to change the prosthesis in two separate procedures.
Severe treatment-resistant diseases of the soft tissue (necrotizing fasciitis, gangrene). These are extremely unusual lesions and when do they appear they are often fatal. Excessive localized pain may be the only initial symptom, making it very difficult to diagnose at this stage. When diagnosed, aggressive treatment with antibiotics and surgical debridement can have an impact on survival and the need for amputation.
Patient-related factors (control of additional diseases or disorders) are very important in the prevention of osteoarticular infection, as are those related to surgery (antibiotic prophylaxis), the presence of implants, and tissue condition (bone and cutaneous covering) amongst others.
This type of infection requires a multidisciplinary team as treatment is very complex.
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