Última revisión: 26 Ago 2021
Última actualización: 02 Sep 2021
02 Sep 2021

Novedades de esta actualización

La FDA autoriza una dosis de refuerzo para personas inmunodeprimidas

  • La Administración de Medicamentos y Alimentos de EE. UU. de los Estados Unidos ha autorizado una dosis adicional (tercera) de las vacunas de Pfizer/BioNTech y Moderna en personas con inmunodeficiencia moderada o grave, al menos 28 días después de la finalización de la serie de vacunas inicial.

  • Consulte la sección de prevención para obtener más información.

La MHRA autoriza un anticuerpo monoclonal para la profilaxis postexposición

  • La Medicines and Healthcare products Regulatory Agency del Reino Unido ha concedido una autorización de comercialización condicional a casirivimab/imdevimab para la profilaxis postexposición en adultos y niños mayores de 12 años y con un peso superior a 40 kg. La Administración de Medicamentos y Alimentos de EE. UU. también ha autorizado el casirivimab/imdevimab para esta indicación en determinadas personas. El casirivimab/imdevimab también está autorizado para el tratamiento del COVID-19.

  • Los National Institutes of Health de EE.UU. recomiendan el casirivimab/imdevimab para la profilaxis posterior a la exposición en personas con alto riesgo de avance de la enfermedad grave y que no están totalmente vacunadas (o que están totalmente vacunadas pero no se espera que den una respuesta inmunitaria adecuada) y que cumplen ciertos criterios de exposición.

  • Consulte la sección de Emergentes para más información.

Los CDC recomiendan las vacunas de ARNm en personas con antecedentes de síndrome de Guillain-Barré

  • Los Centers for Disease Control and Prevention de EE.UU. recomiendan que las personas con antecedentes de síndrome de Guillain-Barré consideren una vacuna de ARNm en lugar de las vacunas con vectores de adenovirus, que se han relacionado con casos de síndrome de Guillain-Barré.

  • Consulte la sección de prevención para obtener más información.

Número de casos de COVID-19 informados semanalmente por región de la OMS y muertes globales, a partir del 18 de julio de 2021[Figure caption and citation for the preceding image starts]: Número de casos de COVID-19 informados semanalmente por región de la OMS y muertes globales, a partir del 18 de julio de 2021Organización Mundial de la Salud [Citation ends].

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Resumen

Definición

Anamnesis y examen

Principales factores de diagnóstico

  • fiebre
  • tos
  • disnea
  • sentido del olfato/gusto alterado

Otros factores de diagnóstico

  • fatiga
  • mialgia o artralgia
  • producción de esputo/expectoración
  • opresión en el pecho
  • síntomas gastrointestinales
  • dolor de garganta
  • cefalea
  • mareos
  • síntomas neurológicos
  • síntomas oculares
  • rinorrea/congestión nasal
  • síntomas audio-vestibulares
  • dolor torácico
  • síntomas cutáneos
  • síntomas del tracto urinario inferior
  • hemoptisis
  • sonidos de respiración bronquial
  • taquipnea
  • taquicardia
  • cianosis
  • crepitaciones/estertores durante la auscultación

Factores de riesgo

  • contacto con el caso probable o confirmado
  • residencia/trabajo/viajes en lugares con alto riesgo de transmisión
  • edad avanzada
  • sexo masculino
  • grupo étnico
  • residencia en un centro de cuidados a largo plazo
  • presencia de comorbilidades
  • obesidad
  • enfermedad cardiovascular
  • diabetes
  • enfermedad respiratoria crónica
  • enfermedad renal crónica
  • embarazo
  • tabaquismo
  • neoplasia maligna
  • enfermedad cerebrovascular
  • trasplante de órgano sólido o de células madre
  • Síndrome de Down o problemas de aprendizaje
  • trastornos de la hemoglobina
  • hipertensión
  • demencia
  • inmunosupresión
  • Infección por VIH
  • trastornos por consumo de sustancias
  • niños con ciertas afecciones subyacentes
  • hepatopatía crónica.
  • deficiencia de vitamina D
  • uso de inhibidores de la bomba de protones
  • enfermedad autoinmune
  • Enfermedad de Parkinson
  • inactividad física
  • dislipidemia
  • cirugía
  • grupos sanguíneos A y B
  • Disbiosis intestinal
  • Factores ambientales

Pruebas diagnósticas

Primeras pruebas diagnósticas para solicitar

  • Reacción en cadena de la polimerasa de transcripción inversa en tiempo real (RT-PCR)
  • oximetría de pulso
  • GSA
  • hemograma completo (HC)
  • perfil metabólico completo (PMC)
  • pruebas de función tiroidea
  • nivel de glucemia
  • cribado de coagulación
  • biomarcadores cardíacos
  • proteína C-reactiva sérica
  • velocidad de sedimentación globular en suero
  • lactato deshidrogenasa en suero
  • nivel de interleucina-6 en suero
  • procalcitonina sérica
  • nivel de ferritina en suero
  • amiloide sérico nivel A
  • creatina-cinasa y mioglobina en suero
  • cultivos de esputo y hemocultivos
  • radiografía de tórax

Pruebas diagnósticas que deben considerarse

  • Tomografía computarizada (TC) de tórax
  • serología
  • prueba de antígenos

Pruebas emergentes

  • amplificación isotérmica mediada por bucles de la transcripción inversa (RT-LAMP)
  • ultrasonido de pulmón
  • calprotectina

Algoritmo de tratamiento

Colaboradores

Consejeros especializados

Nicholas J. Beeching, MA, BM BCh, FRCP, FRACP, FFTM RCPS (Glasg), FESCMID, DCH, DTM&H

Consultant and Emeritus Professor of Tropical and Infectious Diseases

Royal Liverpool University Hospital and Liverpool School of Tropical Medicine

Liverpool

UK

Divulgaciones

NJB is partially supported by the National Institute of Health Research Health Protection Unit (NIHR HPRU) in Emerging and Zoonotic Infections at University of Liverpool in partnership with Public Health England (PHE), in collaboration with Liverpool School of Tropical Medicine. He is affiliated with Liverpool School of Tropical Medicine. The views expressed are those of the author and not necessarily those of the NHS, the NIHR, the Department of Health, or PHE.

Tom E. Fletcher, MBE, PhD, MBChB, MRCP, DTM&H

Senior Clinical Lecturer and Defence Consultant in Infectious Diseases

Royal Liverpool University Hospital and Liverpool School of Tropical Medicine

Liverpool

UK

Divulgaciones

TEF is a consultant/expert panel member to the World Health Organization, and is funded by the UK Surgeon General, the NHS, and Liverpool School of Tropical Medicine. TEF is partially supported by the National Institute of Health Research Health Protection Unit (NIHR HPRU) in Emerging and Zoonotic Infections at University of Liverpool in partnership with Public Health England (PHE), in collaboration with Liverpool School of Tropical Medicine. He is affiliated with Liverpool School of Tropical Medicine. He has received research grants from the Wellcome Trust, Medical Research Council, and the UK Public Health Rapid Support Team (UK-PHRST). The views expressed are those of the author and not necessarily those of the NHS, the NIHR, the Department of Health, or PHE.

Robert Fowler, MDCM, MS (Epi), FRCP(C)

H. Barrie Fairley Professor of Critical Care

University Health Network and Interdepartmental Division of Critical Care Medicine

Director

Clinical Epidemiology and Health Care Research

Institute of Health Policy, Management and Evaluation

Dalla Lana School of Public Health

University of Toronto

Chief

Tory Trauma Program

Sunnybrook Hospital

Toronto

Canada

Divulgaciones

RF declares that he has no competing interests.

Revisores por pares

William A. Petri, Jr., MD, PhD

Professor

Division of Infectious Diseases and International Health

University of Virginia

Charlottesville

VA

Divulgaciones

WAP declares that he has no competing interests.

Xin Zhang, MD, PhD

Attending Physician

The Fifth Medical Center of PLA General Hospital

Clinical Division and Research Center of Infectious Disease

Beijing

China

Divulgaciones

XZ declares that he has no competing interests.

Ran Nir-Paz, MD

Associate Professor in Medicine

Department of Clinical Microbiology and Infectious Diseases

Hadassah Hebrew University Medical Center

Jerusalem

Israel

Divulgaciones

RNP has received research grants from US-Israel Binational Science Foundation, Hebrew University, Rosetrees Trust, and SpeeDx. He is chair of the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Study Group for Mycoplasma and Chlamydia Infections (ESGMAC). RNP is a consultant for and has stocks in eDAS Healthcare. He is also chairperson of the Israeli Society for Infectious Diseases guidelines committee.

Editores

Adam Mitchell,

Section Editor (Infectious Diseases)/Drug Editor, BMJ Best Practice

Divulgaciones

AM declares that he has no competing interests.

Irene Chiwele,

Lead Section Editor, BMJ Best Practice

Divulgaciones

IC declares that she has no competing interests.

Julie Costello,

Comorbidities Editor, BMJ Best Practice

Divulgaciones

JC declares that she has no competing interests.

Consejeros especializados: comorbilidades

Martyn Patel, BMBcH, FRCP, MA

Consultant, Older People's Medicine

Norfolk and Norwich University Hospitals

NHS Foundation Trust

Norwich

UK

Divulgaciones

MP is a contributor to the Oxford Textbook of Otolaryngology, Oxford University Press, 2021, having written a chapter about mental capacity law, for which he received no fee. MP is the NHS representative on the board for Norwich Institute for Healthy Ageing (unpaid role). MP has spoken at the International Forum on Quality and Safety in Healthcare virtual conference in November 2020, for which he received no fee. MP has accepted speaker fees and/or travel expenses to deliver lectures from: University of East Anglia, Leicester University (speaker fees only); Astellas Pharma Ltd (speaker fees and travel expenses). MP has accepted travel expenses from Newton Europe to present a joint project conducted by his main employer (Norfolk and Norwich University Hospitals NHS Trust) and Newton Europe at the NHS Confederation conference (Manchester 2018).

Andrew Lewington, BSc (Hons), MBBS, MEd, MD, FRCP

Consultant Renal Physician

Honorary Associate Professor

Nephrology Department

Leeds Teaching Hospitals NHS Trust

Leeds

UK

Divulgaciones

AL is Associate Clinical Director of NIHR Leeds In-Vitro Diagnostics Co-operative, Co-Chair of UK Kidney Research Consortium Renal Clinical Study Group, Member of Kidney Research UK Research Grant Committee, Committee Member of NICE Kidney Injury Clinical Guideline Update 2018-20, Committee Member of NICE Diagnostic Assessment for Point of Care Creatinine Testing 2018-19. AL attended the Acute Dialysis Quality Initiative Meeting in San Diego 2018 (accommodation expenses); AL was a speaker at the AKI & CRRT Conference in San Diego 2019 (travel and accommodation expenses), the AKI Conference in Coventry 2019 (travel expenses), and the NIHR AKI and Sepsis Meeting in Leeds 2019 (no expenses).

Martin Cowie, MD, MSc, FRCP, FRCP (Ed), FESC, FHFA, FACC

Professor of Cardiology

Imperial College London (Royal Brompton Hospital)

London

UK

Divulgaciones

MC is chair of the European Society of Cardiology Digital Health Committee and a trustee of the Atrial Fibrillation Society. He has previously been a non-executive director of the National Institute for Health and Care Excellence. MC provides consultancy advice to AstraZeneca, Servier, Abbott, Medtronic, Boston Scientific, and Genomics PLC. MC declares that none of these interests is directly related to topics advised on for this project.

Rachael Evans, MBChB, FRCP (UK), PhD

Associate Professor (Clinical)

University of Leicester

Honorary Consultant Respiratory Physician

Glenfield Hospital

Leicester

UK

Divulgaciones

RAE has been reimbursed for a GSK Advisory Board meeting on Physical Activity and Asthma in November 2016, and three Chiesi Education meetings for GPs on COPD care in 2019. RAE received a travel award for ERS 2017 from Chiesi and participated in the GSK clinical experience programme - respiratory in August 2018. RAE participated in the BTS/SIGN guidelines for asthma update 2016 (no fee).

Gerry Rayman, MD, FRCP

Consultant Physician and Head of Service

Diabetes and Endocrine Centre and the Diabetes Research Unit

Ipswich Hospitals NHS Trust

Ipswich

UK

Divulgaciones

GR has been paid for advisory board meetings with the following companies: Safoni Aventis, Abbott Diabetes UK, Lilly Diabetes, Bayer. GR has received lecture fees from Safoni Aventis, Abbott Diabetes UK, Lilly Diabetes, Novonordisk, Napp Pharmaceuticals Ltd.

Sotiris Posporelis, MD, MRCPsych

Consultant Liaison Neuropsychiatrist

King’s College Hospital

South London and Maudsley NHS Foundation Trust

Honorary Senior Clinical Lecturer

Institute of Psychiatry, Psychology & Neuroscience

King’s College London

London

UK

Divulgaciones

SP declares that he has no competing interests.

Acknowledgements,

BMJ Best Practice would like to gratefully acknowledge Dr Matthew Jones for his advice on a section of the stroke comorbidity content.

Matthew Jones, MD, FRCP

Consultant Neurologist

Greater Manchester Neurosciences Centre

Salford Royal Foundation Trust

Honorary Senior Lecturer

University of Manchester

Manchester

UK

Divulgaciones

AA and MJ declare that they have no competing interests.

Revisores por pares: comorbilidades

Martyn Patel, BMBcH, FRCP, MA

Consultant, Older People's Medicine

Norfolk and Norwich University Hospitals

NHS Foundation Trust

Norwich

UK

Divulgaciones

MP is a contributor to the Oxford Textbook of Otolaryngology, Oxford University Press, 2021, having written a chapter about mental capacity law, for which he received no fee. MP is the NHS representative on the board for Norwich Institute for Healthy Ageing (unpaid role). MP has spoken at the International Forum on Quality and Safety in Healthcare virtual conference in November 2020, for which he received no fee. MP has accepted speaker fees and/or travel expenses to deliver lectures from: University of East Anglia, Leicester University (speaker fees only); Astellas Pharma Ltd (speaker fees and travel expenses). MP has accepted travel expenses from Newton Europe to present a joint project conducted by his main employer (Norfolk and Norwich University Hospitals NHS Trust) and Newton Europe at the NHS Confederation conference (Manchester 2018).

Asangaedem Akpan, MPH, FRCP

Consultant Geriatrician

Liverpool University Hospitals NHS Foundation Trust

Visiting Professor

University of Cumbria

Carlisle

Honorary Clinical Associate Professor

University of Liverpool

Liverpool

UK

Divulgaciones

AA declares that he has no competing interests.

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