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.
[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].
Fuente original de la actualizaciónexternal link opens in a new window
Resumen
Definición
Anamnesis y examen
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.
El uso de este contenido está sujeto a nuestra cláusula de exención de responsabilidad