Perfil serológico en gestantes extranjeras frente a VIH,VHB, VHC,virus de la rubéola, Toxoplasma gondii,Treponema pallidum, y Trypanosoma cruzi

Introduction

The increase in immigration is changing the prevalence of mother to child infectious diseases. Our aim is to determine the serological profile of foreign pregnant women against these infections.

Methods

A retrospective cross sectional study was performed in a tertiary hospital from Madrid between August 2007 and October 2008. The seroprevalence against HIV, HBV, HCV, rubeola, T. gondii, T. pallidum and T. cruzi was determined in every pregnant immigrant, as well as in a representative group of Spanish pregnant women.

Results

A total of 2526 immigrant and 157 Spanish pregnant women were studied. None of the Spanish and 0.5% of the foreigners showed antibodies against HIV; 18.9% of them were Sub-Saharan women. Antigen HBs was detected in 2% of the immigrant women and in 1.1% of the Spanish women. Asian women had the highest rate of type B Hepatitis (10.9%). There was 0.9% of type C Hepatitis among the immigrants and 1% among the Spanish. Within the cases with RPR ≥ 1/8, 1.6% were immigrants, most of whom were Latin American. Thirty-one per cent of the immigrants showed antibodies against T. gondii (37.5% from Central America, 2.5% from the Far East). More than 95% of the Spanish women had antibodies against Rubella, this being lower in the rest of the areas (75.5% in Sub-Saharan Africa). T. cruzi infection was detected in 12.1% of the Bolivian women studied.

Conclusion

The prevalence of mother-to-child transmitted infections depends on the origin of pregnant women. Knowledge of these differences may lead to improved control these diseases.     

Fièvre prolongée intermittente survenant à l’effort

Introduction

Fever of unknown origin is a common reason for care in internal medicine. The wide variety of possible etiologies makes it difficult to standardize the diagnostic work-up that has to be primarily guided by the interview and physical examination.

Case report

We report a case of prolonged fever having as main characteristics to be intermittent and triggered by efforts. The diagnosis of cerebrospinal fluid shunt infection with Propionibacterium acnes was finally made. In reaching this conclusion, many tests were needed, including renal explorations with biopsy showing an aspect of shunt nephritis.

Conclusion

Prolonged fever of unknown origin in a patient having prosthetic material should raise the suspicion of prosthesis infection (especially if the fever is associated with efforts).     

Características clínico-epidemiológicas de los pacientes inmigrantes con infección por el VIH: estudio de 371 casos

Introduction

The number of HIV-positive immigrants have increased in Spain in the last few years, and now represent a significant proportion of the epidemic. Our objective is to describe the clinico-epidemiological characteristics of HIV-positive immigrants seen in a specialist unit in Madrid.

Material and methods

Retrospective study. Every patient born in a country other than Spain and attended an HIV Unit in Madrid between 1992 and 2009 was included.

Results

Of the 371 patients included, 53.1% were Latin Americans, 24.5% Sub-Saharan Africans, and 22.4% others), and 60% were males. Immigrants represented 0.3% of new patients in 1992 and rose to 49.2% in 2009. The principal reason for HIV testing had been pregnancy/delivery among women (32.7%) and having a category-B disease among men (17.4%). Sexual transmission accounted for 92% of patients. Tuberculosis was the principal AIDS-diagnosing illness. Respectively 90%, 7.7%, 60%, 26.7%, 96% and 95% of patients had an IgG for HAV, HCV, Toxoplasma, Treponema, CMV and VZV. VHB-Ags+: 5.4%; PPD+: 17%. At least one syphilis episode was recorded in 62% of the men who have sex with men (MSM). Prevalence of HLA-B5701 was 6%, 0.9% and 3.8% in Caucasians, Amerindians and Afro-Americans, respectively.

Conclusions

Immigrants represent a significant proportion of new HIV-positive patients. It is a very heterogeneous group according to their clinical and epidemiological characteristics.     

Colonización nasal por Staphylococcus aureus en estudiantes de medicina: importancia en la transmisión hospitalaria

Background

Staphylococcus aureus is the main pathogen causing nosocomial infections. Health professionals, including medical students, could be a source of transmission. The aims of the study were to determine the rate of nasal carriage of S. aureus susceptible and resistant to methicillin (MRSA) and evaluate the knowledge and adherence that students had about hand hygiene.

Methods

The study included medical students attached to the Hospital Universitario 12 de Octubre (Madrid, Spain). We collected samples from both nasal vestibules, and the antimicrobial susceptibility was determined on all isolates. Data collection was performed using a self-administered questionnaire that included risk factors for colonization, hygiene habits and knowledge of hand hygiene protocols.

Results

Of the 140 students included, 55 (39.3%) were colonized by S. aureus, and 3 (2,1%) by MRSA. The exposure to antibiotics in the last 3 months was lower in colonized students (12.3% vs. 25.9%, P = .03). Self-assessment showed that 56.4% of students almost never washed their hands before to attending to the first patient, and only 38.6% always washed after examining patients. More than a third (35.7%) ignored the hand hygiene protocol, and 38.6% had not received specific formation.

Conclusions

Medical students should be included in hospital infection control programs. Hand hygiene training should be given to students before they begin their practices in the hospital.     

Infecciones neonatales por Staphylococcus aureus de inicio en la comunidad

Introduction

Staphylococcus aureus is a major cause of neonatal community-onset infections. The emergence of methicillin-resistant S. aureus infections in this age group has been reported in USA in the last few years; however there are no studies in Spain. The aim of this study is to describe the epidemiological, clinical and microbiological characteristics of S. aureus community-onset infections in neonates.

Methods

We prospectively reviewed the S. aureus infections in neonates over a three year period (2007-2009) in the Pediatric Emergency Department of Hospital 12 de Octubre in Madrid (Spain).

Results

We recorded 30 cases of neonatal S. aureus community-onset infections. Only one isolated (3.3%) was resistant to methicillin, and two (6.7%) were PVL(+).

Conclusions

Despite the emergence of MRSA outside the hospital in pediatric population in Spain, CA-MRSA and SA PVL(+) infections are not frequent in neonates.     

Sensibilidad a azitromicina y otros antibióticos en aislados recientes de Salmonella,Shigella y Yersinia

Introduction

Azithromycin represents an alternative option to treat bacterial diarrhea when the antibiotic therapy is indicated. Little is known regarding the susceptibility to azithromycin in enteropathogens in Spain.

Methods

The MICs of azithromycin were determined by E-test against Salmonella non-typhi (SNT), Shigella and Yersinia isolates collected over the last three years (2010-2012). In addition, the susceptibility to other antibiotics usually used to treat gastrointestinal diseases was determined in these isolates by using a microdilution method.

Results

A total of 139 strains of SNT, Shigella and Yersinia were studied. All of them, except one strain, had a MIC ≤ 16 mg/L of azithromycin. In the adult population, 14.7% and 40.6% of SNT and Shigella isolates, respectively, were resistant to at least 2 of following antibiotics: amoxicillin, trimethoprim-sulfamethoxazole and ciprofloxacin. In the pediatric population, 10% of SNT clinical isolates and 28.6% (2/7) of Shigella isolates were resistant to amoxicillin and trimethoprim-sulfamethoxazole.

Conclusions

In our experience, azithromycin would be a useful antibiotic alternative to treat bacterial diarrhea.     

Caractéristiques clinicobiologiques des méningites à Enterovirus de l’adulte : étude de 59 cas

Purpose

To describe the epidemiological and clinical features of enteroviral meningitis as well as the biological profile of the cerebrospinal fluid (CSF).

Methods

A retrospective study conducted in a single centre between 2004 and 2008. All aseptic meningitis due to Enterovirus were included.

Results

Fifty-nine patients were included. The triad including fever, headache and neck stiffness was reported in 62% of patients. Twelve patients (20%) had a neutrophilic leukocytosis and 23 (39%) an elevated CRP level. Twenty-eight patients (47%) had a prominent neutrophilic reaction in the CSF and nine (15.2%) had a low glucose concentration. A presumptive anti-bacterial treatment was initiated in 47 patients (80%) for an average of 3.2 days.

Conclusion

Due to the lack of specificity of clinical features and biological manifestations of Enterovirus meningitis, the widespread use of real-time Enterovirus PCR is a priority for reducing the number of unnecessary anti-bacterial treatment. Guidelines based on clinical and biological features may be associated to help physicians in the differential diagnosis between bacterial and viral meningitides.     

Enterococcus faecium resistente a glucopéptidos. Análisis del genotipo de resistencia,virulencia y líneas genéticas

Objective

The objective of this study was to analyse the genotypic characteristics of all Enterococcus isolates with acquired vancomycin resistance (VRE) recovered in the Hospital Clinic (Barcelona, Spain) in a period of three years and two months.

Methods

All VRE isolated in the referred Hospital in the period January 2004-March 2007 were included in the study. The vancomycin resistance mechanism was investigated, as well as other antibiotic resistance mechanisms. Isolates were also typed by pulsed-field-gel-electrophoresis (PFGE) and multi-locus-sequence-typing (MLST).

Results

Thirty-nine VRE were recovered, all being identified as E. faecium, representing 2% of total enterococci obtained in that period. Thirty-eight of them carried the vanA gene, and one isolate the vanB2 gene. The 39 VRE were classified into 13 different pulsotypes (A-M), with one main pulsotype, A, which included 13 isolates. The sequence type was identified by MLST in 24 VRE (with unrelated or closely-related PFGE patterns), and they were ascribed to the clonal complex CC17, but two classified as CC9. All VRE showed a multiresistance phenotype, including, in most cases ampicillin, ciprofloxacin, erythromycin, streptomycin, gentamicin, kanamycin and chloramphenicol, harbouring multiple antibiotic resistance genes. The presence of esp and/or hyl genes was identified in 37 VRE.

Conclusion

All VRE, but one, showed the vanA genotype and they were mostly ascribed to the high-risk clonal complex CC17.     

Aumento significativo de la colonización por Staphylococcus aureus entre los estudiantes de medicina durante la realización de las prácticas en el hospital

Introduction

Staphylococcus aureus is a pathogen of major concern. The emergence of methicillin-resistant S. aureus (MRSA) has increasingly complicated the therapeutic approach of hospital-acquired infections. Surveillance of MRSA and control measures must be implemented in different healthcare settings, including screening programs for carriers. Our first aim was to determine the prevalence of methicillin-susceptible S. aureus (MSSA) and MRSA nasal carriage in medical students from the Clínico San Carlos Hospital (Madrid). As the MRSA carrier rate in healthcare workers is higher than in the general population, we hypothesised that carrier rate could be increased during their clinical practice in their last three years.

Methods

We performed an epidemiologic al study of the prevalence of S. aureus colonisation among a group of medical students, who were sampled in 2008 in their third-year, and in 2012 when this class was in its sixth year.

Results

We have found a significant increase in MSSA carriage, from 27% to 46%. There were no MRSA colonisations in the third-year, but one was found in the sixth-year group. The large majority of strains (89%) of strains were resistant to penicillin, and 27% to erythromycin and clindamycin. As 19 coagulase-negative Staphylococcus MR were also identified, a horizontal transfer of genes, such as mecA gene to S. aureus, could have occurred.

Conclusions

Medical students are both, at risk for acquiring, and a potential source of nosocomial pathogens, mainly MSSA. Therefore, they should take special care for hygienic precautions, such as frequent and proper hand washing, while working in the hospital.     

Culture-negative Prosthetic Joint Arthritis Related to Coxiella burnetii

Background

The number of hip and knee arthroplasty procedures is steadily increasing as life expectancy increases. Coxiella burnetii may be responsible for culture-negative prosthetic joint arthritis and is associated with antibiotic failure and repeated surgeries. We report the first case series of C. burnetii–related culture-negative prosthetic joint arthritis.

Methods

Cases were retrieved from the French National Referral center for Q fever. Diagnosis was based on ¹⁸fluorodeoxyglucose positron emission tomography, serology, broad-range polymerase chain reaction, and C. burnetii–specific polymerase chain reaction.

Results

Four cases of C. burnetii–related culture-negative prosthetic joint arthritis were found. Standard bacteriologic procedures would have missed the diagnosis in all cases. Etiologic diagnosis improved the outcome in all but 1 case.

Conclusions

A systematic, comprehensive diagnostic strategy should be used in culture-negative prosthetic joint arthritis, including testing for C. burnetii in endemic areas.     

Caracterización molecular de cepas de Staphylococcus aureus resistentes a meticilina ST398 en pacientes con infecciones cutáneas y sus familiares

Introduction

Livestock-associated methicillin-resistant Staphylococcus aureus (LA-MRSA) of sequence type ST398 is a genetic lineage also described in human infections.

Methods

Cutaneous infections related with MRSA ST398 are described in 3 patients, two of them pig farmers. The MRSA nasal carriage by patients and their relatives was also studied. MRSA ST398 strains were typed (SCCmec, spa, agr and MLST) and the antimicrobial resistance pattern and virulence genes were determined.

Results

Twenty MRSA ST398 isolates were recovered in lesions of three patients, and in nasal samples of two patients and five relatives. Isolates were typed: spa-type t011 or t108; agr-type I and SCCmec IVa or V. MRSA strains were tetracycline-resistant and 15 of them showed a phenotype and genotype of multi-resistance, but they were free of tested virulence genes.

Conclusions

LA-MRSA ST398 is an emergent problem in our country, mainly associated with skin and soft tissue infections in people with professional relationships with pig farms. Tetracycline resistance is an important marker for MRSA ST398 detection.     

Two cases of zoonotic cryptosporidiosis in Spain by the unusual species Cryptosporidium ubiquitum and Cryptosporidium felis

Introduction

Two cases of infection by zoonotic transmission of unusual species of Cryptosporidium were detected in 2010–2011 in Spain (León and Zaragoza).

Materials and methods

Cryptosporidium spp. was detected by microscopic examination of modified Ziehl–Neelsen stained fecal smears. PCR-RFLP of the SSUrDNA gene and sequencing of the amplified fragment confirmed the species.

Results

C. ubiquitum and C. felis were identified in samples from an immunocompetent child and from a HIV-positive adult, respectively.

Conclusions

This is the first report of human infection by C. ubiquitum (cervine) and autochthonous C. felis, identified in Spain.     

La infección neonatal tardía por Streptococcus agalactiae en el área de Barcelona (1996-2010)

Objetive

To study the characteristics and evolution of group B Streptococcus (GBS) late-onset diseases, over a period of 15 years in 8 hospitals the Barcelona area and analyze the possible impact of prophylactic measures for the prevention of early-onset neonatal infections.

Methods

Retrospective review of all patients diagnosed with late-onset neonatal disease due to GBS from 1996 to 2010.

Results

A total of 143 patients were diagnosed. Of these, 51 were born in others hospitals. The overalll incidence was 0.42 per 1000 live births, varying between 0.14‰ in the year 2000 and 0.80‰ in 2009. A slight but sustained tendency of increased risk was observed over the years, 6.9% in the overall disease (with no statistical significance). Sepsis/bacteremia was detected in 63.6% of the newborns, meningitis in 32.8%, and arthritis/osteomyelitis in 3.5%. In cases with known obstetrics dates, 53% of mothers had been colonized by GBS during pregnancy, 53.8% received intrapartum antibiotic prophylaxis, and 41.2% had some obstetric risk factors, particularly premature birth in 35.9%. There was a 2.8% mortality rate in the neonates, and predominant serotypes were III and Ia.

Conclusions

The incidence of GBS late-onset disease has not decreased despite the control practices of early-onset disease, and possibility of this appearing must be taken into account.     

Méningite à éosinophiles

Introduction

Diagnosis of Angiostrongylus cantonensis meningitis is not always obvious, even in endemic areas.

Case report

We report a 51-year-old Polynesian man, farmer without past medical history, who was admitted for mild fever, headache, neurological subjective symptoms, and severe muscle pain impeding walking. The diagnosis of A. cantonensis meningitis, guided by hypereosinophilia was confirmed by lumbar puncture and positive specific serology. Lumbar puncture and administration of corticosteroids rapidly reduced headache whereas paraesthesias declined more progressively.

Conclusion

Diagnosis of A. cantonensis meningitis should be considered in patients living or returning from endemic areas with headache associated with subjective neurological symptoms and hypereosinophilia.     

Asociación en un mismo plásmido de blaVIM-1 y qnrS2 en Klebsiella pneumoniae y Klebsiella oxytoca aisladas en Sevilla

Background

Combined resistance to quinolones and β-lactams is common in Enterobacteriaceae. The appearance in enterobacteria coding for metallo-β-lactamases and determinants of plasmid-mediated quinolone resistance are an emerging problem in our country.

Methods

The susceptibility was determined by E-test. The resistance genes were detected by PCR and the corresponding plasmids were characterised.

Results

This study describes 2 strains (1 Klebsiella oxytoca, 1 Klebsiella pneumoniae) carrying the genes qnrS2 and blaVIM-1 in a transferable plasmid of 70-Kb isolated in surveillance cultures at the University Hospital Virgen Macarena in Seville.

Conclusion

This is the first combination of qnrS2 and bla_VIM-1 on the same non-typeable plasmid isolated in our centre.     

Maladie de Lyme avec hépatite et corticothérapie : à propos d’une observation

Introduction

Abnormalities of liver function tests have been occasionally described in large series of Lyme disease, but only one case of hepatitis directly related to infection have been described in literature.

Case report

A 78-year-old-man, with a past medical history of polymyalgia rheumatica (PMR) who had discontinued corticosteroids two years before, presented a transient acute fever and liver cholestasis and cytolysis after an exposure to tick bites. A few days later, cervical pain occurred and corticosteroids were resumed as a PMR relapse was suspected. Hematogenous dissemination with acute meningoradiculitis and multiple erythema migrans led to conclude to a stage 2 Lyme disease.

Conclusion

Although hepatitis complicating the course of Lyme disease has been described in literature, the marked inflammation in our patient led us to investigate the possibility of a co-infection. Also, we discuss the responsibility of corticosteroids in clinical worsening of Lyme disease if they are prescribed without concomitant antibiotics.     

Registro Español de Desfibrilador Automático Implantable. VIII Informe Oficial del Grupo de Trabajo de Desfibrilador Automático Implantable de la Sociedad Española de Cardiología (2011)

Introduction and objectives

To summarize the findings of the Spanish Implantable Cardioverter-Defibrillator Registry for 2011 compiled by the Electrophysiology and Arrhythmia Section of the Spanish Society of Cardiology.

Methods

Each implantation team voluntarily and prospectively recorded data on a data collection form, which was then sent to the Spanish Society of Cardiology.

Results

Overall, 4481 device implantations were notified, representing 83.6% of the estimated total number of implantations. The notified implantation rate was 97 per million population and the estimated total implantation rate was 116.2 per million. First implantations accounted for 70.2% of the total notified. Data were collected from 167 hospitals (22 more than in 2010). Most implantable cardioverter-defibrillator implantations took place in men (82.1%). The mean age was 62.4 (14.1) years. Most patients had severe or moderate-to-severe ventricular dysfunction and were in New York Heart Association functional class II. The most frequent underlying cardiac condition was ischemic heart disease, followed by dilated cardiomyopathy. The number of indications for primary prevention increased over the previous year and accounted for 70.6% of first implantations. Overall, 78.4% of implantable cardioverter-defibrillators were implanted by cardiac electrophysiologists.

Conclusions

The 2011 Spanish Implantable Cardioverter-Defibrillator Registry includes data on almost 84% of all implantations of these devices performed in Spain. This was the first year in which the number of implants decreased slightly from the previous year, as also occurred in the rest of Europe. The percentage of implants for primary prevention continued to increase.Full English text available from:www.revespcardiol.org     

Hallazgos radiológicos en pacientes con esquistosomiasis importada

Introduction

Imaging techniques, primarily ultrasound, are useful in the diagnosis and monitoring of patients with schistosomiasis in endemic areas.

Methods

Study of 219 patients treated in sub-Saharan Tropical Medicine Unit with a diagnosis of imported schistosomiasis by imaging techniques investigations including plain abdominal radiography and ultrasound.

Results

A total of 17.8% of patients who had an abdominal X-ray showed findings suggestive of schistosomiasis, in most cases bladder calcifications. In 73 patients (41%) ultrasound showed pathological findings, mainly diffuse or focal wall thickening (26 patients), nodular lesions (n = 14), and pseudopolyps (n = 8). One patient, who had a large bladder mass (9 cm) and bilateral ureterohydronephrosis, was finally diagnosed with squamous cell carcinoma of the bladder. Ultrasound liver abnormalities were found in 10 patients, 4 with signs of portal hypertension, of which 3 had the characteristic periportal fibrosis in schistosomiasis.

Conclusion

Imaging studies, especially abdominal and bladder ultrasound, are useful for diagnosis, the study of disease and monitoring of patients with schistosomiasis in non-endemic countries.