Antimicrobial resistance and molecular epidemiology of Panton-Valentine leukocidin-positive community-associated methicillin-resistant Staphylococcus aureus from Gran Canaria (Canary Islands, Spain).

Among 3967 Staphylococcus aureus recovered from a Gran Canaria hospital (2003-2010), 28 strains were Panton-Valentine leukocidin-positive community-associated methicillin-resistant Staphylococcus aureus and were included in this study. Most isolates (89.3%) caused skin and skin-structure infections. Isolates belonging to clonal complex (CC)8 (ST8 and ST931; USA300) prevailed (82.1%). Among these, 5 (21.7%) were resistant to at least 3 antimicrobial classes.

[Epidemiological features of invasive pneumococcal disease before and after the introduction of pneumococcal conjugate vaccine in Gran Canaria (Canary Islands)]. / Aspectos epidemiológicos de la enfermedad neumocócica invasiva antes y después del uso de la vacuna neumocócica conjugada en Gran Canaria.

INTRODUCTION: The introduction of pneumococcal conjugate vaccine (PCV-7) has modified the epidemiology of invasive pneumococcal disease (IPD). Our aim was to investigate the epidemiological features of IPD before and after implementing the use of PCV-7. METHODS: All invasive Streptococcus pneumoniae strains isolated in our hospital from 2000 to 2006 were included. Serotypes were identified and antibiograms were performed in all cases. Data obtained before (2000-2001) and after (2004-2006) authorization of PCV-7 use in Spain were compared. RESULTS: There were 241 cases of IPD. None of the patients with IPD aged 2 years or younger had received PCV-7. PCV-7 coverage in children aged 5 or younger was about 48%. There was a non-significant increase in the incidence of IPD in children (from 53.8 to 57.8 cases/100 000 population), with no change in adults. When IPD incidence was adjusted by the number of blood samples collected, there was a non-significant decrease in both children and adults. Since PCV-7 came on the market, there has been a decrease in vaccine serotypes and an increase in non-vaccine serotypes. The emergent serotypes since that time include 3, 6A, 15, and 19A. Penicillin resistance decreased significantly (p<0.001) from the pre-vaccine period (87.3%) to 2003 (13.8%), and later rose from 2003 through 2006 (41.7%). Erythromycin resistance showed no changes during the study. CONCLUSIONS: The incidence of IPD in children aged 2 years and younger in Gran Canaria has not decreased despite the introduction of PCV-7. However, there has been a reduction in the number of cases related to vaccine serotypes and a significant decrease in penicillin resistance. In contrast, non-vaccine serotype IPD cases have increased. Universal vaccination and the use of new polyvalent vaccines may enhance these effects.

[Value of the polymerase chain reaction in the diagnosis of herpes infections of the nervous system]. / Utilidad de la reacción en cadena de la polimerasa en el diagnóstico de las infecciones herpéticas del sistema nervioso.

OBJECTIVE: To assess the performance of a polymerase chain reaction (PCR) method in cerebrospinal fluid (CSF) for the diagnosis of nervous system infections caused by herpesvirus, and to estimate the incidence of encephalitis due to herpes simplex virus type 1 in the adult population of the island of Gran Canaria. METHODS: We studied 330 CSF specimens from 312 patients (281 HIV-negative and 31 HIV-positive) remitted to investigate clinically suspected encephalitis or meningitis, or to study neuropathy or demyelinating disease. A multiplex PCR technique was used to detect herpes simplex virus types 1 and 2 (HSV-1 and HSV-2), varicella-zoster virus (VZV), human cytomegalovirus (CMV), Epstein-Barr virus and human herpesvirus type 6. The patients' clinical records were reviewed to establish the definite diagnosis. RESULTS: Nine samples from eight patients (2.6%) showed positive results (9.7% of patients with pathological CSF and none with normal CSF). The eight patients had clinical and analytic findings of herpesvirus nervous system infection: HSV-1 DNA in four patients with encephalitis, HSV-2 DNA in one patient with meningitis, VZV DNA in two patients with meningitis and CMV DNA in one HIV-positive patient with encephalitis. Herpesvirus was the cause of 50% of encephalitis cases and 10% of meningitis cases. The incidence of HSV-1 encephalitis was five cases per million inhabitants per year. CONCLUSIONS: Diagnosis of herpesvirus nervous system infections by PCR in CSF is not appropriate when CSF parameters are normal. We found a higher incidence of herpesvirus encephalitis than has been reported in other studies.

[Epidemic outbreak of meningitis due to Echovirus type 13 on the island of Gran Canaria (Spain)]. / Brote epidémico de meningitis por virus Echo serotipo 13 en la isla de Gran Canaria.

INTRODUCTION: Since the implementation of routine vaccination against mumps, enteroviruses have become the commonest cause of viral meningitis. In Spain the most frequently isolated echoviruses are serotypes 30, 9, 6 and 4.Objectives. Determine the clinical-epidemiological characteristics of a meningitis outbreak due to echovirus type 13. METHODS: We studied 152 cases of enteroviral meningitis diagnosed in the year 2000. Viral isolation was performed on fibroblast MRC-5 and human rhabdomyosarcoma cells. The viruses were identified with monoclonal antibodies and serotyped by neutralization. RESULTS: Echovirus was isolated in 131 out of 152 CSF samples (86.2%). In 21 patients with negative CSF culture, the diagnosis was made by echovirus isolation from upper respiratory tract and/or feces samples. The cytopathic effect was seen in all cases in monolayers of rhabdomyosarcoma cells. The average age of the patients was 67 months (range: 1-350) and the male:female ratio was 2:1. Most of the patients had fever, headache and other signs of meningitis. Hospitalization was required in 52.6%. All patients were discharged without sequelae. The highest incidence was recorded from April to June. CONCLUSIONS: There had been no record of the presence of echovirus 13 in Spain in recent years until the emergence of this outbreak. Isolation of the virus from sites other than CSF is often helpful in establishing the diagnosis and patient management. Enterovirus isolates must be specifically serotyped to determine enteroviral activity in the population, which can be sporadic or epidemic.