Mother-to-child Chagas disease transmission: The challenge of detection and prevention in areas without the risk of vectorial transmission.

Chagas disease (CD) is caused by the parasite Trypanosoma cruzi. Although it is endemic in many Latin American (LA) countries, mother-to-child transmission has caused it to expand to other countries and continents. In places where vector transmission is controlled or absent, the epidemiological importance of T. cruzi transmission of the infected mother to her child during pregnancy or childbirth (i.e., perinatal CD) increases. In countries where CD is not endemic, CD screening should be performed in pregnant or fertile women who are native to LA countries or whose mothers are native to LA countries. Diagnosis is established by detecting anti-T. cruzi IgG antibodies in a serum or plasma sample. Antiparasitic treatment cannot be offered during pregnancy, and since the majority of infected newborns are asymptomatic at birth, a diagnosis is made by direct observation or concentration (microhematocrit) or by using molecular testing techniques. Once the infected child receives a diagnosis, it is essential to offer treatment (benznidazole/nifurtimox) as soon as possible, with good tolerance and effectiveness in the first year of life. Even if the diagnosis is negative at birth, the newborn must be followed up for at least the first 9 months of life.

Cerebral echinococcosis: Case report and literature review.

Echinococcosis is a zoonosis caused by the larval form of the cestode Echinococcus granulosus. The cerebral affectation in the human is uncommon; only in 1-2% cases is observed encephalic involvement. This condition occurs mainly in the pediatric population and it is characterized by the presence of single and unilocular cysts. We report a case of a 29-year-old patient who came to the emergency department with a disabling headache of several weeks of evolution. In the brain imaging study a mass of unknown origin was visualized, finally it turned out to be a bilobed hydatid cyst. Regarding this case, the clinic-epidemiological, diagnostics and treatments aspects of cerebral hydatid disease will be reviewed.

Cerebral echinococcosis: Case report and literature review. / Hidatidosis cerebral: caso clínico y revisión de la literatura.

Echinococcosis is a zoonosis caused by the larval form of the cestode Echinococcus granulosus. The cerebral affectation in the human is uncommon; only in 1-2% cases is observed encephalic involvement. This condition occurs mainly in the pediatric population and it is characterized by the presence of single and unilocular cysts. We report a case of a 29-year-old patient who came to the emergency department with a disabling headache of several weeks of evolution. In the brain imaging study a mass of unknown origin was visualized, finally it turned out to be a bilobed hydatid cyst. Regarding this case, the clinic-epidemiological, diagnostics and treatments aspects of cerebral hydatid disease will be reviewed.

[New public health challenges in vector management: black flies in Murcia (Spain)]. / Nuevos retos en gestión de vectores en salud pública: la mosca negra en Murcia (España).

Historically, no black fly (Diptera: Simuliidae) nuisance has been reported in the Murcia Region. Back in September 2016 the Ojós City Council has contacted the Regional Public Health General Directorate for help regarding a local insect nuisance, most probably based on mosquitoes. After sampling with a BG-sentinel 2 trap, collecting adult specimens with an entomological aspirator, and collect larvae and pupae on submerged giant cane stalks at the river, it turned out that Simulium sergenti was the insect species causing the nuisance. This species is not considered particularly anthropophilic; therefore, a low vector risk for human health was considered. However, the high fly density impaired the life quality of the people at the village. A management plan was recommended, treating the river with Bacillus thuringiensis var israelensis.

[ARCHITECT Chagas(®): a new diagnostic tool in Chagas disease]. / ARCHITECT Chagas(®): una nueva herramienta diagnóstica en la enfermedad de Chagas.

OBJECTIVE: To evaluate a new chemiluminescent microparticle immunoassay (ARCHITECT Chagas(®), Abbott). METHODS: In this study, 165 samples were tested by two different serological tests. The ARCHITECT Chagas(®) assay was performed using ARCHITECT i2000(SR) system (Abbott). RESULTS: The sensitivity and specificity of ARCHITECT assay was 100% and 96.6%, respectively. The concordance rate was 0.96 (95%CI: 0.92-1) for ELISA and 0.91 (95%CI: 0.85-0.97) for immunofluorescence assay (IFA). CONCLUSIONS: The ARCHITECT Chagas(®) assay demonstrates a sensitivity and specificity similar to ELISA and IFA assays; it allows a large volume of samples to be processed with a good standardization and reproducibility, as well as an objective interpretation.

Antimicrobial chemotherapy for Legionnaires disease: levofloxacin versus macrolides.

BACKGROUND: The community outbreak of legionnaires disease that occurred in Murcia, Spain, in July 2001--to our knowledge, the largest such outbreak ever reported--afforded an unusual opportunity to compare the clinical response of patients with Legionella pneumonia treated with levofloxacin with that of patients treated with macrolides and to determine the role of rifampicin combined with levofloxacin in treating severe legionellosis. METHODS: An observational, prospective, nonrandomized study was conducted involving 292 patients seen at our hospital (Hospital "J. M. Morales Meseguer"; Murcia, Spain) who received a diagnosis of Legionella pneumonia during the Murcia outbreak. To compare both antibiotic regimens (macrolides vs. levofloxacin), patients were stratified by the severity of pneumonia. Duration of fever, clinical outcome, complications, side effects, and length of hospital stay were recorded. To assess the potential effects of adjuvant therapy with rifampicin, 45 case patients treated with levofloxacin plus rifampicin were evaluated and compared with 45 control pairs who were treated with levofloxacin alone. RESULTS: With the exception of 2 patients who died, all patients were cured. There were no significant differences between treatment groups in clinical outcome for patients with mild-to-moderate pneumonia. Nevertheless, in patients with severe pneumonia, levofloxacin exerted superior activity; it was associated with fewer complications (3.4% of patients receiving levofloxacin experienced complications, compared with 27.2% of patients receiving macrolides; P=.02) and shorter mean hospital stays (5.5 vs. 11.3 days; P=.04). Addition of rifampicin to the treatment regimen for patients receiveing levofloxacin for severe pneumonia provides no additional benefit. CONCLUSIONS: Our findings strongly suggest that monotherapy with levofloxacin is a safe and effective treatment for legionnaires disease, including in patients with severe disease. In these patients, levofloxacin appears to be more effective than clarithromycin.

[The journey of Legionella pneumophila from amoebae to macrophage. Reflections on the largest outbreak of legionnaire's disease]. / El viaje de Legionella pneumophila desde la ameba hasta el macrofrago. Reflexiones sobre la mayor epidemia de la enfermedad del legionario.

Legionella, the causative agent of legionnaire's disease (LD), can survive and grow in amoebic cells. Free-living amoebae may play a role in the selection of virulence traits and in adaptation to survival in macrophages, and represent an important reservoir of Legionella. These amoebae may act as a Trojan horse bringing hidden bacteria within the human environments. The community outbreak of LD that occurred in Murcia in July 2001, the largest such outbreak ever reported, afforded an unusual opportunity to improve the knowledge of this disease.