HTLV infection in persons with sexually transmitted diseases in Spain.

Background: HTLV-1 infection is a neglected disease, despite estimates of 10 million people infected worldwide and producing life-threatening illnesses in 10% of carriers. Sexual transmission is the main route of contagion. However, HTLV-1 is not listed among sexually transmitted infections (STIs). Methods: Serum from all consecutive individuals who had attended six STI clinics across Spain during the last 12 months were tested for HTLV antibodies using a commercial enzyme immunoassay (EIA). Reactive samples were confirmed by immunoblot. Results: A total of 2,524 samples were examined. The majority (1,936; 76.7%) belonged to men, of whom 676 (34.9%) were men who have sex with men (MSM) receiving HIV pre-exposure prophylaxis. Although native Spaniards predominated (1,470; 58.2%), up to 593 (23.5%) came from Latin America and 139 (5.5%) were African. A total of 26 individuals were initially EIA reactive and immunoblot confirmed 5 as HTLV-1 and 7 as HTLV-2. All but one HTLV-1+ case came from Latin America. Three were men and two were women. Among Latin Americans, the HTLV-1 seroprevalence was 0.67%. In contrast, all seven HTLV-2+ were native Spaniards and former injection drug users, and all but one were HIV+. Conclusion: The rate of HTLV infection among individuals with STIs in Spain is 0.5%, which is greater than in the general population. These results support the introduction of universal HTLV screening in persons who attend clinics for STIs.

The slowdown of new infections by human retroviruses has reached a plateau in Spain.

The 2022 annual meeting of the HTLV & HIV-2 Spanish Network was held in Madrid on December 14. We summarize here the main information presented and discussed at the workshop and review time trends for human retroviral infections in Spain. As transmissible agents, infections by human retroviruses are of obligatory declaration. Until the end of 2022, the Spanish national registry had recorded 451 cases of HTLV-1, 821 of HTLV-2, and 416 of HIV-2. For HIV-1, estimates are of 150 000 people currently living with HIV-1 and 60 000 cumulative deaths due to AIDS. During year 2022, new diagnoses in Spain were of 22 for HTLV-1, 6 for HTLV-2, and 7 for HIV-2. The last updated figures for HIV-1 are from 2021 and counted 2786 new diagnoses. The slowdown in yearly infections for HIV-1 in Spain points out that new strategies are needed to achieve the United Nations 95-95-95 targets by 2025. For the remaining neglected human retroviral infections, their control might be pushed throughout four interventions: (1) expanding testing; (2) improving education and interventions aimed to reduce risk behaviors; (3) facilitating access to antiretrovirals as treatment and prevention, including further development of long-acting formulations; and (4) increasing vaccine research efforts. Spain is a 47 million population country in South Europe with strong migration flows from HTLV-1 endemic regions in Latin America and Sub-Saharan Africa. At this time universal HTLV screening has been implemented only in the transplantation setting, following the report of 5 cases of HTLV-associated myelopathy shortly after transplantation of organs from HTLV-1 positive donors. There are four target populations for expanding testing and unveiling asymptomatic carriers responsible for silent HTLV-1 transmissions: (1) migrants; (2) individuals with sexually transmitted infections; (3) pregnant women; and (4) blood donors.

Hepatitis C: Problems to extinction and residual hepatic and extrahepatic lesions after sustained virological response.

Loss of follow-up or reinfections hinder the expectations of hepatitis C eradication despite the existence of highly effective treatments. Moreover, the elimination of the infection does not imply the reversion of those chronic alterations derived from the previous infection by hepatitis C virus (HCV). This review analyzes the risk factors associated with loss to follow-up in diagnosis or treatment, and the possibility of reinfection. Likewise, it assesses the residual alterations induced by chronic HCV infection considering the liver alterations (inflammation, fibrosis, risk of decompensation, hepatocellular carcinoma, liver transplantation) and, on the other hand, the comorbidities and extrahepatic manifestations (cryoglobulinemia, non-Hodgkin lymphoma, peripheral insulin resistance, and lipid, bone and cognitive alterations). Peculiarities present in subjects coinfected with human immunodeficiency virus are analyzed in each section.

Revisión de desobturación de gutapercha con limas manuales, Xilol y Reciproc / Review of gutta-percha removal with manual files, xylol and Reciproc

El tratamiento endodóntico no quirúrgico es de primera elección en el caso de fracasos endodónticos. El primer paso del retratamiento es la desobturación del conducto radicular, que va a permitir la preparación biomecánica del conducto radicular con irrigación y desinfección correcta. El protocolo de desobturación incluye limas manuales, solventes y una lima de uso único con movimiento alternativo como es el Reciproc. En la revisión de la literatura científica se ven las características particulares de fabricación, cinemática y función de los instrumentales y productos químicos utilizados en este protocolo. Se concluye en que la elección de limas manuales, xilol y Reciproc permitiría una desobturación del conducto radicular de manera simple, segura y eficaz

Nonsurgical endodontic treatment is the first choice in case of endodontic failure. The first step of retreatment is root canal opening, which will enable the biomechanical preparation of the root canal with proper irrigation and disinfection. The obturation removal protocol includes manual files, solvents and Reciproc, a single-use reciprocating file. This review of the scientific literature addresses the specific characteristics of manufacture, kinematics and function of the instruments and chemical products used in this protocol. We found that the choice of manual files, xylol and Reciproc would allow for a simple, safe and effective opening of the root canal

[Invasive neumococcal disease in Costa del Sol Hospital: replacement by non-vaccinable serotypes]. / Enfermedad neumocócica invasiva en el Hospital Costa del Sol: emergencia de serotipos no vacunables.

OBJECTIVE: Streptococcus pneumoniae can cause invasive and noninvasive diseases. Invasive pneumococcal disease causes infections in tissues, organs and fluids that are normally sterile and is associated with severe clinical processes generally. The aim of this study was to characterize ENI episodes as well as to describe the antimicrobial susceptibility and distribution of serotypes (vaccinal and non-vacunal) of S. pneumoniae strains isolated in blood cultures of patients treated at the Hospital Costa del Sol between September 2012 and January 2017. METHODS: Descriptive study from S. pneumoniae strains isolated in blood cultures. The variables studied were: age, sex, death, smoking, HIV infection, clinical diagnosis, serotype and antibiotic susceptibility profile. The source of information used was the clinic management program called Doctor. RESULTS: 76 S. pneumoniae strains were isolated. The most prevalent serotypes were 8, 3, 9N, 6C, 22F, 11A and 14. 77.3% of the strains were responsible for IPD (Invasive Pneumococcal Disease) episodes with clinical diagnosis of bacterial pneumonia. According to the CLSI 2016 (Clinical & Laboratory Standards Institute) criteria, 2 strains were non-susceptible to penicillin, 23 strains were non-susceptible to erythromycin and 3 were strains non-susceptible to levofloxacin. CONCLUSIONS: The results of this study show that the most frequent serotypes among ENI patients attended in our hospital are not covered by conjugate vaccines, although they do so by VNP23. Serotype 6C, not covered by any vaccine, was among the three most frequently isolated, causing death in one third of patients.

OBJETIVO: Streptococcus pneumoniae puede causar enfermedades invasivas y no invasivas. Bajo la denominación de enfermedad neumocócica invasiva, se incluyen aquellas infecciones que se localizan en tejidos, órganos y fluidos que normalmente son estériles y que se asocian con procesos clínicos generalmente severos. El objetivo de este estudio fue caracterizar los episodios de ENI (Enfermedad Neumocócica Invasiva) así como describir la sensibilidad antimicrobiana y distribución de los serotipos (vacunales y no vacunales) de cepas de S. pneumoniae aisladas en hemocultivos de pacientes atendidos en el Hospital Costa del Sol entre septiembre de 2012 y enero de 2017. METODOS: Estudio descriptivo a partir de cepas de S. pneumoniae aisladas en hemocultivos. Las variables de estudio fueron: edad, sexo, fallecimiento, tabaquismo, infección por VIH, diagnóstico clínico, serotipo y perfil de sensibilidad antimicrobiana. La fuente de información utilizada fue el programa de gestión clínica "Doctor". El análisis estadístico se llevó a cabo mediante el software SPSS (SPSS, version 15,0; SPSS, Chicago Illinois, USA). RESULTADOS: Se aislaron un total de 76 cepas de S. pneumoniae. Los serotipos más prevalentes fueron, en orden descendente 8, 3, 9N, 6C, 22F, 11A y 14. El 77,3% de las cepas fueron causantes de episodios de ENI con diagnóstico clínico de neumonía bacteriémica. Según el criterio del CLSI 2016 (Clinical & Laboratory Standards Institute), encontramos 2 cepas no sensibles a penicilina, 23 cepas no sensibles a eritromicina y 3 cepas no sensibles a levofloxacino. CONCLUSIONES: Los resultados de este estudio muestran que los serotipos más frecuentes entre los pacientes con ENI atendidos en nuestro hospital no están cubiertos por las vacunas conjugadas, aunque sí por la VNP23. El serotipo 6C, no cubierto por ninguna vacuna, se situó entre los tres más frecuentemente aislados, causando exitus en un tercio de los pacientes.

Seroprevalence of antibodies to the influenza A (H1N1) virus among healthcare workers prior to the 2009 pandemic peak.

OBJECTIVE: Our aim was to study the proportion of healthcare workers with a positive serology for Influenza A(H1N1)2009 without having flu, in a Spanish hospital at the beginning of the pandemic. METHODS: A survey study carried out during August 2009 (before the peak of the pandemic in Spain) in the Hospital Costa del Sol, a second level hospital with almost 300 beds in the South of Spain. The participants were workers in the following hospital units: Emergencies, Medical Area (Internal Medicine, Chest Diseases), Surgical Area (General Surgery and Anaesthesia) of any professional category. A study was made of the proportion of healthcare workers in our hospital with positive serology for the new influenza A (H1N1)2009 virus, as determined by the haemagglutination inhibition technique (≥1/40). The subjects completed a health status questionnaire, and provided a blood sample for serology testing. RESULTS: A total of 239 workers participated, of whom 25.1% had positive serology. The hospital area in which most individuals had positive serology was the Emergency Department (36.6%), while the professional category in which most individuals with a positive serology worked was that of the orderlies (41.7%). CONCLUSION: Around 25% of healthcare workers in our hospital had positive serology before the peak of the pandemic, none of them had received vaccine for Influenza A (H1N1) 2009 or had been diagnosed of influenza previously.

Distribución de Lutzomyia longipalpis en la Mesopotamia Argentina, 2010 / Distribution of Lutzomyia longipalpis in the Argentine Mesopotamia, 2010

El primer caso autóctono de leishmaniasis visceral (LV) en la Argentina se notificó en el año 2006 en Posadas, Misiones, y en el verano 2008-2009 se comprobó la dispersión del vector de LV, Lutzomyia longipalpis y casos de LV canina en la provincia de Corrientes. Para conocer la distribución del riesgo, entre febrero y marzo del 2010 se realizó la búsqueda sistemática del vector de LV en 18 localidades de las provincias de Entre Ríos, Corrientes y en la ciudad de Puerto Iguazú, Misiones, totalizando 313 trampas/noche. Se comprobó la presencia de Lu. longipalpis, por primera vez, en las localidades de Chajarí (Entre Ríos), Alvear, La Cruz, Curuzú Cuatiá y Bella Vista (Corrientes), y en Puerto Iguazú (Misiones). En Santo Tomé y Monte Caseros (Corrientes) se volvió a registrar la presencia del vector, y se obtuvieron las trampas con más ejemplares, 830 y 126 Lu. longipalpis trampa/sitio/noche respectivamente. Los resultados muestran que el vector de la LV urbana, continúa dispersándose en el territorio argentino. Simultáneamente, la propagación del parásito, y los consecuentes casos de LV humana se asocian al aumento de reservorios, perros infectados con o sin clínica, debidos al tránsito humano.

The first case of visceral leishmaniasis (VL) in Argentina was reported in 2006 in Posadas, Misiones. During the summer 2008-2009 Lutzomyia longipalpis, the VL vector, and canine VL cases were already spread along the province of Corrientes. In order to know the distribution of VL risk, systematic captures of the vector were performed between February and March 2010, in 18 areas of the provinces of Entre Ríos and Corrientes, and the city of Puerto Iguazú, Misiones, with a total of 313 traps/night. We confirmed the presence of Lu. longipalpis, for the first time in Chajarí (Entre Ríos), Alvear, La Cruz, Curuzú Cuatiá and Bella Vista (Corrientes), and Puerto Iguazú (Misiones). In Santo Tome and Monte Caseros (Corrientes), where the vector had been previously reported, traps with more samples were obtained with 830 and 126 Lu. Longipalpis trap/site/night respectively. These results show that the vector of urban VL continues spreading in the Argentine territory. Simultaneously, the spread of the parasite and the resulting human VL cases are associated with the dispersion of reservoirs, infected dogs, with or without clinical symptoms or signs, due to human transit.