Characterization of Latin American migrants at risk for Trypanosoma cruzi infection in a non-endemic setting. Insights into initial evaluation of cardiac and digestive involvement.

BACKGROUND: Trypanosoma cruzi causes Chagas disease (CD), a potentially fatal disease characterized by cardiac disorders and digestive, neurological or mixed alterations. T. cruzi is transmitted to humans by the bite of triatomine vectors; both the parasite and disease are endemic in Latin America and the United States. In the last decades, population migration has changed the classic epidemiology of T. cruzi, contributing to its global spread to traditionally non-endemic countries. Screening is recommended for Latin American populations residing in non-endemic countries. METHODS: The present study analyzes the epidemiological characteristics of 2,820 Latin American individuals who attended the International Health Service (IHS) of the Hospital Clinic de Barcelona between 2002 and 2019. The initial assessment of organ damage among positive cases of T. cruzi infection was analyzed, including the results of electrocardiogram (ECG), echocardiogram, barium enema and esophagogram. RESULTS: Among all the screened individuals attending the clinic, 2,441 (86.6%) were born in Bolivia and 1,993 (70.7%) were female. Of individuals, 1,517 (81.5%) reported previous exposure to the vector, which is a strong risk factor associated with T. cruzi infection; 1,382 individuals were positive for T. cruzi infection. The first evaluation of individuals with confirmed T. cruzi infection, showed 148 (17.1%) individuals with Chagasic cardiomyopathy, the main diagnostic method being an ECG and the right bundle branch block (RBBB) for the most frequent disorder; 16 (10.8%) individuals had a normal ECG and were diagnosed of Chagasic cardiomyopathy by echocardiogram. CONCLUSIONS: We still observe many Latin American individuals who were at risk of T. cruzi infection in highly endemic areas in their countries of origin, and who have not been previously tested for T. cruzi infection. In fact, even in Spain, a country with one of the highest proportion of diagnosis of Latin American populations, T. cruzi infection remains underdiagnosed. The screening of Latin American populations presenting with a similar profile as reported here should be promoted. ECG is considered necessary to assess Chagasic cardiomyopathy in positive individuals, but echocardiograms should also be considered as a diagnostic approach given that it can detect cardiac abnormalities when the ECG is normal.

Emergence of Resistance to Quinolones and ß-Lactam Antibiotics in Enteroaggregative and Enterotoxigenic Escherichia coli Causing Traveler's Diarrhea.

The objective of this study was to assess the antimicrobial resistance of enteroaggregative Escherichia coli (EAEC) and enterotoxigenic E. coli (ETEC) strains causing traveler's diarrhea (TD) and to investigate the molecular characterization of antimicrobial resistance genes to third-generation cephalosporins, cephamycins, and quinolones. Overall, 39 EAEC and 43 ETEC clinical isolates were studied. The susceptibilities of EAEC and ETEC against ampicillin, amoxicillin-clavulanic acid, cefotaxime, imipenem, chloramphenicol, tetracycline, co-trimoxazole, nalidixic acid, ciprofloxacin, azithromycin, and rifaximin were determined. All genes encoding resistance determinants were detected by PCR or PCR plus DNA sequencing. The epidemiology of selected EAEC and ETEC strains was studied using multilocus sequence typing (MLST). The resistance to quinolones of EAEC and ETEC strains causing TD has significantly increased over the last decades, and high percentages have been found especially in patients traveling to India and sub-Saharan Africa. Sequence type 38 (ST38) and ST131, carrying the blaCTX-M-15 and blaCTX-M-27 genes, respectively, are highly prevalent among extended-spectrum ß-lactamase (ESBL)-producing EAEC and ETEC strains. The cephamycinase ACT-20 is described in the present study for the first time in EAEC and ETEC strains causing TD in patients who had traveled to Central America. The percentages of resistance to azithromycin in EAEC and ETEC isolates from patients to Southeast Asia/India and Africa are above 25%. Meanwhile, rifaximin is still active against EAEC and ETEC, with the prevalence of resistant strains not being high. In conclusion, fluoroquinolones should no longer be considered the drugs of choice for the prevention or treatment in TD for travelers traveling to India and Africa. Azithromycin and rifaximin are still a good alternative to treat TD caused by EAEC or ETEC.

Enterococcus faecium resistente a glucopéptidos. Análisis del genotipode resistencia, virulencia y líneas genéticas / Glycopeptide-resistant Enterococcus faecium. Analysis of the resistance genotype, virulence and genetic lines

Objetivo: El objetivo de este estudio fue analizar las características genotípicas de los aislados de Enterococcus con resistencia adquirida a vancomicina (ERV) obtenidos durante un período de 3 años y 2 meses en el Hospital Clínic de Barcelona. Métodos: Se incluyeron en el estudio todos los aislados de ERV obtenidos en el período de enero de2004 a marzo de 2007. Se analizó el mecanismo de resistencia a vancomicina y las resistencias asociadas a otros antibióticos. Los aislados ERV fueron tipificados por electroforesis en campo pulsante (PFGE) ymulti-locus-sequence-typing (MLST).Resultados: Se obtuvieron 39 ERV que fueron identificados como Enterococcus faecium y representaron el 2% del total de enterococos aislados durante el período de tiempo estudiado. El genotipo van A fue detectado en 38 de los aislados y el genotipo vanB2 en uno adicional. Los 39 ERV fueron clasificados en 13 pulsotipos diferentes (A-M) por PFGE, incluyendo un pulsotipo principal, A, que agrupaba 13 aislados. La secuencia tipo fue identificada por MLST en 24 de las cepas (con patrones diferentes o estrechamente relacionados) y todas ellas fueron adscritas al complejo clonal CC17, excepto 2 que fueron adscritasal complejo CC9. Todas las cepas mostraron un fenotipo de multirresistencia, incluyendo en muchos casos ampicilina, ciprofoxacina, eritromicina, estreptomicina, gentamicina, kanamicina y cloranfenicol,albergando múltiples genes de resistencia asociados. Los genes esp y/o hyl fueron detectados en 37 de losERV. Conclusión: Todas las cepas, excepto una, presentaron el genotipo van A y formaban parte mayoritariamente del complejo clonal CC17 (AU)

Objective: The objective of this study was to analyse the genotypic characteristics of all Enterococcusisolates 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-fleld-gel-electrophoresis (PFGE) and multilocus-sequence-typing (MLST).Results: Thirty-nine VRE were recovered, all being identifled as E. faecium, representing 2% of total enterococci obtained in that period. Thirty-eight of them carried the van A gene, and one isolate the vanB2 gene.T he 39 VRE were classifled into 13 different pulsotypes (A-M), with one main pulsotype, A, which included 13 isolates. The sequence type was identifled by MLST in 24 VRE (with unrelated or closely-related PFGE patterns), and they were ascribed to the clonal complex CC17, but two classifled 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 identifled in 37 VRE. Conclusion: All VRE, but one, showed the van A genotype and they were mostly ascribed to the high-riskclonal complex CC17 (AU)