Sexually transmitted infections in Spain: Current status.

Sexually Transmitted Infections (STI) are a major public health problem. The problems inherent to their diagnosis, treatment and prevention have to do not only with their nature, but also with organizational issues and overlapping competencies of the different health authorities in Spain. The real situation of STI in Spain, at present, is poorly known. For this reason, the Scientific Committee on COVID and Emerging Pathogens of the Illustrious Official College of Physicians of Madrid (ICOMEM) has formulated a series of questions on this subject which were distributed, not only among the members of the Committee, but also among experts outside it. The central health authorities provide very high and increasing figures for gonococcal infection, syphilis, Chlamydia trachomatis infection and lymphogranuloma venereum (LGV). Both HIV infection and Monkeypox are two important STI caused by viruses in our environment, to which it should be added, mainly, Herpes simplex virus (HSV) and Human papillomavirus (HPV) infections. Emerging microorganisms such as Mycoplasma genitalium pose not only pathogenic challenges but also therapeutic problems, as in the case of N. gonohrroeae. The pathways that patients with suspected STI follow until they are adequately diagnosed and treated are not well known in Spain. Experts understand that this problem is fundamentally managed in public health institutions, and that Primary Care and Hospital Emergency Services, together with some institutions that deal monographically with this problem, are the recipients of most of these patients. One of the most serious difficulties of STI lies in the availability of the microbiological tests necessary for their diagnosis, particularly in this era of outsourcing of microbiology services. Added to this is the increased cost of implementing the latest generation of molecular techniques and the difficulties of transporting samples. It is clear that STI are not diseases to which the entire population is equally exposed and it is necessary to have a better knowledge of the risk groups where to focus the necessary interventions adapted to their characteristics. It should not be forgotten that STI are also a problem in the pediatric age group and that their presence can be a marker of sexual abuse with all that this implies in terms of health care and medicolegal activity. Finally, STI are infections that are associated with a high cost of care for which we have very little information. The possibility of expanding the automatic performance of laboratory tests for STI surveillance through laboratory routines is encountering ethical and legal problems that are not always easy to solve. Spain has created a ministerial area of specific attention to STI and there are plans to improve the diagnosis, treatment and prevention of these problems, but we still lack the necessary evidence on their impact. We cannot forget that these are diseases that transcend the individual and constitute a Public Health problem.

The misleading effect of serum galactomannan testing in high-risk haematology patients receiving prophylaxis with micafungin.

OBJECTIVES: To investigate the performance of the routine serum galactomannan (sGM) assay in the diagnosis of invasive aspergillosis (IA) in high-risk haematology patients receiving prophylaxis with micafungin. METHODS: Retrospective study including all haematological patients who received prophylaxis with micafungin during high-risk IA episodes (neutropenic patients after chemotherapy for acute myeloid leukaemia/myelodysplastic syndrome; allogeneic haematopoietic stem-cell transplantation during early neutropenic phase or graft-versus-host disease requiring high prednisone doses) and for whom at least one sGM result was available. Episodes were classified as follows: true-positive (positive GM in the context of IA), false-positive (positive GM result in patients who had no evidence of IA), true-negative (negative GM test results and no IA), or false-negative (negative GM test in the context of IA). Non-evaluable patients were excluded. RESULTS: Among 146 evaluable episodes, four were true-positive in the context of probable breakthrough IA (incidence of breakthrough IA, 2.7%); 111/146 high-risk episodes (76%) were considered true-negative and 31/146 (21.2%) were considered false-positive. No false-negative episodes were detected. All but one of the false-positive episodes were detected in surveillance GM tests, leading to high-resolution CT scans in eight cases (8/31; 25.8%), all of which were negative. The positive predictive and negative predictive values of sGM for surveillance and diagnostic approaches were 3.2% (1/31) and 100% (110/110) and 75% (3/4) and 100% (1/1), respectively. CONCLUSIONS: Surveillance of asymptomatic patients receiving prophylaxis with micafungin using sGM is unnecessary, because the results are either negative or false-positive. However, sGM remains useful in the diagnosis of breakthrough IA in symptomatic patients during prophylaxis.

Six-Year Follow-up of Slaughterhouse Surveillance (2008-2013): The Catalan Slaughterhouse Support Network (SESC).

Meat inspection has the ultimate objective of declaring the meat and offal obtained from carcasses of slaughtered animals fit or unfit for human consumption. This safeguards the health of consumers by ensuring that the food coming from these establishments poses no risk to public health. Concomitantly, it contributes to animal disease surveillance. The Catalan Public Health Protection Agency (Generalitat de Catalunya) identified the need to provide its meat inspectors with a support structure to improve diagnostic capacity: the Slaughterhouse Support Network (SESC). The main goal of the SESC was to offer continuing education to meat inspectors to improve the diagnostic capacity for lesions observed in slaughterhouses. With this aim, a web-based application was designed that allowed meat inspectors to submit their inquiries, images of the lesions, and samples for laboratory analysis. This commentary reviews the cases from the first 6 years of SESC operation (2008-2013). The program not only provides continuing education to inspectors but also contributes to the collection of useful information on animal health and welfare. Therefore, SESC complements animal disease surveillance programs, such as those for tuberculosis, bovine cysticercosis, and porcine trichinellosis, and is a powerful tool for early detection of emerging animal diseases and zoonoses.

Detection and monitoring of mosquito flaviviruses in Spain between 2001 and 2005.

Between the years 2001 and 2005, a total of 72,895 female mosquitoes were trapped during their season of abundance, and analyzed. They were sorted into 4,723 pools belonging to 20 Culicidae species from the Anopheles, Aedes, Ochlerotatus, Culex, Culiseta, Coquillettidia, and Uranotaenia genera. The aim was to detect arboviral RNA directly from mosquito homogenates for the genera Alphavirus, Flavivirus, and Phlebovirus. The study formed part of general arbovirus transmission research in four of the most important wetlands in Spain; in the provinces of Girona, Barcelona, Tarragona, and Huelva. The mosquitoes were collected using human bait, CO(2) traps, or light traps, and they were pooled according to date of collection, location, and species. No arboviral RNA from known pathogenic arboviruses was found. However, 111 pools tested positive for unknown mosquito Flavivirus, the only genus detected. The Flavivirus sequences identified were different from all known Flavivirus mosquito viruses, but very close to Kamiti River virus or cell fusing agent virus. The maximum likelihood estimation infection rate (MLE) was calculated for all regions and species. Aedes albopictus had the highest MLE at 47.14, followed by Ae. vexans with 43.67 (over the entire area). These species were followed by Culiseta annulata, with 36.00. The most common species, Ochlerotatus caspius and Culex pipiens, had low MLE values-0.94 and 0.38, respectively-over the area as a whole.

Molecular detection of a Hepatozoon species in stray cats from a feline colony in North-eastern Spain.

Within the framework of a local animal health programme, the presence of ectoparasites and haemoparasites was investigated in a colony of 25 cats in Barcelona. Diagnosis was performed both by standard parasitological procedures and molecular techniques. All cats were negative to haematozoan infection by microscopic examination of blood smears. However, Hepatozoon spp. was found in four cats as shown by amplification and sequencing of the 18S rRNA gene. Cat isolates were 100% identical to the isolate Hepatozoon spp. (Spain 2) from Southern Spain. This is the first time that Hepatozoon spp. has been identified in cats from Northern Spain.

The role of wild boar (Sus scrofa) in the eco-epidemiology of R. slovaca in Northeastern Spain.

Rickettsia slovaca is considered the etiological agent of tick-borne lymphadenopathy (TIBOLA), an emerging disease transmitted by tick bites. Dermacentor marginatus constitutes the most important vector and wild boar (Sus scrofa) is the main wild host in our area. The epidemiology of this tick-borne rickettsioses has not been completely clarified. During hunting season 2004, wild boar sera sample were collected from northeastern Spain. Ticks were collected both from wild boar and from flagging vegetation in the same areas where wild boar were hunted. Serologic study was carried out using the immunofluorescent antibody (IFA) technique. Ticks were identified as D. marginatus and Rhipicephalus uranicus. Based on sequence analysis on ompA gene, R. slovaca was identified in 30.5% D. marginatus ticks removed from wild boar and in 33.3% D. marginatus collected from flagging vegetation. Rickettsia sp. RpA4 was identified in 4 specimens of D. marginatus removed from wild boar. Twelve of 23 wild boar were seropositive to R. slovaca. Results suggested wild boar are exposed to R. slovaca infection and this pathogen is well established in the wild cycle of D. marginatus in our area.

Prevalence of Rickettsia slovaca in Dermacentor marginatus ticks removed from wild boar (Sus scrofa) in northeastern Spain.

Rickettsia slovaca, the causative agent of TIBOLA, is transmitted by Dermacentor ticks. Dermacentor marginatus is the most widely species distributed in northeastern Spain, and the wild boar constitutes the main host. D. marginatus ticks were collected from hunter-killed wild boar and were tested by PCR/RFLP. Rickettsial DNA-positive ticks were sequenced using the ompA PCR primers. The prevalence of R. slovaca in D. marginatus ticks was 17.7%. Other spotted fever group rickettsiae were detected in ticks, but these were not definitely identified.

Taenia solium: the complex interactions, of biological, social, geographical and commercial factors, involved in the transmission dynamics of pig cysticercosis in highly endemic areas.

If a programme for the control of pig cysticercosis is to be effective it has to be based on good data on the local epidemiology of Taenia solium. In 2002-2003, in a cross-sectional study of pig cysticercosis in the Mexican state of Morelos, 1747 pigs that had been born and reared in rural areas of the state were checked for T. solium infection by tongue inspection. The prevalence of cysticercosis in the pigs was found to vary from 0% to 30% according to the municipality from which the pigs came. Although prevalence appeared to be unaffected by the socio-economic status of the municipality, it was relatively high in areas that lacked latrines, and in pigs that were castrated, pregnant and/or of the native (rather than an imported) breed. The results of questionnaire-based interviews with pig owners revealed that most (64.5%) of the rural pigs, whether infected or not, are slaughtered and consumed within the locality where they were reared. The other pigs are sold at low prices to organised traffickers who take the uninspected pigs to neighbouring urban areas for sale. The observed complexity in the factors affecting the transmission of T. solium to the pigs of Morelos state calls for an intervention strategy of matching complexity, initially targeted at those villages with the highest prevalences of pig cysticercosis. The road transport of pigs needs to be better regulated, and the vaccination and genetic improvement of the rural pigs, and delaying the castration of the boars, should all be considered.

[Risk factors for atopic dermatitis and familial prevalence in Spain (ELIHO study)]. / Factores de riesgo y prevalencia familiar de la dermatitis atópica en España (estudio ELIHO).

INTRODUCTION: Atopic dermatitis (AD) is a cutaneous disease of unknown etiology. It shows a clear genetic predisposition with probable environmental modulation. This study evaluated risk factors associated with diagnosis and flares of AD in Spanish children. PATIENTS AND METHODS: We performed an observational, multicenter, retrospective case-control study that included 4243 children aged less than 14 years old with AD and 978 controls matched for age and sex. Family history of disease and environmental variables were collected in both groups and clinical history of AD was recorded in the case group. RESULTS: Significant risk factors for AD were: a family history of the disease and concomitant cutaneous infections. The prevalence of AD in first degree relatives was 39 % and that in second degree relatives was 19 % (higher in maternal than paternal lines). The mean age of children with AD was 4.2 (SD 3.4) years and the mean age at diagnosis was 1.5 (SD 2.2) years, with a mean of 2.9 (SD 2.6) flares during the previous year. Cold weather (Cantabrian and Continental Iberian Peninsula areas) was related to a greater number of flares. Children with AD had a greater number of concomitant cutaneous diseases and infections than children in the control group. CONCLUSIONS: AD is mainly a genetic disease, with climatic factors involved in severity modulation, and with important immunological alterations. In contrast, this study found no domestic environmental factors that were associated with disease onset.

Prevalence of antibodies to Borrelia burgdorferi sensu lato in southern chamois (Rupicapra pyrenaica) in Spain.

Ungulates are involved in the epidemiology of Borreliosis as maintenance hosts for vector tick species. We evaluated the prevalence of antibodies to Borrelia burgdorferi sensu lato in two different populations of southern chamois in Spain. Forty-six sera (40.4%) were positive at titres >/=1 : 64 using an indirect immunofluorescence assay (IFAT).

In-use evaluation of Perasafe compared with Cidex in fibreoptic bronchoscope disinfection.

The mycobactericidal activity of Perasafe (0.26% peracetic acid) was compared with that of Cidex (2% alkaline glutaraldehyde) by an in-use test. Fibreoptic bronchoscopes were artificially contaminated with Mycobacterium tuberculosis or Mycobacterium avium-intracellulare in sputum and, after manual pre-cleaning with a neutral soap, 10 and 20 min disinfection periods were tested. Perasafe was as effective as Cidex, thus requiring a 10 min disinfection period against M. tuberculosis and 20 min against M. avium-intracellulare. The results demonstrate that Perasafe is an effective disinfectant for use in reprocessing fibreoptic bronchoscopes.

Red foxes (Vulpes vulpes) are a natural intermediate host of Neospora caninum.

The present study was undertaken to determine if red foxes are natural intermediate and/or definitive host for Neospora caninum and to study the importance of infection of N. caninum in this species in North-eastern Spain. Faecal samples and brain tissues were obtained from 122 foxes from 21 rural areas of Catalonia. Faeces collected were examined for parasite eggs and coccidian oocysts using sucrose flotation. For PCR-based diagnosis of N. caninum in brain tissues, the specific genomic Nc5 region was selected as the target sequence for DNA amplification. To control for PCR failure and facilitate identification of truly negative samples, the competitor pNc5C molecule was added to all negative samples in a second round of PCR reactions. Of the 122 foxes analysed, 13 (10.7%) were positive by PCR for N. caninum. Signal intensities of all positive samples were relatively weak with the exception of one sample from a 3-month male animal, that also showed the highest repeatability. No differences were observed by sex, age or area of sampling analysis. Detection of stages of N. caninum in brain from naturally infected red foxes demonstrated that red foxes are a natural intermediate host for N. caninum. Faecal samples were analysed for the presence of N. caninum oocysts, however, no oocysts compatible with N. caninum were found. A widespread latent infection of red foxes in North-eastern Spain found in the present study indicates that red foxes could have a very important role in the epidemiology of neosporosis in our area.

Bovine piroplasms in Minorca (Balearic Islands, Spain): a comparison of PCR-based and light microscopy detection.

The present study provides the first epidemiological data regarding infection by Theileria and Babesia piroplasms in cattle in Minorca. More than 94% of the studied animals were positive for the presence of Theileria sp., and of those, 41.3% were positive for the presence of Theileria annulata. These results indicate that the prevalence of Mediterranean theileriosis caused by T. annulata is very high in Minorcan dairy farms and that other Theileria sp. are also present in the area. The prevalence of infection was similar throughout the study indicating an endemic situation in this island. The use of PCR resulted in significantly higher efficacy of detection of Theileria sp. compared to microscopical observation (MO) of blood smears and allowed the specific discrimination between pathogenic and non-pathogenic theilerias which cannot be accomplished by traditional diagnosis by MO. Babesia infection in the area was mainly due to Babesia bigemina (6.0% of the studied animals were infected), while one animal (0.75%) was found to be infected by Babesia bovis. It was observed that 31% of animals infected with B. bigemina had a concurrent infection of T. annulata. PCR also resulted in a significantly higher efficacy of detection of Babesia sp. compared to MO when infection levels were higher, towards the end of the study period. The results clearly demonstrate that parasitic infection by piroplasms, especially Theileria sp. is common and endemic in the island of Minorca and that PCR is the optimal approach for the detection and discrimination of these important parasites.

A survey of ticks (Acari: Ixodidae) on dairy cattle on the island of Menorca in Spain.

A survey of ticks affecting dairy cattle under extensive management on Menorca island (off the Spanish Mediterranean coast) was performed through 1999-2000 on seven farms. The species collected were Rhipicephalus bursa, R. turanicus, Hyalomma m. marginatum, H. lusitanicum and Boophilus annulatus. The most abundant species were R. bursa and H. m. marginatum, with peaks of 10.7 (in summer) and 7.5 (in spring) ticks/cow, respectively. R. turanicus was scarcely encountered, while B. annulatus and H. lusitanicum were abundant only in a few localities. The mild climate and adequate vegetation on the island provide satisfactory habitat for extended periods of tick activity, as compared with other regions where these ticks have been collected. The competence of the ticks as vectors for pathogens and the difficulty of using acaricide treatments in the region are discussed.

Physiological Status and Community Composition of Microbial Mats of the Ebro Delta, Spain, by Signature Lipid Biomarkers.

Physiological status of microbial mats of the Ebro Delta (Tarragona, Spain) based on the extraction of lipids considered "signature lipid biomarkers" (SLB) from the cell membranes and walls of microorganisms has been analyzed. Data from a day-night cycle show significant differences in viable cells countings (PLFA cells counts) ranging from 1.5 x 10(10) to 5.0 x 10(10) cells g(-1) of sediment. Minimum values were observed at 18:00 and 6:00, when physicochemical conditions change drastically. The diversity of the microbial community was assessed by GC/MS analysis of phospholipid fatty acids (PLFA). The ratio of PLFA, representative of Gram-negative bacteria, comprises 47.8% of the total PLFA of the microbial mat community. The remaining PLFA was representative of Gram-positive (10.0%), anaerobic (5.7%), and eukaryotic microorganisms (5.7%), and other common lipids. Two different approaches were used as a comparative study to assess the physiological status of the microbial mats. Two parameters (cyclopropane fatty acids/omega7c monoenoic fatty acids, and measurement of the trans/cis monoenoic PLFA ratio) showed a minimum at midnight, suggesting the highest microbial activity. Higher values were observed at 18:00 and 6:00, coinciding with lower PLFA cell counts.

Presumptive Babesia ovis infection in a spanish ibex (Capra pyrenaica).

On December 29 1995, a 13-year old, male Spanish ibex was easily captured by hand, with depression, weakness and severe tick infestation, mainly in the periocular and auricular regions. Blood and serum samples were collected and haematological analysis and serum iron levels were determined. Red blood cell count, haematocrit, haemoglobin concentration and mean corpuscular haemoglobin concentration (MCHC) were decreased and mean corpuscular volume (MCV) increased (macrocytic-hypochromic anemia). Serum iron and transferrin saturation were decreased and total and unbound iron-binding capacity were increased. Piroplasms were observed within parasitized erythrocytes and presumptively identified as Babesia spp. Ticks were identified exclusively as Ripicephalus bursa. The animal was treated with imidocarb but died after 15 days of capture. Histopathological examination revealed congestion of pulmonary capillaries and spleen, glomerulonephritis, hemoglobinuric nephrosis and generalized hemosiderosis. An indirect fluorescent antibody test was performed using a Babesia ovis isolate of ovine origin as antigen and the animal was positive with a titre of 1:640.