Performance of a Quantitative PCR-Based Assay and Beta-d-Glucan Detection for Diagnosis of Invasive Candidiasis in Very-Low-Birth-Weight Preterm Neonatal Patients (CANDINEO Study).

An epidemiological, multicenter, noninterventional, observational case-control study was conducted to describe the performance of serum beta-d-glucan (BDG) and Candida PCR in blood, serum, and sterile samples for the diagnosis of invasive candidiasis (IC) in very-low-birth-weight (VLBW) preterm neonates and to compare these techniques with culture of samples from blood and other sterile sites. Seventeen centers participated in the study, and the number of episodes analyzed was 159. A total of 9 episodes of IC from 9 patients (7 confirmed and 2 probable) and 150 episodes of suspected sepsis from 117 controls were identified. The prevalence of IC was 5.7% (95% confidence interval [95% CI], 2.1 to 9.3). The mortality was significantly higher in episodes of IC (44.4%) than in the non-IC episodes (11.1%, P < 0.01). The sensitivity and specificity of the PCR performed on blood/serum samples were 87.5% and 81.6%, respectively. The sensitivity and specificity of the BDG results were lower (75.0% and 64.6%). For cases with negative culture results, the PCR and the BDG results were positive in 27 (17.4%) and 52 (33.5%) episodes, respectively. The presence of multiorgan failure, improvement with empirical antifungal therapy, thrombocytopenia, and Candida colonization were significantly associated (P < 0.01) with PCR or BDG positivity regardless of the results of the cultures. Serum BDG analysis and Candida PCR could be used as complementary diagnostic techniques to detect IC in VLBW neonates.

Cryptococcus gattii infection in a Spanish pet ferret (Mustela putorius furo) and asymptomatic carriage in ferrets and humans from its environment.

A domestic ferret (Mustela putorius furo) was presented with lymphadenopathy and acute bilateral blindness. Cytologic evaluation and biopsy of an affected lymph node revealed pyogranulomatous lymphadenitis with intralesional yeast consistent with Cryptococcus sp. Subsequent studies demonstrated Cryptococcus gattii serotype B VGI/AFLP4 as the causative agent. The ferret was treated with fluconazole and prednisone. After one month of therapy, an improvement of the clinical symptoms was detected although blindness persisted. Seven months after presentation, the disease progressed to a severe neurologic condition, and it was euthanized. Postmortem exam revealed disseminated cryptococcosis with prominent neurologic involvement. Nasal swabs of other ferrets and humans from the same household revealed that two ferrets and two humans to be asymptomatic carriers of the same strain of cryptococcus as the necropsied ferret. These findings stress the importance of veterinary diagnostic work with pets and epidemiological investigations for disease prevention in them and in their owners.

Serological study of Trypanosoma cruzi, Strongyloides stercoralis, HIV, human T cell lymphotropic virus (HTLV) and syphilis infections in asymptomatic Latin-American immigrants in Spain.

OBJECTIVE: We aimed to perform a serological screening for T. cruzi, Strongyloides stercoralis, HIV, human T cell lymphotropic virus (HTLV) and syphilis in Latin American immigrants admitted to hospital in Spain. METHODS: We have carried out a cross-sectional study of Latin American immigrants admitted to the Hospital General Universitario Alicante (Spain) from June 2012 to May 2014, where screening of Chagas disease, strongyloidiasis, HTLV, HIV and syphilis was performed by serology. RESULTS: A total 180 patients were included in the study. Patients' median age was 38 years old, 123 (68.3%; 123/180) were female and 57 (31.7%; 57/180) male. Five of the 180 (2.5%) patients were positive for Chagas disease; associated with knowledge about Chagas disease (p=0.005), previous contact with patients with Chagas disease (p=0.04) and being Bolivian (p<0.001). Forty-two of the 157 (26.8%) patients were positive for Strongyloides serology; associated positively with being male (p<0.001), eosinophilia (p=0.001), hyper-IgE (p<0.001) and being Ecuadorian (p=0.001), and negatively associated with being Colombian (p=0.03). Positive serology of latent syphilis was found in 1.8% (3/171) of patients. Serology of HTLV was negative in all cases. No new cases of HIV infection were diagnosed. CONCLUSIONS: We propose that Latin American immigrant patients admitted to hospital in Spain be screened for strongyloidiasis, Chagas disease and syphilis by serology.

Comparison of stool immunoassay with standard methods for detection of Helicobacter pylori infection in patients with upper-gastrointestinal bleeding of peptic origin.

OBJECTIVE: To assess the accuracy of the determination of Helicobacter pylori infection by a stool immunoassay in patients with upper-gastrointestinal bleeding (UGB) of peptic origin, in comparison with the routine histological study, serology, rapid urease and 13C-breath tests. METHODS: Sixty-eight patients with endoscopically proven UGB of peptic origin were included. The presence of H. pylori was considered when observed on histology or, if negative, by the positive indications of two of the remaining tests (serology, rapid urease,13C-breath test). The accuracy of stool immunoassay was estimated according to results obtained with other diagnostic methods. RESULTS: Lesions causing gastrointestinal bleeding were 49 duodenal ulcers, 11 gastric ulcers, six pyloric channel ulcers, 13 acute lesions of the gastric mucosa, and 16 erosive duodenitis. H. pylori infection was present in 59 (86.76%) patients. Forty-one patients had received nonsteroidal anti-inflammatory drugs. The sensitivity and specificity of the diagnostic methods were 47.5% and 100% for the rapid urease test, 93% and 87.5% for the breath test, 86.4% and 77.7% for serology, 89.4% and 100% for histology, and 96.6% and 33.3% for the stool test. CONCLUSIONS: The detection of H. pylori antigen in stools in patients with UGB of peptic origin has a good sensitivity (96.6%) but a low specificity (33.3%) for the diagnosis of H. pylori infection, which probably makes this test an inadequate tool in this setting if utilized alone.

Bicitopenia secundaria a infección por parvovirus B19 en un octogenario. Presentación de un caso / Bicytopenia due to parvovirus b19 infection in octogenarian: a case report

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Endophthalmitis caused by Fusarium proliferatum.

Fusarium proliferatum caused endophthalmitis after cataract surgery. Diagnosis was established by classical microbiology and molecular biology methods (PCR and DNA typing). The treatment with local amphotericin B, oral ketoconazole, and topical natamycin was successful.

First case of human cryptococcosis due to Cryptococcus neoformans var. gattii in Spain.

We report the first case of human cryptococcosis due to Cryptococcus neoformans var. gattii described in our country, which was presented as brain cryptococcoma in an immunocompetent patient. An extensive sampling of the patient's environment was carried out to find the source of infection.

[Parvovirus B19 outbreak in a rural community in Alicante]. / Brote por parvovirus B19 en una comunidad rural del área de salud de Alicante.

BACKGROUND: Parvovirus B19 (PVB19) has been identified as the cause of erythema infectiosum. The epidemiology of PVB19 has not been extensively studied in Spain or in the autonomic community of Valencia. The aim of this work is to describe an outbreak of PVB19 infection occurring in the area of Monforte del Cid, Alicante. METHODS: A probable case was defined as: all subjects living in Monforte who presented a rash (mainly facial) and/or arthralgia starting from November 1999. A confirmed case was defined as: a probable case confirmed by laboratory analysis or a case having an epidemiological link. Laboratory confirmation included specific IgG or IgM antibodies to PVB19. Cases were mainly detected through the Monforte del Cid Primary Health Care Center. RESULTS: The outbreak occurred from November 1999 to August 2000. A total of 118 cases were detected, giving an overall attack rate (AR) of 23.2 cases per 1,000 inhabitants. The highest rates were in the age groups of 0-4 years old (AR 5 114.5 per 1,000) and 5-9 years old (AR 5 180.3 per 1,000). By gender, the AR per 1,000 inhabitants was 26.9 in men and 16.7 in women. Two of the cases were pregnant women and one of them had a miscarriage. CONCLUSIONS: The outbreak of erythema infectiosum lasted 10 months and mainly affected children under 14 years old. Active surveillance was focussed on women in the first three months of pregnancy.

El laboratorio de microbiología clínica en el brote de Legionella SPP, en la comarca de Alcoy: rentabilidad de las diferentes técnicas diagnósticas / The role of the clinical microbiology laboratory during the outbreak of Legionella spp., in the municipality of Alcoy: the effectiveness of different diagnosis methods

FUNDAMENTO. La rentabilidad de diferentes técnicas de laboratorio en el diagnóstico de Legionella spp. en muestras clínicas varía según el contexto epidemiológico. En este trabajo se evalúa la utilidad de los métodos de laboratorio en un brote aparecido en la comarca de Alcoy (Alicante). MATERIAL Y MÉTODOS. Se estudian 222 casos comunitarios de infección por Legionella pneumophila serogrupo I, subtipo Pontiac-Knoxville, genotipos I y II, diagnosticados por el laboratorio de Microbiología, en el período comprendido entre enero de 1999 y diciembre del año 2000, correspondientes a pacientes residentes en la comarca de Alcoy (Alicante). Las técnicas empleadas han sido la detección directa de antígeno en muestras respiratorias por inmunofluorescencia, la detección directa de antígeno en orina, el cultivo y la serología. RESULTADOS. El antígeno en orina permitió diagnosticar 201 casos (90,5 por ciento). La inmunofluorescencia directa dio una alta tasa de resultados falsamente positivos (n=24). El cultivo fue esencial para confirmar la etiología del brote (25 cepas de esputos de 22 enfermos). La serología complementó al resto de técnicas y ayudó a diagnosticar retrospectivamente a 21 enfermos (9 por ciento) en los que el resto de pruebas no se solicitaron o resultaron negativas. CONCLUSIONES. El diagnóstico rápido es esencial para la evaluación de los pacientes y para el control de los brotes epidémicos, a lo que ayuda en gran medida la detección de antígeno urinario, pero debe ser complementado por otras técnicas. El cultivo de las muestras respiratorias y posterior tipado de las cepas permite establecer de forma certera la etiología y ayuda a precisar la/s fuente/s de la infección. La serología complementó el diagnóstico en el 9 por ciento de casos (AU)

Brote por parvovirus B19 en una comunidad rural del área de salud de Alicante / Parvovirus B19 outbreak in a rural community in Alicante

FUNDAMENTOS. El parvovirus B19 (PVB19) es el agente etiológico del eritema infeccioso. La epidemiología del PVB19 ha sido poco estudiada en España y en la Comunidad Valenciana. El objetivo del estudio es describir un brote epidémico de PVB19 ocurrido en Monforte del Cid (Alicante).MÉTODOS. Se definió como caso probable: toda persona que vive en Monforte y desde el mes de noviembre del año 1999 presentó un cuadro exantemático, principalmente facial, y/o artralgias. Se definió como caso confirmado todo caso probable confirmado por laboratorio o por vínculo epidemiológico. La confirmación por laboratorio se realizó por la investigación de anticuerpos IgG o IgM específicos a PVB19. La detección de casos se realizó principalmente a través del Centro de Atención Primaria de Monforte. RESULTADOS. El brote ocurrió entre el mes de noviembre del 1999 y agosto de 2000. Se detectaron 118 casos lo que supone una tasa de ataque (TA) global de 23,2/1.000 habitantes. Las tasas de ataque más altas fueron para el grupo de edad de 0-4 (TA 114,5/1.000) y el grupo de 5-9 (TA 180,3/1.000). Por sexo, la tasa de ataque por 1.000 habitantes para los varones fue de 26,9 y para las mujeres de 16,7. Dos de los casos detectados fueron mujeres embarazadas, una de las cuales sufrió un aborto espontáneo. CONCLUSIONES. Brote de eritema infeccioso que afectó principalmente a niños menores de 14 años. El brote duró 10 meses. La vigilancia activa se focalizó principalmente en las mujeres que estaban en el primer trimestre del embarazo (AU)