Molecular diagnosis of Chagas disease: a systematic review and meta-analysis.

BACKGROUND: The complexity of the Chagas disease and its phases is impossible to have a unique test for both phases and a lot of different epidemiological scenarios. Currently, serology is the reference standard technique; occasionally, results are inconclusive, and a different diagnostic technique is needed. Some guidelines recommend molecular testing. A systematic review and meta-analysis of available molecular tools/techniques for the diagnosis of Chagas disease was performed to measure their heterogeneity and efficacy in detecting Trypanosoma cruzi infection in blood samples. METHODS: A systematic review was conducted up to July 27, 2022, including studies published in international databases. Inclusion and exclusion criteria were defined to select eligible studies. Data were extracted and presented according to PRISMA 2020 guidelines. Study quality was assessed using Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2). A random-effects model was used to calculate pooled sensitivity, specificity, and diagnostic odds ratio (DOR). Forest plots and a summary of the receiving operating characteristics (SROC) curves displayed the outcomes. Heterogeneity was determined by I2 and Tau2 statistics and P values. Funnel plots and Deek's test were used to assess publication bias. A quantitative meta-analysis of the different outcomes in the two different clinical phases was performed. RESULTS: We identified 858 records and selected 32 papers. Studies pertained to endemic countries and nonendemic areas with adult and paediatric populations. The sample sizes ranged from 17 to 708 patients. There were no concerns regarding the risk of bias and applicability of all included studies. A positive and nonsignificant correlation coefficient (S = 0.020; P = 0.992) was obtained in the set of studies that evaluated diagnostic tests in the acute phase population (ACD). A positive and significant correlation coefficient (S = 0.597; P < 0.000) was obtained in the case of studies performed in the chronic phase population (CCD). This resulted in high heterogeneity between studies, with the master mix origin and guanidine addition representing significant sources. INTERPRETATION/CONCLUSIONS AND RELEVANCE: The results described in this meta-analysis (qualitative and quantitative analyses) do not allow the selection of the optimal protocol of molecular method for the study of Trypanosoma cruzi infection in any of its phases, among other reasons due to the complexity of this infection. Continuous analysis and optimization of the different molecular techniques is crucial to implement this efficient diagnosis in endemic areas.

Síndrome de úlcera rectal solitaria en un centro hospitalario de tercer nivel entre los años 2010-2020: ¿estamos haciendo bien las cosas? / Solitary rectal ulcer syndrome in a tertiary care hospital between 2010-2020: are we doing things right?

Introduction: Solitary rectal ulcer syndrome is a poorly studied pathology. Its diagnosis is established by the combination of clinical, endoscopic, histopathological and microbiological findings. The objective of this work is to describe the main clinical characteristics and characteristics of patients with solitary rectal ulcer treated at the Salamanca University Assistance Complex (CAUSA). Material and methods: Retrospective observational descriptive study, between 2010 and 2020. Results: Of the 157 patients studied, 52.9% (83) were men, with a mean age of 68.8 ± 18.2 years. The diagnostic delay was 6.85±16.56 months (1-84). Non-infectious etiology was described in 93.6% of cases, with nonspecific rectal ulcer (36%), solitary rectalulcer (14.9%) and actinic proctitis (14.2%) being the most frequent. Infections were studied in 56 patients, objectifying an infectious agent in 10 patients, the most frequent pathogens were Clostridoides difficile (40%), Cytomegalovirus (20%), Chlamydia trachomatis (10%) and Epstein Barr Virus (10%). The most frequent symptom was rectal bleeding (43.3%), followed by anemia (15.3%), constipation (10.8%), and diarrhea (6.37%). Symptom resolution occurred in 30.6% (48) of the patients and symptom recurrence was present in 10.2% (16). Conclusions: In most cases, the study of rectal ulcer syndrome is not carried out exhaustively, which determines a low rate of etiological diagnosis. In our series, adult males without etiological diagnosis predominate. It is essential to coordinate the different services involved and protocolize their management to optimize their diagnosis and treatment. (AU)

Introducción: El síndrome de úlcera rectal solitaria es una patología poco estudiada puede presentarse con sangrado rectal, y una sensación de evacuación incompleta. Su diagnóstico se establece por la combinación de hallazgos clínicos, endoscópicos, histopatológicos y microbiológicos. El objetivo de este trabajo es describir las principales características clínicas y de los pacientes con úlcera rectal solitaria atendidos en el Complejo Asistencial Universitario de Salamanca (CAUSA). Material y métodos: Estudio descriptivo observacional retrospectivo,entre los años 2010 y 2020. Resultados: De los 157 pacientes estudiados, 52,9 % (83) fueron hombres, con edad media de 68,8 ±18,2 años. El retraso diagnóstico fue de 6,85± 16,56 meses (1-84). La etiología no infecciosa se describió en el 93,6% de los casos, siendo más frecuente la úlcera rectal inespecífica (36%), úlcera rectal solitaria (14,9%) y proctitis actínica(14,2%). Se estudiaron infecciones en 56 pacientes, objetivándose un agente infeccioso en 10 pacientes, los patógenos más frecuentes fueron Clostridoides difficile (40%), Citomegalovirus (20%), Chlamydia trachomatis (10%) y Virus de Epstein Barr (10%). El síntoma más frecuente fue rectorragia (43,3%), seguido de anemia (15,3%), estreñimiento (10,8%), y diarrea (6,37%). La resolución de los síntomas tuvo lugar un 30,6% (48) de los pacientes y la recurrencia de la sintomatología estuvo presente en 10,2% (16). Conclusiones: En la mayoría de las ocasiones no se realiza de forma exhaustiva el estudio del síndrome de úlcera rectal solitaria, lo que condiciona una baja tasa del diagnóstico etiológico. En nuestra serie predominan varones adultos sin diagnóstico etiológico. Es imprescindible coordinar a los diferentes servicios implicados y protocolizar su manejo para optimizar su diagnóstico y tratamiento. (AU)

Impact of pneumocystosis on the Spanish health care system, 1997-2020: Profile of HIV and non-HIV immunocompromised patients.

BACKGROUND: Pneumocystis jirovecii is an opportunistic fungus recognized for causing P. jirovecii pneumonia. The global prevalence is thought to be higher than 400,000 annual cases, although detailed information about epidemiological patterns is scarce. METHODOLOGY: A retrospective longitudinal descriptive study was performed among patients with diagnosis of pneumocystosis according to Classification of Diseases 9th edition, Clinical Modification (code 136.3 for the cases from 1997 to 2015; and 10th edition code B59.0 for cases from 2016 to 2020 in Spanish public hospitals from 1 January 1997-31 December 2020. RESULTS: A total of 25289 cases were diagnosed. The period incidence rate was 2.36 (95 % CI, 2.33-2.39) cases per 100,000 person-years. Infection was more frequent among men (72.2 %) than among women (27.8 %). Comorbidity was the main characteristic of this cohort. Up to 72.3 % of pneumocystis-infected patients (18293) had HIV coinfection. During the study period, there was a progressive decrease in the number of HIV coinfected cases as the group of patients without HIV infection increased, with the largest group in 2017. The lethality rate in the cohort was 16.7 %. The global cost was €229,234,805 and the average ( ± SD) cost per patient was €9065 ( ± 9315). CONCLUSIONS: The epidemiology of pneumocystosis in Spain has changed in the last two decades. We noted in our study the possibility of a reemergence among non-HIV immunocompromised patients as patients with hematological and nonhematological neoplasia and other risk groups. The lethality of pneumocystosis continues to be high, and the underlying diseases are the main variable associated with lethality.

Is babesiosis a rare zoonosis in Spain? Its impact on the Spanish Health System over 23 years.

BACKGROUND: Babesiosis is a zoonosis caused by an intraerythrocytic protozoan of the genus Babesia and transmitted mainly by ticks of the Ixodes spp. complex. There is no comprehensive global incidence in the literature, although the United States, Europe and Asia are considered to be endemic areas. In Europe, the percentage of ticks infected with Babesia spp. ranges from 0.78% to 51.78%. The incidence of babesiosis in hospitalized patients in Spain is 2.35 cases per 10,000,000 inhabitants/year. The mortality rate is estimated to be approximately 9% in hospitalized patients but can reach 20% if the disease is transmitted by transfusion. OBJECTIVE: To analyze the epidemiological impact of inpatients diagnosed with babesiosis on the National Health System (NHS) of Spain between 1997 and 2019. METHODOLOGY: A retrospective longitudinal descriptive study that included inpatients diagnosed with babesiosis [ICD-9-CM code 088.82, ICD-10 code B60.0, cases ap2016-2019] in public Spanish NHS hospitals between 1 January 1997 and 31 December 2019 was developed. Data were obtained from the minimum basic dataset (CMBD in Spanish), which was provided by the Ministerio de Sanidad, Servicios Sociales e Igualdad after the receipt of a duly substantiated request and the signing of a confidentiality agreement. MAIN FINDINGS: Twenty-nine inpatients diagnosed with babesiosis were identified in Spain between 1997 and 2019 (IR: 0.28 cases/10,000,000 person-years). A total of 82.8% of the cases were men from urban areas who were approximately 46 years old. The rate of primary diagnoses was 55.2% and the number of readmissions was 79.3%. The mean hospital stay was 20.3±19.2 days, with an estimated cost of €186,925.66. Two patients, both with secondary diagnoses of babesiosis, died in our study. CONCLUSIONS: Human babesiosis is still a rare zoonosis in Spain, with an incidence rate that has been increasing over the years. Most cases occurred in middle-aged men from urban areas between summer and autumn. The Castilla-La-Mancha and Extremadura regions recorded the highest number of cases. Given the low rate of primary diagnoses (55.2%) and the high number of readmissions (79.3%), a low clinical suspicion is likely. There was a 6.9% mortality in our study. Both patients who died were patients with secondary diagnoses of the disease.

How Has the Aspergillosis Case Fatality Rate Changed over the Last Two Decades in Spain?

(1) Background: Aspergillus produces high morbidity and mortality, especially in at-risk populations. In Spain, the evolution of mortality in recent years due to this fungus is not well established. The aim of this study was to estimate the case fatality rate of aspergillosis in inpatients from 1997 to 2017 in Spain. (2) Methodology: A retrospective descriptive study was conducted with records of inpatients admitted to the National Health System with a diagnosis of aspergillosis. (3) Principal findings: Of 32,960 aspergillosis inpatients, 24.5% of deaths were registered, and 71% of the patients who died were men. The percentage of deaths increased progressively with age. The case fatality rate progressively decreased over the period, from 25.4 and 27.8% in 1997-1998 to values of 20.6 and 20.8% in 2016 and 2017. Influenza and pneumonia occurrence/association significantly increased case fatality rates in all cases. (4) Conclusions: Our study shows that lethality significantly decreased in the last two decades despite the increase in cases. This highlights the fact that patients with solid and/or hematological cancer do not have a much higher mortality rate than the group of patients with pneumonia or influenza alone, these two factors being the ones that cause the highest CFRs. We also need studies that analyze the causes of mortality to decrease it and studies that evaluate the impact of COVID-19.

Usefulness of the FDG PET/CT in the management of cystic echinococcosis: A pilot study.

OBJECTIVES: Cystic echinococcosis is a zoonotic disease caused by the cestode Echinococcus granulosus. The activity of the cysts is assessed through the WHO-IWGE standardized classification based on ultrasound features. However, viability of the cysts is not always concordant with the activity assessed by ultrasound. The aim of the present study is to describe the metabolic activity of cysts in patients with cystic echinococcosis through FDG-PET. METHODS: Prospective observational study where adult patients diagnosed of cystic echinococcosis were offered to undergo FDG PET/CT before treatment onset. Demographic, clinical, radiological, and histopathological information was collected from all patients. RESULTS: Sixteen patients were included, 50% were male, and age ranged from 18 to 85 years. Most of the patients had liver involvement, and all patients had CE3, CE4 or CE5 stage of the WHO-IWGE classification. Only one patient (CE5) had an increased 18F-FDG uptake of the cyst in the FDG PET/CT. From the 5 patients who underwent surgical treatment, only one showed signs of viability of the cyst: a patient with CE5 with no increased 18F-FDG uptake of the cyst. CONCLUSION: In our pilot study, we did not find the correlation between the FDG PET/CT imaging and the cystic echinococcosis cyst bioactivity.

Increasing Incidence of mucormycosis in Spanish inpatients from 1997 to 2018.

BACKGROUND: Mucormycosis is a worldwide angio-invasive fungal infection that is associated with high morbidity and mortality. A few European studies have focused on the epidemiology. METHODOLOGY: A retrospective longitudinal descriptive study was performed with inpatients diagnosed with mucormycosis (ICD-9-CM, code 117.7, cases 1997-2015; and ICD-10, code B46, cases 2016-2018; along with length of hospital stay) in Spanish public hospitals between 1 January 1997 and 31 December 2018. Data were obtained from the Minimum Basic Data Set (CMBD in Spanish). PRINCIPAL FINDINGS: A total of 962 patients were recorded; 665 were men. The mean age (±SD) was 55 ± 18.8 years. The annual incidence rate increased from 0.74 to 1.24 cases per million person-years. The lethality rate was 31.3%. Renal failure (41.6%) and haematological malignancy (36.3%) were the main factors involved. CONCLUSIONS: Mucormycosis is a rare infectious disease in Spain, but it has had a significantly increased incidence in the last two decades. Being an adult male and having diabetes, neoplasm or renal failure are the main factors associated. High mortality is usually associated mainly with haematological malignancy and renal failure. CMBD studies could be an efficient tool for assessing changes in the epidemiology of mucormycosis.

Portal Hypertension as a Complication of Cystic Echinococcosis: A 20-Year Cohort Analysis.

Cystic echinococcosis (CE) is a parasitic disease caused by the larval forms of species of the tapeworm Echinococcus. The most common location is the liver. To assess the frequency and clinical characteristics of portal hypertension (PH) and the risk factors for PH development, we performed a retrospective observational study of inpatients diagnosed with hepatic CE and PH from January 1998 to December 2018, at Complejo Asistencial Universitario de Salamanca, Spain. Of 362 patients analyzed with hepatic CE, 15 inpatients (4.1%) had a portal vein diameter ≥ 14 mm, and the mean diameter of the portal vein was 16.9 (standard deviation [SD] ±2.1) mm. Twelve patients were men. The mean age was 59.5 years (SD ± 17.8 years). Four patients had ascites (26.6%), four had collateral circulation (26.6%), 14 had hepatosplenomegaly (93.3%), five had esophageal varices (33.3%), four had hematemesis, and three had jaundice. Other causes of PH included hepatitis B virus (1 patient) and hepatitis C virus (1 patient) infections and alcohol abuse (1 patient). The host variables associated with PH development were male sex (odds ratio, 4.6; 95% confidence interval, 1.1-20.9; P = 0.030) and larger cyst size (10.8 ± 6.3 versus 7.6 ± 4.1; P = 0.004). Hepatic CE is an infrequent cause of PH that usually occurs without indications of liver failure. Larger cyst size and male sex were the main risk factors associated with this complication. Mortality was higher for patients with hepatic CE with PH than for patients with hepatic CE without PH.

Epidemiological assessment of 5598 brucellosis inpatients in Spain (1997-2015).

Brucellosis remains one of the main zoonoses worldwide. Epidemiological data on human brucellosis in Spain are scarce. The objective of this study was to assess the epidemiological characteristics of inpatient brucellosis in Spain between 1997 and 2015. A retrospective longitudinal descriptive study was performed. Data were requested from the Health Information Institute of the Ministry of Health and Equality, which provided us with the Minimum Basic Data Set of patients admitted to the National Health System. We also obtained data published in the System of Obligatory Notifiable Diseases. A total of 5598 cases were registered. The period incidence rate was 0.67 (95% CI 0.65-0.68) cases per 100 000 person-years. We observed a progressive decrease in the number of cases and annual incidence rates. A total of 3187 cases (56.9%) came from urban areas. The group most at risk comprised men around the fifth decade of life. The average (±s.d.) hospital stay was 12.6 days (±13.1). The overall lethality rate of the cohort was 1.5%. The number of inpatients diagnosed with brucellosis decreased exponentially. The group of patients with the highest risk of brucellosis in our study was males under 45 years of age and of urban origin. The lethality rate has reduced to minimum values. It is probable that hospital discharge records could be a good database for the epidemiological analysis of the hospital management of brucellosis and offer a better information collection system than the notifiable diseases system (EDO in Spanish).

Epidemiology of aspergillosis in hospitalised Spanish patients-A 21-year retrospective study.

BACKGROUND: Aspergillosis is a serious infection, and in Spain, the influence of epidemiology and climate on the resulting expenses of aspergillosis is not well established. AIM: A retrospective descriptive study using the Minimum Basic Data Set was performed on records of patients admitted to hospitals of the National Health System between 1997 and 2017 with a diagnosis of aspergillosis. The weather parameters were obtained from the State Agency of Meteorology from Spain. RESULTS: A total of 32,960 patients were identified, of whom 22,383 were men (68%). The mean age (±SD) was 61.1 ± 19.1 years. The mean incidence rate for all diagnoses was 3.54 cases per 100,000 person-years (95% CI, 3.50-3.57). The incidence rate in men was twice as high as that in women, 4.89 (95% CI, 4.82-4.95) vs. 2.24 (95% CI, 2.19-2.27) cases per 100,000 person-years (p > .001). The highest incidence rates were concentrated in northern Spain. One in four patients died (8,080 cases; 25%). There was a moderate positive linear association between rainfall and incidence rate (rP  = .508; p = .026). In contrast, the Pearson's correlation coefficient indicated a moderate negative linear relationship between temperature and incidence rate (rP  = -.447; p = .050). We observed a higher incidence in the months with higher humidity and rainfall. CONCLUSIONS: Our study supports a high burden of aspergillosis in Spain, with an increase in cases in the past two decades. Additionally, the influence of climatological factors on the incidence of aspergillosis is highlighted. Despite preemptive treatment strategies, this infection still has a high mortality.

Epidemiological of cat scratch disease among inpatients in the Spanish health system (1997-2015).

Cat scratch disease, whose causative agent is Bartonella henselae, is an anthropozoonosis with a worldwide distribution that causes significant public health problems. Although it is an endemic disease in Spain, the available data are very limited. The aim of our study was to describe cat scratch disease inpatients in the National Health System (NHS) of Spain. This was a retrospective descriptive study using the minimum basic data set (CMBD in Spanish) in patients admitted to hospitals of the NHS between 1997 and 2015 with a diagnosis of cat scratch disease (ICD-9: 078.3). We found 781 hospitalized patients diagnosed with cat scratch disease. The mean age (± SD) was 30.7 ± 25.3 years old. The male/female ratio was 1.1:1. The incidence rate over the study period was 0.93 (95% CI, 0.86-0.99) cases per million person-years. The incidence rate in men was 0.98 cases per million person-years and that in women was 0.88 cases per million person-years. The cases were more frequent from September to January. A total of 652 (83.5%) cases were urgent hospital admissions. The average hospital stay was 8.4 ± 8.9 days. The overall lethality rate of the cohort was 1.3%. We have demonstrated that CSD causes a substantial burden of disease in Spain, affecting both adult and pediatric patients with a stable incidence rate. Our data suggest that CSD is benign and self-limited, with low mortality, and its incidence is possibly underestimated. Finally, there is a need for a common national strategy for data collection, monitoring, and reporting, which would facilitate a more accurate picture and the design of more strategic control measures. Hospital discharge records (HDRs) could be a good database for the epidemiological analysis of the hospital management of CSD.

Eosinophilia and cystic echinococcosis: what is the relationship?

BACKGROUND: Cystic echinococcosis (CE) is a chronic, complex and neglected zoonotic disease caused by Echinococcus granulosus. Eosinophilia in CE is a classic analytic alteration, although its presentation and importance is very variable and not well established. METHODS: We performed a retrospective observational study of inpatients diagnosed with CE and eosinophilia from January 1998 to December 2017 in the Complejo Asistencial Universitario de Salamanca in western Spain. RESULTS: During the study period, 475 patients with a CE diagnosis underwent a haemogram and 118 (24.8%) patients had eosinophilia. Eighty-two (69.5%) were male and the mean age was 52.1±20.8 y, which was younger in the group with eosinophilia (p<0.001). The patients with eosinophilia had less comorbidity (33.1% vs 52.9%; p<0.001) and they were diagnosed with more complications (60.2% vs 39.8% asymptomatic; p<0.001). Clinical manifestations appeared in 71 cases (60.2%). The eosinophilia was related to the presence of pre-surgical fistulas (p=0.005). We observed significant differences when considering whether eosinophilia is a marker of the type of treatment (p<0.001). CONCLUSIONS: Eosinophilia can be an indicator for an active search in CE because as much as 40% of cases are asymptomatic at diagnosis. In patients with eosinophilia, management is usually more aggressive and is usually a combined treatment. Our work shows the importance of eosinophilia in our patients with CE and raises unresolved questions.

Complications Associated with Initial Clinical Presentation of Cystic Echinococcosis: A 20-year Cohort Analysis.

Cystic echinococcosis (CE) is a chronic, complex, and overlooked zoonotic disease caused by Echinococcus granulosus. In humans, it may result in a wide spectrum of clinical manifestations depending on the type of complications, ranging from asymptomatic infection to fatal disease. The primary complications and risk factors associated with CE are not well defined. We performed a retrospective, observational study of inpatients diagnosed with CE from January 1998 to December 2017 in the public health-care system of western Spain. Five hundred and six cases were analyzed. More than half of the patients (302 [59.7%]) were asymptomatic, and the diagnoses were made incidentally. A total of 204 (40.3%) patients had complications associated with CE; 97 (47.5%) were mechanical, 62 (30.4%) were infectious, 15 (7.3%) were immunoallergic, and 30 (14.7%) involved a combination of complications. Mortality was higher in patients with mechanical complications (9.4%) than in patients with infectious complications (5.6%) and in patients with allergic complications (0%) (odds ratio = 19.7, 95% CI, 4.3-89.1, P < 0.001). In summary, CE frequently results in complications, especially in the liver in younger patients and, regardless of other variables, such as size or stage of cyst. Mechanical problems and superinfection are the most frequent complications. CE is an obligatory diagnosis in patients with urticarial or anaphylactoid reactions of unknown cause in endemic areas.

Medical treatment of cystic echinococcosis: systematic review and meta-analysis.

BACKGROUND: Cystic echinococcosis (CE) is a well-known neglected parasitic disease. However, evidence supporting the four current treatment modalities is inadequate, and treatment options remain controversial. The aim of this work is to analyse the available data to answer clinical questions regarding medical treatment of CE. METHODS: A thorough electronic search of the relevant literature without language restrictions was carried out using PubMed (Medline), Cochrane Central Register of Controlled Trials, BioMed, Database of Abstracts of Reviews of Effects, and Cochrane Plus databases up to February 1, 2017. All descriptive studies reporting an assessment of CE treatment and published in a peer-reviewed journal with available full-text were considered for a qualitative analysis. Randomized controlled trials were included in a quantitative meta-analysis. We used the standard methodological procedures established by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. RESULTS: We included 33 studies related to the pharmacological treatment of CE in humans. Of these, 22 studies with levels of evidence 2 to 4 were qualitatively analysed, and 11 randomized controlled trials were quantitatively analysed by meta-analysis. CONCLUSIONS: Treatment outcomes are better when surgery or PAIR (Puncture, Aspiration, Injection of protoscolicidal agent and Reaspiration) is combined with benzimidazole drugs given pre- and/or post-operation. Albendazole chemotherapy was found to be the primary pharmacological treatment to consider in the medical management of CE. Nevertheless, combined treatment with albendazole plus praziquantel resulted in higher scolicidal and anti-cyst activity and was more likely to result in cure or improvement relative to albendazole alone.

Life-threatening dermatoses: Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis. Impact on the Spanish public health system (2010-2015).

BACKGROUND: Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) are serious mucocutaneous reactions. In Spain, the epidemiology and resulting expenses of these diseases are not well established. METHODOLOGY: Retrospective descriptive study using the Minimum Basic Data Set (CMBD in Spanish) in patients admitted to hospitals of the National Health System between 2010 and 2015 with a diagnosis of SJS and TEN (combination of ICD-9 codes 695.13, 695.14, and 695.15, along with length of hospital stay). PRINCIPAL FINDINGS: A total of 1,468 patients were recorded, 773 were men (52.7%). The mean age (± SD) was 52.25 ± 26.15 years. The mean incidence rate for all diagnoses was 5.19 cases per million person-years (2.96 in SJS, 0.31 in SJS/TEN and 1.90 in TEN). 148 patients died (10.1%), 47 due to SJS (5.6%) and 90 (16.7%) due to TEN. The estimated total medical cost of SJS, SJS/TEN, and TEN in Spain was €11.576.456,18, and the average medical cost per patient was €7.885,86 ± €11.686,26, higher medical cost in TEN (€10352.46 ± €16319,93) than in SJS (€6340,05 ± €7078,85) (p<0.001). CONCLUSIONS: Older patients have a more severe clinical picture and higher mortality rates. The overall mortality of both diseases is approximately 10%, and clinical diagnosis and age were the variables with the greatest influence on mortality. This study describes a stable incidence and a similar prevalence to other European countries. Additionally, the data show a high cost due to hospitalizations. Finally, the CMBD could be a good system of epidemiological analysis for the study of infrequent diseases and hospital management of conditions such as SJS and TEN.

Management of cystic echinococcosis in the last two decades: what have we learned?

Background: Management options for cystic echinococcosis (CE) remain a serious problem. The main aim of this study was to examine the selection and complications of treatment applied in patients with CE. The second aim was to evaluate the mortality rate and causative factors. Methods: A retrospective descriptive study of patients diagnosed with CE between 1998 and 2015 was conducted, according to ICD-9 (code 122·0 to 122·9) criteria in the Complejo Asistencial Universitario of Salamanca, Spain. Results: Four-hundred-ninety-one (491) patients were diagnosed with CE disease and the treatment applied in these patients were: 166 (33.8%) patients received only surgery, 176 (35.8%) surgery and drugs, 17 (3.5%) drugs alone, in 131 (26.7%) patients the strategy was 'watch and wait', and only one patient (0.2%) was applied puncture-aspiration-injection-respiration (PAIR). Thus, a total of 342 patients received surgery, either alone (166) or combined with drugs (176), and a total of 193 (39.4%) patients were medically treated, either alone (17) or combined with surgery (176); 123 (63.7%) patients used albendazole alone; and 70 (36.3%) patients used a combination of albendazole and praziquantel. Sixty-five patients (19.0%) had complications after surgery and seven of them (2%) died. Only 15 (7.8%) cases had side effects from anthelmintics. Throughout the study period, 80 (16.3%) patients died, 14 (2.9%) of them due to CE disease. Conclusions: Complications of CE are one of the most common causes of mortality in CE patients, with size, location, and number of cysts, and the 'watch and wait' treatment strategy being the main factors associated with mortality.

Recurrence of cystic echinococcosis in an endemic area: a retrospective study.

BACKGROUND: Cystic echinococcosis (CE) is a chronic, complex and neglected zoonotic disease. CE occurs worldwide. In humans, it may result in a wide spectrum of clinical manifestations, ranging from asymptomatic infection to fatal disease. Clinical management procedures have evolved over decades without adequate evaluation. Despite advances in surgical techniques and the use of chemotherapy, recurrence remains one of the major problems in the management of hydatid disease. The aim of this study was to determine the frequency of CE recurrence and the risk factors involved in recurrence. METHODS: A descriptive longitudinal-retrospective study was designed. We reviewed all patients diagnosed with CE according to ICD-9 (code 122-0 to 122-9) criteria admitted at Complejo Asistencial Universitario de Salamanca, Spain, between January 1998 and December 2015. RESULTS: Among the 217 patients studied, 25 (11.5%) had a hydatid recurrence after curative intention treatment. Median duration of recurrence's diagnosis was 12.35 years (SD: ±9.31). The likelihood of recurrence was higher [OR = 2.7; 95% CI, 1.1-7.1; p < 0.05] when the cyst was located in organs other than liver and lung, 22.6% (7/31) vs 14.2% (31/217) in the cohort. We detected a chance of recurrence [OR = 2.3; 95% CI, 1.4-6.5; p > 0.05] that was two times higher in those patients treated with a combination of antihelminthic treatments and surgical intervention (20/141, 14.2%) than in patients treated with surgical intervention alone (5/76, 6.6%). CONCLUSIONS: Despite advances in diagnosis and therapeutic techniques in hydatid disease, recurrence remains one of the major problems in the management of hydatid disease. The current management and treatment of recurrences is still largely based on expert opinion and moderate-to-poor quality of evidence. Consequently, large prospective and multicenter studies will be needed to provide definitive recommendations for its clinical management.

Imported cystic echinococcosis in western Spain: a retrospective study.

BACKGROUND: In Spain, 12% of the population are immigrants. The impact of immigration in Spain on cystic echinococcosis (CE) is unknown. The aim of this study was to describe the epidemiology of CE in immigrants in western Spain. METHODS: First, a retrospective descriptive study of patients diagnosed with CE in the University Hospital of Salamanca (CAUSA) between January 1998 and December 2014 was designed. Second, we studied the seroprevalence of CE in sera from foreigners who received treatment in the Tropical Medicine Unit. RESULTS: A total of 550 patients with new CE-related diagnoses were registered; of these, 16 (2.9%) were immigrants, of whom 10 (63%) were male. The age (mean±SD) was 34.6±12.8 years. The incidence rate of CE in immigrants was 8.76 cases per 105 person-years. Eight (50%) cases presented asymptomatically. Seroprevalence of CE in foreign patients was 2.3%. It was higher in North African population (4.2%), followed by sub-Saharan (2.4%) and Latin American (1.8%) (p=0.592) populations. The seroprevalence was higher in those who arrived recently (<12 months) vs those who arrived earlier (≥12 months), 3.5% vs 1.3% (p=0.077). CONCLUSIONS: The epidemiological and clinical characteristics of CE in immigrants are different than those of the native population, and their influence on CE burden in our endemic area is still limited.

Surveillance of Human Echinococcosis in Castilla-Leon (Spain) between 2000-2012.

BACKGROUND: Cystic echinococcosis (CE) is an important health problem in many areas of the world including the Mediterranean region. However, the real CE epidemiological situation is not well established. In fact, it is possible that CE is a re-emerging disease due to the weakness of current control programs. METHODOLOGY: We performed a retrospective observational study of inpatients diagnosed with CE from January 2000 to December 2012 in the Western Spain Public Health-Care System. PRINCIPAL FINDINGS: During the study period, 5510 cases of CE were diagnosed and 3161 (57.4%) of the cases were males. The age mean and standard deviation were 67.8 ± 16.98 years old, respectively, and 634 patients (11.5%) were younger than 45 years old. A total of 1568 patients (28.5%) had CE as the primary diagnosis, and it was most frequently described in patients <45 years old. Futhermore, a secondary diagnosis of CE was usually found in patients >70 year old associated with other causes of comorbidity. The period incidence rate was 17 cases per 105 person-years and was significantly higher when compared to the incidence declared through the Notifiable Disease System (1.88 cases per 105 person-years; p<0.001). CONCLUSIONS: CE in western Spain is an underestimated parasitic disease. It has an active transmission, with an occurrence in pediatric cases, but has decreased in the recent years. The systematic search of Hospital Discharge Records of the National Health System Register (HDR) may be a more accurate method than other methods for the estimation of the incidence of CE in endemic areas.

Atypical progressive multifocal leukoencephalopathy in a patient with antisynthetase syndrome.

Antisynthetase syndrome is a disorder belonging to the dermatomyositis/polymyositis group, with high rates of morbidity and mortality. We herein present the case of a 71-year-old man who was diagnosed with antisynthetase syndrome and treated with rituximab. Almost three years later, the patient showed right-sided hemiparesis that ultimately progressed to complete hemiplegia and advancing cognitive deterioration with a poor clinical outcome. The neuropathological diagnosis was progressive multifocal leukoencephalopathy. Treatment with rituximab for antisynthetase syndrome itself plays a fundamental role in the development of infectious complications.