Clinical and Epidemiological Characteristics of Patients Being Treated for Scabies in Spain: Opportunities for Improvement - A Multicenter Cross-Sectional CLINI-AEDV Study. / Características clínicas y epidemiológicas de pacientes diagnosticados de escabiosis en España: oportunidades de mejora. Estudio transversal multicéntrico CLINI-AEDV.

BACKGROUND: Several studies support the hypothesis that scabies is on the rise in Spain. There are also concerns about the possible development of resistance to treatment and an increase in atypical presentations. The aims of this study were to describe the demographic and clinical characteristics of patients with scabies seen by dermatologists in Spain, to identify the possible emergence of atypical forms of scabies, and to explore the frequency of treatment failures and associated risk factors. METHODS: We conducted an observational, cross-sectional, multicenter study of data collected prospectively in April and May 2023 using the CLINI-AEDVp platform created by the Spanish Academy of Dermatology and Venereology (AEDV). RESULTS: Participating dermatologists from 31 hospitals in 15 of Spain's autonomous communities recorded 186 cases of active scabies (51% in women) during the study period. A diagnostic certainty level of A, B or C as per the International Alliance for the Control of Scabies Consensus Criteria was required for diagnosis. Overall, 92% of patients had typical scabies and 66% had already been treated with a scabicide for the current episode. Of the treated patients, only 36% had received and completed adequate treatment (including the simultaneous treatment of all household members) and 50% had not received clear written recommendations. CONCLUSIONS: In a high proportion of the cases of scabies studied, the patient had already received treatment. In those cases, we observed several remediable shortcomings that could explain why some of these treatments had failed. Remedying these deficiencies should lead to better control of scabies and an improved assessment of the actual effectiveness of currently available scabicides.

[Translated article] Clinical and Epidemiological Characteristics of Patients Being Treated for Scabies in Spain: Opportunities for Improvement - A Multicenter Cross-Sectional CLINI-AEDV Study.

BACKGROUND: Several studies support the hypothesis that scabies is on the rise in Spain. There are also concerns about the possible development of resistance to treatment and an increase in atypical presentations. The aims of this study were to describe the demographic and clinical characteristics of patients with scabies seen by dermatologists in Spain, to identify the possible emergence of atypical forms of scabies, and to explore the frequency of treatment failures and associated risk factors. METHODS: We conducted an observational, cross-sectional, multicenter study of data collected prospectively in April and May 2023 using the CLINI-AEDVp platform created by the Spanish Academy of Dermatology and Venereology (AEDV). RESULTS: Participating dermatologists from 31 hospitals in 15 of Spain's autonomous communities recorded 186 cases of active scabies (51% in women) during the study period. A diagnostic certainty level of A, B or C as per the International Alliance for the Control of Scabies Consensus Criteria was required for diagnosis. Overall, 92% of patients had clinical features of classic scabies and 66% had already been treated with a scabicide for the current episode. Of the treated patients, only 36% had received and completed adequate treatment (including the simultaneous treatment of all household members) and 50% had not received clear written recommendations. CONCLUSIONS: In a high proportion of scabies cases, the patient has already received treatment. In those cases, we observe several remediable shortcomings that could explain why some of these treatments fail. Remedying these deficiencies should lead to better control of scabies and an improved assessment of the actual effectiveness of currently available scabicides.

Amelanotic melanoma in a patient with oculocutaneous albinism.

Oculocutaneous albinism is a genetically heterogeneous, autosomal recessive group of disorders characterized by a generalized decreased or absence of melanin pigment in the eyes, hair, and skin. These patients have a greater sensitivity to UV radiation and a predisposition to skin tumors, mainly squamous cell carcinoma and basal cell carcinomas, and to a lesser extent malignant melanomas. Melanoma can be one of the most challenging cancers to diagnose in patients with albinism. We report an uncommon clinical presentation of melanoma, an amelanotic melanoma in the right supraciliar region in a patient with oculocutaneous albinism. The clinical presentation was an erythematous, scaly and ill-defined plaque. The skin biopsy revealed a lentigo maligna melanoma. Amelanotic melanomas are one of the two most difficult to diagnose subtypes of melanoma, together with the nevoid type. Melanoma in oculocutaneous albinism patients are often amelanotic, which makes their clinical diagnosis very difficult. These patients should be examined in the dermatology department at least once a year and it is recommended to have a high index of suspicion.

Intestinal candidiasis. A clinical report and comments about this opportunistic pathology.

UNLABELLED: An eight-years-old girl, who presented with recurrent upper respiratory tract infections, was treated with broad-spectrum antibiotics. Afterward she presented with intestinal candidiasis. The isolated species was identified as Candida albicans by differential tests. Treatment given was with 500,000 IU of oral nystatin every 8 hours for 10 days and intestinal normal microbiota restoratives. Evolution has been satisfactory, although concomitantly type A hepatitis developed. Rest and a soft diet were recommended. The child is now perfectly healthy with normal liver function tests. CONCLUSION: Prolonged treatments with broad-spectrum antibiotics destroyed the indigenous intestinal microbiota, which provoked intestinal C. Albicans proliferation and adversely affected the immunological system of the patient, thus facilitating the establishment of a viral infection.

[Frequency of Gardnerella vaginalis vaginosis and its association with other pathogens causing genital infections in the female]. / Frecuencia de vaginosis producida por Gardnerella vaginalis y su asociación con otros patógenos causantes de infección genital en la mujer.

In order to determine the presence of unspecific vaginosis and their causes, 700 vaginal smears were obtained from patients assisting to the Clinical Laboratory of the Familiar Medicine Unit No. 28 "Gabriel Mancera" of the Instituto Mexicano del Seguro Social, during 6 months. The patients age was from 18 to 55 years old. To establish the infectious etiology of these pathologies the vaginal smears were observed freshly and stained by Gram's method. Specific test for differentiate Gardnerella vaginalis and Candida albicans were also performed. From 700 vaginal smears, 160 were positive to Candida albicans (22.86%); 150 to Gardnerella vaginalis (21.43%); and 14 to Trichomonas vaginalis (2%). The most frequent association were Candida albicans with Gardnerella vaginalis in 14 women, who 12 had a reduced number of pregnancy, and 7 had only one pregnancy (58.3%). The age groups most affected were between 18 and 35 years old, corresponding to the reproductive stage of the woman. Gardnerella vaginalis predominated in the 30-35 years old group.

[The mycetisms and their relevancy in medicine.]. / Los micetismos y su relevancia en medicina.

Poisonous mushrooms play an important role in public health, since the poisonings caused by their toxins have very high morbidity-mortality rates. No real data are available on this problem because diagnosis is often difficult. This work points out the important role of poisonous mushrooms. An analysis is included of the clinical features of the most important mycetisms, the mushrooms that produce them and the toxins that cause this pathology. A guide to aid clinical doctors in the diagnosis and treatment of mycetisms and recomendations to prevent these poisonings are provided.

Microsporidiosis: estado actual de una nueva parasitosis / Microsporidiosis: current status of a new parasitosis

Los protozoos del orden Microsporida se han considerado como causantes de diversas patologías en pacientes con inmunodeficiencias severas. Aparentemente se trasmiten al humano por fecalismo, pero también se ha considerado la vía respiratoria. Los más afectados son adultos jóvenes del sexo masculino infectados con virus de la inmunodeficiencia humana. Entre los géneros más importantes se encuentran: Enterocytozoon, Encephalitozoom, Septata, Nosema y Pleistophora. Aún existen discrepancias en cuanto a la biología del parásito y poco se conoce acerca de su comportamiento dentro del humano. Se concluye que con el Advenimiento del SIDA, se están presentando múltiples nosologías por oportunistas que anteriormente no se consideraban como infecciones humanas. Este trabajo es una revisión de lo publicado de 1959 a 1995, relativo a aspectos epidemiológicos, clínicos, diagnósticos y terapéuticos

[Microsporidiosis: current state of a new parasitosis]. / Microsporidiosis: estado actual de una nueva parasitosis.

Protozoa of the order Microsporida have become regarded as causes of several pathologies in patients with severe immunodeficiencies. Apparently they are transmitted to the human through fecalism, but also the respiratory route has been considered. People most affected are young males infected with the human immunodeficiency virus. The most important genera are: Enterocytozoon, Encephalitozoon, Septata, Nosema and Pleistophora. There are discrepancies about the biology of these parasites and little is known of their behavior in the human host. It is concluded that with the advent of AIDS, many nosological entities by opportunistic organisms, that were not previously considered as human infections are appearing. This work is a review of the literature published from 1959 to 1995, related to epidemiological, clinical, diagnostic and therapeutic aspects.

[Frequency of vaginal trichomoniasis and candidiasis and its relation to the clinical profile]. / Frecuencia de tricomoniasis y candidiasis vaginal y su relación con el cuadro clínico.

Eight hundred samples of vaginal swabs were taken from women with active sexual life attending the Cervicouterine Cancer Opportune Detection Service at the Familial Medicine Unit No. 18 of the National Institute of Social Security, to study the incidence and prevalence of vaginal trichomoniasis, the presence of yeasts of the genus Candida and their relationships with clinical features of vulvovaginitis. Identification of parasites was made by means of direct examination with light microscope; 14.39 per cent of candida vulvovaginitis against 3.13 per cent of trichomoniasis was found; in only five cases the two parasites were associated. Leukorrhea and vaginal pruritus were the major symptoms found and the most affected anatomical regions were vaginal walls in trichomoniasis and cervix in candidiasis. Although vaginal trichomoniasis is a worldwide distributed parasitosis, its frequency is very variable, not so vaginal candidiasis, which is more frequent.

[Seasonal variation of allergy-causing fungi in the southern part of Mexico City]. / Variación estacional de hongos productores de alergia en el sur de la ciudad de México.

The presence of mycotic flora in atmospheric medium has always been an interesting field for allergologists and ecologists interested in the problems of environmental contamination. In 1904 Saito in Japan demonstrated that certain spores of fungus when inhaled by susceptible individuals can produce severe respiratory processes. Since then many studies have been performed to determine the generic and species of causative fungus responsible for respiratory allergy, as well to understand its growth, movement and seasonal variations and its relation with the habits of man. Fungi which may produce allergy were investigated in 6 zones of the south of Mexico City, from November, 1981 to October, 1982. In each zone 108 samples were taken. Petri dishes containing Sabouraud medium were exposed during 10 minutes. The number of colonies per Petri dish; 27.6 per cent of the micro-organisms isolated corresponded to allergy producing fungi. The highest frequency of fungal isolation (6,512 colonies) was obtained in summer and the least (1,397 colonies) during winter. The principal genera isolated were: Rhodotorula: 2,418 (16.7%); Phialophora: 2,071 (14.4%); Penicillium: 743 (5.1%); Alternaria: 111 (0.7%). The most frequent species of the Aspergillus were: A. niger, A. fumigatus and A. flavus. The paper discusses the importance of the different factors which can influence the frequency and the seasonal variations of these fungi.

Vaginal candidosis. Opportunistic factors and clinical correlation in 600 patients.

Vaginal exudates were taken from 600 new patients of the gyneco -obstetrics outpatient clinic. Candida was isolated from 261 patients, 134 (22.3%) of which had this yeast as a component of the normal flora, and in 127 (21.2%) it was considered as a pathogen. The most frequent symptoms in the last group were vaginal discharge, erythema and pruritus. Pregnancy was the most frequent opportunistic factor, followed by the association of pregnancy and malnutrition, and anemia. Vaginal candidosis was more frequent in patients of the medium socio-economical stratum. The species of Candida isolated were C. albicans (67.7%), C. tropicalis (18.8%), C. stellatoidea (8.7%), C. pseudotropicalis (2.4%), C. parakrusei (1.6%) and C. guillermondi (0.8%).

Exposicion ocupacional a la hepatitis viral del tipo B en un centro medico. / Occupational exposure to virus B hepatitis a medical centre

Se realizo una encuesta seroepidemiologica en 545 empleados de dos hospitales del Centro Medico La Raza, IMSS, los cuales habian tenido diferentes grados de exposicion al virus de la hepatitis viral de tipo B. Se encontraron uno o mas marcadores serologicos de infeccion en 144 de ellos (26.4 por ciento), frecuencia estadisticamente significativa mayor que la de un grupo testigo de personas con ocupaciones no relacionadas con la salud(500, 14.4 por ciento). La frecuencia de estos marcadores aumento en funcion de antecendentes de hepatitis viral aguda, edad, tiempo en la ocupacion actual, contacto con sangre y contacto con pacientes con hepatitis viral aguda. Los resultados obtenidos mostraron que una exposicion continua de baja intensidad al virus de la hepatitis viral de tipo B predispone al parecer a la inmunizacion, mientras que la exposicion menos frecuente pero mas intensa predispone mayormente a adquirir la enfermedad

El hemocultivo en el diagnostico de bacteriemia. / Blood cultures in bacteremia diagnosis

En este trabajo se analizam las experiencias de diez anos de trabajo del Laboratorio Clinico del Hospital de Infectologia del Centro Medico La Raza, en el diagnostico etiologico de bacteremia. El objetivo del mismo es mostrar la importancia que tiene para el clinico el hecho de que los laboratorios clinicos dispongan de los medios y tecnicas apropiadas para el cultivo de sangre, para lograr un descubrimiento temprano y oportuno de la presencia de bacteremia, dada su elevada frecuencia y mortalidad en el enfermo hospitalizado; asi como senalar las numerosas situaciones tanto clinicas, como de laboratorio, que pueden alterar sus resultado final y senalar los generos y especies de los microorganismos aislados en 29 886 hemocultivos realizados

Significacion patogenica de Candida en pacientes con vaginitis. / Pathogenic significance of Candida in papatients with vaginitis

Se tomaron 500 muestras de exudado vaginal en mujeres que asistian por primera vez a consulta gineco-obstetrica. En 229 pacientes se aislo Candida, de las cuales 134 (26.8 por ciento) correspondian a flora normal y 95 (19.0 por ciento) a candidosis enfermedad. Los sintomas mas frecuentes fueron leucorrea, eritema y prurito; el embarazo fue el factor de oportunismo mas frecuente, seguido por la desnutricion y anemia. En la clase socio-economica media se encontro la mayor frecuencia de candidosis vaginal, en relacion a las clases alta y baja. Las especies mas frecuentes fueron C. albicans (69.9 por ciento), C.tropicalis (20 por ciento) y C. stellatoides (5.2 por ciento)