Changes in Group A Streptococcus emm Types Associated with Invasive Infections in Adults, Spain, 2023.

An increase in invasive group A Streptococcus infection was detected in the northeast of Spain in November 2022. A postpandemic decline in the diversity of circulating emm types involved in invasive group A Streptococcus was observed, along with the emergence of emm49 in this geographic area.

Clinical relevance of viral codetection in infants with respiratory syncytial virus bronchiolitis.

INTRODUCTION: Respiratory syncytial virus (RSV) is the main cause of severe bronchiolitis, especially in infants. The aim of this study is to assess whether codetection of RSV and other respiratory viruses could affect the severity of this infection comparing with unique RSV detection. METHODS: A prospective study from 2016 to 2019 including children under 2 years who were admitted in the Emergency Service of the Hospital Universitari Arnau de Vilanova de Lleida (Spain) was performed. Nasopharyngeal samples from all patients were sent to the laboratory for RSV real-time PCR detection (GeneXpert®). A multiplex PCR that detects other respiratory viruses was done in all RSV-positive samples. Patients'medical records were checked to collect clinical data (hospital length of stay, BROSJOD score, ICU admission, need for ventilatory support or transfer to a reference hospital). Patients were divided in two groups: infants with unique RSV detection and infants with viral codetection. Bivariant analyses were performed to analyze the data obtained. RESULTS: During the period of study 437 RSV bronchiolitis were diagnosed. In 199 of them (177/437; 45,5%) another respiratory virus was detected concomitantly. Bivariant analyses do not show statistically significant differences between both groups. CONCLUSIONS: Viral codetection in infants with RSV bronchiolitis is frequent. However, it does not seems to affect the severity of this infection.

Antibiotic Susceptibility and Clarithromycin Resistance Determinants in Helicobacter pylori in the Northeast of Spain: A One-Year Prospective Study.

Helicobacter pylori is one of the most widespread infections, and it is reaching alarming resistance levels worldwide. The recommended first-line empirical treatment differs according to the local rate of clarithromycin resistance. Macrolide resistance is mainly associated with three point mutations in the 23S rRNA gene. The aim of this study was to describe the antibiotic susceptibility of H. pylori in our healthcare area and the main mechanisms involved in clarithromycin resistance. Gastric biopsies (n = 641) were collected and cultured in a one-year prospective study. Antibiotic susceptibility testing was performed by gradient diffusion. A multiplex real-time PCR test (AllplexTMH.pylori & ClariR Assay, Seegene) was used to detect the most frequent mutations associated with clarithromycin resistance. Overall, 141 isolates were available for antibiotic susceptibility testing. The highest resistance rates were detected in metronidazole and levofloxacin. The rate of clarithromycin resistance was 12.1%, and the associated mutations were A2143G and A2142G. More than half of the clarithromycin-resistant isolates presented high MIC values (>256 mg/L). Tetracycline resistance was not detected, suggesting that therapies that contain tetracycline could be a suitable option. The low clarithromycin resistance rate coupled with the high rates of metronidazole resistance may support the recovery of the classical triple therapy in our healthcare area.

Detection and pathological role of intestinal protozoa in children.

INTRODUCTION: Intestinal parasites are considered a growing public health problem, being protozoa the main cause of intestinal disease. The objective of our study is to compare the detection of intestinal protozoa by microscopy versus real-time PCR, as well as to determine the most prevalent protozoa in our environment in the paediatric population. METHOD: An observational longitudinal study was carried out, both by microscopy and real time-PCR in stool samples from children (0- 15 years) received from April 2019 to March 2021.Children were classified in two groups according if they had or not had clinical parasitosis. Microscopic examination was performed in all samples using the Ritchie concentration technique with the commercial Mini PARASEP system (Movaco-Grifols®). The presence of Cryptosporidium sp. was evaluated with the modified Ziehl-Neelsen acid-fast stain. The real-time PCR was performed to all samples using the Allplex ™ gastrointestinal parasite panel 4 (Seegene®). RESULTS: During the study period, 500 samples were received, being positive 31 (6.2%) by microscopy and 256 (51.2 %) by PCR. By microscopy, Blastocystis hominis was the most frequently observed (4.8%), followed by Giardia lamblia (1.6%), Dientamoeba fragilis (0.2%) and Cryptosporidium species (0.2%). Regarding the identification by PCR, D. fragilis (35.2%) was mainly identified, followed by B. hominis (28.1%), G. lamblia (7%) and Cryptosporidium sp. (0.8%) without finding clear differences in aetiology according to age. In the case of B. hominis and D. fragilis, there were not differences in the detection of these protozoa between the control group and children with clinical parasitosis (p = 0.11). CONCLUSIONS: Real-time PCR increases the detection of intestinal protozoa, being underdiagnosed by microscopy, especially D. fragilis, in which PCR is considered the most appropriate method for its detection.

Report of sexually transmitted infections prevalence in asymptomatic pregnant women under 25 years old in Lleida, Spain

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Clinical and Epidemiological Characteristics of Streptococcus suis Infections in Catalonia, Spain.

Introduction: Streptococcus suis (S. suis) is a human zoonotic pathogen of occupational origin, with infection acquired through contact with live pigs or pig meat. Pig farming is one of Catalonia's biggest industries and as a result this region of Spain has one of the highest density pig populations per km2. The aim of our study was to describe the infections caused by S. suis occurring in that area over a 9-year period. Materials and Methods: A retrospective, multi-center study was carried out by searching records from 15 hospitals in Catalonia for the period between 2010 and 2019. Results: Over the study period altogether nine cases of S. suis infection were identified in five hospitals, with five of these cases occurring in the 2018-2019 period. The mean age of patients was 48 ± 8.9 years and all of them were males. Five patients (55.6%) worked in pig farms. The most frequent manifestation of infection was meningitis (5 cases; 55.6%) followed by septic arthritis (3 cases; 33.3%). None of the patients died at 30 days; nonetheless, 4 developed hearing loss as a long-term complication. Conclusion: The most commonly identified S. suis infection was meningitis. Over 50% of the episodes occurred in the last 2 years and have affected pig farm workers. Further surveillance is needed in order to know its prevalence.

E-gene RT-PCR Crossing Point Value and Other Biochemical Parameters as Useful Markers of Death Risk in COVID-19 Patients.

The identification of laboratory markers which predict the outcome of COVID-19 patients is a great concern. Real-time reverse transcriptase-polymerase chain reaction (RT-PCR) has been used to confirm the clinical diagnosis. The aim of this study is to evaluate laboratory parameters of COVID-19 patients as well as to evaluate the RT-PCR crossing point (Cp) value and correlate blood test abnormalities and the Cp value with patients survival. Two hundred thirty patients with positive RT-PCR of SARS-CoV-2 were included in the study. Molecular diagnosis of SARS-CoV-2 was performed by RT-PCR (LightMix, TibMolbiol, Germany). Clinical information, biochemical parameters and Cp values were collected in an anonymized database and variables were analyzed with SPSS v25.0 (IBM Corporation, Armonk, NY, USA). No-survivors were significantly older (>65 years old) than survivors (p=0.007). A higher prevalence of cardiovascular comorbidities in patients who died than in those who survived was found (p=0.002). Statistically significant differences were obtained comparing RT-PCR Cp values for the E-gene of patients who died and those who survived, being lower (<=28) those of patients who died (p=0.004). No-survivors had significantly higher levels of CRP (>100) (p=0.007). E-gene Cp values <=28, which correlate with a high number of copies of SARS-CoV-2, as well as several demographical and biochemical parameters (Age above 65 years old, CRP levels >100 mg/L or cardiovascular comorbidities) could be useful markers of death risk in these patients.

Entamoeba histolytica liver abscess case: could stool PCR avoid it?

Background Liver abscess is the most common extraintestinal manifestation of Entamoeba histolytica. Clinical manifestations could appear after returning from an endemic area or several years after the exposure. The diagnosis usually requires microbiological confirmation. Case presentation We present a case of a 55-year-old woman diagnosed with Crohn's disease treated with immunosuppressive drugs, who was admitted to the Emergency Service with liver parenchyma abscesses. Computed tomography (CT)-guided puncture showed pus, and both Gram staining and fresh parasite visualization were negative. Hepatic pus bacteriological culture was reported as negative and parasite multiplex polymerase chain reaction (PCR) was performed, being positive for E. histolytica. The same PCR was performed on blood, pleural fluid and stool samples, all of them being positive for E. histolytica. Conclusions Reviewing the clinical history of this patient, it was observed that parasite detection in three stool samples was negative 2 months before the current admission. Due to the lack of sensitivity of the microscopy techniques, we propose to routinely perform parasite detection in stools using molecular techniques, especially in immunocompromised patients.

Tratamiento con dalbavancina de infección protésica de rodilla por Staphylococcus epidermidis resistente a la oxacilina / Dalbavancin treatment of prosthetic knee infection due to oxacillin-resistant Staphylococcus epidermidis

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Osteomielitis aguda per Staphylococcus aureus sensible a la meticil·lina productor de leucocidina de Panton-Valentine associada a trombosi venosa i èmbols sèptics pulmonars / Osteomielitis aguda por Staphylococcus Aureus meticilin-sensible productor de leucocidina de Panton-Valentine asociada a trombosis venosa y émbolos sépticos pulmonares / Acute osteomyelitus due to Panton-Valentine leukocidine-producing methicilin-susceptible Staphylococcus Aureus with deep vein thrombosis and pulmonary septic emboli in a child

Introducció: la leucocidina de Panton-Valentine (LPV) és un factor de virulència identificat en infeccions per Staphyloccus aureus (SA), més freqüent en resistents a meticil•lina (MRSA), nosocomials i adults. Es presenta un cas d'osteomielitis aguda (OA) per SA sensible a la meticil•lina (MSSA) productor de LPV adquirit en la comunitat. Cas clínic: nen de 7 anys remès a urgències per febre i dolor de l'extremitat inferior esquerra amb eritema, edema i actitud antiàlgica. Presentava leucocitosi (28.100/mm3), neutrofília (78%) i elevació de la proteïna C reactiva (199 mg/L) i de la procalcitonina (1,86 ng/mL). La ressonància magnètica feta mostrà OA greu de tíbia amb cel•lulitis, miositis i abscés de 18 cm. Va ser intervingut quirúrgicament i s'aillà MSSA productor de LPV a hemocultiu i ma-terial purulent. Es confirmà trombosi venosa profunda po-plítia amb estudi de trombofília i immunitari normals. Presentava condensació pulmonar basal esquerra amb vessament pleural (6 mm) i ecocardiografia normal. Va rebre antibioteràpia endovenosa sis setmanes (més dues més oral) amb bona evolució en el seguiment posterior. Comentaris: els primers casos d'OA per MSSA productor de LPV en edat pediàtrica al nostre país es van publicar l'any 2011. S'alerta de la possibilitat d'emergència d'aquest gèrmen com a productor d'OA en infants. Està associat a malaltia més greu, resposta sistèmica més extensa i risc de trombosi. Requereix antibioteràpia més perllongada, més necessitat de cirurgia i més risc de complicacions. La tríada OA, trombosi venosa profunda i èmbols sèptics pulmonars és característica i cal un alt índex de sospita per fer un abordatge i un tractament precoços

Introducción. La leucocidina de Panton-Valentine (LPV) es un factor de virulencia identificado en infecciones por Staphyloccus aureus (SA), más frecuente en resistentes a meticilina (MRSA), nosocomiales y adultos. Se presenta un caso de osteomielitis aguda (OA) por SA meticilin-sensible (MSSA) productor de LPV adquirido en la comunidad. Caso clínico. Niño de 7 años remitido a urgencias por fiebre y dolor de la extremidad inferior izquierda con eritema, edema y actitud antiálgica en flexión y rotación. Presentaba leucocitosis (28.100/ mm3), neutrofilia (78%) y elevación de proteína C reactiva (199 mg/L) y procalcitonina (1,86 ng/mL). La resonancia magnética mostró OA grave de tibia con celulitis, miositis y absceso de 18 cm. Se intervino quirúrgicamente y se aisló MSSA productor de LPV en hemocultivo y material purulento. Se confirmó trombosis venosa profunda poplítea con estudio de trombofilia e immunitario normales. Presentaba condensación pulmonar basal izquierda con derrame pleural (6 mm) y ecocardiografía normal. Recibió antibioterapia endovenosa seis semanas (más dos oral) con buena evolución en el seguimiento posterior. Comentarios. Los primeros casos de OA por MSSA productor de LPV en edad pediátrica en nuestro país se publicaron en el año 2011. Se alerta de la posibilidad de emergencia de este germen como productor de OA en niños. Está asociado a enfermedad más grave, respuesta sistémica más extensa y riesgo de trombosis. Requiere antibioterapia más prolongada, más necesidad de cirugía y mayor riesgo de complicaciones. La tríada OA, trombosis venosa profunda y émbolos sépticos pulmonares es característica y se precisa de un alto índice de sospecha para realizar abordaje y tratamiento precoces (AU)

Introduction. The Panton-Valentine leukocidin (PVL) is a virulence factor identified in Staphylococcus aureus (SA) infections, more commonly in methicillin-resistant (MRSA), nosocomial infections, and adults. We report a case of community acquired acute osteomyelitis (AO) by PVL-producing methicillin-susceptible SA (MSSA). Case report. A 7-year-old boy was referred to the emergency department because of fever and pain in the left lower extremity, with associated erythema and edema. Laboratory evaluation showed leukocytosis (28,100/mm3), neutrophilia (78%), and elevated C-reactive protein (199 mg/L) and procalcitonin (1.86 ng/mL). The magnetic resonance imaging showed severe AO of the tibia with cellulitis, myositis and bone abscess. He underwent surgery and PVL-producing MSSA was isolated from the blood and bone cultures. A popliteal deep vein thrombosis (DVT) was documented, and thrombophilia and immunology work-up were unremarkable. The patient was noted to have left basal pulmonary consolidation with pleural effusion and normal echocardiography. He received intravenous antibiotic therapy for six weeks, followed by two weeks of oral therapy, with a good clinical outcome. Discussion. The first cases of AO by PVL-producing MSSA in children in our country were published in 2011; this prompted concerns about the possible emergence of this new pathogen in AO. This agent is associated with more severe disease, a more extensive systemic involvement, and higher rate of complications, including DVT. It requires prolonged antibiotic therapy and more need for surgery. The occurrence of the triad AO, DVT, and pulmonary septic emboli should cause a high index of suspicion and aid in early diagnosis and treatment (AU)