Update in Infectious Diseases 2019.

The IX Course of Antimicrobials and Infectious Diseases update included a review of the main issues in clinical microbiology, epidemiology and clinical aspects for a current approach of infectious pathology. The present introduction summarizes about the most important meetings related to infectious diseases during 2018 (ECCMID, IAS, ASM and ID Week). In addition, the course provides a practical information to focus on nosocomial infection models, with immunosuppressed patients or complex multidrug-resistant pathogens. The closing lecture of this year reviewed the infection during donation process.

Update in Infectious Diseases 2018.

VIII Updating Course of Antimicrobials and Infectious Diseases has reviewed useful microbiological, epidemiological and clinical aspects for a current approach of infectious pathology. Present manuscript summarizes a chronicle about the main infection related meetings during 2017 (ECCMID, IAS, ASM and ID Week). In addition, the course proposed a practical approach for understanding different type of pathogens and our selected topics this year were the epidemiology of bacterial nosocomial infection, a practical approach to Clostridium difficile infection patients, a two year selection of the top ten papers about fungal infection and an update in fungal biofilms. Finally, proffesors made a practical approach by main clinical syndromes like sepsis, infections in oncohematological patients, CNS infections in immunosuppressed patients and reviewed the top ten papers in transplant infectious diseases and infection control during the last two years.

How should we approach Aspergillus in lung secretions of patients with COPD?

Aspergillus spp. is frequently isolated in respiratory samples from patients with severe COPD; however, the clinical significance of this mold is unclear and its presence may indicate temporary passage, benign chronic carriage, or onset of invasive disease. The definitive diagnosis of pulmonary aspergillosis in COPD patients is often difficult owing to the lack of specific clinical and radiological signs. However, retrospective studies show the risk for developing pulmonary aspergillosis in older patients with severe COPD, and a high number of comorbidities who have received treatment with corticosteroids and/or broad spectrum antibioties. The development of algorithms based on microbiological and radiological data and risk factors for pulmonary aspergillosis can help to differentiate between colonization and infection.

Estudio piloto de utilización deantifúngicos sistémicos en el HospitalClínico San Carlos. Propuesta de unmétodo de estudio / Pilot Drug Utilization Study of systemic antifungal agents in the Hospital Clínico San Carlos. Proposal of a study method

Introducción. El estudio propone definir una metodologíade evaluación del uso habitual de antifúngicos sistémicosy ponerla a prueba en un estudio piloto con el fin de facilitarel diseño de estudios de mayor tamaño.Método. Se diseñó en un Estudio de Utilización deMedicamentos, piloto, observacional, de prescripción-indicación.Se propuso una definición de tipo de tratamiento antifúngico(microbiológico, empírico y uso profiláctico) utilizandolos criterios de la EORTC (European Organization for Researchand Treatment of Cancer), la clínica del paciente y la evidenciamicrobiológica, conforme a las pautas de diagnóstico en lapráctica clínica habitual. La adecuación de los tratamientos sevaloró según tres patrones de comparación: ficha técnica, recomendacioneshospitalarias y comité de expertos.Resultados. Se recogieron 60 prescripciones de antifúngicos.39 casos fueron de fluconazol, 6 de itraconazol, 5 deanfotericina liposomal, 5 de caspofungina y 5 de voriconazol.El inicio del tratamiento se realizó en 28 casos como tratamientomicrobiológico (46,7%), en 22 casos como empírico(36,7%) y en 7 casos como uso profiláctico (11,7%). La indicaciónde tratamiento antifúngico se consideró adecuada enmás de un 90% de los casos para los tres patrones de comparación,mientras que adecuación de la selección osciló entreun 75 y un 83%.Conclusiones. El método propuesto para la definición deltipo de tratamiento antifúngico según criterios aplicables en lapráctica clínica se considera satisfactorio y se propone para suempleo en un estudio de mayor tamaño. Para todos los antifúngicosy patrones de comparación, la evaluación resultó conun alto grado de adecuación, sin embargo no resulta fácil sistematizarlas condiciones de utilización de los antifúngicos, debidoa la heterogeneidad de los pacientes e indicaciones (AU)

Introduction. The study aims to define a method forthe evaluation of the usage of systemic antifungal agents,and test it, in order to be able to develop larger studies.Method. Drug Use Study, pilot, observational, prescription-indication. We proposed a definition of antifungaltype of treatment using as host factors the EORTC(European Organization for Research and Treatment ofCancer) criteria, the patient’s clinical data as well as anyevidence of fungal infection. Adequate use was evaluatedby three standards of comparison: summary of productcharacteristics, hospital recommendations and an experts’committee.Results. 60 antifungal prescriptions were recovered:fluconazole: 39; itraconazole: 6; liposomal amphotericinB: 5; caspofungin: 5; voriconazole: 5. Treatment wasstarted as follows (N;%): microbiological (28;46.7), empirical(22;36.7) and prophylactic use (7;11.7). The indicationfor antifungal treatment was considered adequatein more than 90% of the cases for the three standards ofcomparison, whereas selection in 75-83% of the cases.Conclusions. The method is considered satisfactoryfor the evaluation of antifungal treatments and is proposedfor being used in larger studies. For all the antifungalagents evaluated, a high degree of appropriateness of usewas found, though some conditions are considered improvable (AU)

[Pilot Drug Utilization Study of systemic antifungal agents in the Hospital Clínico San Carlos. Proposal of a study method]. / Estudio piloto de utilización de antifúngicos sistémicos en el Hospital Clínico San Carlos. Propuesta de un método de estudio.

INTRODUCTION: The study aims to define a method for the evaluation of the usage of systemic antifungal agents, and test it, in order to be able to develop larger studies. METHOD: Drug Use Study, pilot, observational, prescription- indication. We proposed a definition of antifungal type of treatment using as host factors the EORTC (European Organization for Research and Treatment of Cancer) criteria, the patient's clinical data as well as any evidence of fungal infection. Adequate use was evaluated by three standards of comparison: summary of product characteristics, hospital recommendations and an experts' committee. RESULTS: 60 antifungal prescriptions were recovered: fluconazole: 39; itraconazole: 6; liposomal amphotericin B: 5; caspofungin: 5; voriconazole: 5. Treatment was started as follows (N;%): microbiological (28;46.7), empirical (22;36.7) and prophylactic use (7;11.7). The indication for antifungal treatment was considered adequate in more than 90% of the cases for the three standards of comparison, whereas selection in 75-83% of the cases. CONCLUSIONS: The method is considered satisfactory for the evaluation of antifungal treatments and is proposed for being used in larger studies. For all the antifungal agents evaluated, a high degree of appropriateness of use was found, though some conditions are considered improvable.

Utility of real-time PCR for the detection of Paracoccidioides brasiliensis DNA in the diagnosis of imported paracoccidioidomycosis.

An increase in immigration from endemic regions has resulted in a number of cases of paracoccidioidomycosis (PCM) being imported into Spain. A molecular diagnostic technique based on real-time PCR was developed for the detection of Paracoccidioides brasiliensis DNA in both culture and patients' clinical samples. A Molecular Beacon probe was used, labelled with FAM and directed at the ITS1 region of ribosomic DNA. The detection limit of the technique developed was 1 fg of fungal DNA per microl of sample. This procedure proved to be very reproducible and specific. The technique was tested with cultures of 12 clinical strains and on samples from two patients with proven PCM. Real-time PCR was positive for all the culture strains, as well as those from both patients. By samples, the technique was positive in sputum and tissue biopsies but less useful on blood samples. Samples were analyzed several months after patient treatment, detecting a small amount of fungal DNA in one respiratory sample. This technique of real-time PCR is a sensitive method for rapid diagnosis of paracoccidioidomycosis and could serve to monitor patients after treatment has begun.

[Candidemia and cutaneous lesions in two patients without intravenous drug addiction.]. / Candidemia y lesiones cutáneas en pacientes no adictos a drogas por vía parenteral: a propósito de dos casos.

We report here two cases of disseminated candidosis with typical folliculitis, cutaneous nodules and chorioretinitis in two patients with severe underlying conditions. Histological and microbiological studies showed Candida albicans in blood and cutaneous lesions. The outcome was favourable with azole systemic treatment.

[Scedosporium apiospermum external otitis.]. / Otitis externa por Scedosporium apiospermum.

We report a case of Scedosporium apiospermum external otitis. The patient was topically treated with miconazole cream and achieved a clinical and mycological cure. The etiology, diagnosis and treatment of external fungal otitis are discussed.

[Five cases of zygomycosis.]. / Zigomicosis. A propósito de cinco casos.

Combined histological and mycological study of tissue specimens established a proven diagnosis of cutaneous zygomycosis in four patients. All patients had been treated with wide spectrum antibiotics and one patient (liver transplantation) was in addition also treated with cyclosporine. All had acidosis and cutaneous breaks and four had also been treated with systemic corticosteroids. The infecting organisms were Absidia corymbifera (n=2), Rhizopus stolonifer (n=1) and Mucor circinelloides (n=1). Combined treatment with i.v. conventional and liposomal formulations of amphotericin B and surgical treatment lead to a favourable clinical and mycological cure in three patients (A. corymbifera and R. stolonifer infections). One lymphoma patient with suspected Rhizopus pusillus infection of the lungs (presence of hyphae in sputum and positive culture) had an unfavourable outcome. The patient had been treated with wide spectrum antibiotics, corticosteroids and showed severe neutropenia and acidosis. The clinical presentations are outlined, including the outcomes and predisposing factors and focus on the diagnostic procedures, treatment and preventive measures.

[Need for systematic HIV serological study during pregnancy]. / Necesidad del estudio serológico sistemático del virus de l a inmunodeficiencia humana durante la gestación.

BACKGROUND: To evaluate human immunodeficiency virus (HIV) screening usefulness in pregnancy and to know the prevalence of this infection in an urban area of Spain. PATIENTS AND METHOD: Routine prenatal screening for antibodies to HIV was offered to pregnant women from Fuenlabrada-Leganés Health Care Area (Madrid) from 1992 to 1995. Unlinked anonymous screening of HIV was done with the sera from women refusing the assay or if it had not been offered. RESULTS: HIV prevalence was 0.28% (CI: 95%; 0.19 to 0.40) in the 11.021 pregnant women group studied. 87.1% pregnant seropositive women were detected by consented screening. 55.6% of them recognized risk behavior (73.33% by intravenous drug use) and 44.4% did not do it. With a second anamnesis in this group 75% admitted risk conducts and 25% confirmed their ignorance about them. CONCLUSIONS: HIV seropositive screening in pregnant women selected only by risk behavior may be unsuccessful. For that reason, it is more convenient the perform a routine test for detection of HIV antibodies after informed consent in high prevalence areas of HIV infection.

[Invasive maxilar sinusitis by Rhizopus oryzae]. / Sinusitis maxilar invasiva por Rhizopus oryzae.

We herein present a diabetic with non Hodgkin lymphoma patient that had been treated with steroids and developed fungal invasive sinusitis. The patient had intensive facial pain that did not respond to antibiotics and on clinical inspection had a necrotic lesion on right nasal area. A smear and biopsy tissue showed broad non septate hyphae and on cultures Rhizopus oryzae was isolated. There was an unfavorable outcome, and the patient died even though liposomal Amphotericin B was administered and surgical treatment was performed.

[Bipolaris australiensis in a Spanish patient with allergic chronic sinusitis]. / Bipolaris australiensis en un enfermo Español con sinusitis alérgica crónica.

Allergic fungal sinusitis is a disease that results from hypersensitivity reaction of the host against fungi colonizing the paranasal sinuses. A 36 years old Spanish man with no history of travel abroad had a history of asthma, nasal polyps, allergic rhinitis and a chronic sinusitis with nasal congestion and headaches. Computed tomography showed pansinusitis and opacification of the paranasal sinuses. A pure culture of Bipolaris australiensis was grown from sinus tissues. Infections caused by Bipolaris spp. and treatment regimes are discussed.