Epidemiology of Clostridioides difficile Infection in Portugal: A Retrospective, Observational Study of Hospitalized Patients.

INTRODUCTION: Clostridioides difficile is the main cause of healthcare-associated diarrhea in Europe and North America. The aim of this study was to characterize the epidemiology and clinical burden of Clostridioides difficile infection among hospitalized patients in Portugal. MATERIAL AND METHODS: Retrospective study conducted in six public hospital centers in Portugal. All primary Clostridioides difficile infection episodes and related recurrences occurring in 2017, as well as episodes developing two to eight weeks after the last episode diagnosed in that year, were documented. The National Reference Laboratory (National Institute of Health Dr. Ricardo Jorge) provided national surveillance data on Clostridioides difficile infection. RESULTS: A total of 385 inpatients with at least one primary episode diagnosed in 2017 were included. Most patients were aged over 70 years-old (73.2%). The included patients developed 451 episodes during the observation period. Approximately 44% of primary episodes were community-associated. Most episodes (94.9%) occurred in patients with one or more risk factors, with recent antibiotic exposure being particularly common (86.0%). All-cause in-hospital mortality was 19.5%, being significantly higher in patients aged over 65 years-old versus those aged 18 to 64 years-old (22.4% vs 7.8%, respectively). Over 50 different ribotypes were observed among 206 Clostridioides difficile strains received by the National Reference Laboratory. CONCLUSION: In Portugal, hospitalized patients with Clostridioides difficile infection are mostly older patients presenting risk factors for the development of this infection, particularly recent antibiotic exposure. Mortality is disproportionately high among the older population. Community-associated Clostridioides difficile infection is common among inpatients with this infection.

Introdução: Clostridioides difficile é a principal causa de diarreia nosocomial na Europa e América do Norte. Este estudo teve como objetivo caracterizar a epidemiologia e o impacto clínico da infeção por Clostridioides difficile em doentes hospitalizados em Portugal. Material e Métodos: Estudo retrospetivo conduzido em seis centros hospitalares públicos de Portugal. Foram documentados todos os episódios primários de infeção por Clostridioides difficile ocorridos em 2017 e consequentes recorrências, bem como os episódios que ocorreram entre duas a oito semanas após o último episódio diagnosticado neste ano. Os dados de vigilância nacional de infeção por Clostridioides difficile foram fornecidos pelo laboratório nacional de referência (Instituto Nacional de Saúde Doutor Ricardo Jorge). Resultados: Foram incluídos 385 doentes hospitalizados com pelo menos um episódio primário diagnosticado em 2017. A maioria dos doentes tinha idade igual ou superior a 70 anos (73,2%). Os doentes incluídos tiveram 451 episódios durante o período de observação. Aproximadamente 44% dos episódios primários eram episódios de infeção por Clostridioides difficile adquirida na comunidade. A maioria dos episódios (91,8%) ocorreu em doentes com um ou mais fatores de risco, sendo a exposição recente a antibióticos particularmente comum (86,0%). A mortalidade hospitalar por todas as causas foi de 19,5%, sendo significativamente superior em doentes com idade igual ou superior a 65 anos comparativamente a doentes com idade entre 18 e 64 anos (22,4% versus 7,8%, respetivamente). Mais de 50 ribotipos diferentes foram detetados entre as 206 estirpes de Clostridioides difficile recebidas pelo laboratório nacional de referência. Conclusão: Em Portugal, doentes hospitalizados com infeção por Clostridioides difficile são, na sua maioria, doentes idosos com fatores de risco para o seu desenvolvimento, particularmente exposição recente a antibióticos. A mortalidade é desproporcionalmente elevada na população idosa. Episódios associados à comunidade são comuns em doentes hospitalizados com esta infeção.

Rickettsia slovaca infection in humans, Portugal.

Fifteen years after the initial detection of Rickettsia slovaca in ticks in Portugal, 3 autochthonous cases of R. slovaca infection were diagnosed in humans. All patients had an eschar on the scalp and lymphadenopathy; 2 patients had facial edema. R. slovaca infection was confirmed by serologic testing, culture, and PCR.

[Transfusion-transmitted protozoal infections: what is the risk in non-endemic countries?]. / Infecções parasitárias transmitidas por transfusão de sangue: qual o risco nos países não endémicos?

Protozoal infections that are efficiently transmitted by blood transfusion include Malaria, Chagas Disease, African Trypanosomiasis, Leshmaniasis, Toxoplasmosis and Babesiosis. With exception of Toxoplasmosis and Leishmaniasis, these diseases are endemic in mainly tropical low income countries and, in non-endemic countries like Portugal, the reported cases are imported from these endemic areas by travelers or immigrants. Globalization, with increasing travel and immigration poses the risk of exposition to these infectious agents and raises the issue of possible transmission by blood transfusion. According to recommendations of the Council of Europe, strategies to prevent the transmission of these infections by blood transfusion have been implemented. Given that the risk is introduced by a specific group of donors, travelers or immigrants from endemic areas, the main strategy to prevent this transmission depends on the identification of these groups of donors using questionnaires during the pre-donation procedures. Additional measures, like serological testing and pathogen inactivation procedures, when available, contribute not only to reduce the risk of transmission but also to avoid unnecessary rejections.