Multicenter evaluation of BioFire JI panel related to improved microbiological diagnostics on acute osteoarticular infections.

Microbiological diagnosis of osteoarticular infections (OI) is crucial for a successful treatment. A prospective multicenter study including 262 synovial fluids with suspicion of acute OI was performed between July 2021 and October of 2022. BioFire Joint Infection Panel multiplex-PCR test was performed and results were compared with conventional cultures of synovial fluid specimens. In total, 136 microorganisms were detected, and fourteen samples were positive for more than one microorganism. In monomicrobial infections (n = 87) agreement with culture was 69%. In 26 samples, the multiplex PCR yield an additional positive result when culture result was negative. It helped in the detection of fastidious microorganisms as K. kingae and N. gonorrhoeae. This multiplex PCR has proven to be a useful technique that can be used for patients with high suspicion of acute OI in a rapid and automated manner.

Validation of the International Classification of Functioning, Disability, and Health (ICF) core set for post-acute musculoskeletal conditions in a primary care physiotherapy setting from the perspective of patients using focus groups.

PURPOSE: To validate the comprehensive ICF core set for post-acute musculoskeletal conditions from the perspective of patients in a primary care physiotherapy setting. MATERIALS AND METHODS: A qualitative study was conducted with patients suffering from musculoskeletal problems. A phenomenological approach based on focus groups was used to identify the most relevant aspects related to physical therapy care in their condition. The data were analyzed using a meaning condensation procedure, identifying relevant themes and concepts. The identified concepts were linked to the ICF and compared to the ICF core set for post-acute musculoskeletal conditions. RESULTS: Forty-three patients were included in eight focus groups. A total of 1281 relevant concepts were extracted and related to 156 ICF second-level entities. Entities in the ICF core set for post-acute musculoskeletal conditions were 95.7% confirmed. Eighty-nine additional second-level ICF entities were identified. CONCLUSIONS: Entities in the ICF core set for post-acute musculoskeletal conditions are relevant to patients seen in primary care physical therapy units. However, there are areas of functioning related to community health care not covered by this ICF-based tool.IMPLICATIONS OF REHABILITATIONAn ICF-based framework is feasible for the assessment of musculoskeletal conditions.Post-acute musculoskeletal ICF core set was confirmed in patient focus groups.Additional ICF categories emerged for a primary care physical therapy setting.Community features of functioning could be addressed by a tailored ICF core set.

Descripción de la epidemia estacional por Gripe B en Cantabria durante los inicios de la pandemia por SARS-CoV-2 / Description of influenza B in seasonal epidemic in Cantabria during the beginning of the pandemia due to SARS-CoV-2

INTRODUCCIÓN: La cocirculación de los dos linajes de gripe B dificulta la predicción de la cepa a incluir en la vacuna trivalente. Comunidades autónomas (CCAA) como Cantabria continúan sin suministrar la vacuna tetravalente. El objetivo de este estudio fue analizar las características epidemiológicas de la gripe B en Cantabria (temporada 2019-2020), y determinar el linaje predominante y su relación con la vacuna recomendada. MÉTODOS: Estudio retrospectivo en el que el diagnóstico de gripe y los linajes de gripe B se determinaron mediante RTPCR. RESULTADOS: Todas las muestras pertenecieron al linaje Victoria. La coinfección vírica más frecuente fue por SARSCoV-2. La población afectada por gripe B fue fundamentalmente pediátrica y los pacientes no vacunados requirieron más frecuentemente ingreso hospitalario. CONCLUSIÓN: La gripe B presenta una mayor incidencia sobre población pediátrica, y la gripe A afecta más a población adulta. Sólo el 28,8% de los pacientes con gripe B que presentaban algún factor de riesgo estaban vacunados, existiendo la necesidad de aumentar la cobertura con vacunas tetravalentes para reducir la carga de enfermedad asociada al virus gripal B

INTRODUCTION: Co-circulation of the two Influenza B lineages hinders forecast of strain to include in trivalent vaccine. Autonomous Communities such as Cantabria continue without supplying tetravalent vaccine. The aim of this study was to analyse epidemiological characteristics of influenza type B in Cantabria (2019-2020 season) as well as to establish the predominant lineage and its relation to the recommended vaccine. METHODS: Retrospective study whereby flu diagnosis and lineage analysis were determined by RT-PCR. RESULTS: All samples belonged to the Victoria lineage. Most prevalent viral co-infection was due to SARS-CoV-2. The population affected by influenza B was mainly paediatric and non-vaccinated patients more frequently required hospital admittance. CONCLUSIONS: Influenza type B has a higher incidence in the paediatric population and type A affects more the adult population. Only 28.8% of patients with Influenza B that presented with some underlying condition or risk factor were vaccinated. This shows the need to increase coverage with tetravalent vaccines in order to reduce the burden of disease associated with the Influenza B virus

Antimicrobial Susceptibility and Characterization of Resistance Mechanisms of Corynebacterium urealyticum Clinical Isolates.

Corynebacterium urealyticum is a non-diphtherial urease-producing clinically relevant corynebacterial, most frequently involved in urinary tract infections. Most of the C. urealyticum clinical isolates are frequently resistant to several antibiotics. We investigated the susceptibility of 40 C. urealyticum isolated in our institution during the period 2005-2017 to eight compounds representative of the main clinically relevant classes of antimicrobial agents. Antimicrobial susceptibility was determined by the Epsilometer test. Resistance genes were searched by PCR. All strains were susceptible to vancomycin whereas linezolid and rifampicin also showed good activity (MICs90 = 1 and 0.4 mg/L, respectively). Almost all isolates (39/40, 97.5%) were multidrug resistant. The highest resistance rate was observed for ampicillin (100%), followed by erythromycin (95%) and levofloxacin (95%). Ampicillin resistance was associated with the presence of the blaA gene, encoding a class A ß-lactamase. The two rifampicin-resistant strains showed point mutations driving amino acid replacements in conserved residues of RNA polymerase subunit ß (RpoB). Tetracycline resistance was due to an efflux-mediated mechanism. Thirty-nine PFGE patterns were identified among the 40 C. urealyticum, indicating that they were not clonally related, but producing sporadic infections. These findings raise the need of maintaining surveillance strategies among this multidrug resistant pathogen.

Allergic Contact Dermatitis to Fentanyl TTS with Good Tolerance to Systemic Fentanyl.

BACKGROUND: Fentanyl is primarily an opioid agonist. It is frequently used in general anesthesia as a potent analgesic. It can be administered either orally, transdermally or systemically. Adverse effects due to opium alkaloids are usually because of a non-specific histamine release. Only in a few cases, a true allergy mechanism could be involved. Immediate reactions to opioids are most frequent than delayed reactions. In the past years, delayed reactions have increased in frequency because of the wide use of Transdermal Therapeutic System (TTS) with several opioids for its potent analgesic properties. OBJECTIVE: The objective was to study delayed reaction to fentanyl TTS and cross-reactivity with other opioids. METHODS: A 52-year-old man with a diagnosis of pancreatic cancer who began treatment for a bone metastases pain with fentanyl TTS, at a dose of 50 micrograms per hour (mcg/h) is the subject of the study. After 10-15 days of treatment, he developed an itchy papulovesicular rash in the application site of the fentanyl TTS. Afterward, eczema and superficial desquamation just on the application site of the patch were observed. He changed several times the site of application, but always developing the same symptoms in every single application. Later on, he tolerated other opioids such as oral morphine or tramadol. An allergy workout was performed. We performed Patch Tests (PT) with fentanyl at a concentration of 10% in aqua (aq) and with buprenorphine 10% aq., in order to investigate probable crossreactivity among other topical opioids. RESULTS: Readings were recorded at day 2 (D2) and day 4 (D4), with positive PT only with fentanyl at D2 (+++) and D4 (+++). We decided to perform a single-blind challenge test with buprenorphine 35 mcg/h in TTS, with a negative result. At this moment, fentanyl TTS was replaced by buprenorphine TTS, with good tolerance. CONCLUSION: We present the case of Allergic Contact Dermatitis (ACD) due to hypersensitivity to fentanyl with good tolerance to buprenorphine. Positive PT in this patient suggests a type IV hypersensitivity mechanism. Allergic reactions to opioids are frequently immediate, but delayed reactions could appear, especially when the drug is administered topically.

Flare-Up Phenomenon of Intradermal Test with Anaphylactic Reaction to Paracetamol (Acetaminophen).

BACKGROUND: Paracetamol is a Non-Steroidal Anti-Inflammatory Drug (NSAID) that can produce hypersensitive reactions mediated by specific immunological mechanisms (IgE or T celldependent) or by a non-immunological mechanism (inhibition of cyclooxygenase COX-1). OBJECTIVE: An 80-year-old man with a history of allergy to pyrazolones, with good tolerance to other NSAIDs was referred to our allergy department because he presented a generalized urticaria after the administration of Intravenous (IV) paracetamol. METHODS: We performed an Intradermal Test (IDT) with paracetamol (0.02mg/ml) and later a Single Blind Oral Challenge Test (SBOCT) with oral paracetamol. RESULTS: IDT reading at 15min showed negative result so an SBOCT was performed with oral paracetamol. With an accumulative dose of 250mg, after 20min, he developed discomfort, nausea and dizziness, urticarial, hypotension (BP 80/40) as well as flare-up phenomenon was observed in the site of the IDT with paracetamol. Tryptase levels during the reaction and 2hrs later were increased. CONCLUSION: We present an anaphylactic shock due to sensitization to paracetamol because of a type I hypersensitivity mechanism, diagnosed by SBOCT and a positive IDT because of flare-up phenomenon, in a patient with previous pyrazolones allergy and with tolerance to other NSAIDs. Some relevant patents are also summarized in this paper.

Artritis séptica por Klebsiella oxytoca / Septic arthritis due to Klebsiella oxytoca

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The protective association of endogenous immunoglobulins against sepsis mortality is restricted to patients with moderate organ failure.

BACKGROUND: Pre-evaluation of endogenous immunoglobulin levels is a potential strategy to improve the results of intravenous immunoglobulins in sepsis, but more work has to be done to identify those patients who could benefit the most from this treatment. The objective of this study was to evaluate the impact of endogenous immunoglobulins on the mortality risk in sepsis depending on disease severity. METHODS: This was a retrospective observational study including 278 patients admitted to the ICU with sepsis fulfilling the SEPSIS-3 criteria, coming from the Spanish GRECIA and ABISS-EDUSEPSIS cohorts. Patients were distributed into two groups depending on their Sequential Organ Failure Assessment score at ICU admission (SOFA < 8, n = 122 and SOFA ≥ 8, n = 156), and the association between immunoglobulin levels at ICU admission with mortality was studied in each group by Kaplan-Meier and multivariate logistic regression analysis. RESULTS: ICU/hospital mortality in the SOFA < 8 group was 14.8/23.0%, compared to 30.1/35.3% in the SOFA ≥ 8 group. In the group with SOFA < 8, the simultaneous presence of total IgG < 407 mg/dl, IgM < 43 mg/dl and IgA < 219 mg/dl was associated with a reduction in the survival mean time of 6.6 days in the first 28 days and was a robust predictor of mortality risk either during the acute or during the post-acute phase of the disease (OR for ICU mortality: 13.79; OR for hospital mortality: 7.98). This predictive ability remained in the absence of prior immunosuppression (OR for ICU mortality: 17.53; OR for hospital mortality: 5.63). Total IgG < 407 mg/dl or IgG1 < 332 mg/dl was also an independent predictor of ICU mortality in this group. In contrast, in the SOFA ≥ 8 group, we found no immunoglobulin thresholds associated with neither ICU nor hospital mortality. CONCLUSIONS: Endogenous immunoglobulin levels may have a different impact on the mortality risk of sepsis patients based on their severity. In patients with moderate organ failure, the simultaneous presence of low levels of IgG, IgA and IgM was a consistent predictor of both acute and post-acute mortalities.

Sternal wound infection caused by Gordonia bronchialis: identification by MALDI-TOF MS.

INTRODUCTION: Gordonia spp. infections are uncommon. However, a few clinical cases have been reported in the literature, particularly those involving immunocompromised hosts. Advanced microbiology diagnosis techniques, such as matrix-assisted laser desorption ionization-time of flight MS (MALDI-TOF MS), have been recently introduced in clinical microbiology laboratories in order to improve microbial identification, resulting in better patient management. CASE PRESENTATION: Here, we present a new clinical case of persistent wound infection caused by Gordonia bronchialis in a 64-year-old woman after a mitral valve replacement, using two MALDI-TOF-based systems for identifying this micro-organism. CONCLUSION: Both MALDI-TOF systems were able to identify Gordonia spp.; thus, providing a useful tool that overcomes the current limitations of phenotypic identification associated with this micro-organism. Although the technique validation deserves additional verification, our study provides guidance about MALDI-TOF as a fast and easy method for Gordonia spp. identification.

Vertical transmission of bacterial eye infections, Angola, 2011-2012.

To determine transmission rates for neonatal conjunctivitis causative microorganisms in Angola, we analyzed 312 endocervical and 255 conjunctival samples from mothers and newborns, respectively, during 2011-2012. Transmission rates were 50% for Chlamydia trachomatis and Neisseria gonorrhoeae and 10.5% for Mycoplasma genitalium. Possible pathogenic effects of M. genitalium in children's eyes are unknown.

Sugerencias sobre el análisis molecular microbiológico post mortem / Suggestions on post mortem molecular microbiology analysis

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Hernia diafragmática congénita atascada / Stuck congenital diaphragmatic hernia

La hernia diafragmática congénita constituye uno de los retos pendientes dentro de las enfermedades quirúrgicas del recién nacido. Se presenta un caso muy inusual, en el cual se diagnosticó una hernia diafragmática derecha atascada, con compromiso de gran parte del intestino. Se describen los medios diagnósticos utilizados, el procedimiento quirúrgico realizado y las complicaciones presentadas. La hernia diafragmática congénita atascada es una complicación potencialmente letal, por el amplio compromiso vascular que produce en los órganos abdominales y que conlleva a la necrosis de estos si no se diagnostica precozmente. Por ello, debe ser considerada en el diagnóstico diferencial de la insuficiencia respiratoria en los recién nacidos y lactantes pequeños(AU)

Congenital diaphragmatic hernia is one of the pending challenges in dealing with the surgical diseases of the newborn. This was a very unusual case of a right stuck diaphragmatic hernia that affected a large part of the intestine. The used diagnostic means, the surgical procedure and the observed complications were described. Stuck congenital diaphragmatic hernia is a potentially lethal complication because of the wide vascular effect on the abdominal organs, leading to their necrosis if this problem is not early diagnosed. Therefore, it must be taken into account in the differential diagnosis of the respiratory failure in newborns and small infants(AU)

Hernia diafragmática congénita atascada / Stuck congenital diaphragmatic hernia

La hernia diafragmática congénita constituye uno de los retos pendientes dentro de las enfermedades quirúrgicas del recién nacido. Se presenta un caso muy inusual, en el cual se diagnosticó una hernia diafragmática derecha atascada, con compromiso de gran parte del intestino. Se describen los medios diagnósticos utilizados, el procedimiento quirúrgico realizado y las complicaciones presentadas. La hernia diafragmática congénita atascada es una complicación potencialmente letal, por el amplio compromiso vascular que produce en los órganos abdominales y que conlleva a la necrosis de estos si no se diagnostica precozmente. Por ello, debe ser considerada en el diagnóstico diferencial de la insuficiencia respiratoria en los recién nacidos y lactantes pequeños

Congenital diaphragmatic hernia is one of the pending challenges in dealing with the surgical diseases of the newborn. This was a very unusual case of a right stuck diaphragmatic hernia that affected a large part of the intestine. The used diagnostic means, the surgical procedure and the observed complications were described. Stuck congenital diaphragmatic hernia is a potentially lethal complication because of the wide vascular effect on the abdominal organs, leading to their necrosis if this problem is not early diagnosed. Therefore, it must be taken into account in the differential diagnosis of the respiratory failure in newborns and small infants

Eosinophil as a protective cell in S. aureus ventilator-associated pneumonia.

Cell counts of leukocytes subpopulations are demonstrating to have an important value in predicting outcome in severe infections. We evaluated here the render of leukogram counts to predict outcome in patients with ventilator-associated pneumonia (VAP) caused by Staphylococcus aureus. Data from patients admitted to the ICU of Hospital Clínico Universitario de Valladolid from 2006 to 2011 with diagnosis of VAP caused by S. aureus were retrospectively collected for the study (n = 44). Leukocyte counts were collected at ICU admission and also at VAP diagnosis. Our results showed that nonsurvivors had significant lower eosinophil counts at VAP diagnosis. Multivariate Cox regression analysis performed by the Wald test for forward selection showed that eosinophil increments from ICU admission to VAP diagnosis and total eosinophil counts at VAP diagnosis were protective factors against mortality in the first 28 days following diagnosis: (HR [CI 95%], P): (0.996 [0.993-0.999], 0.010); (0.370 [0.180-0.750], 0.006). Patients with eosinophil counts <30 cells/mm(3) at diagnosis died earlier. Eosinophil counts identified survivors: (AUROC [CI 95%], P): (0.701 [0.519-0.882], 0.042). Eosinophil behaves as a protective cell in patients with VAP caused by S. aureus.

Enfisema lobar congénito: Experiencia con 15 casos / Congenital lobar emphysema: experience with 15 cases

El enfisema lobar congénito es una malformación quística congénita del pulmón casi exclusiva de la infancia. Se realizó un estudio retrospectivo de 15 pacientes tratados en el Hospital Pediátrico Universitario William Soler durante 10 años, con el objetivo de estudiar el comportamiento clínico y terapéutico. Se encontró que 10 casos correspondieron al sexo femenino (66,66 por ciento) y 5 al masculino (33,33 por ciento); la edad de inicio de los síntomas varió desde menos de 24 horas de nacido hasta 24 semanas y la manifestación clínica más frecuente fue la disnea en 14 pacientes (93,33 por ciento). El lóbulo superior izquierdo estuvo afectado en 9 casos (60,00 por ciento) con mayor gravedad, seguido del lóbulo medio derecho en 5 niños (33,33 por ciento) y el lóbulo superior derecho en uno (6,66 por ciento); la lobectomía se realizó en la mayoría de los casos. Se concluye que esta enfermedad fue más frecuente en el sexo femenino, en menores de 24 semanas y en el lóbulo superior izquierdo; la severidad del cuadro clínico obligó al tratamiento quirúrgico de urgencia en muchos pacientes.