Tiña por Nannizzia nana: caso clínico y revisión bibliográfica / Ringworm by Nannizzia nana: Clinical case and literature review

Introducción Las dermatofitosis humanas son el grupo más extendido de infecciones causadas por hongos. Estos son capaces de invadir los tejidos que contienen queratina de los animales. Nannizzia nana (N. nana) puede causar tiña en cerdos y que de manera excepcional puede producir infecciones en humanos. Métodos Realizamos una búsqueda en PubMed de artículos publicados desde el 1 de enero de 1990 hasta el 31 de marzo del 2022 para identificar casos adicionales. Los términos de búsqueda empleados fueron «Microsporum nanum» y «Nannizzia nana». Resultados Tras la revisión bibliográfica identificamos un total 16 casos de dermatofitosis por N. nana desde 1990. En la mayoría de los pacientes, el diagnóstico clínico fue tinea corporis y los antifúngicos más utilizados fueron terbinafina y griseofulvina. Conclusión N. nana es una especie de dermatofito aislada infrecuentemente en humanos, pero que representa una fuente potencial de dermatofitosis en personas que entran en contacto directo o indirecto con animales y con el suelo (AU)

Introduction Human dermatophytoses are the most widespread infections caused by fungi. These are capable of invading the keratin-containing tissues of animals. Nannizzia nana (N. nana) can cause ringworm in pigs and rarely cause infections in humans. Methods We conducted a search using PubMed for articles published from January 1, 1990 to March 31, 2022 to identify additional cases. The search terms used were “Microsporum nanum” and “Nannizzia nana”. Results After reviewing the literature, we identified a total of 16 cases of dermatophytosis due to N. nana since 1990. In most of the patients, the clinical diagnosis was tinea corporis and the most widely used antifungals were: terbinafine and griseofulvin. Conclusion N. nana is a dermatophyte species isolated infrequently in humans, but it represents a potential source of dermatophytosis in people who come into direct or indirect contact with animals and soil (AU)

Species and biotypes of Streptococcus bovis causing infective endocarditis / Especies y biotipos de Streptococcus bovis causantes de endocarditis infecciosa

Introduction: Streptococcus bovis/equinus complex (SBEC) is a major cause of infective endocarditis (IE), although its incidence varies greatly depending on the geographical area. The characteristics of IE caused by Streptococcus gallolyticus susp. gallolyticus are well known; there are hardly any descriptions of IE caused by other species or biotypes. Methods: Retrospective cohort study, from 1990 to 2019, of all SBEC IE in adults in three Spanish hospitals, Lugo (LH), Barcelona (BH) and Ferrol (FH) where the population is mainly rural, urban and mixed, respectively. The incidence of IE was analyzed in 3 areas. Clinical characteristics of IE (277 cases, 258 biotyped) were compared according to SBEC species and biotypes. Results: There are significant differences between the incidence of SBEC IE in HL (27.9/106) vs. HF and HB (8.8 and 7,1, respectively, p<0.001). We found significant differences (SbI vs. SbII) in mean age (68.5 vs. 73 years; p<0.01), duration of symptoms before diagnosis (46.9±46.5 vs. 30.4±40.9 days; p<0.01), presence of comorbidities: 39.1% (78) vs. 54.2% (32; p<0.04), predisposing heart illness:62.3% (124) vs. 81.3% (48; p<0.006), particularly, prosthetic or intravascular devices IE: 24.6% (49) vs. 52.4% (31; p<0.001), bi-valve involvement:23.6% (47) vs. 11.8% (7; p<0.05) and heart failure: 24.6% (49) vs. 38.9% (23; p<0.03). There were no significant differences in embolic events, need for surgery or mortality. The association with CRC was high in both groups: 77.7% vs. 66.6%. Conclusions: IE due to SBEC has geographical variations in incidence and different clinical characteristics among biotypes. The association with CRC was high.(AU)

Introducción: El complejo Streptococcus bovis/equinus (SBEC) es una de las principales causas de endocarditis infecciosa (EI), aunque su incidencia es muy variable según la zona geográfica. Las características de EI causada por Streptococcus gallolyticus subsp. gallolyticus son bien conocidas; apenas hay descripciones de EI causada por otras especies o biotipos. Métodos: Estudio de cohorte retrospectivo, desde 1990 hasta 2019, de todas las EI por SBEC en adultos en 3 hospitales españoles, Lugo (LH), Barcelona (BH) y Ferrol (FH) donde la población es mayoritariamente rural, urbana y mixta, respectivamente. Se analizó la incidencia de EI en 3 áreas. Se compararon las características clínicas de EI (277 casos, 258 biotipados) según las especies y biotipos de SBEC. Resultados: Existen diferencias significativas entre la incidencia de EI por SBEC en HL (27,9/106) vs. HF y HB (8,8 y 7,1, respectivamente, p<0,001). Encontramos diferencias significativas (SbI vs. SbII) en edad media (68,5 vs. 73 años; p<0,01), duración de los síntomas antes del diagnóstico (46,9±46,5 vs. 30,4±40,9 días; p<0,01); comorbilidades: 39,1 (78) vs. 54,2% (32; p<0,04); enfermedad cardíaca predisponente: 62,3 (124) vs. 81,3% (48; p<0,006), en particular, EI protésica o sobre dispositivos intravasculares: 24,6 (49) vs. 52,4% (31; p<0,001); afectación bivalva: 23,6 (47) vs. 11,8% (7; p<0,05) e insuficiencia cardiaca: 24,6 (49) vs. 38,9% (23; p<0,03). No hubo diferencias significativas en cuanto a eventos embólicos, necesidad de cirugía o mortalidad. La asociación con el CCR fue alta en ambos grupos: 77,7 vs. 66,6%. Conclusiones: La EI por SBEC tiene variaciones geográficas en la incidencia y diferentes características clínicas entre los biotipos. La asociación con el CCR fue elevada.(AU)

Ringworm by Nannizzia nana: Clinical case and literature review.

INTRODUCTION: Human dermatophytoses are the most widespread infections caused by fungi. These are capable of invading the keratin-containing tissues of animals. Nannizzia nana (N. nana) can cause ringworm in pigs and rarely cause infections in humans. METHODS: We conducted a search using PUBMED for articles published from January 1, 1990 to March 31, 2022 to identify additional cases. The search terms used were "Microsporum nanum" and "Nannizzia nana". RESULTS: After reviewing the literature, we identified a total of 16 cases of dermatophytosis due to N. nana since 1990. In most of the patients, the clinical diagnosis was tinea corporis and the most widely used antifungals were: terbinafine and griseofulvin. CONCLUSION: N. nana is a dermatophyte species isolated infrequently in humans, but it represents a potential source of dermatophytosis in people who come into direct or indirect contact with animals and soil.

Species and biotypes of Streptococcus bovis causing infective endocarditis.

INTRODUCTION: Streptococcus bovis/equinus complex (SBEC) is a major cause of infective endocarditis (IE), although its incidence varies greatly depending on the geographical area. The characteristics of IE caused by Streptococcus gallolyticus susp. gallolyticus are well known; there are hardly any descriptions of IE caused by other species or biotypes. METHODS: Retrospective cohort study, from 1990 to 2019, of all SBEC IE in adults in three Spanish hospitals, Lugo (LH), Barcelona (BH) and Ferrol (FH) where the population is mainly rural, urban and mixed, respectively. The incidence of IE was analyzed in 3 areas. Clinical characteristics of IE (277 cases, 258 biotyped) were compared according to SBEC species and biotypes. RESULTS: There are significant differences between the incidence of SBEC IE in HL (27.9/106) vs. HF and HB (8.8 and 7,1, respectively, p<0.001). We found significant differences (SbI vs. SbII) in mean age (68.5 vs. 73 years; p<0.01), duration of symptoms before diagnosis (46.9±46.5 vs. 30.4±40.9 days; p<0.01), presence of comorbidities: 39.1% (78) vs. 54.2% (32; p<0.04), predisposing heart illness:62.3% (124) vs. 81.3% (48; p<0.006), particularly, prosthetic or intravascular devices IE: 24.6% (49) vs. 52.4% (31; p<0.001), bi-valve involvement:23.6% (47) vs. 11.8% (7; p<0.05) and heart failure: 24.6% (49) vs. 38.9% (23; p<0.03). There were no significant differences in embolic events, need for surgery or mortality. The association with CRC was high in both groups: 77.7% vs. 66.6%. CONCLUSIONS: IE due to SBEC has geographical variations in incidence and different clinical characteristics among biotypes. The association with CRC was high.

Relationship among Streptococcus gallolyticus Subsp. gallolyticus, Enterococcus faecalis and Colorectal Neoplasms in Recurrent Endocarditis: A Historical Case Series.

OBJECTIVES: The role of colorectal neoplasms (CRN) as a common potential source of recurrent Streptococcus gallolyticus subsp. gallolyticus (SGG) and Enterococcus faecalis (EF) endocarditis remains unstudied. We aimed to investigate what proportion of episodes of recurrent endocarditis are caused by a succession of SGG and EF, or vice versa, and to assess the role of a colonic source in such recurrent episodes. METHODS: we conducted a retrospective analysis of two prospective endocarditis cohorts (1979-2019) from two Spanish hospitals, providing descriptive analyses of the major features of the endocarditis episodes, colonoscopy findings, and histologic results. RESULTS: among 1552 IE episodes, 204 (13.1%) were caused by EF and 197 (12.7%) by SGG, respectively. There were 155 episodes (10%) of recurrent IE, 20 of which (12.9%) were due to a succession of SGG/EF IE in 10 patients (the first episode caused by SGG in eight cases, and by EF in two cases). The median follow-up was 86 (interquartile range 34-156) months. In 8/10 initial episodes, the causative microorganism was SGG, and all patients were diagnosed with CRN either during the initial episode or during follow-up. During the second episode of IE or follow-up, colonoscopies revealed CRN in six patients. CONCLUSIONS: There seems to be an association between SGG and EF in recurrent endocarditis that warrants further investigation. Our findings reinforce the need for systematically performing colonoscopy in the event of endocarditis caused by both microorganisms.

Espondilodiscitis por Streptococcus suis: 2 nuevos casos y revisión bibliográfica / Streptococcus suis spondylodiscitis: 2 new cases and a literature review

IntroducciónLa infección por Streptococcus suis (S. suis) es una zoonosis poco descrita en nuestro país, que se relaciona con la exposición al ganado porcino o su carne. La forma de presentación más frecuente es la meningitis, mientras que la afectación de la columna vertebral es rara.MétodosPresentamos 2 casos de infección por S. suis y realizamos una revisión sistemática de los trabajos publicados sobre espondilodiscitis por S. suis entre enero de 1994 y mayo de 2020 con el objetivo de definir las características clínicas, sus factores predisponentes y su evolución.ResultadosSe describen 17 casos, el 76,5% varones con una edad media de 57,6 años, generalmente sin enfermedad de base asociada. El enolismo fue un factor presente en casi el 17,6% de los pacientes. Un 70,6% presentaron exposición a ganado porcino o su carne y un 20% heridas en manos. La duración media de los síntomas fue de 10,2 días y el segmento más afectado fue el lumbar. Un 70,6% cursó con meningitis. Todos se trataron con betalactámicos con una duración media de 53,2 días. Hubo una recidiva y ninguno falleció.ConclusiónExisten pocos casos de espondilodiscitis por S. suis en la literatura. Cuando ocurre, se asocia a otro tipo de infección en la mayoría de los casos. Presentan buena respuesta al tratamiento médico y buen pronóstico.

IntroductionStreptococcus suis (S. suis) infection is poorly described zoonosis in our country, which is related with exposure to pigs or their meat. The most common clinical presentation is meningitis, while spinés involvement is rare.MethodsWe report 2 cases of S. suis infection and perform a systematic review of the articles published on S. suis spondylodiscitis between January 1994 and May 2020 with the aim of defining the clinical characteristics, predisposing factors and evolution.Results17 cases are described, 76.5% males with a mean age of 57.6 years, generally without associated underlying disease. Enolism was a factor present in 17.6%. 70.6% had exposure to pigs or their meat and 20% hand injuries. The mean duration of symptoms was 10.2 days and the most affected segment was the lumbar level. 70.6% had meningitis. All were treated with beta-lactams with an average duration of 53.2 days. There was a recurrence and none died.ConclusionThere are few cases of S. suis spondylodiscitis in the literature. When occurs, it is associated with another type of infection in most cases. They present a good response to medical treatment and a good prognosis.

Emergence of methicillin resistance predates the clinical use of antibiotics.

The discovery of antibiotics more than 80 years ago has led to considerable improvements in human and animal health. Although antibiotic resistance in environmental bacteria is ancient, resistance in human pathogens is thought to be a modern phenomenon that is driven by the clinical use of antibiotics1. Here we show that particular lineages of methicillin-resistant Staphylococcus aureus-a notorious human pathogen-appeared in European hedgehogs in the pre-antibiotic era. Subsequently, these lineages spread within the local hedgehog populations and between hedgehogs and secondary hosts, including livestock and humans. We also demonstrate that the hedgehog dermatophyte Trichophyton erinacei produces two ß-lactam antibiotics that provide a natural selective environment in which methicillin-resistant S. aureus isolates have an advantage over susceptible isolates. Together, these results suggest that methicillin resistance emerged in the pre-antibiotic era as a co-evolutionary adaptation of S. aureus to the colonization of dermatophyte-infected hedgehogs. The evolution of clinically relevant antibiotic-resistance genes in wild animals and the connectivity of natural, agricultural and human ecosystems demonstrate that the use of a One Health approach is critical for our understanding and management of antibiotic resistance, which is one of the biggest threats to global health, food security and development.

Streptococcus suis spondylodiscitis: 2 new cases and a literature review.

INTRODUCTION: Streptococcus suis (S. suis) infection is poorly described zoonosis in our country, which is related with exposure to pigs or their meat. The most common clinical presentation is meningitis, while spine's involvement is rare. METHODS: We report 2 cases of S. suis infection and perform a systematic review of the articles published on S. suis spondylodiscitis between January 1994 and May 2020 with the aim of defining the clinical characteristics, predisposing factors and evolution. RESULTS: 17 cases are described, 76.5% males with a mean age of 57.6 years, generally without associated underlying disease. Enolism was a factor present in 17.6%. 70.6% had exposure to pigs or their meat and 20% hand injuries. The mean duration of symptoms was 10.2 days and the most affected segment was the lumbar level. 70.6% had meningitis. All were treated with beta-lactams with an average duration of 53.2 days. There was a recurrence and none died. CONCLUSION: There are few cases of S. suis spondylodiscitis in the literature. When occurs, it is associated with another type of infection in most cases. They present a good response to medical treatment and a good prognosis.

Streptococcus suis spondylodiscitis: 2 new cases and a literature review. / Espondilodiscitis por Streptococcus suis: 2 nuevos casos y revisión bibliográfica.

INTRODUCTION: Streptococcus suis (S. suis) infection is poorly described zoonosis in our country, which is related with exposure to pigs or their meat. The most common clinical presentation is meningitis, while spinés involvement is rare. METHODS: We report 2 cases of S. suis infection and perform a systematic review of the articles published on S. suis spondylodiscitis between January 1994 and May 2020 with the aim of defining the clinical characteristics, predisposing factors and evolution. RESULTS: 17 cases are described, 76.5% males with a mean age of 57.6 years, generally without associated underlying disease. Enolism was a factor present in 17.6%. 70.6% had exposure to pigs or their meat and 20% hand injuries. The mean duration of symptoms was 10.2 days and the most affected segment was the lumbar level. 70.6% had meningitis. All were treated with beta-lactams with an average duration of 53.2 days. There was a recurrence and none died. CONCLUSION: There are few cases of S. suis spondylodiscitis in the literature. When occurs, it is associated with another type of infection in most cases. They present a good response to medical treatment and a good prognosis.

Estudio de sensibilidad de Escherichia coli productores de infecciones del tracto urinario comunitarias en Galicia. Período: 2016-2017 / Antimicrobial susceptibility of Escherichia coli producers of community urinary tract infections in Galicia (Spain). Period: 2016-2017

OBJETIVO: Escherichia coli (E. coli) es el responsable de la mayoría de las infecciones del tracto urinario comunitarias. El objetivo del estudio es conocer el espectro de sensibilidad de E. coli en infecciones del tracto urinario para recomendar el tratamiento antibiótico empírico adecuado. DISEÑO: Estudio transversal, multicéntrico, retrospectivo. EMPLAZAMIENTO: Ocho hospitales públicos gallegos, prácticamente toda la población de Galicia (España). PARTICIPANTES: Cuarenta y tres mil ciento treinta y siete pacientes ambulatorios con infección del tracto urinario por E. coli aislados en orina en 2016/2017. MEDICIONES PRINCIPALES: Variables analizadas: demográficas, concentración mínima inhibitoria e interpretación de la sensibilidad según criterios de CLSI y mecanismos de resistencia. Los antibióticos estudiados fueron: ampicilina, amoxicilina-ácido clavulánico, ciprofloxacino, cefotaxima, cefepime, gentamicina, nitrofurantoína, fosfomicina, cotrimoxazol, imipenem y ertapenem. La identificación y sensibilidad se hicieron principalmente por sistemas automatizados. RESULTADOS: Los porcentajes de no sensibilidad de los aislamientos de E. coli fueron: ampicilina 49,2%, amoxicilina-ácido clavulánico 17,8%, cefotaxima 6,7%, cefepime 5,7%, ertapenem 0,04%, imipenem 0,05%, gentamicina 9,1%, ciprofloxacino 26,2%, fosfomicina 3,3%, nitrofurantoína 2,4% y cotrimoxazol 23,9%. Las no sensibilidades fueron superiores en hombres y a medida que aumenta la edad. El 6% fueron productores de betalactamasas de espectro extendido. CONCLUSIONES: El tratamiento empírico en Galicia para cistitis no complicadas producidas por E. coli en mujeres continúa siendo nitrofurantoína y fosfomicina. En hombres menores de 15 años se indica fosfomicina y en hombres mayores de 15 años el tratamiento en nuestro medio debe incluir la realización de cultivo y administrar una cefalosporina de 3.a generación oral empíricamente. No se recomienda cotrimoxazol ni ciprofloxacino como tratamiento empírico por sus altos porcentajes de resistencia

OBJECTIVE: Escherichia coli (E. coli) is responsible for the majority of community urinary tract infections. The objective of the study is to know the sensitivity spectrum of E. coli in urinary tract infections to be able to recommend the appropriate empirical antibiotic treatment. DESIGN: Cross-sectional, multicentric, retrospective study. LOCATION: Galician 8 public hospitals, practically the entire population of Galicia (Spain). PARTICIPANTS: 43,137 outpatients with urinary tract infection due to E. coli isolated in urine in 2016/2017. MAIN MEASUREMENTS: Analyzed variables: demographic, minimum inhibitory concentration and interpretation of sensitivity according to CLSI criteria and resistance mechanisms. The antibiotics studied were: ampicillin, amoxicillin-clavulanic acid, ciprofloxacin, cefotaxime, cefepime, gentamicin, nitrofurantoin, fosfomycin, cotrimoxazole, imipenem and ertapenem. The identification and sensitivity were made mainly by automated methods. RESULTS: The percentages of non-sensitivity of E. coli isolates were: ampicillin 49.2%, amoxicillin-clavulanic acid 17.8%, cefotaxime 6.7%, cefepime 5.7%, ertapenem 0.04%, imipenem 0.05%, gentamicin 9,1%, ciprofloxacin 26.2%, fosfomycin 3.3%, nitrofurantoin 2.4% and cotrimoxazole 23.9%. The non-sensitivities were higher in men and as age increases. Six percent of E. coli were producers of extended-spectrum beta-lactamases. CONCLUSIONS: The empirical treatment in Galicia for uncomplicated cystitis produced by E. coli in women continues to be nitrofurantoin and fosfomycin. In men under 15 years of age, fosfomycin is indicated and in men older than 15 years, treatment in our environment should include culture and administer a 3rd generation oral cephalosporin empirically. Cotrimoxazole and ciprofloxacin are not recommended as empirical treatment because of their high resistance rates

[Antimicrobial susceptibility of Escherichia coli producers of community urinary tract infections in Galicia (Spain). Period: 2016-2017]. / Estudio de sensibilidad de Escherichia coli productores de infecciones del tracto urinario comunitarias en Galicia. Período: 2016-2017.

OBJECTIVE: Escherichia coli (E. coli) is responsible for the majority of community urinary tract infections. The objective of the study is to know the sensitivity spectrum of E. coli in urinary tract infections to be able to recommend the appropriate empirical antibiotic treatment. DESIGN: Cross-sectional, multicentric, retrospective study. LOCATION: Galician 8 public hospitals, practically the entire population of Galicia (Spain). PARTICIPANTS: 43,137 outpatients with urinary tract infection due to E. coli isolated in urine in 2016/2017. MAIN MEASUREMENTS: Analyzed variables: demographic, minimum inhibitory concentration and interpretation of sensitivity according to CLSI criteria and resistance mechanisms. The antibiotics studied were: ampicillin, amoxicillin-clavulanic acid, ciprofloxacin, cefotaxime, cefepime, gentamicin, nitrofurantoin, fosfomycin, cotrimoxazole, imipenem and ertapenem. The identification and sensitivity were made mainly by automated methods. RESULTS: The percentages of non-sensitivity of E. coli isolates were: ampicillin 49.2%, amoxicillin-clavulanic acid 17.8%, cefotaxime 6.7%, cefepime 5.7%, ertapenem 0.04%, imipenem 0.05%, gentamicin 9,1%, ciprofloxacin 26.2%, fosfomycin 3.3%, nitrofurantoin 2.4% and cotrimoxazole 23.9%. The non-sensitivities were higher in men and as age increases. Six percent of E. coli were producers of extended-spectrum beta-lactamases. CONCLUSIONS: The empirical treatment in Galicia for uncomplicated cystitis produced by E. coli in women continues to be nitrofurantoin and fosfomycin. In men under 15 years of age, fosfomycin is indicated and in men older than 15 years, treatment in our environment should include culture and administer a 3rd generation oral cephalosporin empirically. Cotrimoxazole and ciprofloxacin are not recommended as empirical treatment because of their high resistance rates.

Neumonía comunitaria por Legionella pneumophila: estudio de 136 casos / Community acquired pneumonia by Legionella pneumophila: Study of 136 cases

Objetivo: La mayoría de los datos de la neumonía por Legionella en nuestro país proceden del área mediterránea, y apenas existen estudios en la zona del Noroeste. Con este trabajo se pretende conocer la situación de la infección en nuestro medio. Método: Estudio retrospectivo de todos los pacientes con antigenuria positiva para Legionella en el Hospital Universitario Lucus Augusti de Lugo desde 2001, año en que se introdujo la antigenuria como prueba diagnóstica en nuestro centro, hasta 2015. Se analizaron datos epidemiológicos, factores de riesgo, hallazgos clínicos, radiológicos, analíticos y evolutivos. Resultados: Se registraron 136 pacientes. Si comparamos los primeros 5años del estudio con los 5últimos, la incidencia aumentó de 10,9 a 64,5 casos/1.000.000, el número de peticiones de antigenuria se incrementó 3,4 veces, y con respecto a otras neumonías, Legionella pasó del 0,9 al 15% de ellas. La edad media fue de 64,1años, y el 84,6% fueron varones. El 74,3% tenían comorbilidades. Los varones fueron significativamente más jóvenes (62,7±16,6 vs 71,9±17,3) y consumían más alcohol (26,1% vs 0%) y tabaco (67,8% vs 14,3%). El 88,9% se diagnosticaron dentro de las primeras 72h y la mayoría recibió levofloxacino (95,6%). El 85% necesitaron ingreso hospitalario, el 11,7% en UCI y el 4,4% fallecieron. Conclusiones: Coincidiendo con la introducción de la antigenuria, se observa un aumento de incidencia de neumonía por Legionella en nuestra área sanitaria, con tasas en los últimos años que se sitúan entre las más altas de nuestro país. A pesar de tener pacientes con elevada edad media y un alto porcentaje de comorbilidades, la mortalidad fue reducida

Objective: Most of the data on Legionella pneumonia in our country come from the Mediterranean area, and there are few studies from the Northwest area. This study tries to assess the situation of this infection in this area. Method: Retrospective study of all patients with positive Legionella antigenuria treated at the University Hospital Lucus Augusti in Lugo (Spain) from 2001, the year in which this test was introduced in our centre, until 2015. We analysed epidemiological data, risk factors, clinical, radiological and biochemical findings, and clinical outcome. Results: The sampled included 136 patients. When comparing the first five years of the study with the last five, the incidence increased from 10.9 to 64.5 cases/1,000,000; the number of antigenuria requests increased 3.4 times, and compared to other pneumonia aetiologies Legionella increased from 0.9% to 15%. The mean age was 64.1years and 84.6% were males; 74.3% had comorbidities. Males were significantly younger (62.7±16.6 vs 71.9±17.3) and consumed more alcohol (26.1% vs 0%) and tobacco (67.8% vs 14.3%). Diagnosis was established within the first 72hours in 88.9% of cases and most received levofloxacin (95.6%). Hospitalisation was needed in 85% of cases, 11.7% in ICU and 4.4% died. Conclusions: After the introduction of antigenuria there was an increase in the incidence of Legionella pneumonia recorded in our health area. Its rate in recent years has been one of the highest in our country. Despite the fact that the patients had advanced age and comorbidities, mortality was low

Community acquired pneumonia by Legionella pneumophila: Study of 136 cases. / Neumonía comunitaria por Legionella pneumophila: estudio de 136 casos.

OBJECTIVE: Most of the data on Legionella pneumonia in our country come from the Mediterranean area, and there are few studies from the Northwest area. This study tries to assess the situation of this infection in this area. METHOD: Retrospective study of all patients with positive Legionella antigenuria treated at the University Hospital Lucus Augusti in Lugo (Spain) from 2001, the year in which this test was introduced in our centre, until 2015. We analysed epidemiological data, risk factors, clinical, radiological and biochemical findings, and clinical outcome. RESULTS: The sampled included 136 patients. When comparing the first five years of the study with the last five, the incidence increased from 10.9 to 64.5 cases/1,000,000; the number of antigenuria requests increased 3.4 times, and compared to other pneumonia aetiologies Legionella increased from 0.9% to 15%. The mean age was 64.1years and 84.6% were males; 74.3% had comorbidities. Males were significantly younger (62.7±16.6 vs 71.9±17.3) and consumed more alcohol (26.1% vs 0%) and tobacco (67.8% vs 14.3%). Diagnosis was established within the first 72hours in 88.9% of cases and most received levofloxacin (95.6%). Hospitalisation was needed in 85% of cases, 11.7% in ICU and 4.4% died. CONCLUSIONS: After the introduction of antigenuria there was an increase in the incidence of Legionella pneumonia recorded in our health area. Its rate in recent years has been one of the highest in our country. Despite the fact that the patients had advanced age and comorbidities, mortality was low.

Colorectal neoplasm in cases of Clostridium septicum and Streptococcus gallolyticus subsp. gallolyticus bacteraemia.

BACKGROUND: Bacteremia with Clostridium septicum (CS) and Streptococcus gallolyticus subsp. gallolyticus (SGG) have both been associated with colorectal neoplasms (CRN) and colonoscopic examination is advised, however the differences and similarities in colorectal findings are not well known. METHODS: This is a multicenter, comparative study of patients with CS bacteremia [44 of 664 cases (6.6%) of Clostridium spp.] and SGG bacteremia [257 of 596 cases (44.2%) of S. bovis group], carried out in three hospitals from Spain. Clinical findings related to bacteremia and associated CRN were collected. RESULTS: The main sources of infection were abdominal (77.7%) for CS bacteremia and endovascular (75%) for SGG bacteremia. CS bacteremia was more often associated with malignancies, (72.6% vs. 19.4%) and neutropenia (29.5% vs. 3.1%), and was more acute, with shock at presentation (63.6% vs. 3.9%) and higher 30-day mortality (47.7% vs. 9.7%) compared to SGG (P<0.05 for all). Both, patients with CS and SGG bacteremia often had concomitant CRN (43.1% vs. 49.8%) and most of them presented as occult CRN (73.7% vs. 91.4%; P=0.02). CS cases more often had invasive carcinomas (94.7% vs. 19.5%), location of CRN in the right colon (73.7% vs. 23.4%), larger tumor size (median 7 vs. 1.5cm), and a higher overall CRN related mortality rate (68.4% vs. 7.8%) compared to SGG cases (P<0.05 for all). CONCLUSIONS: Both, CS and SGG bacteremia are associated with occult CRN. CS cases more often had advanced carcinomas than SGG cases, suggesting a distinct temporal association with CRN.

Diagnóstico microbiológico de la infección bacteriana asociada al parto y puerperio / Microbiological diagnosis of bacterial infection associated with delivery and postpartum

La infección en el recién nacido puede adquirirse a través del canal del parto por colonización materna, como la infección neonatal precoz por Streptococcus agalactiae, o por adquisición a través de la placenta, líquido amniótico o productos del parto. Tras el parto, el recién nacido que precisa ingreso hospitalario puede adquirir infecciones nosocomiales durante su estancia y de forma excepcional, a través de la lactancia, por mastitis infecciosa o por incorrecta manipulación de la leche materna propia o donada de bancos de leche, lo que no obliga a suspender la lactancia en la mayoría de las ocasiones pero sí a establecer un tratamiento. Por los motivos expuestos es necesario establecer un correcto diagnóstico microbiológico de las infecciones perinatales, especialmente relevantes en el recién nacido pretérmino de bajo o muy bajo peso con una elevada mortalidad

The newborn may acquire infections during delivery due to maternal colonization of the birth canal, by microorganisms such as Streptococcus agalactiae that caused early neonatal infection, or acquisition through the placenta, amniotic fluid or birth products. After birth, the newborn that needs hospitalization can develop nosocomial infections during their care and exceptionally through lactation by infectious mastitis or incorrect handling of human milk, which does not require to stop breastfeeding in most cases. It is important and necessary to perform microbiological diagnosis for the correct treatment of perinatal infections, especially relevant in preterm infants with low or very low weight with high mortality rates

Streptococcus bovis septic arthritis and osteomyelitis: A report of 21 cases and a literature review.

BACKGROUND: The Streptococcus bovis group (SBG) is a well-known cause of endocarditis, but its role in osteoarticular infections (OAIs) has not been well described. METHODS: We analyzed all patients with OAIs by SBG diagnosed in our hospital (1988-2014). We selected those cases with septic arthritis and osteomyelitis, as defined according to clinical, microbiological, and imaging studies. Identification of the strains was performed by using the API 20 Strep and the GP card of the Vitek 2 system, and confirmed the identification by molecular methods. In addition, we reviewed the literature to select all cases of OAI by SBG during the period 1980-2015. RESULTS: From the 83 cases of OAI included in the analysis (21 from our center and 62 from the literature review), 59 were osteomyelitis (57 of them spondylodiscitis) and 24 were arthritis (2 with associated spondylodiscitis). The mean age was 66.9 years, and 79.2% of the patients were men. Endocarditis (IE) was associated with 59% of the cases and this association was greater for osteomyelitis than for arthritis (78.9% vs. 13.6%; P = 0.001). OAI was a presenting symptom in 63% of the cases of IE. Colonoscopy was performed in 64 cases, which detected colorectal neoplasm (CRN) in 46 patients (71.8%), almost all asymptomatic. Some 69.5% of these neoplasm were carcinomas or advanced adenomas. The blood cultures were positive in 78.3% cases. In 45 cases, the S. bovis species was identified; in 82.2% of the cases the cause was Streptococcus gallolyticus subsp. gallolyticus. The mortality was 7.2%, which in no case was attributable to the OAI. CONCLUSIONS: OAIs are frequently the initial manifestation of IE caused by SBG. S. gallolyticus causes most of these infections. Echocardiogram and colonoscopy are therefore mandatory, given the species' close association with IE and CRN.

[Microbiological diagnosis of bacterial infection associated with delivery and postpartum]. / Diagnóstico microbiológico de la infección bacteriana asociada al parto y puerperio.

The newborn may acquire infections during delivery due to maternal colonization of the birth canal, by microorganisms such as Streptococcus agalactiae that caused early neonatal infection, or acquisition through the placenta, amniotic fluid or birth products. After birth, the newborn that needs hospitalization can develop nosocomial infections during their care and exceptionally through lactation by infectious mastitis or incorrect handling of human milk, which does not require to stop breastfeeding in most cases. It is important and necessary to perform microbiological diagnosis for the correct treatment of perinatal infections, especially relevant in preterm infants with low or very low weight with high mortality rates.

The clinical epidemiology and malignancies associated with Streptococcus bovis biotypes in 506 cases of bloodstream infections.

OBJECTIVES: To determine the incidence of Streptococcus bovis (Sb) biotypes causing bacteraemia and associated malignancies. METHODS: This is a retrospective analysis of patients with Sb bacteraemia, pulled out from a prospective surveillance protocol of bacteraemia cases, in three areas of Spain (1990-2013): a cattle area (Lugo), a fishing area (Ferrol) and an urban area (Barcelona). Colonoscopy and Sb biotypes (Sb-I and Sb-II) were determined in most cases. RESULTS: 506 patients with Sb bacteraemia; mean age 68.1 (±14.1) years, and 66.2% were males. The cattle area, compared with the fishing and urban areas, had higher incidence of bacteraemia by SbI (40.29 vs 9.38 vs 6.15 cases/10(6) person-years, P < 0.001) and bacteraemia by Sb-II (29.07 vs 9.84 vs 13.37 cases/10(6) person-years, P < 0.001). The Sb-I cases (n = 224), compared with Sb-II cases (n = 270), had greater rates of endocarditis (77.6% vs 9.6%, P < 0.001) and colorectal neoplasm (CRN) (50.9% vs 16.6%, P < 0.001), and smaller rates of biliary tract infection (2.2% vs 29.6%, P < 0.001) and non-colorectal malignancy (8.9% vs 31.4%, P < 0.001). CONCLUSION: There was a link between the cattle area and higher incidence of Sb bacteraemia. Sb-I differed from Sb-II cases in clinical findings and associated malignancies. Colonoscopy is mandatory in cases of endocarditis or bacteraemia caused by Sb-I.

Molecular epidemiology and virulence of Escherichia coli O16:H5-ST131: comparison with H30 and H30-Rx subclones of O25b:H4-ST131.

The present study was carried out to evaluate the prevalence of the clonal subgroup O16:H5-ST131 and the H30 and H30-Rx subclones among E. coli isolates causing extraintestinal infections and to know their virulence potential. The ST131 clonal group accounted for 490 (16%) of the 2995 isolates obtained from clinical samples in five Spanish hospitals during the study period (2005-2012). Among those 490 ST131 isolates, 456 belonged to serotype O25b:H4, 27 to O16:H5 and seven were O-non-typeable:H4 (ONT:H4). All 27 O16:H5 isolates showed fimH41, whereas fimH30 and fimH22 alleles were the most frequently detected among O25b:H4 isolates. The majority (381/490; 78%) of ST131 isolates belonged to H30 subclone, and 302 of 381 (79%) H30 isolates belonged to the H30-Rx subclone. Of the 27 O16:H5 isolates, 48% produced CTX-M-14; however, none produced CTX-M-15. In contrast, 46% of O25b:H4 isolates produced CTX-M-15 while only 2% produced CTX-M-14. More than a half of the O16:H5 isolates (56%) showed the ExPEC status which was significantly more prevalent within O25b:H4 isolates (81%) (P<0.01), especially among H30-Rx (97%) isolates. In the present study, a modified virotype scheme was applied within which approximately half (52%) of the O16:H5 isolates showed the C1 specific virotype. Despite their low virulence-gene score (mean of virulence genes 6.4 versus 8.5 in O25b:H4 isolates), six out of the 10 O16:H5 isolates assayed showed high virulence in the mouse model of sepsis (killed 90-100% of mice challenged). Furthermore, four O16:H5 isolates of virotypes A and C1, carrying K2 variant of group II capsule, showed lethality at 24h. Thus, certain O16:H5 fimH41 isolates show a similar in vivo virulence to that reported with the highly virulent O25b:H4 H30-Rx isolates (Mora et al., PLOS ONE 2014, e87025), supporting their potential virulence for humans.