Identification and Distribution of Human-Biting Ticks in Northwestern Spain.

Ticks transmit a wide diversity of pathogens to a great variety of hosts, including humans. We conducted a tick surveillance study in northwestern Spain between 2014 and 2019. Ticks were removed from people and identified. Tick numbers, species, development stages, the timeline, seasonal and geographical distribution and epidemiological characteristics of people bitten by ticks were studied. We collected ticks from 8143 people. Nymphs of I. ricinus were the most frequently collected. Rhipicephalus bursa, R. sanguineus s.l., Hy. marginatum, Hy. lusitanicum, D. marginatus, D. reticulatus and H. punctata were also found, with adults as the main stage. The number of collected Hyalomma spp. and R. bursa has been progressively increasing over time. Although bites occurred throughout the year, the highest number of incidents was reported from April to July. The distribution patterns of the tick species were different between the north and the south of the region, which was related to cases detected in humans of the pathogens they carried. Adult men were more likely to be bitten by ticks than women. Ticks were most frequently removed from adults from the lower limbs, while for children, they were mainly attached to the head. Epidemiological surveillance is essential given the increase in tick populations in recent years, mainly of species potentially carrying pathogens causing emerging diseases in Spain, such as Crimean-Congo hemorrhagic fever (CCFH).

Influence of the drugs used in migrant patients with severe acute respiratory syndrome coronavirus 2 and the development of symptomatic strongyloidiasis.

BACKGROUND: The use of dexamethasone in patients infected with Strongyloides stercoralis can cause severe complications. It is necessary to investigate the relationship between coronavirus disease 2019 (COVID-19) and strongyloidiasis infection. METHODS: A retrospective, longitudinal, descriptive study was undertaken to review all patients admitted with a diagnosis of COVID-19 infection at the Complejo Asistencial Universitario de Salamanca, Spain, during 1 March-31 December 2020. RESULTS: A total of 2567 patients received a diagnosis of COVID-19. Eighty-six patients from endemic areas were included. Seven patients had strongyloidiasis. Five patients were female. The mean age (±SD) was 39 (±10.8) y. Six patients were Latin-American and only one patient was from Africa. Six patients had previous symptoms compatible with strongyloidiasis infections. Only three patients received dexamethasone (6 mg once daily) for 10 d. In all cases, the clinical courses of the patients were satisfactory. No patient died or was admitted to the ICU. CONCLUSIONS: Screening programmes using serological techniques should be implemented in COVID-19 patients to prevent strongyloidiasis. Our study suggested that drugs used against COVID-19 in patients with strongyloidiasis did not affect the evolution of the disease. However, more studies are necessary to elucidate the role of dexamethasone in COVID-19 patients infected with Strongyloides.

New circulation of genotype V of Crimean-Congo haemorrhagic fever virus in humans from Spain.

BACKGROUND: Crimean-Congo haemorrhagic fever (CCHF) is a widespread tick-borne viral disease caused by the Crimean-Congo haemorrhagic fever virus (CCHFV). CCHFV has been implicated in severe viral haemorrhagic fever outbreaks. During the summer of 2016, the first two cases with genotype III (Africa 3) were reported in Spain. The first objective of our study was to determine the presence of CCHFV among patients with febrile illness during the spring and summer periods in 2017 and 2018. Finally, we perform a phylogenetic analysis to determine the genotype of the virus. METHODOLOGY: We prospectively evaluated patients aged 18 years and older who came to the emergency department at the Salamanca's University Hospital (HUS) with fever. Specific IgM and IgG antibodies against CCHFV by ELISA and one immunofluorescence assay against two different proteins (nucleoprotein and glycoprotein C) was done. Moreover, molecular detection by Real Time PCR was performed in all collected samples. A phylogenetic analysis was carried out to genetically characterize CCHFV detected in this study. PRINCIPAL FINDINGS: A total of 133 patients were selected. The mean age was 67.63 years and 60.9% were male. One-third of the patients presented an acute undifferentiated febrile illness. Three patients had anti-CCHFV IgG antibodies, suggesting a previous infection. One patient had anti-CCHFV IgM antibodies and a confirmatory RT-PCR. Phylogenetic analysis indicated that the virus corresponds to the European genotype V. This patient came to the emergency department at HUS in August 2018 presenting an acute febrile syndrome with thrombopenia and liver impairment. CONCLUSIONS: We describe a new circulation of European genotype V CCHFV in Spain. Moreover, this study suggests that CCHFV is an identifiable cause of febrile illness of unknown origin in Spain. Thus, CCHF could be suspected in patients with fever, liver damage, and/or haemorrhagic disorders, particularly in people with risk activities who present in the spring or summer.

Seroprevalence of Crimean-Congo hemorrhagic fever in humans in the World Health Organization European region: A systematic review.

BACKGROUND: Crimean-Congo hemorrhagic fever (CCHF) is an emerging infectious disease caused by a Nairovirus. CCHF is a tick-borne disease that is predominantly associated with Hyalomma ticks and have a widespread distribution in Africa, Asia and Europe. CCHF usually presents as a subclinical disease, but in some cases, it may present as a hemorrhagic fever with a high mortality rate. This systematic review of the literature was performed to identify the available evidence on the prevalence of CCHF in the European Region of the World Health Organization, based on seroprevalence (IgG antibodies). METHODOLOGY: A systematic review was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement protocol. PubMed, Embase, and the Web of Science were used for the search (up to January 31, 2019), combining the following MeSH terms: ["Crimean-Congo haemorrhagic fever" OR "Crimean-Congo hemorrhagic fever virus" OR "Congo-Crimea" OR "Crimea-Congo"] AND ["Europe"] AND ["epidemiology" OR "seroprevalence"]. The abstracts were screened. Subsequently, full-text articles were selected and reviewed based on the PICOS (Population-Intervention-Comparison-Outcomes-Study type) criteria by two independent reviewers for inclusion in the final analysis. The data were qualitatively synthesized without quantitative pooling due to the heterogeneity in the study populations and methodologies. PRINCIPAL FINDINGS: Thirty articles (9 from western Europe, 18 from central Europe and 3 from eastern Europe) were included in the analysis. All articles were cross-sectional studies (descriptive studies). CONCLUSIONS: The highest seroprevalence of CCHF is found in central and eastern European countries. Southern and western Europe countries, such as Greece and Spain, have low levels of endemicity, but the spread of the infection, which is associated with climate change, is a possibility that we should keep in mind. Further studies, especially larger seroprevalence studies in humans and animals, are needed to establish the current status of the CCHF epidemiology and to generate standardized guidelines for action in the region.

Crimean-Congo haemorrhagic fever (CCHF) virus-specific antibody detection in blood donors, Castile-León, Spain, 2017 and 2018.

BackgroundCrimean-Congo haemorrhagic fever virus (CCHFV) is considered an emerging or even a probable re-emerging pathogen in southern Europe. Presence of this virus had been reported previously in Spain in 2010.AimWe aimed to evaluate the potential circulation of CCHFV in western Spain with a serosurvey in asymptomatic adults (blood donors).MethodsDuring 2017 and 2018, we conducted a CCHFV serosurvey in randomly selected asymptomatic blood donors from western Spain. Three assays using specific IgG antibodies against CCHFV were performed: the VectoCrimea ELISA test, an in-house ELISA and indirect immunofluorescence (EuroImmun) test with glycoprotein and nucleoprotein.ResultsA total of 516 blood donors participated in this cross-sectional study. The majority of the study participants were male (68.4%), and the mean age was 46.3 years. Most of the participants came from rural areas (86.8%) and 68.6% had contact with animals and 20.9% had animal husbandry practices. One in five participants (109/516, 21.1%) were engaged in at-risk professional activities such as agriculture and shepherding, slaughtering, hunting, veterinary and healthcare work (mainly nursing staff and laboratory technicians). A total of 15.3% of the participants were bitten by ticks in the days or months before the date of sampling. We detected anti-CCHFV IgG antibodies with two diagnostic assays in three of the 516 individuals and with one diagnostic assay in six of the 516 individuals.ConclusionSeroprevalence of CCHFV was between 0.58% and 1.16% in Castile-León, Spain. This is the first study in western Spain that showed circulation of CCHFV in healthy people.

Recurrent hematuria caused by nutcracker syndrome.

A 26-year-old woman presented to the emergency department complaining of left flank pain, and proteinuria and hematuria were detected during urinalysis. A renal ultrasound did not reveal any disorder, and after performing a computed tomography angiography scan, compression of the left renal vein between the superior mesenteric artery and the aorta was seen. This compression is known as Nutcracker syndrome. From among the different treatment options available, it was decided, with patient consensus, to use open surgical management, performing a transposition of the left renal vein to a more distal level in the inferior vena cava. The immediate postoperative care progressed without complications and the symptoms resolved; after 1 year of surveillance, the patient continues to be asymptomatic. Nutcracker syndrome is a rare phenomenon, with few cases described. There are different therapeutic options for the treatment of Nutcracker syndrome, such as open surgery, endovascular treatment, or conservative treatment; because of the low prevalence of this syndrome, there are no sufficiently large series at present or with the necessary long-term surveillance to decide on the most suitable treatment. Distal transposition of the left renal vein in the inferior cava vein has proved to offer good long-term results, and this option offers a higher chance of resolution without the need for as many postsurgery controls as would be required with endovascular treatment.

Estudio de prevalencia de isquemia crónica de miembros inferiores y de aneurisma de aorta abdominal en mayores de 65 años / A study of the prevalence of chronic ischaemia in the lower limbs and abdominal aortic aneurysms in persons over the age of 65

Introducción. El aumento de la expectativa de vida ha conducido a que patologías vasculares, especialmente prevalentes en el segmento de población con más edad, se hayan constituido en problemas de salud. Objetivo. Determinar la prevalencia de la isquemia crónica (IC) y de los aneurismas de aorta abdominal (AAA) infrarrenal en la población mayor de 65 años del Área Sanitaria V (Gijón) del Servicio de Salud del Principado de Asturias. Pacientes y métodos. Se diseña un estudio descriptivo transversal, incluyendo finalmente 232 pacientes, 114 hombres y 118 mujeres, seleccionados aleatoriamente a partir de los datos de la tarjeta sanitaria. Se les explora, se realiza un eco-Doppler de la aorta abdominal y se calcula el índice tobillo-brazo. Resultados. La prevalencia de la IC es del 9,9% y de un 2,6% para el AAA. Se desagregan los resultados por sexos y dos grupos de edad, de 65-74 años y mayores de 75. La prevalencia de la IC está seis puntos por encima en el grupo de los mayores de 75 años (13,4%) y la del AAA es más de siete veces superior (5,2%). Conclusión. La prevalencia es más elevada en los mayores de 75 años y los varones para la IC y el AAA, con diferencias estadísticamente significativas. Este estudio abre las puertas a un seguimiento de los integrantes de la muestra, que permita determinar la incidencia de las diversas patologías

Introduction. As life expectancy has increased, vascular pathologies, which are especially prevalent in the most elderly segment of the population, have become a health problem. Aim. To determine the prevalence of chronic ischaemia (CI) and infrarenal abdominal aortic aneurysms (AAA) in a population of persons over 65 years of age from Health Care District V (Gijón) of the Principality of Asturias Health Service. Patients and methods. A cross-sectional descriptive study was designed, which finally included 232 patients (114 males and 118 females) who were selected at random from the data contained in their health card. They were examined, submitted to a Doppler ultrasound scan of the abdominal aorta and their ankle-brachial index was calculated. Results. The prevalence of CI was found to be 9.9% and 2.6% for AAA. Results were broken down by sexes and two age groups: 65-74 years and over 75 years of age. The prevalence of CI was six points higher in the group of over 75s (13.4%) and that of AAA was seven times higher (5.2%). Conclusions. For CI and AAA, prevalence was higher in persons over 75 years old and males, with statistically significant differences. This study opens the way to a follow-up of the participants in the sample, which would allow us to determine the incidence of several different pathologies

Insuficiencia venosa superficial de miembros inferiores. ¿Cuál es el punto de fuga? / Superficial venous insufficiency in the lower limbs. Where is the leakage point?

La causa más frecuente de varices es el reflujo en el confluente safenofemoral, pero no es la única. La correcta identificación preoperatoria de los puntos de fuga (PF) parece básica a la hora de plantear una correcta indicación quirúrgica. Objetivo. Identificar los diferentes PF en los pacientes enviados por varices primarias no evolucionadas. Pacientes y métodos. Durante el año 2003 se realizó un eco-Doppler (ED) venoso a todos los pacientes incluidos en el estudio. La exploración se llevó a cabo en bipedestación, sobre la extremidad de mayor relevancia clínica, mediante las maniobras de compresión-relajación, Valsalva y Paraná. Los resultados se almacenaron en una base de datos informática y en una cartografía hemodinámica. Resultados. Se objetivó reflujo safeno en 95 pacientes y no safeno en 5. El flujo retrógrado afectó a la safena interna en 87 pacientes y en 12 a la externa. Sólo el 71% de los flujos retrógrados de la interna fueron ostiales puros, presentando 30 pacientes un PF diferente a los cayados de safena, ya fuese aislado o asociado a éste. Conclusión. En un porcentaje no despreciable de pacientes el PF no se sitúa en los cayados safenianos, o existe más de uno, por lo que la cirugía no guiada por ED podría conllevar un inadecuado tratamiento y contribuir a la elevación de la tasa de recidivas

The origin of varicose veins most often lies in the backflow that occurs in the saphenofemoral junction, but it is not the only cause. Correct preoperative identification of the leakage points (LP) is essential when it comes to designing the right surgical approach. AIMS. The aim of this study was to identify the different LP in patients referred because of undeveloped primary varicose veins. PATIENTS AND METHODS. Throughout the year 2003 all the patients included in the study were submitted to venous Doppler ultrasound recording (DU). The examination (of the clinically more affected limb) was performed while patients were standing, using the compression-relaxation, Valsalva and Paraná manoeuvres. Results were saved in a computer database and in a blood map. RESULTS. Saphenous backflow was observed in 95 patients and in 5 of them it was non-saphenous. Backflow affected the great saphenous vein in 87 patients and in 12 of them it involved the small saphenous vein. Only 71% of the backflows in the great saphenous vein were purely ostial, and 30 patients presented an LP other than the saphenous arches, some being isolated while others were associated to it. CONCLUSIONS. In a fairly important number of patients, the LP is not situated in the saphenous arches, or there are more than one, and therefore surgery that is not guided by DU could lead to unsuitable treatment and contribute to an increase in the rates of relapses