Demographic, clinical and microbiological characteristics of the first 30 human monkeypox confirmed cases attended in a tertiary hospital in Madrid (Spain), during the May-June 2022 international outbreak / Características demográficas, clínicas y microbiológicas de los primeros 30 casos humanos confirmados de viruela del mono atendidos en un hospital terciario de Madrid (España), durante el brote internacional de mayo-junio de 2022

The present outbreak of Human Monkeypox (HMPX) that has begun in May 2022 and has spread across all continents in less than two months has qualitative and quantitative characteristics that make it different from the pattern of human disease previously caused by this virus. It has spread with enormous ease, affects almost exclusively adults, behaves as a sexually transmitted disease and focuses on very specific groups and transmission conditions. The high incidence in the city of Madrid in males that have sex with males (MSM) has allowed us to observe and report the experience with the first 30 cases diagnosed in our institution. Patients presented with febrile symptoms, genital and paragenital skin lesions reminiscent of smallpox, but less extensive and severe. The disease may also cause proctitis, pharyngitis and perioral lesions. The PCR test for diagnostic confirmation has been shown to be very sensitive and effective, not only in skin lesions but also in blood and other fluids such as pharyngeal, rectal exudates and blood. A very high proportion of patients with HMPX also have other sexually transmitted diseases that must be actively detected in this context. The spontaneous evolution of our patients has been good and hospitalization has been practically unnecessary. Transmission to non-sexual cohabitants and health personnel has been nonexistent and the lesions have disappeared in less than 30 days without leaving sequelae and no need for specific antiviral treatment. (AU)

El actual brote de la enfermedad por el virus de la viruela del mono humana (HMPX), que ha comenzado en mayo de 2022 y se ha extendido por todos los continentes en menos de dos meses, tiene unas características cualitativas y cuantitativas que lo diferencian del patrón de enfermedad humana causado anteriormente por este virus. Se ha extendido con enorme facilidad, afecta casi exclusivamente a adultos, se comporta como una enfermedad de transmisión sexual y se centra en grupos y condiciones de transmisión muy específicas. La alta incidencia en la ciudad de Madrid en varones que tienen sexo con varones (HSH) nos ha permitido observar y comunicar la experiencia con los primeros 30 casos diagnosticados en nuestra institución. Los pacientes se presentaron con síntomas febriles, lesiones cutáneas genitales y paragenitales que recuerdan a la viruela, pero menos extensas y graves. La enfermedad también puede causar proctitis, faringitis y lesiones periorales. La prueba PCR para la confirmación del diagnóstico ha demostrado ser muy sensible y eficaz, no sólo en las lesiones cutáneas sino también en la sangre y otros fluidos como los exudados faríngeos y rectales y la sangre. Una proporción muy elevada de pacientes con HMPX presentan también otras enfermedades de transmisión sexual que deben ser detectadas activamente en este contexto. La evolución espontánea de nuestros pacientes ha sido buena y la hospitalización ha sido prácticamente innecesaria. La transmisión a convivientes no sexuales y al personal sanitario ha sido inexistente y las lesiones han desaparecido en menos de 30 días sin dejar secuelas y sin necesidad de tratamiento antiviral específico. (AU)

The relevance of multiple clinical specimens in the diagnosis of monkeypox virus, Spain, June 2022.

A monkeypox virus (MPXV) outbreak has been ongoing worldwide since May 2022. The role of specimens other than skin lesions for MPXV diagnosis is unknown. We evaluated 140 different clinical specimens by real-time PCR. The highest positivity rates (97%) were from skin lesions of any part of the body, followed by plasma, pharyngeal and anal swabs. Testing specimens from multiple sites may improve the sensitivity and reduce false-negative test results.

In vitro activity of delafloxacin against highly levofloxacin-resistant invasive isolates of Streptococcus pneumoniae.

INTRODUCTION: We report the activity of delafloxacin, a new fluoroquinolone with high affinity for both topoisomerase IV and DNA gyrase, against highly-levofloxacin-resistant invasive strains of Streptococcus pneumoniae. METHODS: A total of 173 highly-levofloxacin-resistant (MIC>32mg/L) S. pneumoniae invasive isolates were studied. The strains were isolated from blood (n=162) and other sterile fluids (n=11). Serotyping was performed by the Pneumotest-Latex and Quellung reaction. Delafloxacin, levofloxacin, penicillin, cefotaxime, erythromycin and vancomycin MICs were determined by the gradient diffusion method following EUCAST guidelines and breakpoints. RESULTS: Among the isolates, 32.9% were penicillin non-susceptible, 19.7% cefotaxime non-susceptible, and 76.9% erythromycin resistant. All were susceptible to vancomycin. Delafloxacin MIC50 and MIC90 (mg/L) values were 0.064 and 0.12, respectively; 60% (15/25) of serotype 9V isolates showed delafloxacin MICs≥0.12mg/L. CONCLUSIONS: Delafloxacin was very active against highly-levofloxacin-resistant invasive isolates of S. pneumoniae. Isolates belonging to serotype 9V showed higher delafloxacin MIC values.

In vitro activity of delafloxacin against highly levofloxacin-resistant invasive isolates of Streptococcus pneumoniae / Actividad in vitro de delafloxacino frente a aislados invasivos de Streptococcus pneumoniae altamente resistentes a levofloxacino

IntroductionWe report the activity of delafloxacin, a new fluoroquinolone with high affinity for both topoisomerase IV and DNA gyrase, against highly-levofloxacin-resistant invasive strains of Streptococcus pneumoniae.MethodsA total of 173 highly-levofloxacin-resistant (MIC>32mg/L) S. pneumoniae invasive isolates were studied. The strains were isolated from blood (n=162) and other sterile fluids (n=11). Serotyping was performed by the Pneumotest-Latex and Quellung reaction.Delafloxacin, levofloxacin, penicillin, cefotaxime, erythromycin and vancomycin MICs were determined by the gradient diffusion method following EUCAST guidelines and breakpoints.ResultsAmong the isolates, 32.9% were penicillin non-susceptible, 19.7% cefotaxime non-susceptible, and 76.9% erythromycin resistant. All were susceptible to vancomycin. Delafloxacin MIC50 and MIC90 (mg/L) values were 0.064 and 0.12, respectively; 60% (15/25) of serotype 9V isolates showed delafloxacin MICs≥0.12mg/L.ConclusionsDelafloxacin was very active against highly-levofloxacin-resistant invasive isolates of S. pneumoniae. Isolates belonging to serotype 9V showed higher delafloxacin MIC values.

IntroducciónAnalizamos la actividad de delafloxacino, una fluoroquinolona con elevada afinidad por la topoisomerasa i.v. y la ADN girasa, frente a cepas invasivas de Streptococcus pneumoniae altamente resistentes a levofloxacino.MétodosSe estudiaron 173 cepas con CMI de levofloxacino >32mg/l procedentes de sangre (n=162) y otros fluidos estériles (n=11). El serotipado se realizó mediante Pneumotest-Latex y test de Quellung.Las CMI de delafloxacino, levofloxacino, penicilina, cefotaxima, eritromicina y vancomicina se determinaron mediante gradiente de difusión siguiendo las recomendaciones del EUCAST.ResultadosEl 32,9% de las cepas fueron no-sensibles a penicilina, el 19,7% no-sensibles a cefotaxima y el 76,9% resistentes a eritromicina. Todas fueron sensibles a vancomicina. Las CMI50 y CMI90 de delafloxacino (mg/l) fueron 0,064 y 0,120, respectivamente; 60% (15/25) de cepas del serotipo 9V presentaron CMI de delafloxacino ≥0,12mg/l.ConclusionesDelafloxacino fue muy activo frente a S. pneumoniae altamente resistente a levofloxacino. Los aislados del serotipo 9V presentaron mayores valores de CMI de delafloxacino.

In vitro activity of delafloxacin against highly levofloxacin-resistant invasive isolates of Streptococcus pneumoniae.

INTRODUCTION: We report the activity of delafloxacin, a new fluoroquinolone with high affinity for both topoisomerase IV and DNA gyrase, against highly-levofloxacin-resistant invasive strains of Streptococcus pneumoniae. METHODS: A total of 173 highly-levofloxacin-resistant (MIC>32mg/L) S. pneumoniae invasive isolates were studied. The strains were isolated from blood (n=162) and other sterile fluids (n=11). Serotyping was performed by the Pneumotest-Latex and Quellung reaction. Delafloxacin, levofloxacin, penicillin, cefotaxime, erythromycin and vancomycin MICs were determined by the gradient diffusion method following EUCAST guidelines and breakpoints. RESULTS: Among the isolates, 32.9% were penicillin non-susceptible, 19.7% cefotaxime non-susceptible, and 76.9% erythromycin resistant. All were susceptible to vancomycin. Delafloxacin MIC50 and MIC90 (mg/L) values were 0.064 and 0.12, respectively; 60% (15/25) of serotype 9V isolates showed delafloxacin MICs≥0.12mg/L. CONCLUSIONS: Delafloxacin was very active against highly-levofloxacin-resistant invasive isolates of S. pneumoniae. Isolates belonging to serotype 9V showed higher delafloxacin MIC values.