Genetic Characterization of Extensively Drug-Resistant Shigella sonnei Infections, Spain, 2021-2022.

In 2022, the United Kingdom reported an increase in drug resistance in Shigella sonnei isolates. We report 33 cases in Spain genetically related to the UK cases and 4 cases with similar antimicrobial resistance profiles infected with genetically distant strains. Our results suggest circulation of multiple genetic clusters of multidrug-resistant S. sonnei in Spain.

An Unexpected Case of Disseminated Amebiasis with Cerebral Involvement and Successful Recovery in a Non-Endemic Context.

BACKGROUND Amebiasis is a parasitic infection caused by the protozoan Entamoeba histolytica. Amebic brain abscesses are a rare form of invasive amebiasis frequently lethal due to the difficulty of its diagnosis and inadequate treatment. Cerebral amebiasis poses a therapeutic challenge as evidenced by the scarcity of papers reporting complete recovering after treatment. CASE REPORT We report the case of a 39-year-old Spanish man, with a history of alcohol and drug abuse. He had never traveled outside of Europe, no reported oral-anal sexual contact, and no history of immunosuppressant medication. He was admitted to the Emergency department with temperature of 38°C, abdominal pain, and diarrhea. An abdominal CT scan showed multiples abscesses in the liver. Therefore, empirical meropenem treatment was started on suspicion of pyogenic liver abscesses due to lack of epidemiological risk factors for parasitic infection. In the liver aspirate samples, E. histolytica trophozoites were directly visualized and a real-time PCR was also positive for it. After amebiasis diagnosis, intravenous (IV) metronidazole therapy was initiated. During his admission, the patient developed pulmonary, cutaneous and cerebral involvement amebiasis. The management of amebic brain abscesses includes surgical drainage and antiparasitic treatment, in our case IV metronidazole was maintained for 10 weeks. No surgical treatment was performed and even so, the patient evolved favorably. CONCLUSIONS Amebic brain abscesses have a high mortality rate if inadequate treatment. A timely diagnosis and suitable treat can reduce its mortality, so the diagnosis of amebic infection should not be precluded in non-endemic countries.

Imported cryptosporidiosis caused by Cryptosporidium hominis IbA13G3 in Spain. The relevance of molecular-based surveillance / Criptosporidiosis importada por Cryptosporidium hominis IbA13G3. La relevancia de la vigilancia basada en métodos moleculares

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Prevalence of submicroscopic malaria infection in immigrants living in Spain.

BACKGROUND: The importance of submicroscopic malaria infections in high-transmission areas could contribute to maintain the parasite cycle. Regarding non-endemic areas, its importance remains barely understood because parasitaemia in these afebrile patients is usually below the detection limits for microscopy, hence molecular techniques are often needed for its diagnosis. In addition to this, the lack of standardized protocols for the screening of submicroscopic malaria in immigrants from endemic areas may underestimate the infection with Plasmodium spp. The aim of this study was to assess the prevalence of submicroscopic malaria in afebrile immigrants living in a non-endemic area. METHODS: A prospective, observational, multicentre study was conducted. Afebrile immigrants were included, microscopic observation of Giemsa-stained thin and thick blood smears, and two different molecular techniques detecting Plasmodium spp. were performed. Patients with submicroscopic malaria were defined as patients with negative blood smears and detection of DNA of Plasmodium spp. with one or both molecular techniques. Demographic, clinical, analytical and microbiological features were recorded and univariate analysis by subgroups was carried out with STATA v15. RESULTS: A total of 244 afebrile immigrants were included in the study. Of them, 14 had a submicroscopic malaria infection, yielding a prevalence of 5.7% (95% confidence interval 3.45-9.40). In 71.4% of the positive PCR/negative microscopy cases, Plasmodium falciparum alone was the main detected species (10 out of the 14 patients) and in 4 cases (28.6%) Plasmodium vivax or Plasmodium ovale were detected. One patient had a mixed infection including three different species. CONCLUSIONS: The prevalence of submicroscopic malaria in afebrile immigrants was similar to that previously described in Spain. Plasmodium vivax and P. ovale were detected in almost a third of the submicroscopic infections. Screening protocols for afebrile immigrants with molecular techniques could be useful for a proper management of these patients.

Enfermedades emergentes e importadas diagnosticadas en el servicio de urgencias de un hospital de Madrid / Emerging and imported diseases diagnosed in the emergency department of a hospital in Madrid

Objetivo. Describir las características clínicas y epidemiológicas de los pacientes diagnosticados de malaria, dengue, zika y chikungunya en un servicio de urgencias hospitalario (SUH), así como el valor de diagnóstico de las técnicas de las que se disponen en el SUH. Método. Estudio descriptivo, observacional, en el que se incluyeron pacientes diagnosticados de enfermedades infecciosas tropicales a partir de pruebas solicitadas desde un SUH. Resultados. Se diagnosticaron cuatro casos de dengue, siete casos de zika, tres casos de malaria y dos casos de coinfección (malaria + dengue y malaria + chikungunya). Conclusiones. La mayoría de los pacientes valorados son varones, nativos de zonas endémicas. Aunque se realice un diagnóstico precoz de malaria, es necesario descartar coinfección por distintos arbovirus. Para estudio de virus zika, hay que solicitar una prueba de PCR en orina, además de serología y PCR en suero

Objectives. To describe the clinical and epidemiologic characteristics of patients diagnosed with malaria, dengue fever, and Zika or chikungunya virus infections in a hospital emergency department. To describe the usefulness of the department's diagnostic resources. Methods. Descriptive observational study of patients diagnosed with infectious tropical diseases on the basis of samples collected in the emergency department. Results. The department diagnosed 4 cases of dengue fever, 7 cases of Zika virus infection, 7 of malaria, and 2 concomitant infections (malaria plus dengue fever and malaria plus chikungunya infection). Conclusions. Most patients with these infections were males and natives of areas where the diseases were endemic. Even when malaria is diagnosed early, the possibility of concomitant infection by other arboviruses must be ruled out. Serology is necessary to rule out Zika virus infection; polymerase chain reaction testing of urine and serum should be included

Emerging and imported diseases diagnosed in the emergency department of a hospital in Madrid. / Enfermedades emergentes e importadas diagnosticadas en el servicio de urgencias de un hospital de Madrid.

OBJECTIVES: To describe the clinical and epidemiologic characteristics of patients diagnosed with malaria, dengue fever, and Zika or chikungunya virus infections in a hospital emergency department. To describe the usefulness of the department's diagnostic resources. MATERIAL AND METHODS: Descriptive observational study of patients diagnosed with infectious tropical diseases on the basis of samples collected in the emergency department. RESULTS: The department diagnosed 4 cases of dengue fever, 7 cases of Zika virus infection, 7 of malaria, and 2 concomitant infections (malaria plus dengue fever and malaria plus chikungunya infection). CONCLUSION: Most patients with these infections were males and natives of areas where the diseases were endemic. Even when malaria is diagnosed early, the possibility of concomitant infection by other arboviruses must be ruled out. Serology is necessary to rule out Zika virus infection; polymerase chain reaction testing of urine and serum should be included.

OBJETIVO: Describir las características clínicas y epidemiológicas de los pacientes diagnosticados de malaria, dengue, zika y chikungunya en un servicio de urgencias hospitalario (SUH), así como el valor de diagnóstico de las técnicas de las que se disponen en el SUH. METODO: . Estudio descriptivo, observacional, en el que se incluyeron pacientes diagnosticados de enfermedades infecciosas tropicales a partir de pruebas solicitadas desde un SUH. RESULTADOS: Se diagnosticaron cuatro casos de dengue, siete casos de zika, tres casos de malaria y dos casos de coinfección (malaria + dengue y malaria + chikungunya). CONCLUSIONES: . La mayoría de los pacientes valorados son varones, nativos de zonas endémicas. Aunque se realice un diagnóstico precoz de malaria, es necesario descartar coinfección por distintos arbovirus. Para estudio de virus zika, hay que solicitar una prueba de PCR en orina, además de serología y PCR en suero.

Comparative Evaluation of Indirect Immunofluorescence and NS-1-Based ELISA to Determine Zika Virus-Specific IgM.

Differential diagnosis of the Zika virus (ZIKV) is hampered by cross-reactivity with other flaviviruses, mainly dengue viruses. The aim of this study was to compare two commercial methods for detecting ZIKV immunoglobulin M (IgM), an indirect immunofluorescence (IIF) and an enzyme immunoassay (ELISA), using the non-structural (NS) 1 protein as an antigen, both from EuroImmun, Germany. In total, 255 serum samples were analyzed, 203 of which showed laboratory markers of ZIKV infections (PCR-positive in serum and/or in urine and/or positive or indeterminate specific IgM). When tested with IIF, 163 samples were IgM-positive, while 13 samples were indeterminate and 78 were negative. When IIF-positive samples were tested using ELISA, we found 61 positive results, 14 indeterminate results, and 88 negative results. Among the indeterminate cases tested with IIF, ELISA analysis found two positive, two indeterminate, and nine negative results. Finally, 74 of the 78 IIF-negative samples proved also to be negative using ELISA. For the calculations, all indeterminate results were considered to be positive. The agreement, sensitivity, and specificity between ELISA and IIF were 60.2%, 44.9%, and 94.9%, respectively. Overall, 101 samples showed discrepant results; these samples were finally classified on the basis of other ZIKV diagnostic approaches (PCR-positive in serum and/or in urine, IgG determinations using IIF or ELISA, and ZIKV Plaque Reduction Neutralization test-positive), when available. A final classification of 228 samples was possible; 126 of them were positive and 102 were negative. The corresponding values of agreement, sensitivity, and specificity of IIF were 86.0%, 96.8%, and 72.5%, respectively. The corresponding figures for ELISA were 81.1%, 65.9%, and 100%, respectively. The ELISA and IIF methods are both adequate approaches for detecting ZIKV-specific IgM. However, considering their respective weaknesses (low sensitivity in ELISA and low specificity in IIF), serological results must be considered jointly with other laboratory results.

Monoclinic polymorph of chlorido-(dimethyl sulfoxide-κO)tri-phenyl-tin(IV).

The crystal structure of the title tin complex, [Sn(C6H5)3Cl(C2H6OS)], (I), has been reported with one mol-ecule in the asymmetric unit in an ortho-rhom-bic cell [Kumar et al. (2009 ▸). Acta Cryst. E65, m1602-m1603]. While using SnPh3Cl as a starting material for a reaction for which the products were recrystallized over a very long time (six months) from dimethyl sulfoxide (DMSO), a new polymorph was obtained for (I), with two independent mol-ecules in the asymmetric unit of a monoclinic cell. The coordination geometry of the Sn centres remains unchanged, with the Cl- ion and the DMSO mol-ecule in the apical positions and the phenyl C atoms in the equatorial positions of a trigonal bipyramid. The main difference between the polymorphs is the relative orientation of the phenyl rings in the equatorial plane, reflecting a degree of free rotation of these groups about their Sn-C bonds. In the crystal, mol-ecules are linked into [010] chains mediated by weak C-H⋯O inter-actions.

HDP2: a ribosomal DNA (NTS-ETS) sequence as a target for species-specific molecular diagnosis of intestinal taeniasis in humans.

BACKGROUND: Taenia solium, T. asiatica and T. saginata tapeworms cause human taeniasis and are the origin of porcine and bovine cysticercosis. Furthermore, T. solium eggs can cause human cysticercosis, with neurocysticercosis being the most serious form of the disease. These helminth infections are neglected tropical diseases and are endemic in several countries in the Americas, Asia and Africa. As a result of globalization, migration in particular, the infections have been extending to non-endemic territories. Species-specific diagnosis of taeniasis is subject to drawbacks that could be resolved using molecular approaches. In the present study, conventional and real-time amplification protocols (cPCR and qPCR) based on the T. saginata HDP2 sequence were applied in the differential diagnosis of taeniasis (T. saginata, T. solium) in both fecal samples and proglottids expelled by patients. The HDP2 homolog in T. solium was cloned and characterized. RESULTS: Semi-nested cPCR and qPCR (Sn-HDP2 cPCR and Sn-HDP2 qPCR) amplified T. saginata and T. solium DNA, with an analytical sensitivity of 40 and 400 fg, respectively, and identically in both protocols. Eighteen taeniasis patients were diagnosed directly with T. saginata or T. solium, either from proglottids or fecal samples with/without eggs (detected using microscopy), based on the optimized Sn-HDP2 qPCR. After cloning, the T. solium HDP2 homolog sequence was confirmed to be a ribosomal sequence. The HDP2 fragment corresponded to a non-transcribed sequence/external transcribed repeat (NTS/ETS) of ribosomal DNA. Compared with the T. saginata HDP2 homolog, the T solium HDP2 sequence lacked the first 900 nt at the 5' end and showed nucleotide substitutions and small deletions. CONCLUSIONS: Sn-HDP2 cPCR and Sn-HDP2 qPCR were set up for the diagnosis of human taeniasis, using proglottids and fecal samples from affected patients. The new Sn-HDP2 qPCR protocol was the best option, as it directly differentiated T. saginata from T. solium. The diagnosis of an imported T. solium-taeniasis case and nine European T. saginata cases was relevant. Finally, the cloning and sequencing of the T. solium HDP2 fragment confirmed that HDP2 was part of a ribosomal unit.

Actividad sinérgica y eficacia clínica de la asociación fosfomicina-ciprofloxacino en el tratamiento de una infección de malla quirúrgica con absceso de partes blandas por Enterobacter cloacae productor de carbapenemasa / Synergistic activity and clinical efficacy of fosfomycin and ciprofloxacin combination treatment for soft tissue infection caused by carbapenemase-producing Enterobacter cloacae

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Outcomes of pediatric living donor kidney transplantation: A single-center experience.

Renal transplantation is the treatment of choice for children with ESRD offering advantages of improved survival, growth potential, cognitive development, and quality of life. The aim of our study was to compare the outcomes of LDKT vs DDKT performed in children at a single center. Retrospective chart review of pediatric patients who underwent kidney transplantation from 2005 to 2014 was performed. Ninety-one renal transplants were accomplished, and 31 cases (38.27%) were LDKT, and in 96.7% of the cases, the graft was obtained through laparoscopy. Thirty-four receptors weighted <25 kg. LDKT group had statistically significant lower cold ischemia times than DDKT one. Complication rate was 9.67% for LDKT and 18.33% for DDKT. eGFR was better in LDKT. Patient survival rate was 100% for LDKT and 98.3% for DDKT, and graft survival rate was 96.7% for LDKT and 88.33%-80% for DDKT at a year and 5 years. Our program of pediatric kidney transplantation has achieved optimal patient and graft survival rates with low rate of complications. Living donor pediatric kidney transplants have higher patient and better graft survival rates than deceased donor kidney transplants.

Oral etoposide in Merkel cell carcinoma.

BACKGROUND: Merkel cell carcinoma (MCC) is a very infrequent and aggressive skin tumor with high recurrence and metastasis rates. MCC treatment is currently not well defined. CASE PRESENTATION: We present the case of a 75-year-old woman who was diagnosed with MCC in 2010 and suffered a third relapse in 2012 which could not be treated surgically. RESULTS: The patient began oral etoposide treatment reaching complete response after eight cycles and receiving a total of 11 cycles. As side effects, the patient suffered from neutropenia, candidiasis and mucositis, but after reducing the dosage to 50% it was well tolerated. DISCUSSION: Chemotherapy treatment in this setting is poorly defined. In this case, monotherapy treatment with oral etoposide was decided due to the patient's age and comorbidities, achieving a very positive outcome.

Crystal structure of 3,5-di-methyl-pyridine N-oxide dihydrate.

In the title compound, also known as 3,5-lutidine N-oxide dihydrate, C7H9NO·2H2O, the N-O bond is weakened due to the involvement of the O atom as an acceptor of hydrogen bonds from the two water mol-ecules of crystallization present in the asymmetric unit. Fused R35(10) ring motifs based on O-H⋯O hydrogen bonds form chains in the [010] direction, which are further connected by weak C-H⋯O inter-molecular contacts. As a result, the lutidine mol-ecules are stacked in an efficient manner, with π-π contacts characterized by a short separation of 3.569 (1) Šbetween the benzene rings.

Crystal structure of trans-N,N'-bis-(3,5-di-tert-butyl-2-hy-droxy-phen-yl)oxamide methanol monosolvate.

The here crystallized oxamide was previously characterized as an unsolvated species [Jímenez-Pérez et al. (2000 ▸). J. Organomet. Chem. 614-615, 283-293], and is now reported with methanol as a solvent of crystallization, C30H44N2O4·CH3OH, in a different space group. The introduction of the solvent influences neither the mol-ecular symmetry of the oxamide, which remains centrosymmetric, nor the mol-ecular conformation. However, the unsolvated mol-ecule crystallized as an ordered system, while many parts of the solvated crystal are disordered. The hy-droxy group in the oxamide is disordered over two chemically equivalent positions, with occupancies 0.696 (4):0.304 (4); one tert-butyl group is disordered by rotation about the C-C bond, and was modelled with three sites for each methyl group, each one with occupancy 1/3. Finally, the methanol solvent, which lies on a twofold axis, is disordered by symmetry. The disorder affecting hy-droxy groups and the solvent of crystallization allows the formation of numerous supra-molecular motifs using four hydrogen bonds, with N-H and O-H groups as donors and the oxamide and methanol mol-ecule as acceptors.

Atypical Mansonella ozzardi Microfilariae from an Endemic Area of Brazilian Amazonia.

Mansonellosis is endemic in several regions of Africa, the Caribbean, and Latin America. Mansonella ozzardi and Mansonella perstans have been reported in Latin America, including the Amazon region. A morphological and molecular microfilariae study was performed in Pauini (Brazil). Blood samples were collected from 40 individuals, and were analyzed by Giemsa-stained blood film and by two different nested polymerase chain reactions which detect internal transcribed spacer-1 and the major sperm protein gene. By microscopy, 14 of 40 were positive: 11 as M. ozzardi and three as M. perstans-like infections. Both molecular methods detected 19 positive cases as M. ozzardi, including those 14 individuals detected by microscopy, without detectable genetic differences among any of the 19 positive samples. Molecular techniques showed an improvement of mansonellosis diagnosis and may become an effective tool to evaluate the present status of M. ozzardi and M. perstans in Latin America.

Ectopic Vas Deferens Inserting Into Distal Retroiliac Ureter in the Currarino Syndrome.

Vas deferens ectopia is a rare congenital anomaly frequently associated with anorectal abnormalities and hypospadias. We present a Currarino syndrome case with an ectopic vas deferens terminating in a distal retroiliac ureter. A left vasectomy, ureteral decussation over the iliac vessels, and a Cohen's-type ureteral reimplantation were performed. The objectives are to preserve renal function, prevent epididymitis, and preserve fertility. There is no evidence in the literature that recommends surgical correction of the vas deferens. Microsurgical epididymal sperm aspiration or testicular sperm extraction combined with intracytoplasmic sperm injection might be a viable strategy for these affected individuals.

Crystal structures of four chiral imine-substituted thio-phene derivatives.

A series of thio-phenes substituted in positions 2 and 5 by imine groups have been synthesized using a solvent-free approach, and their crystal structures determined. The substituents are chiral groups, and the expected absolute configuration for each mol-ecule was confirmed by refinement of the Flack parameter. The compounds are 2,5-bis-[(S)-(+)-(1,2,3,4-tetra-hydro-naphthalen-1-yl)imino]-thio-phene, C26H26N2S, (I), 2,5-bis-{[(R)-(-)-1-(4-meth-oxy-phen-yl)eth-yl]imino-meth-yl}thio-phene, C24H26N2O2S, (II), 2,5-bis-{[(R)-(-)-1-(4-fluoro-phen-yl)eth-yl]imino-meth-yl}thio-phene, C22H20F2N2S, (III), and 2,5-bis-{[(S)-(+)-1-(4-chloro-phen-yl)eth-yl]imino-meth-yl}thio-phene, C22H20Cl2N2S, (IV). A common feature of all four mol-ecules is the presence of twofold symmetry. For (I), which crystallizes in the triclinic space group P1, this symmetry is non-crystallographic, but for (II) in C2 and the isomorphous structures (III) and (IV) that crystallize in P21212, the twofold symmetry is crystallographically imposed with one half of each mol-ecule in the asymmetric unit. The comparable mol-ecular symmetry in the four structures is also reflected in similar packing, with mol-ecules aggregated to form chains through weak C-H⋯S inter-actions.

Molecular genotyping and sub-genotyping of Cryptosporidium spp. isolates from symptomatic individuals attending two major public hospitals in Madrid, Spain.

Infections by members of the protozoan genus Cryptosporidium are among the most common causes of human gastrointestinal illness worldwide. In Spain cryptosporidiosis is not a compulsory notifiable disease, so the actual burden of the infection in both clinical and general populations remains largely unknown. We present here data on the diversity and frequency of the Cryptosporidium species and sub-genotypes identified in symptomatic individuals seeking medical care in two major hospitals in Madrid, Spain, between December 2013 and January 2015. Initial detection of the parasite was conducted on a total of 122 stool samples collected from 120 patients by microscopy with modified Ziehl-Neelsen and/or immunochromatographic tests. We used immunofluorescence, PCR-based methods and sequence analyses of the 60-kDa (GP60) glycoprotein and the small subunit ribosomal RNA (SSU rRNA) genes for confirmatory purposes and to characterize Cryptosporidium isolates. A total of 110 patients were confirmed with cryptosporidiosis. Overall, 101 isolates were successfully sub-genotyped at the GP60 locus, and an additional seven at the SSU rRNA locus. The analyses of all amplicons defined 10 distinct sequence types representing the GP60 family sub-genotypes IbA10G2 (78.7%), IeA11G3T3 (3.7%) of C. hominis, and the GP60 family sub-types IIaA15G2R1 (5.6%), IIaA18G6R1 (0.9%), IIcA5G3a (0.9%), IIdA18G1 (0.9%), IIdA19G1 (0.9%), IIdA21G1 (0.9%), and IIdA22G1 (0.9%) of C. parvum. A single isolate was assigned to C. felis (0.9%), two C. parvum isolates (1.9%) could not be characterized at the sub-genotype level and an additional four isolates (3.7%) were not typable. These results strongly suggest that transmission of cryptosporidiosis is mostly anthroponotic in origin in the clinical sample under study. We expect that our molecular epidemiological data will make a significant contribution to unravel the actual epidemiological situation of cryptosporidiosis in Spain, providing health care and policy makers with solid baseline information to unavoidably improve the national surveillance system and allocate additional resources to research, diagnosis, and treatment of cryptosporidiosis.