Monkeypox and HIV in the Canary Islands: A Different Pattern in a Mobile Population.

BACKGROUND: The clinical and epidemiological data of the recent outbreak of monkeypox (MPX) differ from previous reports. One difference is the epidemiological profile; the disease mainly affects a subgroup of MSM (men who have sex with men) with high-risk sexual behaviors, frequently persons living with human immunodeficiency virus (PLHIV). METHODS: In this observational analysis, all patients with PCR (polymerase chain reaction)-confirmed MPX attending an Infectious Diseases and Tropical Medicine Unit in Gran Canaria (Spain) between May and July 2022 were considered. RESULTS: In total, 42 men were included; 88% were identified as MSM, with a median age of 40 years. Only 43% were born in Spain. All the patients had systemic symptoms and skin lesions. The distribution of lesions was more frequent in the genital/anal region, and the involvement of hands and feet was less common. Fever and lymphadenopathies were less frequent than in other series. Other unusual manifestations were proctitis, pharyngitis and penile-scrotal edema. Half of the patients had other associated infections (mainly STIs, sexually transmitted infections), and 60% of the monkeypox patients had PLHIV (People Living with HIV). When comparing the clinical characteristics between HIV-positive and -negative patients, we found three main differences: (i) a higher frequency of perioral lesions, (ii) a higher frequency of pharyngitis and (iii) a higher number of sexually transmitted infections in HIV-positive patients. CONCLUSIONS: The clinical findings in this outbreak of MPX had great variability in presentation. Several clinical differences were found in PLHIV-coinfected patients.

Murine Typhus in Canary Islands, Spain, 1999-2015.

To document the epidemiology, clinical features, and outcomes of murine typhus patients in the Canary Islands (Spain), we analyzed data that were retrospectively collected for 16 years for 221 patients. Murine typhus in the Canary Islands is characterized by a high rate of complications (31.6%), mainly liver, lung, kidney or central nervous system involvement.

Hemophagocytic syndrome in patients infected with the human immunodeficiency virus: a study of 15 consecutive patients / Síndrome hemofagocítico en pacientes infectados con el virus de la inmunodeficiencia humana: un estudio en 15 pacientes consecutivos

OBJECTIVES: Hemophagocytic syndrome (HPS) is characterized by various clinical and biological data derived from cytokine hyperproduction and cell proliferation. The objectives of this study were to evaluate the epidemiological, etiological, clinical and evolutionary characteristics of patients diagnosed with hemophagocytic syndrome and HIV infection, as well as their comparison with data from the literature. METHODS: A retrospective descriptive observational study was performed, including all adult patients with a diagnosis of HPS and HIV infection treated in the Infectious Diseases and Tropical Medicine Unit of the Hospital Universitario Insular, Las Palmas, Gran Canaria from June 1, 1998 to December 31, 2018. RESULTS: An analysis of this series of case reports of 15 patients showed a higher percentage of males than females, with a mean age of 42 years. With respect to the diagnostic criteria for HPS, presence of fever, cytopenias and hyperferritinemia were a constant in all patients. Clinical neurological manifestations were frequent and clinical respiratory signs and symptoms absent. HPS was confirmed in some patients who were not severely immune-depressed and had undetectable viral loads. Furthermore, 40% of cases were not receiving ART. The most frequent triggering causes of HPS were viral, especially HHV-8. In addition, two new HPS triggers were identified: Blastocystis dermatitidis and Mycobacterium chelonae. CONCLUSION: Administration of treatment in HPS is arbitrary. This, together with the high mortality rate and the fact that it is underdiagnosed, indicates the importance of conducting future studies

OBJETIVOS: El síndrome hemofagocítico (HPS) se caracteriza por varios datos clínicos y biológicos derivados de la hiperproducción de citocinas y proliferación celular. Los objetivos fueron evaluar las características epidemiológicas, etiológicas, clínicas y evolutivas de los pacientes con diagnóstico de síndrome hemofagocítico e infección por VIH así como su comparación con los datos bibliográficos. PACIENTES Y MÉTODOS: Se realizó un estudio observacional descriptivo retrospectivo incluyendo todos los pacientes adultos con diagnóstico de HPS e infección por VIH, atendidos en la Unidad de Enfermedades Infecciosas y Medicina Tropical del Hospital Universitario Insular de Las Palmas de Gran Canaria desde 1 de junio 1998 hasta 31 de diciembre de 2018. RESULTADOS: Se analizó una serie de casos de 15 pacientes, observando un mayor porcentaje de varones con edad media de 42 años. En cuanto a los criterios de HPS se observa que la presencia de fiebre, citopenias e hiperferritinemia era constante en todos los pacientes. Las manifestaciones clínicas neurológicas fueron frecuentes y ausente la clínica respiratoria. Se confirmó HPS en algunos pacientes sin inmunodepresión grave y carga viral indetectable. Además, un 40% de los casos no recibían ART. Las causas desencadenantes de HPS más frecuentes fueron las víricas, especialmente HHV-8. Además, se identificaron dos nuevos agentes desencadenantes de HPS: Blastocystis dermatitidis y Mycobacterium chelonae. CONCLUSIÓN: La administración de tratamiento en HPS es arbitraria lo que unido a su alta tasa de mortalidad e infradiagnóstico indican la importancia de continuar realizando estudios futuros

Uso de cotrimoxazol en sellado de catéter. A propósito de un caso en una situación difícil / The use of co-trimoxazole in catheter lock therapy. A report on a difficult case

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Síndromes febriles en el viajero que regresa de regiones tropicales atendidos en una unidad monográfica / Febrile syndromes in the traveler returning from tropical regions admitted in a monographic unit

Introducción. El objetivo fue analizar los síndromes febriles en pacientes que regresan de regiones tropicales, atendidos en la Unidad de Enfermedades Infecciosas y Medicina Tropical (UEIMT) de nuestro centro. El conocimiento de estas enfermedades persigue realizar un diagnóstico precoz y, de esta forma, evitar la emergencia y diseminación de enfermedades importadas, así como establecer actividades preventivas adecuadas. Métodos. Se realizó un estudio observacional descriptivo transversal, seleccionando de la cohorte de viajeros atendidos en la UEIMT entre 1998 y 2013 aquéllos que consultaban al regreso con fiebre (n = 247). Se analizaron las características demográficas relativas al viaje, así como motivos de consulta y el diagnóstico final. Resultados. Se incluyeron 241 viajeros con fiebre al regreso. Los diagnósticos más comunes fueron: fiebre autolimitada sin foco (29,1%), malaria (25,1%), gastroenteritis invasiva (15,4%), otras infecciones bacterianas (7,4%) e infecciones parenquimatosas genitourinarias (4,5%). De todos los casos sólo un 8,5% requirió ingreso hospitalario, no registrándose ningún caso de mortalidad. Conclusiones. En la serie presentada existen datos comunes con otras publicadas (malaria como enfermedad fundamental, dificultades en el diagnóstico) y otros diferentes (menor número de consultas pre-viaje e ingresos, mayor incidencia de prostatitis y menor número de casos de dengue) (AU)

Background. The aim was to analyse those syndromes with fever in travellers who return from tropical regions evaluated at our Department of Infectology and Tropical Medicine. Clarifying these conditions intends to reach earlier diagnoses and, perhaps, to avoid the emergence and spread of imported diseases, as well as to establish appropriate preventive measures. Methods. An observational descriptive transversal study was performed, selecting those patients who returned from tropical regions with fever, amongst all travellers evaluated in our department between 1998 and 2013. We analysed demographic features, information related to the trip, as well as the presenting complaints and the diagnoses. Results. A total of 247 international travellers presenting with fever were analysed. The most common diagnoses were self-limiting fever (29.1%), malaria (25.1%), invasive gastroenteritis (15.4%), other bacterial infections (7.4%) and genitourinary parenchymal infections (4.5%). Of all the cases, only 8.5% required hospitalization, and no case of mortality was recorded. Conclusions. In the series presented, there are common data with other published data (malaria as a fundamental disease, difficulties in diagnosis) and different ones (less number of pre-trip consultations and admissions, higher incidence of prostatitis and fewer dengue cases) (AU)

Utilidad del diagnóstico molecular precoz de fiebre Q y rickettsiosis en pacientes con fiebre de duración intermedia / Usefulness of the early molecular diagnosis of Q fever and rickettsial diseases in patients with fever of intermediate duration

La mayor parte de los casos de fiebre de duración intermedia (FDI) en España corresponden a enfermedades infecciosas (principalmente fiebre Q y rickettsiosis). En la práctica clínica el diagnóstico causal de estas entidades se basa en el inmunodiagnóstico, con una escasa utilidad en fases precoces. Por ello, el objetivo de este trabajo fue la evaluación de la utilidad de técnicas moleculares en el diagnóstico precoz de fiebre Q y rickettsiosis en pacientes con FDI. Se estudió mediante PCR la presencia de material genético de Coxiella burnetii y Rickettsia spp. en muestras sanguíneas de 271 pacientes con FDI. La especificidad de ambas técnicas es elevada, permitiendo el diagnóstico en casos no diagnosticados mediante detección de anticuerpos específicos. Estos datos sugieren que el empleo de técnicas moleculares, con una adecuada selección de la muestra de estudio y el empleo de cebadores adecuados, es un elemento útil en el diagnóstico precoz de las principales causas de FDI, principalmente si la serología es negativa o no es concluyente (AU)

Most cases of fever of intermediate duration (FDI) in Spain are associated with infectious diseases (mainly Q fever and rickettsia infections). In clinical practice, the causal diagnosis of these entities is based on immunodiagnostic techniques, which are of little help in the early stages. Therefore, the aim of this study was to evaluate the usefulness of molecular techniques for the early diagnosis of Q fever and rickettsia diseases in patients with FDI. A PCR method was used to detect the presence of genetic material of Coxiella burnetii and Rickettsia spp. in blood specimens from 271 patients with FDI. The specificity of both techniques is high, allowing diagnosis in cases undiagnosed by specific antibodies detection. These data suggest that the use of molecular techniques, with proper selection of the study specimen, and using appropriate primers is a useful tool in the early diagnosis of the main causes of FDI, especially if serology is negative or inconclusive (AU)

Immune Reconstitution Inflammatory Syndrome in HIV-Infected Immigrants.

Immune reconstitution inflammatory syndrome (IRIS) includes a group of potentially serious inflammatory processes that may be present in HIV-infected patients after initiating highly active antiretroviral therapy (HAART). Paradoxical IRIS is a worsening of symptoms, after an overwhelming response to a previously diagnosed opportunistic infection (OI); unmasking IRIS reveals a previously occult OI. The main objective of the study was to describe the epidemiological, clinical, and outcome data of HIV-infected immigrants, stratified according to high- or low-income countries of origin, who developed IRIS and to compare them with native-born Spanish patients. This retrospective study reviewed all patients with HIV infection admitted to the Unit of Infectious Diseases and Tropical Medicine between 1998 and 2014. IRIS was identified in 25/138 (18%) immigrant patients and 24/473 (5%) native-born Spanish patients infected with HIV. Most cases, 19/25 (76%), were of unmasking IRIS. The time elapsed between initiation of HAART and development of IRIS was significantly longer in patients with unmasking versus paradoxical IRIS. OIs, in particular due to mycobacteria, were the most frequently involved processes. Twenty percent of patients died. The comparison of immigrant and native-born patients found significant differences for both IRIS type (higher incidence of paradoxical forms among immigrants) and for the absence of malignancies in native-born patients. No significant differences were found when the data of immigrants from low- and high-income countries were compared.

Síndromes no febriles en el viajero que regresa de regiones tropicales atendidos en una unidad monográfica / Non-febrile syndromes in the traveler returning from tropical regions admitted in a monographic unit

Introducción. El objetivo fue analizar los síndromes no asociados a fiebre en pacientes que regresan de regiones tropicales, atendidos en la Unidad de Enfermedades Infecciosas y Medicina Tropical (UEIMT) de nuestro centro. El conocimiento de estas enfermedades persigue realizar un diagnóstico precoz y, así, evitar la emergencia y diseminación de enfermedades importadas, así como establecer actividades preventivas adecuadas. Métodos. Se realizó un estudio observacional descriptivo transversal, seleccionando de la cohorte de viajeros atendidos en la UEIMT entre 1998 y 2013 aquéllos que consultaban al regreso y sin fiebre (n = 281). Se analizaron las características demográficas relativas al viaje, así como motivos de consulta y el diagnóstico final. Resultados. Se incluyeron 281 viajeros sin fiebre al regreso. Sólo un 39% de ellos había consultado antes del viaje. Las regiones más visitadas fueron Latinoamérica (38,8%), África (37,8%) y Asia (13,6%). Un 15% de los sujetos estaba asintomático o consultaba por problemas no infecciosos. Del resto, la mayoría presentaba un proceso digestivo (46%) o cutáneo (34%). El principal cuadro digestivo fue la diarrea, alcanzándose un diagnóstico microbiológico en casi la mitad de los casos. Con respecto a los síndromes cutáneos, lo más frecuente fueron las picaduras de artrópodos (31%) y diversas piodermitis (20%). Conclusiones. Aproximadamente el 10% de las consultas de viajeros se debe a problemas al regreso, en la mitad de los casos sin fiebre. La mayoría presenta enfermedades infecciosas, fundamentalmente digestivas o cutáneas. La eosinofilia es el tercer motivo de consulta y las infecciones de transmisión sexual son excepcionales en nuestra serie. Es necesario insistir en actividades preventivas (AU)

Background. The aim was to analyse those syndromes without fever in travellers who return from tropical regions evaluated at our Department of Infectology and Tropical Medicine. Clarifying these conditions intends to reach earlier diagnoses and, perhaps, to avoid the emergence and spread of imported diseases, as well as to establish appropriate preventive measures. Methods. An observational descriptive transversal study was performed, selecting those patients who returned from tropical regions without fever (n = 281), amongst all travellers evaluated in our department between 1998 and 2013. We analysed demographic features, information related to the trip, as well as the presenting complaints and the diagnoses. Results. A total of 281 international travellers presenting without fever were analysed. Only 39% had received health counsel prior to travelling. The most visited regions were Latin America (38.8%), Africa (37.8%) and Asia (13.6%). 15% of patients were asymptomatic or suffered from non-infectious conditions. Among the rest, most had either gastrointestinal (46%) or cutaneous (34%) syndromes. The main gastrointestinal condition was diarrhoea, with a microbiological diagnosis reached in almost 50% of cases. Regarding cutaneous syndromes, arthropods bites (31%) and different bacterial lesions (20%) were most common. Conclusions. Approximately 10% of patients in Travel Medicine are international travellers returning from tropical regions, half of them with no fever. Most are diagnosed with infectious diseases, mainly gastrointestinal or cutaneous syndromes. Eosinophilia is the third problem in frequency among this group of patients, and sexually transmitted infections are rare in our cohort. It is important to emphasize in preventive activities (AU)

Endomyocardial involvement in asymptomatic sub-Saharan immigrants with helminth-related eosinophilia.

BACKGROUND: Among immigrants of sub-Saharan origin, parasitic infection is the leading cause of eosinophilia, which is generally interpreted as a defense mechanism. A side effect of the inflammatory mediators released by eosinophils is damage to host organs, especially the heart. The main objectives of this study were to i) assess cardiac involvement in asymptomatic sub-Saharan immigrants with eosinophilia, ii) relate the presence of lesions with the degree of eosinophilia, and iii) study the relationship between cardiac involvement and the type of causative parasite. METHODOLOGY/PRINCIPLE FINDINGS: In total, the study included 50 black immigrants (37 patients and 13 controls) from sub-Saharan Africa. In all subjects, heart structure and function were evaluated in a blinded manner using Sonos 5500 echocardiographic equipment. The findings were classified and described according to established criteria. The diagnostic criteria for helminthosis were those reported in the literature. Serum eosinophil-derived neurotoxin levels were measured using enzyme-linked immunosorbent assay. A significant association was found between the presence of eosinophilia and structural alterations (mitral valve thickening). However, the lack of an association between the degree of eosinophilia and heart valve disease and the absence of valve involvement in some patients with eosinophilia suggest the role of other factors in the appearance of endocardial lesions. There was also no association between the type of helminth and valve involvement. CONCLUSIONS: We, therefore, suggest that transthoracic echocardiography be performed in every sub-Saharan individual with eosinophilia in order to rule out early heart valve lesions.

Usefulness of the early molecular diagnosis of Q fever and rickettsial diseases in patients with fever of intermediate duration. / Utilidad del diagnóstico molecular precoz de fiebre Q y rickettsiosis en pacientes con fiebre de duración intermedia.

Most cases of fever of intermediate duration (FDI) in Spain are associated with infectious diseases (mainly Q fever and rickettsia infections). In clinical practice, the causal diagnosis of these entities is based on immunodiagnostic techniques, which are of little help in the early stages. Therefore, the aim of this study was to evaluate the usefulness of molecular techniques for the early diagnosis of Q fever and rickettsia diseases in patients with FDI. A PCR method was used to detect the presence of genetic material of Coxiella burnetii and Rickettsia spp. in blood specimens from 271 patients with FDI. The specificity of both techniques is high, allowing diagnosis in cases undiagnosed by specific antibodies detection. These data suggest that the use of molecular techniques, with proper selection of the study specimen, and using appropriate primers is a useful tool in the early diagnosis of the main causes of FDI, especially if serology is negative or inconclusive.

Características demográficas, quimioprofilaxis antimalárica e inmunoprofilaxis en 6.783 viajeros internacionales atendidos en una unidad monográfica / Demographic characteristics, malaria chemoprophylaxis and vaccination in 6,783 international travelers attended in a specialized unit

Introduccion. El objetivo fue conocer las características demográficas y la evolución temporal de los viajeros internacionales atendidos en la Unidad de Enfermedades Infecciosas y Medicina Tropical con el fin de mejorar las precauciones previas al viaje y disminuir la aparición de dichas enfermedades. Métodos. Se realizó un estudio descriptivo retrospectivo de todos los viajeros internacionales atendidos en la UEIMT (Las Palmas de Gran Canaria) durante el periodo 1998 - 2013. Se analizaron las siguientes variables que fueron recogidas mediante un protocolo estandarizado: edad, género, fecha de la consulta, tipo de viajero, país/es de destino y medidas preventivas realizadas (quimioprofilaxis antipalúdica y vacunas). El análisis estadístico se realizó usando el paquete SPSS versión 19.0. Resultados. Se analizaron un total de 6.783 viajeros internacionales de los cuales 52% fueron mujeres. La media de edad fue de 36 años (DT 13). El continente de destino más frecuente fue África (39%) seguido de Asia (36%) y América Latina (23%). El país de destino más habitual fue la India 13% (882), seguido de Senegal 7,5% (509) y Tailandia 6,3% (429). Las vacunas más frecuentemente recomendadas fueron, fiebre tifoidea (82,9%) y hepatitis A (66,9%). En cuanto a la profilaxis antipalúdica, los fármacos indicados fueron atovacuonaproguanil (56,5%), mefloquina (36,7 %), En lo que respecta a los viajeros que regresan para visitar a amigos y familiares un 26,81% eran niños (0-9 años). Conclusiones. El perfil general del viajero es un joven que con motivo vacacional elige como destino África seguido de Asia y Latinoamérica. Más del 50% de los viajeros recibieron vacunación frente a la fiebre tifoidea y a la hepatitis A. La quimioprofilaxis antipalúdica más utilizada fue atovacuona/ proguanil seguida de mefloquina (AU)

Background. The objective of this paper was to determine the demographic characteristics and the evolution of international travelers treated at the Unit of Infectious and Tropical Medicine in order to improve precautions prior to travel and, thus reduce the occurrence of these diseases. Methods. A retrospective study of all international travelers served in UEIMT (Las Palmas de Gran Canaria) during the period 1998-2013 was performed. The following variables were collected using a standardized protocol were analyzed: age, gender, date of consultation, type of traveler, countries of destination and preventive measures undertaken (malaria chemoprophylaxis and vaccines). Results. A total of 6,783 international travelers of which 52% were women were analyzed. The average age was 36 years (SD 13). The most frequent destination continent was Africa (39%) followed by Asia (36%) and Latin America (23%). The most common country of destination was India 13% (882), followed by Senegal 7.5% (509) and Thailand 6.3% (429). The most frequently recommended vaccines were typhoid fever (82.9%) and hepatitis A (66.9%). As for malaria prophylaxis, the indicated drugs were atovaquone-proguanil (56.5%), mefloquine (36.7%), in regard to travelers returning to visit relatives and friends with a 26.81% were children (0-9 years). Conclusions. The overall profile of the traveler is a young man who chooses holiday destination Africa followed by Asia and Latin America. Over 50% of travelers received vaccination against typhoid and hepatitis A. The most commonly used malaria chemoprophylaxis was atovaquone / proguanil followed by mefloquine (AU)

Espondilodiscitis por Streptococcus dysgalactiae subsp. equisimilis (grupo G) / Spondylodiscitis by Streptococcus dysgalactiae subsp. equisimilis (group G)

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Compartmental syndrome of the upper limb due to Moraxella lacunata infection: a link to patera foot syndrome?

We report a case of compartmental syndrome of the left upper limb secondary to a severe Moraxella lacunata infection, an unusual pathogen, occurring in a young black male immigrant to the island of Gran Canaria, Spain. We propose a pathophysiological relationship with patera foot syndrome.

Skin and soft tissue infections (patera foot) in immigrants, Spain.

An unusual skin and soft tissue infection of the lower limbs has been observed in immigrants from sub-Saharan Africa who cross the Atlantic Ocean crowded on small fishing boats (pateras). Response to conventional treatment is usually poor. Extreme extrinsic factors (including new pathogens) may contribute to the etiology of the infection and its pathogenesis.