COVID-19 Associated Pulmonary Aspergillosis (CAPA): Hospital or Home Environment as a Source of Life-Threatening Aspergillus fumigatus Infection?

Most cases of invasive aspergillosis are caused by Aspergillus fumigatus, whose conidia are ubiquitous in the environment. Additionally, in indoor environments, such as houses or hospitals, conidia are frequently detected too. Hospital-acquired aspergillosis is usually associated with airborne fungal contamination of the hospital air, especially after building construction events. A. fumigatus strain typing can fulfill many needs both in clinical settings and otherwise. The high incidence of aspergillosis in COVID patients from our hospital, made us wonder if they were hospital-acquired aspergillosis. The purpose of this study was to evaluate whether the hospital environment was the source of aspergillosis infection in CAPA patients, admitted to the Hospital Universitario Central de Asturias, during the first and second wave of the COVID-19 pandemic, or whether it was community-acquired aspergillosis before admission. During 2020, sixty-nine A. fumigatus strains were collected for this study: 59 were clinical isolates from 28 COVID-19 patients, and 10 strains were environmentally isolated from seven hospital rooms and intensive care units. A diagnosis of pulmonary aspergillosis was based on the ECCM/ISHAM criteria. Strains were genotyped by PCR amplification and sequencing of a panel of four hypervariable tandem repeats within exons of surface protein coding genes (TRESPERG). A total of seven genotypes among the 10 environmental strains and 28 genotypes among the 59 clinical strains were identified. Genotyping revealed that only one environmental A. fumigatus from UCI 5 (box 54) isolated in October (30 October 2020) and one A. fumigatus isolated from a COVID-19 patient admitted in Pneumology (Room 532-B) in November (24 November 2020) had the same genotype, but there was a significant difference in time and location. There was also no relationship in time and location between similar A. fumigatus genotypes of patients. The global A. fumigatus, environmental and clinical isolates, showed a wide diversity of genotypes. To our knowledge, this is the first study monitoring and genotyping A. fumigatus isolates obtained from hospital air and COVID-19 patients, admitted with aspergillosis, during one year. Our work shows that patients do not acquire A. fumigatus in the hospital. This proves that COVID-associated aspergillosis in our hospital is not a nosocomial infection, but supports the hypothesis of "community aspergillosis" acquisition outside the hospital, having the home environment (pandemic period at home) as the main suspected focus of infection.

Diagnóstico molecular de la sífilis / Molecular diagnostic of syphilis

La sífilis es una infección de transmisión sexual causada por Treponema pallidum subsp. pallidum, cuya incidencia está aumentando en España y en el resto del mundo. El diagnóstico se basa fundamentalmente en la serología, puesto que el diagnóstico directo mediante microscopía de campo oscuro presenta dificultades que limitan su generalización. Las técnicas de biología molecular pueden ser una herramienta útil para el diagnóstico en sífilis primaria y secundaria, si bien no todos los tipos de muestra se comportan igual. También son útiles para el diagnóstico de la sífilis congénita, mientras que para la neurosífilis, y debido a la baja sensibilidad de la reacción en cadena de la polimerasa en el líquido cefalorraquídeo, no se recomiendan. Estás técnicas se han empleado para estudiar el controvertido origen de la sífilis, y mediante el sistema mejorado de los Centers for Disease Control and Prevention para realizar la tipificación que ayude a comprender mejor la epidemiología. Por último, las técnicas moleculares permiten determinar la presencia de mutaciones relacionadas con resistencia a los macrólidos, presentes en un porcentaje muy elevado de las infecciones

Syphilis is a sexually transmitted infection caused by Treponema pallidum subsp. pallidum with an increasing incidence in Spain and in the rest of the world. Diagnosis is based mainly on serology, since direct diagnosis by dark field microscopy presents difficulties that limit its widespread use. Molecular biology techniques can be a useful tool for diagnosis in primary and secondary syphilis, although not all types of samples show the same behaviour. These techniques are also useful for the diagnosis of congenital syphilis. They are not recommended, however, for neurosyphilis, due to the low sensitivity of polymerase chain reaction in cerebrospinal fluid. These techniques have been used to study the controversial origin of syphilis, and, through the enhanced Centers for Disease Control method, to perform typing, which helps to elucidate the epidemiology of this infection. Finally, molecular techniques can detect mutations related to macrolide resistance, which are present in a very high percentage of infections

Incidentes y eventos adversos en la Unidad de Cuidados Paliativos de un hospital de agudos geriátricos / Incidents and adverse events in the palliative care unit of an acute geriatric hospital

OBJETIVOS: Mejorar la seguridad del paciente es necesario en las unidades de cuidados paliativos donde no hay datos de incidentes y eventos adversos. Se analizaron los tipos de incidentes/eventos adversos, su frecuencia y gravedad en la Unidad de Cuidados Paliativos de un hospital de agudos geriátrico con el objetivo de introducir medidas que pudieran reducir su incidencia. MATERIAL Y MÉTODOS: Estudio retrospectivo de 6 años utilizando un sistema de notificación voluntaria, un sistema de notificación obligatoria para las caídas de los pacientes y la herramienta Global Trigger Tool. Se llevó a cabo en un hospital geriátrico universitario español de 200 camas (27 camas en la Unidad de Cuidados Paliativos). Se incluyeron todos los pacientes ingresados en la Unidad (1.854). La severidad del daño se calculó por el Index of the National Coordinating Council for Medication Error Reporting and Prevention. RESULTADOS: Se identificaron 743 incidentes/eventos adversos, de los cuales 518 (69,7%) eran incidentes (categorías A-D de la clasificación del National Coordinating Council for Medication Error Reporting and Prevention) y 201 eventos adversos (categorías E-I). Los cuidados generales (51,5%) y los errores de medicación (45,2%) fueron los más frecuentes. De estos últimos, los más comunes eran las omisiones de dosis/medicamentos (43,5%). Tanto los antihipertensivos-IECA, antibióticos, antiepilépticos y neurolépticos presentaban tasas de error por encima de la media (5,2), cuando se calcularon los cocientes de incidentes/dispensación. CONCLUSIONES: Este estudio revela un nivel de eventos adversos nada desdeñable dada la conocida falta de sensibilidad de los métodos de detección de eventos adversos, lo que implica la necesidad de desarrollar marcadores de alarma específicos de cuidados paliativos

OBJECTIVES: Improving patient safety is necessary in palliative care units where data on incidents and adverse events are lacking. An analysis was performed on the types of incidents/adverse events, their frequency and severity in the Palliative Care Unit of an Acute Geriatric Hospital with the aim of introducing measures that might lower their incidence. MATERIAL AND METHODS: A 6 year retrospective study was conducted using a voluntary reporting system, a compulsory reporting system for patient falls, and the Global Trigger Tool in a Spanish urban geriatric teaching hospital of 200 beds (27 beds in the Palliative Care Unit). All patients (1,854) admitted to the Unit were included. The Index of the National Coordinating Council for Medication Error Reporting and Prevention was used to evaluate severity. RESULTS: A total of 743 incidents/adverse events were identified, of which 518 (69.7%) were incidents (categories A-D of the National Coordinating Council for Medication Error Reporting and Prevention classification), and 201 were adverse events (categories E-I). General care (51.5%) and medication errors (45.2%) were the most frequent. Of the latter, missing doses/drugs were most common (43.5%). Antihypertensives-ACEIs, antibiotics, antiepileptics, and neuroleptics showed mistake rates above the mean (5.2) when the incident-adverse events/dispensation ratios were calculated. CONCLUSIONS: This study reveals a negligible level of adverse events, given the known low sensitivity of the detection methods of incidents/adverse events, which implies the need to develop specific alarms in Palliative Care

[Strongyloides stercoralis infestation in an immunocompetent 82-year-old woman]. / Infestación por Strongyloides stercoralis en una paciente de 82 años inmunocompetente.

A laboratory finding of eosinophilia in patients with gastrointestinal symptoms should prompt the differential diagnosis of a parasitosis. The diagnosis is based on identification of larvae in three different stool samples. We report the case of an 82-year-old woman who was independent for instrumental and advanced activities of daily living and showed no risk factors for strongyloidiasis who was admitted to our service with diarrhoea and abdominal pain. Blood examination showed peripheral eosinophilia of 38%. Stool sample revealed Strongyloides stercoralis. In the patient's case history, we found similar clinical features with fluctuating eosinophilia over the previous 8 years. The patient was treated with albendazole, resulting in clinical improvement and elimination of eosinophilia.

Infestación por Strongyloides stercoralis en una paciente de 82 años inmunocompetente / Strongyloides stercoralis infestation in an immunocompetent 82-year-old woman

La presencia de clínica abdominal y eosinofilia debe hacernos sospechar una infección por parásitos. El diagnóstico se realiza a través del examen de heces, analizando 3 muestras distintas. Presentamos el caso de una mujer de 82 años, independiente para las actividades instrumentales y avanzadas, sin factores de riesgo conocidos para estrongiloidosis, que ingresó en nuestro servicio con un cuadro de diarrea y molestias abdominales. En las pruebas complementarias destacaba una eosinofilia del 38%. En el examen de las heces se observaron larvas compatibles con Strongyloides stercoralis. En su historia clínica encontramos varios episodios previos con clínica similar y presencia de eosinofilia fluctuante que comenzaron 8 años antes. Fue tratada con albendazol con resolución de la clínica y desaparición de la eosinofilia (AU)

A laboratory finding of eosinophilia in patients with gastrointestinal symptoms should prompt the differential diagnosis of a parasitosis. The diagnosis is based on identification of larvae in three different stool samples. We report the case of an 82-year-old woman who was independent for instrumental and advanced activities of daily living and showed no risk factors for strongyloidiasis who was admitted to our service with diarrhoea and abdominal pain. Blood examination showed peripheral eosinophilia of 38%. Stool sample revealed Strongyloides stercoralis. In the patient's case history, we found similar clinical features with fluctuating eosinophilia over the previous 8 years. The patient was treated with albendazole, resulting in clinical improvement and elimination of eosinophilia (AU)

[Update on the epidemiology, diagnosis and treatment of sexually-transmitted infections]. / Panorama actual de la epidemiología, diagnóstico y tratamiento de las infecciones de transmisión sexual.

In the last decade, cases of sexually-transmitted infections (STIs) have progressively increased in Europe. The reasons for this increase are unclear, but may involve changes in social behavior, migration and international travel, coupled with the emergence of risk groups that have not been taken into sufficient consideration to date. The routine use of molecular diagnostic techniques for many of these infections has solved many problems of sensitivity and the suitability of samples for microbiological diagnosis: non-invasive samples can be used, which has undoubtedly contributed to the increase in the number of cases. Moreover, molecular methods have also been introduced for antibiotic and antiviral susceptibility testing, as well as for molecular characterization of clinical isolates. All of these factors, together with the approval of the vaccine against the human papillomavirus, have changed the landscape of STIs across Europe.

Panorama actual de la epidemiología, diagnóstico y tratamiento de las infecciones de transmisión sexual / Update on the epidemiology, diagnosis and treatment of sexually-transmitted infections

En la última década se ha constatado un aumentoprogresivo de los casos de infecciones de transmisiónsexual en el territorio europeo. Las causas de esteaumento no están claras, pero parece influido por cambiosen las conductas sociales, los fenómenos migratorios y losviajes internacionales, junto con la aparición de grupos deriesgo no suficientemente valorados hasta ahora. Lautilización habitual de técnicas de diagnóstico molecularpara muchas de estas infecciones ha resuelto muchosproblemas de sensibilidad e idoneidad de las muestraspara el diagnóstico microbiológico, pudiéndose emplearmuestras no invasivas, y ha contribuido, sin duda, a esteaumento de casos. Por otro lado, los métodos molecularestambién se van implantando en el estudio de lasensibilidad a los antibióticos y antivirales, así como parala caracterización molecular de los aislados. Todo loanterior, junto a la aprobación de la vacuna frente al virusdel papiloma humano, ha cambiado el panorama de lasinfecciones de transmisión sexual en el territorio europeo(AU)

In the last decade, cases of sexually-transmitted infections(STIs) have progressively increased in Europe. The reasonsfor this increase are unclear, but may involve changes insocial behavior, migration and international travel, coupledwith the emergence of risk groups that have not beentaken into sufficient consideration to date.The routine use of molecular diagnostic techniques formany of these infections has solved many problems of sensitivity and the suitability of samples formicrobiological diagnosis: non-invasive samples can beused, which has undoubtedly contributed to the increasein the number of cases. Moreover, molecular methodshave also been introduced for antibiotic and antiviralsusceptibility testing, as well as for molecularcharacterization of clinical isolates. All of these factors,together with the approval of the vaccine against thehuman papillomavirus, have changed the landscape ofSTIs across Europe(AU)

Panorama actual de la epidemiología, diagnóstico y tratamiento de las infecciones de transmisión sexual / Update on the epidemiology, diagnosis and treatment of sexually-transmitted infections

En la última década se ha constatado un aumentoprogresivo de los casos de infecciones de transmisiónsexual en el territorio europeo. Las causas de esteaumento no están claras, pero parece influido por cambiosen las conductas sociales, los fenómenos migratorios y los viajes internacionales, junto con la aparición de grupos de riesgo no suficientemente valorados hasta ahora. La utilización habitual de técnicas de diagnóstico molecular para muchas de estas infecciones ha resuelto muchos problemas de sensibilidad e idoneidad de las muestras para el diagnóstico microbiológico, pudiéndose emplear muestras no invasivas, y ha contribuido, sin duda, a este aumento de casos. Por otro lado, los métodos moleculares también se van implantando en el estudio de la sensibilidad a los antibióticos y antivirales, así como para la caracterización molecular de los aislados. Todo lo anterior, junto a la aprobación de la vacuna frente al virus del papiloma humano, ha cambiado el panorama de las infecciones de transmisión sexual en el territorio europeo

In the last decade, cases of sexually-transmitted infections (STIs) have progressively increased in Europe. The reasons for this increase are unclear, but may involve changes in social behavior, migration and international travel, coupled with the emergence of risk groups that have not been taken into sufficient consideration to date.The routine use of molecular diagnostic techniques formany of these infections has solved many problems ofsensitivity and the suitability of samples formicrobiological diagnosis: non-invasive samples can beused, which has undoubtedly contributed to the increasein the number of cases. Moreover, molecular methodshave also been introduced for antibiotic and antiviralsusceptibility testing, as well as for molecularcharacterization of clinical isolates. All of these factors, together with the approval of the vaccine against the human papillomavirus, have changed the landscape of STIs across Europe

Utilidad de las técnicas de biología molecular en el diagnóstico de las infecciones de transmisión sexual y otras infecciones genitales / Utility of molecular biology techniques in the diagnosis of sexually transmitted diseases and genital infections

Históricamente, el diagnóstico de las infecciones de transmisión sexual ha sido difícil. La introducción en el diagnóstico microbiológico de las técnicas de biología molecular y su aplicación a muestras no invasivas ha permitido importantes avances en su diagnóstico. En general, la detección de Neisseria gonorrhoeae mediante técnicas de biología molecular proporciona un diagnóstico presuntivo y requiere confirmación por cultivo en zonas de baja prevalencia. Para Chlamydia trachomatis, estas técnicas se consideran como las más sensibles y específicas, tanto para estudios de cribado poblacional, como para el diagnóstico de pacientes sintomáticos. El diagnóstico de Mycoplasma genitalium por cultivo es muy lento, por ello, las técnicas moleculares son las únicas que pueden aportar información diagnóstica relevante. Para Treponema pallidum, las técnicas moleculares pueden aportar ventajas en el diagnóstico directo de la infección. Respecto a la donovaniosis, las técnicas moleculares no están establecidas para el diagnóstico sistemático, aunque se recomiendan en manos expertas. En el caso de Haemophilus ducreyi, las dificultades del cultivo y su baja sensibilidad aconsejan el uso de métodos moleculares. En el herpes genital, las técnicas moleculares han comenzado a recomendarse para el diagnóstico sistemático y pueden convertirse en la técnica de referencia en poco tiempo. Para otras infecciones genitales, como vaginosis bacteriana, vulvovaginitis candidiásica y tricomoniasis, los métodos moleculares para el diagnóstico están poco establecidos. Respecto a las verrugas genitales, las técnicas de cribado y genotipado disponibles para muestras endocervicales podrían utilizarse para ciertas poblaciones, aunque no se han validado para este cometido(AU)

Historically, the diagnosis of sexually transmitted diseases (STDs) has been difficult. The introduction of molecular biology techniques in microbiological diagnosis and their application to non-invasive samples has produced significant advances in the diagnosis of these diseases. Overall, detection of Neisseria gonorrhoeae by molecular biology techniques provides a presumptive diagnosis and requires confirmation by culture in areas with a low prevalence. For Chlamydia trachomatis infections, these techniques are considered to be the most sensitive and specific procedures for mass screening studies, as well as for the diagnosis of symptomatic patients. Diagnosis of Mycoplasma genitalium infection by culture is very slow and consequently molecular techniques are the only procedures that can provide relevant diagnostic information. For Treponema pallidum, molecular techniques can provide direct benefits in the diagnosis of infection. Molecular techniques are not established for the routine diagnosis of donovanosis, but can be recommended when performed by experts. Molecular methods are advisable in Haemophilus ducreyi, because of the difficulties of culture and its low sensitivity. In genital herpes, molecular techniques have begun to be recommended for routine diagnosis and could soon become the technique of choice. For other genital infections, bacterial vaginosis, vulvovaginal candidosis and trichomoniasis, diagnosis by molecular methods is poorly established. With genital warts, techniques available for screening and genotyping of endocervical samples could be used for certain populations, but are not validated for this purpose(AU)

Utilidad de las técnicas de biología molecular en el diagnóstico de las infecciones de transmisión sexual y otras infecciones genitales / Utility of molecular biology techniques in the diagnosis of sexually transmitted diseases and genital infections

Históricamente, el diagnóstico de las infecciones detransmisión sexual ha sido difícil. La introducción en eldiagnóstico microbiológico de las técnicas de biologíamolecular y su aplicación a muestras no invasivas hapermitido importantes avances en su diagnóstico. Engeneral, la detección de Neisseria gonorrhoeae mediantetécnicas de biología molecular proporciona un diagnósticopresuntivo y requiere confirmación por cultivo en zonas de baja prevalencia. Para Chlamydia trachomatis, estastécnicas se consideran como las más sensibles yespecíficas, tanto para estudios de cribado poblacional,como para el diagnóstico de pacientes sintomáticos. Eldiagnóstico de Mycoplasma genitalium por cultivo es muylento, por ello, las técnicas moleculares son las únicas que pueden aportar información diagnóstica relevante. Para Treponema pallidum, las técnicas moleculares puedenaportar ventajas en el diagnóstico directo de la infección. Respecto a la donovaniosis, las técnicas moleculares no están establecidas para el diagnóstico sistemático, aunque se recomiendan en manos expertas. En el caso de Haemophilus ducreyi, las dificultades del cultivo y su baja sensibilidad aconsejan el uso de métodos moleculares. En el herpes genital, las técnicas moleculares han comenzado a recomendarse para el diagnóstico sistemático y pueden convertirse en la técnica de referencia en poco tiempo. Para otras infecciones genitales, como vaginosis bacteriana, vulvovaginitis candidiásica y tricomoniasis, losmétodos moleculares para el diagnóstico están pocoestablecidos. Respecto a las verrugas genitales, lastécnicas de cribado y genotipado disponibles paramuestras endocervicales podrían utilizarse para ciertaspoblaciones, aunque no se han validado para estecometido

Historically, the diagnosis of sexually transmitted diseases (STDs) has been difficult. The introduction of molecular biology techniques in microbiological diagnosis and their application to non-invasive samples has produced significant advances in the diagnosis of these diseases. Overall, detection of Neisseria gonorrhoeae by molecular biology techniques provides a presumptive diagnosis and requires confirmation by culture in areas with a low prevalence. For Chlamydia trachomatis infections, these techniques are considered to be the most sensitive and specific procedures for mass screening studies, as well as for the diagnosis of symptomatic patients. Diagnosis of Mycoplasma genitalium infection by culture is very slow and consequently molecular techniques are the only procedures that can provide relevant diagnostic information. For Treponema pallidum, molecular techniques can provide direct benefits in the diagnosis of infection. Molecular techniques are not established for the routine diagnosis of donovanosis, but can be recommended when performed by experts. Molecular methods are advisable in Haemophilus ducreyi, because of the difficulties of culture and its low sensitivity. In genital herpes, molecular techniques have begun to be recommended for routine diagnosis and could soon become the technique of choice. For other genital infections, bacterial vaginosis, vulvovaginal candidosis and trichomoniasis, diagnosis by molecular methods is poorly established. With genital warts, techniques available for screening and genotyping of endocervical samples could be used for certain populations, but are not validated for this purpose

Factors associated with induced abortion in women prostitutes in Asturias (Spain).

BACKGROUND: The aim is to investigate the factors that might be associated with the presence of induced abortion (IA) in women prostitutes in Asturias (Spain). METHODOLOGY/PRINCIPAL FINDINGS: Cross-sectional descriptive study by self-completion questionnaire of 212 women prostitutes who attended the three Sexually Transmitted Disease Clinics in Asturias, between January-December 2003. The questionnaire was designed to investigate the women's perceived knowledge (what they claimed to know), their real knowledge (what they really knew), the use of contraceptive methods and socio-demographic variables. Multivariate analysis was carried out. 92% of the participants were immigrants. 76% were practising at brothel. 37.6% (95%CI:30.7-44.4%) reported to have undergone at least one IA during their life. According to the logistic regression the "presence of IA" was directly associated with the variables "number of pregnancies" (OR:65.82;95%IC:7.73-560.14) and "years of practising prostitution" (OR:1.13;95%CI:0.99-1.29); and inversely associated with "children" (0 = no children;1 = one or more children; OR:0.005;95%CI:0.000-0.057), "women's age" (OR:0.89;95%CI:0.82-0.97) and "real contraceptive knowledge" (OR:0.50; 95%CI:0.34-0.75). Married women were more likely to have undergone an IA (OR:2.74;95%IC:1.05-7.13). No association with "perceived contraceptive knowledge" was found. CONCLUSIONS/SIGNIFICANCE: The characteristics more closely linked to the reproductive history of the women (such as "pregnancies", "children"), together with the "real contraceptive knowledge" and the "time practising prostitution" explain the presence of IA better than factors more closely linked to the conditions in which the women practise prostitution ("place of activity", "other activities compatible with prostitution", "use of safe method in commercial relation"). It is possible that IA is being used as a birth control method, hypothesis suggested by the inverse association observed between the variable "children" and the "presence of IA". Therefore, the promotion of the use of safe contraceptive methods should be a high-priority. If the real contraceptive knowledge was measured correctly, all strategies to increase it would be justified because it was inversely associated with the presence of IA.

[Utility of molecular biology techniques in the diagnosis of sexually transmitted diseases and genital infections]. / Utilidad de las técnicas de biología molecular en el diagnóstico de las infecciones de transmisión sexual y otras infecciones genitales.

Historically, the diagnosis of sexually transmitted diseases (STDs) has been difficult. The introduction of molecular biology techniques in microbiological diagnosis and their application to non-invasive samples has produced significant advances in the diagnosis of these diseases. Overall, detection of Neisseria gonorrhoeae by molecular biology techniques provides a presumptive diagnosis and requires confirmation by culture in areas with a low prevalence. For Chlamydia trachomatis infections, these techniques are considered to be the most sensitive and specific procedures for mass screening studies, as well as for the diagnosis of symptomatic patients. Diagnosis of Mycoplasma genitalium infection by culture is very slow and consequently molecular techniques are the only procedures that can provide relevant diagnostic information. For Treponema pallidum, molecular techniques can provide direct benefits in the diagnosis of infection. Molecular techniques are not established for the routine diagnosis of donovanosis, but can be recommended when performed by experts. Molecular methods are advisable in Haemophilus ducreyi, because of the difficulties of culture and its low sensitivity. In genital herpes, molecular techniques have begun to be recommended for routine diagnosis and could soon become the technique of choice. For other genital infections, bacterial vaginosis, vulvovaginal candidosis and trichomoniasis, diagnosis by molecular methods is poorly established. With genital warts, techniques available for screening and genotyping of endocervical samples could be used for certain populations, but are not validated for this purpose.