First morphogenetic analysis of parasite eggs from Schistosomiasis haematobium infected sub-Saharan migrants in Spain and proposal for a new standardised study methodology.

Schistosomiasis is a Neglected Tropical Disease caused by trematode species of the genus Schistosoma. Both, autochthonous and imported cases of urogenital schistosomiasis have been described in Europe. The present study focuses on eggs, considered pure S. haematobium by genetic characterisation (intergenic ITS region of the rDNA and cox1 mtDNA). A phenotypic characterisation of S. haematobium eggs was made by morphometric comparison with experimental populations of S. bovis and S. mansoni, to help in the diagnosis of S. haematobium populations infecting sub-Saharan migrants in Spain. Analyses were made by Computer Image Analysis System (CIAS) applied on the basis of new standardised measurements and geometric morphometric tools. The principal component analysis (PCA), including seventeen non-redundant measurements, showed three phenotypic patterns in eggs of S. haematobium, S. bovis and S. mansoni. PCA showed that the S. bovis population presented a large egg size range with a pronouncedly larger maximum size. Similarly, S. bovis shows bigger spine values than S. haematobium. Mahalanobis distances between each pair of groups were calculated for each discriminant analysis performed. In general, S. mansoni and S. bovis present larger distances between them than with S. haematobium, i.e. they present the greatest differences. Regarding the spine, S. haematobium and S. mansoni are the most distant species. Results show the usefulness of this methodology for the phenotypic differentiation between eggs from these Schistosoma species, capable of discerning morphologically close eggs, as is the case of the haematobium group. Schistosoma egg phenotyping approaches may be applied to assess not only hybrid forms but also potential influences of a variety of other factors.

Antimicrobial susceptibility and typing of Neisseria gonorrhoeae strains from Southern Spain, 2012-2014 / Sensibilidad a antimicrobianos y tipado de cepas de Neisseria gonorrhoeae procedentes del sur de España, 2012-2014

BACKGROUND: Gonorrhoea remains an important health problem worldwide. The latest European guidelines have recommended the introduction of dual antimicrobial therapy due to the increase in its resistance to antimicrobial agents. METHODS: In the present study, the susceptibility to some antibiotics was evaluated, and the typing of Neisseria gonorrhoeae strains was also performed. All Neisseria gonorrhoeae (NG) strains isolated from January 2012 to October 2014 were included in this work. Gonococcal isolates were tested for susceptibility according to the recommendations of both the Clinical and Laboratory Standards Institute (CLSI) and the European Committee on Antimicrobial Susceptibility Testing (EUCAST). A total of 65 isolates were typed by the NG multi-antigen sequence types (NG-MAST) technique. RESULTS: The most frequent types found were ST 1407, ST 5405, ST 2992, and ST 5120. If CLSI and EUCAST criteria were applied, an ST 9807 type was found non-susceptible to ceftriaxone and cefixime (MIC 0.5 mig/mL). When only EUCAST breakpoints were taken into account, three strains were also resistant to cefixime (MIC 0.25 mig/mL) and two isolates were resistant to ceftriaxone (MIC 0.19 and 0.25 mig/mL, respectively). The majority of strains were resistant to ciprofloxacin, and all Neisseria gonorrhoeaestrains were susceptible to spectinomycin; twenty-five percent of isolates were resistant to azithromycin. CONCLUSIONS: The implementation of antimicrobial surveillance programs at regional level should be part of an overall gonococcal infection control strategy. Efforts should be made to perform antimicrobial susceptibility, a "cured test" in all gonorrhoea cases, and identify treatment failures to verify emerging resistance. Some types have been associated with decreased susceptibility to cephalosporins, making molecular typing a useful tool to predict antimicrobial resistance

ANTECEDENTES: La gonorrea sigue siendo un importante problema de salud pública a nivel mundial. Las últimas guías en Europa han recomendado la introducción de tratamiento antimicrobiano dual debido al incremento de las resistencias a los antimicrobianos. MÉTODOS: En este estudio fue evaluada la sensibilidad a algunos antibióticos y se realizó el tipado de cepas deNeisseria gonorrhoeae. Todas las cepas aisladas desde enero de 2012 hasta octubre de 2014 fueron incluidas en este trabajo. El estudio de la sensibilidad de las cepas de gonococo fue realizado según las recomendaciones del Clinical and Laboratory Standards Institute (CLSI) y del European Committee on Antimicrobial Susceptibility Testing (EUCAST). Un total de 65 cepas fueron tipadas mediante la técnica NG-multiantigen sequence types (NG-MAST). RESULTADOS: Los tipos encontrados más frecuentemente fueron el ST 1407, ST 5405, ST 2992 y el ST 5120. Al aplicar los criterios del CLSI y del EUCAST, un tipo ST 9807 resultó no sensible a ceftriaxona y cefixime (CMI 0,5 mig/mL). Al tener solo en cuenta los puntos de corte del EUCAST, 3 cepas más fueron también resistentes a cefixime (CMI 0,25 migr/mL) y 2 más fueron resistentes a ceftriaxona (CMI 0,19 y 0,25 mig/mL, respectivamente). La mayoría de las cepas fueron resistentes a ciprofloxacino, y todas las cepas testadas fueron sensibles a espectinomicina; el 25% de los aislamientos fueron resistentes a azitromicina. CONCLUSIONES: La implementación de programas de vigilancia antimicrobiana a nivel regional debe ser parte de la estrategia de control para la infección gonocócica. Deben ser realizados esfuerzos para el estudio de la sensibilidad antimicrobiana, test de cura en todos los casos de gonorrea y la identificación de los fallos de tratamiento para verificar el aumento de resistencias. Algunos tipos han sido asociados con disminución de la sensibilidad a cefalosporinas, por lo que el tipado molecular puede ser una herramienta diagnóstica útil para predecir la resistencia a antibióticos

Infectious Diseases in Immigrant Population Related to the Time of Residence in Spain.

The aim of this study was to evaluate the data on the main imported infectious diseases and public health issues arising from the risk of transmission of tropical and common diseases in the immigrant population. During the period of study, 2,426 immigrants were attended in the Tropical Medicine Unit of the Hospital of Poniente. For each patient, a complete screening for common and tropical diseases was performed. The prevalence and main features of intestinal and urinary parasites, microfilarias, Chagas disease, malaria, hepatitis B (HBV) and C (HCV) viruses, extrapulmonary tuberculosis and syphilis was investigated taking into account the length of stay in Spain. Sub-Saharan Africa patients who had lived for <3 years in Spain had a high significantly number of infections produced by hookworms, Ascaris lumbricoides, Trichuris trichiura, Schistosoma mansoni, Giardia lamblia, Entamoeba histolytica/dispar and Plasmodium spp. In patients who had lived for more than 3 years, there were significantly high rates of HBV infections, although HBV rates in sub-Saharan African patients are high even if the patients have been in Spain for <3 years. However, patients with large stays in Spain had also an important number of parasitological diseases. The main objective of the diagnosis is to avoid important public health problems and further complications in patients. It is advisable to carry out a screening of the main transmissible infections in all immigrant population regardless of the time outside their country. This screening should be individualized according to the geographical area of origin.

Antimicrobial susceptibility and typing of Neisseria gonorrhoeae strains from Southern Spain, 2012-2014.

BACKGROUND: Gonorrhoea remains an important health problem worldwide. The latest European guidelines have recommended the introduction of dual antimicrobial therapy due to the increase in its resistance to antimicrobial agents. METHODS: In the present study, the susceptibility to some antibiotics was evaluated, and the typing of Neisseria gonorrhoeae strains was also performed. All Neisseria gonorrhoeae (NG) strains isolated from January 2012 to October 2014 were included in this work. Gonococcal isolates were tested for susceptibility according to the recommendations of both the Clinical and Laboratory Standards Institute (CLSI) and the European Committee on Antimicrobial Susceptibility Testing (EUCAST). A total of 65 isolates were typed by the NG multi-antigen sequence types (NG-MAST) technique. RESULTS: The most frequent types found were ST 1407, ST 5405, ST 2992, and ST 5120. If CLSI and EUCAST criteria were applied, an ST 9807 type was found non-susceptible to ceftriaxone and cefixime (MIC 0.5µg/mL). When only EUCAST breakpoints were taken into account, three strains were also resistant to cefixime (MIC 0.25µg/mL) and two isolates were resistant to ceftriaxone (MIC 0.19 and 0.25µg/mL, respectively). The majority of strains were resistant to ciprofloxacin, and all Neisseria gonorrhoeae strains were susceptible to spectinomycin; twenty-five percent of isolates were resistant to azithromycin. CONCLUSIONS: The implementation of antimicrobial surveillance programs at regional level should be part of an overall gonococcal infection control strategy. Efforts should be made to perform antimicrobial susceptibility, a "cured test" in all gonorrhoea cases, and identify treatment failures to verify emerging resistance. Some types have been associated with decreased susceptibility to cephalosporins, making molecular typing a useful tool to predict antimicrobial resistance.

Strongyloidiasis in immigrants in Southern Spain

OBJECTIVE: To analyse clinical and epidemiological characteristics of immigrant patients diagnosed with strongyloidiasis in our area. METHODS: An analyse was performed on patients with strongyloidiasis seen in the Tropical Medicine Unit of the "Hospital de Poniente" in Almeria (Spain), from April 2004 to May 2012. RESULTS: A total of 320 patients were diagnosed with Strongyloides stercoralis infection, and 284 out of 314 patients (90.4%) had a positive specific serology. Forty-two percent of the patients reported symptoms and 45% had eosinophilia. The serological results were monitored in some of the patients, confirming a loss of antibodies in all 20 patients studied. CONCLUSIONS: Strongyloidiasis is a parasitic disease increasingly diagnosed in developed countries due to increased migratory flows from endemic areas. Often being asymptomatic, its diagnosis and treatment may prevent fatal outcomes, especially in immunocompromised patients

OBJETIVO: Analizar las características clínicas y epidemiológicas de los pacientes inmigrantes diagnosticados de strongyloidiasis en nuestra área. MÉTODOS: Se analizaron retrospectivamente los pacientes con strongyloidiasis que acudieron a la Unidad de Medicina Tropical del Hospital de Poniente de Almería (España), entre abril de 2004 mayo de 2012. RESULTADOS: 320 pacientes han sido diagnosticados con infección por S. stercoralis, 284/314 pacientes (90,4%) tenían una serología específica positiva. 42,3% de los pacientes presentaron síntomas y el 45% de los pacientes tenían eosinofilia. La monitorización del tratamiento confirmó la pérdida de anticuerpos en los 20 pacientes estudiados. CONCLUSIONES: La estrongiloidiasis es una parasitosis diagnosticada cada vez con más frecuencia en países desarrollados debido al aumento de los movimientos migratorios procedentes de zonas endémicas. Siendo a menudo asintomática, su diagnóstico y tratamiento pueden prevenir resultados fatales

Strongyloidiasis in immigrants in Southern Spain.

OBJECTIVE: To analyse clinical and epidemiological characteristics of immigrant patients diagnosed with strongyloidiasis in our area. METHODS: An analyse was performed on patients with strongyloidiasis seen in the Tropical Medicine Unit of the "Hospital de Poniente" in Almeria (Spain), from April 2004 to May 2012. RESULTS: A total of 320 patients were diagnosed with Strongyloides stercoralis infection, and 284 out of 314 patients (90.4%) had a positive specific serology. Forty-two percent of the patients reported symptoms and 45% had eosinophilia. The serological results were monitored in some of the patients, confirming a loss of antibodies in all 20 patients studied. CONCLUSIONS: Strongyloidiasis is a parasitic disease increasingly diagnosed in developed countries due to increased migratory flows from endemic areas. Often being asymptomatic, its diagnosis and treatment may prevent fatal outcomes, especially in immunocompromised patients.

Hallazgos radiológicos en pacientes con esquistosomiasis importada / Radiological findings in patients with imported schistosomiasis

Introducción Los estudios de imagen, fundamentalmente la ecografía, son de gran utilidad en el diagnóstico y el seguimiento de los pacientes con esquistosomiasis en zonas endémicas. Métodos Estudio de 219 pacientes subsaharianos atendidos en la Unidad de Medicina Tropical con diagnóstico de esquistosomiasis importada mediante técnicas de imagen que incluyen la radiografía simple de abdomen y la ecografía. Resultados El 17,8% de los pacientes a los que se realizó radiografía de abdomen presentaron hallazgos sugerentes de esquistosomiasis, en la mayoría de los casos calcificaciones vesicales. En 73 pacientes (41%) la ecografía presentó hallazgos patológicos, fundamentalmente engrosamiento parietal difuso o focal (n=26), lesiones nodulares (n=14) y seudopólipos vesicales (n=8). Uno de los pacientes, que presentaba una gran masa vesical de 9cm y ureterohidronefrosis bilateral, fue finalmente diagnosticado de carcinoma escamoso de vejiga. A nivel hepático, 10 pacientes presentaron alteraciones ecográficas, 4 con signos de hipertensión portal, de los cuales 3 presentaban la característica fibrosis periportal de la esquistosomiasis. Conclusión Los estudios de imagen, y en especial la ecografía abdominal y vesical, son de gran utilidad para el diagnóstico, el estudio de la morbilidad y el seguimiento de los pacientes con esquistosomiasis en países no endémicos (AU)

Introduction Imaging techniques, primarily ultrasound, are useful in the diagnosis and monitoring of patients with schistosomiasis in endemic areas. Methods Study of 219 patients treated in sub-Saharan Tropical Medicine Unit with a diagnosis of imported schistosomiasis by imaging techniques investigations including plain abdominal radiography and ultrasound. Results A total of 17.8% of patients who had an abdominal X-ray showed findings suggestive of schistosomiasis, in most cases bladder calcifications. In 73 patients (41%) ultrasound showed pathological findings, mainly diffuse or focal wall thickening (26 patients), nodular lesions (n=14), and pseudopolyps (n=8). One patient, who had a large bladder mass (9cm) and bilateral ureterohydronephrosis, was finally diagnosed with squamous cell carcinoma of the bladder. Ultrasound liver abnormalities were found in 10 patients, 4 with signs of portal hypertension, of which 3 had the characteristic periportal fibrosis in schistosomiasis. Conclusion Imaging studies, especially abdominal and bladder ultrasound, are useful for diagnosis, the study of disease and monitoring of patients with schistosomiasis in non-endemic countries (AU)

[Radiological findings in patients with imported schistosomiasis]. / Hallazgos radiológicos en pacientes con esquistosomiasis importada.

INTRODUCTION: Imaging techniques, primarily ultrasound, are useful in the diagnosis and monitoring of patients with schistosomiasis in endemic areas. METHODS: Study of 219 patients treated in sub-Saharan Tropical Medicine Unit with a diagnosis of imported schistosomiasis by imaging techniques investigations including plain abdominal radiography and ultrasound. RESULTS: A total of 17.8% of patients who had an abdominal X-ray showed findings suggestive of schistosomiasis, in most cases bladder calcifications. In 73 patients (41%) ultrasound showed pathological findings, mainly diffuse or focal wall thickening (26 patients), nodular lesions (n=14), and pseudopolyps (n=8). One patient, who had a large bladder mass (9cm) and bilateral ureterohydronephrosis, was finally diagnosed with squamous cell carcinoma of the bladder. Ultrasound liver abnormalities were found in 10 patients, 4 with signs of portal hypertension, of which 3 had the characteristic periportal fibrosis in schistosomiasis. CONCLUSION: Imaging studies, especially abdominal and bladder ultrasound, are useful for diagnosis, the study of disease and monitoring of patients with schistosomiasis in non-endemic countries.

Dolor abdominal en una paciente de origen magrebí / Magrebian patient with abdominal pain

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