Cutaneous infection by Phomopsis longicolla in a renal transplant recipient from Guinea: first report of human infection by this fungus.

We report the case of a 72-year-old female renal transplant recipient with a nodular lesion in the distal phalange of the third left finger produced by a dematiaceous fungus that was identified as Phomopsis longicolla. She was treated with itraconazole and terbinafine and later with voriconazole, without response. The patient underwent a surgical resection with lesion-free edge and continued on voriconazole. One year later she was asymptomatic and had not developed new lesions.

Variability of Bartonella genotypes among small mammals in Spain.

In order to study which Bartonella genotypes are circulating among small mammals in Spain, we analyzed the spleens of 395 animals from three different areas-247 animals from the Basque Country (northern Spain), 121 animals from Catalonia (northeastern Spain), and 27 animals from Madrid (central Spain)-by a triplex PCR combined with a reverse line blot previously described by our group. The prevalence of Bartonella was 26.8% (106/395), and in 4.8% (19/395) of the animals more than one Bartonella genotype was detected. The study of gltA and the intergenic transcribed spacer in the positive samples demonstrated a large diversity, allowing the assignation of them into 22 genotypes. The most prevalent genotypes were 2 and 3, which are closely related to Bartonella taylorii. In addition, nine genotypes were associated with specific mammal species. Genotypes close to the zoonotic Bartonella grahamii, Bartonella elizabethae, and Bartonella rochalimae were also detected. Ten genotypes showed a percentage of similarity with known Bartonella species lower than 96%, suggesting the presence of potential new species. Further studies of the impact of these pathogens on human health and especially in cases of febrile illness in Spain are strongly recommended. Furthermore, our method has been updated with 21 new probes in a final panel of 36, which represents a robust molecular tool for clinical and environmental Bartonella studies.

Diagnóstico y tratamiento de la leishmaniasis visceral infantil / Visceral childhood leishmaniasis: Diagnosis and treatment

Introducción: La leishmaniasis visceral es una enfermedad potencialmente grave y endémica en España. Recientes avances en las técnicas diagnósticas y el tratamiento permiten mejorar el abordaje de la enfermedad. Objetivos: Analizar las características clínicas y epidemiológicas de los pacientes diagnosticados de leishmaniasis visceral, evaluar las técnicas diagnósticas utilizadas y la eficacia y la seguridad de los tratamientos empleados. Métodos: Se revisaron de forma retrospectiva las historias clínicas de los niños diagnosticados de leishmaniasis visceral desde enero de 1994 hasta diciembre de 2007 en un hospital de tercer nivel del área sur de Madrid. Se consideró diagnóstico de enfermedad la existencia de clínica compatible y la visualización del parásito, o el aislamiento en cultivo del aspirado de médula ósea (AMO) o la detección del ADN del parásito mediante técnicas moleculares (reacción en cadena de la polimerasa). Resultados: En el periodo de tiempo estudiado se diagnosticó de leishmaniasis visceral a 11 pacientes. La mediana de edad fue de 21 meses (rango: 4 meses–13 años). La fiebre estaba presente en todos los casos, y la hepatomegalia y esplenomegalia en el 91%. La anemia fue el hallazgo hematológico más frecuente (100%). El AMO se realizó en todos los pacientes. El examen microscópico del AMO detectó la presencia de amastigotes intracelulares en el 73% de los casos. Se detectó la presencia de ADN del parásito en todos los casos. Los títulos de inmunofluorescencia indirecta fueron superiores a 1/40 en el momento del diagnóstico en el 63%. La determinación del antígeno del parásito en la orina fue positiva en 4 de 6 pacientes (67%). Se trató a 3 pacientes con antimoniato de N-metil-glucamina y a 8 pacientes (73%) con anfotericina B liposómica. Se observó una respuesta clínica precoz en todos los pacientes. Un paciente tratado con anfotericina B liposómica presentó una recaída de la enfermedad. No se registraron reacciones adversas graves al tratamiento. Conclusiones: La leishmaniasis visceral sigue siendo una enfermedad frecuente en nuestro medio. Las características clínicas y analíticas al diagnóstico son similares a las observadas en otros estudios del área mediterránea. La técnica de reacción en cadena de la polimerasa en el AMO mostró una sensibilidad mayor que las técnicas tradicionales. Las técnicas no invasivas pueden ser de utilidad en pacientes con cuadro clínico compatible. La anfotericina B liposómica en pauta corta se mostró segura y eficaz en el tratamiento de la leishmaniasis visceral (AU)

Introduction: Visceral leishmaniasis is endemic in Spain. New diagnostic tools and shorter regimens of treatment are been increasingly being used in children. Objectives: To analyze the clinical and epidemiological characteristics of cases of visceral leishmaniasis, to evaluate the diagnostic techniques tested and the safety and efficacy of treatments used. Methods: We retrospectively reviewed the medical records of children diagnosed with visceral leishmaniasis between January 1994 and December 2007 in a tertiary public Hospital in the South of Madrid. The diagnosis of visceral leishmaniasis was based on visualization of Leishmania sp. in bone marrow aspirate or culture or positive PCR analysis of the bone marrow aspirate. Results: Eleven immunocompetent children were identified. Median age was 21 months (range: 4 months – 13 years). Fever was present in all cases, and hepatomegaly and splenomegaly in 10 (91%). Anemia was the most frequent haematological finding (100%). A bone marrow aspirate was obtained in all cases. Leishmania amastigotes were observed in 8 (73%) cases. Leishmania DNA in the bone marrow aspirate was detected in all patients who underwent this procedure. Positive immunofluorescent-antibody test (IFAT) analysis at baseline was observed in 63% of cases tested. The threshold titer for positivity was 1/40. Urinary antigen detection test was positive in 4 out of 6 (67%) children in whom I was performed. Initial treatment consisted of meglumine antimoniate in 3 patients and liposomal amphotericin B (LAB) in 8 (73%) patients. All children had an early clinical response. Only one child treated with LAB relapsed. No severe adverse events were observed with treatment. Conclusions: Visceral leishmaniasis is still a common disease in our area. Clinical and laboratory findings of visceral leishmaniasis are similar to other Mediterranean area reports. PCR analysis of the bone marrow aspirate was more sensitive than traditional diagnostic techniques. Non-invasive diagnostic techniques may be used as an aid in the diagnosis of visceral leishmaniasis in children. Short course treatment of visceral leishmaniasis with liposomal amphotericin B has been safe and effective (AU)

[Visceral childhood leishmaniasis: diagnosis and treatment]. / Diagnóstico y tratamiento de la leishmaniasis visceral infantil.

INTRODUCTION: Visceral leishmaniasis is endemic in Spain. New diagnostic tools and shorter regimens of treatment are been increasingly being used in children. OBJECTIVES: To analyze the clinical and epidemiological characteristics of cases of visceral leishmaniasis, to evaluate the diagnostic techniques tested and the safety and efficacy of treatments used. METHODS: We retrospectively reviewed the medical records of children diagnosed with visceral leishmaniasis between January 1994 and December 2007 in a tertiary public Hospital in the South of Madrid. The diagnosis of visceral leishmaniasis was based on visualization of Leishmania sp. in bone marrow aspirate or culture or positive PCR analysis of the bone marrow aspirate. RESULTS: Eleven immunocompetent children were identified. Median age was 21 months (range: 4 months - 13 years). Fever was present in all cases, and hepatomegaly and splenomegaly in 10 (91%). Anemia was the most frequent haematological finding (100%). A bone marrow aspirate was obtained in all cases. Leishmania amastigotes were observed in 8 (73%) cases. Leishmania DNA in the bone marrow aspirate was detected in all patients who underwent this procedure. Positive immunofluorescent-antibody test (IFAT) analysis at baseline was observed in 63% of cases tested. The threshold titer for positivity was 1/40. Urinary antigen detection test was positive in 4 out of 6 (67%) children in whom I was performed. Initial treatment consisted of meglumine antimoniate in 3 patients and liposomal amphotericin B (LAB) in 8 (73%) patients. All children had an early clinical response. Only one child treated with LAB relapsed. No severe adverse events were observed with treatment. CONCLUSIONS: Visceral leishmaniasis is still a common disease in our area. Clinical and laboratory findings of visceral leishmaniasis are similar to other Mediterranean area reports. PCR analysis of the bone marrow aspirate was more sensitive than traditional diagnostic techniques. Non-invasive diagnostic techniques may be used as an aid in the diagnosis of visceral leishmaniasis in children. Short course treatment of visceral leishmaniasis with liposomal amphotericin B has been safe and effective.

Revisión de los casos de paludismo de los últimos 12 años en el Hospital Universitario de Getafe / Malaria in the South of Madrid: A clinical and epidemiological review

Introducción: La incidencia del paludismo está creciendo en España y es potencialmente grave en niños. Hay poca información sobre el paludismo infantil en España. El objetivo de este estudio es evaluar las características clínicas y epidemiológicas, así como el tratamiento efectuado en los casos de paludismo en el Hospital Universitario de Getafe. Pacientes y métodos: Estudio descriptivo y retrospectivo de los casos diagnosticados en el hospital desde 1995 hasta 2007. Se analizaron datos sobre epidemiología, clínica, métodos diagnósticos y tratamiento en 2 períodos comparativos de 6 años: antes y después de enero de 2001. Resultados: Se confirmaron 18 casos de paludismo, con predominio de mujeres (2:1). El rango de edad osciló entre 13 meses y 13 años, con una mediana de 60 meses. Todos habían realizado un viaje reciente a un país endémico. Se detectó un aumento en la incidencia (p<0,01) a partir del año 2001. La clínica más frecuente fue fiebre y síntomas gastrointestinales, con hepatomegalia o esplenomegalia en el 75%. La trombopenia y la anemia fueron hallazgos frecuentes. Se realizó un examen microscópico (frotis fino) en el 100% de los casos. La identificación de la especie de Plasmodium se obtuvo mediante PCR (polymerase chain reaction ‘reacción en cadena de la polimerasa’) en 16 casos, y se detectó Plasmodium falciparum en un 89% de éstos. Se trataron con sulfato de quinina y clindamicina un 72% de los casos. No hubo ningún caso de malaria complicada o fallecimiento. Conclusiones: La incidencia del paludismo importado está aumentando en el área sur de Madrid, y el agente causal mayoritario es el P. falciparum. La visualización del protozoo en el examen microscópico y la detección de su antígeno en sangre son buenos métodos de diagnóstico, pero es fundamental realizar una PCR al ingreso para conocer la especie de Plasmodium y para identificar posibles parasitaciones mixtas. Dada su potencial gravedad en la infancia, se debe tener un alto índice de sospecha para iniciar de forma precoz un adecuado tratamiento, lo que condiciona un mejor pronóstico (AU)

Introduction: Malaria has increased in Spain, and is potentially severe in children. Information on pediatric malaria in Spain is scarce. The aim is to evaluate the clinical, therapeutic and epidemiological characteristics of children diagnosed with malaria in our hospital. Patients and methods: A retrospective descriptive study was performed on all pediatric cases of malaria diagnosed in Getafe University Hospital, from January 1995 to November 2006. Epidemiological and clinical features, as well as diagnostic methods, treatments and outcome were studied. An analysis of two comparative periods (before and after January 2000) was carried out. Results: Eighteen cases of confirmed malaria were identified, twelve girls and six boys. The age range was from 13 months to 13 years with a median age of 60 months. All patients had recently travelled to or from endemic countries. Despite having a stable number of admissions to hospital over time, all but two patients were diagnosed in the second period (P<0.01).Fever and gastrointestinal symptoms were the most common symptoms, with liver or spleen enlargement in 75%. Thrombocytopenia and anemia were common. No cases of complicated malaria or death occurred. Plasmodium identification by microscopic examination was used in all cases. Identification of Plasmodium species with PCR was carried out in 16 children. P. falciparum was found in 89% of these cases. Quinine-sulphate and clindamycin were used in 72%. Conclusions: The incidence of pediatric malaria is increasing in the southern area of Madrid, with P. falciparum as the most frequently identified species. Microscopic visualization or identification of its antigen are gold-standard diagnostic methods, however, identification with PCR is essential upon admission to determine the species and discard possible multiple infestations. Pediatricians must learn to suspect this potentially severe disease, in order to establish an early treatment that may improve the prognosis (AU)

[Malaria in the South of Madrid: a clinical and epidemiological review]. / Revisión de los casos de paludismo de los últimos 12 años en el Hospital Universitario de Getafe.

INTRODUCTION: Malaria has increased in Spain, and is potentially severe in children. Information on pediatric malaria in Spain is scarce. The aim is to evaluate the clinical, therapeutic and epidemiological characteristics of children diagnosed with malaria in our hospital. PATIENTS AND METHODS: A retrospective descriptive study was performed on all pediatric cases of malaria diagnosed in Getafe University Hospital, from January 1995 to November 2006. Epidemiological and clinical features, as well as diagnostic methods, treatments and outcome were studied. An analysis of two comparative periods (before and after January 2000) was carried out. RESULTS: Eighteen cases of confirmed malaria were identified, twelve girls and six boys. The age range was from 13 months to 13 years with a median age of 60 months. All patients had recently travelled to or from endemic countries. Despite having a stable number of admissions to hospital over time, all but two patients were diagnosed in the second period (P<0.01). Fever and gastrointestinal symptoms were the most common symptoms, with liver or spleen enlargement in 75%. Thrombocytopenia and anemia were common. No cases of complicated malaria or death occurred. Plasmodium identification by microscopic examination was used in all cases. Identification of Plasmodium species with PCR was carried out in 16 children. P. falciparum was found in 89% of these cases. Quinine-sulphate and clindamycin were used in 72%. CONCLUSIONS: The incidence of pediatric malaria is increasing in the southern area of Madrid, with P. falciparum as the most frequently identified species. Microscopic visualization or identification of its antigen are gold-standard diagnostic methods, however, identification with PCR is essential upon admission to determine the species and discard possible multiple infestations. Pediatricians must learn to suspect this potentially severe disease, in order to establish an early treatment that may improve the prognosis.

Tick-borne zoonotic bacteria in wild and domestic small mammals in northern Spain.

The prevalence and diversity of tick-borne zoonotic bacteria (Borrelia spp., Anaplasma phagocytophilum, Coxiella burnetii, and spotted fever group rickettsiae) infecting 253 small mammals captured in the Basque Country (Spain) were assessed using PCR and reverse line blot hybridization. Trapping sites were selected around sheep farms (study 1, 2000 to 2002) and recreational parks (study 2, 2003 to 2005). The majority of the studied mammals (162) were wood mice (Apodemus sylvaticus), but six other different species were also analyzed: yellow-necked mice (Apodemus flavicollis), shrews (Crocidura russula and Sorex coronatus), bank voles (Clethrionomys glareolus), domestic mice (Mus domesticus), and moles (Talpa europaea). The results showed an infection rate ranging from 10.7% to 68.8%, depending on the small mammal species. One C. russula shrew and one A. sylvaticus mouse gave positive reactions for A. phagocytophilum, and C. burnetii was detected in two domestic mice and one A. sylvaticus mouse in a farm. The DNA of Borrelia spp. was detected in 67 animals (26.5%), most of them presenting positive hybridization with the probe for Borrelia sp. strain R57, the new Borrelia species previously detected in small mammals in our region. Furthermore, a second PCR and reverse line blot hybridization specific for B. burgdorferi sensu lato revealed the presence of Borrelia afzelii in 6.3% of C. glareolus voles and 14.3% of S. coronatus shrews. All small mammals were negative for spotted fever group rickettsiae. These results highlight the relevance of small mammals as reservoirs of some zoonotic bacteria.