Increase in gonococcal arthritis in Madrid, Spain, 2022-2023.

In recent years, there has been an increase in Neisseria gonorrhoeae infections in Europe and Spain. Disseminated gonococcal infection is an uncommon clinical presentation that includes gonococcal arthritis. Improved antibiotic treatment has reduced the incidence of gonococcal arthritis. However, the increase in gonococcal infections may have increased the frequency of this clinical entity in recent times. We report five cases of gonococcal arthritis in patients in a tertiary-care hospital in the northern area of Madrid (Spain) from October 2022 to October 2023. Major cases occurred in male patients with unprotected sex and polyarticular symptoms requiring hospital admission and treatment with ceftriaxone and cefixime. The use of molecular techniques has allowed the detection of a greater number of culture-negative cases of gonococcal arthritis, as well as the detection of mutations associated with resistance to fluoroquinolone for switching to oral treatment.

Epidemiology and prevalence of mutations associated with resistance to macrolides and fluoroquinolones in Mycoplasma genitalium in a tertiary hospital from Madrid, Spain / Epidemiología y prevalencia de mutaciones asociadas a la resistencia a macrólidos y fluoroquinolonas en Mycoplasma genitalium en un hospital terciario de Madrid, España

Objectives: Mycoplasma genitalium causes persistent sexually transmitted infections. The aims of this study were to estimate the prevalence of resistances to macrolides and fluoroquinolones in M. genitalium and the sexually transmitted coinfections in patients at Hospital Universitario La Paz (Madrid, Spain). Material and methods: Patients attended between January and October 2021 were studied. Screening for sexually transmitted pathogens and detection of 23S rRNA and parC genes mutations were performed by real-time PCR (Allplex,SeegeneTM). Results: A total of 1,518 females and 1,136 males were studied. The prevalence of M. genitalium was 2.1%. The macrolides resistance rate was 51.8%. The mutations found were A2059G, A2058T and A2058G. The rate of resistance to fluoroquinolones was 17.8% being the G248T mutation (S83I) the most frequent. Seven males had some sexual transmitted coinfection. Conclusions: Although the percentage of M. genitalium infections is low, the high rate of resistance to macrolides makes it necessary to revise the protocols for diagnosis and empirical treatment of sexually transmitted infections. The use of fluoroquinolones is appropriate after screening of macrolide resistance profile. (AU)

Objetivos: Mycoplasma genitalium causa infecciones de transmisión sexual persistentes. Los objetivos de este trabajo fueron estimar la prevalencia de resistencias a macrólidos y fluoroquinolonas en M. genitalium así como las coinfecciones de transmisión sexual en pacientes del Hospital Universitario La Paz (Madrid, España). Material y métodos: Se estudiaron pacientes atendidos entre enero y octubre de 2021. El cribado de patógenos de transmisión sexual y la detección de mutaciones de los genes ARNr 23S y parC se realizaron por PCR en tiempo real (Allplex, SeegeneTM). Resultados: Se estudiaron 1.518 mujeres y 1.136 hombres. La prevalencia de M. genitalium fue del 2,1%. La tasa de resistencia a macrólidos fue del 51.8%. Las mutaciones encontradas fueron A2059G, A2058T y A2058G. La tasa de resistencias a fluoroquinolonas fue del 17.8% siendo la mutación G248T (S83I) la más frecuente. Siete hombres presentaron alguna coinfección de transmisión sexual. Conclusiones: Aunque el porcentaje de infecciones por M. genitalium es bajo, la elevada tasa de resistencias frente a macrólidos hace necesario modificar los protocolos de diagnóstico y tratamiento empírico de las infecciones de transmisión sexual. El uso de fluoroquinolonas es adecuado tras testar previamente el perfil de resistencia a macrólidos. (AU)

Sexually transmitted infections and clinical features in monkeypox (mpox) patients in Madrid, Spain.

Since the beginning of the monkeypox (mpox) virus outbreak in May 2022, there has been an increase in the number of cases worldwide in the setting of sexual transmission. We have tested by real-time PCR 187 mpox patients, of which 157 patients were screened for sexually transmitted infections (STI) in 245 samples. Thirty-six pathogens were detected in 30 patients: herpes simplex virus (HSV-I/II, 12/36, 33.3%), Neisseria gonorrhoeae (NG, 9/36, 25%), Chlamydia trachomatis (CT, 5/36, 13.8%), Chlamydia trachomatis-lymphogranuloma venereum (CT-LGV, 3/36, 8.3%), Treponema pallidum (TP, 4/36, 11.1%) and Mycoplasma genitalium (MG, 3/36, 8.3%). Screening of STI is recommended in mpox patients for the differential diagnosis of the main infections of sexual tract especially in patients with rectal involvement.

Neurorretinitis por Bartonella henselae en Gipuzkoa, 2014-2019 / Neuroretinitis caused by Bartonella henselae in Gipuzkoa, 2014-2019

Introducción: Bartonella henselae causa la enfermedad por arañazo de gato (EAG), transmitida por arañazo o mordedura de gato, su principal reservorio. En ocasiones produce neuritis óptica o neurorretinitis.Objetivo: Revisar estas dolencias en Gipuzkoa (España), 2014-2019. Métodos: Revisión retrospectiva de registros serológicos y clínicos, seleccionando aquellos con manifestaciones clínicas compatibles, contacto con gatos y serología positiva para B. henselae (IFI-IgG≥1/256). Resultados: Sesenta y cuatro pacientes presentaron EAG; entre estos, uno tenía neuritis óptica y 3, neurorretinitis (4/64, 6,3%). En 3 casos un cuadro pseudogripal precedió a los síntomas oculares; 2 presentaron pérdida de agudeza visual al alta, a pesar del tratamiento prolongado con antibióticos y corticoides. Conclusión: La neuritis óptica y la neurorretinitis por B. henselae son complicaciones graves que presentan una incidencia no despreciable entre los pacientes con EAG de Gipuzkoa. Recomendamos descartar la EAG en pacientes con síntomas de neuritis óptica o neurorretinitis (pérdida brusca de visión, etc.) y contacto con gatos.(AU)

Introduction: Bartonella henselae causes cat scratch disease (CSD), spread by a cat scratch or bite. Cats are its main reservoir. This sometimes results in optic neuritis or neuroretinitis. Objective: To review these conditions in Gipuzkoa (Spain), 2014-2019. Methods: A retrospective review of serology and clinical records, selecting those with consistent clinical signs, contact with cats and positive serology for B. henselae (IgG-IFA≥1/256). Results: Sixty-four patients had CSD. Of these, one had optic neuritis and 3 had neuroretinitis (4/64; 6.3%). In 3 patients, flu-like symptoms preceded eye symptoms. Two suffered from loss of visual acuity at discharge, despite prolonged treatment with antibiotics and corticosteroids. Conclusion: Optic neuritis and neuroretinitis caused by B. henselae are severe complications with a non-negligible incidence among patients with CSD in Gipuzkoa. We recommend ruling out CSD in patients with symptoms of optic neuritis or neuroretinitis (sudden vision loss, etc.) and contact with cats.(AU)

Neuroretinitis caused by Bartonella henselae in Gipuzkoa, 2014-2019.

INTRODUCTION: Bartonella henselae causes cat scratch disease (CSD), spread by a cat scratch or bite. Cats are its main reservoir. This sometimes results in optic neuritis or neuroretinitis. OBJECTIVE: To review these conditions in Gipuzkoa (Spain), 2014-2019. METHODS: A retrospective review of serology registries and clinical registries, selecting those with consistent clinical signs, contact with cats and positive serology for B. henselae (IgG-IFA ≥1/256). RESULTS: Sixty-four patients had CSD. Of these, one had optic neuritis and 3 had neuroretinitis (4/64; 6.3%). In 3 patients, flu-like symptoms preceded eye symptoms. Two suffered from loss of visual acuity at discharge, despite prolonged treatment with antibiotics and corticosteroids. CONCLUSION: Optic neuritis and neuroretinitis caused by B. henselae are severe complications with a non-negligible incidence among patients with CSD in Gipuzkoa. We recommend ruling out CSD in patients with symptoms of optic neuritis or neuroretinitis (sudden vision loss, etc.) and contact with cats.

Neuroretinitis caused by Bartonella henselae in Gipuzkoa, 2014-2019. / Neurorretinitis por Bartonella henselae en Gipuzkoa, 2014-2019.

INTRODUCTION: Bartonella henselae causes cat scratch disease (CSD), spread by a cat scratch or bite. Cats are its main reservoir. This sometimes results in optic neuritis or neuroretinitis. OBJECTIVE: To review these conditions in Gipuzkoa (Spain), 2014-2019. METHODS: A retrospective review of serology and clinical records, selecting those with consistent clinical signs, contact with cats and positive serology for B. henselae (IgG-IFA≥1/256). RESULTS: Sixty-four patients had CSD. Of these, one had optic neuritis and 3 had neuroretinitis (4/64; 6.3%). In 3 patients, flu-like symptoms preceded eye symptoms. Two suffered from loss of visual acuity at discharge, despite prolonged treatment with antibiotics and corticosteroids. CONCLUSION: Optic neuritis and neuroretinitis caused by B. henselae are severe complications with a non-negligible incidence among patients with CSD in Gipuzkoa. We recommend ruling out CSD in patients with symptoms of optic neuritis or neuroretinitis (sudden vision loss, etc.) and contact with cats.