ABSTRACT
IntroductionEnterovirus A71 (EV-A71) is an emerging pathogen that causes a wide range of disorders including severe neurological manifestations. In the past 20 years, this virus has been associated with large outbreaks of hand, foot and mouth disease with neurological complications in the Asia-Pacific region, while in Europe mainly sporadic cases have been reported. In spring 2016, however, an EV-A71 outbreak associated with severe neurological cases was reported in Catalonia and spread further to other Spanish regions.AimOur objective was to investigate the epidemiology and clinical characteristics of the outbreak.MethodsWe carried out a retrospective study which included 233 EV-A71-positive samples collected during 2016 from hospitalised patients. We analysed the clinical manifestations associated with EV-A71 infections and performed phylogenetic analyses of the 3'-VP1 and 3Dpol regions from all Spanish strains and a set of EV-A71 from other countries.ResultsMost EV-A71 infections were reported in children (mean age: 2.6 years) and the highest incidence was between May and July 2016 (83%). Most isolates (218/233) were classified as subgenogroup C1 and 217 of them were grouped in one cluster phylogenetically related to a new recombinant variant strain associated with severe neurological diseases in Germany and France in 2015 and 2016. Moreover, we found a clear association of EV-A71-C1 infection with severe neurological disorders, brainstem encephalitis being the most commonly reported.ConclusionAn emerging recombinant variant of EV-A71-C1 was responsible for the large outbreak in 2016 in Spain that was associated with many severe neurological cases.
Subject(s)
Disease Outbreaks/statistics & numerical data , Enterovirus A, Human/genetics , Enterovirus A, Human/isolation & purification , Enterovirus Infections/epidemiology , Nervous System Diseases/diagnosis , Nervous System Diseases/virology , RNA, Viral/genetics , Respiratory Tract Infections/virology , Antigens, Viral , Child, Preschool , Enterovirus A, Human/classification , Enterovirus Infections/diagnosis , Enterovirus Infections/virology , Hospitalization , Humans , Infant , Molecular Epidemiology , Nervous System Diseases/cerebrospinal fluid , Nervous System Diseases/epidemiology , Phylogeny , Phylogeography , RNA, Viral/isolation & purification , Respiratory Tract Infections/epidemiology , Retrospective Studies , Reverse Transcriptase Polymerase Chain Reaction , Sequence Analysis, DNA , Sequence Analysis, RNA , Spain/epidemiologyABSTRACT
BACKGROUND: The aims of this study were to evaluate the prevalence of HIV and its associated demographic and clinical factors among psychiatric inpatients of a general hospital. METHODS: This was a single-center, observational, cross-sectional study that included patients consecutively admitted to our unit aged 16 years or older and with no relevant cognitive problems. The patients were evaluated using a semistructured interview and an appropriate test for HIV infection. RESULTS: Of the 637 patients who were screened, 546 (86%) who consented to participate were included in the analyses. Twenty-five (4.6%, 95% confidence interval [CI] 3.0-6.8) patients were HIV-positive. The prevalence was higher among patients with substance misuse (17.4%, 95% CI 9.7-28.8). All except one of the 25 patients knew of their seropositive condition prior to participation in the study. Only 14 (56%) of the 25 seropositive patients had previously received pharmacological treatment for their infection. According to the multiple logistic regression analysis, the likelihood of HIV infection was lower in patients with higher levels of education and higher among patients who were single, had history of intravenous drug use, and had an HIV-positive partner, particularly if they did not use condoms. Among the patients with HIV infection, 18 (72%) had a history of suicide attempts compared with 181 (34.7%) of the patients without HIV infection (relative risk 2.1, 95% CI 1.6-2.7; P<0.001). CONCLUSION: HIV infection is highly prevalent in patients admitted to a psychiatric unit, especially those with a diagnosis of substance misuse. Seropositive patients show very poor treatment adherence. The risk of suicide seems to be very high in this population. Implementing interventions to reduce the suicide risk and improve adherence to antiretroviral therapy and psychotropic medications seems crucial.
Subject(s)
Chlamydia trachomatis/isolation & purification , Heterosexuality , Lymphogranuloma Venereum/diagnosis , Sexually Transmitted Diseases, Bacterial/diagnosis , Adult , Anti-Bacterial Agents/therapeutic use , Chlamydia trachomatis/classification , Chlamydia trachomatis/genetics , Doxycycline/therapeutic use , Erythromycin/therapeutic use , Female , Humans , Lymphogranuloma Venereum/drug therapy , Lymphogranuloma Venereum/microbiology , Male , Polymerase Chain Reaction , Pregnancy , Pregnancy Complications, Infectious/diagnosis , Pregnancy Complications, Infectious/drug therapy , Pregnancy Complications, Infectious/microbiology , Sexually Transmitted Diseases, Bacterial/drug therapy , Sexually Transmitted Diseases, Bacterial/microbiology , SpainABSTRACT
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Subject(s)
Adult , Female , Humans , Virus Cultivation , Splenomegaly , Urine , Syndrome , Antibodies, Viral , Cytomegalovirus Infections , Cytomegalovirus , Cytopathogenic Effect, Viral , Hepatomegaly , Immunoglobulin M , Lymphocytosis , Immunoglobulin G , Fever of Unknown Origin , Diagnostic Tests, Routine , Liver Function TestsABSTRACT
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