Prevalence of submicroscopic malaria infection in immigrants living in Spain.

BACKGROUND: The importance of submicroscopic malaria infections in high-transmission areas could contribute to maintain the parasite cycle. Regarding non-endemic areas, its importance remains barely understood because parasitaemia in these afebrile patients is usually below the detection limits for microscopy, hence molecular techniques are often needed for its diagnosis. In addition to this, the lack of standardized protocols for the screening of submicroscopic malaria in immigrants from endemic areas may underestimate the infection with Plasmodium spp. The aim of this study was to assess the prevalence of submicroscopic malaria in afebrile immigrants living in a non-endemic area. METHODS: A prospective, observational, multicentre study was conducted. Afebrile immigrants were included, microscopic observation of Giemsa-stained thin and thick blood smears, and two different molecular techniques detecting Plasmodium spp. were performed. Patients with submicroscopic malaria were defined as patients with negative blood smears and detection of DNA of Plasmodium spp. with one or both molecular techniques. Demographic, clinical, analytical and microbiological features were recorded and univariate analysis by subgroups was carried out with STATA v15. RESULTS: A total of 244 afebrile immigrants were included in the study. Of them, 14 had a submicroscopic malaria infection, yielding a prevalence of 5.7% (95% confidence interval 3.45-9.40). In 71.4% of the positive PCR/negative microscopy cases, Plasmodium falciparum alone was the main detected species (10 out of the 14 patients) and in 4 cases (28.6%) Plasmodium vivax or Plasmodium ovale were detected. One patient had a mixed infection including three different species. CONCLUSIONS: The prevalence of submicroscopic malaria in afebrile immigrants was similar to that previously described in Spain. Plasmodium vivax and P. ovale were detected in almost a third of the submicroscopic infections. Screening protocols for afebrile immigrants with molecular techniques could be useful for a proper management of these patients.

Enfermedades emergentes e importadas diagnosticadas en el servicio de urgencias de un hospital de Madrid / Emerging and imported diseases diagnosed in the emergency department of a hospital in Madrid

Objetivo. Describir las características clínicas y epidemiológicas de los pacientes diagnosticados de malaria, dengue, zika y chikungunya en un servicio de urgencias hospitalario (SUH), así como el valor de diagnóstico de las técnicas de las que se disponen en el SUH. Método. Estudio descriptivo, observacional, en el que se incluyeron pacientes diagnosticados de enfermedades infecciosas tropicales a partir de pruebas solicitadas desde un SUH. Resultados. Se diagnosticaron cuatro casos de dengue, siete casos de zika, tres casos de malaria y dos casos de coinfección (malaria + dengue y malaria + chikungunya). Conclusiones. La mayoría de los pacientes valorados son varones, nativos de zonas endémicas. Aunque se realice un diagnóstico precoz de malaria, es necesario descartar coinfección por distintos arbovirus. Para estudio de virus zika, hay que solicitar una prueba de PCR en orina, además de serología y PCR en suero

Objectives. To describe the clinical and epidemiologic characteristics of patients diagnosed with malaria, dengue fever, and Zika or chikungunya virus infections in a hospital emergency department. To describe the usefulness of the department's diagnostic resources. Methods. Descriptive observational study of patients diagnosed with infectious tropical diseases on the basis of samples collected in the emergency department. Results. The department diagnosed 4 cases of dengue fever, 7 cases of Zika virus infection, 7 of malaria, and 2 concomitant infections (malaria plus dengue fever and malaria plus chikungunya infection). Conclusions. Most patients with these infections were males and natives of areas where the diseases were endemic. Even when malaria is diagnosed early, the possibility of concomitant infection by other arboviruses must be ruled out. Serology is necessary to rule out Zika virus infection; polymerase chain reaction testing of urine and serum should be included

HDP2: a ribosomal DNA (NTS-ETS) sequence as a target for species-specific molecular diagnosis of intestinal taeniasis in humans.

BACKGROUND: Taenia solium, T. asiatica and T. saginata tapeworms cause human taeniasis and are the origin of porcine and bovine cysticercosis. Furthermore, T. solium eggs can cause human cysticercosis, with neurocysticercosis being the most serious form of the disease. These helminth infections are neglected tropical diseases and are endemic in several countries in the Americas, Asia and Africa. As a result of globalization, migration in particular, the infections have been extending to non-endemic territories. Species-specific diagnosis of taeniasis is subject to drawbacks that could be resolved using molecular approaches. In the present study, conventional and real-time amplification protocols (cPCR and qPCR) based on the T. saginata HDP2 sequence were applied in the differential diagnosis of taeniasis (T. saginata, T. solium) in both fecal samples and proglottids expelled by patients. The HDP2 homolog in T. solium was cloned and characterized. RESULTS: Semi-nested cPCR and qPCR (Sn-HDP2 cPCR and Sn-HDP2 qPCR) amplified T. saginata and T. solium DNA, with an analytical sensitivity of 40 and 400 fg, respectively, and identically in both protocols. Eighteen taeniasis patients were diagnosed directly with T. saginata or T. solium, either from proglottids or fecal samples with/without eggs (detected using microscopy), based on the optimized Sn-HDP2 qPCR. After cloning, the T. solium HDP2 homolog sequence was confirmed to be a ribosomal sequence. The HDP2 fragment corresponded to a non-transcribed sequence/external transcribed repeat (NTS/ETS) of ribosomal DNA. Compared with the T. saginata HDP2 homolog, the T solium HDP2 sequence lacked the first 900 nt at the 5' end and showed nucleotide substitutions and small deletions. CONCLUSIONS: Sn-HDP2 cPCR and Sn-HDP2 qPCR were set up for the diagnosis of human taeniasis, using proglottids and fecal samples from affected patients. The new Sn-HDP2 qPCR protocol was the best option, as it directly differentiated T. saginata from T. solium. The diagnosis of an imported T. solium-taeniasis case and nine European T. saginata cases was relevant. Finally, the cloning and sequencing of the T. solium HDP2 fragment confirmed that HDP2 was part of a ribosomal unit.

Evaluación de dos métodos inmunocromatográficos comerciales para el diagnóstico rápido de Giardia duodenalis y Cryptosporidium spp. en muestras de heces / Assessment of two commercially available immunochromatographic assays for a rapid diagnosis of Giardia duodenalis and Cryptosporidium spp. in human fecal specimens

Introducción En este trabajo se evalúan y comparan dos métodos inmunocromatográficos para la detección simultánea de Giardia duodenalis y Cryptosporidium spp. en muestras de heces. Métodos Se han analizado 254 muestras de heces con dos métodos inmunocromatográficos, Crypto-Giardia (CerTest Biotec) y Stick Crypto-Giardia (Operon). Resultados En el diagnóstico de G. duodenalis, la sensibilidad y especificidad fueron del 97 y el 100%, respectivamente, para CerTest; y del 97 y el 95% para Operon. En el diagnóstico de Cryptosporidium spp., la sensibilidad obtenida con el método de CerTest fue del 100%, frente a la sensibilidad del 92% obtenida con Operon. No hubo falsos positivos con ninguna de las dos técnicas. Conclusiones Ambos métodos presentan buenas sensibilidad y especificidad, por lo que son de utilidad para el diagnóstico rápido de G. duodenalis y Cryptosporidium spp. Las ventajas de los métodos inmunocromatográficos son su rapidez y que no necesitan de personas expertas en microscopia ni de equipos especiales (AU)

Introduction: To assess and compare the performance of two immunochromatographic tests for the simultaneous detection of Giardia duodenalis and Cryptosporidium spp. in faeces.Materials and methods: In this study 254 faeces samples were tested using the two immunochromatographystrips Cryto-Giardia (CerTest Biotec) and Stick Crypto-Giardia (Operon). Results: In the diagnosis of G. duodenalis, the sensitivity and specificity of the kits were 97% and 100%, respectively for the CerTest; and 97% and 95% for Operon. In the diagnosis of Cryptosporidium spp. Certeststrip rendering a sensitivity of 100%, compared to with a sensitivity of 92% using Operon. There were nofalse positives using either technique.Conclusions: Both methods yielded good sensitivity and specificity values and are thus useful tools fora rapid diagnosis of G. duodenalis and Cryptosporidium spp. The benefits of immunochromatography methods are that there is no requirement for expert microscopists or special equipment (AU)

[Assessment of two commercially available immunochromatographic assays for a rapid diagnosis of Giardia duodenalis and Cryptosporidium spp. in human fecal specimens]. / Evaluación de dos métodos inmunocromatográficos comerciales para el diagnóstico rápido de Giardia duodenalis y Cryptosporidium spp. en muestras de heces.

INTRODUCTION: To assess and compare the performance of two immunochromatographic tests for the simultaneous detection of Giardia duodenalis and Cryptosporidium spp. in faeces. MATERIALS AND METHODS: In this study 254 faeces samples were tested using the two immunochromatography strips Cryto-Giardia (CerTest Biotec) and Stick Crypto-Giardia (Operon). RESULTS: In the diagnosis of G. duodenalis, the sensitivity and specificity of the kits were 97% and 100%, respectively for the CerTest; and 97% and 95% for Operon. In the diagnosis of Cryptosporidium spp. Certest strip rendering a sensitivity of 100%, compared to with a sensitivity of 92% using Operon. There were no false positives using either technique. CONCLUSIONS: Both methods yielded good sensitivity and specificity values and are thus useful tools for a rapid diagnosis of G. duodenalis and Cryptosporidium spp. The benefits of immunochromatography methods are that there is no requirement for expert microscopists or special equipment.

Tick species and tick-borne infections identified in population from a rural area of Spain.

To determine the tick species that bite humans in the province of Soria (Spain) and ascertain the tick-borne pathogens that threaten people's health in that province, 185 tick specimens were collected from 179 patients who sought medical advice at health-care centres. The ticks were identified, and their DNA examined by PCR for pathogens. Most ticks were collected in autumn and spring (59 and 57 respectively). Nine species of ticks were identified, the most frequent being Dermacentor marginatus (55.7%), Ixodes ricinus (12.4%) and Rhipicephalus bursa (11.9%). Ninety-seven females, 66 males, 21 nymphs and one larva were identified. Twenty-six ticks carried DNA from Rickettsia spp. (11 Rickettsia slovaca, 6 Rickettsia spp. RpA4/DnS14, 1 Rickettsia massiliae/Bar29, and 8 unidentified); two ticks carried DNA from Borrelia burgdorferi sensu lato and seven ticks harboured DNA from Anaplasma phagocytophilum.

Brote de fiebre Q y seroprevalencia en una población rural de la provincia de Soria / Outbreak of Q fever and seroprevalence in a rural town from Soria

Fundamento. El propósito de este estudio es describir un brote de fiebre Q aguda en una población rural de Soria durante la primavera de 1998 y estudiar la prevalencia de anticuerpos IgG frente a Coxiella burnetii en dicha población. Métodos. 1. Brote de fiebre Q: los datos epidemiológicos, clínicos y analíticos se obtuvieron de la historia clínica y por encuesta estandarizada de todos los casos clínicos. Estos se confirmaron por fijación del complemento. 2. Seroprevalencia: 253 sueros fueron seleccionados por muestreo no probabilístico de conveniencia a partir de muestras de sueros extraídas entre el 1 septiembre de 1996 y el 28 de febrero de 1999. Se consideraron positivos aquellos que por inmunofluorescencia indirecta tenían títulos de anticuerpos IgG frente a C. burnetii fase II iguales o superiores a 1/ 80.Resultados. 1. Se confirmaron 14 casos de fiebre Q con una media de edad de 21,5 ñ3,1 años. El 64 por ciento de los pacientes presentaron neumonía y el 36 por ciento una clínica inespecífica. No se encontraron antecedentes de contacto directo con animales, pero en los alrededores del pueblo había 4 rebaños con un total de 2.614 ovejas. 2. La seroprevalencia fue del 60 por ciento (intervalo de confianza del 95 por ciento: 54÷66). La seroprevalencia no se incrementó a raíz del brote descrito en este estudio (p > 0,05).Conclusión. La alta seroprevalencia de anticuerpos frente a C. burnetii en esta población indica que esta área es hiperendémica para dicha infección y al no haberse declarado ningún caso de infección en los años anteriores parece indicar que o bien cursa de forma asintomática o los signos clínicos son extremadamente leves. Probablemente los rebaños de ovejas fueron el foco de infección y la vía aérea el mecanismo de transmisión (AU)