Typing and antimicrobial susceptibility of 134 Neisseria gonorrhoeae strains from Southern Spain / Tipado y sensibilidad a antimicrobianos de 134 cepas de Neisseria gonorrhoeae en el sur de España

Introduction: Last guidelines have recommended the introduction of dual antimicrobial therapy in order to avoid treatment failure. In the present report, the susceptibility to some antibiotics was evaluated, and the typing of Neisseria gonorrhoeae strains was performed. Material and methods: Gonococcal isolates were tested for susceptibility according to the recommendations of both CLSI and EUCAST. A total of 134 isolates were typed by the NG-MAST technique. Results: Seventy-two different N. gonorrhoeae types were found, and the most frequent types obtained were ST 1407, ST 14958, ST 7192, ST 13251 and ST 5405. If CLSI/EUCAST criteria were applied, a ST 9807 type was found nonsusceptible to ceftriaxone and cefixime (MIC 0.5 mg/L), and a ST 12800 type was found nonsusceptible only to cefixime (MIC 0.25 mg/L). When only EUCAST breakpoints were taken into account, three strains were also resistant to cefixime (MIC 0.25 mg/L) and three isolates were resistant to ceftriaxone (MIC 0.19, 0.16 and 0.25 mg/L, respectively). The majority of strains were resistant to ciprofloxacin (68.6%), and all N. gonorrhoeae strains were susceptible to spectinomycin; 9.7% of isolates were resistant to azithromycin. Conclusions: Molecular typing may be a useful tool to predict antimicrobial resistance. High rates of resistance to penicillin, tetracycline and ciprofloxacin were found in this area. It is highly recommended to carry out antimicrobial susceptibility in all gonorrhoea cases and to identify treatment failures to verify emerging resistance

Introducción: Las últimas guías recomiendan la introducción de tratamiento antimicrobiano doble para evitar fallos de tratamiento. En esta publicación, se evaluó la sensibilidad a algunos antibióticos, y se realizó el tipado de las cepas de Neisseria gonorrhoeae. Material y métodos: La determinación de sensibilidad fue realizada según las recomendaciones tanto del CLSI como del (EUCAST). Un total de 134 cepas fueron tipadas mediante la técnica de NG-MAST. Resultados: Se encontraron 72 tipos diferentes de N. gonorrhoeae, siendo los más frecuentes el ST 1407, 14958, 7192, 13251 y 5405. Aplicando los criterios del CLSI/EUCAST, un tipo ST 9807 fue no sensible a ceftriaxona y cefixima (CMI 0,5 mg/L), y un tipo ST 12800 fue no sensible solo a cefixima (CMI 0,25 mg/L). Al aplicar solamente los puntos de corte de EUCAST, tres cepas fueron también resistentes a cefixima (CMI 0,25 mg/L) y tres lo fueron también a ceftriaxona (CMI 0,19, 0,16 y 0,25 mg/L, respectivamente). La mayoría de cepas fueron resistentes a ciprofloxacino (68,6%), y todas las cepas de N. gonorrhoeae fueron sensibles a espectinomicina; el 9,7% de aislamientos fueron resistentes a azitromicina. Conclusiones: El tipado molecular puede ser una herramienta útil para predecir resistencia a antimicrobianos. En esta área se encontraron altas tasas de resistencia a penicilina, tetraciclina y ciprofloxacino. Se recomienda encarecidamente realizar estudio de sensibilidad a antibióticos en todos los casos de gonorrea e identificar fallos de tratamiento para verificar la aparición de resistencias

Impact of using artemisinin-based combination therapy (ACT) in the treatment of uncomplicated malaria from Plasmodium falciparum in a non-endemic zone.

BACKGROUND: Artemisinin-based combination therapy (ACT) has been adopted by the World Health Organization as a first-line treatment for uncomplicated Plasmodium falciparum malaria. In endemic regions, it has proven more effective in treating the disease, and even in reducing its transmission. Nonetheless, there is a scarcity of studies carried out in non-endemic areas on imported uncomplicated malaria. METHODS: This is a retrospective, observational study performed on patients diagnosed and admitted with uncomplicated P. falciparum malaria between 2004 and 2015. The objective was to compare the parasite clearance period and the average hospital length of stay for patients treated with ACT vs those receiving other treatment regimens. RESULTS: Eighty-five patients were included in the study. Fifty-one received ACT treatment (dihydroartemisinin-piperaquine) and thirty-four patients were treated with quinine sulfate+doxycycline or atovaquone/proguanil. The parasite clearance period was shorter in the group of patients treated with ACT compared to those receiving other treatment types: 24 h (IQR 24) vs 48 h (IQR 48), p < 0.01. The average hospital stay was also shorter in the ACT group with respect to the second group: 2.67 days (IQR 1.08) vs 3.96 days (IQR 2.87), p < 0.001. A mild case of hepatitis was registered in the group treated with ACT. CONCLUSIONS: ACT treatment of admitted hospital patients with imported uncomplicated malaria from P. falciparum reduced the days spent hospitalized as well as producing a more rapid parasite clearance compared to classic treatment. In spite of being treated with safe medications, one has to be alert to possible adverse effects such as hepatitis and delayed haemolytic anaemia.

Tuberculosis e inmigración / Tuberculosis and immigration

La incidencia de tuberculosis va descendiendo a nivel mundial. Sin embargo, en los países occidentales este descenso es más lento debido al impacto de la inmigración. La tuberculosis en la población inmigrante se relaciona con el estatus de salud en el país de origen y con las condiciones de hacinamiento y pobreza en el país de acogida. Los inmigrantes con tuberculosis son más jóvenes, tienen mayor prevalencia de formas extrapulmonares, mayor proporción de casos de resistencia y tasas de abandono de tratamiento superiores a los autóctonos. Las nuevas técnicas moleculares, además de reducir el tiempo de demora diagnóstica, permiten la identificación rápida de resistencias y mejoran el conocimiento de los patrones de transmisión. Es necesario implementar medidas que mejoren la cumplimentación del tratamiento de este grupo de población como el uso de pautas fijas de tratamiento, el empleo de mediadores y agentes comunitarios de salud, facilitar el acceso a la tarjeta sanitaria y la gratuidad de los fármacos

The incidence of tuberculosis worldwide is declining. However, in Western countries this decline is slower due to the impact of immigration. Tuberculosis in the immigrant population is related to health status in the country of origin and with overcrowding and poverty conditions in the host country. Immigrants with tuberculosis are younger, have a higher prevalence of extrapulmonary forms, greater proportion of drug resistance and higher treatment default rates than those of natives. New molecular techniques not only reduce diagnostic delay time but also allow the rapid identification of resistances and improve knowledge of transmission patterns. It is necessary to implement measures to improve treatment compliance in this population group like facilitating access to health card, the use of fixed-dose combination drugs, the participation of cultural mediators and community health workers and gratuity of drugs

[Tuberculosis and immigration]. / Tuberculosis e inmigración.

The incidence of tuberculosis worldwide is declining. However, in Western countries this decline is slower due to the impact of immigration. Tuberculosis in the immigrant population is related to health status in the country of origin and with overcrowding and poverty conditions in the host country. Immigrants with tuberculosis are younger, have a higher prevalence of extrapulmonary forms, greater proportion of drug resistance and higher treatment default rates than those of natives. New molecular techniques not only reduce diagnostic delay time but also allow the rapid identification of resistances and improve knowledge of transmission patterns. It is necessary to implement measures to improve treatment compliance in this population group like facilitating access to health card, the use of fixed-dose combination drugs, the participation of cultural mediators and community health workers and gratuity of drugs.

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

Estudio de hepatitis B oculta en población inmigrante africana sin datos de hepatopatía / Study of hidden hepatitis B in African immigrant people without data of liver disease

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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.

Esquistosomiasis urinaria / Urinary schistosomiasis

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Uncinariasis importada en Almería / Imported Hookworm infection in Almeria

Objetivos: Estudio de las características clínicas y epidemiológicas de los pacientes inmigrantes diagnosticados de uncinariasis en la Unidad de Medicina Tropical del Hospital de Poniente (El Ejido, Almería).Material y métodos Estudio observacional retrospectivo de todos los pacientes inmigrantes diagnosticados de uncinariasis mediante visualización directa de los huevos en heces desde octubre de 2004 hasta diciembre de 2012.ResultadosDe 1.872 pacientes estudiados, 253 (13,5%) fueron diagnosticados de uncinariasis. En los pacientes con uncinariasis como única helmintiasis, el 8,3% presentó anemia ferropénica, el 65,7% no presentaba eosinofilia, y de estos, el 25,9% tampoco presentaba dolor abdominal. Conclusiones La uncinariasis es una parasitación frecuente en población inmigrante subsahariana. Muchos pacientes se encuentran asintomáticos, por lo que la aplicación del estudio protocolizado en población procedente de zonas endémicas permitiría diagnosticar y tratar un mayor número de pacientes con esta enfermedad (AU)

Objectives: To study the clinical and epidemiological characteristics of immigrant patients diagnosed with a hookworm infection in the Tropical Medicine Unit of the Hospital de Poniente in El Ejido (Almería, Spain).Material and methods: A retrospective observational study of all immigrant patients diagnosed with hookworm, by direct visualization of eggs in stool samples, from October 2004 until December 2012.Results: Of the 1872 patients studied, 253 (13.5%) were diagnosed with a hookworm infection. In patients where hookworm was the only helminthiasis diagnosed, 8.3% had iron deficiency anaemia, 65.7% did not have eosinophilia, and of these, 25.9% had no abdominal pain. Conclusions: Hookworm is a frequent parasite infestation in the Sub-Saharan immigrant population. Many patients are asymptomatic; thus the implementation of a study protocol for immigrants from endemic areas could diagnose and treat more patients with this disease (AU)

[Imported hookworm infection in Almeria]. / Uncinariasis importada en Almería.

OBJECTIVES: To study the clinical and epidemiological characteristics of immigrant patients diagnosed with a hookworm infection in the Tropical Medicine Unit of the Hospital de Poniente in El Ejido (Almería, Spain). MATERIAL AND METHODS: A retrospective observational study of all immigrant patients diagnosed with hookworm, by direct visualization of eggs in stool samples, from October 2004 until December 2012. RESULTS: Of the 1872patients studied, 253 (13.5%) were diagnosed with a hookworm infection. In patients where hookworm was the only helminthiasis diagnosed, 8.3% had iron deficiency anaemia, 65.7% did not have eosinophilia, and of these, 25.9% had no abdominal pain. CONCLUSIONS: Hookworm is a frequent parasite infestation in the Sub-Saharan immigrant population. Many patients are asymptomatic; thus the implementation of a study protocol for immigrants from endemic areas could diagnose and treat more patients with this disease.

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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