Persistence and infectivity of Zika virus in semen after returning from endemic areas: Report of 5 cases.

BACKGROUND: There are limited data about the persistence and infectivity of Zika virus in semen of symptomatic travelers returning from endemic areas and even less data in asymptomatic cases. OBJECTIVE: We investigated the persistence and infectivity of ZIKA virus in semen in five patients with Zika virus infection returning to Spain from endemic areas. STUDY DESIGN: We evaluated the epidemiological, clinical and virological characteristic of the five patients. In semen we detected ZIKA virus by PCR, partial sequencing and cell culture. We also performed phylogenetic analysis. RESULTS: We detected Zika virus RNA (Asian lineage) by PCR in semen samples from day 14th to day 96th since the day of illness onset. Semen viral culture was positive for Zika virus in two patients at days of illness 30 and 69 by virus propagation. Phylogenetic analysis strongly suggested male to female sexual transmission in a couple returning from Maldives. CONCLUSION: This case series confirms that Zika virus RNA can be detected in semen up to three months after infection. Viral culture of semen samples shows prolonged infectivity that can lead to sexual transmission of Zika virus.

Prevalence and distribution of hepatitis C virus genotypes in Spain during the 2000-2015 period (the GEHEP 005 study).

We report the largest study on the prevalence and distribution of HCV genotypes in Spain (2000-2015), and we relate them with clinical, epidemiological and virological factors. Patients from 29 hospitals in 10 autonomous communities (Andalusia, Aragon, Castilla-Leon, Catalonia, Galicia, Canary Islands, Madrid Community, Valencian Community, Murcia Region and Basque Country) have been studied. Annual distribution of HCV genotypes and subtypes, as well as gender, age, transmission route, HIV and/or HBV coinfection, and treatment details were recorded. We included 48595 chronically HCV-infected patients with the following characteristics: median age 51 years (IQR, 44-58), 67.9% male, 19.1% HIV-coinfected, 23.5% HBV-coinfected. Parenteral transmission route was the most frequent (58.7%). Genotype distribution was 66.9% GT1 (24.9% subtype 1a and 37.9% subtype 1b), 2.8% GT2, 17.3% GT3, 11.4% GT4 and 0.1% GT5 and 0.02% GT6. LiPA was the most widely HCV genotyping test used (52.4%). HCV subtype 1a and genotypes 3 and 4 were closely associated with male gender, parenteral route of infection and HIV and HBV coinfection; in contrast, subtype 1b and genotype 2 were associated with female gender, nonparenteral route and mono-infection. Age was related to genotype distribution, and different patterns of distribution and biodiversity index were observed between different geographical areas. Finally, we describe how treatment and changes in transmission routes may have affected HCV genotype prevalence and distribution patterns. We present the most recent data on molecular epidemiology of hepatitis C virus in Spain. This study confirms that genotype distributions vary with age, sex, HIV and HBV coinfection and within geographical areas and epidemiological groups.

Analysis of transmitted drug resistance in Spain in the years 2007-2010 documents a decline in mutations to the non-nucleoside drug class.

We have studied transmitted drug resistance (TDR) in 1.864 antiretroviral-naïve patients entering CoRIS (Spain) during 2007-2010. An overall 8.58% TDR was observed (3.92%, nucleoside reverse transcriptase inhibitors (NRTIs); 3.86%, non-nucleoside reverse transcriptase inhibitors (NNRTIs); 2.31%, protease inhibitors), with a significant decreasing trend over time for NNRTIs (5.53%, 2007; 2.45%, 2010; p for trend = 0.044). Non-B subtype prevalence was 15.93%, with a significant increase (11.95%, 2007; 18.14%, 2010; p for trend = 0.018), mainly related to immigration. Having no formal education increased the risk of TDR to NNRTIs (OR, 7.26), and carrying a non-B subtype reduced the risk of TDR to NRTIs (OR, 0.27). These findings may have important implications for treatment guidelines and laboratory testing recommendations.

Surveillance of Chagas disease in pregnant women in Madrid, Spain, from 2008 to 2010.

One of the most important modes of transmission of Trypanosoma cruzi infection in areas where it is not endemic is vertical transmission: from mother to child. The objective of this report is to assess the efficacy of different programmes of serological screening to monitor infection with T. cruzi in pregnant Latin American women living in Madrid (Spain). To achieve this, a retrospective study was undertaken from January 2008 to December 2010 in seven hospitals in the Autonomous Community of Madrid. Serological screening programmes were classified in two main strategies: a selective one (pregnant women from Bolivia) and a universal one (pregnant women from Latin America). A total of 3,839 pregnant women were tested and the overall prevalence was 3.96%. The rate of congenital transmission was 2.6%. The current monitoring programmes have variable coverage ranging between 26% (selective screening) and 100% (universal screening). Monitoring of pregnant women from Latin America only reaches full coverage if universal screening of pregnant women is carried out at any moment of pregnancy, including at delivery. A common national regulation is necessary in order to ensure homogenous implementation of screening.

Elevation of viral load by PCR and use of plasma preparation tubes for quantification of human immunodeficiency virus type 1.

HIV-1 viral load testing from 51 patients was compared in plasma samples simultaneously processed and stored in primary Vacutainer plasma preparation tubes (PPTs) and PPT sample aliquots transferred in secondary tubes before freezing, using RT-PCR quantification with an ultrasensitive method (the Roche AMPLICOR HIV-1 MONITOR). We concluded that freezing the primary sample in the PPT collection tube can artificially elevate the HIV-1 viral load. We therefore store samples as frozen aliquots in a second tube.

[False negative diagnosis of HIV-1]. / Falso negativo en el diagnóstico de VIH-1.

We report a case of a false negative diagnosis of HIV-1 infection in an African girl. Two HIV-1 DNA polymerase chain reaction (PCR) tests were negative at the second and fourth months of life. Because anti-HIV antibodies persisted when the patient was 18 months old, the HIV-1 RNA PCR test was performed with a positive result, confirming HIV-1 non-B subtype, recombinant A-G. The prevalence of non-B HIV-1 subtypes are increasing in Spain, which could be related to the phenomenon of immigration. Approximately one-third of HIV-infected foreigners have non-B subtypes and the percentage increases to 70 % of the African population in Spain. In non-B HIV-1 subtypes, false negative results and inconsistencies between viral load and CD4 count are more frequent. These subtypes also show a higher rate of resistance to protease inhibitors, which can have therapeutic implications.

Falso negativo en el diagnóstico de VIH-1 / False negative diagnosis of HIV-1

Se presenta un caso de falso negativo en el diagnóstico de infección por virus de la inmunodeficiencia humana tipo 1 (VIH-1) en una niña de origen africano. Las pruebas de reacción en cadena de la polimerasa (PCR) de ADN proviral realizadas a los 2 y 4 meses de vida fueron negativas. A los 18 meses, por persistencia de los anticuerpos anti-VIH-1, se realizó una PCR de ARN que resultó positiva, confirmándose la infección por VIH-1, subtipo no B, forma recombinante A-G. La prevalencia de los subtipos no B está en aumento en nuestro medio en relación con el fenómeno de la inmigración, ya que un tercio de los extranjeros infectados lo están por subtipos no B y asciende al 70 % de los pacientes africanos. En estos subtipos son más frecuentes los resultados falsos negativos y las discrepancias entre la carga viral y el recuento de linfocitos CD4. Los subtipos no B muestran una mayor tasa de resistencias a los inhibidores de la proteasa, lo que puede tener implicaciones terapéutica

We report a case of a false negative diagnosis of HIV-1 infection in an African girl. Two HIV-1 DNA polymerase chain reaction (PCR) tests were negative at the second and fourth months of life. Because anti-HIV antibodies persisted when the patient was 18 months old, the HIV-1 RNA PCR test was performed with a positive result, confirming HIV-1 non-B subtype, recombinant A-G. The prevalence of non-B HIV-1 subtypes are increasing in Spain, which could be related to the phenomenon of immigration. Approximately one-third of HIV-infected foreigners have non-B subtypes and the percentage increases to 70 % of the African population in Spain. In non-B HIV-1 subtypes, false negative results and inconsistencies between viral load and CD4 count are more frequent. These subtypes also show a higher rate of resistance to protease inhibitors, which can have therapeutic implications

Comparison between sequence analysis and a line probe assay for testing genotypic resistance of human immunodeficiency virus type 1 to antiretroviral drugs.

The purpose of this study was to compare a line probe assay (LiPA) with sequence analysis for the detection of mutations conferring resistance to nucleoside and non-nucleoside inhibitors in human immunodeficiency reverse transcriptase and protease inhibitors. The limitations for interpreting LiPA make it unacceptable for routine clinical practice.

Quantitation of human immunodeficiency virus type 1 RNA loads in cervicovaginal secretions in pregnant women and relationship between viral loads in the genital tract and blood.

The purpose of this study was to analyze the quantitation of the human immunodeficiency virus type 1 RNA (HIV-1 RNA) in the genital tract of HIV-1-infected pregnant women and to evaluate a possible correlation with the viral load in blood plasma (Spearman's rank correlation coefficient). A total of 38 each of cervical, vaginal, and blood samples from 38 women were obtained during the third trimester of pregnancy for quantitation of the HIV-1 RNA load. Viral loads were determined by reverse transcription-polymerase chain reaction. The HIV-1 RNA viral load was detectable in 29 of the 38 (76.3%) blood samples, in 6 of the 38 (15.7%) cervical secretion samples, and in 8 of the 38 (21%) vaginal secretion samples. Overall, the correlation between the HIV-1 RNA viral load in the blood plasma and in cervical secretion samples was 0.51 ( P<0.001). However, the correlation disappeared ( r=0.27) when three patients with high blood plasma viral loads were eliminated from the statistical study. The viral load in the vaginal secretions did not correlate with that in the blood samples ( r=0.26). There were two cases in which HIV-1 RNA was undetectable in the blood and cervix but was detectable in vaginal secretions: one woman had 220 copies/ml and the other 68 copies/ml. These results suggest that pregnant women with undetectable viral loads in blood plasma are still at risk of transmitting the virus vertically during vaginal delivery. Because of this, antiretroviral prophylaxis during vaginal delivery must be administered to HIV-1-infected women and their newborns, regardless of the mother's viral load in plasma. In conclusion, quantification of cervicovaginal levels of HIV-1 may represent a useful tool for assessing the individual risk associated with a vaginal delivery and for guiding decisions about whether a scheduled caesarean should be recommended.

[Toxoplasmosis after antineoplastic therapy in non-Hodgkin lymphoma. Demand of preventive measures]. / Toxoplasmosis después de tratamiento antineoplásico en linfoma no Hodgkin. Demanda de medidas preventivas.

BACKGROUND. Toxoplasmosis is an opportunistic infection reported in several groups of inmunosupressed patients. It is considered uncommon in patients with lymphoproliferative disorders and in bone marrow transplant recipiets (BMT). Nevertheless, recent reviews have reported cases of cerebral and disseminated toxoplasmosis in BMT recipients, particularly among patients with IgG antibodies to Toxoplasma sp. prior to BMT and antineoplastic treatment. PATIENTS AND METHODS. Two cases of toxoplasmosis are reported of patients with non-Hodgkin lymphoma who did not have graft-versus-host-disease and with positive antitoxoplasma serologic response. In the first patient, the predominant clinical picture was febrile neutropenia without source, with good response to specific treatment for toxoplasmosis; in the second patient, and autologous BMT was performed and six months later the patient developed a retino-choroiditis by toxoplasmosis reactivation. CONCLUSIONS. The excessive morbidity and mortality associated with toxoplasmosis reactivations in lymphomyeloproliferative neoplasms with antineoplastic therapy and both allogenic and autologous BMT, demand preventive measures. The pretransplant serologic tests can be helpful in evaluating the potential risk of suffering a reactivation by Toxoplasma sp. and considering the administration of chemoprophylaxis in selected patients with positive serology.

Toxoplasmosis después de tratamiento antineoplásico en linfoma no Hodgkin. Demanda de medidas preventivas / Toxoplasmosis after antineoplastic therapy in non-Hodgkin lymphoma. Demand of preventive measures

Fundamento. La toxoplasmosis es una infección oportunista descrita en diversos grupos de enfermos inmunocomprometidos y se considera inusual en neoplasias linfomieloproliferativas y receptores de trasplante de médula ósea (TMO). Sin embargo, revisiones recientes describen casos de toxoplasmosis cerebral y diseminada en receptores de TMO, sobre todo en enfermos que presentan anticuerpos de tipo IgG frente a Toxoplasma sp. anteriores al TMO y al tratamiento antineoplásico. Pacientes y resultados. Se presentan dos casos de toxoplasmosis en enfermos con linfoma no Hodgkin, que no sufren enfermedad injerto contra huésped y con respuesta serológica positiva antitoxoplasma. En el primero, la clínica predominante fue neutropenia febril sin foco, con buena respuesta al tratamiento específico para toxoplasmosis; en el segundo se le practicó TMO autólogo y 6 meses después desarrolló una retinocoroiditis por reactivación de toxoplasmosis. Conclusiones. La morbilidad y mortalidad excesiva asociada a reactivaciones de toxoplasmosis en neoplasias linfomieloproliferativas con tratamiento antineoplásico y TMO, tanto alogénico como autólogo, demandan medidas preventivas. Las pruebas serológicas pretrasplante pueden ayudar a evaluar el riesgo potencial de sufrir una reactivación por Toxoplasma sp. y considerar la administración de quimioprofilaxis en enfermos seleccionados con serología positiva (AU)

Background. Toxoplasmosis is an opportunistic infection reported in several groups of inmunosupressed patients. It is considered uncommon in patients with lymphoproliferative disorders and in bone marrow transplant recipiets (BMT). Nevertheless, recent reviews have reported cases of cerebral and disseminated toxoplasmosis in BMT recipients, particularly among patients with IgG antibodies to Toxoplasma sp. prior to BMT and antineoplastic treatment. Patients and results. Two cases of toxoplasmosis are reported of patients with non-Hodgkin lymphoma who did not have graft-versus-host- disease and with positive antitoxoplasma serologic response. In the first patient, the predominant clinical picture was febrile neutropenia without source, with good response to specific treatment for toxoplasmosis; in the second patient, and autologous BMT was performed and six months later the patient developed a retino-choroiditis by toxoplasmosis reactivation. Conclusions. The excessive morbidity and mortality associated with toxoplasmosis reactivations in lymphomyeloproliferative neoplasms with antineoplastic therapy and both allogenic and autologous BMT, demand preventive measures. The pretransplant serologic tests can be helpful in evaluating the potential risk of suffering a reactivation by Toxoplasma sp. and considering the administration of chemoprophylaxis in selected patients with positive serology (AU)