Search

Hepatitis A Virus Infection (HAI) has been related to the hygienic-sanitary situation of an area, the changes in the epidemiology of HAI in the province of Guadalajara between 1991 and 2017 are analyzed.Cases of HAI declared between 1991 and 2017 in Guadalajara were included. The variables analyzed were age, sex, environment, risk factors for HAI and need for hospitalization. The incidence was compared in three periods: 1991-1999, 2000-2008 and 2009-2017.Two hundred and thirty-three cases of HAI were declared, the average incidence rate was 4.27 cases/100,000 inhabitants, highest between 1991 and 1999 (6.93) and lowest between 2009 and 2017 (1.92), with an increment in 2017 (5.5). The median age was 16 years (IR: 8.5-28.5 years), 58.4% were male, and the highest incidence occurred between 5 and 14 years in both sexes. The most frequent risk factors were family and non-family contact and trips to endemic areas (18.6%, 17.3% and 18.2%, respectively). The last risk factor increased after 2000 (P=.001), as did the incidence in urban areas. The MSM group showed an increase in the last period (P.001). Hospital admissions increased progressively from the first to the third period studied (P=.001).HAI has a low incidence in our area. More cases related to travel or sexual practices are observed. This should be considered when establishing prevention policies, including vaccination of the most exposed people.

Resumen Introduccion En Espana, al igual que en otros paises donde el sarampion endemico ha sido eliminado, es necesario utilizar de forma rutinaria las herramientas diagnosticas que confirmen los casos para su prevencion y control de la diseminacion. Se describen los diferentes ensayos microbiologicos utilizados para su diagnostico durante un brote de sarampion en 2019 en la provincia de Guadalajara (Espana). Metodos Las pruebas serologicas y moleculares se realizaron en el laboratorio de Microbiologia del Hospital Universitario de Guadalajara y en el Centro Nacional de Microbiologia del Instituto de Salud Carlos III (Majadahonda, Espana). Los datos de los pacientes se obtuvieron del sistema epidemiologico de vigilancia. Resultados Se diagnosticaron de sarampion un total de 43 pacientes por metodos microbiologicos: 29 casos por PCR (exudado faringeo u orina) junto con IgM especifica positiva, 11 pacientes solamente por PCR, y 3 pacientes exclusivamente por presencia de IgM. El genotipo D8 fue identificado en 35 pacientes y el genotipo A en 2 casos descartados como postvacunal. La PCR en suero fue positiva en 11 de 14 pacientes con ausencia de IgM en su primera muestra recogida de suero. Once casos confirmados habian recibido una o 2 dosis de la vacuna. Doce adultos fueron ingresados, todos diagnosticados de hepatitis. Conclusiones La combinacion de pruebas moleculares y la presencia de IgG e IgM especificas son necesarias para un diagnostico correcto y la clasificacion de los pacientes como fallo vacunal (primario o secundario). El genotipado es una herramienta fundamental para la correcta clasificacion de los pacientes en el contexto de un programa de eliminacion del sarampion.

In autumn 2022, the Spanish Influenza National Reference Laboratory (NRL) confirmed the detection of influenza A(H5N1) in samples from two asymptomatic workers linked to an outbreak in a poultry farm in Spain. Nasopharyngeal swabs were taken according to a national screening protocol for exposed workers. Absence of symptoms, low viral load and negative serology in both workers suggested environmental contamination. These findings motivated an update of the early detection strategy specifying timing and sampling conditions in asymptomatic exposed persons.

Hepatitis B virus (HBV)-specific CD8To predict this response with variables involved in T-cell exhaustion for use as a treatment stopping tool.In NUC-treated CHBe(-) patients, we considered a functional response in cases with HBV-specific CD8We developed an LRM that predicted the presence of a proliferative type I cytokine-secreting CD8Short-term low-level antigen exposure and early long-term NUC treatment influence the restoration of a functional HBV-specific CD8

In Spain, like in other countries where endemic measles has been eliminated, there is a need for available diagnostic tools for confirming any cases in order to prevent and control its transmission. We describe the different microbiological tests used for the diagnosis of measles during an outbreak that occurred in 2019 in the province of Guadalajara (Spain).Serological and molecular tests were performed at the Microbiology laboratory of the Guadalajara University Hospital and at the National Center for Microbiology of the Carlos III Health Institute (Majadahonda, Spain). Patient data were obtained from the surveillance system.A total of 43 patients had a laboratory diagnosis of measles: 29 cases by PCR (pharyngeal exudate or urine) and positive specific IgM, 11 cases by PCR, and 3 cases only by a positive IgM. Genotype D8 was identified in 35 confirmed cases and genotype A in 2 that were discarded as post-vaccination cases. PCR was positive in the acute sera of 11 out of 14 patients with a negative IgM. Eleven confirmed cases had recieved one or 2 vaccine doses. Twelve adult patients were hospitalizated, all of them with a diagnostic of hepatitis.The combination of molecular tests and the presence of specific IgG and IgM are necessary for a correct diagnosis of measles and also to classify patients with a breakthrough infection or vaccine failures (primary or secondary). Genotyping is essential for the correct classification of the patients in the context of a measles elimination program.

Infectious keratitis is a serious ocular infection that can lead to loss of vision. The aim of this study was to investigate the microbiological characteristics of this infection at the University Hospital of Guadalajara (Spain). We retrospectively reviewed all cases diagnosed between January 2010 and December 2016. During the 7-year study period, 297 corneal scrapes corresponding to 298 patients were performed. Antibiotic treatment prior to the culture was administered in 59 cases (19.9%). Contact lens wear was the most common risk factor (33.2%). Bacterial keratitis accounted for 64.6% of cases, viral keratitis for 3.4%, and fungal keratitis for 1%. A total of 241 bacterial strains were identified. Gram-positive isolates represented 87.1%, and gram-negative 12.7%. Coagulase-negative Staphylococcus strains were the most common microorganisms isolated (30.3%). When gram-positive microorganisms were analyzed, the sensitivity prevalence rates for vancomycin (VCM), levofloxacin, gentamicin (GM), and tobramycin (TO) were 99.4%, 84.6%, 87.9%, and 88.3%, respectively. For the gram-negative organisms, the sensitivity prevalence rates for ceftazidime, ciprofloxacin, GM, and TO were 83.3%, 93.5%, 96.3%, and 100%, respectively. Our study revealed strong predominance of gram-positive microorganisms. We suggest empirically treating bacterial keratitis originating in our area with VCM and TO, especially severe bacterial keratitis and pretreated cases in the community without a clinical response.

HDV infection may occur within a primary HBV infection (co-infection) or by sub sequent acquisition ofthe virus in patients with chronic hepatitis B (superinfection). Acute HDV infection is rarely diagnosed. Since cero conversion usually takes place about six weeks after viral infection, early diagnosis requires the use of direct diagnostic techniques, such as antigen HD V (HDAg) detection, or genomic amplification by means of molecular biology methods (RT-PCR). Here were port the case of a patient with chronic HBV infection that develops a severe acute hepatitis due to VHD superinfec- tion only detected by molecular biology.

Hepatitis C virus (HCV)-specific CD8+ T cells suffer a progressive exhaustion during persistent infection (PI) with HCV. This process could involve the positive immune checkpoint 4-1BB/4-1BBL through the loss of its signal transducer, TRAF1. To address this issue, peripheral HCV-specific CD8+ T cells (pentamer-positive [pentamer+]/CD8+ T cells) from patients with PI and resolved infection (RI) after treatment were studied. The duration of HCV infection and the liver fibrosis progression rate inversely correlated with the likelihood of detection of peripheral pentamer+/CD8+ cells. In PI, pentamer+/CD8+ cells had impaired antigen-specific reactivity that worsened when these cells were not detectable ex vivo. Short/midduration PI was characterized by detectable peripheral PD-1+ CD127low TRAF1low cells. After triggering of T cell receptors (TCR), the TRAF1 level positively correlated with the levels of CD127, Mcl-1, and CD107a expression and proliferation intensity but negatively with PD-1 expression, linking TRAF1low to exhaustion. In vitro treatment with interleukin-7 (IL-7) upregulated TRAF1 expression, while treatment with transforming growth factor-β1 (TGF-β1) did the opposite, suggesting that the IL-7/TGF-β1 balance, besides TCR stimulation, could be involved in TRAF1 regulation. In fact, the serum TGF-β1 concentration was higher in patients with PI than in patients with RI, and it negatively correlated with TRAF1 expression. In line with IL-7 increasing the level of TRAF1 expression, IL-7 plus 4-1BBL treatment in vitro enhanced T cell reactivity in patients with short/midduration infection. However, in patients with long-lasting PI, anti-PD-L1, in addition to the combination of IL-7 and 4-1BBL, was necessary to reestablish T cell proliferation in individuals with slowly progressing liver fibrosis (slow fibrosers) but had no effect in rapid fibrosers. In conclusion, a peripheral hyporeactive TRAF1low HCV-specific CD8+ T cell response, restorable by IL-7 plus 4-1BBL treatment, characterizes short/midduration PI. In long-lasting disease, HCV-specific CD8+ T cells are rarely detectable ex vivo, but treatment with IL-7, 4-1BBL, and anti-PD-L1 recovers their reactivity in vitro in slow fibrosers.

Resumen Introduccion El sarampion es una infeccion casi erradicada que en los ultimos anos esta reemergiendo en Espana y en Europa. El objetivo del estudio fue describir las caracteristicas microbiologicas y clinico-epidemiologicas de un brote de sarampion ocurrido en la provincia de Guadalajara de junio a agosto de 2012. Metodos Estudio descriptivo y retrospectivo. Se analizaron 117 muestras (suero, orina y exudado faringeo) de 52 casos sospechosos de sarampion. Resultados Se confirmaron 50 casos de sarampion, 41 por laboratorio y 9 por vinculo epidemiologico, agrupados en 4 brotes comunitarios. No se observaron casos importados. La IgM y la PCR fueron positivas en 25 pacientes, solo PCR en 11 y solo IgM en 5. El genotipo fue D4 en 13/14 cepas y genotipo A en un caso posvacunal. Los grupos de edades mas afectados fueron adultos entre 20 y 34 anos (38%) y menores de 15 meses (26%). El 88% de pacientes no estaban vacunados (43% etnia gitana, 27% menores de 15 meses, 11% razones ideologicas), y el 6% habia recibido una dosis. La clinica fue exantema y fiebre (100%), tos (82%) y conjuntivitis (50%). El 32% requirio hospitalizacion y el 28% presento complicaciones. Conclusion Es de especial importancia intensificar la vigilancia epidemiologica en infecciones en fase de eliminacion. El aumento de la incidencia de sarampion estuvo asociado a bolsas de no vacunados que representan un desafio para la salud publica, que debera elaborar estrategias para conseguir una elevada cobertura vacunal y alcanzar la erradicacion del sarampion.

Urinary tract infection (UTI) due to Achromobacter xylosoxidans is rare. The aims were to know the frequency and clinical characteristics of this infection in our area. We performed a retrospective analysis of 9 patients with UTI caused by this organism diagnosed over a period of 13 y. The mean age was 63.1 y. All patients had underlying diseases or urological abnormalities. The most frequent underlying diseases were solid or hematological malignancies (3 cases). Seven patients (77.7%) had urological abnormalities. Eight patients had symptoms of cystitis and 1 remained asymptomatic. Seven patients had community acquired UTIs. Clinical outcome was favourable in 5 patients after antibiotic treatment and recurrence occurred in 3 patients who had urological abnormalities. All isolates were susceptible to imipenem and piperacillin-tazobactam, 88.8% were susceptible to ceftazidime and 77.7% were susceptible to trimethoprim-sulfamethoxazole. High frequencies of resistance to ampicillin (100%), amoxicillin/clavulanic acid (78%), cefuroxime (100%), cefotaxime (67%), norfloxacin (89%), ciprofloxacin (78%), nitrofurantoin (89%) and gentamicin (67%) were observed. UTI due to A. xylosoxidans was predominantly observed in elderly patients with predisposing factors, especially urological abnormalities, malignancies and immunosuppression. Treatment can be difficult due to the high level of antibiotic resistance. Trimethoprim-sulfamethoxazole may be useful for treatment, particularly in outpatients with community acquired infections.

The National Plan for the Elimination of Rubella was implemented in Spain in 2008 using the logistics of the National Plan for the Elimination of Measles that have been employed since year 2000. Molecular characterization of rubella virus (RUBV) is important for disease surveillance and for monitoring elimination of the disease throughout the world. We describe the first complete series of data regarding the circulation of RUBV genotypes in Spain. The 739-nucleotide fragment designated by the WHO for RUBV genotyping was sequenced in 88 selected cases collected from 1998 to 2014. Five genotypes were identified: 1E, 2B, 1J, 1I, and 1a. Genotype 1E was predominant between 1998 and 2003 but was replaced by genotype 2B, which was detected in sporadic cases in 2004, 2006, 2008, 2012, 2013 and 2014. There was an outbreak of genotype 2B in Algeciras (Andalusia) in 2008. Genotype 1J caused an outbreak in Madrid in 2004/2005 and sporadic cases in 2005 and 2007. Genotype 1I was found to have infected an immune-suppressed patient with neurological symptoms in 2008. Finally, vaccine strain RA 27/3 was detected in three sporadic cases, two of them immune-suppressed and without a recent history of vaccination. This suggests that during these years there were a series of imported sporadic cases and outbreaks, confirming the findings of epidemiological data analysis. The importation sources were generally consistent with our geographic and cultural ties, mainly with Europe (genotypes 1E, 2B, 1I) and Latin America (1J). This work has received financial support from the fellowship for Ph.D. Study by Republic of Panama and Acuerdo de Encomienda de Gestión entre la Dirección General de Salud Pública del Ministerio de Sanidad y Consumo y el Instituto de Salud Carlos III. N° expediente: DGVI-1429/05-3, and Fondo de Investigación Sanitaria, Instituto de Salud Carlos III (IP12/02006). Also, has been developed under the Project FIS PI12/02006 funded by the Strategic Action on Health of the Instituto de Salud Carlos III. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Sí

Resumen Introduccion Aeromonas spp. es una causa habitual de gastroenteritis pero ocasionalmente puede producir infecciones extraintestinales. El objetivo de este estudio es conocer las caracteristicas clinicas y microbiologicas de las infecciones extraintestinales producidas por este microorganismo en nuestro medio. Pacientes y metodos Se revisaron retrospectivamente las historias clinicas de los enfermos con infecciones extraintestinales por Aeromonas spp., diagnosticadas en el Hospital Universitario de Guadalajara entre enero de 1990 y diciembre de 2005. La identificacion microbiologica y la susceptibilidad antimicrobiana de las cepas aisladas se realizaron mediante el sistema automatico MicroScan WalkAway-40 (DadeBerhing). Resultados Se diagnosticaron 38 casos: 18 infecciones abdominales, 11 de piel y partes blandas, 3 del tracto urinario, 3 del aparato respiratorio y 3 bacteriemias sin foco primario. La especie mas frecuente fue A. hydrophila (16 casos). El 76,3% de los enfermos presentaron patologias de base predisponentes, siendo las de naturaleza neoplasica las mas frecuentes (34,2%), seguida de diabetes mellitus (21%). El 50% de las infecciones fueron polimicrobianas y el 21% de origen nosocomial. La mortalidad global fue del 16,2%. Los antibioticos con mayor porcentaje de sensibilidad fueron gentamicina, amikacina, cefotaxima y ciprofloxacino. Conclusiones Aeromonas spp. debe ser tenida en cuenta en infecciones del sistema biliar, infecciones de heridas quirurgicas abdominales y celulitis postraumaticas. La infeccion extraintestinal con frecuencia es polimicrobiana, suele aparecer en enfermos con patologias de base y en general el pronostico es bueno. Los antibioticos mas activos in vitro fueron gentamicina, amikacina, cefotaxima y ciprofloxacino.

Summary Background Most available information on carbapenemase-producing Enterobacteriaceae (CPE) is usually associated with specific types of infection or patient or with descriptions of outbreaks. The aim of this study was to comprehensively analyse the clinical epidemiology, clinical features and outcomes of colonisation and infections due to CPE in Spain. Methods A multicentre prospective cohort study was carried out in 34 Spanish hospitals from February to May 2013. All new patients testing positive for CPE in clinical samples were included. Logistic regression was used to identify predictors of mortality. Results Overall, 245 cases were included. The most frequent organism was Klebsiella pneumoniae (74%) and the carbapenemases belonged to the OXA-48 (74%), metallo-β-lactamase (MBL) (24%) and KPC (2%) groups. Acquisition was nosocomial in 145 cases (60%) and healthcare-associated (HCA) in 91 (37%); 42% of the latter were nursing home residents, in whom OXA-48-producing K. pneumoniae ST405 predominated. MBLs and OXA-48 predominated in ICU and medical patients, respectively. Overall, 67% of patients had infections. The most frequent infections identified in this study were urinary tract (43%) and skin structure (21%) infections, and 10% of infections were bacteraemic. Crude mortality was 20%. Inappropriate antibiotic therapy was independently associated with an increased risk of death (OR = 3.30; 95% CI: 1.34–8.11). Conclusions We found some differences in the epidemiology of CPE depending on the type of carbapenemase produced. Although a low proportion of CPE infections were bacteraemic, active antibiotic therapy was a protective factor for reducing mortality.

Fundamento Espana junto con los paises de Europa del sur era considerada zona de endemia de grado intermedio. Este hecho tiene consecuencias de cara a los viajeros que visitan estas zonas y a la estrategia de vacunacion. Se plantea realizar un estudio de prevalencia para conocer la situacion de la infeccion en la provincia de Guadalajara Metodos Se seleccionaron 284 muestras de suero de pacientes que fueron clasificadas por edad, sexo y lugar de residencia (mayor o menor de 10.000 habitantes). En ellos se estudio la presencia de anticuerpos frente al virus de la hepatitis A mediante enzimoinmunoensayo de microparticulas (MEIA) (Abbott) Resultados Se observo un aumento de prevalencia con la edad de forma que existe una poblacion de baja prevalencia (≤ 5%) entre los 0-29 anos junto con otra de alta prevalencia (>80%) en los adultos entre 30 y 74 anos. No se observaron diferencias en funcion del sexo. En el analisis estratificado por edad se observaron diferencias entre los grupos de procedencia rural y urbana Conclusiones La baja prevalencia de hepatitis A encontrada en la poblacion mas joven, al igual que en otros estudios nacionales, junto con el descenso de la incidencia nos incluye dentro de los paises de baja endemia. Este hecho tiene consecuencias en cuanto a los viajeros que visiten nuestro pais y de cara a una estrategia vacunal debido al aumento de adultos susceptibles a la infeccion

Fundamento. Las hepatitis virales son uno de los grupos de enfermedades infecciosas más frecuentes en patología humana y aunque la mayoría son benignas algunas pueden evolucionar hacia formas crónicas. El objetivo del estudio fue conocer la prevalencia de la infección por los virus de la hepatitis C, Epstein-Barr y herpesvirus humano tipo 6, en los escolares de 8.º de EGB (13-14 años), y relacionarla con las variables sexo y el hábitat (rural o urbano) en el que vivían. Métodos. Estudio descriptivo de tipo transversal, en una muestra representativa de la población escolar de 8.º de EGB de la provincia de Guadalajara en 1998-1999. Muestreo aleatorio sistemático estratificado según sexo y centro escolar (diseño muestral polietápico). Se determinó la tasa de anticuerpos específicos de la clase IgG, mediante técnica de ELISA. Resultados. Se estudió a 268 escolares (46,6% varones). La prevalencia de anticuerpos frente al virus de Epstein-Barr fue de 73,5% (IC: 67,9%-78,5%); el 72% (IC: 64%-80%) entre los varones y el 74,8% (IC: 67,7%-81,9%) entre las mujeres (NS); el 65,6% (IC: 57,4%-73,8%) vivían en medio urbano y el 80,7% (IC: 74,2%-87,2%) en el rural (p < 0,05). La prevalencia de positivos para el virus de la hepatitis C fue del 0,7% -dos personas, siendo ambas del sexo femenino y viviendo una en el medio urbano y otra en el rural-. Para el virus herpes tipo 6 la prevalencia fue del 82,4% (IC: 77,9%-86,9%), el 81,5% (IC: 74,7%-88,3%) entre los varones y el 83,2% (IC: 77,1%-89,3%) entre las mujeres (NS), el 86,7% (IC: 80,4%-92,2%) vivían en medio urbano y el 78,5% (IC: 73,1%-86,5%) en el rural (p < 0,05). Conclusiones. La prevalencia por los virus de Epstein-Barr y herpes humano tipo 6 y baja frente al VHC es elevada, lo cual concuerda con las características del medio y edad de las personas estudiadas.

Measles is a viral infection that was almost eradicated, but it is re-emerging in Spain and Europe in recent years. The aim of this study was to describe the microbiological, clinical and epidemiological characteristics of a measles outbreak that occurred in Guadalajara (Spain) from June to August 2012.A descriptive and retrospective study was conducted. A total of 117 samples (including serum, urine and pharyngeal swabs) from 52 patients were analyzed for measles.Measles was diagnosed in 50 patients, 41 of them by microbiological diagnosis, and 9 by epidemiological link. The patients were grouped in four community outbreaks. No imported cases were observed. Positive IgM and positive CRP were detected in 25 patients, positive CRP only in 11 and positive IgM only in 5. The genotype D4 was identified in 13 patients and the genotype A in a post-vaccine case. The age groups most affected were adults between 20-34 years of age (38%) and younger than 15 months (26%). The large majority (86%) of patients were unvaccinated (44% Roma population, 27% younger than 15 months, 11% ideological reasons), 6% had one vaccine dose. The signs/symptoms were: rash and fever, 100%, cough, 82%, and conjunctivitis 50%. Almost one-third (32%) of patients were hospitalized, and 28% had complications.It is very important to intensify the epidemiological surveillance of infections in the elimination phase. The increased incidence of measles was associated to unvaccinated pockets, presenting a challenge for Public Health Centers. These agencies should prepare strategies to obtain a higher vaccine coverage for the eradication of measles.

La infección por citomegalovirus (CMV) debe ser investigada en pacientes sanos con cuadro pseudogripal consistente en fiebre, astenia, aumento inexplicado de los niveles de transaminasas y linfomonocitosis periférica. Es un cuadro relativamente frecuente, por lo que puede pasar totalmente desapercibido o con escasas manifestaciones clínicas, sobre todo en el paciente inmunocompetente. Los síntomas faríngeos y adenomegalias son menos frecuentes que en la infección mononucleósica por virus de Epstein-Barr. Presentamos el caso de un paciente sin factores de riesgo que presenta un cuadro febril prolongado y alteraciones hepáticas, con evolución espontánea a la normalización y serología compatible con infección por CMV.

To know the evolution of susceptibility patterns of Escherichia coli in patients with community diagnosed urinary tract infections (UTIs) during last years in Castilla la Mancha (Spain).Descriptive and retrospective study performed between january 2003 and december 2007. We studied data about frequency and susceptibility of 33.651 E. coli isolates from urine cultures that were remited from primary care centres depending of 6 hospitals in Castilla la Mancha (Spain).Susceptibility rates of E. coli for most antibiotics decreased significantly during the 5-year period, especially for amoxicillin-clavulanic acid, cefuroxime and quinolones. Average rates of susceptibility for amoxicillin-clavulanic acid, ciprofloxacin, cefuroxime, fosfomycin and nitrofurantoin were: 86.7, 75.4, 87.3, 97.6 and 96.2%, respectively. We observed a significantly increase of E. coli isolates producing extended-spectrum betalactamases ESBLs), from 1.9% in 2003 to 4,9% in 2007 (χ² TL = 143.6, p0.001).We observed a significantly reduction of E. coli susceptibility for most antibiotics and an increase of E. coli isolates producing ESBLs. Fosfomycin and nitrofurantoin are the best choices for empiric treatment. Prospective studies should be performed in the future to confirm the results of our study.

Gastrointestinal and wound infections are the most common clinical presentation of Aeromonas. Surgical site infections (SSIs) due to this microorganism are rare. We studied the clinical and microbiological characteristics of 9 cases that appeared at 2 Spanish hospitals and reviewed 15 cases available in the literature. All patients (including our cases) had gastrointestinal or biliary diseases. 21 patients (91.3%) developed SSIs after abdominal or pelvic surgery. The mean duration from surgery to the onset of wound infection was 2.2 d in our 9 patients. The infection was polymicrobial in 17 patients (77.2%) and 19 cases were nosocomial (95%). Clinical outcome of all cases was uniformly good after treatment except for 2 patients. Two patients were cured only with surgical drainage. In conclusion, SSIs due to Aeromonas species have a probable endogenous source after abdominal or pelvic surgery and the onset is rapid in most cases. Clinical outcome is good after antibiotic treatment but surgical drainage without antibiotic therapy can be sufficient to clear the infection in some cases.

Aeromonas spp. typically cause gastroenteritis, but can occasionally produce extraintestinal infections. The aim of this study was to determine the clinical and microbiological characteristics of extraintestinal infections caused by Aeromonas spp. in our area.The clinical histories of patients with extraintestinal infections by Aeromonas spp. diagnosed in Hospital Universitario de Guadalajara (Guadalajara, Spain) from January 1990 to December 2005 were reviewed. Identification and susceptibility testing of the strains were performed by the MicroScan WalkAway-40 automated method (DadeBerhing).Thirty-eight cases of extraintestinal infections were diagnosed: 18 abdominal infections, 11 skin and soft tissue infections, 3 urinary tract infections, and 3 episodes of bacteremia with no primary focus. The species most frequently found was A. hydrophila (16 cases). Infection occurred most often in patients with underlying diseases (76.3%), including malignancy (34.2%) and diabetes mellitus (21%). Polymicrobial infections were detected in 50% and the etiology was nosocomial in 21%. The mortality rate was 16.2%. Gentamicin, amikacin, cefotaxime and ciprofloxacin had the highest activity against the Aeromonas species isolated.Aeromonas spp. as the causative infectious agent should be kept in mind in patients with infections of the biliary system, surgical wounds in the abdomen and posttraumatic cellulitis. Extraintestinal infection is usually polymicrobial, appears most commonly in patients with underlying diseases, and generally has a good prognosis. The most active antibiotics in vitro were gentamicin, amikacin, cefotaxime and ciprofloxacin.

Summary Objectives Urinary tract infection (UTI) caused by non-typhoidal Salmonella (NTS) is rare. The aims were to know the frequency and clinical characteristics of this infection in our area. Patients and methods We performed a retrospective analysis of patients with bacteriuria due to NTS diagnosed in our hospital from January 1990 to December 2005. Results Nineteen patients with bacteriuria caused by NTS were diagnosed, representing 0.07% of the UTIs diagnosed in our area over the same period. The mean age was 62.5years old. Eighteen patients (94.7%) had symptoms of UTI (12, cystitis; 6, pyelonephritis), and 1 remained asymptomatic. Fourteen patients (73.6%) had chronic diseases; diabetes mellitus was present in 8 of them (42.1%) and 7 patients (36.8%) were undergoing immunosuppressor treatment. Eight patients (42.1%) had urologic abnormalities. S. enteritidis was the most common serotype isolated (16 cases). Eleven patients required antibiotic treatment over 2 or more weeks. Four patients had recurrent Salmonella UTIs (22.2%), and in 2 of them recurrence occurred after prolonged treatment during 3.5 and 5weeks, respectively. Conclusions UTI due to NTS was predominantly observed in elderly patients with underlying diseases, especially diabetes mellitus , urologic abnormalities and immunosuppression. Prolonged antibiotic treatment should be considered due to the high frequency of complicating conditions, although the infection can be recurrent despite prolonged treatment.

Brucella spp. should be considered in the differential diagnosis of acute meningitis of children living in areas where brucellosis is endemic.

To the Editor: Increased atmospheric CO2 concentrations promote the growth of fastidious microorganisms. However, the possibility that a strain of Escherichia coli can be CO2 dependent is exceptional (1). An isolate of capnophilic E. coli was responsible for a urinary tract infection (UTI) in a 77-year-old woman at the University Hospital of Guadalajara (Spain) in November 2002. Urine was cultured on a cystine-lactose-electrolyte-deficient agar plate and incubated at 37°C in an atmosphere containing 6% CO2 for 1 day. After 24 hours, the culture yielded gram-negative rods (>105 CFU/mL) in pure culture. The organism was motile, catalase positive, and oxidase negative. The strain could not be identified by using the MicroScan WalkAway-40 system (DadeBerhing, Inc., West Sacramento, CA, USA). A subculture was performed, and the organism did not grow on sheep blood agar and MacConkey agar plates at 37°C in ambient air. However, a subculture incubated at 37°C for 24 hours in an atmosphere of 6% CO2 produced smooth colonies 2–3 mm in diameter on sheep blood agar and MacConkey agar plates. The organism fermented lactose, and the indole reaction (BBL DrySlidet, Becton Dickinson Co., Sparks, MD, USA) performed on sheep blood agar was negative. The strain grew well on Schaedler agar plates after anaerobic incubation for 48 hours. The isolate remained capnophilic after 5 subcultures. The strain was identified as E. coli by using the Biolog GN2 panel (Biolog, Inc., Hayward, CA, USA) (100%, T = 0,534), after incubation of the panel in an atmosphere containing 6% CO2 for 1 day. The API 20E system (bioMerieux, Marcy-l’Etoile, France) according to the manufacturer’s instructions without C02 incubation also identified E. coli (profile 5004512). The identification was confirmed by means of 16S rDNA sequence analysis (1,472 bp obtained by PCR amplification by a previously reported method [2]), which showed 99% similarity with E. coli sequence (GenBank accession no. {"type":"entrez-nucleotide","attrs":{"text":"CP000802","term_id":"157065147"}}CP000802). The 16S sequence showed similarity with Shigella species; however, this identification was not considered because the strain fermented lactose on MacConkey agar and agglutinations with Shigella antiserum were negative. The original 16S rDNA sequence was deposited in GenBank (accession no. {"type":"entrez-nucleotide","attrs":{"text":"EU555536","term_id":"171262526"}}EU555536). The antimicrobial drug susceptibility profile was determined by incubating Mueller-Hinton agar plates at 37°C in an atmosphere containing 6% CO2 by the disk diffusion method, according to National Committee for Clinical Laboratory Standards recommendations (3). The isolate was susceptible to ampicillin, amoxicillin/clavulanic acid, piperacillin, cefazolin, cefuroxime, cefotaxime, nitrofurantoin, fosfomycin, trimethoprim-sulfamethoxazole, gentamicin, tobramycin, amikacin, norfloxacin, and ciprofloxacin. MICs were obtained for the following antimicrobial agents with the E-test method (AB Biodisk, Solna, Sweden), performed on Mueller-Hinton agar plates incubated in a 6% CO2 atmosphere: ampicillin (1.5 μg/mL), amoxicillin (3 μg/mL), cefotaxime (0.064 μg/mL), imipenem (0.094 μg/mL), piperacillin (2 μg/mL), and ciprofloxacin (0.008 μg/mL). E. coli is the most common pathogen among patients with uncomplicated UTIs (4). Two cases of UTIs due to carbon dioxide–dependent strains of E. coli have been reported (1). The mechanisms for development of CO2 dependence are unknown (5). CO2 can play a role in the growth of E. coli as a substrate for carboxylation reactions (6). Other members of the family Enterobacteriaceae (such as some strains of Klebsiella spp.) and other organisms (such as Staphylococcus aureus), can have similar requirements (7,8). There is not 1 best way of performing urine cultures. Guidelines for the diagnosis of UTI includes the use of sheep blood agar and either MacConkey agar or a similar selective medium for routine urine culture. The plates should be incubated overnight (at least 16 hours) at 37°C in ambient air; alternatively, the blood agar plate can be incubated in elevated (3%–8%) CO2 (9). For fastidious microorganisms, chocolate agar can be added to the MacConkey agar and the plates incubated in 5% CO2 for 2 days (9). The real incidence of these infections is unknown, but the rarity of these strains suggests that the incidence is low. However, the real incidence of UTI caused by capnophilic E. coli may be underestimated because urine cultures are not usually incubated in CO2. In addition, urine cultures are not performed for many women with uncomplicated cystitis. Other fastidious uropathogens such as Haemophilus influenzae and H. parainfluenzae, also require special media and incubation in an atmosphere of CO2 (9). The low frequency of these strains suggests that incubation of routine urine cultures in an atmosphere containing CO2 is not necessary. Incubation in CO2 should be ordered only if the patient has pyuria and a previous negative urine culture after incubation in ambient air or if the patient is unresponsive to empiric therapy and routine urine culture is negative. Good clinician–laboratory communication is vital. Further studies should be performed to ascertain the real incidence of UTIs caused by capnophilic strains of E. coli. Because no breakpoints are available for antimicrobial agents against capnophilic strains of E. coli, we used published interpretative criteria or Enterobacteriaceae (3). The strain was susceptible to all antimicrobial agents that we tested. The impact of CO2 on the susceptibility of capnophilic strains of E. coli is unknown. Susceptibility of some antimicrobial agents such as quinolones can be influenced by the pH change and enhanced growth that occur during CO2 incubation when testing capnophilic organisms (10).

H. nana es un cestodo descrito con mayor frecuencia en ninos de zonas tropicales y templadas del Sudeste asiatico, Oriente Medio, Africa y Sudamerica, donde se han informado cifras de prevalencia que oscilan entre el 0,2 %-24%1-4. En Espana, las comunicaciones de cestodiasis por H. nana son escasas y se ha descrito de forma ocasional como agente causal de dolor abdominal inespecifico en ninos con malas condiciones higienico-sanitarias5. El reservorio habitual es el hombre y la transmision interhumana ocurre por via fecal-oral por ingestion de alimentos contaminados. Cuando el hombre ingiere los huevos, la oncosfera se libera en el intestino delgado y penetra en las vellosidades, donde al cabo de unos 5 dias se convierte en larva cisticercoide. La larva rompe la vellosidad, sale a la luz del intestino y se fija en la parte inferior del intestino delgado, donde llega a la fase adulta en 2 semanas e inicia la oviposicion, reanudandose el ciclo. La autoinfeccion es frecuente (por via endogena o exogena) y explica la facilidad con la que se producen reinfecciones6. La intensidad de las manifestaciones clinicas depende de la carga parasitaria y de la edad. En ninos con frecuencia es un proceso asintomatico, pero los casos moderados de parasitacion pueden cursar con dolor abdominal, meteorismo, diarrea, nauseas, vomitos, irritabilidad y nerviosismo. En las formas severas pueden aparecer diarrea intensa, malabsorcion y retraso de crecimiento7. En el caso que presentamos, el retraso pondestatural podria estar relacionado con la parasitacion doble por H. nana y G. lamblia. En adultos la expresividad clinica es menor, y con mayor frecuencia que en los ninos cursa sin sintomas Correspondencia: Dra. J. Bisquert. Seccion de Microbiologia. Hospital General de Guadalajara. C/ Donantes de sangre s/n. 19002 Guadalajara.