First imported case of tick-borne encephalitis in Spain - was it alimentary?

As described by Kerlik, et al, tick-borne encephalitis (TBE) is an emerging infectionin Europe and alimentary transmission is increasingly being reported in some European countries[1,2]. However, this is not the case in Spain where no previous cases have been reported [2,3]. Herein, we describe an imported case of TBE in Spain in a boy who probably acquired the virus by ingestion of contaminated milky products in a trip to Estonia

Positive direct antiglobulin test in post-artesunate delayed haemolysis: more than a coincidence?

Background: Delayed haemolysis is a frequent adverse event after treatment with artesunate (AS). Removing onceinfected “pitted” erythrocytes by the spleen is the most accepted mechanism of haemolysis in these cases. However, an increasing number of cases with positive direct antiglobulin test (DAT) haemolysis after AS have been reported. Methods: All malaria cases seen at Hospital Clinic of Barcelona between 2015 and 2017 were retrospectively reviewed. Clinical, parasitological and laboratory data from patients treated with intravenous artesunate—specifcally looking for delayed haemolysis and DAT—was collected. Results: Among the 36 severe malaria patients treated with artesunate at the hospital, 10 (27.8%) developed postartesunate delayed haemolysis. Out of these, DAT was performed in six, being positive in four of them (at least 40%). DAT was positive only for complement—without IgG—suggesting drug-dependent immune-haemolytic anaemia of the immune-complex type. Three of the four patients were treated with corticosteroids and two also received blood transfusion, with a complete recovery. Conclusions: Drug-induced auto-immune phenomena in post-artesunate delayed haemolysis may be underre‑ ported and must be considered. The role of corticosteroids should be reassessed

Positive direct antiglobulin test in post-artesunate delayed haemolysis: more than a coincidence?

BACKGROUND: Delayed haemolysis is a frequent adverse event after treatment with artesunate (AS). Removing once-infected 'pitted' erythrocytes by the spleen is the most accepted mechanism of haemolysis in these cases. However, an increasing number of cases with positive direct antiglobulin test (DAT) haemolysis after AS have been reported. METHODS: All malaria cases seen at Hospital Clinic of Barcelona between 2015 and 2017 were retrospectively reviewed. Clinical, parasitological and laboratory data from patients treated with intravenous artesunate-specifically looking for delayed haemolysis and DAT-was collected. RESULTS: Among the 36 severe malaria patients treated with artesunate at the hospital, 10 (27.8%) developed post-artesunate delayed haemolysis. Out of these, DAT was performed in six, being positive in four of them (at least 40%). DAT was positive only for complement-without IgG-suggesting drug-dependent immune-haemolytic anaemia of the immune-complex type. Three of the four patients were treated with corticosteroids and two also received blood transfusion, with a complete recovery. CONCLUSIONS: Drug-induced auto-immune phenomena in post-artesunate delayed haemolysis may be underreported and must be considered. The role of corticosteroids should be reassessed

Lack of efficacy of standard doses of ivermectin in severe COVID-19 patients

Ivermectin has recently shown efficacy against SARS-CoV-2 in-vitro. We retrospectively reviewed severe COVID-19 patients receiving standard doses of ivermectin and we compared clinical and microbiological outcomes with a similar group of patients not receiving ivermectin. No differences were found between groups. We recommend the evaluation of high-doses of ivermectin in randomized trials against SARS-CoV-2

Post-splenectomy acute glomerulonephritis due to a chronic infection with Plasmodium falciparum and malariae

A 38-year-old Senegalese man with no previous medical history and living in Spain since 2004 was admitted due to fever, hypotension and edemas. The patient had not traveled to malaria endemic areas for the last 2 years, and 43 days before this episode he underwent an elective splenectomy in order to rule out a hematologic neoplasm due to a 27-cm splenomegaly and pancytopenia

Sporotrichoid dissemination of cutaneous leishmaniasis possibly triggered by a diagnostic puncture

Case report: A 31 year old Spanish woman attended Hospital Clinic in Barcelona in August 2018, after working in La Paz (Bolivia) for six months. She remembered an insect bite on her right thigh, during a trip to Beni (Brazilian border) with progression to a papule with a central crater within one month. Treatment with oral moxicillin/clavulanic acid yielded no improvement. Thereupon, a diagnostic puncture of the ulcer was performed, with a positive result of polymerase chain eaction (PCR) for Leishmania spp. without bacterial isolates in the culture. She then decided to return to Spain for management

Mirroring the Zika epidemics in Cuba: The view from a European imported diseases clinic

Dear Editor, the changing epidemiology of Zika virus infection has been described before and in this letter we would like to show how the local epidemiology of Zika in Cuba is reflected in imported cases in returning travellers to Barcelona. The spread of the 2015 Zika epidemic was mostly reported in South America and the Caribbean. While increasing numbers of cases raised in South-America, Cuba was still free of cases. On 2nd March 2016 the first imported case from Cuba (Artemisa province) was reported. The first autochthonous case was reported on 16th March 2016 in La Habana. Onwards, cases were reported in Camagüey, Cienfuegos, Guantánamo, Havana and Santiago. During 2017 transmission has been reported in municipalities of Arroyo Naranjo and Regla in the province of Havana

Orientacions sobre la diversitat cultural i la salut

Diversitat cultural; Atenció sanitària; ImmigracióDiversidad cultural; Atención sanitaria; InmigraciónCultural diversity; Health care; ImmigrationEl respecte a la dignitat, a la llibertat i a la igualtat de les persones pot plantejar dubtes a l’hora de desenvolupar determinades pràctiques socials. L’àmbit sanitari és receptor de moltes peticions i fins i tot d’exigències que els professionals poden arribar a qüestionar dins la seva responsabilitat i el seu compromís social. Cada vegada amb més freqüència, s’adrecen al Comitè Consultiu de Bioètica sol·licituds d’orientació i aclariment respecte de problemes concrets. La via de la casuística circumstancial no sembla la millor manera d’afrontar els problemes actuals. Cal dur a terme una reflexió àmplia, que permeti comprendre la situació i fixar unes línies mestres per abordar els casos concrets. Aquesta és la tasca que s’intenta amb aquest document, és a dir, contribuir a fer el camí vers la comprensió de la diversitat cultural en l’àmbit de la salut, ja iniciat per altres grups institucionals

Skin manifestations in COVID-19: prevalence and relationship with disease severity

Background: Data on the clinical patterns and histopathology of SARS-CoV-2 related skin lesions, as well as on their relationship with the severity of COVID-19 are limited. Methods and Materials: Retrospective analysis of a prospectively collected cohort of patients with SARS-CoV-2 infection in a teaching hospital in Barcelona, Spain, from 1 April to 1 May 2020. Clinical, microbiological and therapeutic characteristics, clinicopathological patterns of skin lesions, and direct immunofluorescence and immunohistochemical findings in skin biopsies were analyzed. Results: Fifty-eight out of the 2761 patients (2.1%) either consulting to the emergency room or admitted to the hospital for COVID-19 suspicion during the study period presented COVID-19 related skin lesions. Cutaneous lesions could be categorized into six patterns represented by the acronym "GROUCH": Generalized maculo-papular (20.7%), Grover's disease and other papulo-vesicular eruptions (13.8%), livedo Reticularis (6.9%), Other eruptions (22.4%), Urticarial (6.9%), and CHilblain-like (29.3%). Skin biopsies were performed in 72.4%, including direct immunofluorescence in 71.4% and immunohistochemistry in 28.6%. Patients with chilblain-like lesions exhibited a characteristic histology and were significantly younger and presented lower rates of systemic symptoms, radiological lung infiltrates and analytical abnormalities, and hospital and ICU admission compared to the rest of patients. Conclusion: Cutaneous lesions in patients with COVID-19 appear to be relatively rare and varied. Patients with chilblain-like lesions have a characteristic clinicopathological pattern and a less severe presentation of COVID-19

C-reactive protein cut-off for early tocilizumab and dexamethasone prescription in hospitalized patients with COVID-19

Dexamethasone and tocilizumab have been associated with reduction in mortality, however, the beneficial effect is not for all patients and the impact on viral replication is not well defined. We hypostatized that C-reactive protein (CRP) could help in the identification of patients requiring anti-inflammatory therapy. Patients admitted for > 48 h in our hospital for a confirmed or suspected infection by SARS-CoV-2 from February 2020 to February 2021 were retrospectively evaluated. The primary outcome was mortality at 30 days. Demographics and the most relevant variables related with the outcome were included. CRP was stratified by percentiles. Univariate and multivariate analysis were performed. A total of 3218 patients were included with a median (IQR) age of 66 (74-78) years and 58.9% were males. The rate of intensive care unit admission was 24.4% and the 30-day mortality rate was 11.8%. Within the first 5 days from admission, 1018 (31.7%) patients received dexamethasone and 549 tocilizumab (17.1%). The crude analysis showed a mortality reduction in patients receiving dexamethasone when CRP was > 13.75 mg/dL and > 3.5 mg/dL for those receiving tocilizumab. Multivariate analysis identified the interaction of CRP > 13.75 mg/dL with dexamethasone (OR 0.57; CI 95% 0.37-0.89, P = 0014) and CRP > 3.5 mg/dL with tocilizumab (0.65; CI95%:0.44-0.95, P = 0.029) as independent predictors of mortality. Our results suggest that dexamethasone and tocilizumab are associated with a reduction in mortality when prescribed to patients with a certain inflammatory activity assessed by C-reactive protein