Hidatidosis: evaluación epidemiológica en zona endémica

Tesis por compendio de publicaciones[ES]La hidatidosis humana es una zoonosis causada por Echicoccus granulosus, un cestodo cuyo hospedador definitivo es el perro, y en la que el hombre constituye un hospedador intermediario accidental. Debido al impacto en términos de morbilidad, la especial afectación en áreas desfavorecidas y la escasa inversión en investigación, esta enfermedad está incluida en el listado de enfermedades "olvidada" de la Organización Mundial de la Salud. Así el presente trabajo se centra en el estudio de la hidatidosis en España constituyéndola los siguientes artículos originales que responden a los objetivos planteados para la misma: 1)"Is cystic echinococcosis re-emerging in Western Spain?", 2)"Surveillance of Human Echinococcosis in Castilla-León (Spain) between 2000-2012", 3)"Situación epidemiológica de la hidatidosis en los centros hospitalarios del sistema público de salud de Extremadura". Además en el presenta trabajo también se incluye a modo de revisión bibliográfica el capítulo del libro "Epidemiology and Microbiology of Hepatic Echinococcosis" en el que se describe los aspectos más importantes de la epidemiología de la enfermedad a nivel mundial, así como su impacto económico

Clinical Spectrum of Schistosomiasis: An Update

Schistosomiasis is a helminthic infection and one of the neglected tropical diseases (NTDs). It is caused by blood flukes of the genus Schistosoma. It is an important public health problem, particularly in poverty-stricken areas, especially those within the tropics and subtropics. It is estimated that at least 236 million people worldwide are infected, 90% of them in sub-Saharan Africa, and that this disease causes approximately 300,000 deaths annually. The clinical manifestations are varied and affect practically all organs. There are substantial differences in the clinical presentation, depending on the phase and clinical form of schistosomiasis in which it occurs. Schistosomiasis can remain undiagnosed for a long period of time, with secondary clinical lesion. Here, we review the clinical profile of schistosomiasis. This information may aid in the development of more efficacious treatments and improved disease prognosis

Is babesiosis a rare zoonosis in Spain? Its impact on the Spanish Health System over 23 years

Background: Babesiosis is a zoonosis caused by an intraerythrocytic protozoan of the genus Babesia and transmitted mainly by ticks of the Ixodes spp. complex. There is no comprehensive global incidence in the literature, although the United States, Europe and Asia are considered to be endemic areas. In Europe, the percentage of ticks infected with Babesia spp. ranges from 0.78% to 51.78%. The incidence of babesiosis in hospitalized patients in Spain is 2.35 cases per 10,000,000 inhabitants/year. The mortality rate is estimated to be approximately 9% in hospitalized patients but can reach 20% if the disease is transmitted by transfusion. Objective: To analyze the epidemiological impact of inpatients diagnosed with babesiosis on the National Health System (NHS) of Spain between 1997 and 2019. Methodology: A retrospective longitudinal descriptive study that included inpatients diagnosed with babesiosis [ICD-9-CM code 088.82, ICD-10 code B60.0, cases ap2016-2019] in public Spanish NHS hospitals between 1 January 1997 and 31 December 2019 was developed. Data were obtained from the minimum basic dataset (CMBD in Spanish), which was provided by the Ministerio de Sanidad, Servicios Sociales e Igualdad after the receipt of a duly substantiated request and the signing of a confidentiality agreement. Main findings: Twenty-nine inpatients diagnosed with babesiosis were identified in Spain between 1997 and 2019 (IR: 0.28 cases/10,000,000 person-years). A total of 82.8% of the cases were men from urban areas who were approximately 46 years old. The rate of primary diagnoses was 55.2% and the number of readmissions was 79.3%. The mean hospital stay was 20.3±19.2 days, with an estimated cost of €186,925.66. Two patients, both with secondary diagnoses of babesiosis, died in our study. Conclusions: Human babesiosis is still a rare zoonosis in Spain, with an incidence rate that has been increasing over the years. Most cases occurred in middle-aged men from urban areas between summer and autumn. The Castilla-La-Mancha and Extremadura regions recorded the highest number of cases. Given the low rate of primary diagnoses (55.2%) and the high number of readmissions (79.3%), a low clinical suspicion is likely. There was a 6.9% mortality in our study. Both patients who died were patients with secondary diagnoses of the disease

The educational challenge in infectious diseases: analysis of Official Master's degrees in Spain

[EN] Introduction: Infectious diseases are one of the main causes of morbidity and mortality worldwide. In this way, the Spanish University has increased and complemented postgraduate training with an offer of its own degrees and official master's degrees that seek the most advanced specialization and updating, whether professional or research, in ​​knowledge of infectious diseases. Aim: To know and evaluate the current offer of master's degrees related to infectious diseases in Spanish universities. Methods: Literature review carried out in the months of February-March 2022 for the collection of information on postgraduate studies, specifically Official Master's Degree studies, offered in Health Sciences in Spanish Universities. Results: From the year 2005, when the "Master's Degree in Tropical Parasitic Diseases" was established, until the year 2022, 11 postgraduate studies related to infectious diseases have been implemented in 10 Spanish universities. Most of them have one-year duration and an average teaching load of 70.91±20.23 ECTS-credits. Average number of students per course: 26.27±5.98. Average price: €3,095.8±2,479.4. There are currently master's degrees in 8 autonomous communities, and non-face-to-face formats are gaining notoriety. Conclusions: The exponential growth in the number of master's degrees in Spain in recent years demonstrates the growing interest and updating needs in this area of ​​knowledge. Although the offer is extensive, it is neither homogeneous nor balanced, presenting potential areas for significant improvement. Health organizations and scientific societies should promote the relationship between the different levels of postgraduate training.[ES] Introducción: Las enfermedades infecciosas son una de las principales causas de morbimortalidad. Por ello, la Universidad Española ha incrementado y complementado la formación postgrado con una oferta de Títulos Propios y Másteres Oficiales que buscan la especialización y actualización más avanzada, ya sea profesional o investigadora, en esta área de conocimiento. Objetivo: Conocer y evaluar la oferta actual de másteres relacionados con las enfermedades infecciosas en las universidades españolas. Métodos: Revisión bibliográfica realizada en los meses de febrero-marzo 2022 para recoger información sobre estudios de Postgrado, específicamente estudios de Máster Oficial, en el área de Ciencias de la Salud en las Universidades españolas. Resultados: Desde 2005 en que se instauró el Máster Universitario en Enfermedades Parasitarias Tropicales , hasta 2022, se han implantado 11 estudios de postgrado relacionados con las enfermedades infecciosas en 10 universidades españolas. La mayoría tienen una duración de un año y una carga docente media de 70,91±20,23 créditos-ECTS. Número medio de alumnos: 26,27±5,98. Precio medio: 3.095,8±2.479,4 . Existen actualmente másteres en 8 comunidades autónomas y los formatos no presenciales van adquiriendo notoriedad. Conclusiones: El crecimiento exponencial del número de másteres en España en los últimos años, demuestra el interés creciente y las necesidades de actualización en esta área de conocimiento. Aunque la oferta es extensa, no es homogénea ni equilibrada, presentando áreas potenciales de mejora significativa. Organismos sanitarios y sociedades científicas deberían fomentar la relación entre los diferentes estamentos de la formación de postgrado.Belhassen García, M.; Hernández-Goenaga, J.; Alonso-Sardón, M.; López-Bernús, A.; Rodríguez-Alonso, B.; Pardo-Lledías, J.; Del Olmo, E.... (2023). El reto formativo en enfermedades infecciosas: análisis de los Másteres Oficiales en España. REDU. Revista de Docencia Universitaria. 21(2):117-131. https://doi.org/10.4995/redu.2023.1879211713121

How Has the Aspergillosis Case Fatality Rate Changed over the Last Two Decades in Spain?

Background: Aspergillus produces high morbidity and mortality, especially in at-risk populations. In Spain, the evolution of mortality in recent years due to this fungus is not well established. The aim of this study was to estimate the case fatality rate of aspergillosis in inpatients from 1997 to 2017 in Spain. (2) Methodology: A retrospective descriptive study was conducted with records of inpatients admitted to the National Health System with a diagnosis of aspergillosis. (3) Principal findings: Of 32,960 aspergillosis inpatients, 24.5% of deaths were registered, and 71% of the patients who died were men. The percentage of deaths increased progressively with age. The case fatality rate progressively decreased over the period, from 25.4 and 27.8% in 1997–1998 to values of 20.6 and 20.8% in 2016 and 2017. Influenza and pneumonia occurrence/association significantly increased case fatality rates in all cases. (4) Conclusions: Our study shows that lethality significantly decreased in the last two decades despite the increase in cases. This highlights the fact that patients with solid and/or hematological cancer do not have a much higher mortality rate than the group of patients with pneumonia or influenza alone, these two factors being the ones that cause the highest CFRs. We also need studies that analyze the causes of mortality to decrease it and studies that evaluate the impact of COVID-19.Peer reviewe

High frequency of low-count monoclonal B-cell lymphocytosis in hospitalized COVID-19 patients

Low-count monoclonal B-cell lymphocytosis (MBLlo, <500 clonal B-cells/μL) is a highly prevalent condition in the general population (4% to 16% of otherwise healthy adults), which increases significantly with age.1-7 In most cases, clonal B-cells share phenotypic and cytogenetic features with chronic lymphocytic leukemia (CLL), but only a small fraction (≈1.8%) progresses to high-count MBL (MBLhi; ≥500 and <5000 clonal B-cells/μL)3 in the medium-term.8 However, previous reports showed that MBLlo subjects had an increased risk of severe infections in association with a (predominantly) secondary antibody deficiency,8-10 suggesting that MBLlo might be a risk marker for developing more severe infections.This work was supported by the Instituto de Salud Carlos III (Ministerio de Ciencia e Innovación, Madrid, Spain, and FONDOS FEDER (a way to build Europe) grants CB16/12/00400 (CIBERONC), COV20/00386, and PI17/00399; the Consejería de Educación and the Gerencia Regional de Salud, Consejería de Sanidad from Junta de Castilla y León (Valladolid, Spain) grants SA109P20 and GRS-COVID-33/A/20; the European Regional Development Fund (INTERREG POCTEP Spain-Portugal) grant 0639-IDIAL-NET-3-3; and the CRUK (United Kingdom), Fundación AECC (Spain), and Associazione Italiana per la Ricerca Sul Cancro (Italy) “Early Cancer Research Initiative Network on MBL (ECRINM3)” ACCELERATOR award. G.O.-A. is supported by a grant from the Consejería de Educación, Junta de Castilla y León (Valladolid, Spain); B.F.-H. was supported by grant 0639-IDIAL-NET-3-3.Peer reviewe

Clonal chromosomal mosaicism and loss of chromosome Y in elderly men increase vulnerability for SARS-CoV-2

The pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, COVID-19) had an estimated overall case fatality ratio of 1.38% (pre-vaccination), being 53% higher in males and increasing exponentially with age. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, we found 133 cases (1.42%) with detectable clonal mosaicism for chromosome alterations (mCA) and 226 males (5.08%) with acquired loss of chromosome Y (LOY). Individuals with clonal mosaic events (mCA and/or LOY) showed a 54% increase in the risk of COVID-19 lethality. LOY is associated with transcriptomic biomarkers of immune dysfunction, pro-coagulation activity and cardiovascular risk. Interferon-induced genes involved in the initial immune response to SARS-CoV-2 are also down-regulated in LOY. Thus, mCA and LOY underlie at least part of the sex-biased severity and mortality of COVID-19 in aging patients. Given its potential therapeutic and prognostic relevance, evaluation of clonal mosaicism should be implemented as biomarker of COVID-19 severity in elderly people. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, individuals with clonal mosaic events (clonal mosaicism for chromosome alterations and/or loss of chromosome Y) showed an increased risk of COVID-19 lethality

Detection of SARS-CoV-2 RNA in Urine by RT-LAMP: A Very Rare Finding

Detection of SARS-CoV-2 is routinely performed in naso/oropharyngeal swabs samples from patients via RT-qPCR. The RT-LAMP technology has also been used for viral RNA detection in respiratory specimens with both high sensitivity and specificity. Recently, we developed a novel RT-LAMP test for SARS-CoV-2 RNA detection in nasopharyngeal swab specimens (named, N15-RT-LAMP) that can be performed as a single-tube colorimetric method, in a real-time platform, and as dry-LAMP. To date, there has been very little success in detecting SARS-CoV-2 RNA in urine by RT-qPCR, and the information regarding urine viral excretion is still scarce and not comprehensive. Here, we tested our N15-RT-LAMP on the urine of 300 patients admitted to the Hospital of Salamanca, Spain with clinical suspicion of COVID-19, who had a nasopharyngeal swab RT-qPCR-positive (n = 100), negative (n = 100), and positive with disease recovery (n = 100) result. The positive group was also tested by RT-qPCR for comparison to N15-RT-LAMP. Only a 4% positivity rate was found in the positive group via colorimetric N15-RT-LAMP and 2% via RT-qPCR. Our results are consistent with those obtained in other studies that the presence of SARS-CoV-2 RNA in urine is a very rare finding. The absence of SARS-CoV-2 RNA in urine in the recovered patients might suggest that the urinary route is very rarely used for viral particle clearance

Recurrence of cystic echinococcosis in an endemic area: a retrospective study

Abstract Background Cystic echinococcosis (CE) is a chronic, complex and neglected zoonotic disease. CE occurs worldwide. In humans, it may result in a wide spectrum of clinical manifestations, ranging from asymptomatic infection to fatal disease. Clinical management procedures have evolved over decades without adequate evaluation. Despite advances in surgical techniques and the use of chemotherapy, recurrence remains one of the major problems in the management of hydatid disease. The aim of this study was to determine the frequency of CE recurrence and the risk factors involved in recurrence. Methods A descriptive longitudinal-retrospective study was designed. We reviewed all patients diagnosed with CE according to ICD-9 (code 122–0 to 122–9) criteria admitted at Complejo Asistencial Universitario de Salamanca, Spain, between January 1998 and December 2015. Results Among the 217 patients studied, 25 (11.5%) had a hydatid recurrence after curative intention treatment. Median duration of recurrence’s diagnosis was 12.35 years (SD: ±9.31). The likelihood of recurrence was higher [OR = 2.7; 95% CI, 1.1–7.1; p  0.05] that was two times higher in those patients treated with a combination of antihelminthic treatments and surgical intervention (20/141, 14.2%) than in patients treated with surgical intervention alone (5/76, 6.6%). Conclusions Despite advances in diagnosis and therapeutic techniques in hydatid disease, recurrence remains one of the major problems in the management of hydatid disease. The current management and treatment of recurrences is still largely based on expert opinion and moderate-to-poor quality of evidence. Consequently, large prospective and multicenter studies will be needed to provide definitive recommendations for its clinical management

New circulation of genotype V of Crimean-Congo haemorrhagic fever virus in humans from Spain.

Crimean-Congo haemorrhagic fever (CCHF) is a widespread tick-borne viral disease caused by the Crimean-Congo haemorrhagic fever virus (CCHFV). CCHFV has been implicated in severe viral haemorrhagic fever outbreaks. During the summer of 2016, the first two cases with genotype III (Africa 3) were reported in Spain. The first objective of our study was to determine the presence of CCHFV among patients with febrile illness during the spring and summer periods in 2017 and 2018. Finally, we perform a phylogenetic analysis to determine the genotype of the virus. We prospectively evaluated patients aged 18 years and older who came to the emergency department at the Salamanca's University Hospital (HUS) with fever. Specific IgM and IgG antibodies against CCHFV by ELISA and one immunofluorescence assay against two different proteins (nucleoprotein and glycoprotein C) was done. Moreover, molecular detection by Real Time PCR was performed in all collected samples. A phylogenetic analysis was carried out to genetically characterize CCHFV detected in this study. A total of 133 patients were selected. The mean age was 67.63 years and 60.9% were male. One-third of the patients presented an acute undifferentiated febrile illness. Three patients had anti-CCHFV IgG antibodies, suggesting a previous infection. One patient had anti-CCHFV IgM antibodies and a confirmatory RT-PCR. Phylogenetic analysis indicated that the virus corresponds to the European genotype V. This patient came to the emergency department at HUS in August 2018 presenting an acute febrile syndrome with thrombopenia and liver impairment. We describe a new circulation of European genotype V CCHFV in Spain. Moreover, this study suggests that CCHFV is an identifiable cause of febrile illness of unknown origin in Spain. Thus, CCHF could be suspected in patients with fever, liver damage, and/or haemorrhagic disorders, particularly in people with risk activities who present in the spring or summer.This study was supported by the Institute of Health Carlos III, ISCIII, Spain (www.isciii.es) RICET, RD16/0027/0018 and RD16CIII/0003/0003 CNM/ISCIII-D, with European Union co-financing by FEDER (Fondo Europeo de Desarrollo Regional) ‘Una manera de hacer Europa’ to LMA. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.S