Background
Fluconazole‐resistant Candida parapsilosis is a matter of concern.
Objectives
To describe fluconazole‐resistant C. parapsilosis genotypes circulating across hospitals in Spain and Rome and ...to study their azole‐resistance profile associated with ERG11p substitutions.
Patients/Methods
We selected fluconazole‐resistant C. parapsilosis isolates (n = 528 from 2019 to 2023; MIC ≥8 mg/L according to EUCAST) from patients admitted to 13 hospitals located in five Spanish cities and Rome. Additionally, we tested voriconazole, posaconazole, isavuconazole, amphotericin B, micafungin, anidulafungin and ibrexafungerp susceptibility.
Results
Of the 53 genotypes found, 49 harboured the Y132F substitution, five of which were dominating city‐specific genotypes involving almost half the isolates. Another genotype involved isolates harbouring the G458S substitution. Finally, we found two genotypes with the wild‐type ERG11 gene sequence and one with the R398I substitution. All isolates were fully susceptible/wild‐type to amphotericin B, anidulafungin, micafungin and ibrexafungerp. The azole‐resistance patterns found were: voriconazole‐resistant (74.1%) or voriconazole‐intermediate (25.2%), posaconazole‐resistant (10%) and isavuconazole non‐wild‐type (47.5%). Fluconazole‐resistant and voriconazole non‐wild‐type isolates were likely to harbour substitution Y132F if posaconazole was wild type; however, if posaconazole was non‐wild type, substitution G458S was indicated if isavuconazole MIC was >0.125 mg/L or substitution Y132F if isavuconazole MIC was ≤0.125 mg/L.
Conclusions
We detected a recent clonal spread of fluconazole‐resistant C. parapsilosis across some cities in Spain, mostly driven by dominating city‐specific genotypes, which involved a large number of isolates harbouring the Y132F ERG11p substitution. Isolates harbouring substitution Y132F can be suspected because they are non‐susceptible to voriconazole and rarely posaconazole‐resistant.
Objectives
Imported Chagas disease (CD) is an emerging health problem in Europe due to immigration from endemic countries. Although WHO currently recommends two different serological methods to ...establish diagnosis, new tools like the ARCHITECT Chagas assay have potential for use as a single diagnostic test. Our objective was to determine an optimal signal‐to‐cut‐off (S/CO) value for the ARCHITECT Chagas assay to diagnose CD with a single test.
Methods
A retrospective study conducted at the 12 de Octubre University Hospital (Madrid, Spain). All patients with requests for Chagas screening between January 2014 and August 2017 were consecutively included. All samples were routinely tested with the ARCHITECT assay. Negative samples (S/CO < 0.8) required no further testing. Immunochromatographic testing (ICT) and/or indirect immunofluorescence (IFI) was used to confirm samples with S/CO ≥ 0.8. Receiver operator characteristic (ROC) curve analysis determined the ARCHITECT S/CO value that yielded 100% specificity and positive predictive value. SPSS software, version 22.0 was used for data analysis.
Results
A total of 4153 samples were analysed; 361 (8.69%) gave a reactive ARCHITECT Chagas result. 261/361 (72.3%) were women; median age was 38 years old (2–79). 92.8% were Bolivian. A total of 307 (85.0%) were confirmed as cases of Chagas; 52 (14.4%) were not infected; two (0.6%) were not evaluable. Seroprevalence was 7.39%. An S/CO ≥ 3.80 yielded 100% specificity (95% confidence interval CI, 0.93–1.00) and 100% positive predictive value (95% CI, 0.99–1.00).
Conclusions
Using S/CO ≥ 3.80, the ARCHITECT Chagas could be used as a single test for diagnosis of chronic CD in Bolivian immigrants. Patients with S/CO between 0.80 and 3.80 would require additional testing.
Objectifs
La maladie de Chagas (MC) importée est un problème de santé émergent en Europe dû à l'immigration en provenance des pays d'endémie. Bien que l’OMS recommande actuellement deux méthodes sérologiques différentes pour établir le diagnostic, de nouveaux outils comme le test Architect Chagas pourraient être utilisés comme test unique de diagnostic. Notre objectif était de déterminer une valeur seuil optimale du signal (S/CO) pour le test Architect Chagas afin de pouvoir diagnostiquer la MC à l'aide d'un seul test.
Méthodes
Une étude rétrospective menée à l'Hôpital Universitaire du 12 octobre, à Madrid, en Espagne. Tous les patients requérant un dépistage de la MC entre janvier 2014 et août 2017 ont été inclus consécutivement. Tous les échantillons ont été testés en routine avec le test Architect. Les échantillons négatifs (valeur S/CO < 0,8) n'ont pas nécessité de test supplémentaire. Le test immunochromatographique (ICT) et/ou à immunofluorescence indirecte (IFI) ont été utilisés pour confirmer les échantillons avec une valeur S/CO > 0,8. L'analyse de la courbe caractéristique du récepteur (ROC) a permis de déterminer la valeur S/CO du test Architect donnant une spécificité et une valeur prédictive positive de 100%. Le logiciel SPSS, version 22.0, a été utilisé pour l'analyse des données.
Résultats
4153 échantillons ont été analysés; 361 (8,69%) ont donné un résultat réactif avec Architecte Chagas. 261/361 (72,3%) provenaient de femmes; l’âge médian était de 38 ans (2 à 79). 92,8% étaient des boliviens. 307 (85,0%) ont été confirmés comme des cas de Chagas; 52 (14,4%) n’étaient pas infectés; 2 (0,6%) n’étaient pas évaluables. La séroprévalence était de 7,39%. Une valeur S/CO > 3,80 donnait une spécificité de 100% (IC95%: 0,93‐1,00) et une valeur prédictive positive de 100% (IC95%: 0,99‐1,00).
Conclusions
En utilisant une valeur S/CO de 3,80, le test Architecte Chagas pourrait être utilisé comme un test unique pour le diagnostic de la MC chronique chez les immigrants boliviens. Les patients avec une valeur S/CO comprise entre 0,80 et 3,80 nécessiteraient des tests supplémentaires.
In this retrospective cohort study, we aimed to assess whether introducing benznidazole at escalating doses reduces the probability of adverse events or treatment discontinuation compared with a ...full-dose scheme. We collected data from patients who had chronic
infection and underwent treatment from July 2008 to January 2017 in a referral center in Madrid. Dose was adjusted to body weight (5 mg/kg/day), with treatment introduction with full dose or escalating dose according to local consensus and protocols. Among the 62 patients treated, benznidazole was introduced at full dose in 28 patients and on escalating dose in the remaining 34. We found no statistical differences in the number of adverse events, treatment discontinuations, days of treatment, or sociodemographic profiles. There is insufficient evidence to support escalating dose as a strategy for reducing the adverse effects of benznidazole. Further research is needed to evaluate this approach.
During a visceral leishmaniasis outbreak in an area of Madrid, Spain, the incidence of disease among solid organ transplant recipients was 10.3% (7/68). Being a black person from sub-Saharan Africa, ...undergoing transplantation during the outbreak, and residing <1,000 m from the epidemic focus were risk factors for posttransplant visceral leishmaniasis.
Migration has contributed to the emergence of certain infectious diseases. To determine which infectious diseases were most common among 2 mobile immigrant groups (sub-Saharan Africans and Latin ...Americans) in Spain, we analyzed health and demographic characteristics of 2,198 immigrants referred to the Tropical Medicine Unit of Ramon y Cajal Hospital over a 20-year period. The most frequent diagnoses were for latent tuberculosis (716 patients 32.6%), filariasis (421 19.2%), hepatropic virus chronic infection (262 19.2%), intestinal parasites (242 11.0%), and malaria (212 9.6%). Health screening of immigrant populations is needed to ensure early diagnosis and treatment of potentially transmissible infections.
Malaria is currently the most important human parasitic disease in the world responsible for high morbidity and mortality. Appropriate diagnostic methods are essential for early detection. Microscopy ...examination remains the gold standard, although molecular techniques have higher sensitivity and are very useful in cases of low parasitaemia and mixed infections. The objective of this study was to evaluate a new commercial molecular diagnostic technique.
A prospective, observational, multicentre study was performed between January 2015 and April 2017. All participants were immigrants from malaria-endemic areas, who were divided into two groups: asymptomatic group and symptomatic. Samples from both groups were evaluated by a rapid diagnostic test (ImmunoQuick
Malaria + 4 RDT), microscopy examination, and two commercial molecular malaria tests (FTD Malaria and FTD Malaria Differentiation), then compared against an in-house reference PCR technique.
In all, 250 patients were included: 164 (65.6%) in the asymptomatic group, and 86 (34.4%) in the symptomatic group. There were seven cases of asymptomatic parasitaemia (prevalence = 2.8%) that were detected only by molecular methods. In the symptomatic group, there were seven cases of submicroscopic malaria. The main species detected was Plasmodium falciparum (96.6%). The commercial molecular technique had higher sensitivity than the other methods (S = 96%) and a high rate of concordance with the in-house reference PCR technique (Kappa score = 0.93).
The molecular techniques, although slower than microscopy, have adequate diagnostic accuracy and are very useful for the detection of P. falciparum in cases with low parasitaemia.
To determine whether increased migration is associated with an increase in incidence of toxocariasis (visceral larva migrans), we analyzed clinical data obtained from immigrants from Latin America. ...Although infection with Toxocara sp. roundworm larvae is distributed worldwide, seroprevalence is highest in tropical and subtropical areas.
The neglected tropical diseases (NTDs) cause significant morbidity and mortality worldwide. Due to the growth in international travel and immigration, NTDs may be diagnosed in countries of the ...western world, but there has been no specific focus in the literature on imported NTDs.
Retrospective study of a cohort of immigrants and travelers diagnosed with one of the 13 core NTDs at a Tropical Medicine Referral Unit in Spain during the period April 1989-December 2007. Area of origin or travel was recorded and analyzed.
There were 6168 patients (2634 immigrants, 3277 travelers and 257 VFR travelers) in the cohort. NTDs occurred more frequently in immigrants, followed by VFR travelers and then by other travelers (p<0.001 for trend). The main NTDs diagnosed in immigrants were onchocerciasis (n = 240, 9.1%) acquired mainly in sub-Saharan Africa, Chagas disease (n = 95, 3.6%) in immigrants from South America, and ascariasis (n = 86, 3.3%) found mainly in immigrants from sub-Saharan Africa. Most frequent NTDs in travelers were: schistosomiasis (n = 43, 1.3%), onchocerciasis (n = 17, 0.5%) and ascariasis (n = 16, 0.5%), and all were mainly acquired in sub-Saharan Africa. The main NTDs diagnosed in VFR travelers were onchocerciasis (n = 14, 5.4%), and schistosomiasis (n = 2, 0.8%).
The concept of imported NTDs is emerging as these infections acquire a more public profile. Specific issues such as the possibility of non-vectorial transmission outside endemic areas and how some eradication programmes in endemic countries may have an impact even in non-tropical western countries are addressed. Recognising NTDs even outside tropical settings would allow specific prevention and control measures to be implemented and may create unique opportunities for research in future.
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