Juan Luis Muñoz Bellido

Relevance of eosinophilia and hyper-IgE in immigrant children.

AbstractImmigrants from undeveloped countries are a growing problem in Europe. Spain has become a frequent destination for immigrants (20% of whom are children) because of its geographic location and its historic and cultural links with Africa and Latin America. Eosinophilia is frequent in adult immigrants, travelers and expatriates coming from tropical areas. However, there are few studies that focus on the incidence and causes of tropical eosinophilia and hyper-IgE in immigrant children.We evaluated, prospectively, the prevalence and causes of eosinophilia and hyper-immunoglobulin E (IgE) in 362 immigrant children coming from Sub-Saharan Africa, Northern Africa and Latin America to Salamanca, Spain, between January 2007 and December 2011.Absolute eosinophilia and hyper-IgE were present in 22.9% and 56.8% of the analyzed children, respectively. The most frequent causes of absolute eosinophilia were filariasis (52.6%), strongyloidiasis (46.8%) and schistosomiasis (28.9%). Filariasis (41.9%), strongyloidiasis (29.6%) and schistosomiasis (22.2%) were the most frequent causes of increased levels of IgE. The area under the ROC curve showed similar values between eosinophil count and IgE levels in the diagnosis of helminthiasis (69% [95% confidence interval (CI) 63%–74%] vs 67% [95% CI 60%–72%], P = 0.24). Eosinophilia and hyper-IgE have a high value as biomarkers of helminthiasis in children coming from tropical and subtropical areas.

Risk Factors Associated with Colonization by Pneumococci with Reduced Susceptibility to Fluoroquinolones in Adult Outpatients

ABSTRACT We developed a case-control study in order to identify risk factors associated with pharyngeal colonization by Streptococcus pneumoniae with reduced susceptibility to fluoroquinolones (ciprofloxacin MIC, ≥4 μg/ml). A total of 400 patients were studied for colonization by quinolone-nonsusceptible S. pneumoniae (QNSP) isolates and risk factors for this colonization. Isolate susceptibility was determined by the agar dilution method. Forty patients were colonized by QNSP (case patients), and 360 patients were not colonized by QNSP (control patients). The MIC range of ciprofloxacin for QNSP isolates was 4 to 8 μg/ml. No isolates were resistant to levofloxacin and moxifloxacin. Risk factors significantly associated with QNSP colonization, according to univariate analysis, were recent hospitalizations (odds ratio [OR], 3.43; 95% confidence interval [CI], 1.6 to 7.2; P < 0.01) and prior exposure to fluoroquinolones (OR, 6.04; 95% CI, 3.0 to 12.0; P < 0.01). Other factors such as chronic obstructive pulmonary disease (OR, 1.94; 95% CI; 0.7 to 5.0), prior exposure to penicillins (OR, 1,68; 95% CI, 0.8 to 3.3) and prior exposure to macrolides (OR 2; 95% CI, 0.6 to 6.2) were more frequent among patients colonized with QNSP, but there was no statistical significance. Multivariate analysis showed that exposure to fluoroquinolones was the only independent factor associated with colonization by QNSP (OR, 4.2; 95% CI, 1.8 to 9.4; P < 0.01). Throat colonization by QNSP is becoming frequent, though most of these isolates (all the isolates in this case) remain susceptible to newer fluoroquinolones. Previous treatment with fluoroquinolones seems to be the main risk factor associated with colonization by QNSP.

Salmonella enterica Serovar Infantis Producing a CTX-M-9 β-Lactamase

Since extended-spectrum β-lactamases (ESBLs) were first described, some 20 years ago, these enzymes have been described in several species, including most enterobacteria. ESBLs have been described in some Salmonella enterica serovars ([5][1]) but remain infrequent in this genus. CTX-M-like β-

Current status of bacterial resistance to third-generation cephalosporins

A review of the evolution of bacterial resistance to third-generation cephalosporins is presented, focusing mainly on the prototypical member of this group-cefotaxime. Third-generation cephalosporins generally remain highly active against most Enterobacteriaceae, staphylococci, streptococci, Haemophilus, and Neisseriaceae. Only enterobacteria with a high frequency of mutant derepressed strains that hyperproduce chromosomally mediated beta-lactamase, Pseudomonas spp., and some glucose nonfermenter Gram-negative bacilli have demonstrated increased levels of resistance. The significance of derepressed strains and of the recently described extended-spectrum, plasmid-mediated beta-lactamases to the usefulness of the third-generation cephalosporins is discussed.

Hepatitis B reactivation in a hepatitis B surface antigen-negative patient after allogeneic bone marrow transplant: successful treatment with lamivudine and seroconversion☆

Hepatitis B reactivation in hepatitis B surface antigen (HBsAg)-negative and anti-HBsAg antibodies-positive patients is an infrequent complication of chemotherapy, usually with fatal evolution. Here we report an HBsAg-negative patient with a myelodysplastic syndrome, who developed hepatitis B reactivation after chemotherapy and evolved favorably after lamivudine treatment, allowing seroconversion.

Adverse reaction to bupivacaine.

DVERSE reactions to local anesthetics (LA) have A been widely described, and various mechanisms have been proposed to explain such reactions ( 1 ). Most of them are thought to be toxic, mainly after unintentional intravascular injection, eliciting cardiovascular and neurologic symptoms; other clinical manifestations include cutaneous and respiratory symptoms. Allergic reactions are rare ( 2 ) , and contact dermatitis is the most frequently described allergic reaction, mainly due to the ester class of LA. Bupivacaine is one of the LA most frequently used in medicine. In this paper, we report on a bizarre adverse reaction to bupivacaine.

Imported cystic echinococcosis in western Spain: a retrospective study.

BACKGROUND In Spain, 12% of the population are immigrants. The impact of immigration in Spain on cystic echinococcosis (CE) is unknown. The aim of this study was to describe the epidemiology of CE in immigrants in western Spain. METHODS First, a retrospective descriptive study of patients diagnosed with CE in the University Hospital of Salamanca (CAUSA) between January 1998 and December 2014 was designed. Second, we studied the seroprevalence of CE in sera from foreigners who received treatment in the Tropical Medicine Unit. RESULTS A total of 550 patients with new CE-related diagnoses were registered; of these, 16 (2.9%) were immigrants, of whom 10 (63%) were male. The age (mean±SD) was 34.6±12.8 years. The incidence rate of CE in immigrants was 8.76 cases per 105 person-years. Eight (50%) cases presented asymptomatically. Seroprevalence of CE in foreign patients was 2.3%. It was higher in North African population (4.2%), followed by sub-Saharan (2.4%) and Latin American (1.8%) (p=0.592) populations. The seroprevalence was higher in those who arrived recently (<12 months) vs those who arrived earlier (≥12 months), 3.5% vs 1.3% (p=0.077). CONCLUSIONS The epidemiological and clinical characteristics of CE in immigrants are different than those of the native population, and their influence on CE burden in our endemic area is still limited.

Unusual clinical presentations of Actinotignum (Actinobaculum) schaalii infection

Actinotignum (Actinobaculum) schaalii are considered commenal bacteria of the genital and urinary tract.1 They have been ransferred to a new genus, Actinotignum, along with A. urinale and . sanguinis.2 They are frequently overlooked because of their slow growth nd their difficult identification by conventional methods, and heir prevalence is very likely underestimated. Newer identificaion methods, such as MALDI-TOF MS, have made it an emerging athogen involved in UTIs, but also in other locations such as steomyelitis, bacteremia and skin infections.3 We describe three nusual clinical presentations of A. schaalii infections.

Should parasitic disease be investigated in immigrant children with relative eosinophilia from tropical and sub-tropical regions?

Background: Immigrants to Spain are mainly from low- and middle-income countries, and around 20% are children. Absolute eosinophilia is defined as >0.45×109 eosinophilic leucocytes/L of peripheral blood. Absolute eosinophilia in travelers and immigrants from tropical and sub-tropical areas is frequently associated with parasitic diseases. However, the significance of relative eosinophilia in immigrant children, defined as >5% eosinophilic leucocytes in those with <0.45×109 eosinophils/L, is unresolved. Objectives: To describe the importance of relative eosinophilia in a cohort of immigrant children (<18 years) from sub-Saharan Africa, North Africa and Latin America. Methods: 176 immigrant children without absolute eosinophilia were prospectively evaluated. Results: 25 of them (14.2%) had relative eosinophilia. 10 patients with relative eosinophilia had no diagnosis. 15 with relative eosinophilia (60%) were diagnosed with a parasitic disease, 7 (46.7%) of whom had only one parasite, while co-infection accounted for 8 of the 15 cases (53.3%). Of the parasitic infections, the most frequent causes of relative eosinophilia were filariasis spp. (7/15, 46.7%), strongyloides spp. (5/15, 33.3%), schistosoma spp. (4/15, 26.6%) and Ascaris lumbricoides (2/15, 13.3%). Conclusion: The findings suggest that relative eosinophilia is frequently associated with helminthic infection in immigrant children from tropical and sub-tropical areas, so a thorough parasitological study is highly advisable in this group of patients.

Estudio comparativo de la prevalencia de virus de papiloma humano en las mujeres españolas y extranjeras, participantes en un programa de cribado poblacional en Castilla y León

INTRODUCTION The objective of this study was to compare the prevalence of human papilloma virus (HPV) in Spanish and foreign women in a cervical cancer screening programme of Castilla y León and foreign women living in the community who participated in the programme. METHODS This was an observational, descriptive, cross - sectional, retrospective study of period prevalence. The sample consisted of all the women included in the cervical cancer prevention programme of the Regional Ministry of Health of the Junta de Castilla y León who were screened for cervical cancer during the period from 2012 to 2014, aged between 25 and 64 years of age. RESULTS Of the 190,203 cervical smear samples collected, 10.2% were foreign (n=19,329). The prevalence of HPV in the foreign women was 23.51%, significantly higher than in the Spanish women (P<.001). The presence of morphological and microbiological changes in the foreign women was also greater. CONCLUSIONS This study makes an important contribution, since it comprised a voluminous population screening sample. The prevalence of HPV in the foreign women was significantly higher than in the women born in Spain. It is important to continue studying this type of population, who are difficult to recruit for cultural reasons.