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Rev Esp Quimioter 2018; 31(6): 511-519

Description of Influenza B in seasonal epidemics in Spain

RAÚL ORTIZ DE LEJARAZU, JAVIER DÍEZ DOMINGO, ÁNGEL GIL DE MIGUEL, FEDERICO MARTINÓN TORRES, CARLOS GUZMÁN QUILO, JOSÉ MARÍA GUILLÉN, BLANCA PIEDRAFITA, ESTHER REDONDO MARGUELLO

Introduction. Seasonal influenza epidemics are a major public health concern. They are caused by the influenza A and B viruses; although the A virus is more prominent, influenza B virus infection causes a disease with similar characteristics. There are two phylogenetically distinct influenza B lineages (B/Victoria and B/Yamagata), only one of which is present in the trivalent vaccine formulated each season.
Methods. Epidemiological data from the Spanish Influenza Surveillance System for 2007 to 2017 were reviewed to establish the relative proportion of each type of virus and the characterization of the B lineages in relation to the composition of the trivalent vaccine.
Results. The median proportion of B (2007-2017) was 27.2% (0.7%-74.8%) vs. 16.3% (0.4%-98.6%) for A-H3 and 44.2% (0.1%-98.0%) for pandemic A-H1N1 (20092017). The B lineages co-circulated in 8/10 seasons and there was mismatch with the B vaccine strain in 4/10 seasons. The B virus was dominant in 2007/08 and 2012/13 throughout Spain. There was a combination of dominance/codominance of influenza B and mismatch with the vaccine lineage in at least one third of epidemic seasons reviewed.
Conclusions. Epidemiological information on influenza B has been less compiled in comparison with data on the A virus. Influenza virus type B is responsible for a significant number of cases in almost all seasons. The predominant B lineage in each season is unpredictable, affecting the protection conferred by the seasonal vaccine. Spanish epidemiological data support the rationale for a quadrivalent vaccine with both B virus lineages similarly to data from other settings.

Rev Esp Quimioter 2018; 31(6): 511-519  [Texto completo PDF]

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Rev Esp Quimioter 2018; 31(6): 494-505

Infectious postoperative endophthalmitis after cataract surgery performed over 7 years. The role of azithromycin versus ciprofloxacin eye drops

JOSEP TUÑÍ-PICADO, ANA MARTÍNEZ-PALMER, XÈNIA FERNÁNDEZ-SALA, JAIME BARCELÓ-VIDAL, MIGUEL CASTILLA-MARTÍ, YASMIN CARTAGENA-GUARDADO, SANTIAGO GRAU

Introduction. Although topical antibiotics have been used as antimicrobial prophylaxis after ocular surgery, recent studies have determined that intracameral cefuroxime at the end of surgery significantly reduce the risk to suffer an infection and suggest that the use of topical antibiotics in the prophylaxis of infectious postoperative endophthalmitis (IPOE) is controversial. Moreover, there is no evidence to confirm the higher effectiveness of topical ciprofloxacin, considered the standard of care, or topical azithromycin in preventing IPOE of cataract surgeries.
Patients and methods. IPOE topical prophylaxis was performed with two different strategies: with azithromycin from January 1st, 2010 to December 31st, 2014 (group I) and with ciprofloxacin from January 1st, 2015 to January 31st, 2017 (group II). Patient characteristics and clinical signs and symptoms of IPOE from all consecutive cataract surgeries performed over a 7-year period were collected.
Results. A total of 15,146 cataract surgeries were conducted; 10,756 in group I and 4,390 in group II. Two cases of IPOE in each group were diagnosed, showing a 0.019% and 0.046% rate respectively, with no statistically significance. IPOE cases were related with aging, systemic and ocular comorbidities or with a complicated cataract surgery.
Conclusions. The benefit of the application of topical antibiotics after cataract surgery is questionable when intracameral cefuroxime prophylaxis is performed and no better effectiveness with ciprofloxacin or azithromycin was observed.

Rev Esp Quimioter 2018; 31(6): 494-505  [Full-text PDF]

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Rev Esp Quimioter 2018; 31(6): 493-498

CD64 index as a marker of infection in patients with postoperative fever

NATALIA VICENTE LÓPEZ, RAFAEL FORÉS CACHÓN, REYES IRANZO VALERO, ANA LERMA VERDEJO, ELENA MÚÑEZ RUBIO, ANA ROYUELA VICENTE, ANTONIO RAMOS MARTÍNEZ

Objective. To evaluate the utility of the granulocyte CD64 index as a marker of infection in patients with postoperative fever.
Methods. Prospective observational study of a cohort of patients with postoperative fever (2nd-21st day after the intervention) collected during 14 months. Obtaining blood samples during the first 24 hours after the febrile peak to determine the CD64 index (ratio of fluorescence intensity, measured, in the granulocytes of the patient with respect to healthy controls), procalcitonin and C-reactive protein (CRP).
Results. During the study period, 50 patients were included, 28 patients (56%) with infection and 22 patients (44%) without evidence of infection. The PCR, procalcitonin and the CD64 index showed significantly higher values in the group of patients who suffered infection. The CD64 index showed a sensitivity of 88.9%, with a specificity of 65.2%. The positive predictive value (PPV) was 75% and the negative predictive value (NPV) was 83.3%, with an area under the curve (AUC) of 0.805 (95% CI 0.68-0.93). Procalcitonin presented a sensitivity of 53.9% and specificity of 86.4%, with NPV and PPV of 82.4% and 61.3% respectively, with AUC of 0.752 (95% CI 0.61-0.89). Regarding the PCR, it showed a sensitivity of 100%, with specificity of 4.4% with an area under the curve of 0.676 (95% CI 0.52-0.83).
Conclusions. The quantification of the CD64 index in patients who develop fever in the early postoperative period is useful to distinguish post-surgical inflammatory phenomena from episodes of established infection.

Rev Esp Quimioter 2018; 31(6): 493-498.  [Texto completo PDF]

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Rev Esp Quimioter 2018; 31(6): 537-541

In silico analysis of transferable QepA variants and related chromosomal efflux pumps

JOAQUIM RUIZ

Objectives. The present study aimed to detect the presence of undescribed QepA variants in GenBank records.
Material and methods. The DNA and amino acid sequences of QepA1 were compared with what is present in GenBank. Only annealings with a >80% identity were considered. No synthetic or partial sequences were included in the analyses.
Results. The results showed the presence of 10 different QepA variants, 6 of them which were previously non-designated as specific allelic variants. In addition, high identity levels with chromosomal MSF efflux pumps belonging to microorganisms of the Pseudorhodoferax genus and other Comamonadaceae were detected
Conclusions. The presence of undescribed QepA variants in GenBank is reported and the presence of related sequences among members of Burkholderiales order is described.

Rev Esp Quimioter 2018; 31(6): 537-541  [Full-text PDF]

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Rev Esp Quimioter 2018; 31(6): 506-510

Frequency of sero-positivity in household members of the patients with positive toxoplasma serology

MOHAMMAD REZA YAZDANI, ZEINAB MEHRABI, BEHROOZ ATAEI, AZAR BARADARAN GHAHFAROKHI, ROHOLLAH MOSLEMI, MORTEZA POURAHMAD

Introduction. Toxoplasma gondii is cause of a wide variety of infections in human. The aim of this study was; to evaluate the frequency of sero-positivity of the members in a family with a positive serologic person.
Methods. A case-control study with 170 enrolled units which was conducted in Iran in 2017. The units were settled into two group: I: the family members of seropositive individuals and II: the family members of seronegative individuals. The level of IgG and IgM anti-toxoplasma antibodies were evaluated by ELISA qualitative manner in both groups.
Results. Frequency of individuals with positive serology was 52.9% and 34.1% in group I and II, respectively (P value = 0.01).
Conclusion. Clusters of toxoplasma infection would be an event in the family members. Therefore evaluation of the family members (especially high risk persons) of a patient may be necessary.

Rev Esp Quimioter 2018;  31(6): 506-510  [Full-text PDF]

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Rev Esp Quimioter 2018; 31(6): 532-536

Spontaneous bacterial peritonitis caused by Listeria monocytogenes: eight case reports (1992-2017) and literature review

MARINA FERNÁNDEZ TORRES, ITZIAR ANGULO LÓPEZ, PATRICIA RUIZ BUENO, MARTA GONZÁLEZ MARTINEZ, CARLOS RUIZ DE ALEGRÍA PUIG, JESÚS RODRÍGUEZ LOZANO, JESÚS AGÜERO BALBÍN, JAVIER CRESPO GARCÍA, JORGE CALVO MONTES

Background. Spontaneous bacterial peritonitis (SBP) is a frequent and severe entity in patients with cirrhosis or ascites due to other causes. However, Listeria monocytogenes is a microorganism that has been scarcely identified as a causative agent of SBP.
Methods. In this study, a descriptive analysis of cases of L. monocytogenes SBP was carried out in our center for 26 years (1992-2017).
Results. A total of eight patients were diagnosed, with an average age of 58 years, with no differences in sex distribution and all of them were community acquired cases. Half of the patients had underlying liver disease, two of them active malignancies; one was undergoing continuous ambulatory peritoneal dialysis and the last one with hypertensive heart disease. Six (75%) of the patients received a third-generation cephalosporin as empirical treatment. The clinical course was favorable after receiving directed antibiotic treatment in five (62.5%) of the patients. However, three of them, under the age of 59, died. Serotyping of L. monocytogenes isolates revealed that half of them were serovar 4, two 1 / 2a and the remaining one 1 / 2c. All strains were susceptible to ampicillin, meropenem, erythromycin and cotrimoxazole.
Conclusions. We conclude by emphasizing the importance of taking this etiology into account in patients with underlying liver disease and with clinical or laboratory data suggesting SBP, mainly due to the need for specific antibiotic treatment different from conventionally empirically used.

Rev Esp Quimioter 2018; 31(6): 532-536  [Texto completo PDF]

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Rev Esp Quimioter 2018; 31(6): 528-531

Fake imported tropical diseases: A retrospective study

ÁNGELA ROMERO-ALEGRÍA, MICHELE HERNANDEZ CABRERA, VIRGINIA VELASCO-TIRADO, ELENA PISOS ÁLAMO, JAVIER PARDO-LLEDÍAS, NIEVES JAÉN SÁNCHEZ, MONCEF BELHASSEN-GARCÍA, JOSÉ LUIS PÉREZ ARELLANO

Background. When we evaluate a patient with a suspected imported disease we cannot forget to include any autochthonous causes that may mimic imported pathologies to avoid misdiagnosis and therapeutic delay.
Methods. A descriptive longitudinal retrospective study was designed with patients in whom an imported disease was suspected but who were finally diagnosed with autochthonous processes. The patients were selected from two internal medicine practices specializing in tropical diseases between 2008-2017 in Spain.
Results. We report 16 patients, 11 (68.7%) were males, and the mean age was 43.4 ± 13.7 years old. Thirteen patients (81.2%) were travellers. Half of the patients were from Latin America, 7 (43.5%) were from Africa, and 1 (6.2%) was from Asia. The time from trip to evaluation ranged between 1 week and 20 years (median, 4 weeks), and the mean time from evaluation to diagnosis was 58.4 ± 100.9 days. There were 5 (31.2%) cases of autochthonous infection, 5 (31.2%) cases of cancer, 2 (12.5%) cases of inflammatory disease, and 2 (12.5%) cases of vascular disease.
Conclusions. Travel or migration by a patient can sometimes be a confusing factor if an imported disease is suspected and may cause delays in the diagnosis and treatment of an autochthonous disease. We highlight that 1/3 of the patients with autochthonous diseases in this study had cancer. The evaluation of imported diseases requires a comprehensive approach by the internist, especially if he specializes in infectious and/or tropical diseases and is, therefore, the best qualified to make an accurate diagnosis.

Rev Esp Quimioter 2018; 31(6): 528-531  [Full-text PDF]

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Rev Esp Quimioter 2018; 31(5):461-484

Integral approach to the acute exacerbation of chronic obstructive pulmonary disease

JUAN GONZÁLEZ DEL CASTILLO, FRANCISCO JAVIER CANDEL, JAVIER DE LA FUENTE, FEDERICO GORDO, FRANCISCO JAVIER MARTÍN-SÁNCHEZ, ROSARIO MENÉNDEZ, ABEL MUJAL, JOSÉ BARBERÁN

Chronic obstructive pulmonary disease is a set of clinical processes that have in common a chronic and progressive obstruction to airflow, with episodes of exacerbation. These exacerbations are more frequent and severe over time, deteriorating the lung function. The main cause of exacerbations is bacterial infection. There are multiple guidelines and documents that statement the management of this pathology. However, they focus primarily on the treatment during the stable phase. This document addresses the problem of acute exacerbation due to an infection from a multidisciplinary perspective, focusing on the integral approach to the process, and including etiology, microbiological studies, resistance to antimicrobials, risk stratification and initial empirical therapeutic management (antibiotic and concomitant). In addition, it includes an approach to more complex aspects such as the management of special populations (elderly and immunosuppressed) or therapeutic failure. Finally, more controversial topics such as prophylaxis of infection or palliative treatment are specifically discussed.

Rev Esp Quimioter 2018; 31(5):461-484 [Texto completo PDF]

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Rev Esp Quimioter 2018; 31(5):439-442

Kingella kingae as a common cause of arthritis septic in children

MARTA ILLÁN-RAMOS, SARA GUILLÉN-MARTÍN, LUIS MANUEL PRIETO-TATO, JUANA BEGOÑA CACHO-CALVO, FERNANDO GONZÁLEZ-ROMO, LAURA FRANCISCO-GONZÁLEZ, JOSÉ TOMÁS RAMOS-AMADOR

Introduction. Kingella kingae is a common colonizer of the oropharynx in children that may lead to invasive infection, mainly osteoarticular infections. Invasive infections occur almost exclusively in young children, fundamentally fewer than two years old. K. kingae infections in children are probably underdiagnosed due to the difficulty in growing in routine cultures and the absence of systematic realization of molecular techniques to identify it. It is the most common bacteria involved in childhood osteoarticular infections in recent series and increasingly being recognized in Spain. We report our experience on the epidemiological and clinical characteristics of osteoarticular infections in children in recent years.
Patients and methods. Retrospective analysis of septic arthritis by K. kingae identified by PCR in joint fluid in children during 2010-2016. Epidemiological, clinical and laboratory characteristics are presented.
Results. Five arthritis by K. kingae were identified, all of them in ≤6 years old children. Median leukocytes, CRP and ESR were 12950 leukocytes/μL, 4.84 mg/dL and 58 mm/h respectively, and 61,322 leukocytes /μL in joint fluid. All patients evolved favorably.
Conclusions. Osteoarticular infections by K. kingae in children usually present low increase of inflammatory markers despite being invasive infections. The development of PCR in sterile samples has greatly improved the diagnostic yield of K. kingae infections improving the management of osteoarthritis in children.

Rev Esp Quimioter 2018; 31(5):439-442 [Texto completo PDF]

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Rev Esp Quimioter 2018; 31(5):435-438

Comparison of culture, microscopic smear and molecular methods in diagnosis of tuberculosis

ILHAN AFSAR, MERYEM GUNES, HAKAN ER, ASLI GAMZE SENER

Objectives. Tuberculosis (TB) is a public health problem worldwide, with the highest mortality . The development of nucleic acid-based tests for detection of Mycobacterium tuberculosis complex (MTBC) has significantly increased sensitivity compared to conventional smear microscopy and provides results within a matter of hours compared to weeks for solid culture, which is the current gold standart. The aim of this study was to compare the culture, microscopic smear and molecular method in the diagnosis of TB .
Material and methods. Seven hundred ninety specimens belonging to clinically suspected cases of TB were studied retrospectively. The specimens were grouped as respiratory and non-respiratory and the groups were compared for mycobacterial detection assays. The culture and the molecular diagnostic GeneXpert MTB/RIF (GX) assay method were compared.
Results. When culture was used as the reference standart, 32 (4.05%) specimens were positive for MTBC. Of the 32 culture positive clinical specimens 24 (3.03%) were respiratory and 8 (1.01%) were non-respiratory specimens. All 24 of the 24 respiratory specimens were positive by the GX test, Seven of the eight non-respiratory specimens positive for culture were positive by GX assay. Five of the seven hundred fifty-eight samples of culture negative were positive with GX assay. Sensitivity and specificity of GX were found to be 96.8 % and 99.3 %, respectively.
Concluisons. Molecular methods to acquire time in diagnosis as well as the increase in linearity gives a different perspective to the diagnosis of tuberculosis. The GX assay has a diagnostic utility for rapid diagnosis of TB.

Rev Esp Quimioter 2018; 31(5):435-438 [Full-text PDF]

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