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Hasan MM, Proma SB, Hossain MS, Arifuzzaman M, Islam N, Siddique MAB, Amiruzzaman. A case report on para-kala-azar dermal leishmaniasis: an unresolved mystery. BMC Infect Dis 2023; 23:885. [PMID: 38110894 PMCID: PMC10729440 DOI: 10.1186/s12879-023-08918-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 12/14/2023] [Indexed: 12/20/2023] Open
Abstract
BACKGROUND Post-kala-azar dermal leishmaniasis (PKDL) is a dermatosis that occurs 2-3 years after an apparently successful treatment of visceral leishmaniasis (VL). In rare cases, PKDL occurs concurrently with VL and is characterized by fever, splenomegaly, hepatomegaly or lymphadenopathy, and poor nutritional status and is known as Para-kala-azar dermal leishmaniasis (Para-KDL). Co-association of active VL in PKDL patients is documented in Africa, but very few case reports are found in South Asia. We present a case of Para-kala-azar Dermal Leishmaniasis (Para-KDL) in a 50-year-old male patient with a history of one primary Visceral Leishmaniasis (VL) and 2 times relapse of Visceral Leishmaniasis (VL). The patient presented with fever, skin lesions, and hepatosplenomegaly. Laboratory tests revealed LD bodies in the slit skin smear and splenic biopsy. The patient was treated with two cycles of Amphotericin B with Miltefosine in between cycles for 12 weeks to obtain full recovery. CONCLUSION This case report serves as a reminder that Para-kala-azar dermal leishmaniasis can develop as a consequence of prior visceral leishmaniasis episodes, even after apparently effective therapy. Since para-kala-azar is a source of infectious spread, endemics cannot be avoided unless it is effectively recognized and treated.
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Affiliation(s)
- Md Mehedi Hasan
- Department of Medicine, Sir Salimullah Medical College Mitford Hospital, Dhaka, Bangladesh.
| | - Sanghita Banik Proma
- Department of Medicine, Sir Salimullah Medical College Mitford Hospital, Dhaka, Bangladesh.
| | - Md Saddam Hossain
- Department of Medicine, Sir Salimullah Medical College Mitford Hospital, Dhaka, Bangladesh
| | | | - Naylla Islam
- Department of Medicine, Sir Salimullah Medical College Mitford Hospital, Dhaka, Bangladesh
| | | | - Amiruzzaman
- Department of Medicine, Sir Salimullah Medical College Mitford Hospital, Dhaka, Bangladesh
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Lourenço EMG, da Silva F, das Neves AR, Bonfá IS, Ferreira AMT, Menezes ACG, da Silva MEC, Dos Santos JT, Martines MAU, Perdomo RT, Toffoli-Kadri MC, G Barbosa E, Saba S, Beatriz A, Rafique J, de Arruda CCP, de Lima DP. Investigation of the Potential Targets behind the Promising and Highly Selective Antileishmanial Action of Synthetic Flavonoid Derivatives. ACS Infect Dis 2023; 9:2048-2061. [PMID: 37772925 DOI: 10.1021/acsinfecdis.3c00336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/30/2023]
Abstract
Leishmaniases are among the neglected tropical diseases that still cause devastating health, social, and economic consequences to more than 350 million people worldwide. Despite efforts to combat these vector-borne diseases, their incidence does not decrease. Meanwhile, current antileishmanial drugs are old and highly toxic, and safer presentations are unaffordable to the most severely affected human populations. In a previous study by our research group, we synthesized 17 flavonoid derivatives that demonstrated impressive inhibition capacity against rCPB2.8, rCPB3, and rH84Y. These cysteine proteases are highly expressed in the amastigote stage, the target form of the parasite. However, although these compounds have been already described in the literature, until now, the amastigote effect of any of these molecules has not been proven. In this work, we aimed to deeply analyze the antileishmanial action of this set of synthetic flavonoid derivatives by correlating their ability to inhibit cysteine proteases with the action against the parasite. Among all the synthesized flavonoid derivatives, 11 of them showed high activity against amastigotes of Leishmania amazonensis, also providing safety to mammalian host cells. Furthermore, the high production of nitric oxide by infected cells treated with the most active cysteine protease B (CPB) inhibitors confirms a potential immunomodulatory response of macrophages. Besides, considering flavonoids as multitarget drugs, we also investigated other potential antileishmanial mechanisms. The most active compounds were selected to investigate another potential biological pathway behind their antileishmanial action using flow cytometry analysis. The results confirmed an oxidative stress after 48 h of treatment. These data represent an important step toward the validation of CPB as an antileishmanial target, as well as aiding in new drug discovery studies based on this protease.
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Affiliation(s)
- Estela M G Lourenço
- Laboratório de Síntese e Transformação de Moléculas Orgânicas -SINTMOL, Instituto de Química, Universidade Federal de Mato Grosso do Sul, Av. Senador Filinto Muller, Campo Grande, 79074-460 MS, Brazil
| | - Fernanda da Silva
- Laboratório de Parasitologia Humana, Instituto de Biociências, Universidade Federal de Mato Grosso do Sul, Campo Grande, 79070-900, MS, Brazil
| | - Amarith R das Neves
- Laboratório de Parasitologia Humana, Instituto de Biociências, Universidade Federal de Mato Grosso do Sul, Campo Grande, 79070-900, MS, Brazil
| | - Iluska S Bonfá
- Laboratório de Farmacologia e Inflamação, Faculdade de Ciências Farmacêuticas, Alimentos e Nutrição, Universidade Federal de Mato Grosso do Sul, Campo Grande, 79074-460 MS, Brazil
| | - Alda Maria T Ferreira
- Laboratório de Imunologia, Biologia Molecular e Bioensaios Instituto de Biociências, Universidade Federal de Mato Grosso do Sul, Campo Grande, 79070-900 MS, Brazil
| | - Adriana C G Menezes
- Biotério Central, Universidade Federal de Mato Grosso do Sul, Campo Grande, 79070-900 MS, Brazil
| | - Maria E C da Silva
- Laboratório de Síntese e Transformação de Moléculas Orgânicas -SINTMOL, Instituto de Química, Universidade Federal de Mato Grosso do Sul, Av. Senador Filinto Muller, Campo Grande, 79074-460 MS, Brazil
| | - Jéssica T Dos Santos
- Laboratório de Síntese e Transformação de Moléculas Orgânicas -SINTMOL, Instituto de Química, Universidade Federal de Mato Grosso do Sul, Av. Senador Filinto Muller, Campo Grande, 79074-460 MS, Brazil
| | - Marco A U Martines
- Instituto de Química, Universidade Federal de Mato Grosso do Sul, Av. Senador Filinto Muller, Campo Grande, 79074-460 MS, Brazil
| | - Renata T Perdomo
- Laboratório de Biologia Molecular e Cultura de Células, Faculdade de Ciências Farmacêuticas, Alimentos e Nutrição, Universidade Federal de Mato Grosso do Sul, Campo Grande, 79070-900 MS, Brazil
| | - Mônica C Toffoli-Kadri
- Laboratório de Farmacologia e Inflamação, Faculdade de Ciências Farmacêuticas, Alimentos e Nutrição, Universidade Federal de Mato Grosso do Sul, Campo Grande, 79074-460 MS, Brazil
| | - Euzébio G Barbosa
- Laboratório de Química Farmacêutica Computacional, Departamento de Farmácia, Universidade Federal do Rio Grande do Norte, Natal, 59012-570, RN, Brazil
| | - Sumbal Saba
- Laboratório de Síntese Sustentável e Organocalcogênio - LabSO, Instituto de Química, Universidade Federal de Goiás-UFG, Goiânia, 74690-900 GO, Brazil
| | - Adilson Beatriz
- Laboratório de Síntese e Transformação de Moléculas Orgânicas -SINTMOL, Instituto de Química, Universidade Federal de Mato Grosso do Sul, Av. Senador Filinto Muller, Campo Grande, 79074-460 MS, Brazil
| | - Jamal Rafique
- Laboratório de Síntese e Transformação de Moléculas Orgânicas -SINTMOL, Instituto de Química, Universidade Federal de Mato Grosso do Sul, Av. Senador Filinto Muller, Campo Grande, 79074-460 MS, Brazil
- Laboratório de Síntese Sustentável e Organocalcogênio - LabSO, Instituto de Química, Universidade Federal de Goiás-UFG, Goiânia, 74690-900 GO, Brazil
| | - Carla C P de Arruda
- Laboratório de Parasitologia Humana, Instituto de Biociências, Universidade Federal de Mato Grosso do Sul, Campo Grande, 79070-900, MS, Brazil
| | - Dênis P de Lima
- Laboratório de Síntese e Transformação de Moléculas Orgânicas -SINTMOL, Instituto de Química, Universidade Federal de Mato Grosso do Sul, Av. Senador Filinto Muller, Campo Grande, 79074-460 MS, Brazil
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Henriquez-Figuereo A, Alcon M, Moreno E, Sanmartín C, Espuelas S, Lucio HD, Jiménez-Ruiz A, Plano D. Next generation of selenocyanate and diselenides with upgraded leishmanicidal activity. Bioorg Chem 2023; 138:106624. [PMID: 37295238 DOI: 10.1016/j.bioorg.2023.106624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 05/08/2023] [Accepted: 05/21/2023] [Indexed: 06/12/2023]
Abstract
Nowadays, leishmaniasis is still treated with outdated drugs that present several obstacles related to their high toxicity, long duration, parenteral administration, high costs and drug resistance. Therefore, there is an urgent demand for safer and more effective novel drugs. Previous studies indicated that selenium compounds are promising derivatives for innovative therapy in leishmaniasis treatment. With this background, a new library of 20 selenocyanate and diselenide derivatives were designed based on structural features present in the leishmanicidal drug miltefosine. Compounds were initially screened against promastigotes of L. major and L. infantum and their cytotoxicity was evaluated in THP-1 cells. Compounds B8 and B9 were the most potent and less cytotoxic and were further screened for the intracellular back transformation assay. The results obtained revealed that B8 and B9 showed EC50 values of 7.7 µM and 5.7 µM, respectively, in L. major amastigotes, while they presented values of 6.0 µM and 7.4 µM, respectively, against L. infantum amastigotes. Furthermore, they exerted high selectivity (60 < SI > 70) towards bone marrow-derived macrophages. Finally, these compounds exhibited higher TryR inhibitory activity than mepacrine (IC50 7.6 and 9.2 µM, respectively), and induced nitric oxide (NO) and reactive oxygen species (ROS) production in macrophages. These results suggest that the compounds B8 and B9 could not only exert a direct leishmanicidal activity against the parasite but also present an indirect action by activating the microbicidal arsenal of the macrophage. Overall, these new generation of diselenides could constitute promising leishmanicidal drug candidates for further studies.
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Affiliation(s)
- Andreina Henriquez-Figuereo
- University of Navarra, Faculty of Pharmacy and Nutrition, Department of Pharmaceutical Technology and Chemistry, Pamplona, Spain; Institute of Tropical Health, University of Navarra, ISTUN, Pamplona, Spain
| | - Mercedes Alcon
- Universidad de Alcalá, Departamento de Biología de Sistemas, 28805 Alcalá de Henares, Madrid, Spain
| | - Esther Moreno
- University of Navarra, Faculty of Pharmacy and Nutrition, Department of Pharmaceutical Technology and Chemistry, Pamplona, Spain; Institute of Tropical Health, University of Navarra, ISTUN, Pamplona, Spain; IdisNA, Navarra Institute for Health Research, Pamplona, Spain.
| | - Carmen Sanmartín
- University of Navarra, Faculty of Pharmacy and Nutrition, Department of Pharmaceutical Technology and Chemistry, Pamplona, Spain; Institute of Tropical Health, University of Navarra, ISTUN, Pamplona, Spain; IdisNA, Navarra Institute for Health Research, Pamplona, Spain.
| | - Socorro Espuelas
- University of Navarra, Faculty of Pharmacy and Nutrition, Department of Pharmaceutical Technology and Chemistry, Pamplona, Spain; Institute of Tropical Health, University of Navarra, ISTUN, Pamplona, Spain; IdisNA, Navarra Institute for Health Research, Pamplona, Spain
| | - Héctor de Lucio
- Universidad de Alcalá, Departamento de Biología de Sistemas, 28805 Alcalá de Henares, Madrid, Spain
| | - Antonio Jiménez-Ruiz
- Universidad de Alcalá, Departamento de Biología de Sistemas, 28805 Alcalá de Henares, Madrid, Spain
| | - Daniel Plano
- University of Navarra, Faculty of Pharmacy and Nutrition, Department of Pharmaceutical Technology and Chemistry, Pamplona, Spain; Institute of Tropical Health, University of Navarra, ISTUN, Pamplona, Spain; IdisNA, Navarra Institute for Health Research, Pamplona, Spain
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Kmetiuk LB, Tirado TC, Biondo LM, Biondo AW, Figueiredo FB. Leishmania spp. in indigenous populations: A mini-review. Front Public Health 2022; 10:1033803. [PMID: 36620288 PMCID: PMC9815601 DOI: 10.3389/fpubh.2022.1033803] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 11/28/2022] [Indexed: 12/24/2022] Open
Abstract
Leishmaniasis, considered a neglected vector-borne disease complex of global concern, has a significant impact on indigenous communities due to daily human and animal exposure in periurban, rural, and naturally preserved areas. This mini-review aims to assess and discuss studies of leishmaniasis in these communities of the New World and Old World, particularly those in the Americas and Asia. Such indigenous communities have been mostly built in poor traditional households with no mosquito-net protection, mostly located in environmentally protected areas, favoring vectors and reservoirs. The presence of leishmaniasis cases surrounding such indigenous areas indicated a high risk of infection, which may have been historically underestimated due to a lack of surveillance, even at present. The absence of studies of indigenous populations in recognized endemic areas may reflect insufficient health services. In conclusion, the persistence of this neglectful scenario may impact tragic outcomes and potential outbreaks in indigenous peoples and surroundings populations worldwide.
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Affiliation(s)
- Louise Bach Kmetiuk
- Graduate Program in Biosciences and Biotechnology, Instituto Carlos Chagas, Fundação Oswaldo Cruz, Curitiba, Paraná, Brazil,Louise Bach Kmetiuk ✉
| | - Thais Cristina Tirado
- Graduate Program in Biosciences and Biotechnology, Instituto Carlos Chagas, Fundação Oswaldo Cruz, Curitiba, Paraná, Brazil,Reference Laboratory for Leishmaniasis, Instituto Carlos Chagas, Fundação Oswaldo Cruz, Curitiba, Paraná, Brazil
| | - Leandro Meneguelli Biondo
- National Institute of the Atlantic Forest (INMA), Brazilian Ministry of Science, Technology, and Innovation, Santa Teresa, Espírito Santo, Brazil
| | - Alexander Welker Biondo
- Department of Veterinary Medicine, Federal University of Paraná (UFPR), Curitiba, Paraná, Brazil
| | - Fabiano Borges Figueiredo
- Graduate Program in Biosciences and Biotechnology, Instituto Carlos Chagas, Fundação Oswaldo Cruz, Curitiba, Paraná, Brazil,Reference Laboratory for Leishmaniasis, Instituto Carlos Chagas, Fundação Oswaldo Cruz, Curitiba, Paraná, Brazil,*Correspondence: Fabiano Borges Figueiredo ✉
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Gutiérrez-Corbo C, Domínguez-Asenjo B, Pérez-Pertejo Y, García-Estrada C, Bello FJ, Balaña-Fouce R, Reguera RM. Axenic interspecies and intraclonal hybrid formation in Leishmania: Successful crossings between visceral and cutaneous strains. PLoS Negl Trop Dis 2022; 16:e0010170. [PMID: 35139072 PMCID: PMC8827483 DOI: 10.1371/journal.pntd.0010170] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 01/13/2022] [Indexed: 12/29/2022] Open
Abstract
Diseases caused by trypanosomatids are serious public health concerns in low-income endemic countries. Leishmaniasis is presented in two main clinical forms, visceral leishmaniasis-caused by L. infantum and L. donovani-and cutaneous leishmaniasis-caused by many species, including L. major, L. tropica and L. braziliensis. As for certain other trypanosomatids, sexual reproduction has been confirmed in these parasites, and formation of hybrids can contribute to virulence, drug resistance or adaptation to the host immune system. In the present work, the capability of intraclonal and interspecies genetic exchange has been investigated using three parental strains: L. donovani, L. tropica and L. major, which have been engineered to express different fluorescent proteins and antibiotic resistance markers in order to facilitate the phenotypic selection of hybrid parasites after mating events. Stationary and exponential-phase promastigotes of each species were used, in in vitro experiments, some of them containing LULO cells (an embryonic cell line derived from Lutzomyia longipalpis). Several intraclonal hybrids were obtained with L. tropica as crossing progenitor, but not with L. donovani or L. major. In interspecies crossings, three L. donovani x L. major hybrids and two L. donovani x L. tropica hybrids were isolated, thereby demonstrating the feasibility to obtain in vitro hybrids of parental lines causing different tropism of leishmaniasis. Ploidy analysis revealed an increase in DNA content in all hybrids compared to the parental strains, and nuclear analysis showed that interspecies hybrids are complete hybrids, i.e. each of them showing at least one chromosomal set from each parental. Regarding kDNA inheritance, discrepancies were observed between maxi and minicircle heritage. Finally, phenotypic studies showed either intermediate phenotypes in terms of growth profiles, or a decreased in vitro infection capacity compared to the parental cells. To the best of our knowledge, this is the first time that in vitro interspecies outcrossing has been demonstrated between Leishmania species with different tropism, thus contributing to shed light on the mechanisms underlying sexual reproduction in these parasites.
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Affiliation(s)
- Camino Gutiérrez-Corbo
- Departamento de Ciencias Biomédicas, Facultad de Veterinaria, Universidad de León, León, Spain
| | | | - Yolanda Pérez-Pertejo
- Departamento de Ciencias Biomédicas, Facultad de Veterinaria, Universidad de León, León, Spain
| | - Carlos García-Estrada
- Departamento de Ciencias Biomédicas, Facultad de Veterinaria, Universidad de León, León, Spain
| | - Felio J Bello
- Facultad de Ciencias Agropecuarias, Programa de Medicina Veterinaria, Universidad de la Salle, Bogotá, Colombia
| | - Rafael Balaña-Fouce
- Departamento de Ciencias Biomédicas, Facultad de Veterinaria, Universidad de León, León, Spain
- * E-mail: (RB-F); (RMR)
| | - Rosa M. Reguera
- Departamento de Ciencias Biomédicas, Facultad de Veterinaria, Universidad de León, León, Spain
- * E-mail: (RB-F); (RMR)
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Silgado A, Armas M, Sánchez-Montalvá A, Goterris L, Ubals M, Temprana-Salvador J, Aparicio G, Chicharro C, Serre-Delcor N, Ferrer B, Molina I, García-Patos V, Pumarola T, Sulleiro E. Changes in the microbiological diagnosis and epidemiology of cutaneous leishmaniasis in real-time PCR era: A six-year experience in a referral center in Barcelona. PLoS Negl Trop Dis 2021; 15:e0009884. [PMID: 34758023 PMCID: PMC8580242 DOI: 10.1371/journal.pntd.0009884] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 10/07/2021] [Indexed: 11/18/2022] Open
Abstract
Background Leishmaniasis is a neglected disease caused by different species of the protozoa Leishmania spp. Cutaneous lesions are the most common clinical manifestation. This disease is prevalent in tropical and subtropical areas, including the Mediterranean basin. In Spain, Leishmania (L.) infantum is the only endemic species, but imported cases are often diagnosed. Different classical parasitological methods can be performed for cutaneous leishmaniasis (CL) diagnosis; but currently molecular techniques serve as a relevant tool for the detection and characterization of Leishmania parasites. We aimed to evaluate clinical and epidemiological characteristics of CL diagnosed patients by real-time PCR in a tertiary hospital over a six-year period. Methodology/Principal findings Clinical, epidemiological and microbiological data were retrospectively collected and analyzed. In our study, CL was confirmed in 59 (31.4%) out of 188 patients by real-time PCR, showing an increase over recent years: 11 cases of CL between 2014 and 2016 and 48 between 2017 and 2019. Real-time PCR was performed on skin swabs and/or biopsies samples, with a positivity of 38.5% and 26.5%, respectively. Results were 100% concordant when biopsy and skin swab were performed simultaneously. L. (L.) infantum was the most frequent species detected (50%), followed by L. (L.) major (45%) and Viannia subgenus (5%), which were detected only in imported cases. L. (L.) major was almost entirely detected in travelers/migrants from Morocco. Multiple and atypical skin lesions were more common in imported cases than in autochthonous cases (44.4% vs. 21.8%). Conclusions/Significance An increase in both autochthonous and imported CL cases has been observed in past years in our hospital. Molecular techniques assist in improving CL diagnosis and characterization of the Leishmania species, mainly in imported cases. Leishmaniasis is a neglected disease caused by different species of the genus Leishmania. This disease is prevalent in tropical and subtropical areas, including the Mediterranean basin. In Spain, the only endemic species is L. (L) infantum, although there are cases of imported leishmaniasis due to travel and migration of people from other endemic areas. Cutaneous lesions are the most common clinical form, but L. (L) infantum can also cause mucosal or visceral involvement. Although microscopic diagnosis and skin biopsy specimens are still used in routine diagnosis for cutaneous leishmaniasis, they are time-consuming and invasive, respectively. Currently, molecular techniques, such as real-time PCR, are very sensitive tools for the detection and identification of Leishmania parasites. In addition, the skin swab sample seems to be a non-invasive alternative for the diagnosis of cutaneous leishmaniasis. In the present work, we describe the clinical characteristics of 59 patients diagnosed by real-time PCR of cutaneous leishmaniasis, as well as the molecular epidemiology of the causative species. We show that there has been an increase in cutaneous leishmaniasis cases, both autochthonous and imported cases, over the study period. The presence of Leishmania species other than L. (L) infantum is also highlighted.
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Affiliation(s)
- Aroa Silgado
- Department of Microbiology, Vall d’Hebron University Hospital, Universitat Autònoma de Barcelona, PROSICS Barcelona, Barcelona, Spain
| | - Mayuli Armas
- Department of Microbiology, Vall d’Hebron University Hospital, Universitat Autònoma de Barcelona, PROSICS Barcelona, Barcelona, Spain
| | - Adrián Sánchez-Montalvá
- Department of Infectious Diseases-Drassanes, Vall d’Hebron University Hospital, Universitat Autònoma de Barcelona, PROSICS Barcelona, Barcelona, Spain
| | - Lidia Goterris
- Department of Microbiology, Vall d’Hebron University Hospital, Universitat Autònoma de Barcelona, PROSICS Barcelona, Barcelona, Spain
| | - Maria Ubals
- Department of Dermatology, Vall d’Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jordi Temprana-Salvador
- Department of Pathology, Vall d’Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Gloria Aparicio
- Department of Dermatology, Vall d’Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | - Núria Serre-Delcor
- Department of Infectious Diseases-Drassanes, Vall d’Hebron University Hospital, Universitat Autònoma de Barcelona, PROSICS Barcelona, Barcelona, Spain
| | - Berta Ferrer
- Department of Pathology, Vall d’Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Israel Molina
- Department of Infectious Diseases-Drassanes, Vall d’Hebron University Hospital, Universitat Autònoma de Barcelona, PROSICS Barcelona, Barcelona, Spain
| | - Vicenç García-Patos
- Department of Dermatology, Vall d’Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Tomas Pumarola
- Department of Microbiology, Vall d’Hebron University Hospital, Universitat Autònoma de Barcelona, PROSICS Barcelona, Barcelona, Spain
| | - Elena Sulleiro
- Department of Microbiology, Vall d’Hebron University Hospital, Universitat Autònoma de Barcelona, PROSICS Barcelona, Barcelona, Spain
- * E-mail:
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