Isolation of Candida auris in large hospitals in the Autonomous Community of Valencia; population-based study (2013-2017)

BACKGROUND

Candida auris is an emerging multidrug-resistant and highly virulent yeast that spreads easily among patients.

AIMS

To describe the characteristics of candidemia caused by C. auris in the southeast of Spain (Autonomous Community of Valencia - ACV) through a 5-year population-based study.

METHODS

An analysis of all the episodes of candidemia diagnosed in the ACV, with approximately 4,500,000 inhabitants, during 2013-2017, was done. Data were obtained from the Epidemiological Surveillance Valencian Network, a network that collects all the microbiological data from the hospitals in the study region.

RESULTS

Based on the records, 1.9% of the isolates recovered from the positive blood cultures (corresponding to 1789 patients) were yeasts. This implies an annual rate of 7.09 cases/100,000 inhabitants. Of the 23 yeast species isolated, Candida albicans was the most frequent (37.3%), showing a higher frequency than Candida parapsilosis (28.4%) and Candida glabrata (15.6%) (p<0.0001). It is remarkable the emergence of C. auris during 2016 and 2017, as this species became the fourth more prevalent in 2016 (9.2%), and the third in 2017 (15.7%). Fungemia was more common in hospitals with >500 beds (63.3% versus 36.7% in small hospitals) (p<0.0001), and C. auris was mostly isolated in large hospitals (8.5% versus 0.3%); its incidence was higher in autumn and among the age group of 65-84 years.

CONCLUSIONS

The information about the local epidemiology of candidemia is essential in order to decide the best empirical treatment approach. This study reports the novel presence of C. auris in large hospitals. This pathogen has usually resistance to several antifungals and causes severe fungemia, so the results of this work reveal the need to monitor the presence of this species systematically.

Pregnancy outcomes in female hairdressers

PURPOSE

The hairdressing occupation may entail exposure to a wide range of chemical products, psychosocial and physical stress. All these factors may affect the health of a pregnant hairdresser and her offspring. Our aim was to analyse whether employment in this profession is associated with adverse reproductive effects.

METHOD

Female hairdressers working in the 248 hairdressing salons in Alicante (Spain), who became pregnant for the first time after 1990 were included (n = 94). The incidence of spontaneous abortions, number of children born and their birth weight and preterm delivery among hairdressers was compared with a control group of shop assistants and office workers (n = 138). Information was collected through personal interviews at their work place. A structured questionnaire was used gathering information concerning exposure variables including the use of chemical products, ventilation at the salons, work-related stress and hours of standing work. In addition, socio-demographic factors and smoking information were obtained. Crude and adjusted relative risks (RR) and 95% confidence intervals (95%CI) were calculated using logbinomial regression.

RESULTS

Hairdressers showed a non-significant increased risk of spontaneous abortions (RR = 1.6, 95%CI 0.9-2.7). There were no differences in preterm delivery and birth weight of the children born of mothers in the two groups. Among hairdressers, the RR of spontaneous abortion among those with high perceived work-related stress was 2.4 (95%CI: 0.2-28.3) relative to those with low or normal perceived stress.

CONCLUSIONS

A slightly increased risk of spontaneous abortion among hairdressers was found, mainly associated with perceived work-related stress. Observed results deserve further research.

Menstrual disorders and subfertility in Spanish hairdressers

OBJECTIVE

Hairdressing is associated with adverse effects on reproductive health. This research investigates whether female hairdressers have increased risks of subfertility and menstrual disorders.

STUDY DESIGN

Cross sectional study. Participants were all female hairdressers below 50 years of age (n=310) working in registered hairdressing salons in Alicante, Spain and a control group comprising female shop assistants and office workers (n=310). Menstrual disorders were defined as any of five menstrual cycle characteristics: short cycles, long cycles, irregular cycles, not experiencing a period for more than 6 weeks (missed period), and bleeding or spotting between periods (intermenstrual bleeding). Subfertility problems were defined as reporting unprotected intercourse over a period of more than 12 months without a pregnancy. The data were analysed by logistic regression, calculating odds ratios (OR), crude and adjusted for age and smoking status.

RESULTS

Menstrual disorder prevalence among hairdressers over 12 months prior to the study was 9.7%, with an adjusted odds ratio of 1.87(CI(95%) 0.99-3.91) compared with the control group. Furthermore, 5.5% of hairdressers reported unprotected intercourse over a period of more than 12 months without a pregnancy, adjusted OR of 2.17(CI(95%) 0.91-5.17).

CONCLUSIONS

Our results suggest an increased risk of subfertility and menstrual disorders in hairdressers compared to a control group of office workers and shop assistants. More research is needed in order to elucidate what particular occupational exposure may explain this association. Nevertheless, it would seem that chemicals present in hairdressing salons could be responsible.

Situación nutricional de yodo en la población escolar de Alicante

BACKGROUND

According to the World Health Organization (WHO), goiter is endemic in Spain. The main cause of endemic goiter is iodine deficiency, which is also the principal cause of mental retardation and avoidable cerebral palsy throughout the world.

MATERIAL AND METHODS

We conducted an observational study to determine the prevalence of endemic goiter and nutritional iodine status in the province of Alicante. Urinary iodine excretion was measured in a morning urine sample, and thyroid volume was measured by means of a thyroid ultrasound scan. A case of goiter was diagnosed if thyroid volume was above the 97th percentile adjusted by age, as published by the WHO.

RESULTS

No cases of goiter were found. In addition, the median urinary iodine excretion levels adjusted by age were within the normal range, as defined by the WHO's criteria.

CONCLUSIONS

Endemic goiter was not found in the province of Alicante and urinary iodine excretion values demonstrated adequate iodine intake. Further ultrasound studies are needed to establish reference thyroid volumes for our population.

Quadruple-2 protease inhibitors (PI)-therapy does not accelerate viral decay and suppression in PI-naive HIV-1 infected patients with severe immunosuppression and high viral load as compared with standard triple therapy

To analyse if a four-drug combination including two protease inhibitors (PIs) accelerates viral decay and suppression as compared with standard triple therapy in heavily immunosuppressed HIV-1 infected patients, an open label clinical trial was designed. PIs naive patients receiving their first highly active antiretroviral therapy were included if their CD4 cell count was lower than 200/mm3 and their HIV viral load (VL) >100,000 RNA copies/mL. Every patient received two analogues and was randomized in two groups receiving either one PI (saquinavir soft gel capsule) or two PIs (saquinavir + nelfinavir). Viral efficacy (VL <50), time to reach VL <50, viral clearance rate constant and plasmatic elimination half-life were determined. In all, 30 patients were enrolled. No viral variable was significatively improved by the four-drug combination in the short term. No clinical benefit should be expected with a four-drug (two PIs) regimen in patients with low CD4+ cell count and high VL.

Study of the correlation between two methods used to monitor thymoglobulin therapy in renal transplantation

The aim of this study is to evaluate the correlation between the 2 methods used to monitor thymoglobulin therapy: the total lymphocyte count and the number of T cells. We have performed daily collections of peripherical blood samples from 24 renal grafts, recipients who were receiving thymoglobulin, including 14 cases for induction and 10 for acute rejection. Absolute lymphocyte and T-cell counts were measured in the 298 samples after administration of a dose of 1.25 mg/kg/d. The dose was omitted if the T-cell count had decreased to <10 cells/microL. The theoretical total lymphocyte count considered to omit dose was <100 cells/microL. A total of 137 doses were given according to T-cell count. We performed the comparison in 3 steps. First, we correlated values in the daily samples; second, we examined samples as a whole and third, assessed the percentage of discrepancy between the omission of the daily dose according to each method. There was a poor correlation between the methods according to sets of daily samples or the sets as a whole. The rate of discrepancy was 66%, including 121 of 216 decisions (P<.001). In conclusion, the results of the 2 methods of monitoring thymoglobulin therapy are different, and the total administered dose depends on the method used.

Influence of diuretics on the concentration of proteins and other components of pleural transudates in patients with heart failure

PURPOSE

Diuretic therapy increases the total protein and lactate dehydrogenase concentrations in pleural fluid in patients with transudates due to heart failure, but the effect of diuresis on other substances in pleural fluid constituents is not known.

SUBJECTS AND METHODS

Twenty-one patients with transudative pleural effusions due to congestive heart failure were prospectively studied. Repeated diagnostic thoracentesis (mean +/- SD = 3 +/- 1; range, 2 to 6) was performed until the effusions were radiographically unapparent (5 +/- 2 days). Thirty-one patients with congestive heart failure who underwent only a single thoracentesis after diuretic therapy served as controls. We measured the concentrations of various components of pleural effusions in the serum and in the pleural fluid, and determined the serum-pleural fluid gradient (serum concentration minus pleural fluid concentration) and ratio (serum concentration divided by pleural fluid concentration).

RESULTS

The pleural concentrations of most components increased significantly (P <0.001) from the initial specimen to the final specimen: total protein, from 23 +/- 7 g/L to 33 +/- 9 g/L; albumin, from 13 +/- 4 g/L to 18 +/- 6 g/L; lactate dehydrogenase, from 177 +/- 62 U/L to 288 +/- 90 U/L; cholesterol, from 31 +/- 16 mg/dL to 52 +/- 22 mg/dL; and cholinesterase, from 1,304 +/- 616 U/L to 1,884 +/- 674 U/L. Expressed as percentage change, the increases in the serum-pleural fluid gradients for albumin (12% +/- 22%) and total protein (11% +/- 12%) were significantly less than the increases in their concentrations in pleural fluid (albumin, 47% +/- 49%; total protein, 48% +/- 40%) or in their pleural fluid/serum ratios (albumin, 27% +/- 29%; total protein, 38% +/- 34%).

CONCLUSIONS

The concentrations of the biochemical components commonly measured in pleural fluid increase progressively during diuretic therapy. Calculation of the serum-pleural fluid gradients for protein and albumin may be the most useful way to distinguish transudates from exudates in patients with congestive heart failure who have undergone diuresis.

[Neurological involvement following triple virus vaccine]

INTRODUCTION

Prophylactic immunization against measles, rubella and mumps is carried out using a trivalent vaccine. The second dose is recommended at 11-12 years-old. Neurological complications have been described after vaccination for measles and rubella. All cases occurred several days after vaccination.

CLINICAL CASES

We describe four girls aged between 10 and 11 years old who were vaccinated on the same day. Almost immediately they complained of symptoms in the vaccinated arm. These were pain, paresthesia, coldness, pallor and sweating of the hand. On the following days there was loss of strength and alterations in sensation. All laboratory, radiological, neurophysiological and psychiatric studies were normal. Immunological study showed changes in the immunohumeral response to the vaccine. Complete recovery was made.

CONCLUSIONS

The different types of post-vaccination complications described to date are reviewed, together with conditions showing features such as those described, particularly the reflex sympathetic syndrome. Possible reasons for the poor immunohumoral response to the vaccine in these patients are discussed.