Introduction Histoplasmosis is a systemic mycosis caused by Histoplasma capsulatum. Genital involvement is exceptional and has not been previously reported in Spain. Methods We report a case of vulvar infection by H. capsulatum and review the literature to identify additional cases. Results Four cases of vulvar histoplasmosis were identified, including the present one. All occurred in immunocompromised patients, mostly with HIV infection, and presented as vulvar lesions suggestive of neoplasia or sexually transmitted infections. In our case, a 38-year-old woman with advanced human immunodeficiency virus (HIV) infection, presented with a lesion suggestive of carcinoma. The diagnosis of histoplasmosis was confirmed by histopathology, fungal culture and molecular techniques, identifying H. capsulatum var. duboisii. All cases received antifungal therapy with favorable outcomes. Conclusion Vulvar histoplasmosis is an exceptional entity that may mimic other diseases, particularly in immunocompromised patients, and should be considered in the differential diagnosis.
Introduction: In 2023, 10,879 cases of syphilis were diagnosed in Spain, with an annual increase of 24.1% between 2021 and 2023. The PrEP programme was implemented in 2019, providing regular screening for STIs, including syphilis, to enable early diagnosis during the asymptomatic phase. This study aims to evaluate the association between PrEP use and the presentation of syphilis at an STI clinic in Barcelona. Methods: This was a single-centre, retrospective, comparative study of patients diagnosed with early syphilis in 2023. Demographic, behavioural, and clinical variables were collected and compared between individuals using PrEP and those not using it. Results: A total of 290 cases of early syphilis were diagnosed in 2023: 52 (17.9%) primary syphilis, 88 (30.3%) secondary syphilis, and 150 (51.7%) early latent syphilis. Of these, 157 (54.1%) were on PrEP; among the 133 not on PrEP, 51 (38%) were HIV-positive. Of those on PrEP, 111 (70.7%) were diagnosed at the time of their follow-up visit, of whom 34 (30%) were symptomatic. Comparison of clinical presentation showed that early latent syphilis was more frequent in the PrEP group (60% vs 42%, p < 0.001). There were no significant differences in most behavioural variables, except for number of sexual contacts. Conclusions: Early latent syphilis was diagnosed more frequently in individuals on PrEP than in those not using PrEP, likely due to the regular screening provided within the programme.
Background: Older adults residing in long-term care facilities are at high risk of infection and adverse outcomes related to hospitalization, including functional decline and loss of independence. Outpatient parenteral antimicrobial therapy (OPAT) may represent an alternative to hospital admission in this population, although data remain limited. We aimed to evaluate the safety and clinical outcomes of an OPAT program in institutionalized older adults. Methods: We conducted a retrospective descriptive study including consecutive institutionalized patients aged >= 18 years enrolled in an OPAT program between January 2021 and December 2023 at a tertiary hospital in northern Spain. Demographic, clinical, microbiological, and treatment-related variables were collected. The primary outcome was clinical success. Secondary outcomes included complications and 30-day mortality. Results: A total of 47 patients were included, with a median age of 82 years (Interquartile range or IQR 17). Urinary tract infections were the most frequent diagnosis (61.7%) and were mainly caused by Gram-negative bacilli, frequently ESBL-producing organisms. Ertapenem was the most commonly prescribed antibiotic. Nine patients developed catheter-related complications, all involving peripheral venous lines. Thirty-six patients successfully completed OPAT. Only four patients required hospital readmission related to OPAT, and only one death was considered related to the index infection. Conclusions: OPAT may be a safe and feasible alternative to hospitalization in selected frail institutionalized older adults, allowing treatment of complex infections outside the hospital setting. Optimization of antimicrobial stewardship and vascular access strategies remains important in this population.
Introduction: Romanian migrants may beat increased risk of viral hepatitis because many originate from countries with intermediate or high endemicity. Targeted, culturally adapted screening strategies are therefore needed to improve case finding and prevention. Our aim was to explore the feasibility of two sequential viral hepatitis screening strategies among Romanian migrants living in Seville, Spain. Methods: We conducted a two-phase opportunistic screening study. Phase 1 was a Consulate-facilitated, hospital-based program using venipuncture and comprehensive serological testing. Phase 2 was a community-based program delivered at an Orthodox church using rapid diagnostic tests. Demographic characteristics, recruitment output, serological findings, fibrosis markers, and linkage to care were recorded. Results: Of the total participants (n = 54), the number of individuals screened was higher in the community-based intervention (n = 39) than the hospital-based program (n = 15). Median age was 48.5 (39.5-58) years, and 74.1% were women. No active viral hepatitis infections were identified. In phase 1, 66.7% of participants (10/15) lacked hepatitis B immunity and were candidates for vaccination, while 6.7% (1/15) had non-invasive markers compatible with intermediate fibrosis and required further assessment. In phase 2, 2.6% of participants (1/39) had antibodies against hepatitis C virus with documented prior cured infection. Conclusions: In this pilot study, community-based screening in a familiar religious setting appeared more produc tive and operationally feasible for short-term recruitment than a hospital-based approach. These findings support the feasibility of decentralized strategies to improve engagement and may inform future micro-elimination programs in migrant populations.
