Objective: There are a lack of consistency among articles in regards to the evolution of peripheral immune biomarkers after HCV therapy. We aimed to detect the most relevant changes in peripheral immune biomarkers among HIV/HCV-coinfected patients who achieved sustained virologic response (SVR) following peg-IFN-alpha/ribavirin therapy and to evaluate its normalization with respect to an HIV-monoinfected control group. Methods: We performed a prospective cohort study in 99 HIV/HCV-coinfected patients with samples at baseline (HIV/HCV-b-group) and at week 24 after SVR (HIV/HCV-f-group). We also used a control group of 39 HIV-monoinfected patients (HIV-group) negative for HCV and HBV infections, and who had undetectable HIV viral load and CD4(+) >500 cells/mm(3). Peripheral T cell subsets were assessed by flow cytometry and plasma biomarkers by immunoassays. Results: HIV/HCV-coinfected patients had higher values of in IL-10, IL-4, IP-10, IL-8, IL-1 beta, IL-18, IL-6, IFN-gamma, IL-12p70, TNF-alpha, sVCAM-1, sICAM-1, and sTNFR-1 than HIV control subjects, both at the beginning and at the end of follow-up. Moreover, three biomarkers (CD4(+)CD38(+), telomere length, and IL-1RA) were normalized in relation to the control group at the end of follow-up (the HIV/HCV-b group had higher values and the HIV/HCV-f group had similar values as the HIV-group). Additionally, LPS, IL-2, and IL-17A levels were higher in the HIV/HCV-f group than the HIV-group (24 weeks after SVR). During the follow-up, HIV/HCV-coinfected patients had a significant decrease by the end of follow-up in CD8(+)CD45RA(-)CD28(+), CD4(+)CD38(+), CD4(+)CD25(+)CD127(-/lo)(w), CD4(+)CD25(+)CD127(-/low) CD45RA(-), FABP2, LBP, IP-10, sVCAM1. Only CD4(+)CD38(+) was normalized. Conclusion: HIV/HCV-patients showed a slight improvement in the overall profile of immune biomarkers after achieving SVR. (C) 2019 The British Infection Association. Published by Elsevier Ltd. All rights reserved.

Introduction: The aim of this study was to know, through a national survey, the methods and techniques used for the diagnosis of Helicobacter pylori (Hp) in the different Clinical Microbiology Services/Laboratories in Spain, as well as antibiotic resistance data. Methods: The survey requested information about the diagnostic methods performed for Hp detection in Clinical Microbiology laboratories, including serology, stool antigen, culture from gastric biopsies, and PCR. In addition, the performance of antibiotic susceptibility was collected. Data on the number of samples processed in 2016, positivity of each technique and resistance data were requested. The survey was sent by email (October-December 2017) to the heads of 198 Clinical Microbiology Laboratories in Spain. Results: Overall, 51 centers from 29 regions answered the survey and 48/51 provided Hp microbiological diagnostic testing. Concerning the microbiological methods used to diagnose Hp infection, the culture of gastric biopsies was the most frequent (37/48), followed by stool antigen detection (35/48), serology (19/48) and biopsy PCR (5/48). Regarding antibiotic resistance, high resistance rates were observed, especially in metronidazole and clarithromycin (over 33%). Conclusion: Culture of gastric biopsies was the most frequent method for detection of Hp, but the immunochromatographic stool antigen test was the one with which the largest number of samples were analyzed. Nowadays, in Spain, it concerns the problem of increased antibiotic resistance to 'first-line' antibiotics. (C) 2019 Elsevier Espana, S.L.U. and Sociedad Espanola de Enfermedades Infecciosas y Microbiologia Clinica. All rights reserved.

The epidemiology of non-tuberculous mycobacteria (NTM) in Spain is largely unknown because systematic reporting is not compulsory. The aim of our study was to describe the frequency and diversity of NTM species in our region and their distribution according to the source sample, gender, and age of the patients. We performed a multicenter study of all NTM isolated in 24 public hospitals in Madrid from 2013 to 2017. A total of 6.923 mycobacteria were isolated: 4535 (65.5%) NTM, and 2.388 (34.5%) Mycobacterium tuberculosis complex (MTB). Overall, 61 different NTM species were identified. The most frequently isolated species were Mycobacterium avium complex (47.7%), M. lentiflavum (12.2%), M. gordonae (9.2%), M. fortuitum (8.9%), and M. abscessus (3.9%). Whereas MTB cases were stable during the study period, the number of NTM isolates increased considerably from 930 isolates in 2013 to 1012 in 2017; a sharp increase occurred in the last year. The rise in NTM isolates was mostly due to M. lentiflavum, M. kansasii, and M. abscessus mainly isolated from respiratory specimens in patients older than 60. The increase in isolation rate of NTM in our region is consistent with the increasing rates reported worldwide in the last decades. The rise in NTM isolates was mainly attributed to M. lentiflavum but it also should be noted the increasing of species with high pathogenic potential such as M. kansasii and M. abscessus.

Background Our objective was to assess the therapeutic noninferiority of dual therapy with darunavir/ritonavir and lamivudine compared to triple therapy with darunavir/ritonavir plus 2 nucleos(t)ides for maintenance of human immunodeficiency virus type 1 (HIV-1) suppression. Methods This was a multicenter, open-label, noninferiority trial (margin 12%). Patients with HIV-1 RNA <50 copies/mL for 6 months or longer on triple therapy with darunavir/ritonavir and 2 nucleos(t)ides (tenofovir disoproxil fumarate and emtricitabine or abacavir and lamivudine) and with no resistance were randomized to continue therapy (n = 128) or switch to darunavir/ritonavir and lamivudine (n = 129). The primary endpoint was the proportion of participants with HIV-RNA <50 copies/mL after 48 weeks of follow-up according to the snapshot algorithm. Results A total of 249 participants received study drugs (intention-to-treat exposed). The proportion of participants with HIV-RNA <50 copies/mL in the dual- and triple-therapy arms was 88.9% (112/126) and 92.7% (114/123; difference, -3.8%; 95% confidence interval, -11.0 to 3.4), respectively. Four participants in the dual-therapy arm and 2 in the triple-therapy arm developed protocol-defined virological failure. Switching to dual therapy was associated with a significant increase in total, low-density lipoprotein, and high-density lipoprotein (HDL) cholesterol, but not in the total-to-HDL cholesterol ratio. Serious adverse events and study drug discontinuations due to adverse events occurred in 4.8% vs 4.9%P = .97) and in 0.8% (1/126) vs 1.6% P = .55) in dual therapy vs triple therapy, respectively. Conclusions Dual therapy with darunavir/ritonavir and lamivudine demonstrated noninferior therapeutic efficacy and similar tolerability compared to triple therapy. Clinical Trials Registration NCT02159599.

/l, acido folico 3,50 ng/ml, parametrosbioquimicos y metabolismo ferrico en suero dentro de la nor-malidad, salvo cifras discretamente bajas de ferritina 24,9 ng/ml.Parametros bioquimicos en orina normales. No se observo eosino-filia y la morfologia de sangre periferica se informo como discretaanisocitosis.Losresultadosdelacolonoscopiafueron:doserosionesenciegode etiologia incierta y 2 formas compatibles con gusanos, de 5mmde longitud aproximadamente (figs.1y2).EvolucionUnavezinformadoslosresultadosporelserviciodemicrobiolo-gia, se decide tratar con mebendazol 100mg/12h durante 3 dias ysuplementos de hierro oral. Tras un mes de evolucion, deja de pre-sentar prurito, rectorragia y se observo una normalizacion de losparametros hematologicos. Se diagnostico de cuadro anemico porsangrado de origen digestivo y parasitacion por Trichuris trichiura.ComentarioTrichuris trichiura es un parasito nematelminto, de la claseAphasmidia, orden Enoplida y familia Trichuridae, que tiene unadistribucion mundial cosmopolita, pero que habita principalmenteen zonas tropicales y subtropicales, climas calidos y humedos con

Detection of Salmonella spp. isolates showing decreased susceptibility to fluoroquinolones has become important owing to the increasing prevalence of these strains and their association with treatment failure. Nalidixic acid agar dilution, nalidixic acid disk diffusion, MicroScan automated system and real-time polymerase chain reaction (PCR) (LightCycler) followed by melting temperature (Tm) analysis are compared with ciprofloxacin agar dilution as suitable methods to detect decreased susceptibility to fluoroquinolones in 100 Salmonella spp. isolates. Three minor discrepancies were found for nalidixic acid disk diffusion, one minor discrepancy was found for nalidixic acid agar dilution and Tm analysis, and one major discrepancy was found for MicroScan. Nalidixic acid disk diffusion was confirmed as a good screening method. Tm analysis is a rapid and accurate method for detecting decreased susceptibility to fluoroquinolones due to gyrA mutations in Salmonella spp.

The objective of this study was to compare the susceptibility to seven antimicrobials of Acinetobacter baumannii clinical isolates from H. U. de La Princesa of Madrid vs. A. baumannii clinical isolates from Hospital Queen Mary of Hong Kong from January 2004 to March 2005. A total of 74 strains isolated from our hospital and 30 strains attended to Hospital Queen Mary were studied. The MIC (minimal inhibitory concentration) was determined by agar dilution method. NCCLS recommended breakpoints were used against imipenem, tobramycin, amikacin, ofloxacin and ceftazidime. For sulbactam the break point for ampicillin/sulbactam was used. BSAC breakpoint was considered against colistin. Colistin showed the highest susceptibility percentage in Spanish strains (98.64%), followed by imipenem (94.59%) and tobramycin (78.37%). About 50% of the clinical isolates were susceptible to sulbactam (54.05%) and amikacin (51.35%). The majority of the strains were resistant to ofloxacin (2.7% of susceptible strains) and ceftazidime (1.35% of susceptible strains). In the Hong Kong clinical isolates, high susceptibility percentages were shown for most antimicrobials: 96.66% to colistin, sulbactam, tobramycin and amikacin; lower for imipenem (93.33%) and ofloxacin (90%). Ceftazidime presented the lowest susceptibility percentage (10%). In conclusion, higher resistant percentages in Spanish strains than Chinese strains were obtained for most antimicrobials tested. To ofloxacin, 90% of Hong Kong isolates were susceptible while 93% of Madrid isolates were resistant. Geographically remote populations (such as Madrid and Hong Kong) showed important differences according to the susceptibility patterns.

La tuberculosis es considerada un grave problema de salud publica. Algunos factores, como la infeccion por VIH o la inmigracion, han afectado de manera importante a la epidemiologia de esta enfermedad en Espana. El problema se ha visto agravado en los ultimos anos con la diseminacion de cepas multirresistentes. Por todo ello debe establecerse una vigilancia periodica respecto a la incidencia y las resistencias observadas. En este estudio se recogen los aislamientos de Mycobacterium tuberculosis obtenidos en los anos 2001, 2002, 2003 y 2004, y sus caracteristicas de sensibilidad a los antituberculosos en pacientes del Area 2 de Madrid. Para evaluar la sensibilidad de las cepas se utilizo el sistema MGIT 960®. Se aislaron 244 cepas, de las cuales el 15,2% fue resistente al menos a un antibiotico (distinto de la estreptomicina). Un 29,9% de los aislamientos se obtuvieron en muestras de pacientes inmigrantes. Ademas, la poblacion inmigrante afectada mostro un mayor porcentaje de resistencias (p <0.01) y una edad media menor (p <0.01) que la poblacion autoctona.

Tuberculosis is considered a serious public health problem. Some factors, such as HIV infection and immigration, have had a major impact on the epidemiology of this illness in Spain. The problem has worsened in recent years due to the dissemination of multiresistant strains. Therefore, a periodic surveillance should be established with respect to the incidence and the resistances observed. In this study we collect M. tuberculosis isolates carried out in the years 2001, 2002, 2003 and 2004, and their susceptibility characteristics in patients from Area 2 in Madrid. To evaluate the isolates' susceptibilities, the MGIT 960 system was used. Of a total of 244 isolates, 15.2% were resistant to at least one antibiotic (different to streptomycin), and 29.9% of the isolates were obtained in samples from immigrant patients. In addition, the immigrant population affected showed a greater percentage of resistances (p <0.01) and a younger mean age (p <0.01) than the indigenous population.

OBJECTIVES:To select a group of useful serum markers in renal cell carcinoma (RCC) with investigational purpose in future.MATERIAL AND METHODS:Periodic determination in serum of 21 RCC patients of the following markers: EGR, RPC, hemogram and leucocyte differential count (LDC), standard biochemist parameters, beta-2 microglobuline, CEA, CA 12.5, CA 50, CA 15.3, ferritin, interleukin-6, serum interleukin-2 receptor, TNF-alpha and TPSA.RESULTS:Different elements within the LDC had relations with the presence of symptoms/signs, tumour size, pathological stage and disease progression. There was a significant increase of beta-2 microglobuline and sIL-2 receptor when disease progressed, as well as a similar statistical trend with RPC and alkaline phosphatases. Beta-2 microglobuline and sIL-2 receptor also decreased after treatment of the disease progression.CONCLUSIONS:We will keep analysing hemogram, LDC and standard byochemics, RPC, ferritin, beta-2 microglobuline and sIL-2 receptor only with investigational purposes, obviating the determination of the rest of the tested markers.

We present a case of urinary tract infection caused by vancomycin-resistant Enterococcus faecalis. The patient is a 62-year-old woman showing no recent admittances. The isolated microorganism was identified by MicroScan (DADE) and API (BioMerieux) and susceptibility was assessed by disk diffusion, E-test and broth microdilution. The isolate was identified as Enterococcus faecalis and showed high MIC for vancomycin (>128 mg/l) and teicoplanin (8 mg/l) but was susceptible to ampicillin. The transmission routes of vancomycin-resistant enterococci in the community and their clinical implications remain uncertain. Healthy carriers have already been described in several countries but this case report represents an unusual finding.