This work was aimed at increasing epidemiological knowledge of Rickettsia conorii and Rickettsia slovaca in a geographical area in Castilla-La Mancha (Spain) lacking prior data, through a seroprevalence study in potential wild rodent reservoirs. A serological survey collected 118 rodent sera from field (79) and peri-urban (39) areas through convenience sampling between April and September 2019 in Montes de Toledo (56.7% Mus spretus , 24.6% Mus domesticus , 10.1% Apodemus sylvaticus , and 8.5% Rattus norvegicus ). Sera were tested for antibodies to R. conorii and R. slovaca through indirect immunofluorescence assay (IFA). Antibodies to R. conorii were detected in 62/118 rodents (52.5%). The highest prevalence was observed in R. norvegicus (90%) and M. spretus (62.7%). In field areas and peri-urban areas, the prevalence was 53.2% vs 51.3%, respectively (χ 2 =0.04; p=0.847). Antibodies to R. slovaca were found in 22/118 (18.6%), primarily in R. norvegicus (90%) and M. spretus (17.9%), and did not show differences between field and peri-urban environments (15.2% vs 25.6%; χ 2 =1.88; p=0.17). The overall prevalence of R. conorii was significantly elevated (χ 2 =29.57; p<0.001). Our data indicated widespread R. conorii and R. slovaca infection among rodents in Montes de Toledo, thus suggesting their potential role as reservoirs and highlighting zoonotic transmission risk in this area.

Introducción: La simulación clínica se ha consolidado como un recurso clave en la educación médica, pero su integración sistemática en asignaturas básicas como Microbiología Médica sigue siendo escasa en el contexto español, lo que facilitaría que el estudiantado conectara los contenidos microbiológicos con el razonamiento clínico y la solicitud razonada de estudios microbiológicos. Objetivo: Analizar los resultados académicos y la utilidad percibida de las prácticas de simulación clínica realizadas en dicha asignatura. Método: Se realizó un estudio descriptivo observacional de las calificaciones de la parte de la asignatura vinculada a unas prácticas de simulación basadas en entrevistas clínicas sobre síndromes infecciosos en Microbiología Médica de tercer curso de Medicina (cursos 2012-2013 a 2025-2026). Las prácticas se estructuraron en torno a entrevistas clínicas simuladas sobre síndromes frecuentes y se evaluaron mediante tres formatos sucesivos (preguntas abiertas en cuaderno de prácticas, test online domiciliario y test online presencial), aplicando estadística descriptiva y un ANOVA de medidas repetidas. De forma complementaria, se revisaron comentarios abiertos del estudiantado sobre la utilidad formativa de la experiencia. Resultados: Las calificaciones medias oscilaron entre 7,54 y 9,67 sobre 10, con medianas altas y desviaciones estándar bajas o moderadas. El ANOVA mostró diferencias significativas entre formatos (F = 466,92; p < 0,001), con puntuaciones más altas en el test online domiciliario y estabilidad posterior en el test online presencial. Estos hallazgos aconsejan interpretar los resultados académicos con cautela, ya que parte de la variación observada puede estar relacionada con el formato de evaluación y no exclusivamente con la intervención docente. El estudiantado valoró muy positivamente las prácticas, destacando su utilidad para comprender la relevancia clínica de la Microbiología, organizar el estudio en torno a síndromes infecciosos y prepararse para ECOE y rotaciones clínicas. Conclusiones: La simulación de entrevistas clínicas en Microbiología Médica constituye una innovación docente sostenible, asociada a resultados académicos elevados y consistentes, y a una utilidad formativa claramente percibida por el estudiantado, que favorece la integración básico-clínica en el grado de Medicina y ofrece un modelo transferible a otras facultades de diferentes sistemas educativos interesadas en incorporar la simulación en materias básicas.

Background: The study aimed to characterize patients with leprosy admitted to Fontilles throughout the 20th and 21st centuries, focusing on differences across three periods (I, II, and III). It also explored variables linked to patient survival. Methods: This was a retrospective descriptive study analyzing the medical records of Fontilles patients from 1909 to 2020. It assessed 26 clinical, sociodemographic, and temporal variables (n = 2652). Results: Most patients were male, single, multibacillary (MB), and farmers, from Andalusia and the Valencian Community. The origin of patients shifted over time towards being mostly foreign-born in period III. More than a half were previously admitted and had family members with leprosy. While leprosy reactions decreased over time, neurological symptoms were increasingly diagnosed. The age at onset, admission, and death increased progressively over time. The survival of patients with leprosy at Fontilles depended on the age at admission and the period. Conclusions: Improved knowledge, services, and awareness regarding leprosy led to increased age at onset and more favorable outcomes. The prolonged time between symptom onset and diagnosis indicates that leprosy is still a neglected disease. Although MB forms are more severe, leprosy classification did not significantly impact the survival rates of patients at Fontilles.

El proyecto “PCG/ER: Prácticas Clínicas de Grado en Entornos Rurales”, implementando este curso académico 2022/23 como proyecto piloto, tiene como objetivo general la adquisición de competencias específicas y el desarrollo de un mayor grado de destrezas clínicas, comunicativas, de prevención y promoción de la salud comunitaria e individual en entornos rurales, mediante la implementación de un rotatorio clínico curricular realizado por estudiantes de sexto curso del Grado de Medicina, que sin duda contribuirá a la sostenibilidad del sistema sanitario público de salud en el ámbito rural de nuestro país.

A limited number of longitudinal studies have examined the symptoms associated with long-COVID-19. We conducted an assessment of symptom onset, severity and patient recovery, and determined the percentage of patients who experienced reinfection up to 2 years after the initial onset of the disease. Our cohort comprises 377 patients (≥18 years) with laboratory-confirmed COVID-19 in a secondary hospital (Madrid, Spain), throughout March 3–16, 2020. Disease outcomes and clinical data were followed-up until August 12, 2022. We reviewed the evolution of the 253 patients who had survived as of April 2020 (67.1%). Nine died between April 2020 and August 2022. A multivariate regression analysis performed to detect the risk factors associated with long-COVID-19 revealed that the increased likelihood was associated with chronic obstructive lung disease (OR 14.35, 95% CI 1.89–109.09; p = 0.010), dyspnea (5.02, 1.02–24.75; p = 0.048), higher LDH (3.23, 1.34–7.52; p = 0.006), and lower D-dimer levels (0.164, 0.04–0.678; p = 0.012). Reinfected patients (n = 45) (47.8 years; 39.7–67.2) were younger than non-reinfected patients (64.1 years; 48.6–74.4)) (p < 0.001). Patients who received a combination of vaccines exhibited fewer symptoms (44.4%) compared to those who received a single type of vaccine (77.8%) (p = 0.048). Long-COVID-19 was detected in 27.05% (66/244) of patients. The early detection of risk factors helps predict the clinical course of patients with COVID-19. Middle-aged adults could be susceptible to reinfection, highlighting the importance of prevention and control measures regardless of vaccination status.

Background The long-standing underrepresentation of women in leadership positions in medicine is well-known, but poorly documented globally. There is some evidence of the gender gap in academia, medical society leadership, or specific problems in some specialties. However, there are no investigations analyzing all medical specialties together and reporting the glass ceiling from a 360º perspective that includes positions in academia, research, professional organizations, and clinical activity. Additionally, the majority of studies have a US perspective, and we wonder if the perspective of a European country might be different. The WOmen in MEDicine in Spain (WOMEDS) project ( https://womeds.es ) aims to describe and characterize, in a systematic and detailed way, the gender bias in the medical profession in Spain in order to monitor its evolution over time and contribute to prioritizing gender policies. Methods We retrieved data for the calendar years 2019–2021 from several sources and selected surveys. We built four groups of indicators to describe leadership positions in the medical profession: (i) leadership in healthcare according to specialty and region; (ii) leadership in scientific and professional bodies; (iii) academic career; and (iv) leadership in clinical research activity. As a summary measure, we reported the women ratios, calculated as the percentage of women in specific top positions divided by the percentage of women in the relevant population. Results We found gender inequity in leadership positions in all four settings. During the observed period, only 27.6% of the heads of departments in hospitals were women compared to 61.1% of women in medical staff. Ten of the 46 medical societies grouped in the Spanish Federation of Medical Societies (FACME) (21.7%) had a women president at some point during the study period, and only 4 annual congresses had ratios of women speakers higher than 1. Women were over-represented in the lower positions and underrepresented in the top academic ones. Only 26% and 27%, respectively, of the heads of departments and deans were women. The applications for public funding for research projects are led by women only in 45% of the cases, and the budget granted to women in public calls was 24.3% lower than that of men. Conclusion In all the areas analyzed, the leadership positions are still mostly occupied by men despite the feminization of medicine in Spain. The severe gender inequity found calls for urgent interventions within a defined time horizon. Such measures must concern all levels, from national or regional regulation to changes in organizational culture or incentives in specific organizations.

Functional neurological disorders (FND) are a frequent reason for visits in neurology. However, specific training on these disorders during undergraduate and residency training is limited. This study assesses the knowledge, attitude and exposure of medical students to FNDs before completing their medical degree.We conducted a 15-item survey to explore understanding, exposure and attitudes towards FNDs among sixth-year medical students at four Spanish universities.A total of 118 students (mean age 23.6 ± 1.2 years; 71.2% female) returned the survey. Of these, 88 (74.6%) were aware of the concept of FNDs and 78 (66.1%) had studied them in psychiatry classes. The term 'psychosomatic' was chosen by 54.1% of the students as the most appropriate term to refer to these disorders, and 111 (94.1%) believed that a history of sexual or physical abuse was common among FND patients. Fifty-seven students (48.3%) assumed that the diagnosis of FND was mostly a clinical diagnosis of exclusion and 63 (53.4%) indicated that it is managed only by psychiatry. One hundred and one students (85.6%) considered that adequate training on FNDs is an important aspect of their medical training.Medical students are aware of the existence of FNDs, but their preferred terminology, as well as the perceived aetiological factors, reflect that the historical view of these disorders is still deeply rooted. Medical students feel that they should receive adequate education on FNDs from specialists in neurology and psychiatry as part of their training.¿Qué piensan los estudiantes de Medicina sobre los trastornos neurológicos funcionales?Introducción. Los trastornos neurológicos funcionales (TNF) son un motivo de consulta frecuente en neurología. Sin embargo, la formación específica sobre estos trastornos durante la formación universitaria y el período de residencia es limitada. En este estudio se evalúan los conocimientos, la actitud y la exposición de los estudiantes de Medicina a los TNF antes de terminar el grado de Medicina. Sujetos y métodos. Realizamos una encuesta de 15 ítems para explorar la comprensión, la exposición y las actitudes hacia los TNF entre los estudiantes de Medicina de sexto año en cuatro universidades españolas. Resultados. Devolvieron la encuesta 118 estudiantes (edad media 23,6 ± 1,2 años; 71,2%, mujeres). De ellos, 88 (74,6%) conocían el concepto de TNF y 78 (66,1%) los habían estudiado en las clases de psiquiatría. El 54,1% de los estudiantes eligió el término ‘psicosomático’ como el más adecuado para referirse a estos trastornos, y 111 (94,1%) creían que una historia de abuso sexual o físico era común entre los pacientes con TNF. Cincuenta y siete estudiantes (48,3%) asumieron que el diagnóstico de TNF era mayoritariamente un diagnóstico clínico de exclusión y 63 (53,4%) señalaron que el manejo se realiza únicamente desde psiquiatría. Ciento un estudiantes (85,6%) consideraron que una formación adecuada sobre los TNF es un aspecto importante de su formación médica. Conclusiones. Los estudiantes de Medicina son conscientes de la existencia de los TNF, pero la terminología preferida por ellos, así como los factores etiológicos percibidos, reflejan que la visión histórica acerca de estos trastornos está aún arraigada. Los estudiantes de Medicina consideran que deberían recibir una educación adecuada sobre los TNF como parte de su formación por parte de los especialistas en neurología y psiquiatría.

Introduction. Functional neurological disorders (FND) are a frequent reason for visits in neurology. However, specific training on these disorders during undergraduate and residency training is limited. This study assesses the knowledge, attitude and exposure of medical students to FNDs before completing their medical degree. Patients and methods. We conducted a 15-item survey to explore understanding, exposure and attitudes towards FNDs among sixth-year medical students at four Spanish universities. Results. A total of 118 students (mean age 23.6 +/- 1.2 years; 71.2% female) returned the survey. Of these, 88 (74.6%) were aware of the concept of FNDs and 78 (66.1%) had studied them in psychiatry classes. The term 'psychosomatic' was chosen by 54.1% of the students as the most appropriate term to refer to these disorders, and 111 (94.1%) believed that a history of sexual or physical abuse was common among FND patients. Fifty-seven students (48.3%) assumed that the diagnosis of FND was mostly a clinical diagnosis of exclusion and 63 (53.4%) indicated that it is managed only by psychiatry. One hundred and one students (85.6%) considered that adequate training on FNDs is an important aspect of their medical training. Conclusions. Medical students are aware of the existence of FNDs, but their preferred terminology, as well as the perceived aetiological factors, reflect that the historical view of these disorders is still deeply rooted. Medical students feel that they should receive adequate education on FNDs from specialists in neurology and psychiatry as part of their training.

This study evaluates the degree of empathy among medical students and its influencing factors at three critical moments of their degree studies (beginning of first year and end of third and sixth years) as well as establishes low-, medium-, and high-empathy cut-off points to obtain valid and reliable results that can be extrapolated to the general population. This cross-sectional study of the eight (public and private) medical schools in the province of Madrid, used an electronic questionnaire with the Jefferson Scale of Empathy (JSE), Medical Student Well-Being Index, and other independent characteristics as measuring instruments. Of the 2,264 student participants, 1,679 (74.0%) were women, with a 50.7% participation rate. No significant differences were found in empathy levels by academic year. Regarding range, percentile and cut-off point tables were established to identify students with high, medium, and low empathy levels. Women (p<0.001), volunteer workers (p<0.001), and those preferring general specialties (internal medicine, psychiatry, pediatrics, or family medicine) scored higher on the JSE (p<0.02). Moreover, 41.6% presented high level of psychological distress. Women reported a lower well-being level and a higher risk of psychological distress (p = 0.004). In sum, the empathy of medical students in Madrid did not differ among the three critical moments of their university studies. The established cut-off points could be taken into account when accessing the medical degree and identifying students with low levels of empathy to implement curricular interventions to rectify this perceived deficiency. There was a high percentage of medical students with high levels of psychological distress.

Limited information is available on the presence of rickettsial infection in animal reservoirs in Spain. Antibodies against Rickettsia slovaca and Rickettsia conorii were therefore sought in the sera of farm, domestic and wild animals (n = 223 samples) in an area of northern Spain. Indirect immunofluorescence assays showed: (A) 17/120 and 16/120 (14.2% and 13.3%) of serum samples from sheep (farm animals) reacted with R. slovaca and R. conorii antigens, respectively; (B) 10/73 and 10/73 (13.7% and 13.7%) of samples from dogs (domestic animals) did the same; (C) as did 22/30 and 20/30 (73.3% and 66.6%) of samples from deer (wild animals) (overall titre range: 1/40 to 1/1280). The prevalence of both types of infection was significantly greater in the wild animals than either the farm or domestic animals. The largest titres were recorded for R. slovaca in all three groups.

Purpose Seroprevalence against SARS-CoV-2 within university systems is poorly studied, making evidence-based discussions of educational system reopening difficult. Moreover, few studies evaluate how antibodies against SARS-CoV-2 are maintained over time. We assessed serological response against the SARS-CoV-2 virus among our university students and staff. Patients and Methods In this prospective cohort study, seroprevalence was determined in 705 randomly selected volunteers, members of the Faculty of Medicine and Health Sciences of the University of Alcalá, using a chemiluminescent Siemens’ SARS-CoV-2 immunoassay for total antibodies. Positive samples were tested for IgG and IgM/IgA using VIRCLIA® MONOTEST (Vircell). A first analysis took place during June 2020, and in those testing positive, a determination of secondary outcomes was performed in November 2020. Results A total of 130 subjects showed anti-SARS-CoV-2 antibodies (18.5%, 95% CI, 15.8–21.5%). Of these, IgM/IgA was positive in 27 and indeterminate in 19; IgG was positive in 118, indeterminate in 1. After 23 weeks, among 102 volunteers remeasured, IgG became undetectable in 6. Presence of antibodies was associated, in multivariable logistic regression, with exposure to infected patients (31.3%) [OR 1.84, 95% CI, 1.14–2.96; P = 0.012], presence of COVID-19 symptoms (52.4%) [OR 6.88, 95% CI, 4.28–11.06; P < 0.001], and confirmed earlier infection (82.9%) [OR 11.87, 95% CI, 4.26–33.07; P < 0.001]. Conclusions The faculty of medicine and health sciences personnel and students of our university showed a high infection rate for SARS-CoV-2 during 2020 associated with providing clinical care to infected patients. This emphasizes the importance of the performance of continuous surveillance methods of the most exposed health personnel, including health science students.

AbstractBACKGROUNDThe coronavius disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) reached Spain by 31 January 2020, in April 2020, the Comunidad de Madrid suffered one of the world’s highest crude mortality rate ratios. This study aimed to detect risk factors for mortality in patients with COVID-19.METHODSOur cohort were all consecutive adult patients (≥18 years) with laboratory-confirmed COVID-19 at a secondary hospital in Madrid, March 3-16, 2020. Clinical and laboratory data came from electronic clinical records and were compared between survivors and non-survivors, with outcomes followed up until April 4. Univariable and multivariable logistic regression methods allowed us to explore risk factors associated with in-hospital death.FINDINGSThe cohort comprised 562 patients with COVID-19. Clinical records were available for evaluation for 392 patients attended at the emergency department of our hospital, of whom 199 were discharged, 85 remained hospitalized and 108 died during hospitalization. Among 311 of the hospitalized patients, 34.7% died. Of the 392 patients with records, the median age was 71.5 years (50.6-80.7); 52.6% were men. 252 (64.3%) patients had a comorbidity, hypertension being the most common: 175 (44.6%), followed by other cardiovascular disease: 102 (26.0%) and diabetes: 97 (24.7%). Multivariable regression showed increasing odds of in-hospital death associated with age over 65 (odds ratio 8.32, 95% CI 3.01–22.96; p<0.001), coronary heart disease (2.76, 1.44-5.30; 0.002), and both lower lymphocyte count (0.34, 0.17–0.68; 0.002) and higher LDH (1.25, 1.05-1.50; 0.012) per 1-unit increase and per 100 units respectively.INTERPRETATIONCOVID-19 was associated in our hospital at the peak of the pandemic with a crude mortality ratio of 19.2% and a mortality ratio of 34.7% in admitted patients, considerably above most of the ratios described in the Chinese series. These results leave open the question as to which factors, epidemiological or intrinsically viral, apart from age and comorbidities, can explain this difference in excess mortality.FUNDINGNone.

There is little information on Thogoto virus (THOV) and Dhori virus (DHOV)infection in Spain. A total of 283 serum samples from 150 human subjects (78 males, 72 females) bitten by ticks, as well as samples from 120 sheep (one per animal), were studied by immunofluorescence assay. All human and animal subjects were from the province of Palencia in northern Spain. Eight human subjects had antibodies against THOV (seroprevalence: 5.3%) and six had antibodies against DHOV (seroprevalence: 4%); titers ranged between 1/32-1/256 and 1/32-1/128, respectively. No significant differences were seen in seroprevalence in terms of gender or age, although people with antibodies were significantly more likely to have had contact with livestock for professional reasons. One subject with an acute infection had IgM antibodies to both viruses and seroconverted to IgG. For the sheep, 24 serum samples were positive for antibodies to THOV (seroprevalence: 20%) and 32 for antibodies to DHOV (seroprevalence: 26.8%); titers ranged between 1/16 and 1/128. The seroprevalence of both viruses was significantly higher in animals < 4 years of age. Together, these results reveal the circulation of DHOV and THOV in humans and sheep in the province of Palencia. Sheep might be used as indicators of the presence of these organisms.

Three hundred and fourteen red foxes (Vulpes vulpes) in the province of Soria, Spain, were examined for hantavirus and lymphocytic choriomeningitis virus (LCMV) infection (and were likely to have been infected by feeding on infected rodents). Immunofluorescence and western blot assays confirmed 3.5% (11/314) to have antibodies to hantaviruses, and the immune fluorescence assay showed 2.2% (7/314) to have antibodies to LCMV. The serologic status of the animals showed no statistically significant association with sex or age. Although studies on the prevalence of hantaviruses and LCMV normally focus on rodents, our results showed that foxes can provide complementary information in determined areas.

Resumen: Introducción: Durante el curso académico 2015-16 se implantó el 6.o curso del Grado de Medicina en la Facultad de Medicina y Ciencias de la Salud de la Universidad de Alcalá. Comprende prácticas clínicas tuteladas y trabajo fin de grado/máster. La Facultad de Medicina y Ciencias de la Salud quería que el programa formativo fuera integral e integrador centrado en la adquisición y potenciación de competencias clínicas, de comunicación e investigación, con una estructura de coordinación que permitiera una evaluación y detección continua de desviaciones, y por supuesto establecer una evaluación de los resultados a medio y largo plazo. El objetivo de este trabajo es presentar el programa formativo desarrollado. Materiales y métodos: Se formó un equipo de docente y estudiantes para diseñar el curso, con un calendario de reuniones y un programa de acciones a llevar a cabo, siempre intentando que todas las decisiones fueran consensuadas, se tuvieran en cuenta los diferentes escenarios, con herramientas comunes didácticas y de evaluación, flexibles y adaptadas a los diferentes entornos. Resultados: El curso tiene diversidad de entornos y actividades docentes. Las rotaciones integran al estudiante en los servicios y unidades asistenciales. Además, se realizan actividades innovadoras transversales en la Facultad. Se ha diseñado una estructura de coordinación del programa y para su valoración los instrumentos tanto de evaluación del estudiante como del programa son variados y complejos. Se han diseñado numerosas encuestas de opinión que reflejan una satisfacción muy elevada y los resultados académicos son excelentes. Conclusiones: Se ha conseguido desarrollar un programa formativo integral e integrador, con una estructura de coordinación y unos instrumentos de evaluación adecuados. Los indicadores académicos y de opinión son muy positivos e indican que los objetivos de aprendizaje se cumplen con éxito. La coordinación es eficaz y homogeniza la docencia en entornos diferentes, facilitando la detección y subsanación de deficiencias. Abstract: Introduction: During 2015-16 academic implanted the 6th course of medicine degree in the Faculty of Medicine and Health Sciences of the Universidad de Alcalá. Includes clinical practices and master's dissertation. The Faculty of Medicine and Health Sciences wanted the training program to be integral and integrator focused on the acquisition and promotion of clinical skills, communication and research, with a coordination structure that would enable an assessment and continuous detection of deviations, and of course establish an assessment of results in the medium and long term. The objective of this work is to present the developed training programme. Materials and methods: A team of teachers and students was formed to design the course, with a calendar of meetings and a program of actions to be carried out, always trying to that all decisions were consensual, the different took into account scenarios, with common teaching tools and assessment, flexible and adapted to the different environments. Results: The course has diversity of environments and teaching activities. Rotations integrated student services and healthcare units. In addition, are cross-cutting innovative activities at the Faculty. A coordination of the program structure is designed and for their evaluation, both of student assessment and program, instruments are varied and complex. Numerous opinion tests that reflect a very high satisfaction and academic results are excellent have been designed. Conclusions: We have managed to develop a training program comprehensive and inclusive, with a coordination structure and appropriate assessment tools. Academic and opinion indicators are very positive and indicate that the learning objectives are met with success. He has been established very effective coordination to homogenize the teaching in different environments, and facilitates the detection and correction of deficiencies. Palabras clave: Competencias clínicas, Competencias comunicación, Competencias investigación, Innovación docente, Formación transversal, Keywords: Clinical competencies, Communication skills, Research skills, Educational innovation, Cross training

Exposure to Lymphocytic choriomeningitis virus (LCMV), hantaviruses, Rickettsia spp. and Borrelia burgdorferi among forestry workers from a province in central Spain (Guadalajara) was examined by serological screening. This is the first such study in this rural area, where people often live and work in proximity to domestic and wild animals. Immunofluorescent analyses of the serum of 100 forestry workers detected IgG antibodies to LCMV in 2% (CL 95% 0.55%-7.0%) of this population, to hantaviruses in 4% (CL 95% 1.6%-8.3%) for the serum amyloid A (SAA) serotype, and 2% (CL 95% 0.55%-7.0%) for the Seoul virus (SEO) serotype (samples also positive for SAA), to Rickettsia in 8% (CL 95% 4.1%-15%) (3% (CL 95% 1.0%-8.5%) for R. typhi and 5% (CL 95% 2.2%-11.2%) for R. slovaca, and to B. burgdorferi in 7% (CL 95% 3.4%-13.8%). The number of people who have been exposed to these organisms is commonly underestimated since most infections are asymptomatic. Greater epidemiological surveillance may therefore be recommended.

A molecular survey of 230 serum samples from cattle was studied by PCR-amplification of the citrate synthase gene gltA, the gene coding for protein 190 kDa—ompA—and the gene ompB. The study was carried out in the Junta of Castilla y León (northern Spain). The results suggest that the molecular study of the serum cattle would not make a good method in epidemiological studies on rickettsiae in this region. But it is necessary to continue and expand the work with more sensitive molecular methods.