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The diagnosis of Lyme borreliosis (LB) is based on the epidemiological history, clinical manifestations and microbiological findings in the early disseminated and late phases of the disease. Related to this fact, microbiological diagnostic techniques have recently appeared. Far from facilitating the diagnosis and the clinical-therapeutic management of LB patients, they are generating confusion. Herein, experts and representatives of Spanish Scientific Societies [Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC), Spanish Society of Neurology (SEN), Spanish Society of Immunology (SEI), Spanish Society of Pediatric Infectology (SEIP), Spanish Society of Rheumatology (SER), and Spanish Academy of Dermatology and Venereology (AEDV)] exposed the executive summary after reviewing the epidemiology, clinical spectrum, available diagnostic techniques for the diagnosis of Borrelia burgdorferi infection, therapeutic and prevention options of LB. By consensus, recommendations for microbiological diagnosis are offered together with those supporting the therapeutic management and prophylaxis of infection., (Copyright © 2022 Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. Published by Elsevier España, S.L.U. All rights reserved.)

Introduction: Tularemia is a zoonotic disease that has been regularly reported in Spain since 1997. This study analyzes suspected, probable, and confirmed cases of tularemia in the province of Soria, and compares them with tularemia cases recorded in the autonomous community of Castilla y Léon, which, with the exception of 1 sporadic case, occurred in 2 epidemic outbreaks in 1997/1998 and 2007/2008., Methods: We studied all patients (53) with signs and symptoms of tularemia in the period of 1997 to 2008. Sixty-three serum samples from these patients were tested by a microagglutination assay for antibodies against Francisella tularensis; additionally 10 blood cultures and 1 culture of abscess exudate from an enlarged lymph node were carried out., Results: Over the last decade, 19 cases of tularemia have been diagnosed in Soria (1 sporadic case in 1996, 5 associated with an outbreak reported in 1997/98 and 13 associated with an outbreak occurring in 2007/08). In 95% of the cases, previous contact with hares was reported. The ulceroglandular type was most frequently (62%) observed. F. tularensis was isolated on blood culture in 2 cases. The remaining patients were diagnosed by serology (4 confirmed cases, 13 probable cases)., Conclusion: The cases of tularemia documented in Soria showed clinical and epidemiological features (predominant ulceroglandular clinical presentation and previous contact with hares) identical to the 1997/98 tularemia outbreak in Castilla y Léon, but contrasted with the 2007/08 outbreak in Castilla y León where typhoidal clinical forms of the disease and a relationship with an increased rodent population (Mycrotus spp) were predominant., (Copyright 2008 Elsevier España, S.L. All rights reserved.)

Objectives: To estimate the prevalence of drugs that interact with oral anticoagulants and establish relationships between variables and haemorrhagic complications., Design: Longitudinal, retrospective study of patient anticoagulant., Setting: Colmenar basic health area, Malaga, Spain., Participants: Patients on anticoagulants followed up in primary care., Main Measurements: Indications, time of follow-up, value of last prothrombin time (INR), complications and therapeutic groups of major use., Results: The 74.2% of the patients had a prothrombin time (INR) in the therapeutic range; 16.14% had minor complications; 60.2% of the patients complied with the criteria of multiple medication and 88.2% complied with the criteria of multiple medication in the last 6 months. The drugs used with a higher capacity to interact are: anti-ulcer (26.9%), locomotor system (10.7%), cardiovascular drugs (2.2%), lipid lowering drugs (8.6%), and antidiabetics (17.2%). The number of drugs used in the last 6 months is associated with the presence of haemorrhagic complications (odds ratio [OR], 1.10). Allopurinol and pantoprazole had a significant relationship with the presence of minor haemorrhages (OR, 19.25 and 7.37, respectively). The variables associated with the presence of a haemorrhage were: allopurinol (OR, 25.84), number of controls with an INR outside the therapeutic range in the last 6 months (OR, 1.31) and time on treatment (OR, 1.07)., Conclusions: The percentage of patients within the therapeutic range in the last determination of INR indicates good quality. The number of minor complications exceeded the consensus standard for the control of patients on anticoagulants. The use of drugs with a higher capacity for interacting with oral anticoagulants was very high in the anti-ulcer and antidiabetic groups. Pharmacological control of patients on anticoagulants is necessary and multiple medications should be avoided.

Basis: Anisakiasis is an emerging parasitosis in our environment, although still scarcely known, mainly its gastrointestinal manifestations., Patients and Methods: In this paper 42 cases of anisakiasis with gastrointestinal symptoms (with or without cutaneous allergic manifestations) are described; all cases were studied in our hospital between 1995 and May 2004., Results: Thirty seven cases showed a gastric or gastroallergic form (6 confirmed with gastroscopy) and 5 suffered intestinal symptoms. In those in which endoscopy was not carried out, the diagnosis was done after clinical and biological findings. All patients were sensitized in the presence of Anisakis simplex. The 69% (29 cases) described raw anchovies ingestion or anchovies seasoned in vinegar ingestion some hours before the beginning of the clinical picture. The 59% showed allergic symptoms (gastroallergic anisakiasis); no patient with intestinal affectation showed allergic symptoms. Nausea (67%), vomiting (51%), and epigastralgia (50%) were the dominant symptoms in the group with gastric or gastroallergic anisakiasis without endoscopic confirmation; on the other hand, pain in right ileac fossa was the dominant symptom in the intestinal form. Fever was seen in two of the later patients (40%), but in no patient with gastric or gastroallergic anisakiasis., Conclusions: Gastrointestinal symptomatology after ingestion of fish suspiciously prepared should suggest anisakiasis, regardless if clinical picture includes allergic manifestations. In our study, pain in right ileac fossa, fever, and absence of allergic manifestations were typical of intestinal form.

Introduction: There are differences in the clinical manifestations of Lyme borreliosis (LB) in different parts of the world. The aim of this work was to analyze its clinical manifestations in Spain., Methods: We evaluated by ELISA and IFI the sera of 1,500 patients with clinical suspicion of LB between January 1987 to February 1993. Spanish criteria of LB (amplified CDC criteria of LB for epidemiological purpuse) were used. Clinical and serological data were evaluated with the patients' physicians and other etiologies were reasonably excluded in accepted cases of LB., Results: Sixty-four patients of 138 with a positive serology (46%) met the LB criteria. Neurological manifestations were presented by 40 patients (62.5%) (in control group 23%, p < 0.05) cutaneous lesions by 20 patients (31%), articular manifestations by 18 patients (28%) (in control groups 56%; p < 0.05) and cardiac manifestations in two. Cutaneous manifestations included 17 erythema migrans, 2 acrodermatitis chronica atrophicans and 1 lymphocytoma). Artritis was present in 18 cases. Neurological manifestations included 16 cases of meningitis (2 with encephalitis), 11 of craneal neuropathy and 25 of peripheral neuropathy (13 of polyneuropathy). Cardiac manifestations acepted was 2 atrioventricular blockade. We detected 21% of false positive serology and in 33% of the positive cases, the LB criteria was not met., Conclusions: The low percentage of cutaneous manifestations is probably due to the fact that this series consist predominantly of hospital patients. In Spain, as in the rest Europe the predominant manifestations are neurological, however artritis are not infrequent manifestations.

Objective: To improve the quality of thoracic x-ray requests during chronic illness, presenting criteria for indication in HTA, LCFA and TBC., Design: Intervention study of quality improvement., Setting: Can Misses Health Centre in Ibiza., Participants: The General Practitioners at the above centre., Measurements and Main Results: In this study we proposed to evaluate the work of the doctors at our Health Centre in correctly requesting x-ray explorations on the basis of two explicit, standard criteria: 1) the reason for the thorax x-ray request must be stated in the clinical notes. 2) Thorax x-rays requested for LCFA, HTA and TBC must be correctly indicated., Conclusion: The use of structured criteria in thorax x-ray requests for chronic patients appears to lead to greater quality in requests for this complementary exploration.

Background: A one year prospective study was carried out to assess the etiology of community-acquired pneumonia (CAP), and also to know the incidence, characteristics and evolution of infection by Chlamydia pneumoniae; and the effectiveness of DNA probes in CAP due to Mycoplasma pneumoniae and Legionella., Methods: One hundred and ten patients with a diagnosis of CAP in the emergency department were studied. Serologic studies were performed, and also tests commonly used for the diagnosis of respiratory tract pathogens in respiratory samples, including serology and culture of Chlamydia pneumoniae and DNA probes for Mycoplasma pneumoniae and Legionella., Results: In 72 cases (71.3%) some pathogen was found and in 5 cases more than one microorganism was involved. The etiology was bacterial in 31% of the cases, with S. pneumoniae being the most frequent (19 cases). Forty percent of the cases were "atypical" pneumonias with 33 cases of M. pneumoniae and 5 by Chlamydia pneumoniae. Diagnostic data of viral pneumonia were found in 2 cases. DNA probes were not useful for the diagnosis of pneumonia by Legionella pneumophila and had low effectiveness (31.8%) in Mycoplasma pneumoniae CAP., Conclusions: a) M. pneumoniae was the most frequent pathogen (33%). b) DNA probes for M. pneumoniae had low sensitivity in sputum (31.8%) and none in pharyngeal exudate. c) Acute infection by C. pneumoniae was diagnosed in 5 cases. Previous data of infection were recorded in 60.4% of the patients. d) Bacterial pneumonia (31%) was underestimated due to a low rate of bacteremic cases (7.9%) and the low number of positive cultures with definitive diagnostic value. e) The evolution was good except in two cases (death due to staphylococcal pneumonia with alcohol withdrawal syndrome and multiorganic failure by disseminated chicken-pox).

Background: The aim of this study was to confirm the Sierra del Sueve (Asturias) as an endemic area for Lyme's disease and determine the seroprevalence of this disease in inhabitants of this and other zones of Asturias., Methods: A taxonomic study of 233 ticks in this county was carried out and the rate of infection by Borrelia burgdorferi was determined by culture in modified Kelly medium. Seroprevalence of Lyme's disease was studied by enzyme-immunoanalysis IgG-IgM in 150 inhabitants from several counties of Asturias., Results: The tick Ixodes ricinus is the most abundant species in the zone. All the cultures of Ixodes for Borrelia burgdorferi were negative. Among the farmers of the area of Sueve, seroprevalence of Lyme's disease was higher than in other population groups., Conclusions: The Sierra del Sueve is an endemic area of Lyme's disease because of the appropriate vector I. ricinus and the super-population of Fallow deer. In this county the percentage of asymptomatic seropositives for this disease is much higher than that of other zones in Spain.

Background: Lyme borreliosis is not usually diagnosed in Spanish patients since before 1987. The aim of this study was to know the clinical spectrum of infection by Borrelia burgdorferi in Spain by a prospective epidemiologic study., Methods: The period of collection of cases was from 1987 to 1989 and the follow-up period was of 2 years following diagnosis. Detection of serum antibodies was performed by indirect immunofluorescence and ELISA to patients with clinical suspicion of Lyme borreliosis established in 17 Spanish hospitals. The clinical and serologic data and the possibility of other disease which could justify the symptoms were evaluated with the doctor responsible for the patient., Results: Fifty-four patients with clinical manifestations and serologic data indicative of the disease and in whom other diagnosis were excluded were detected. Other diseases which could be the cause of the symptomatology were diagnosed in 26 patients with positive serology. Sixty-three percent of the patients had neurologic symptoms, 46% articular symptoms, 44% cutaneous symptoms and 9% cardiac symptoms., Conclusions: Lyme borreliosis is not exceptional in Spain. Its clinical spectrum may be situated half way between American and European epidemiologic descriptions. Serology must be interpreted by the clinical manifestations.

Aims: To find out the personal characteristics of patients who receive intra-muscular medication. To examine those illnesses where this treatment is used. To compare the number of intra-muscular treatments prescribed with the nature of the medication, according to a model of Primary Care and to the doctors training., Design: We are dealing with an observational study, in which a questionnaire was used to find patients' characteristics and the prescription given. SITE. The present study was carried out in the Ibiza Health Centre and two old-fashioned out-patient clinics in our Health Area., Patients and Other Participants: The population under study consisted of all those patients above the age of 7 who received intramuscular treatment during the period of the study (October, November and December, 1990)., Interventions: There were no interventions, as this was an observational study., Measurements and Main Findings: The intra-muscular method of administration was used more in women, people over 50 and those with a very low cultural level. The majority of patients (59.66%) believed that this method was superior to enteric treatments. This method was more often used in out-patient clinics than in the Health Centre (p < 0.01). In the Health Centre less medication treating the Locomotive System (p < 0.001) and more dealing with the Centre Nervous System (p < 0.02) was prescribed. In out-patient clinics more antibiotics, either in combination with each other or with other products, were prescribed (p < 0.01)., Conclusions: In the Health Centre the intra-muscular method was used less. Additionally, a smaller proportion of the medication given was intrinsically useless or of unacceptably low value.

We analyze the experience in serologic diagnosis of Lyme's borreliosis. From a total of 551 patients studied from 1987 to 1989, we further evaluate 80 cases with erythema chronicum migrans or a clinical diagnosis of Lyme's disease and positive serological tests. The techniques used were IFI, ELISA1 (Whittaker Bioproducts) and ELISA2 (MarDx Diagnostics). Serological tests results were evaluated in relation to clinical data. Five cases were excluded because of no-specific symptoms. There were 20 false-positive results, mainly due to other infections (HIV infection, tuberculosis, Mediterranean spotted fever and syphilis). Fifty-five patients were considered clinically of having Lyme's disease. IFI test was positive in 81.8% of all the 55 cases, ELISA2 in 58.4% of 53 cases tested and ELISA1 in 23% of 43 cases tested. Correlation between IFI and ELISA2 positive test was seen in 45% of cases. Specificity of all tests was higher than 97%. The study shows that sensitivity for all three techniques used was not optimal, and also there are some differences in their results. However, specificity was adequate.