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Acute infectious gastroenteritis is an important illness worldwide, especially on children, with viruses accounting for approximately 70% of the acute cases. A high number of these cases have an unknown etiological agent and the rise of next generation sequencing technologies has opened new opportunities for viral pathogen detection and discovery. Viral metagenomics in routine clinical settings has the potential to identify unexpected or novel variants of viral pathogens that cause gastroenteritis. In this study, 124 samples from acute gastroenteritis patients from 2012&ndash, 2014 previously tested negative for common gastroenteritis pathogens were pooled by age and analyzed by next generation sequencing (NGS) to elucidate unidentified viral infections. The most abundant sequences detected potentially associated to acute gastroenteritis were from Astroviridae and Caliciviridae families, with the detection of norovirus GIV and sapoviruses. Lower number of contigs associated to rotaviruses were detected. As expected, other viruses that may be associated to gastroenteritis but also produce persistent infections in the gut were identified including several Picornaviridae members (EV, parechoviruses, cardioviruses) and adenoviruses. According to the sequencing data, astroviruses, sapoviruses and NoV GIV should be added to the list of viral pathogens screened in routine clinical analysis.

Describe secular trends in the epidemiology and outcome of Clostridium difficile infection (CDI) at a tertiary hospital.All consecutive primary CDI episodes in adults (January 2006-December 2015) were included. CDI was diagnosed on the presence of diarrhoea and a positive stool test for C. difficile toxin A and/or B. To define trends, a time-series analysis was performed using yearly data on demographics, clinical characteristics, management, antimicrobial treatment, and outcome of CDI. Patients were followed-up for three months after the diagnosis.There were 724 CDI episodes. Over the period from 2006 to 2015, the incidence rose from 0.18 episodes/1000 admissions to 0.26 episodes (relative rate [RR] 1.43; 95%CI, 1.02-2.00; P = 0.035). Median Charlson comorbidity index increased from 2 (IQR 1-3) to 4 (IQR 2-4) (RR 1.65; 95%CI, 1.12-2.41; P = 0.005). Overall, 80.4% of patients received proton pump inhibitors (PPIs) prior to CDI, and the percentage of PPI discontinuations rose from 2.3% to 20.4% (RR 8.80; 95%CI 1.20-64.36; P = 0.006). Management of non-Clostridium antibiotics also changed: antibiotic withdrawals or switches increased from 4.2% to 29.2% (RR 7.00; 95%CI 1.68-29.15, P = 0.001). Regarding CDI treatment, the percentage of patients treated with metronidazole decreased (88.9% vs 52.6%) (RR 0.59 (0.48-0.73), P 0.001), whereas the percentage receiving vancomycin increased (1.9% vs 32.6%) (RR 17.62 (2.47-125.49), P 0.001). The percentages of cures, deaths, and first recurrences did not significantly change over the 10-year period.Changes in CDI management were associated with a stable prognosis (percentage of cures and first recurrences), even though affected patients had a greater number of comorbidities over time.

Noroviruses are the most frequent cause of acute gastroenteritis in the community. In Catalonia, it is not clear how this type of viral gastroenteritis is evolving, and the objective of this prospective population-based study was to describe the incidence and epidemiological and clinical features of outbreaks of acute gastroenteritis due to norovirus in Catalonia between October 2004 and October 2005. Incidence rates were calculated using the estimated population of Catalonia in 2005. For each outbreak, the mode of transmission, the number of persons affected, demographic variables, clinical presentation, the date and time of onset of symptoms and the duration of symptoms, physician visits and hospitalizations were collected. Sixty viral outbreaks affecting 1791 people were identified, with no distinct seasonality. The mean number of outbreaks per month was 4.6. The global incidence was 24.6 per 100 000 person-years. The incidence was higher in women (25.7 per 100 000 person-years) and in the 5–11 years (52.4 per 100 000 person-years) and ≥65 years (42.4 per 100 000 person-years) age groups. The prevalence of vomiting, abdominal pain and general malaise was higher in children and adolescents, whereas the prevalence of diarrhoea and myalgia was higher in adults. These results suggest that norovirus infection has an important public health impact in Catalonia and that prevention strategies should be designed and implemented.

Background Noroviruses (NoV) are highly contagious and the leading cause of nonbacterial outbreaks of gastroenteritis worldwide. Individuals who are infected asymptomatically may act as reservoirs and facilitate the transmission of NoV, but the likelihood of workers of becoming infected in outbreak settings has not been systematically studied. Objectives We evaluated the occurrence of norovirus infections among workers exposed to the virus in different outbreak settings. Study design We screened feces from food handlers and healthcare workers related with gastroenteritis outbreaks, and shedding concentrations over time were calculated from serial samples of infected individuals. Sequence analyses of the capsid P2 domain and region C were used to evaluate linkage between asymptomatic employees and outbreak cases. Results Of all employees, 59.1% were positive for NoV, and more than 70% of them were asymptomatic. Asymptomatic infections were significantly more frequent in foodborne compared to person-to-person transmitted outbreaks; and in restaurants and hotels, compared to nursing homes and healthcare institutions. Mean viral loads were similar between symptomatic and asymptomatic individuals, starting at 7.51 ± 1.80 and 6.49 ± 1.93 log10 genome copies/g, respectively, and decreasing to 5.28 ± 0.76 and 4.52 ± 1.45 log10 genome copies/g after 19 days. Conclusions The likelihood of becoming infected when a NoV outbreak occurs at the work place is high and similar between food handlers and healthcare workers, but asymptomatic infections are more frequently identified among food handlers. Since shed amounts of viruses in the absence of symptoms are also high, reinforcement of hygiene practices among workers is especially relevant to reduce the risk of virus secondary transmissions.

In most developed countries, nontyphoid Salmonella is an important cause of sporadic cases and outbreaks of foodborne gastroenteritis. The aim of this study was to investigate the trend of foodborne Salmonella-caused outbreaks and number of cases, hospitalizations, and deaths and compare them with those caused by other infectious agents. The study was carried out in Catalonia, a region in northeastern Spain with a population of 6.5 million inhabitants, in 2002. All information on reported outbreaks of foodborne disease from 1990 to 2003 was reviewed. For each outbreak, the following variables were collected: year; setting (household, restaurant, school, hospital, nursing home, and others); number of cases, hospitalizations, and deaths; causal agent; and food vehicle involved. Of 1652 reported outbreaks, 1078 had a known causal agent. Among them, 871 (80.8%) were caused by Salmonella, with 14,695 cases, 1534 hospitalizations, and 4 deaths. The rate of hospitalization was higher in outbreaks due to Salmonella than in those caused by other infectious agents (rate ratio, 2.54; 95% confidence interval, 2.20 to 2.94). Forty-eight percent of Salmonella-caused outbreaks were eggborne, compared with 5.3% of those caused by other infectious agents (rate ratio, 1.40; 95% confidence interval, 1.33 to 1.48). The annual number of cases in household outbreaks of eggborne Salmonella rose over time (R2 = 0.82), but the number of outbreaks produced in other settings did not. Eggborne outbreaks caused by Salmonella in households are a major cause of disease, and increased preventive efforts are necessary, especially consumer education and awareness of the risk of eating food containing raw or slightly cooked eggs.

Fundamento y objetivo: Se ha investigado un brote de toxiinfeccion alimentaria que afecto a los clientes de un hotel y en el que la epidemiologia analitica y el analisis microbiologico permitieron determinar que el agente etiologico fue Norovirus y la fuente de infeccion, los manipuladores de alimentos. Pacientes y metodo: El dia 26 de junio de 2002 se detecto un brote de gastroenteritis que afectaba a un grupo de 59 alumnos y profesores de un colegio alojados en un hotel de Espot (Lleida). Se realizo un estudio de cohortes historicas sobre la exposicion a aguas y alimentos y sintomas clinicos. Se estudiaron el sistema de suministro y distribucion del agua de la red municipal y los menus consumidos. La investigacion microbiologica consistio en el coprocultivo y la determinacion de Norovirus en heces de 14 enfermos y de 4 manipuladores. La implicacion de cada alimento se estudio mediante el riesgo relativo (RR) y el intervalo de confianza del 95%. Resultados: Se entrevisto al 96,6% de los expuestos (57/59). La tasa de ataque global fue del 66,7% (38/57). La mediana del periodo de incubacion fue de 25,0 h (maximo de 51 y minimo de 19 h). La proporcion de sintomas fue: dolor abdominal en el 94,7% (36/38), vomitos en el 86,8% (33/38), nauseas en el 76,3% (29/38), diarrea en el 52,6% (20/38) y fiebre en el 48,6% (17/35). De los 4 tipos de agua y de los 13 alimentos estudiados, el unico que resulto implicado fue el consumo de bocadillos (riesgo relativo = 2,3; intervalo de confianza del 95%, 1,1-5,1). Los coprocultivos fueron negativos. En el analisis por reaccion en cadena de la polimerasa, 12 de las 14 muestras de heces de enfermos resultaron positivas a Norovirus. Tambien se obtuvo un resultado positivo al mismo virus en 2 de los 4 manipuladores. Ninguno de ellos habia presentado sintomas clinicos. Conclusiones: Los manipuladores deben ser investigados sistematicamente en los brotes por Norovirus y ademas deben cumplir de forma estricta las recomendaciones higienicas, especialmente en la preparacion de alimentos de consumo en crudo.

Fundamento Esclarecer el papel protector de Lactobacillus frente a la vulvovaginitis candidiasica. Pacientes y metodo Estudio in vitro que determina la capacidad de 15 cepas de Lactobacillus de bloquear la adhesion de dos cepas de Candida albicans y una de C. glabrata a las celulas epiteliales vaginales, asi como la capacidad de inhibir el crecimiento de estas levaduras. Ademas se ha determinado la presencia de Lactobacillus en 115 exudados vaginales de mujeres con vulvovaginitis candidiasica. Resultados Solo 8 de los 15 Lactobacillus bloquearon significativamente la adhesion de C. albicans Y18 a las celulas vaginales. Lactobacillus del grupo hemaglutinante III presentaron la mayor capacidad de bloqueo (62,9%), seguidos de los grupos II (50,6%) y I (26,1%). Ninguno de los 15 Lactobacillus estudiados fue capaz de inhibir en medio solido el crecimiento de las tres levaduras; sin embargo, en medio liquido algunos Lactobacillus evidenciaron cierto poder inhibidor frente a C. albicans Y17 (35,7, 41,7 y 38,1% de transmitancia para los Lactobacillus de los grupos I, II y III, respectivamente). Se detecto la presencia de Lactobacillus en el 89,6% de las mujeres con vulvovaginitis candidiasica, en el 87,8% mediante visualizacion microscopica y en el 72,2% mediante cultivo. Conclusion Los resultados de este estudio sugieren que probablemente Lactobacillus ejerce proteccion contra la vulvovaginitis candidiasica.

From 1979 to 1996, 58 patients (mean age, 39.4 years) were treated for bacteremia due to Campylobacter species at the Hospitals Vall d'Hebron in Barcelona, Spain. Bacteremia was considered to be hospital acquired in 30% of these patients. Almost all the patients (93%) had underlying conditions; liver cirrhosis was the most frequent (34% of patients), and neoplasia, immunosuppressive therapy, and human immunodeficiency virus disease were also common. Of the 58 Campylobacter strains isolated, 81% were C. jejuni, 10% were Campylobacter species, 7% were C. fetus, and one (2%) was C. coli. Resistance rates were: cephalothin, 82%; co-trimoxazole, 79%; quinolones, 54%; ampicillin, 20%; amoxicillin/clavulanate, 4%; erythromycin, 7%; gentamicin, 0; and tetracyclines, 0. Even though the majority of patients were immunocompromised, mortality was low (10.5%), and only one patient relapsed. Because of the high level of resistance to the quinolones in Campylobacter species, these drugs should not be used as empirical treatment, at least in Spain. Although the macrolides remain the antibiotics of choice, amoxicillin/clavulanate may be an effective alternative therapy.

Objective. To describe the epidemiology of norovirus (NV) and Salmonella gastroenteritis outbreaks in Catalonia between 15 October 2004 and 30 October 2005. Material and methods. Epidemiological data were obtained from outbreak reports. The aetiologic agent was investigated by culture for enteric bacteria, enzyme immunoanalyses, reverse transcription polymerase chain reaction (RT-PCR) and molecular epidemiology genotyping for NV. The x 2 test was used to compare proportions. Incidence rates and their confidence intervals (CI) were calculated assuming a Poisson distribution. Results. A total of 225 acute gastroenteritis (AG) outbreaks were reported, with 3436 persons affected and 115 hospitalized. Sixty outbreaks (27%) accounting for 1791 cases (52%) were caused by NV, with an attack rate (AR) of 34.7% and a hospitalization rate (HR) of 0.2%. Seventy- four outbreaks (33%) were caused by Salmonella spp., affecting 646 persons (18.8% (AR 45.6% and HR 13.7%)). The difference in AR between Salmonella spp. and NV was statistically significant (odds ratio (OR) 1.57; 95% CI: 1.391.78; p B0.001). The median number of affected persons per outbreak was 3-fold higher for NV (15 (2174)) than for Salmonella (5 (244)). The incidence rate of AG cases associated with NVoutbreaks was significantly higher (24.9 per 100,000 persons/year (95% CI: 23.726.1)) than for those associated with Salmonella (5 (244)) outbreaks (9.2 per 100,000 persons/year (95% CI: 8.59.9)). Conclusions. The disease burden and impact of NV highlight the importance of timely notification and investigation of outbreaks and the development and implementation of preventive measures, such as health and safety education for caregivers and food handlers in order to reduce the incidence of infections.