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The immune system is the main mechanism of host defense against infections and tumors. Nevertheless, a strong immune response can sometimes worsen the clinical expression and outcome of the disease. This situation is described generally as immune reconstitution inflammatory syndrome (IRIS) and often occurs in HIV-infected patients after initiation of highly active antiretroviral therapy (HAART).1 It can also present in other forms of immunosuppression2–5 in patients thought to be immunocompetent who start receiving treatment of certain infections (such as leprosy or tuberculosis)6–8 and even during physiological conditions such as pregnancy.9 The generally accepted diagnostic criteria for IRIS are as follows1,10,11: 1) there is a temporal relationship with initiation of HAART and a setting of rapid reduction in plasma HIV viral load (VL) (> 2 log copies/mL)10 and a rapid increase in CD4+ cell count; 2) either clinical and/or radiological deterioration (usually with atypical characteristics) of an ongoing opportunistic process (paradoxical IRIS), or the onset of a new, previously undiagnosed opportunistic infection (OI) (unmasking IRIS); and 3) other explanations (treatment failure, drug interactions, or drug toxicity, autoimmune disease, a new OI unrelated to IRIS) have been completely ruled out. The IRIS incidence rate12 and the interval between initiation of HAART and the presentation of the infections involved vary significantly in different series.13–16 Younger age, male sex, low CD4+ cell counts, high VL and certain HLA haplotypes or polymorphisms in some cytokine genes17,18 have all been considered potential risk factors for IRIS. The risk factors can also vary depending on the region of origin of the patient, although this issue has not been extensively studied.19–21 The main objective of this study was to perform a retrospective analysis of all cases of HIV-infected immigrants who developed IRIS and were managed at our center between 1998 and 2014. Secondary objectives were to compare these data with those collected from the native-born population and to study potential effects related to the socioeconomic status (high-income versus low-income) of their countries of origin.

Summary Objective The aim of this work was to evaluate the prevalence of past infection due to Rickettsia typhi and Rickettsia conorii in the Canary Islands (Spain). Methods A representative sample of the population of the seven islands, formed of 662 people aged between 5 and 75 years (368 females, 294 males), was analyzed. Epidemiological data were obtained by direct survey. The detection of serum IgG antibodies against both microorganisms was based on an indirect immunofluorescence test, considered positive if the titers were ≥1/80. Results Of the analyzed population 3.9% had IgG antibodies against R. typhi and 4.4% against R. conorii . Out of these positive samples, only three were positive for both species. The seroprevalence was similar in both sexes. Positive results were found in all age groups, but a higher rate was noticed in those aged 46 years and older ( p R. typhi was found to be more prevalent in rural areas of all islands, as well as in farmers. Conclusions Our results confirm the presence of antibodies against the causative agents of murine typhus and Mediterranean spotted fever in the Canary Islands. Indirect data suggest that the detection of antibodies to R. conorii might be due to a cross-reaction between these species.

Since the introduction of the mumps vaccine, the age of appearance of mumps infection has shifted from children to adolescents and young adults, groups with a higher incidence of disease complications and sequelae. During the years 2000-2001, the Gran Canaria Island was part of an epidemic of mumps. In that period, our institution attended 67 cases of serologically confirmed acute mumps orchitis, the most serious complication of mumps infection in young postpubertal males. We conducted a descriptive and prospective study of this cohort and extensively reviewed the literature from 1967 (the year the first mumps vaccine was introduced) to 2009. Fifty-six patients were admitted because of general impairment and were treated with alpha-interferon. Sixty-six patients presented parotitis previous to orchitis (interval from parotitis to orchitis, 4.9 d). Orchitis was unilateral in 89.5% and bilateral in 10.4% of cases. More than 98% of patients had orchitis-associated fever. Nine patients had clinical and biochemical data showing acute mumps meningitis, and 11 had subclinical pancreatitis. The mean duration of symptoms was 4.6 days (range, 1-9). During the acute phase, more than 41% of the evaluated testes had a volume >25 mL. Acute hormonal disturbances were highly prevalent. These included decreased levels of testosterone and inhibin B with low or normal levels of gonadotropins in 35% of subjects, and, to our knowledge not previously reported, an atypical hormonal pattern consisting of low levels of free testosterone and inhibin B, along with increased measures of luteinizing hormone but low or normal follicle-stimulating hormone levels (11% of cases). During the follow-up period (mean, 331 d) a high incidence of sperm disturbance was found.

Fundamento y objetivos El incremento progresivo del numero de inmigrantes en Espana en los ultimos anos ha obligado a los profesionales sanitarios a considerar las caracteristicas especificas de esta poblacion. En este estudio se intentan determinar los valores normales de los inmigrantes procedentes del Africa subsahariana en los valores analiticos solicitados con mayor frecuencia en la practica clinica. Sujetos de estudio y metodos Se estudiaron los valores habituales de laboratorio (hemograma, pruebas de coagulacion y estudios bioquimicos sanguineos) en 150 inmigrantes previamente definidos como sanos tras efectuar un examen de salud que incluia una historia clinica protocolizada, estudios serologicos y estudio coproparasitario. Estos datos se compararon con los de un grupo control de 81 donantes sanos, de edad y sexo similares, de poblacion autoctona. Resultados Se encontraron diferencias estadisticamente significativas entre ambos grupos en la determinacion de volumen corpuscular medio (VCM), amplitud de distribucion eritrocitaria, leucocitos totales, creatinina, acido urico, proteinas totales, creatin quinasa (CK), aspartato amino transferasa, gamma glutamil transpeptidasa, inmunoglobulinas G y M (IgG, IgM). Teniendo en cuenta los valores de referencia, un porcentaje significativo de personas subsaharianas sanas presentarian valores «anormales» en las siguientes magnitudes: VCM, ADE, leucocitos totales proteinas totales, CK, IgG e IgM. Conclusiones La valoracion de los datos de laboratorio en la poblacion subsahariana, y posiblemente en otros grupos de inmigrantes, requiere establecer previamente el rango de normalidad adecuado para evitar errores diagnosticos y actitudes terapeuticas erroneas.

Fundamento y objetivo: La elevada mortalidad de la malaria grave por Plasmodium falciparum se relaciona con el grado de parasitemia. La eritrocitaferesis automatizada (EA) es una alternativa segura a la exanguinotransfusion, con los mismos beneficios potenciales pero menores efectos secundarios. Sin embargo, son escasas las referencias sobre la eficacia e indicaciones de esta tecnica. El objetivo de este trabajo ha sido describir las caracteristicas clinicas y evolucion de 6 pacientes con malaria grave en los que se empleo esta tecnica terapeutica complementaria. Pacientes y metodo: Se ha realizado un estudio observacional, descriptivo y retrospectivo de todos los pacientes con malaria ingresados en un unico hospital entre 1996 y 2006. En cada caso se recogieron los datos clinicos, epidemiologicos y parasitologicos basicos. Resultados: La serie se compone de 2 mujeres y 4 varones, con una media de edad de 43 anos. En todos los casos la infeccion fue adquirida en Africa subsahariana. Ningun paciente habia efectuado quimioprofilaxis antipaludica y la especie causal fue Plasmodium falciparum. El grado de parasitemia oscilo entre el 10 y el 35%. De los criterios de gravedad, cuyo numero oscilo entre 1 y 4, el mas frecuente fue la hiperbilirrubinemia. Todos los pacientes recibieron tratamiento convencional. La duracion total del ingreso oscilo entre 5 y 37 dias, y la estancia en la unidad de vigilancia intensiva, entre 1 y 17 dias. Todos los pacientes sobrevivieron. Conclusiones: En resumen, la EA es una tecnica segura, con las mismas ventajas que la exanguinotransfusion, pero sin muchos de sus efectos adversos. De acuerdo con los datos de la bibliografia y estas observaciones, podemos senalar que una parasitemia aislada mayor del 10% o una parasitemia superior al 5% asociada a algun criterio de gravedad son indicacion para la realizacion de EA.

Murine typhus and “murine-thypus-like” disease are reemerging infectious diseases. In Canary Islands (Spain), a rather distinct clinical pattern characterized by higher incidence of complications, especially renal damage (including acute failure and urinalysis abnormalities), is apparent and highly suggestive. It could be related to different strains of Rickettsia typhi or other cross-reactive species.

IntroducciOn Describir las caracteristicas clinicas y epidemiologicas de la fiebre Q en la zona sur de la isla de Gran Canaria. Metodos Se realizo un analisis retrospectivo de los casos diagnosticados de fiebre Q en el Servicio de Microbiologia del Hospital Universitario Insular de Gran Canaria entre los anos 1998 y 2000. Para la deteccion de anticuerpos frente a antigenos de fase II de Coxiella burnetii se empleo una tecnica de inmunofluorescencia indirecta. El diagnostico de fiebre Q aguda se realizo cuando se detectaron titulos de inmunoglobulina G (IgG) _ 1:320 e IgM _ 1:80 o cuando se demostro seroconversion. Resultados Durante el periodo de estudio se diagnosticaron serologicamente 59 casos de fiebre Q aguda (incidencia anual de 5 casos/100.000 habitantes). La seroprevalencia (IgG _ 1:80) encontrada en los pacientes a los que se les solicitaba serologia de fiebre Q y durante este periodo fue del 23,9%. Se dispuso de datos clinicos y epidemiologicos en 40 pacientes, siendo todos los casos esporadicos; el 57% de ellos fueron hospitalizados. La edad media fue de 40,6 _ 13,3 anos (intervalo, 20-74), mas frecuente en varones (85%) y procedentes del medio rural (67,5%). El 65% de los casos se produjeron de abril a julio. La manifestacion clinica mas frecuente fue un sindrome febril con elevacion de las enzimas hepaticas (87,5%). La forma neumonica fue rara (solo 3 casos). Conclusiones La fiebre Q se manifiesta fundamentalmente en nuestra zona como un sindrome febril agudo con afectacion hepatica subclinica. Esto, y la escasez de formas neumonicas y cronicas sugieren la implicacion de cepas de C. burnetii diferentes a las de otras zonas geograficas.

WOS: 000329131300012, PubMed ID: 24186907, Background. Interleukin 12R beta 1 (IL-12R beta 1)-deficient patients are prone to clinical disease caused by mycobacteria, Salmonella, and other intramacrophagic pathogens, probably because of impaired interleukin 12-dependent interferon gamma production. About 25% of patients also display mucocutaneous candidiasis, probably owing to impaired interleukin 23-dependent interleukin 17 immunity. The clinical features and outcome of candidiasis in these patients have not been described before, to our knowledge. We report here the clinical signs of candidiasis in 35 patients with IL-12R beta 1 deficiency. Results. Most (n = 71) of the 76 episodes of candidiasis were mucocutaneous. Isolated oropharyngeal candidiasis (OPC) was the most common presentation (59 episodes, 34 patients) and was recurrent or persistent in 26 patients. Esophageal candidiasis (n = 7) was associated with proven OPC in 2 episodes, and cutaneous candidiasis (n = 2) with OPC in 1 patient, whereas isolated vulvovaginal candidiasis (VVC; n = 3) was not. Five episodes of proven invasive candidiasis were documented in 4 patients; 1 of these episodes was community acquired in the absence of any other comorbid condition. The first episode of candidiasis occurred earlier in life (median age +/- standard deviation, 1.5 +/- 7.87 years) than infections with environmental mycobacteria (4.29 +/- 11.9 years), Mycobacterium tuberculosis (4 +/- 3.12 years), or Salmonella species (4.58 +/- 4.17 years) or other rare infections (3 +/- 11.67 years). Candidiasis was the first documented infection in 19 of the 35 patients, despite the vaccination of 10 of these 19 patients with live bacille Calmette-Guerin. Conclusions. Patients who are deficient in IL-12R beta 1 may have candidiasis, usually mucocutaneous, which is frequently recurrent or persistent. Candidiasis may be the first clinical manifestation in these patients., Fondo de Investigaciones Sanitarias, Ministerio de Economia y Competitividad [PI06/1031, PI10/01718]; European Regional Development Fund-European Social Fund (FEDER-FSE); Fundacion Canaria de Investigacion y Salud (Canarian government) [INREDCAN 05/06]; Foundation Caja Rural de Canarias-Chil y Naranjo; Universidad de Las Palmas de Gran Canaria; INSERMInstitut National de la Sante et de la Recherche Medicale (Inserm); University Paris Descartes; Rockefeller University; National Center for Research ResourcesUnited States Department of Health & Human ServicesNational Institutes of Health (NIH) - USANIH National Center for Research Resources (NCRR); National Center for Advancing Sciences of the National Institutes of Health [8UL1TR000043]; Laboratoire d'Excellence "Integrative Biology of Emerging Infectious Diseases" [ANR-10-LABX-62-IBEID]; European Research Council, Agence Nationale de la RechercheFrench National Research Agency (ANR) [GENCMCD 11-BSV3-005-01]; St Giles Foundation; Candidoser Association; Consejo Nacional de Ciencia y Tecnologia de MexicoConsejo Nacional de Ciencia y Tecnologia (CONACyT) [69992, 182817], This work was supported by Fondo de Investigaciones Sanitarias, Ministerio de Economia y Competitividad (grants PI06/1031 and PI10/01718), the European Regional Development Fund-European Social Fund (FEDER-FSE), Fundacion Canaria de Investigacion y Salud (Canarian government; INREDCAN 05/06), Foundation Caja Rural de Canarias-Chil y Naranjo (research prize 2004), Universidad de Las Palmas de Gran Canaria (fellowship to E. H. R), INSERM, University Paris Descartes, Rockefeller University, National Center for Research Resources and the National Center for Advancing Sciences of the National Institutes of Health (grant 8UL1TR000043), Laboratoire d'Excellence "Integrative Biology of Emerging Infectious Diseases" (grant ANR-10-LABX-62-IBEID), the European Research Council, Agence Nationale de la Recherche (grant GENCMCD 11-BSV3-005-01), the St Giles Foundation, the Candidoser Association, and Consejo Nacional de Ciencia y Tecnologia de Mexico (grants 69992 and 182817).

Genetic defects in the IL-12-IL-23/IFN-γ circuit confer Mendelian susceptibility to mycobacteria and salmonella. The IL-12/IFN-γ axis is essential for anti-tumoral immunity in mice. Cancer susceptibility has not been recognised in these patients so far. We report three relatives with IL-12R β 1 deficiency. At the age of 25 years old, one patient presented with oesophageal squamous cell carcinoma (OSCC). The patient had no previous risk factors for OSCC. He died at the age of 29 years. OSCC is exceedingly rare in individuals under 30 years and frequently relates to alcohol intake and smoking. Disorders of the IL-12-IL-23/IFN-γ axis may predispose to cancer.

An unusual skin and soft tissue infection of the lower limbs has been observed in immigrants from sub-Saharan Africa who cross the Atlantic Ocean crowded on small fishing boats (pateras). Response to conventional treatment is usually poor. Extreme extrinsic factors (including new pathogens) may contribute to the etiology of the infection and its pathogenesis.

Catheter removal is now the standard recommendation of catheter-related fungemia even when tunneled devices are used. However, in the clinical practice, this procedure is not always without risks. Antibiotic-lock technique can resolve many cases of catheter-related bacteraemia, but cure of catheter-related candidemia by this method has been attempted in very few instances, reviewed in this article. Herein, we report a case of non-complicated Candida glabrata fungemia related to a Hickman catheter used for parenteral nutrition, cured with intraluminal amphotericin B in addition to systemic therapy. This case demonstrates that 'antifungal-lock therapy' can be effectively used in selected cases of catheter-related candidemia.

In this paper we describe a case in which acute renal colic was associated with elimination of multiple hyphal masses of Aspergillus flavus. Also, we reviewed the literature on similar cases and we found a similar pattern characterized by a marked male predominance, association with at least one underlying medical condition that predisposes to fungal infection, the presence of local symptoms resembling acute ureteral colic, and the absence of systemic manifestations. Moreover, our data suggest that Aspergillus balls must be suspected when a diabetic and intravenous drug user presents with acute renal colic and that non-obstructive renal aspergillosis may be initially treated with itraconazole.

Non-ulcerous dyspepsia is common among sub-Saharan people migrating into Spain. Given the high prevalence of H. pylori (HP) infection in their countries of origin, we studied the prevalence of infection in this population, and specifically the prevalence of infection by the more virulent, cagA-positive strains (CAP). 140 sub-Saharan immigrants recently arrived to Gran Canaria (Canary Islands, Spain) were studied. 80.7% were male, with a mean age of 24.2 y. 90.7% tested seropositive for HP and 72.2% of them carried antibodies against the 'pathogenicity island' cagA. We did not find any relationship between the presence of these antibodies and the clinical variables studied. We can conclude that HP infection is virtually universal in this population, with a high percentage of infection by CAP strains.

The high mortality attributable to severe malaria by Plasmodium falciparum is related to the grade of parasitemia. Automated erithrocytapheresis (AE) is a safe alternative to exchange transfussion, with the same potential benefits but less undesirable side effects. Literature on this technique is scarce, consisting of isolated reports or short series. The objective of this study is to describe the clinical picture and outcome observed in 6 severely ill malaria patients in whom EA was applied as complimentary therapeutic technique.An observational prospective descriptive study was carried out of all inpatients with severe malaria in a single hospital between 1996 and 2006 in whom clinical, epidemiological and parsitological data were analyzed.This series included 2 women and 4 men, with a median age of 43 years. In all cases, the infection was acquired in West Sub-Saharan Africa. No patient had received antimalarial prophylaxis and all were infected by Plasmodium falciparum. The grade of parasitemia was between 10% and 35%. The number of severity criteria was between one and 4, the more frequent being hyperbilirrubinemia. All patients received conventional intravenous treatment. The total length of admission oscillated between 5 and 37 days, while the length of stay in the Intensive Care Unit varied between one and 17 days. All patients survived.AE is a safe technique, with the same advantages that blood exchange but lacking many of its disadvantages. A isolated parasitemia above 10%, or when a parasitaemia above of 5% is associated with any additional World Health Organization-2000 criteria of clinical severity, should constitute an indication for AE.

Of 788 recent African adult immigrants to Las Palmas de Gran Canaria, 213 (27.0%) had eosinophilia. The most frequent causes were filariasis (29.4%), schistosomiasis (17.2%), and hookworm infection (16.8%). Stool microscopy and filarial and schistosomal serologic tests gave the highest diagnostic yield. Country of origin and eosinophil count were associated with specific diagnoses.

In this first part of this paper we review the definition of eosinophilia and their classification according to the degree of elevation of eosinophils/microL. Aetiological factors related with eosinophilia were described in three groups of patients: a). autochthonous non-infected by HIV; b). HIV-infected; and c). arrived from tropical countries (imported eosinophilia). We included an algorithmic approach to the diagnosis, including the diagnostic studies that should be performed in patients with or without organ involvement. Pathological consequences of eosinophilia are indicated in the next part of the paper. Finally, therapeutical options used in patients with eosinophilia are reviewed, with an special emphasis on antihelminthic therapies and the management of the hypereosinophilic syndromes.

Background: Neurosyphilis (NS) is nowadays a less frequent disease. Its incidence and clinical spectrum have changed over time. Objective: To estimate the incidence of NS and describe the clinical spectrum of NS in immunocompetent patients in the last decade. Methods: Demographic and clinical features, cerebrospinal fluid (CSF) changes, neuroimaging findings and outcome were retrospectively analyzed. Results: Forty-three patients met NS criteria. The yearly incidence was 0.2– 2.1 cases per 100,000 inhabitants. The mean age was 48.1 years, males being more frequently involved. The most frequent clinical patterns were meningovascular (30.2%), meningeal (25.6%) and general paresis (25.6%). Compared to prepenicillin series, we observed a decrease in late forms, mainly tabes dorsalis. CSF titers studied by the Venereal Disease Research Laboratory were higher in early NS. Neuroimaging findings were nonspecific. Outcome was better for early forms. Conclusions: Compared to the preantibiotic era, a lower frequency of late NS was observed, similar to that reported in other modern series which include patients with HIV infection. Therefore, this trend seems to be due to the impact of antibiotics rather than to HIV infection.

Objectives: The aims of our study were: (i) to know the seroprevalence of Coxiella burnetii infection in the Canary Islands, (ii) to evaluate its epidemiologic features and (iii) to compare the rates of seroprevalence using two different cut-offs (1:20 and 1:80) for the diagnosis of past infection. Methods: We analysed a representative sample of the canarian population. 662 sera were tested. For the detection of IgG and IgM antibodies against C. burnetii phase II antigens an immuofluorescence assay was used. The serologic screening for IgG detection begun with a 1:20 dilution. A titer of IgG ≥ 1:80 along with a negative IgM were used as criteria for previous infection. Results: At an IgG antibody titer against C. burnetii of 1:80 as diagnostic for past infection, the observed global seroprevalence was 21.5%. If the cut-off used was 1:20, the observed prevalence increased up to 35.8% (p = 0.001). Significantly different seroprevalence rates were obtained at these different cut-offs when results were analysed for groups of age and socioeconomic status, but not for either the island of origin or for farmers. Conclusion: Our results strongly suggest that Coxiella burnetii infection is endemic in all the Canary Islands. Although it is more frequent in males above 30 years old, it do affect people of all ages, and thus it should be borne in mind in the face of any acute febrile syndrome.

The aim of this study was to describe the clinical and epidemiologic features of Q fever in the southern area of the island of Gran Canaria (Spain).We conducted a retrospective analysis of the clinical and epidemiological data of the cases of Q fever diagnosed by the Microbiology Laboratory of the Hospital Universitario Insular in Gran Canaria between 1998 and 2000. Antibodies against phase II Coxiella burnetii antigens were detected using an indirect immunofluorescence test. The diagnosis of acute Q fever was established by IgG titersor = 1:320 and IgM titersor = 1:80, or by seroconversion.During the period of study 59 cases of acute Q fever were diagnosed, making an incidence of 5 cases/100,000 inhabitants/year. The seroprevalence (IgGor = 1:80) in the patients for whom Q fever serology was requested during that period was 23.9%. Clinical and epidemiologic data were available for 40 patients. All were sporadic cases and 57% were hospitalized. The mean age of the patients was 40.6 6 13.3 years (range 20-74 years), 85% were males and 67.5% came from a rural background. The majority of cases (65%) clustered from April to July. The most frequent clinical presentation was an acute febrile process with elevated liver enzymes (87.5%). Pneumonia was infrequent (only three cases).In our area Q fever is mainly manifested as an acute febrile illness with subclinical hepatic involvement. This fact and the small number of cases with pneumonia and chronic forms suggest the etiological involvement of C. burnetii strains different from those in other geographic areas.

We report the first case of S. bovis bacteremia related to endoluminal colonization of a venous access port in a setting of advanced HIV infection, neutropenia and co-infection with HBV. The patient had no bowel abnormalities. The clinical picture was mild and was resolved by removal of the device.

We report on a Subsaharian patient with HIV infection and disseminated tuberculosis who developed acute, severe hypersensitivity reaction to efavirenz including acute renal failure in addition to liver and lung involvement, in the absence of skin changes or blood eosinophilia.

We describe the first case of infection of a neurosurgical shunt by Candida glabrata in an adult. The risk factors, clinical picture and response to therapy have been similar to similar cases caused by other Candida sp. We must emphasize the unequivocal features of infection and the rapid and probably complete response to removal of the device.