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Background: The aim was to evaluate the reinforcement of the standard therapy with hyperimmune plasma (HP) in Coronavirus-19 disease (COVID-19) patients., Methods: Open-label, multicenter, randomized clinical trial performed in three hospitals in the Balearic Islands. Non-severe COVID-19 hospitalized patients with clinical time evolution equal to/less than 7 days were included, and randomized in: plasma group (PG) ( n = 37), receiving 600 mL divided into two doses from convalescent plasma donor, administered on days 1 and 2 after the enrollment; and control group (CG) ( n = 17). Primary outcome was the time for clinical improvement within 21 days, defined as patient achievement of categories 8, 7, and 6 in the Adaptive COVID-19 Treatment Trial scale (ACTT). The trial was terminated early due to the impossibility of recruitment due to the pandemic., Results: PG presented better scores on the ACTT scale at 7 days after HP infusion, whereas CG was needed 14 days to achieve similar results. The plasma infusion was safe., Conclusions: Despite the tendency observed in the plasma group to achieve slightly earlier better physical condition compared with the standard treatment alone. The administration of HP has been shown to be a safe therapy. No robust evidence was found to affirm a therapeutic effect of the early administration of two infusions of HP for non-severe COVID-19 infected patients. The interpretation is limited by the early termination of the trial, which resulted in a small sample size.

Background: Polyserositis (PS) is the inflammation, with effusion, of different serous membranes. It has been associated with different aetiologies, but the aetiology of PS remains unknown in a high percentage of patients., Aims: The general objective of this retrospective study was to analyse the aetiology of PS cases seen at Son Llàtzer Hospital in an 11-year period. Other objectives were to determine the epidemiological, clinical and analytical characteristics of these patients., Methods: An observational, descriptive and retrospective study to analyse the aetiology of PS cases seen at Son Llàtzer Hospital. The inflammation of two or more serous membranes confirmed by an imaging test was required and at least one of the serous fluid should be an exudate., Results: A total of 92 patients was included in the study. The most common diagnosis was neoplasm (nearly one-third of cases) followed by infectious and autoimmune diseases. PS aetiology was unknown in more than one-third. Pleura and pericardium were the most common sites of serosal involvement (83%). Antinuclear antibodies' positivity in serum and increased levels of adenosine deaminase in pleural effusion were significantly associated with a final diagnosis of autoimmune disease. Increased pleural lactate dehydrogenase levels were significantly associated with a final diagnosis of neoplasm. In 9 of 14 patients with a previous cancer, PS represented a recurrence of their cancer. Cases of unknown aetiology presented most frequently as pleural and pericardial involvement, and the majority resolved. In very few patients, an infectious aetiology could be proven., Conclusion: PS is a frequent clinical entity that is associated with different diseases and its diagnosis could be challenging, with a high rate of unknown aetiologies., (© 2018 Royal Australasian College of Physicians.)

Diagnosis of latent tuberculosis infection in patients with immune-mediated inflammatory chronic diseases (IMIDs) can be challenged as diagnostic test reliability could be impaired by immunosuppression. We retrospectively analyzed the Quantiferon Gold-Test in-Tube (QFT-G-IT) results of all patients with IMIDs seen at the Department of Internal Medicine of Son Llàtzer Hospital, Palma de Mallorca (Spain), looking for the factors related to QFT-G-IT indeterminate results. During the study period (2008-2015), 520 patients met the inclusion criteria. Factors associated with indeterminate QFT-G-IT results in a univariate analysis were inflammatory bowel disease, disease activity, lymphopenia, and medium-to-high doses of corticosteroids. In a subsequent multivariate analysis, only lymphopenia (defined as < 1500 cells) was associated with indeterminate QFT-G-IT results. Lymphocyte count was the only factor independently associated with an increased number of indeterminate QFT-G-IT results in patients with different autoimmune diseases. Others factors such as the use of medium-to-high doses of corticosteroids should be considered before testing with QFT-G-IT.

Background: Interferon-γ release assays (IGRAs) are increasingly used for the diagnosis of latent tuberculosis infection (LTBI). Because of the lack of a gold standard for the diagnosis of LTBI, IGRAs are compared to the tuberculin skin test (TST) and yield conflicting results. We assessed the usefulness of an IGRA test, QuantiFERON(®)-TB Gold In-Tube (QFT-G-IT), for diagnosing LTBI compared with TST in the setting of a contact screening study., Methods: A prospective comparison between the QFT-G-IT and the TST in TB contact subjects in a low TB burden area was conducted sequentially between January 2006 and December 2012., Results: A moderate concordance between the two tests (κ = 0.44 for TST cut-off of 5 mm and κ = 0.56 for TST cut-off of 15 mm) was found. A better agreement was shown in younger contacts and in non-vaccinated contacts when using a TST of 15 mm. Independent risk factors for a TST(+)/QFT-G-IT(-) discordance were history of BCG vaccination and age between 31 and 59 years. Discordance was also more frequent using a TST cut-off value of 5 mm. QFT-G-IT(+)/TST(-) was infrequent and was found in older contacts., Conclusions: Based on our data, we cannot recommend the use of QFT-G-IT as the only test to rule out LTBI, especially in older patients.

Introduction: Q fever is a widespread zoonotic infection caused by Coxiella burnetii (C. burnetii). Acute infection varies from a self-limited flu-like illness to pneumonia or hepatitis., Methods: A retrospective case study from March 2003 to December 2011 was conducted in the Hospital Son Llàtzer in Palma de Mallorca. Acute Q-fever was diagnosed in a patient with clinical suspicion and IgM in phase ii positive (≥ 1/40), with a positive IgG (≥1/80), or when IgG seroconversion was observed during convalescence. A total of 87 cases of acute Q fever were diagnosed. The median age was 50 years (range 21-89), and 69 (79.3%) were male. Fever and headache were the most common symptoms. Pneumonia was diagnosed in 39 (44.8%) patients, febrile episode in 21 (24.1%), and acute hepatitis in 23 (25.6%). Increased serum transaminases were observed in 19 (21.8%). Doxycycline was prescribed in 29 cases (33.4%). There were 30 (34.5%) patients lost to follow up after hospital discharge. A favorable outcome was observed in all other cases. Only one new case progressed to chronic Q fever., Results: A total of 87 cases of acute Q fever were diagnosed. The median age was 50 years (range 21-89), and 69 (79.3%) were male. Fever and headache were the most common symptoms. Pneumonia was diagnosed in 39 (44.8%) patients, febrile episode in 21 (24.1%), and acute hepatitis in 23 (25.6%). Increased serum transaminases were observed in 19 (21.8%). Doxycycline was prescribed in 29 cases (33.4%). There were 30 (34.5%) patients lost to follow up after hospital discharge. A favorable outcome was observed in all other cases. Only one new case progressed to chronic Q fever., Conclusion: Acute Q fever acute is common our environment. Pneumonia was the most common clinical presentation. Even although doxycycline was prescribed in a small number of patients, a favorable outcome was observed in all cases., (Copyright © 2013 Elsevier España, S.L. y Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. All rights reserved.)

Background: Pseudomonas aeruginosa is an important nosocomial pathogen that exhibits multiple resistances to antibiotics with increasing frequency, making patient treatment more difficult. The aim of the study is to ascertain the population structure of this clinical pathogen in the Hospital Son Llàtzer, Spain., Results: A significant set (56) of randomly selected clinical P. aeruginosa isolates, including multidrug and non-multidrug resistant isolates, were assigned to sequence types (STs) and compared them with their antibiotic susceptibility profile classified as follows: extensively drug resistant (XDR), multidrug resistant (MDR) and non-multidrug resistant (non-MDR). The genetic diversity was assessed by applying the multilocus sequence typing (MLST) scheme developed by Curran and collaborators, and by the phylogenetic analysis of a concatenated tree. The analysis of seven loci, acsA, aroE, guaA, mutL, nuoD, ppsA and trpE, demonstrated that the prevalent STs were ST-175, ST-235 and ST-253. The majority of the XDR and MDR isolates were included in ST-175 and ST-235. ST-253 is the third in frequency and included non-MDR isolates. The 26 singleton sequence types corresponded mainly to non-MDR isolates. Twenty-two isolates corresponded to new sequence types (not previously defined) of which 12 isolates were non-MDR and 10 isolates were MDR or XDR., Conclusions: The population structure of clinical P. aeruginosa present in our hospital indicates the coexistence of nonresistant and resistant isolates with the same sequence type. The multiresistant isolates studied are grouped in the prevalent sequence types found in other Spanish hospitals and at the international level, and the susceptible isolates correspond mainly to singleton sequence types.

Background/methods: Quantiferon-TB-Gold in Tube(®) test (QFT-G-IT) may have advantages if combined with TST when screening for Latent Tuberculosis Infection (LTBI) prior to initiating anti-TNF therapy in an area of intermediate tuberculosis incidence such as Spain. In a small-scale prospective study, we evaluate the use of QFT-G-IT in combination with the screening recommended in Spain (Tuberculin-Skin Test, TST retest, clinical data, and Chest X-Ray (CXR)) for LTBI in patients considered as candidates for anti-TNFα treatment., Results: From June 2008 to October 2010, 123 patients from a 300-bed hospital in Palma de Mallorca (Spain) were included in the study. The majority of patients were under immunosuppressive therapy. A positive TST and TST booster were found in 22 and 17 patients, respectively. Thus 39 (31.7%) of the 123 patients had a positive TST. QFT-G-IT was positive in 16 patients (13.6%), indeterminate in 4 (3.2%), and negative in 103 (83.7%). One of the two tests was positive and LTBI was diagnosed in 34.1% of patients. The agreement between TST and QFT-G-IT among vaccinated patients was low and not statistically significant (Kappa=0.15) and was almost perfect among non-BCG vaccinated patients (K=0.81). TST positive responses were significantly related to BCG-vaccination (p<0.05) and QFT-G-IT positive response rates were related to older age (p<0.05)., Conclusion: QFT-G-IT may have advantages when combined with TST in immunosuppressed patients especially in older patients with a negative TST; in BCG vaccinated patients with a positive TST, QFT-G-IT could avoid unnecessary treatments and toxicities related to a false-positive TST result., (Copyright © 2011 Elsevier España, S.L. All rights reserved.)

Introduction: The Interferon-γ in vitro detection tests could be a useful tool in the diagnosis of active tuberculosis compared to Mycobacterium tuberculosis (MTB)., Methods: The QuantiFERON-TB-Gold in Tube (QFG-IT) test was performed on the blood of 118 patients with active tuberculosis and the results compared with the tuberculin test., Results: The QFG-IT test was positive in 94 cases (79.7%), negative in 17 (14.4%) and indeterminate in 7 (5.9%). A negative or indeterminate QFG-IT test was more common in older patients (P=0.017) and in cases with negative smear tests (P=0.041). The kappa agreement between the tuberculin and QFG-IT tests was 74.5% with a kappa value of 0.45 (SE:0.136). Thirteen of the patients studied were infected with HIV and the tuberculin was positive in 5 of the 12 cases (38.5%) in whom it was performed, with the QFG-IT being positive in 9/13 (69.2%)., Conclusions: The QFG-IT test may be a useful complimentary tool to the tuberculin test in the diagnosis of tuberculosis., (Copyright © 2009 Elsevier España, S.L. All rights reserved.)

Background: We performed an study of the possible benefits derived from the use of two vials, incubated for 24 and 72 h respectively, in the isolation of CMV from the leukocyte polymorphonuclear (LPMN) of peripheral blood (viremia) in immunosuppressed patients, using the shell-vial culture technique., Material and Methods: The blood samples with EDTA were fractionated by sedimentation with saline dextran. The LPMN-rich upper layer was used for the isolation of CMV in the shell-vial cell culture (MRC-5 cell line) and to prepare the antigenemia pp65 assay. The cultures were stained at 18-24 h (first vial) and 72 h (second vial) with an indirect immunofluorescence assay with a monoclonal antibody against p72 CMV antigen., Results: We studied 878 blood samples of which 247 (28.1%) were positive for CMV. Of the positive samples, 211 (85.4%) were detected in the first vial, and 220 (89%) in the second vial. Neither of the two vials detected all positive samples. An overall toxicity of 3%, in the positive samples, and 8.5% in positive samples was detected, respectively. Of the 28 toxic samples, 25.9% were detected in the first vial and 85.1% in the second (p < 0.001). The use of the second vial increased the number of positive samples in 14.5% (36 blood samples)., Conclusions: In view of the results obtained in this study it would seem that, in order to obtain the maximum diagnostic yield in the isolation of CMV from LPMN of peripheral blood in immunosuppressed patients by means of the shell-vial culture, it is necessary to inoculate all the LPMN extracted into two vials. The lengthening of the incubation period up to 72 h for one of the vials leads to an increased in the isolation of CMV of 14.5% with a low overall toxicity.

Background: To study the prevalence of virulence factors (adhesion, invasion, cytotoxicity and hemolytic activity) and to establish the presence of pathovars (virulence phenotype) in C. jejuni strains isolated in pediatric patients with inflammatory and secretory diarrhea and asymptomatic carriers., Methods: We analyzed 95 strains of 48 patients with inflammatory diarrhea (blood and mucus in feces), 30 patients with secretory diarrhea (watery) and 17 strains isolated in asymptomatic children (control group). The study of adherence capacity, invasion and cytotoxicity was made in the Hep-2 cell line, and the analysis of hemolytic activity in blood agar plates with a 5% sheep's blood. The pathovars were defined by the cellular adhesion (phenotypes A and a) and the cytotoxicity (phenotypes E and e)., Results: 29.1% of inflammatory strains presented adherence capacity, 66.6% were invasive, 64.5% cytotoxic and 52.1% hemolytic. In the secretory strains the values were 70, 20, 10 and 6.6% respectively; in the control group the 11.7% presented adherence capacity and 5.8% were invasive. We obtained difference statistically significative for the secretory strains in the adherence capacity, and in inflammatory strains in the adherence capacity, cytotoxicity and hemolysis. The phenotype Ae predominate in the secretory strains, and the phenotype ae in the strains belonging to the control group. No pathovar predominates in the inflammatory strains., Conclusions: The analysis of virulence markers permit us to establish the pathogenic behaviour of the C. jejuni strains isolated in patients with diarrhea. The study of the adherence capacity and cytotoxicity (pathovars) would be used as a virulence markers and to predict the inflammatory or secretory nature of the diarrhea caused by C. jejuni strains.

Five new cases of peritonitis caused by Aeromonas species are reported, and 29 others described in the literature are reviewed. Males predominated (71%), and the mean age was 56.9 years. Acquisition was nosocomial in 20% of the cases. All patients except one (3%) had significant underlying diseases; 73% had chronic hepatic disease, 15% had chronic renal failure (treated with chronic ambulatory peritoneal dialysis [CAPD]), and 9% had an intestinal perforation. Symptoms were similar to those of peritonitis caused by other pathogens, with the exception of diarrhea, which occurred in 25% of cases. Blood cultures were positive in 74% of the cases. The species isolated were Aeromonas hydrophila (27), Aeromonas sobria (5), and Aeromonas caviae (2). The overall case-fatality rate was 57%. Three strains were resistant to cotrimoxazole. Aeromonas species should be taken into account as a cause of peritonitis in patients with cirrhosis or who are undergoing CAPD.

Background: Rotavirus is one of the major causes of acute gastroenteritis in childhood. Several rapid methods for rotavirus detection are currently available, although their efficacy have a great variability. We performed a prospective study to evaluate two rapid tests for detection of rotavirus antigens in faeces., Methods: Using electron microscopy as the reference method, we compared two techniques for diagnosis of rotavirus infection: a monoclonal ELISA (Rotaclone, Cambridge Bioscencer, Worcester) and a policlonal latex agglutination (Diarlex, Orion Diagnostics, Finland). We tested, in parallel, 192 stools samples received in our laboratory to investigate rotavirus., Results: ELISA showed significantly better sensitivity than latex (100 vs 66.6%), while both methods had similar specificity (98.6%)., Conclusions: Of the tested methods, ELISA was superior due to the high sensibility and specificity, good reproductibility and easy interpretation. It also permits the simultaneous performance of several tests.