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BACKGROUND Invasive pneumococcal disease (IPD) is the most important bacterial infection in young children, and the introduction of pneumococcal conjugate vaccines has changed its presentation. This study compared the incidence, characteristics and serotype distribution of IPD before and after the introduction of the pneumococcal conjugate vaccine (PCV13). METHODS Prospective enrolment of patients with IPD aged less than 60 months and admitted to either of 2 tertiary care hospitals between January 2007 and December 2009 (pre-PCV13 period) and January 2012 and June-2016 (PCV13 period). RESULTS We identified 493 cases, 319 in the pre-PCV13 period and 174 in the PCV13 period. The incidence of IPD decreased from 89.7 to 34.4 casos per 100 000 habitantes ( -62%; P

Objective After the introduction of 13-valent pneumococcal conjugate vaccine (PCV13), a decrease of serotype-3 invasive pneumococcal disease (IPD) has not been homogenously observed around Europe. The aim of the study is to analyze the incidence of serotype-3 IPD in our area (Catalonia, Spain) and describe what microbiological and clinical characteristics distinguish serotype-3 IPD from nonserotype-3 IPD. Methods This study is a prospective observational study performed in three hospitals of Barcelona (Spain), from January 2012 to June 2016. Patients younger than 18 years with a diagnosis of IPD were included. Epidemiological, clinical, and microbiological data were collected. Results A total of 253 cases of IPD were included; of these, 53 were caused by serotype 3. The incidence rate of serotype-3 IPD remained stable over the study years (risk ratio [RR] = 0.64; 95% confidence interval [CI]: 0.3–1.38). In 92.5% (49/53) of the cases of serotype-3 IPD, the diagnosis was pneumonia and 89.8% (44/49) of them reported a complicated pneumonia. Also, 98.1% (52/53) were detected by positive real-time polymerase chain reaction (PCR) in blood or pleural effusion. Seventeen patients were properly vaccinated with PCV13 before the infection. Conclusion After the introduction of PCV13 a global decline of invasive pneumococcal disease has been reported, specially, due to a decrease of serotypes 1 and 19A cases. Serotype-3 Streptococcus pneumoniae IPD remained stable throughout the years of study, being currently the main serotype causing IPD in our area. Serotype 3 causes mostly pneumonia and physicians must be aware of possible complications. Real-time PCR have a significantly higher diagnostic yield for serotype 3 compared with culture. Some vaccination failures were observed.

AIM The aim was to analyze the epidemiological, microbiological and clinical characteristics of patients with complicated pneumococcal pneumonia with pleural effusion (PE) or empyema. METHOD Prospective study in three Catalan hospitals in persons aged

Background The relationship between community-acquired respiratory viruses (CARVs) and chronic lung allograft dysfunction (CLAD) in lung transplant recipients is still controversial. Methods We performed a prospective cohort study (2009–2014) in all consecutive adult patients (≥18 years) undergoing lung transplantation in the Hospital Universitari Vall d’Hebron (Barcelona, Spain). We systematically collected nasopharyngeal swabs from asymptomatic patients during seasonal changes, from patients with upper respiratory tract infectious disease, lower respiratory tract infectious disease (LRTID), or acute rejection. Nasopharyngeal swabs were analyzed by multiplex polymerase chain reaction. Primary outcome was to evaluate the potential association of CARVs and development of CLAD. Time-dependent Cox regression models were performed to identify the independent risk factors for CLAD. Results Overall, 98 patients (67 bilateral lung transplant recipients; 63.3% male; mean age, 49.9 years) were included. Mean postoperative follow-up was 3.4 years (interquartile range [IQR], 2.5–4.0 years). Thirty-eight lung transplant recipients (38.8%) developed CLAD, in a median time of 20.4 months (IQR, 12–30.4 months). In time-controlled multivariate analysis, CARV-LRTID (hazard ratio [HR], 3.00 [95% confidence interval {CI}, 1.52–5.91]; P = .002), acute rejection (HR, 2.97 [95% CI, 1.51–5.83]; P = .002), and cytomegalovirus pneumonitis (HR, 3.76 [95% CI, 1.23–11.49]; P = .02) were independent risk factors associated with developing CLAD. Conclusions Lung transplant recipients with CARVs in the lower respiratory tract are at increased risk to develop CLAD., “Community-acquired respiratory viruses (CARVs) lower respiratory tract infection” should be better than viral lower respiratory tract infection. It should be: CARVs lower respiratory tract infection, acute rejection and cytomegalovirus pneumonitis were independently associated with chronic lung allograft dysfunction.

Introducción: La enfermedad neumocócica invasiva (ENI) es la infección bacteriana más relevante en niños pequeños y la introducción de las vacunas antineumocócicas conjugadas (VNC) ha cambiado su presentación clínica. En este estudio se analizaron los cambios en la incidencia, características clínicas y distribución de serotipos en los casos de ENI antes y después de la disponibilidad de la VNC13. Métodos: Se incluyeron prospectivamente pacientes con ENI menores de 60 meses ingresados en 2 hospitales pediátricos terciarios desde enero de 2007 a diciembre de 2009 (período pre-VNC13) y de enero de 2012 a junio de 2016 (período VNC13). Resultados: Se identificaron 493 casos, 319 en el período pre-VNC13 y 174 en el período VNC13. La incidencia de ENI disminuyó de 89,7 a 34,4 casos por 100.000 habitantes (−62%, p < 0,001). Esta disminución de la incidencia se dio por igual en todas las presentaciones clínicas de la enfermedad excepto en la neumonía necrotizante (aumentó de 0,8 a 3,7 casos por 100.000 habitantes). Todos los serotipos incluidos en la VNC13 pero no incluidos en la VNC7 disminuyeron significativamente. No se encontraron diferencias significativas en la estancia hospitalaria, muerte y/o secuelas entre ambos períodos, aunque durante el período VNC13, los pacientes requirieron más días en la unidad de cuidados intensivos pediátricos y de ventilación mecánica (p = 0,00). La incidencia del serotipo 3 disminuyó de 10,4 a 6,9 casos por 100.000 habitantes, aunque fue el serotipo más frecuente en los pacientes con un cuadro clínico grave. Conclusiones: Luego de la introducción de la VNC13 se ha producido una disminución significativa de los casos de ENI. El serotipo 3 sigue siendo una causa importante de casos graves de ENI. Background: Invasive pneumococcal disease (IPD) is the most important bacterial infection in young children, and the introduction of pneumococcal conjugate vaccines has changed its presentation. This study compared the incidence, characteristics and serotype distribution of IPD before and after the introduction of the pneumococcal conjugate vaccine (PCV13). Methods: Prospective enrolment of patients with IPD aged less than 60 months and admitted to either of 2 tertiary care hospitals between January 2007 and December 2009 (pre-PCV13 period) and January 2012 and June-2016 (PCV13 period). Results: We identified 493 cases, 319 in the pre-PCV13 period and 174 in the PCV13 period. The incidence of IPD decreased from 89.7 to 34.4 cases per 100,000 population (−62%; P < .001). This decrease was observed in all forms of disease except necrotising pneumonia (increase from 0.8 to 3.7 cases/100,000 population). There was a significant reduction in all serotypes included in the PCV13 and not included in the PCV7. We did not find significant differences in length of stay, mortality or the frequency of sequelae between both periods, but in the PCV13 period, the length of stay in the paediatric intensive care unit and the duration of mechanical ventilation were longer (P = .00). The incidence of serotype 3 decreased from 10.4 to 6.9 cases per 100,000 population, although it was the serotype involved most frequently in patients with severe disease. Conclusions: After the introduction of the PCV13, there has been a significant decrease in IPD cases. Serotype 3 continues to be an important cause of severe IPD. info:eu-repo/semantics/publishedVersion

Volume 57, no. 8, e00363-19, 2019, [https://doi.org/10.1128/JCM.00363-19][1]. This article was published on 26 July 2019 with the title “Invasive Pneumococcal Disease and Influenza Activity in a Pediatric Population: Impact of PCV13 Vaccination in Pandemic and Nonpandemic Influenza Periods.” The

Vaccination with the 13-valent conjugated pneumococcal disease (PCV13) has reduced invasive pneumococcal disease (IPD), but there have been reports of vaccine failures. We performed a prospective study in children aged 2-59 months who received diagnoses of IPD during January 2012-June 2016 in 3 pediatric hospitals in Catalonia, Spain, a region with a PCV13 vaccination coverage of 63%. We analyzed patients who had been age-appropriately vaccinated but who developed IPD caused by PCV13 serotypes. We detected 24 vaccine failure cases. The serotypes involved were 3 (16 cases); 19A (5 cases); and 1, 6B, and 14 (1 case each). Cases were associated with children without underlying conditions, with complicated pneumonia (OR 6.65, 95% CI 1.91-23.21), and with diagnosis by PCR (OR 5.18, 95% CI 1.84-14.59). Vaccination coverage should be increased to reduce the circulation of vaccine serotypes. Continuous surveillance of cases of IPD using both culture and PCR to characterize vaccine failures is necessary.

Some studies have observed an increased incidence of necrotizing pneumonia (NP) in recent years. This might be related to the emergence of non-vaccine S. pneumoniae serotypes after PCV7 introduction although it is suggested that evolutionary factors may have modified the virulence and the interactions of pneumococci. The aim of this study was to clinically and microbiologically define NP in the population served by the three major paediatric hospitals in Barcelona (Catalonia, Spain).A prospective observational study was conducted in patients18 years hospitalized due to invasive pneumococcal disease (January 2012-June 2016). Data of confirmed cases of pneumococcal NP (diagnosed by culture or DNA detection and serotyped) were collected. PCV13 was not systematically administered in Catalonia during the study period, but was available in the private market so the vaccination coverage in children increased from 48.2% to 74.5%.35 cases of NP were identified. 77.1% of cases were associated with empyema. In the first 4 years, a trend to a decrease in NP incidence was observed (p=0.021), especially in children5 years (p=0.006). Serotype 3 was responsible for 48.6% of NP cases. Five patients with NP due to serotype 3 were fully vaccinated for their age with PCV13.Serotype 3 has a preeminent role in pneumococcal NP and was associated with all PCV13 vaccination failures. Although in our series the incidence does not seem to be increasing, evolution of pneumococcal NP rates should be monitored after inclusion of PCV13 in the systematic calendar.

Streptococcus pneumoniae; Cuidados intensivos pediátricos; Enfermedad neumocócica invasora Streptococcus pneumoniae; Paediatric intensive care; Invasive pneumococcal disease Streptococcus pneumoniae; Cures intensives pediàtriques; Malaltia pneumocòcica invasora Introducción La enfermedad neumocócica invasora (ENI) puede requerir ingreso en la unidad de cuidados intensivos pediátricos (UCIP). El objetivo de este trabajo es analizar las características epidemiológicas, clínicas y microbiológicas asociadas a la ENI que predisponen el ingreso en la UCIP. Material y métodos Estudio prospectivo de casos diagnosticados con ENI en tres hospitales pediátricos de Barcelona entre enero de 2012 y junio de 2016. Se analizaron las asociaciones entre el ingreso en la UCIP y las variables epidemiológicas, clínicas y microbiológicas. Resultados Se incluyeron 263 casos con ENI. El 19% (n = 50) requirió ingreso en la UCIP. El 100% (7) de los pacientes con shock séptico, 84,2% (16) con meningitis y 15,2% (23) con neumonía complicada ingresaron en la UCIP. Las complicaciones más frecuentes fueron pulmonares (35,2%) y neurológicas (39,5%). La razón entre ingreso y no ingreso en la UCIP fue 4,17 veces mayor en los sujetos con enfermedad de base. Los serotipos asociados al ingreso en la UCIP fueron el 19A (23% del total de este serotipo), el 14 (20%), el 3 (17%) y el serotipo 1 (12,5%). Conclusiones La ENI requiere ingreso en la UCIP en caso de shock séptico y meningitis, no así, de entrada, la neumonía complicada. El porcentaje de ingresos es mayor en los niños con enfermedad de base. El ingreso en la UCIP conlleva una estancia más prolongada, así como complicaciones durante la fase aguda y secuelas, sobre todo, neurológicas. Los serotipos de los pacientes que ingresaron en la UCIP fueron, predominantemente, serotipos vacunales. Introduction Patients with invasive pneumococcal disease (IPD) may require admission into paediatric intensive care units (PICU). The aim of this study is to analyse the epidemiological, clinical, and microbiological characteristics associated with IPD that may require admission to the PICU. Material and methods A prospective study was conducted on cases of IPD diagnosed in three Paediatric Hospitals in Barcelona between January 2012 and June 2016. An analysis was made of the associations between the admission to PICU and the epidemiological, clinical, and microbiological variables. Results A total of 263 cases with IPD were included, of which 19% (n = 50) required admission to PICU. Patients with septic shock (7; 100%), meningitis (16; 84.2%), and those with complicated pneumonia (23; 15.2%) were admitted to the PICU. The most frequent complications were pulmonary (35.2%) and neurological (39.5%). The ratio between admission and non-admission to PICU was 4.7 times higher in subjects with an underlying disease. The serotypes associated with PICU admission were 19A (23% of the total of this serotype), serotype 14 (20%), serotype 3 (17%), and serotype 1 (12.5%). Conclusions IPD required PICU admission in cases of septic shock and meningitis, and less so with complicated pneumonia. The percentage of admissions is greater in children with an underlying disease. Admission into the PICU involves a longer stay, complications during the acute phase, as well as sequelae, particularly neurological ones. The serotypes of the patients that were admitted to PICU were predominantly vaccine serotypes. Plan Nacional I + D + I, ISCIII-Subdirección general de Evaluación y Fomento de la Investigación Sanitaria. Beca número: P111/02081, PI 11/2345; Fondo Europeo de Desarrollo regional (FEDER) y AGAUR. Beca número 2017 SGR 1342.

The lack of invasive pneumococcal disease (IPD) cost studies may underestimate the eect of pneumococcal polysaccharide conjugated vaccines (PCV). The objective of this study was to estimate the direct costs of hospitalized IPD cases. A prospective study was made in children aged

Patients with invasive pneumococcal disease (IPD) may require admission into paediatric intensive care units (PICU). The aim of this study is to analyse the epidemiological, clinical, and microbiological characteristics associated with IPD that may require admission to the PICU.A prospective study was conducted on cases of IPD diagnosed in three Paediatric Hospitals in Barcelona between January 2012 and June 2016. An analysis was made of the associations between the admission to PICU and the epidemiological, clinical, and microbiological variables.A total of 263 cases with IPD were included, of which 19% (n = 50) required admission to PICU. Patients with septic shock (7; 100%), meningitis (16; 84.2%), and those with complicated pneumonia (23; 15.2%) were admitted to the PICU. The most frequent complications were pulmonary (35.2%) and neurological (39.5%). The ratio between admission and non-admission to PICU was 4.7 times higher in subjects with an underlying disease. The serotypes associated with PICU admission were 19A (23% of the total of this serotype), serotype 14 (20%), serotype 3 (17%), and serotype 1 (12.5%).IPD required PICU admission in cases of septic shock and meningitis, and less so with complicated pneumonia. The percentage of admissions is greater in children with an underlying disease. Admission into the PICU involves a longer stay, complications during the acute phase, as well as sequelae, particularly neurological ones. The serotypes of the patients that were admitted to PICU were predominantly vaccine serotypes.

The epidemiology of respiratory viruses (RVs) in lung transplant recipients (LTRs) and the relationship of RVs to lung function, acute rejection (AR) and opportunistic infections in these patients are not well known. We performed a prospective cohort study (2009–2014) by collecting nasopharyngeal swabs (NPSs) from asymptomatic LTRs during seasonal changes and from LTRs with upper respiratory tract infectious disease (URTID), lower respiratory tract infectious disease (LRTID) and AR. NPSs were analyzed by multiplex polymerase chain reaction. Overall, 1094 NPSs were collected from 98 patients with a 23.6% positivity rate and mean follow‐up of 3.4 years (interquartile range 2.5–4.0 years). Approximately half of URTIDs (47 of 97, 48.5%) and tracheobronchitis cases (22 of 56, 39.3%) were caused by picornavirus, whereas pneumonia was caused mainly by paramyxovirus (four of nine, 44.4%) and influenza (two of nine, 22.2%). In LTRs with LRTID, lung function changed significantly at 1 mo (p = 0.03) and 3 mo (p = 0.04). In a nested case–control analysis, AR was associated with RVs (hazard ratio [HR] 6.54), Pseudomonas aeruginosa was associated with LRTID (HR 8.54), and cytomegalovirus (CMV) replication or disease was associated with URTID (HR 2.53) in the previous 3 mo. There was no association between RVs and Aspergillus spp. colonization or infection (HR 0.71). In conclusion, we documented a high incidence of RV infections in LTRs. LRTID produced significant lung function abnormalities. Associations were observed between AR and RVs, between P. aeruginosa colonization or infection and LRTID, and between CMV replication or disease and URTID., A large prospective study of the epidemiology of respiratory viruses in lung transplant recipients using molecular assays demonstrates a very high incidence of respiratory viral infection and an association between respiratory virus infectious diseases, immediate allograft dysfunction, and the development of acute rejection and opportunistic infection.

Background: The aim of this study was to analyse the serotypes causing invasive pneumococcal disease (IPD) according to the clinical presentation, and antimicrobial susceptibility in children aged ≤17 years before the introduction of the 13-valent pneumococcal conjugate vaccine (PCV13) in the official paediatric schedule. Methods: We conducted a prospective study in children ≤17 years with IPD attended in three Catalan hospitals between January 2012 and June 2016. IPD cases were diagnosed by culture or RT-PCR. Demographic, microbiological, and clinical data were analysed. Associations were assessed using the odds ratio (OR) and 95% confidence intervals (CI). Results: Of the 253 cases included, 34.4% were aged < 2 years, 38.7% 2-4 years and 26.9% 5-17 years. Over 64% of cases were PCV13 serotypes. Cases with PCV13 serotypes were associated with overall pneumonia (OR:7.47[4.0-13.96]) and complicated pneumonia (OR:7.2[4.04-12.75]), overall and in each age group (p4 years, respectively. Forty-four cases (36.1%) were non-susceptible to penicillin and 16.4% were also non-susceptible to cefotaxime. There were no significant differences between PCV13 and non-PCV13 cases with non-susceptible penicillin strains (36.1% and 36.0%, respectively), while PCV13 cases showed more frequently non-susceptible cefotaxime strains (23.6%; p=0.010). Serotypes 19A and 14 were associated with non-susceptibility to both penicillin and cefotaxime strains (p=0.003 and p

The objective of this study was to analyze the incidence, clinical presentation, and severity of invasive pneumococcal disease (IPD)-causing serotypes and the impact of the 13-valent pneumococcal conjugate vaccination during epidemic and nonepidemic influenza periods in Catalonia, Spain. This was a prospective study in persons aged

Human parvovirus B19 represents the most common etiology of myocarditis in the pediatric population. Although it usually causes a benign exanthematic viral infection, parvovirus B19 may also present as disseminated disease with tropism for the myocardium, causing heart failure with high mortality. We present the case of a 2-year-old patient with fulminating acute myocarditis in whom the histological, immunophenotypic, and microbiological findings in necropsy showed multiorgan involvement caused by parvovirus B19. The autopsy revealed changes due to infection with parvovirus B19 as well as hypoxic-ischemic and secondary autoimmune changes. Medullary aplasia was observed, transmural lymphocyte myocarditis, lymphocytosis in the dermis with endothelial cells positive for parvovirus B19 in immunohistochemistry, cholestatic hepatitis due to ischemia and autoimmune hepatitis, lymphadenitis, and signs of hemophagocytosis. We also found hypoxic-ischemic encephalopathy.

Background Data are scarce on cytomegalovirus (CMV) and BK virus (BKV) infection after antibody-mediated rejection (ABMR). Objectives We hypothesized that the immunological response in patients with ABMR or the immune modulation associated with its treatment could predispose to CMV and BKV infection. Our objective was to investigate this hypothesis. Study design We conducted a single-center, matched case-control study (1:2 ratio) to analyze CMV and BKV replication during the first year after the ABMR diagnosis in kidney transplant recipients. Adult recipients with a histopathological diagnosis of ABMR between 2007–2015 were included as cases. Controls were kidney recipients who underwent transplantation immediately before and after the index case. Results Fifty-eight patients diagnosed with ABMR (33 chronic active ABMR and 25 acute ABMR), with their matched controls (116) were included. Forty-four cases received treatment for ABMR, including plasmapheresis (41), immunoglobulins (40), and rituximab (31). Within 1 year after ABMR, cases showed CMV replication more often than controls (9/58, 15.5% vs 7/116, 6%, OR = 4.21, CI 1.10–16.16, p = 0.04). Over the study period, CMV PCR determinations were requested more frequently in cases than controls (46/58, 79.3% vs 63/116, 54.3%, OR = 4.58, CI 1.92–10.9, p = 0.001). On multivariate analysis adjusted for CMV PCR determinations, retransplantation, antithymocyte globulin treatment and methylprednisolone treatment for acute rejection, CMV replication remained more common in cases than in controls (OR = 2.41, CI 0.49–11.73, p = 0.28). There were no differences in BKV replication in either urine or blood. Conclusions ABMR may be a risk factor for CMV but not for BKV replication in kidney transplant recipients.

Congenital human cytomegalovirus (HCMV) infection is the most common mother-to-child transmitted infection in the developed world. Certain aspects of its management remain a challenge. Urinary metabolic profiling is a promising tool for use in pediatric conditions. The aim of this study was to investigate the urinary metabolic profile in HCMV-infected infants and controls during acute care hospitalization. Urine samples were collected from 53 patients at five hospitals participating in the Spanish congenital HCMV registry. Thirty-one cases of HCMV infection and 22 uninfected controls were included. Proton nuclear magnetic resonance (1H-NMR) spectra were obtained using NOESYPR1D pulse sequence. The dataset underwent orthogonal projection on latent structures discriminant analysis to identify candidate variables affecting the urinary metabolome: HCMV infection, type of infection, sex, chronological age, gestational age, type of delivery, twins, and diet. Statistically significant discriminative models were obtained only for HCMV infection (p = 0.03) and chronological age (p &lt, 0.01). No significant differences in the metabolomic profile were found between congenital and postnatal HCMV infection. When the HCMV-infected group was analyzed according to chronological age, a statistically significant model was obtained only in the neonatal group (p = 0.01), with the differentiating metabolites being betaine, glycine, alanine, and dimethylamine. Despite the considerable variation in urinary metabolic profiles in a real-life setting, clinical application of metabolomics to the study of HCMV infection seems feasible.

Resumen: Introducción objetivos: La enfermedad meningocócica invasiva (EMI) constituye un grave problema de salud pública. A pesar de que el cultivo es la técnica de referencia para su diagnóstico, la administración previa de antibiótico altera su sensibilidad. Los objetivos de este estudio son el análisis epidemiológico de la EMI en nuestro medio, evaluar la utilidad de la reacción en cadena de la polimerasa (PCR) para incrementar el diagnóstico de confirmación de la EMI y valorar la asociación de la administración de antibiótico con el resultado negativo del cultivo. Pacientes y métodos: Estudio retrospectivo de los pacientes menores de 16 años diagnosticados de EMI mediante cultivo, PCR o ambos, que ingresaron en nuestro centro en el periodo 2004-2012. Resultados: Se incluyó a 75 pacientes, de los cuales el 52% presentó sepsis, el 30,7% meningitis y el 17,3% sepsis con meningitis. La PCR fue positiva en todas las muestras de sangre y líquido cefalorraquídeo analizadas, mientras que el cultivo tuvo una positividad muy inferior (50,7%). Recibieron antibiótico antes de la extracción de las muestras 40 pacientes (53,3%) y el 40% de ellos fueron confirmados por la PCR. Conclusiones: Gracias a la PCR se obtuvo un diagnóstico de confirmación de EMI en el 38,7% de los casos y del serogrupo, hecho relevante para la vigilancia epidemiológica y el estudio de la efectividad vacunal. Abstract: Introduction and objectives and aims: Invasive meningococcal disease (IMD) remains a serious public health problem. Although culture is the gold standard, previous antibiotic therapy reduces its sensibility. The aim of this study is the epidemiological analysis of IMD in our area, to assess the usefulness of polymerase chain reaction (PCR) to increase its diagnostic accuracy,and to show the association of antibiotic administration with the negative result of the culture. Patients and methods: A retrospective study was conducted on all children younger than 16 years with microbiologically (positive culture and/or PCR) confirmed IMD, admitted to our hospital between 2004-2012. Results: Seventy-five patients were included, of whom 52% had sepsis, 30.7% meningitis, and 17.3% with both of them. PCR was positive in all samples, whereas a positive was seen 50.7% of the cultures. Previously administered antibiotic was documented in 40 patients (53.3%), and 40% of them were confirmed by PCR only. Conclusions: PCR was the only test providing evidence for IMD diagnosis and serogroup determination in almost 39% of cases.

Resumen Introduccion La determinacion de la presencia de ADN de citomegalovirus (CMV) mediante tecnicas de reaccion en cadena de la polimerasa a tiempo real (rt-PCR) en la gota de sangre seca en el papel absorbente usado para la realizacion de la prueba de deteccion precoz neonatal ha sido validada para el diagnostico retrospectivo de infeccion congenita por CMV (CMVc) en estudios realizados en otros paises, pero no en el nuestro. El objetivo de este estudio es analizar el valor diagnostico de esta tecnica en nuestro centro. Metodos Estudio retrospectivo transversal observacional de todos los pacientes con diagnostico confirmado de CMVc entre enero de 2007 y septiembre de 2012. Se ha determinado la presencia de ADN viral de CMV en las muestra de sangre seca de la prueba del talon de estos pacientes mediante rt-PCR. Resultados Se incluyeron 14 pacientes; 4/14 sintomaticos y 4/14 con secuelas. La deteccion de CMV por rt-PCR fue positiva unicamente en 7 de ellos. Se demostro una relacion estadisticamente significativa entre la negatividad de la rt-PCR y cargas virales mas bajas al nacimiento. Conclusion A pesar del pequeno tamano muestral, nuestros datos ponen en evidencia la presencia de un numero importante de falsos negativos en la deteccion de CMV por rt-PCR en este tipo de muestras en el diagnostico de CMVc, especialmente en pacientes con cargas virales bajas al nacimiento.

Resumen Objetivo Analizar el estado vacunal de los ninos diagnosticados de tos ferina y comparar las manifestaciones clinicas de los bien vacunados y de los no vacunados o con vacunacion incompleta. Metodos Se ha revisado la historia clinica y el carnet vacunal de los pacientes menores de 16 anos visitados en el servicio de urgencias del Hospital Universitario Vall d’Hebron de Barcelona con tos ferina confirmada por estudio microbiologico. El periodo de estudio comprende del 1 de enero de 2009 al 31 de diciembre de 2011. Resultados Se han investigado 212 casos: 35 en 2009, 28 en 2010 y 149 en 2011. La reaccion en cadena de la polimerasa en tiempo real (RT-PCR) fue positiva en 210 pacientes, y el cultivo, en 73. Los lactantes menores de 6 meses representan el 36,8% de los casos. No estaban vacunados 44 (21,5%) pacientes. Cuarenta y cuatro (21,5%) tenian entre 2 y 5 meses de vida y habian recibido una o 2 dosis de vacuna. Habian completado la primovacunacion y las dosis de recuerdo (3 a 5 dosis, segun la edad) 117 ninos (57%); el 76,9% (90 casos) habia recibido la ultima dosis de vacuna hacia menos de 4 anos. Al comparar las manifestaciones clinicas de los pacientes con vacunacion completa y con vacunacion incompleta o no vacunados, solo la cianosis se ha presentado con mas frecuencia en el segundo grupo (p Conclusiones El numero de casos de tos ferina atendidos en nuestro centro ha aumentado de forma importante en el ultimo ano. El 57% de los pacientes estaban bien vacunados y el 76,9% habian recibido la ultima dosis en los ultimos 4 anos. Se necesitan otras estrategias de vacunacion (adolescentes, adultos y embarazadas, y estrategia del nido) para proteger a los lactantes menores de 6 meses de edad, asi como vacunas mas efectivas.

Resumen Fundamento y objetivo La tos ferina sigue siendo una importante causa de morbimortalidad a pesar de las actuales estrategias vacunales. Se diseno este estudio para describir los resultados y las caracteristicas de los contactos estrechos de casos de tos ferina diagnosticados en menores de 16 anos en un hospital de tercer nivel de Barcelona. Pacientes y metodo Estudio transversal. Los datos se recogieron a partir de las historias clinicas de los contactos de los casos pediatricos diagnosticados de tos ferina en el Hospital Universitario Vall d’Hebron de 2005 a 2009. Se incluyeron solo pacientes con estudio microbiologico realizado. Se calculo la odds ratio (OR) con su intervalo de confianza del 95% (IC 95%) como medida de asociacion. Resultados Fueron estudiados 91 casos indice y 404 contactos. La prevalencia de casos positivos entre los contactos fue del 33,2%. Los contactos de los casos indice menores de 6 meses presentaron mas riesgo de ser positivos que los contactos de los ninos mayores (OR 3,38; IC 95% 1,88-6,10). Se identificaron como casos primarios el 16,7% de los contactos estudiados. Estos representaron la fuente de contagio para el 67,7% de los casos indice menores de 6 meses y para el 26,9% de los ninos mayores. Conclusiones El estudio de contactos de casos pediatricos de tos ferina es una actividad clinica necesaria. Es mas probable hallar casos primarios en el estudio de contactos de ninos menores de 6 meses. Las estrategias preventivas deben ir dirigidas fundamentalmente a los contactos frecuentes de este grupo.

The microbiological diagnosis of mycoplasma and ureaplasma infections has always been limited due to the fastidious growth of these microorganisms, as well as the lack of commercially prepared growth media, absence of rapid diagnostic procedures, and the clinical perception that these organisms are less significant in the infectious diseases setting. During the last few years, this situation has substantially improved due to the commercial availability of culture media, the development of rapid serological techniques, and, in particular, to the introduction of nucleic acid amplification assays, commercially available or "in-house" preparations. Despite the lack of proper standardisation and validation of the molecular and serological techniques, methodological advances have led to an increased detection of these microorganisms and, consequently, a greater appreciation of their clinical relevance.

Vaccine failures occurring with 13-valent pneumococcal conjugate vaccine (PCV13) in 3 pediatric hospitals in Barcelona (2012-2013) are described. PCV13 vaccine failure was defined as the occurrence of an invasive pneumococcal infection in children properly vaccinated by PCV13. Among 84 patients with invasive pneumococcal infection, 32 had received at least one dose of PCV13. Seventeen of them had invasive pneumococcal infection produced by a PCV13 serotype. Among those, 9 patients were considered to have a PCV13 vaccine failure. Serotype 3 was isolated in 6 patients, serotype 19A in 2 and serotype 6B in 1.

The aim of this study was to evaluate the effectiveness of the administration of the 7-valent pneumococcal conjugate vaccine in a region with an intermediate vaccination coverage. A matched case-control study was carried out in children aged 7–59 months with invasive pneumococcal disease (IPD) admitted to two university hospitals in Catalonia. Three controls matched for hospital, age, sex, date of hospitalization and underlying disease were selected for each case. Information on the vaccination status of cases and controls was obtained from the vaccination card, the child's health card, the hospital medical record or the vaccination register of the primary healthcare center where the child was attended for non-severe conditions. A conditional logistic regression analysis was made to control for the effect of possible confounding variables. The adjusted vaccination effectiveness of the complete vaccination schedule (3 doses at 2, 4 and 6 months and a fourth dose at 15 months, 2 doses at least two months apart in children aged 12–23 months or a single dose in children aged >24 months) in preventing IPD caused by vaccine serotypes was 93.7% (95% CI 51.8–99.2). It was not effective in preventing cases caused by non-vaccine serotypes. The results of this study carried out in a population with intermediate vaccination coverage confirm those of other observational studies showing high levels of effectiveness of routine 7-valent pneumococcal conjugate vaccination.

Resumen Introduccion La tos ferina es una enfermedad reemergente. Describimos la investigacion de un brote de tos ferina y las medidas de control adoptadas. Metodos Se reconstruyo el evento a traves de un estudio longitudinal de incidencia. Ademas de los casos notificados, se realizo una busqueda activa a partir de la lista de asistentes a las colonias a traves de llamadas telefonicas. A todos los casos se les aplico la encuesta epidemiologica, se confirmo sus antecedentes vacunales con la historia clinica informatizada y se les propuso la obtencion de muestras para confirmacion analitica. La descripcion del brote se realizo a traves de la curva epidemica, las tasas de ataque, el riesgo relativo, la prueba de tendencia lineal por edades y la cobertura vacunal. Resultados De los 30 casos que se diagnosticaron 22 (73,3%) correspondian a los integrantes de las colonias. En estas, la tasa de ataque fue del 21,8%, del 26,7% entre los ninos y preadolescentes respectivamente, aumentando linealmente con la edad. El 86,4% de este ultimo grupo estaban correctamente vacunados incluyendo la quinta dosis a los cuatro-seis anos de edad. El 90% de los casos del brote fueron detectados a partir del estudio minucioso de los primeros casos y las llamadas telefonicas a los asistentes a las colonias. Conclusiones La busqueda activa de casos permitio el estudio de un brote de tos ferina con elevada tasa de ataque en ninos y preadolescentes y elevada cobertura vacunal y la aplicacion de medidas de control que contribuyeron a la detencion del brote.

Pertussis has been a preventable disease in Catalonia since 1965, but the annual number of cases remains high. The aim of this study was to analyze the epidemiology of pertussis in Catalonia and its implications for control purposes.An epidemiological study was carried out in Catalonia between 2004 and 2008. Pertussis cases reported to the Department of Health were collected and disease reports were filled out with the case information. Incidence rates, rate ratios (RR) and their 95% confidence intervals (CI) were calculated.963 cases were reported: 555 (57.6%) were confirmed and 408 (42.4%) were suspected cases. The reported incidence rate was 2.01 × 10(-5) person years in 2004 and 4.34 in 2008. The biggest increase in cases between 2004 and 2008 was observed in the ≥35 years age group (RR: 6.98; 95%CI: 2.11-36.36). 303 (31.5%) patients were hospitalized, of whom 93.7% were aged1 year. Clinical differences were observed in paroxysmal cough (83.8% in suspected and 76.4% in confirmed cases, p=0.005), posttussive vomiting (47.1% and 36.1%, respectively, p=0.001), apnoea (13.7% and 21.3%, respectively, p=0.003) and fever (20.1% and 12.4%, respectively, p=0.001).Pertussis incidence rates increased during the study period, with the greatest increase occurring in the ≥35 years age group. A booster dose of vaccine in young people could reduce the circulation of B. pertussis in adolescents and adults and indirectly reduce the incidence in children.

Objectives: To determine the proportion and type of mutations in Mycobacterium tuberculosis isolates resistant to streptomycin, and their relationship with the level of resistance and with the epidemiological molecular pattern of the isolates. Methods: Sixty-nine streptomycin-resistant isolates from a M. tuberculosis strain collection (1995– 2005) from Barcelona were studied. The MIC of streptomycin for each isolate was determined using the proportions method with Middlebrook 7H11 medium. The entire rpsL gene and two specific fragments of the rrs gene (the 530 loop and the 912 region) were sequenced. IS6110-restriction fragment length polymorphism and spoligotyping were performed in each isolate. Results: Twenty-six (26/69, 37.7%) streptomycin-resistant isolates presented a mutation in either the rpsL gene and/or the rrs530 loop, with no mutation in the rrs912 region. Seventeen (24.6%) isolates showed rpsL mutations (codons 43 and 88) associated with high MIC levels. Nine (13.0%) isolates had alterations in the rrs gene (A513T, A513C and C516T). Nineteen isolates (19/64, 29.7%) were classified into seven clusters (containing 2– 5 isolates per cluster). Nineteen different spoligotype patterns were found. All the LAM3 spoligotype isolates (10/67, 14.9%) were associated with a C491T change in the rrs gene, being also observed in all LAM3 streptomycin-susceptible isolates. Conclusions: Mutations in therpsL andrrs genes were detected in 37.7% of streptomycin-resistantM.tuberculosis isolates. High-level resistance was associated with mutations in therpsL gene, whereas wild-type isolates showed low MIC levels. The presence of the C491T substitution in the rrs gene in streptomycin-susceptible and -resistant isolates demonstrates that this change is an epidemiological marker associated with LAM3 sublineage.

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.

Objetivo La nocardiosis es una enfermedad de dificil diagnostico que, en contadas ocasiones, se ha asociado a bronquiectasias y/o fibrosis quistica. Se analizan las caracteristicas clinico-microbiologicas de 40 pacientes en los que se aislaron microorganismos pertenecientes al complejo Nocardia asteroides. Metodos Se estudiaron 27 varones y 13 mujeres, con una media de edad de 45 anos (8-82). Se aislo Nocardia spp. en 129 muestras. El cultivo se realizo por metodos convencionales, utilizandose ademas BCYE-α modificado (m) al visualizarse bacilos grampositivos ramificados en el examen microscopico. Resultados En el 77,5% de los casos la investigacion de Nocardia spp. estuvo motivada por el examen microscopico, en 6 pacientes fue un hallazgo fortuito en medio BCYE-α (m) y solo en 3 pacientes existia la sospecha clinica de nocardiosis. Tenian nocardiosis 25 pacientes (5 infecciones diseminadas y 20 pulmonares) y los 15 restantes estaban colonizados. El factor de riesgo mas frecuente en las infecciones, diseminadas o no, fue la utilizacion de glucocorticoides por via sistemica (p = 0,001), la enfermedad de base que mas se asocio a todos los cuadros clinicos fueron las bronquiectasias (80%), asociadas o no a fibrosis quistica (FQ). Se produjeron 7 muertes y 2 pacientes presentaron secuelas neurologicas. Conclusiones Las bronquiectasias suponen un factor importante de riesgo para la colonizacion (p = 0,01) en todos los pacientes y para la infeccion (p = 0,05) por Nocardia spp. en los pacientes sin fibrosis quistica. La utilizacion del medio de BCYE-α (m) en el procesamiento de las secreciones respiratorias facilito extraordinariamente el aislamiento de Nocardia spp.

Although vaccination coverage is high in Catalonia, Spain, pertussis is still a significant cause of morbidity and mortality among infants, overall due to adolescent and adult contacts. An epidemiological study from voluntary health care centres to detect confirmed pertussis cases was carried out in Catalonia. From 465 pertussis-suspect-cases, we identified 126 confirmed events, 73 of them confirmed by laboratory tests. Most of cases were infants less than 4 months old 23 (18.3%), adolescents 22 (17.4%) and adults 46 (36.5%). Sixty-one cases (49.6%) presented paroxysmal cough, 33 (26.8%) post-tussive vomiting and inspiratory whoop, and 27 (22%) apnoea. The vaccination status was not known for 46 (36.5%) patients. Of the total vaccine status documented, 59 (73.8%) patients had received at least one dose. Sixty patients (47.6%) were considered index cases, 32 of them (53.3%) were children under 1-year old. Among contacts identified as pertussis cases, 63.6% (42/66) were older than 14 years of age. These contacts were parents (30), siblings (19), grandmother (4), and others (13). These results confirm protective efficacy of pertussis vaccine only during few time. Regular pertussis boosters in teenagers, and/or in adults who take care of young children, could decrease the incidence of the infection.

The reactivity of the polyamines L, i.e., N-(3-aminopropyl)propane-1,3-diamine (1), spermidine (=N-(3-aminopropyl)butane-1,4-diamine; 2), and spermine (=N,N′-bis(3-aminopropyl)butane-1,4-diamine; 3) vs. palladium(II) and platinum(II) salts is studied. These reactions allowed us to prepare and characterize a wide variety of PdII and PtII complexes containing the polyamines. Compounds of the general formula [MCl(L)]2[MCl4] (L=1; 1a: M=Pd; 1b: M=Pt) or [MCl(L)]Cl (L=1; 1′a: M=Pd; 1′b: M=Pt) were isolated after treatment of K2[MCl4] or cis-[MCl2(dmso)2] respectively, with 1. The reaction of K2[MCl4] with 2 led to [MCl(L)]2[MCl4] (L=2; 2a: M=Pd; 2b: M=Pt), while that with 3 gave the neutral dinuclear compounds [M2Cl4(L)] (L=3; 3a: M=Pd; 3b: M=Pt). A comparative study of the results obtained in these reactions allowed us to evaluate the influence of i) the number of N-atoms in the polyamine, ii) their basicity, and iii) the palladium or platinum salt, upon the nature of the final product. Compounds 1a and (R,S)-3a were characterized by their X-ray crystal-structure analysis. Both exhibited the monoclinic crystal system, 1a the space group P21/c, and 3a the space group P21/n.

The detection of cytomegalovirus (CMV) DNA by real time polymerase chain reaction (rt-PCR) in dried blood spots collected routinely for metabolic screening has been assessed for the retrospective diagnosis of congenital CMV (cCMV) infection in many studies, but not in Spain. The aim of this study is to analyze the diagnostic accuracy of this technique in our hospital.A cross-sectional retrospective observational study was conducted including all patients born between January, 2007 and September, 2012 with confirmed cCMV infection. The assessment of CMV DNA was made by using rt-PCR in dried blood spots of these patients.Fourteen patients were included: 4/14 were symptomatic and 4/14 had sequelae. The detection of CMV DNA by rt-PCR was positive in only 7 patients. A statistically significant relationship between low viral load at birth and negative rt-PCR in dried blood spots was demonstrated.Despite the low number of patients included, our data highlight an important amount of false negative results in the DNA CMV detection by rt-PCR in these samples for the retrospective diagnosis of cCMV infection, especially in cases with low viral load at birth.

The aim of this study was to investigate risk factors for the most common serotypes of invasive pneumococcal disease (IPD). A total of 293 IPD cases were analyzed in children aged 3-59 mo in a community with intermediate vaccination coverage with the 7-valent pneumococcal vaccine (PCV7). IPD cases were reviewed during 2007-2009 in two pediatric hospitals in Catalonia (Spain). A multivariate analysis using unconditional logistic regression was performed to estimate the adjusted odds ratio. PCV7 coverage was 45.4%. Pneumonia with empyema (64.5%) was the most frequent clinical manifestation. The most common serotypes were: serotype 1 (21.2%), 19A (16.0%), 3 (12.6%) and 7F/A (6.8%). 70.0% of serotypes found were included in the 13-valent conjugate vaccine (PCV13), 39.2% in the 10-valent conjugate vaccine and 8.1% in the PCV7. PCV7 was protective in IPD cases due to PCV7-serotypes (aOR: 0.15, 95% CI:0.04-0.55). Serotype 1 was positively associated with attending day care or school (aOR: 3.55, 95% CI: 1.21-10.38) and age 24-59 mo (aOR: 7.70, 95% CI:2.70-21.98). Serotype 19A was positively associated with respiratory infection in the previous month (aOR: 2.26, 95% CI: 1.03-4.94), non-penicillin susceptible IPD (aOR: 1.89, 95% CI:1.13-3.16) and negatively associated with age 24-59 mo (aOR: 0.19, 95% CI:0.09-0.41). Serotype 3 was positively associated with vaccination (aOR: 4.87, 95% CI:2.05-11.59). No factors were associated with serotype 7F/A. Vaccination with pneumococcal vaccines including more serotypes may reduce the risk of disease in our setting.

In cases of multidrug-resistant tuberculosis, it is crucial to rule out resistance to second-line antituberculous (anti-TB) agents. In the present study, a low-cost low-density DNA array including four genetic regions (rrs 530 loop, rrs 1400, rpsL and gyrA) was designed for the rapid detection of the most important mutations related to anti-TB injectable drugs (mainly streptomycin) and fluoroquinolone resistance (LD-SQ array). A total of 108 streptomycin- and/or ofloxacin-resistant and 20 streptomycin- and ofloxacin-susceptible Mycobacterium tuberculosis clinical isolates were analysed with the array. The results obtained were compared with sequencing data and phenotypic susceptibility pattern. The LD-SQ array offered a good sensitivity compared to sequencing, especially among resistant strains: 92.5% (37/40) for streptomycin and 87.5% (7/8) for fluoroquinolones. Therefore, this array could be considered a good approach for the rapid detection of mutations related to streptomycin and fluoroquinolone resistance. On the other hand, there were discordant results in 16 resistant strains and six susceptible isolates, mostly concerning the gyrA region, in which the existence of polymorphisms next to informative positions might cause cross-hybridization. These discrepancies were caused by some technical limitations; consequently, the present array should be considered as a first-step prior to a forthcoming optimized version of the array. (c) 2013 Elsevier Ltd. All rights reserved.

To analyse the vaccination status of children diagnosed with pertussis and to compare the clinical manifestations of fully vaccinated with unvaccinated, or incompletely-vaccinated, children.The clinical histories and vaccination cards of patients under 16years of age seen in the Emergency Room of the University Hospital Vall d'Hebron, Barcelona (Spain), for pertussis confirmed by a microbiological study were reviewed. The study period lasted from January 1, 2009 to December 31, 2011.Two hundred and twelve cases were studied: 35 in 2009, 28 in 2010 and 149 in 2011. RT-PCR was positive in 210 patients, and 73 had a positive culture. Infants under 6months of age account for 36.8% of all cases. Forty-four patients (21.5%) were not vaccinated. Forty-four (21.5%) children were between 2 and 5months of age and had received 1-2vaccine doses. One hundred and seventeen (57%) children were fully vaccinated; 76.9% (90cases) had received the last dose less than 4years ago. When clinical manifestations of the fully vaccinated patients were compared with those of the non-vaccinated or incompletely-vaccinated children, only cyanosis was found with a higher frequency in the latter group (P.001). The age-adjusted probability of hospitalisation was significantly associated with non-vaccination (P=.001). The case mortality rate among inpatients was 1.3%.The number of pertussis cases seen in our centre has risen significantly in the last year. More than half (57%) of the patients were fully vaccinated, and 76.9% had received the last dose in the previous 4years. Other vaccination strategies, such as vaccination of adolescents, adults, and pregnant women, as well as a cocoon strategy are required to protect infants under 6months of age. More effective vaccines need to be developed.

Pertussis remains an important cause of morbimortality despite current vaccination strategies. This study was designed to describe the results and characteristics of close contacts of pertussis cases diagnosed in children less than 16 years in a tertiary hospital in Barcelona.Cross-sectional study. Data were collected from chart review of contacts of paediatric cases of pertussis in Vall d'Hebron University Hospital from 2005 to 2009. Only patients with microbiological study done were included. The odds ratio (OR) and 95% confidence interval (95% CI) were calculated as association measure.Ninety-one index cases and 404 contacts were studied. The prevalence of positive cases among contacts was 33.2%. Contacts of index cases younger than 6 months had a higher risk of being positive for pertussis than contacts of older children (OR: 3.38; 95% CI: 1.88-6.10). Primary cases were identified as 16.7% of the contacts studied, who were the source of infection for 67.7% of index cases younger than 6 months and for 26.9% of older index cases.Contact tracing of paediatric pertussis cases is a necessary clinical activity. It is more likely to find primary cases in the contact investigation of children less than 6 months. Preventive strategies should be targeted primarily to frequent contacts of this age group.

BACKGROUND The aim of this study was to analyze the rate of incidence, clinical presentation, serotype, and clonal distribution of invasive pneumococcal disease (IPD) in the era of heptavalent pneumococcal conjugate vaccine (PCV7) in Barcelona, Spain. METHODS This was a prospective study comprising all children

The microbiological diagnosis of mycoplasma and ureaplasma infections has always been limited due to the fastidious growth of these microorganisms, as well as the lack of commercially prepared growth media, absence of rapid diagnostic procedures, and the clinical perception that these organisms are less significant in the infectious diseases setting. During the last few years, this situation has substantially improved due to the commercial availability of culture media, the development of rapid serological techniques, and, in particular, to the introduction of nucleic acid amplification assays, commercially available or "in-house" preparations. Despite the lack of proper standardisation and validation of the molecular and serological techniques, methodological advances have led to an increased detection of these microorganisms and, consequently, a greater appreciation of their clinical relevance.

Serotype 3 is one of the most often detected pneumococcal serotypes in adults and it is associated with serious disease. In contrast, the isolation of serotype 3 by bacterial culture is unusual in children with invasive pneumococcal disease (IPD). The purpose of this study was to learn the serotype distribution of IPD, including culture-negative episodes, by using molecular methods in normal sterile samples. We studied all children

Whooping cough is a re-emerging disease. We describe the investigation of an outbreak of whooping cough and the measures of control adopted.The event was reconstructed through a longitudinal study of incidence. In addition to the notified cases, an active search from the list of those who attended summer camps was made through telephone calls. An epidemiological survey was applied to all cases; vaccination history was confirmed with computerised clinical history and the obtaining of samples for analytical confirmation was proposed. The description of the outbreak was made through the epidemic curve, the attack rates, the relative risk and the linear trend by ages and the vaccination coverage.Of the 30 cases that appeared, 22 (73.3%) were among the members of the summer camps. In these, the attack rate was 21.8%, 26.7% among the children and adolescents increasing linearly with the age. The large majority (86.4%) of this last group were correctly vaccinated, including the fifth dose at the age of 4-6 years. Through the meticulous study of the first cases and the telephone calls to those who attended the summer camp, 90% of the cases of the outbreak were detected.The active search of cases allowed an outbreak of whooping cough with a high attack rate to be studied in children and adolescents with a high vaccination coverage, and the application of control measures that contributed to stop the outbreak.

Meningococcal disease remains a serious public health problem worldwide. In Catalonia, after implementing the vaccination program, there has been a significant decrease in cases caused by meningococcus C.Reported cases of meningococcal disease between 1997 and 2008 were analyzed to determine the evolution after the introduction of a conjugated vaccine in Catalonia.In6 years, the incidence rate of serogroup C fell from 7.6 to 0.6 per 100,000 persons/year in the periods before (1997-2000) and after (2001-2007) the introduction of the conjugate vaccine. In serogroup B, the reduction was from 15.4 to 11.1. In20 years case-fatality-rate increased only in serogroup B (3% and 7.4%). Serosubtype P1.15was the most frequent in serogroup B (31%), mainly associated with serotype 4 (80%), and in serogroup C subtype P1.5 (36%), with serotype 2a (86%). During 2008, 5 apparently unrelated cases of B:2a:P1.5 were identified in the same geographic area, with a case-fatality-rate of 80%.Exhaustive surveillance of circulating meningococcal strains is essential.