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BACKGROUND The diagnosis of photoallergic contact dermatitis (PACD) is confirmed by photopatch testing (PPT). In Spain, the latest recommendation on which allergens to test in PPT dates from 1995. METHODS In the last 4 years, we studied 455 patients with epicutaneous tests and performed PPT on 33 of those patients (7.3%). RESULTS The most prevalent allergens in PPT were as follows: non-steroidal anti-inflammatory drugs (NSAIDs) (46%), fragrances (21%), and solar filters (18%). DISCUSSION In our country, the most common photoallergens continue to be NSAIDs (ketoprofen). The increasingly common use of sunscreens has led to a growing involvement of solar filters in PACD, which can be also contained in other cosmetics. In our experience, PACD due to fragrances is nonetheless at least similar in frequency. CONCLUSIONS The PPT battery must adapt to the prescription, use, and exposure habits of each country. We propose a diagnostic model to guide which allergens to test in PPT, which in our experience should also include fragrances.

Introduction Delusional parasitosis or Ekbom syndrome is a condition described mainly in the fields of psychiatry and dermatology, with a complex diagnostic and therapeutic approach. However, it is uncommon to assess patients with this disease in infectious disease units. The objective of this work is to describe the experience of three infectious diseases departments with respect to this entity. Methods A retrospective descriptive study of 20 patients diagnosed with delusional parasitosis in three Infectious Diseases Services was performed between 2003 and 2017. Results The median age of the patients was 54 years, with a female/male ratio of 1.5:1. In 9 patients, an endoparasitic delirium (mainly digestive) was described, in 5 an ectoparasitic form was described, and in the remaining 6, a mixed form was described. Fourteen patients presented some type of psychiatric disorder. Four patients had alcohol or drug abuse disorder. All patients had made consultations to other specialties with a median of three per patient (range 1–7). Ten patients received “empirical” antiparasitic treatment and 8 received some type of psychopharmaceutical treatment. The evolution was very variable: in 3 patients, the delusional parasitosis was resolved; in 9 patients, the clinical manifestations persisted, and the remaining patients were lost to follow-up. Conclusions Ekbom syndrome is a common process in infectious diseases, presenting some differences with other series evaluated by dermatologists and psychiatrists. Management of this disease should promote a multidisciplinary approach to enable a joint treatment, thus optimizing patient management and therapeutic adherence.

Cat scratch disease, whose causative agent is Bartonella henselae, is an anthropozoonosis with a worldwide distribution that causes significant public health problems. Although it is an endemic disease in Spain, the available data are very limited. The aim of our study was to describe cat scratch disease inpatients in the National Health System (NHS) of Spain. This was a retrospective descriptive study using the minimum basic data set (CMBD in Spanish) in patients admitted to hospitals of the NHS between 1997 and 2015 with a diagnosis of cat scratch disease (ICD-9: 078.3). We found 781 hospitalized patients diagnosed with cat scratch disease. The mean age (± SD) was 30.7 ± 25.3 years old. The male/female ratio was 1.1:1. The incidence rate over the study period was 0.93 (95% CI, 0.86-0.99) cases per million person-years. The incidence rate in men was 0.98 cases per million person-years and that in women was 0.88 cases per million person-years. The cases were more frequent from September to January. A total of 652 (83.5%) cases were urgent hospital admissions. The average hospital stay was 8.4 ± 8.9 days. The overall lethality rate of the cohort was 1.3%. We have demonstrated that CSD causes a substantial burden of disease in Spain, affecting both adult and pediatric patients with a stable incidence rate. Our data suggest that CSD is benign and self-limited, with low mortality, and its incidence is possibly underestimated. Finally, there is a need for a common national strategy for data collection, monitoring, and reporting, which would facilitate a more accurate picture and the design of more strategic control measures. Hospital discharge records (HDRs) could be a good database for the epidemiological analysis of the hospital management of CSD.

Mucormycosis is a worldwide angio-invasive fungal infection that is associated with high morbidity and mortality. A few European studies have focused on the epidemiology.A retrospective longitudinal descriptive study was performed with inpatients diagnosed with mucormycosis (ICD-9-CM, code 117.7, cases 1997-2015; and ICD-10, code B46, cases 2016-2018; along with length of hospital stay) in Spanish public hospitals between 1 January 1997 and 31 December 2018. Data were obtained from the Minimum Basic Data Set (CMBD in Spanish).A total of 962 patients were recorded; 665 were men. The mean age (±SD) was 55 ± 18.8 years. The annual incidence rate increased from 0.74 to 1.24 cases per million person-years. The lethality rate was 31.3%. Renal failure (41.6%) and haematological malignancy (36.3%) were the main factors involved.Mucormycosis is a rare infectious disease in Spain, but it has had a significantly increased incidence in the last two decades. Being an adult male and having diabetes, neoplasm or renal failure are the main factors associated. High mortality is usually associated mainly with haematological malignancy and renal failure. CMBD studies could be an efficient tool for assessing changes in the epidemiology of mucormycosis.

Schistosomiasis is a helminthic infection and one of the neglected tropical diseases (NTDs). It is caused by blood flukes of the genus Schistosoma. It is an important public health problem, particularly in poverty-stricken areas, especially those within the tropics and subtropics. It is estimated that at least 236 million people worldwide are infected, 90% of them in sub-Saharan Africa, and that this disease causes approximately 300,000 deaths annually. The clinical manifestations are varied and affect practically all organs. There are substantial differences in the clinical presentation, depending on the phase and clinical form of schistosomiasis in which it occurs. Schistosomiasis can remain undiagnosed for a long period of time, with secondary clinical lesion. Here, we review the clinical profile of schistosomiasis. This information may aid in the development of more efficacious treatments and improved disease prognosis.

Background: Mucormycosis is a worldwide angio-invasive fungal infection that is associated with high morbidity and mortality. A few European studies have focused on the epidemiology. Methodology: A retrospective longitudinal descriptive study was performed with inpatients diagnosed with mucormycosis (ICD-9-CM, code 117.7, cases 1997-2015; and ICD-10, code B46, cases 2016-2018; along with length of hospital stay) in Spanish public hospitals between 1 January 1997 and 31 December 2018. Data were obtained from the Minimum Basic Data Set (CMBD in Spanish). Principal findings: A total of 962 patients were recorded; 665 were men. The mean age (±SD) was 55±18.8 years. The annual incidence rate increased from 0.74 to 1.24 cases per million person-years. The lethality rate was 31.3%. Renal failure (41.6%) and hematological malignancy (36.3%) were the main factors involved. Conclusions: Mucormycosis is a rare infectious disease in Spain, but it has had a significantly increased incidence in the last two decades. Being an adult male and having diabetes, neoplasm or renal failure are the main factors associated. High mortality is usually associated mainly with hematological malignancy and renal failure. CMBD studies could be an efficient tool for assessing changes in the epidemiology of mucormycosis.

Brucellosis remains one of the main zoonoses worldwide. Epidemiological data on human brucellosis in Spain are scarce. The objective of this study was to assess the epidemiological characteristics of inpatient brucellosis in Spain between 1997 and 2015. A retrospective longitudinal descriptive study was performed. Data were requested from the Health Information Institute of the Ministry of Health and Equality, which provided us with the Minimum Basic Data Set of patients admitted to the National Health System. We also obtained data published in the System of Obligatory Notifiable Diseases. A total of 5598 cases were registered. The period incidence rate was 0.67 (95% CI 0.65–0.68) cases per 100 000 person-years. We observed a progressive decrease in the number of cases and annual incidence rates. A total of 3187 cases (56.9%) came from urban areas. The group most at risk comprised men around the fifth decade of life. The average (±s.d.) hospital stay was 12.6 days (±13.1). The overall lethality rate of the cohort was 1.5%. The number of inpatients diagnosed with brucellosis decreased exponentially. The group of patients with the highest risk of brucellosis in our study was males under 45 years of age and of urban origin. The lethality rate has reduced to minimum values. It is probable that hospital discharge records could be a good database for the epidemiological analysis of the hospital management of brucellosis and offer a better information collection system than the notifiable diseases system (EDO in Spanish).

Cystic echinococcosis (CE) is a parasitic disease caused by the larval forms of species of the tapeworm Echinococcus. The most common location is the liver. To assess the frequency and clinical characteristics of portal hypertension (PH) and the risk factors for PH development, we performed a retrospective observational study of inpatients diagnosed with hepatic CE and PH from January 1998 to December 2018, at Complejo Asistencial Universitario de Salamanca, Spain. Of 362 patients analyzed with hepatic CE, 15 inpatients (4.1%) had a portal vein diameter ≥ 14 mm, and the mean diameter of the portal vein was 16.9 (standard deviation [SD] ±2.1) mm. Twelve patients were men. The mean age was 59.5 years (SD ± 17.8 years). Four patients had ascites (26.6%), four had collateral circulation (26.6%), 14 had hepatosplenomegaly (93.3%), five had esophageal varices (33.3%), four had hematemesis, and three had jaundice. Other causes of PH included hepatitis B virus (1 patient) and hepatitis C virus (1 patient) infections and alcohol abuse (1 patient). The host variables associated with PH development were male sex (odds ratio, 4.6; 95% confidence interval, 1.1–20.9; P = 0.030) and larger cyst size (10.8 ± 6.3 versus 7.6 ± 4.1; P = 0.004). Hepatic CE is an infrequent cause of PH that usually occurs without indications of liver failure. Larger cyst size and male sex were the main risk factors associated with this complication. Mortality was higher for patients with hepatic CE with PH than for patients with hepatic CE without PH.

Background Management options for cystic echinococcosis (CE) remain a serious problem. The main aim of this study was to examine the selection and complications of treatment applied in patients with CE. The second aim was to evaluate the mortality rate and causative factors. Methods A retrospective descriptive study of patients diagnosed with CE between 1998 and 2015 was conducted, according to ICD-9 (code 122·0 to 122·9) criteria in the Complejo Asistencial Universitario of Salamanca, Spain. Results Four-hundred-ninety-one (491) patients were diagnosed with CE disease and the treatment applied in these patients were: 166 (33.8%) patients received only surgery, 176 (35.8%) surgery and drugs, 17 (3.5%) drugs alone, in 131 (26.7%) patients the strategy was 'watch and wait', and only one patient (0.2%) was applied puncture-aspiration-injection-respiration (PAIR). Thus, a total of 342 patients received surgery, either alone (166) or combined with drugs (176), and a total of 193 (39.4%) patients were medically treated, either alone (17) or combined with surgery (176); 123 (63.7%) patients used albendazole alone; and 70 (36.3%) patients used a combination of albendazole and praziquantel. Sixty-five patients (19.0%) had complications after surgery and seven of them (2%) died. Only 15 (7.8%) cases had side effects from anthelmintics. Throughout the study period, 80 (16.3%) patients died, 14 (2.9%) of them due to CE disease. Conclusions Complications of CE are one of the most common causes of mortality in CE patients, with size, location, and number of cysts, and the 'watch and wait' treatment strategy being the main factors associated with mortality.

Zika virus infection should be suspected in travelers or immigrants with the signs or symptoms of a viral infection (rash, fever, joint pains, conjunctivitis, headache, etc.) and a compatible epidemiological history. Although cutaneous manifestations are among the most common clinical signs of Zika, they are not specific and very few images are available. We present 3 patients (2 travelers and 1 immigrant) in whom a rash was the presenting manifestation of Zika virus infection. Prompt diagnosis optimizes outcomes in these patients, improves the management of severe disease, and minimizes the risk of local transmission by Aedes albopictus, now a potential local vector for the virus due to its presence in areas along Spain's Mediterranean coast.

Resumen La infeccion por el virus Zika debe sospecharse en viajeros o inmigrantes con clinica de viriasis (exantema, fiebre, artralgias, artritis, conjuntivitis, cefalea, etc.) y una historia epidemiologica compatible. Aunque las manifestaciones cutaneas se encuentran entre las mas frecuentes no son especificas y su iconografia es escasa. Presentamos 3 casos, 2 viajeros y un inmigrante que comienzan con un exantema por virus Zika. Alcanzar el diagnostico de forma rapida optimiza el manejo de estos pacientes, mejora el control de los casos graves y permite minimizar una posible transmision autoctona dado el riesgo que supone la presencia del Aedes albopictus como potencial vector transmisor de esta enfermedad en el litoral mediterraneo espanol.

Background Nutritional problems, anaemia and infectious diseases are the main causes of morbidity and mortality in children and adolescents in tropical and subtropical areas. The main objective of this study was to determine the nutritional status in children from low-income countries who migrated to Spain and the value of the usual biochemistry markers of nutrition in these children, as well as to evaluate the nutritional status associated with imported infectious diseases. Moreover, we evaluated the association between anaemia and nutrition problems. Methods We prospectively evaluated immigrants younger than 18 years of age, from tropical or subtropical areas, who were referred on suspicion of or screening for imported diseases. Detailed medical records and physical and oral examinations were obtained. Blood count and biochemical measures of micronutrients and nutritional biomarkers were performed. We included microbiological methods for diagnosing imported infectious diseases according to the region of origin and clinical setting. Results 373 minors were evaluated, including 250 (67.0%) from sub-Saharan Africa, 67 (18.0%) from North Africa and 56 (15.0%) from Latin America. The mean BMI of the subjects was 19.8±0.2. BMI increased by 0.02 for each month of stay in Spain. Nineteen patients (6.8%) had a nutritional risk of growth problems, and 50 (17.8%) were overweight. The time since arrival was longer in patients who were overweight (p

[EN]Background: Cystic echinococcosis (CE) is a chronic, complex and neglected zoonotic disease. CE occurs worldwide. In humans, it may result in a wide spectrum of clinical manifestations, ranging from asymptomatic infection to fatal disease. Clinical management procedures have evolved over decades without adequate evaluation. Despite advances in surgical techniques and the use of chemotherapy, recurrence remains one of the major problems in the management of hydatid disease. The aim of this study was to determine the frequency of CE recurrence and the risk factors involved in recurrence. Methods: A descriptive longitudinal-retrospective study was designed. We reviewed all patients diagnosed with CE according to ICD-9 (code 122–0 to 122–9) criteria admitted at Complejo Asistencial Universitario de Salamanca, Spain, between January 1998 and December 2015. Results: Among the 217 patients studied, 25 (11.5%) had a hydatid recurrence after curative intention treatment. Median duration of recurrence’s diagnosis was 12.35 years (SD: ±9.31). The likelihood of recurrence was higher [OR = 2.7; 95% CI, 1.1–7.1; p < 0.05] when the cyst was located in organs other than liver and lung, 22.6% (7/31) vs 14.2% (31/217) in the cohort. We detected a chance of recurrence [OR = 2.3; 95% CI, 1.4–6.5; p > 0.05] that was two times higher in those patients treated with a combination of antihelminthic treatments and surgical intervention (20/141, 14.2%) than in patients treated with surgical intervention alone (5/76, 6.6%). Conclusions: Despite advances in diagnosis and therapeutic techniques in hydatid disease, recurrence remains one of the major problems in the management of hydatid disease. The current management and treatment of recurrences is still largely based on expert opinion and moderate-to-poor quality of evidence. Consequently, large prospective and multicenter studies will be needed to provide definitive recommendations for its clinical management.

Background Cystic echinococcosis (CE) is a chronic, complex and neglected zoonotic disease caused by Echinococcus granulosus. Eosinophilia in CE is a classic analytic alteration, although its presentation and importance is very variable and not well established. Methods We performed a retrospective observational study of inpatients diagnosed with CE and eosinophilia from January 1998 to December 2017 in the Complejo Asistencial Universitario de Salamanca in western Spain. Results During the study period, 475 patients with a CE diagnosis underwent a haemogram and 118 (24.8%) patients had eosinophilia. Eighty-two (69.5%) were male and the mean age was 52.1±20.8 y, which was younger in the group with eosinophilia (p Conclusions Eosinophilia can be an indicator for an active search in CE because as much as 40% of cases are asymptomatic at diagnosis. In patients with eosinophilia, management is usually more aggressive and is usually a combined treatment. Our work shows the importance of eosinophilia in our patients with CE and raises unresolved questions.

Tuberculosis of the chest wall represents less than 5% of cases of musculoskeletal tuberculosis. We present the case of a patient with a cold abscess in the pectoral region due to Mycobacterium tuberculosis. A 29-year-old male of Senegalese origin reported a progressive increase in size of the right hemi-thorax without trauma or previous effort. A liquid collection of 14 cm on the major axis, between the pectoralis major muscle and the costal wall, was demonstrated on magnetic resonance imaging. Surgical debridement revealed a marked granulomatous inflammatory reaction with focal necrosis; PCR was positive for M. tuberculosis complex and culture subsequently grew M. tuberculosis complex. Specific treatment for tuberculosis achieved a good clinical outcome. The diagnosis of tuberculosis of the chest wall is always difficult, being a clinical challenge. Keywords: Tuberculosis, Mycobacterium tuberculosis, Cold abscess, Chest wall

Cystic echinococcosis (CE) is a chronic, complex, and overlooked zoonotic disease caused by Echinococcus granulosus. In humans, it may result in a wide spectrum of clinical manifestations depending on the type of complications, ranging from asymptomatic infection to fatal disease. The primary complications and risk factors associated with CE are not well defined. We performed a retrospective, observational study of inpatients diagnosed with CE from January 1998 to December 2017 in the public health-care system of western Spain. Five hundred and six cases were analyzed. More than half of the patients (302 [59.7%]) were asymptomatic, and the diagnoses were made incidentally. A total of 204 (40.3%) patients had complications associated with CE; 97 (47.5%) were mechanical, 62 (30.4%) were infectious, 15 (7.3%) were immunoallergic, and 30 (14.7%) involved a combination of complications. Mortality was higher in patients with mechanical complications (9.4%) than in patients with infectious complications (5.6%) and in patients with allergic complications (0%) (odds ratio = 19.7, 95% CI, 4.3-89.1, P < 0.001). In summary, CE frequently results in complications, especially in the liver in younger patients and, regardless of other variables, such as size or stage of cyst. Mechanical problems and superinfection are the most frequent complications. CE is an obligatory diagnosis in patients with urticarial or anaphylactoid reactions of unknown cause in endemic areas.

Objectives: The objective of this study was to assess the epidemiology and burden of Q fever (QF) in Spain. Methods: We designed a retrospective descriptive study using the minimum basic data set in patients admitted to hospitals of the National Health System between 1998 and 2015 with a diagnosis of Q fever (ICD-9: 083.0.). Results: We found 4214 hospitalized patients with a mean age (±SD) of 50.9 ± 19.3 years. The male/female ratio was 3:1. The incidence rate was between 0.41 and 0.65 cases per 100,000 person-years over the 18-year period. The highest incidence of cases was from March to August (p = 0.024). 21.1% patients had pneumonia, 17.5% had liver disease, and only 3.2% had endocarditis. The average hospital stay was 13.8 days (±12.8). A total of 117 (2.8%) patients died. The total mean cost of QF is approximately €154,232,779 (€36,600 ± 139,422 per patient). Conclusions: QF is an important zoonosis in Spain with a stable incidence rate and high cost for hospitalization. Older patients have a more severe clinical picture and higher mortality, which can be decreased with early clinical suspicion. Keywords: Q fever, Coxiella burnetii, Zoonosis, Pneumonia, Hepatitis, Epidemiology

ResumenIntroduccion La hidatidosis humana es una zoonosis con distribucion cosmopolita. Todavia constituye un importante problema de salud publica en muchas regiones del mundo, incluida la cuenca mediterranea. La situacion epidemiologica actual no es conocida en ciertas regiones de Espana. El objetivo de este trabajo es renovar los datos epidemiologicos de la hidatidosis en pacientes hospitalizados en el sistema publico de salud de Extremadura. Metodos Estudio descriptivo longitudinal y retrospectivo de pacientes hospitalizados con diagnostico de hidatidosis (codigos CIE 122.0-122.9) en centros sanitarios del sistema publico de salud de Extremadura durante el periodo 2003-2012. Resultados Se incluyeron 876 pacientes con diagnostico de hidatidosis; 536 (61%) fueron varones, con una edad media de 65,5 ± 17,8; 19 casos (2,2%) fueron menores de 19 anos: 17 (89,47%) casos entre los anos 2003-2007 versus 2 casos entre 2008-2012 (OR = 7,83; IC 95%: 1,79-34,11; p = 0,001). Un total de 141 (16,0%) eran menores de 45 anos. El diagnostico primario fue mas frecuente en menores de 45 anos y el diagnostico secundario mas frecuente en mayores de 70 anos (p

A 39-year-old Caucasian man was referred to University Hospital Salamanca from a primary care unit due to the presence of an erythematous violaceous nodule at the superior portion of his nose. Physical examination indicated that the firm, fixed erythematous violaceous nodule measured approximately 2 cm in diameter and was located inferior to a scar on the nasal bridge. Cutaneous involvement in sarcoidosis occurs in 25% of cases. A wide range of clinical presentations of cutaneous sarcoidosis is recognized. Skin lesions are classified as either non-specific, of which erythema nodosum is the most representative and specific, or as granulomatous, which includes maculopapular nodules, plaques, infiltrated scars, lupus pernio, ulcerations, warty lesions and erythroderma. Scar sarcoidosis is a type of cutaneous sarcoidosis.

[EN] In a global world, knowledge of imported infectious diseases is essential in daily practice, both for the microbiologist–parasitologist and the clinician who diagnoses and treats infectious diseases in returned travelers. Tropical and subtropical countries where there is a greater risk of contracting an infectious disease are among the most frequently visited tourist destinations. The SEIMC considers it appropriate to produce a consensus document that will be useful to primary care physicians as well as specialists in internal medicine, infectious diseases and tropical medicine who help treat travelers returning from tropical and sub-tropical areas with infections. Preventive aspects of infectious diseases and infections imported by immigrants are explicitly excluded here, since they have been dealt with in other SEIMC documents. Various types of professionals (clinicians, microbiologists, and parasitologists) have helped produce this consensus document by evaluating the available evidence-based data in order to propose a series of key facts about individual aspects of the topic. The first section of the document is a summary of some of the general aspects concerning the general assessment of travelers who return home with potential infections. The main second section contains the key facts (causative agents, diagnostic procedures and therapeutic measures) associated with the major infectious syndromes affecting returned travelers [gastrointestinal syndrome (acute or persistent diarrhea); febrile syndrome with no obvious source of infection; localized cutaneous lesions; and respiratory infections]. Finally, the characteristics of special traveler subtypes, such as pregnant women and immunocompromised travelers, are described., [ES] En el mundo global, el conocimiento de las enfermedades infecciosas importadas es esencial en la práctica diaria, tanto para el microbiólogo-parasitólogo como para el clínico en enfermedades infecciosas que atiende a viajeros internacionales. Entre los destinos turísticos más visitados se encuentran muchos países tropicales o subtropicales, donde el riesgo de contraer una enfermedad infecciosa es más elevado. La SEIMC ha considerado pertinente la elaboración de un documento de consenso que sirva de ayuda tanto a médicos de Atención Primaria como a especialistas en Medicina Interna, Enfermedades Infecciosas y Medicina Tropical que atienden a viajeros que regresan con infecciones tras un viaje a zonas tropicales y subtropicales. Se han excluido de forma explícita los aspectos de prevención de estas y las infecciones importadas por inmigrantes, objeto de otros documentos de la SEIMC. Varios tipos de profesionales (clínicos, microbiólogos y parasitólogos) han desarrollado este documento de consenso tras evaluar los datos disponibles basados en la evidencia para proponer una serie de datos clave acerca de este aspecto. Inicialmente se revisan los aspectos generales acerca de la evaluación general del viajero que regresa con una potencial infección. En un segundo bloque se señalan los datos clave (agentes causales, procedimientos diagnósticos y medidas terapéuticas) de los síndromes infecciosos principales en el viajero que regresa (síndrome gastrointestinal (diarrea aguda o persistente), síndrome febril sin foco aparente, lesiones cutáneas localizadas e infecciones respiratorias). Finalmente se describen las características en viajeros especiales como la viajera embarazada y el viajero inmunodeprimido.

Background Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) are serious mucocutaneous reactions. In Spain, the epidemiology and resulting expenses of these diseases are not well established. Methodology Retrospective descriptive study using the Minimum Basic Data Set (CMBD in Spanish) in patients admitted to hospitals of the National Health System between 2010 and 2015 with a diagnosis of SJS and TEN (combination of ICD-9 codes 695.13, 695.14, and 695.15, along with length of hospital stay). Principal findings A total of 1,468 patients were recorded, 773 were men (52.7%). The mean age (± SD) was 52.25 ± 26.15 years. The mean incidence rate for all diagnoses was 5.19 cases per million person-years (2.96 in SJS, 0.31 in SJS/TEN and 1.90 in TEN). 148 patients died (10.1%), 47 due to SJS (5.6%) and 90 (16.7%) due to TEN. The estimated total medical cost of SJS, SJS/TEN, and TEN in Spain was €11.576.456,18, and the average medical cost per patient was €7.885,86 ± €11.686,26, higher medical cost in TEN (€10352.46 ± €16319,93) than in SJS (€6340,05 ± €7078,85) (p

A 61-year-old man from a rural area (Salamanca, Spain), who had contact with dogs, was admitted with generalized itching for 4 years. He was treated with oral antihistamines. A physical examination revealed greyish hyperpigmentation and severe lichenification and infiltration on the face, without mucosal pigmentation. His trunk and limbs showed xerosis, erythematous scaly skin areas with lichenification and hyperpigmentation (Figure 1 ). Figure 1. (A, C, D) Xerosis, erythematous scaly skin areas with lichenification and hyperpigmentation of the trunk and upper limbs. (B) Greyish hyperpigmentation and severe lichenification and infiltration on the patient's face. Increased levels of IgE of 2,864 UI/L (0–114 IU/L), but no eosinophilia, were detected. Skin biopsy revealed perivascular spongiotic dermatitis with eosinophilic infiltrate, congruent with eczema (Figure 2 ). Allergic and photoallergic contact dermatitis and aeroallergen sensitization were ruled out. Bronchial hyperresponsiveness was determined and the patient was treated with salbutamol inhalation. Figure 2. Perivascular spongiotic dermatitis with eosinophilic infiltrate in the histopathological examinations of skin biopsy (H-E × 10). After a diagnosis of generalized eczema, he was managed with topical propionate of clobetasol and topical tacrolimus, oral ebastine, and oral prednisone in a tapering regimen during flares. Skin lesions worsened with bronchial reactivity 4 years later. IgE > 5,000 UI/L and eosinophilia of 900/μL (7.19%) were detected. Chest X-ray was normal. Antibodies against hepatitis B virus, hepatitis C virus, syphilis, Trichinella sp., Toxoplasma gondii, Strongyloides sp., Fasciola hepatica, Taenia solium, and parasites in stool (three serial samples) were negative. IgG results for hydatic disease were repeatedly negative, but specific Echinococcus granulosus IgE was detected (3.13 kUA/L) (negative < 0.35 kUA/L, ImmunoCAP system, Phadia, Uppsala, Sweden). Abdominal computerized tomography showed three focal lesions that were consistent with hepatic hydatid cysts: the first cyst was localized in segment I of 24 × 21 × 18 cm (stage cystic echinococcosis [CE] 5), the second cyst in segment II of 48 × 31 × 36 cm (stage CE3), and the third cyst in segment VII of 45 × 34 × 34 cm (stage CE3) (Figure 3 ). Albendazole (400 mg twice a day) and praziquantel (1,200 mg twice a day) were administered and surgery was subsequently performed. Removal of cysts in segment I, II, and VII was done. Histopathological examination confirmed infection by E. granulosus. Treatment with only albendazole was continued because of digestive intolerance from praziquantel. The patient improved symptomatically and with regard to the skin lesions (Figure 4 ). All treatments (topical, oral, and inhaled) were stopped after 18 months. Figure 3. Computerized tomography showing hepatic hydatid cysts. Figure 4. (A–D) Clear improvement of skin lesions, with (D) hyperpigmentation only in the trunk. In dermatology, increased levels of IgE and eosinophilia are commonly related to atopy, but other entities with skin manifestations, mainly neoplasms and infectious diseases, should also be considered. CE is a chronic, complex, and neglected zoonotic disease, and it remains an important health problem in many areas of the world.1 In humans, it may result in a wide spectrum of clinical manifestations, ranging from asymptomatic infection to severe and even fatal disease.2 CE typically grows slowly and may long remain clinically silent. Common serodiagnotis techniques may produce a high percentage of false-negative results, and thus CE diagnosis can be difficult.3 Echinococcus granulosus infection may produce different cutaneous manifestations, some of which are due to mechanical complication, such as skin fistulae,4 and others are due to anaphylactoid reactions, such as acute or chronic urticaria and flushing.5 It is assumed that these former symptoms may be caused by a partial rupture of the cyst with microscopic drainage. We propose that this continuous antigenic trigger and repeated scratching could potentially result in clinical manifestations in our patient, which were resolved using antiparasitic treatment. We have not found any previously described association between the skin alterations in our patient and hydatid disease. In conclusion, we highlight that skin manifestations may be a clue in the diagnosis of potentially severe infectious diseases, and we should include CE in the differential diagnosis of generalized eczema.

There is still no well-established consensus about the clinical management of hydatidosis. Currently, surgery continues to be the first therapeutic option, although treatment with anti-parasitic drugs is indicated as an adjuvant to surgery to decrease the number of relapses and hydatid cyst size. When surgery is not possible, medical treatment is indicated. Traditionally, albendazole was used in monotherapy as the standard treatment. However, com- bined therapy with albendazole plus praziquantel appears to improve anti-parasitic effectiveness. To date, no safety studies focusing on such combined therapy have been published for the treatment of hydatidosis. In this work, we analyze the adverse effects seen in 57 patients diagnosed with hydatidosis who were treated with praziquantel plus albendazole combined therapy between 2006 and 2010.

Introduction: Abdominal angiostrongyliasis is an infrequently diagnosed disease because it is little known and is usually well tolerated. Methods: We carried out a systematic review with PubMed as a search engine for the MedLine database, and we analysed the clinical, epidemiological and analytical parameters of this disease. Results: In total, reports of 27 case have been found, together with a series of 116 patients, which were later augmented up to 194 patients. In the results, we have observed a predominance of male patients, and Costa Rica, Brazil and the United States as the main countries of origin. Typical symptoms include abdominal pain on the right iliac fossa, with leukocytosis and eosinophilia. Discussion: There are some serological diagnostic methods, although lack of standardization leads to most of the diagnoses being reached via pathology. Surgery is the usual treatment approach. Although there are medical options, this is a controversial subject because of the low number of cases published in the literature, which implies an absence of solid studies.

BACKGROUND In Spain, 12% of the population are immigrants. The impact of immigration in Spain on cystic echinococcosis (CE) is unknown. The aim of this study was to describe the epidemiology of CE in immigrants in western Spain. METHODS First, a retrospective descriptive study of patients diagnosed with CE in the University Hospital of Salamanca (CAUSA) between January 1998 and December 2014 was designed. Second, we studied the seroprevalence of CE in sera from foreigners who received treatment in the Tropical Medicine Unit. RESULTS A total of 550 patients with new CE-related diagnoses were registered; of these, 16 (2.9%) were immigrants, of whom 10 (63%) were male. The age (mean±SD) was 34.6±12.8 years. The incidence rate of CE in immigrants was 8.76 cases per 105 person-years. Eight (50%) cases presented asymptomatically. Seroprevalence of CE in foreign patients was 2.3%. It was higher in North African population (4.2%), followed by sub-Saharan (2.4%) and Latin American (1.8%) (p=0.592) populations. The seroprevalence was higher in those who arrived recently (

Immigrants to Spain are mainly from low- and middle-income countries, and around 20% are children. Absolute eosinophilia is defined as0.45×10To describe the importance of relative eosinophilia in a cohort of immigrant children (18 years) from sub-Saharan Africa, North Africa and Latin America.176 immigrant children without absolute eosinophilia were prospectively evaluated.25 of them (14.2%) had relative eosinophilia. 10 patients with relative eosinophilia had no diagnosis. 15 with relative eosinophilia (60%) were diagnosed with a parasitic disease, 7 (46.7%) of whom had only one parasite, while co-infection accounted for 8 of the 15 cases (53.3%). Of the parasitic infections, the most frequent causes of relative eosinophilia were filariasis spp. (7/15, 46.7%), strongyloides spp. (5/15, 33.3%), schistosoma spp. (4/15, 26.6%) and Ascaris lumbricoides (2/15, 13.3%).The findings suggest that relative eosinophilia is frequently associated with helminthic infection in immigrant children from tropical and sub-tropical areas, so a thorough parasitological study is highly advisable in this group of patients.

La enfermedad de Ormond (EO) es una enfermedad infrecuente con una incidencia aproximada de 1/1.000.000 personas-ano. La etiologia en la mayoria de los casos es desconocida, y en la EO secundaria se han implicado multiples procesos patogenicos. La EO se caracteriza por la presencia de una masa fibroinflamatoria retroperitoneal con tres formas clinicas diferentes: i) fibrosis retroperitoneal; ii) fibrosis perianeurismatica retroperitoneal, y iii) inflamacion de los aneurismas de la aorta abdominal. El manejo clasico se basa en el tratamiento quirurgico y puede asociarse a esteroides. En estos ultimos anos se han empleado otros inmunosupresores sin resultados bien establecidos. Presentamos cinco casos acontecidos en el Hospital Clinico Universitario de Salamanca durante el periodo 2000�2008. Destacamos la falta de estudios para establecer guias de practica clinica que faciliten el manejo y mejoren el pronostico

Resumen El cancer de pulmon es una de las neoplasias mas frecuentes. La clinica se debe al propio tumor, a su extension o a los sindromes paraneoplasicos asociados. A pesar de que las metastasis de localizacion biliopancreatica son frecuentes, la afectacion en esta region como inicio de una neoplasia pulmonar, tanto en la forma de pancreatitis como en la de ictericia obstructiva, es rara. Exponemos nuestra experiencia clinica mediante la presentacion de 2 casos de pancreatitis aguda y uno de ictericia obstructiva como forma de inicio de una neoplasia pulmonar avanzada junto con una breve revision bibliografica, que confirma la ausencia de protocolos de actuacion en esta situacion.

Echinococcosis is a zoonotic infection with a worldwide distribution, and is still an important health problem in many areas of the world, including the Mediterranean basin. At present the epidemiological situation is unclear in certain regions of Spain. The aim of this study was to update the epidemiological situation in Extremadura through an analysis of hospitalised patients in the public health system diagnosed with hydatid disease.A longitudinal retrospective study was conducted between 2003 and 2012 on hospitalised patients with a diagnosis of hydatidosis (ICD 122.0-122.9) in hospitals of the public health service of Extremadura.During the period of study, 876 patients were diagnosed with hydatid disease. Of these 536 (61%) of cases were male, with a mean age of 65.53±17.8 years. More importantly, 19 (2.2%) of patients were 19 years old, with 17 cases between 2003-2007 versus 2 cases between 2008-2012 (OR=7.83; 95%CI: 1.79-34.11; P=.001). A total of 141 (16.0%) were younger than 45 years. The primary diagnosis was most frequently reported in the younger population45 years, whereas the secondary diagnosis was usually found in the elderly population70 years (P.05). The incidence rate of hydatid disease obtained from Hospital Discharge Records (HDRs) was significantly higher compared to the incidence that was declared in the Notifiable Disease System of Extremadura (8.02 cases per 10(5) person-years vs. 1.88 cases per 10(5) person-years [P.05]).In Extremadura hydatid disease is still frequent. With a clear decrease in the number of paediatric cases. The number of cases obtained from HDRs regarding Notification System Diseases Extremadura suggests the need for modifications to improve surveillance and control of hydatid disease.

SUMMARYCystic echinococcosis (CE) remains an important health problem in many areas of the world, including the Mediterranean region. We performed a retrospective study of cases reported from 1998 to 2012 in order to review and update the epidemiology of this disease in a highly endemic area situated in western Spain. A total of 471 patients were diagnosed with hydatid disease. Of these cases, 55·8% were male, with an average age of 62·3 ± 19·5 years. More importantly, 1·5% of patients were children, and 20·5% were aged β = −0·4357, P < 0·001). CE incidence has diminished in recent years, although active transmission remains in paediatric cases. Additionally, CE incidence remains high in our region despite public health plans for its control. The documented incidence of CE disease clearly underestimates the real numbers.

Antisynthetase syndrome is a disorder belonging to the dermatomyositis/polymyositis group, with high rates of morbidity and mortality. We herein present the case of a 71-year-old man who was diagnosed with antisynthetase syndrome and treated with rituximab. Almost three years later, the patient showed right-sided hemiparesis that ultimately progressed to complete hemiplegia and advancing cognitive deterioration with a poor clinical outcome. The neuropathological diagnosis was progressive multifocal leukoencephalopathy. Treatment with rituximab for antisynthetase syndrome itself plays a fundamental role in the development of infectious complications.

We prospectively studied the prevalence of imported transmissible diseases in 373 immigrant children and adolescents coming from Sub-Saharan Africa, North Africa and Latin America to Salamanca, Spain. The most frequent transmissible diseases in this group were latent tuberculosis (12.7%), chronic hepatitis B virus infection (4.2%), hepatitis C virus infection (2.3%), syphilis (1.5%) and human T-lymphotropic virus type 1 or 2 infections (1.4%). A total of 24.2% of patients had serologic profiles suggesting past hepatitis B virus infection. Anti–human immunodeficiency virus antibodies were not detected in any subject. Largely asymptomatic immigrant children show a high prevalence of communicable diseases. Thus, infectious disease screenings are highly advisable in immigrant children coming from low-income countries.

Immigrants from undeveloped countries are a growing problem in Europe. Spain has become a frequent destination for immigrants (20% of whom are children) because of its geographic location and its historic and cultural links with Africa and Latin America. Eosinophilia is frequent in adult immigrants, travelers and expatriates coming from tropical areas. However, there are few studies that focus on the incidence and causes of tropical eosinophilia and hyper-IgE in immigrant children. We evaluated, prospectively, the prevalence and causes of eosinophilia and hyper-immunoglobulin E (IgE) in 362 immigrant children coming from Sub-Saharan Africa, Northern Africa and Latin America to Salamanca, Spain, between January 2007 and December 2011. Absolute eosinophilia and hyper-IgE were present in 22.9% and 56.8% of the analyzed children, respectively. The most frequent causes of absolute eosinophilia were filariasis (52.6%), strongyloidiasis (46.8%) and schistosomiasis (28.9%). Filariasis (41.9%), strongyloidiasis (29.6%) and schistosomiasis (22.2%) were the most frequent causes of increased levels of IgE. The area under the ROC curve showed similar values between eosinophil count and IgE levels in the diagnosis of helminthiasis (69% [95% confidence interval (CI) 63%–74%] vs 67% [95% CI 60%–72%], P = 0.24). Eosinophilia and hyper-IgE have a high value as biomarkers of helminthiasis in children coming from tropical and subtropical areas.

Fever of unknown origin (FUO) is an entity caused by more than 200 diseases. Haematologic neoplasms are the most common malignant cause of FUO. Fever as a first symptom of colonic tumour pathology, both benign and malignant, is a rare form of presentation. Our work is a descriptive study of a series of 23 patients with colonic tumoral pathology who presented with fever of unknown origin. The mean age was 67.6 years; 56.5% of patients were men and 43.5% were women. Primary malignant neoplasia was the most common diagnosis. Blood cultures were positive in 45% of the samples. Coagulase-negative staphylococci were the most common cause of bacteraemia. Nine of 10 faecal occult blood tests performed were positive. Fever secondary to colon neoplasms, both benign and malignant, usually presents with a bacteraemic pattern, with positive results for blood-culture tests in a high percentage of cases.

Objectives Septic thrombophlebitis of the portal vein or its branches, most often secondary to intra-abdominal infection is known as pylephlebitis. The frequency and the prognosis of this complication are unknown. The aim of this study was to determine the global and relative incidence of the most frequent intra-abdominal infections and the real prognosis of this disease. Methods An observational retrospective study was conducted in a tertiary care hospital (University Hospital of Salamanca, Spain) from January 1999 to December 2008. Results A total of 7796 patients with intra-abdominal infection were evaluated, of whom 13 (0.6%) had been diagnosed with pylephlebitis. Diverticulitis was the most frequent underlying process, followed by biliary infection. Early mortality was 23%. Survivors had no recurrences, but one of them developed portal cavernomatosis. Conclusions Pylephlebitis is a rare complication of intra-abdominal infection, with a high early mortality, but with a good prognosis for survivors.