Suchergebnisse

Background: Animals and people in many Spanish regions are increasingly being affected by blackfly bites in the last decade. Because of blackflies, the city of Zaragoza has become in recent years a paradigm of discomfort in Europe, with thousands of citizens affected. The OMI-AP system (Stacks, Barcelona, Spain) implemented by the Government of Aragón, a software that manages the electronic medical history of all patients, has been evaluated in order to document the increase of insect bite recorded by the primary care consultations in Zaragoza after the first outbreak of blackflies occurred in 2011. Methods: An observational, ecological and longitudinal study of insect bites recorded at the primary care consultations was carried out in primary care during the period 2009–2015. Results: The incidence of medical consultations by insect bites in Basic Health Areas (BHA) near to rivers is higher than the furthest BHA. Rural BHA are more affected by insect bites than the urban ones. The increase of medical assistance due to insect bites in Zaragoza since 2011 is correlated with the blackflies bites. Conclusions: This tool was very useful to describe the initial stage of this public health problem. It could be used for guiding public health responses in terms of surveillance and management of this pest.

AbstractIntroduction: Increased bacterial translocation and alterations to gut microbiota composition have been described in HIV infection and contribute to immune activation and inflammation. These effects persist despite combined antiretroviral therapy (cART). However, the contribution of different cART combinations has not yet been investigated. The aim of this study was to analyse the long‐term effects of different combinations of cART on bacterial translocation and gut microbiota composition in HIV‐infected patients.Methods: We carried out a cross‐sectional study of 45 HIV‐infected patients on cART, classified as nucleoside reverse transcriptase inhibitors (NRTIs)+ protease inhibitors (PIs) (n = 15), NRTIs+ non‐nucleoside reverse transcriptase inhibitors (NNRTIs) (n = 22), and NRTIs+ integrase strand transfer inhibitors (INSTIs) (n = 8). Untreated HIV‐infected patients (n = 5) and non‐infected volunteers (n = 21) were also included. Soluble markers of bacterial translocation and inflammation were measured and gut microbiota composition was analysed using 16S rDNA pyrosequencing (Illumina MiSeq).Results: The NRTIs+INSTIs regimen was associated with levels of systemic inflammation that were similar to uninfected controls. The reduction in faecal bacterial diversity induced by HIV infection was also restored by this regimen. HIV infection was more closely related to changes in lower taxonomic units and diversity rather than at the phylum level. The NRTIs+PIs regimen showed the highest reduction in bacterial species, whereas NRTIs+INSTIs induced a minor loss of bacterial species and a significant increase in others.Conclusions: Our study demonstrated that INSTI‐based ART was associated with levels of systemic inflammation and microbial diversity similar to that of uninfected controls. The role of INSTIs other than raltegravir needs to be further investigated. Patients on the NRTIs+PIs regimen presented the highest reduction in bacterial species compared with other antiretrovirals and naive patients. Thus, different cART regimens are associated with diverse profiles in gut microbiota composition. Longitudinal and functional studies are needed to better understand these findings.

Mosquitoes are important to public and animal health due to their capacity to transmit diseases. Since the Zika virus was declared a pandemic by the WHO in 2016, and it has been recorded in different regions of Mediterranean Area (included Spain), the Government of La Rioja (Northern Spain) through the Center of Rickettsiosis and Arthropod-Borne Diseases, implemented an entomological surveillance programme of mosquitoes in La Rioja and in a close area of Navarra. This surveillance extended to some of the pathogens that they can transmit. Here we describe the framework of the initial surveillance programme for the detection of mosquitoes and associated human pathogens. We outline the benefits and the limitation of the programme to date, and explore how greater benefits can be achieved, for example using a One Health approach. Entomological surveillance has been carried out with BG-Sentinel traps, human bait technique and other methods such as collecting adults in resting places or immature stages by dipping in several wetlands. Since Aedes albopictus, vector of arbovirus such as Dengue, Chikungunya, and Zika, has not been detected yet in the region, the entomological programme included the surveillance of this exotic species using ovitraps in the most important cities. Morphological identification was supported using the mitochondrial cytochrome C oxidase subunit I and the internal transcribed spacer 2 genes analysis. In 2016 and 2017, more than 6,000 mosquitoes were collected. The mosquito's community included 21 species associated with six genera: Anopheles (n = 4), Aedes (n = 5), Culex (n = 6), Culiseta (n = 4), Uranotaenia (n = 1) and Coquillettidia (n = 1). Eleven species represent new records for La Rioja and Navarra regions. Several species were collected biting humans and a great proportion of the sampled mosquito population are competent vectors of several pathogens, such as West Nile virus. Sequences closely related to mosquito–only flavivirus have been detected in 0.34% of analysed pools. At the same ...

IntroductionEmerging non‐AIDS related causes of death have been observed in HIV‐positive subjects in industrialized countries. We aimed to analyze overall and cause‐specific excess of mortality of HIV‐positive patients compared to the general population and to assess the effect of prognostic factors.Material and MethodsWe used generalized linear models with Poisson error structure to estimate overall and cause‐specific excess of mortality in HIV‐positive patients from 2004 to 2012 in the cohort of the Spanish Network of HIV Research (CoRIS), compared to Spanish general population and to assess the impact of multiple risk factors. We investigated differences between short‐term and long‐term risk factors effects on excess of mortality. Multiple Imputation by Chained Equations was used to deal with missing data.ResultsIn 9162 patients there were 363 deaths, 16.0% were non‐AIDS malignancies, 10.5% liver and 0.3% cardiovascular related. Excess mortality was 1.20 deaths per 100 person years (py) for all‐cause mortality, 0.16 for liver, 0.10 for non‐AIDS malignancies and 0.03 for cardiovascular. Short‐term (first‐year follow‐up) excess Hazard Ratio (eHR) for global mortality for baseline AIDS was 4.27 (95% CI 3.06–6.01) and 1.47 (95% CI 0.95–2.27) for HCV coinfection; long‐term (subsequent follow‐up) eHR for baseline AIDS was 0.88 (95% CI 0.58–1.35) and 4.48 (95% CI 2.71–7.42) for HCV coinfection. Lower CD4 count and higher viral load at entry, lower education, being male and over 50 years were predictors for overall excess mortality. Excess of liver mortality was higher in patients with CD4 counts at entry below 200 cells compared to those above 350 (eHR: 6.49, 95% CI 1.21–34.84) and in HCV‐coinfected patients (eHR: 3.85, 95% CI 0.85– 17.37), although it was borderline significant. Patients over 50 years old (eHR: 5.55, 95%CI 2.4–12.85) and HCV coinfected (eHR: 5.81, 95% CI 2.6–13) showed a higher risk of non‐AIDS malignancies mortality excess. Excess of cardiovascular mortality was related with HCV coinfection (eHR: 6.68, 95% CI 1.25–35.73).ConclusionsOur results show overall, liver, non‐AIDS malignancies and cardiovascular excess of mortality associated with being HIV‐positive, despite improvements in HIV disease management and antiretroviral therapies. Differential short‐term and long‐term effect of AIDS before entry and HCV coinfection was found for overall mortality.

IntroductionHIV‐associated lipodystrophy syndrome causes systemic metabolic alterations and psychological distress that worsen the quality of life of these patients. An early detection should be considered to efficiently treat it. Objective criteria or reference indices are needed for an early diagnosis. Bioelectrical Impedance Analysis (BIA) is an operator‐independent, repeatable and non‐invasive method of body composition evaluation that is less expensive than dual‐energy X‐ray absorptiometry (DXA) and/or CT scans. The aims of this pilot study were to validate the data obtained by BIA to measure fat mass in HIV‐positive patients with/without lipoatrophy and to determine if BIA correctly diagnoses lipoatrophy in HIV‐positive patients.MethodsThirty‐nine participants were included in this preliminary study. Fourteen were HIV‐negative (eight men) whereas 25 were HIV‐positive patients (17 men). Eleven of the HIV‐positive patients were classified as lipoatrophic according to subjective evaluation by the physicians. Total and regional body composition was measured in basal conditions by DXA and by BIA. To obtain abdominal CT scan fat values, transverse slices with 6‐mm thickness were acquired at the L4‐L5 intervertebral space.ResultsBIA measurements of total and regional body fat were significantly correlated with those obtained by DXA (p < 0.05 to <0.01) in HIV‐positive patients. However, agreement between methods was poor as not very high ICC (intraclass correlation coefficient) values were observed. BIA and DXA showed higher ICC values in lipoatrophic patients. The visceral index obtained by BIA was correlated with total and visceral fat in L4 measured by CT scan (r = 0.607 and r = 0.617, respectively, p < 0.01) in HIV‐positive patients. The Fat Mass Ratio (FMR) calculated by BIA did not correlate or agree with DXA values.ConclusionsMulti‐frequency BIA could be an effective method to evaluate the evolution of total and regional fat composition in HIV‐positive patients with/without lipoatrophy. The correlations between BIA and DXA improved in lipoatrophic patients and in men, suggesting that its efficacy depends on fat mass, gender and probably other factors. The visceral index obtained by BIA seems to be a reliable indicator of abdominal obesity. However, BIA did not fulfil the need for easy quantitative diagnostic tools for lipoatrophy, and it did not provide sufficient diagnostic cut‐off values for this syndrome.

Many factors are involved in determining the latitudinal and altitudinal spread of the important tick vector Ixodes ricinus (Acari: Ixodidae) in Europe, as well as in changes in the distribution within its prior endemic zones. This paper builds on published literature and unpublished expert opinion from the VBORNET network with the aim of reviewing the evidence for these changes in Europe and discusses the many climatic, ecological, landscape and anthropogenic drivers. These can be divided into those directly related to climatic change, contributing to an expansion in the tick's geographic range at extremes of altitude in central Europe, and at extremes of latitude in Scandinavia; those related to changes in the distribution of tick hosts, particularly roe deer and other cervids; other ecological changes such as habitat connectivity and changes in land management; and finally, anthropogenically induced changes. These factors are strongly interlinked and often not well quantified. Although a change in climate plays an important role in certain geographic regions, for much of Europe it is non-climatic factors that are becoming increasingly important. How we manage habitats on a landscape scale, and the changes in the distribution and abundance of tick hosts are important considerations during our assessment and management of the public health risks associated with ticks and tick-borne disease issues in 21st century Europe. Better understanding and mapping of the spread of I. ricinus (and changes in its abundance) is, however, essential to assess the risk of the spread of infections transmitted by this vector species. Enhanced tick surveillance with harmonized approaches for comparison of data enabling the follow-up of trends at EU level will improve the messages on risk related to tick-borne diseases to policy makers, other stake holders and to the general public.

Many factors are involved in the latitudinal and altitudinal spread of Ixodes ricinus as well as in changes in the distribution within its known endemic zones. The drivers can be divided into those directly related to climatic change, those related to changes in the distribution of tick hosts or other ecological changes and anthropogenic induced changes. These factors are strongly interlinked and often not well understood or quantified. Better understanding and mapping of the spread of Ixodes ricinus is however essential to assess the risk of the spread of diseases transmitted by this vector species. Enhanced tick surveillance with harmonized approaches for comparison of data enabling the follow-up of trends at EU level will improve the messages on risk related to tick-borne diseases to policy makers, other stake holders and to the general public. (Texte intégral)

Many factors are involved in determining the latitudinal and altitudinal spread of the important tick vector Ixodes ricinus (Acari: Ixodidae) in Europe, as well as in changes in the distribution within its prior endemic zones. This paper builds on published literature and unpublished expert opinion from the VBORNET network with the aim of reviewing the evidence for these changes in Europe and discusses the many climatic, ecological, landscape and anthropogenic drivers. These can be divided into those directly related to climatic change, contributing to an expansion in the tick's geographic range at extremes of altitude in central Europe, and at extremes of latitude in Scandinavia; those related to changes in the distribution of tick hosts, particularly roe deer and other cervids; other ecological changes such as habitat connectivity and changes in land management; and finally, anthropogenically induced changes. These factors are strongly interlinked and often not well quantified. Although a change in climate plays an important role in certain geographic regions, for much of Europe it is non-climatic factors that are becoming increasingly important. How we manage habitats on a landscape scale, and the changes in the distribution and abundance of tick hosts are important considerations during our assessment and management of the public health risks associated with ticks and tick-borne disease issues in 21st century Europe. Better understanding and mapping of the spread of I. ricinus (and changes in its abundance) is, however, essential to assess the risk of the spread of infections transmitted by this vector species. Enhanced tick surveillance with harmonized approaches for comparison of data enabling the follow-up of trends at EU level will improve the messages on risk related to tick-borne diseases to policy makers, other stake holders and to the general public.

Many factors are involved in determining the latitudinal and altitudinal spread of the important tick vector Ixodes ricinus (Acari: Ixodidae) in Europe, as well as in changes in the distribution within its prior endemic zones. This paper builds on published literature and unpublished expert opinion from the VBORNET network with the aim of reviewing the evidence for these changes in Europe and discusses the many climatic, ecological, landscape and anthropogenic drivers. These can be divided into those directly related to climatic change, contributing to an expansion in the tick's geographic range at extremes of altitude in central Europe, and at extremes of latitude in Scandinavia; those related to changes in the distribution of tick hosts, particularly roe deer and other cervids; other ecological changes such as habitat connectivity and changes in land management; and finally, anthropogenically induced changes. These factors are strongly interlinked and often not well quantified. Although a change in climate plays an important role in certain geographic regions, for much of Europe it is non-climatic factors that are becoming increasingly important. How we manage habitats on a landscape scale, and the changes in the distribution and abundance of tick hosts are important considerations during our assessment and management of the public health risks associated with ticks and tick-borne disease issues in 21§ssup§st§esup§ century Europe. Better understanding and mapping of the spread of I. ricinus (and changes in its abundance) is, however, essential to assess the risk of the spread of infections transmitted by this vector species. Enhanced tick surveillance with harmonized approaches for comparison of data enabling the follow-up of trends at EU level will improve the messages on risk related to tick-borne diseases to policy makers, other stake holders and to the general public.