BackgroundHuman giardiosis and cryptosporidiosis are caused by the enteric protozoan parasites Giardia duodenalis and Cryptosporidium spp. Both pathogens are major contributors to the global burden of diarrhoeal disease, affecting primarily children and immunodebilitated individuals in resource-poor settings. Giardiosis and cryptosporidiosis also represent an important, often underestimate, public health threat in developed countries. In Spain only limited information is currently available on the epidemiology of these infections. Molecular data on the diversity, frequency, geographical distribution, and seasonality of G. duodenalis assemblages/sub-assemblages and Cryptosporidium species/sub-genotypes are particularly scarce.MethodsA longitudinal molecular epidemiological survey was conducted between July 2015 to September 2016 in patients referred to or attended at the Hospital San Pedro (La Rioja, Northern Spain) that tested positive for G. duodenalis (N = 106) or Cryptosporidium spp. (N = 103) by direct microscopy and/or a rapid lateral flow immunochromatographic assay. G. duodenalis infections were subsequently confirmed by real-time PCR and positive isolates assessed by multi-locus sequence genotyping of the glutamate dehydrogenase and β-giardin genes of the parasite. Cryptosporidium species and sub-genotypes were investigated at the 60 kDa glycoprotein or the small subunit ribosomal RNA genes of the parasite. Sociodemographic and clinical parameters of infected patients were also gathered and analysed.Principal findingsOut of 90 G. duodenalis-positive isolates by real-time PCR a total of 16 isolates were successfully typed. AII (44%, 7/16) was the most prevalent sub-assemblage found, followed by BIV (31%, 5/16) and BIII (19%, 3/16). A discordant genotype result AII/AIII was identified in an additional (6%, 1/16) isolate. No mixed infections A+B were detected. Similarly, a total of 81 Cryptosporidium spp. isolates were successfully typed, revealing the presence of C. hominis (81%, 66/81) and C. parvum (19%, 15/81). Obtained GP60 sequences were assigned to sub-type families Ib (73%, 59/81) within C. hominis, and IIa (7%, 6/81) and IId (2%, 2/81) within C. parvum. A marked inter-annual variation in Cryptosporidium cases was observed.ConclusionsHuman giardiasis and cryptosporidiosis are commonly identified in patients seeking medical care in Northern Spain and represent a more important health concern than initially thought. Assemblage A within G. duodenalis and sub-genotype IbA10G2 within C. hominis were the genetic variants of these parasite species more frequently found circulating in the population under study. Molecular data presented here seem to suggest that G. duodenalis and Cryptosporidium infections arise through anthroponotic rather than zoonotic transmission in this Spanish region.

Objective. To define and characterize the progression of the spontaneous autoimmune disease that develops in mice in the absence of the leukocyte adhesion receptor P-selectin glycoprotein ligand 1 (PSGL-1).Methods. Skin-resident immune cells from PSGL-1-deficient mice and C57BL/6 control mice of different ages were isolated and analyzed by flow cytometry. Biochemical parameters were analyzed in mouse serum and urine, and the presence of serum autoantibodies was investigated. Skin and internal organs were extracted, and their structure was analyzed histologically.Results. Skin-resident innate and adaptive immune cells from PSGL-1 ؊/؊ mice had a proinflammatory phenotype with an imbalanced T effector cell:Treg cell ratio. Sera from PSGL-1 ؊/؊ mice had circulating autoantibodies commonly detected in connective tissuerelated human autoimmune diseases. Biochemical and histologic analysis of skin and internal organs revealed skin fibrosis and structural and functional abnormalities in the lungs and kidneys. Furthermore, PSGL-1 ؊/؊ mice exhibited vascular alterations, showing loss of dermal vessels, small vessel medial layer remodeling in the lungs and kidneys, and ischemic processes in the kidney that promote renal infarcts.Conclusion. Our study demonstrates that immune system overactivation due to PSGL-1 deficiency triggers an autoimmune syndrome with characteristics similar to systemic sclerosis, including skin fibrosis, vascular alterations, and systemic organ involvement. These results suggest that PSGL-1 expression contributes to the maintenance of the homeostasis of the immune system and could act as a barrier for autoimmunity in mice.

Neurological complications in patients with human immunodeficiency virus infection/acquired immunodeficiency syndrome (HIV/AIDS) are still common, even in the era of highly active antiretroviral therapy. Opportunistic infections, immune reconstitution, the virus itself, antiretroviral drugs and neurocognitive disorders have to be considered when establishing the differential diagnosis. Toxoplasmic encephalitis remains the major cause of space-occupying lesions in the brain of patients with HIV/AIDS; however, spinal cord involvement has been reported infrequently. Here, we review spinal cord toxoplasmosis in HIV infection and illustrate the condition with a recent case from our hospital. We suggest that most patients with HIV/AIDS and myelitis with enhanced spine lesions, multiple brain lesions and positive serology for Toxoplasma gondii should receive immediate empirical treatment for toxoplasmosis, and a biopsy should be performed in those cases without clinical improvement or with deterioration.

Abstract. The first confirmed case of Rickettsia parkeri infection in Uruguay is reported. To date, in South America, molecularly confirmed cases of human infection have been found in Argentina and probably, Brazil. Our patient returned to Spain after a 7-day trip to Colonia Suiza (Southwestern Uruguay). He presented fever (39 C), chills, and two eschars (tache noire-like) surrounded by an indurated, erythematous halo on the inner side of the left ankle besides a maculopapular rash on the legs. After treatment with doxycycline for 7 days, he fully recovered. R. parkeri infection was diagnosed by molecular-based detection of the microorganism in a swab specimen of the eschar. Diagnosis was supported by seroconversion between acute-and convalescent-phase sera specimens.Until recently, Rocky Mountain spotted fever (RMSF) or Rickettsia rickettsii infection was the unique tick-borne rickettsiosis known in the New World. However, during last decades, new Rickettsia species have been identified as human tick-borne pathogens, which is the case of R. parkeri. Human cases caused by this microorganism and confirmed using molecular assays have been mainly described in North America, [1][2][3][4][5] and retrospective analyses have shown that some cases of RMSF could be now attributed to R. parkeri.6 In South America, two molecularly confirmed cases of human infection with R. parkeri have been reported in Argentina, and recent molecular results strongly suggest that this infection is also distributed in Brazil.7-9 Herein, we report a confirmed case of R. parkeri human disease in a patient who returned to Spain after acquiring the infection in Uruguay.A 54-year-old man returned to Spain on December 16, 2012 after a 7-day trip to Uruguay. He did not notice any arthropod bites. A risk factor for being bitten by ticks is walking in grassy areas, and our patient had been walking barefoot along a grassy area in Colonia Suiza (southwestern Uruguay). Two days after arrival in Spain, he noticed two crusted lesions on the inner side of the left ankle. The next day, he presented with malaise, fever, and chills. He was treated with amoxicillinclavulanic acid and mupirocin cream for 4 days by a primary care physician, but his symptoms persisted. On December 25, he was admitted to the Hospital San Pedro in La Rioja (Spain) with the presumptive diagnosis of cellulitis after probable arthropod bite. Examination showed fever (39 C) and two eschars (tache noire-like) surrounded by an indurated, erythematous halo on the inner side of the left ankle (Figure 1). A petechial rash was also observed on legs. Rickettsiosis was suspected, and DNA was extracted from ethylenediaminetetraacetic acid disodium salt-treated blood and cutaneous swab specimens from the eschar using the DNeasy Blood & Tissue Kit (QIAGEN, Hilden, Germany) and tested for the presence of Rickettsia spp. using polymerase chain reaction (PCR) assays for gltA and ompA genes (Table 1). 10,11 In addition, acute and convalescent sera specimens (collected 2 weeks after the onset of the ...