This report evaluates the June 2008 onychomadesis outbreak in Valencia, Spain. The study sample consisted of 221 onychomadesis cases and 77 nonaffected individuals who lived close to those affected. We collected data on dietary variables, hygiene products, and individual pathological histories. Feces and blood specimens were collected from 44 cases and 24 controls to evaluate exposure to infectious agents. Pathological background data revealed a high frequency (61%) of hand, foot, and mouth disease among the onychomadesis cases. Coxsackievirus A10 was the most commonly detected enterovirus in both case and control groups (49%). Other enteroviruses such as coxsackieviruses A5, A6, A16, B1, and B3; echoviruses 3, 4, and 9; and enterovirus 71 were present in low frequencies in the case and control groups (3-9%). The 2008 onychomadesis outbreak in the metropolitan area of Valencia was associated with an outbreak of hand, foot, and mouth disease primarily caused by coxsackievirus A10.

This was a study of monkeypox-infected patients in a tertiary care center in Spain describing the epidemiologic, clinical, and microbiologic features of 49 patients.

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A 44-year-old homosexual man currently on antiretroviral therapy for HIV infection presented with a three month history of a single annular red plaque of two cm diameter with central clearing and raised borders on the penis, associated with mild pruritus [Figure 1]. There were no lesions in the oral cavity, palms, or soles. Lymphadenopathy and systemic symptoms were absent.Histopathological examination revealed a dense dermal infiltrate composed of lymphocytes and plasma cells in a lichenoid pattern with epitheliotropism. Immunohistochemistry showed the presence of Treponema pallidum. Rapid plasma reagin (RPR) test was reactive in 1:32 dilution and fluorescent treponemal antibody absorption test was positive. The CD4 lymphocyte count was within normal limits. A diagnosis of secondary syphilis was made and the patient received 2.4 million units of penicillin G benzathine weekly for 3 weeks, despite the existing guidelines preferring a single-dose therapy, leading to a complete healing of the lesion. Serology performed 3 months after treatment showed an improved RPR of 1:4 dilution. Declaration of patient consentThe authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given his consent for his images and other clinical information to be reported in the journal. The patient understands that name and initials will not be published and due efforts will be made to conceal identity, but anonymity cannot be guaranteed.

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Background Syphilis is a sexually transmitted infection (STI) caused by the pathogen Treponema pallidum. Its incidence is increasing in our country, especially among men who have sex with men (MSM). Serological tests are still the most widely used technique for diagnosis. The need for an early diagnosis has prompted the introduction of fast techniques, such as Treponema pallidum detection by polymerase chain reaction (PCR) on mucocutaneous samples. The objective of this work is to analyse the sensitivity of this technique in a series of patients diagnosed with syphilis at our centre. Methods Retrospective review of all cases diagnosed with syphilis at our centre between May 2017 and May 2021. Results A total of 203 cases of syphilis were diagnosed with serologic tests: 33% were primary syphilis and 53.1% secondary syphilis. PCR for Treponema pallidum was performed in 117 (57,6%) cases. The sensitivity was highest (95,2%) when performed on samples from mucocutaneous ulcers in primary syphilis. This value decreased to 69,4% in secondary syphilis, although there were variations between the types of samples. Conclusions The PCR test has a high diagnostic value when performed on ulcer exudates in patients with primary syphilis. Its most relevant advantages in clinical practice are the possibility of an early diagnosis before serological tests during the window period, the ability to confirm reinfections in patients with persistent positivity of reaginic antibodies and a history of treated syphilis. Nevertheless, given that a negative PCR test may not rule out infection by Treponema pallidum, serologic tests are still necessary for everyday practice.

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