One hundred eighty-four serologically confirmed cases of hepatitis A were reported in eastern Spain in 1999. A matched case-control study implicated imported coquina clams complying with European Union shellfish standards as the source of infection; this implication was confirmed by the detection by reverse transcription-PCR of hepatitis A virus (HAV) RNA in shellfish samples. In spite of the recognized low variability of HAV, genetic characterization of the complete capsid region of virus isolates from patient serum samples revealed the existence of both synonymous and nonsynonymous variants. Two antigenic variants were detected, one in a discontinuous epitope defined by monoclonal antibody K3-4C8 and a second in a linear VP1 epitope of the virus. In spite of these antigenic variants, all isolates were assigned to genotype IB, providing further evidence that the outbreak originated from a common source, although multiple strains were likely to be involved.Hepatitis A virus (HAV) infection is the leading cause of viral hepatitis in Spain (40) and throughout the world (9). Although transmission through the parenteral route may occur (28, 38), HAV infection is mainly propagated via the fecal-oral route (24). While in approximately 40% of the reported cases of hepatitis A the source of infection cannot be identified (9), waterborne (6) and food-borne (31, 34) outbreaks of the disease have been reported. Within the latter category, shellfish grown and harvested from waters receiving urban contaminants is a frequent cause of infectious hepatitis (17,25).Hepatitis A virus, the prototype of the genus Hepatovirus, belongs to the family Picornaviridae. Its 7.5-kb single-stranded RNA genome bears different regions: the 5Ј and 3Ј noncoding regions (NCRs); the P1 region, which encodes structural proteins VP1, VP2, VP3, and putative VP4; and the P2 and P3 regions, which encode nonstructural proteins associated with replication (18).Immunological evidence has determined the existence of a single serotype of HAV (22), a fact which prevents the use of serological approaches to characterize different virus isolates. To overcome this difficulty, sequencing of the putative VP1/2A junction of the virus genome is used to differentiate HAV isolates into seven genotypes (32).On 22 October 1999, the Health Department in Valencia, Spain, reported the occurrence of a hepatitis A outbreak and its possible association with imported frozen cockles. Concomitantly, a rapid alert system for food-borne outbreaks that was developed within the framework of a European Union project (QLRT-1999-0594) made us aware of the existence of the outbreak. Although the first disease reports appeared in early October, the first cases actually occurred in early September. MATERIALS AND METHODSCase-control study. Cases were identified on the basis of reports from five hospitals-Hospital de La Ribera of Alzira, Hospital General of Ontinyent, Hospital Lluís Alcanyís of Xàtiva, Hospital of Requena, and Hospital La Fe of Valencia-as well as from physicians in the a...

Escherichia coli and the antimicrobial pressure exerted on this microorganism can be modulated by factors dependent on the host. In this paper, we describe the distribution of antimicrobial resistance to amikacin, tobramycin, ampicillin, amoxicillin clavulanate, cefuroxime, cefoxitin, cefotaxime, imipenem, ciprofloxacin, fosfomycin, nitrofurantoin, and trimetoprim-sulfametoxazole in more than 100,000 E. coli isolates according to culture site and patient age, gender, and location. Bayesian inference was planned in all statistical analysis, and Markov chain Monte Carlo simulation was employed to estimate the model parameters. Our findings show the existence of a marked difference in the susceptibility to several antimicrobial agents depending on from where E. coli was isolated, with higher levels of resistance in isolates from medical devices, the respiratory system, and the skin and soft tissues; a higher resistance percentage in men than in women; and the existence of a clear difference in antimicrobial resistance with an age influence that cannot be explained merely by means of an increase of resistance after exposure to antimicrobials. Both men and women show increases in resistance with age, but while women show constant levels of resistance or slight increases during childbearing age and greater increases in the premenopausal age, men show a marked increase in resistance in the pubertal age. In conclusion, an overwhelming amount of data reveals the great adaptation capacity of E. coli and its close interaction with the host. Sex, age, and the origin of infection are determining factors with the ability to modulate antimicrobial resistances.

MI cumulative incidence and mortality rates are low compared with other industrialized countries but, vary considerably among regions in a Mediterranean country like Spain.

Objectives: A long-lasting legionellosis outbreak was reported between November 2011 and July 2012 in a hotel in Calpe (Spain) affecting 44 patients including six deaths. Intensive epidemiological and microbiological investigations were performed in order to detect the reservoirs.Methods: Clinical and environmental samples were tested for the presence and genetic characterization of Legionella pneumophila. Six of the isolates were subjected to whole-genome sequencing.Results: Sequencing of 14 clinical and 260 environmental samples revealed sequence type (ST) 23 as the main responsible strain for the infections. This ST was found in the spa pool, from where it spread to other hotel public spaces, explaining the ST23 clinical cases, including guests who had not visited the spa. Uncultured clinical specimens showed profiles compatible with ST23, ST578, and mixed patterns. Profiles compatible with ST578 were obtained by direct sequencing from biofilm samples collected from the domestic water system, which provided evidence for the source of infection for non ST23 patients. Whole genome data from five ST23 strains and the identification of different STs and Legionella species showed that different hotel premises were likely colonized since the hotel opening thus explaining how different patients had been infected by distinct STs.Conclusions: Both epidemiological and molecular data are essential in the investigation of legionellosis outbreaks. Whole-genome sequencing data revealed significant intra-ST variability and allowed to make further inference on the short-term evolution of a local colonization of L. pneumophila.