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Juan Lama
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In this journal E. Orviz and colleagues recently described the clinical presentation of the first monkeypox patients in Spain, highlighting the frequent co-presence of sexually transmitted infections (STI). To date, no reports of co-infection with monkeypox virus and SARS-CoV-2 have been published. Therefore, in this study we present the clinical features and diagnostic procedure of the first documented case of co-infection with monkeypox virus, SARS-CoV-2 and HIV-1. Since January 2022, more than 16,000 people in over 74 countries have been affected by monkeypox, prompting the World Health Organization to declare this outbreak a public health emergency of international concern. Human-to-human transmission occurs through close contact with infectious material from skin lesions, fomites, seminal fluids and oropharyngeal secretions. The majority of cases were registered in gay or bisexual men often suffering from other STI. At the same time, SARS-CoV-2 is still a major cause of morbidity and mortality globally. COVID-19 shares with monkeypox both the transmission by air droplets and the symptoms of fever, lymphadenopathy, headache, sore throat and fatigue. As these pathogens continue to spread, individuals can be simultaneously infected with monkeypox virus, SARS-CoV-2 and STI, making it difficult for physicians to perform the correct diagnosis, also considering that not all patients with monkeypox develop skin lesions. Our patient, an Italian 36-year-old male spent 5 days in Spain from 16 to 20 June 2022 (Figure 1). Nine days after, he developed fever (up to 39°C), accompanied by sore throat, fatigue, headache and right inguinal lymphadenomegaly. On 2 July he resulted positive for SARS-CoV-2. On the afternoon of the same day a rash started to develop on his left arm. The following day small, painful vesicles surrounded by an erythematous halo appeared on the torso, lower limbs, face and glutes. On 5 July, due to a progressive and uninterrupted spread of vesicles that began to evolve into umbilicated pustules, he went to the emergency department of the Policlinico “G. Rodolico - San Marco” University Hospital in Catania, Italy, and was subsequently transferred to the Infectious Diseases unit. On admission, the patient reported being treated for syphilis in 2019. In September 2021, he performed an HIV test with a negative result. He suffered from bipolar disorder, for which he regularly took carbamazepine 200 mg daily. He was vaccinated for SARS-CoV-2 with two doses of Pfizer's BNT162b2 mRNA vaccine (the last in December 2021) and had already contracted COVID-19 in January 2022. He also reported of having condomless intercourse with men during his stay in Spain. Fever (37.5°C), pharyngodynia, fatigue, headache was still present. On physical examination his body was dotted, including the palm of the right hand and the perianal region, with skin lesions in various stages of progression, ranging from small vesicles (Figure 1, Panel A) to reddened haloed pustules (Figure 1, Panel B and Panel C) and umbilicated plaques (Figure 1, Panel D). The oral mucosa was normal, except for bilateral tonsillar hypertrophy. A modest hepatosplenomegaly and an enlarged (2 cm), hypomobile and painful lymph node in the right inguinal region were found. Laboratory test showed elevated C-reactive protein (69 mg/L, normal values 0.0 - 5.0 mg/L), fibrinogen (713 mg/dL, normal values 170 - 400 mg/dL) and prothrombin time (1.21, normal values 0.8 - 1.2). Chest X-ray revealed a parenchymal hypodiaphany in the right parailary region... Published in Journal of Infection (August 19, 2022):
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Juan Lama
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Scientists not involved in the study seriously doubt the findings, which challenge the current consensus on where and when the virus originated. In a study not yet published in a journal, scientists have reported that the new coronavirus was present in wastewater in Barcelona, Spain in March 2019, a finding that, if confirmed, would show that the pathogen had emerged much earlier than previously thought. But independent experts who reviewed the findings said they doubted the claim. The study was flawed, they said, and other lines of evidence strongly suggest the virus emerged in China late last year. Up until now, the earliest evidence of the virus anywhere in the world has been from December 2019 in China and it was only known to have hit mainland Spain in February 2020. “Barcelona is a city that is frequented by Chinese people, in tourism and business, so probably this happened also elsewhere, and probably at the same time,” said the lead author, Albert Bosch, a professor in the Department of Microbiology of the University of Barcelona who has been studying viruses in wastewater for more than 40 years. Several experts not involved in the research pointed out problems with the new study, which has not yet been subjected to the critical review by outside experts that occurs before publication in a scientific journal. They suggested that the tests might very well have produced false positives because of contamination or improper storage of the samples. “I don’t trust the results,” said Irene Xagoraraki, an environmental engineer at Michigan State University. Researchers at the University of Barcelona posted their findings online on June 13. Most of their report described research on wastewater treatments from early 2020. Preprint available at medRxiv (June 13, 2020): https://doi.org/10.1101/2020.06.13.20129627
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Juan Lama
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Spain is one of the European countries most affected by the COVID-19 pandemic. Serological surveys are a valuable tool to assess the extent of the epidemic, given the existence of asymptomatic cases and little access to diagnostic tests. This nationwide population-based study aims to estimate the seroprevalence of SARS-CoV-2 infection in Spain at national and regional level. 35,883 households were selected from municipal rolls using two-stage random sampling stratified by province and municipality size, with all residents invited to participate. From April 27 to May 11, 2020, 61 075 participants (75·1% of all contacted individuals within selected households) answered a questionnaire on history of symptoms compatible with COVID-19 and risk factors, received a point-of-care antibody test, and, if agreed, donated a blood sample for additional testing with a chemiluminescent microparticle immunoassay. Prevalences of IgG antibodies were adjusted using sampling weights and post-stratification to allow for differences in non-response rates based on age group, sex, and census-tract income. Using results for both tests, we calculated a seroprevalence range maximizing either specificity (positive for both tests) or sensitivity (positive for either test). Seroprevalence was 5·0% (95% CI 4·7–5·4) by the point-of-care test and 4·6% (4·3–5·0) by immunoassay, with a specificity–sensitivity range of 3·7% (3·3–4·0; both tests positive) to 6·2% (5·8–6·6; either test positive), with no differences by sex and lower seroprevalence in children younger than 10 years (<3·1% by the point-of-care test). There was substantial geographical variability, with higher prevalence around Madrid (>10%) and lower in coastal areas (<3%). Seroprevalence among 195 participants with positive PCR more than 14 days before the study visit ranged from 87·6% (81·1–92·1; both tests positive) to 91·8% (86·3–95·3; either test positive). In 7273 individuals with anosmia or at least three symptoms, seroprevalence ranged from 15·3% (13·8–16·8) to 19·3% (17·7–21·0). Around a third of seropositive participants were asymptomatic, ranging from 21·9% (19·1–24·9) to 35·8% (33·1–38·5). Only 19·5% (16·3–23·2) of symptomatic participants who were seropositive by both the point-of-care test and immunoassay reported a previous PCR test. The majority of the Spanish population is seronegative to SARS-CoV-2 infection, even in hotspot areas. Most PCR-confirmed cases have detectable antibodies, but a substantial proportion of people with symptoms compatible with COVID-19 did not have a PCR test and at least a third of infections determined by serology were asymptomatic. These results emphasize the need for maintaining public health measures to avoid a new epidemic wave. Published in The Lancet (July 6, 2020): https://doi.org/10.1016/S0140-6736(20)31483-5
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Juan Lama
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We would like to express our concern about the limited capacity of actions taken by the Spanish Government to successfully control the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outbreak and end the exponential growth phase of new cases. The measures taken so far, consisting primarily of partial restriction mobility, are in the right direction, although some researchers have warned about the pressure placed on the building blocks of the health system. Given that the actual extent of an epidemic can only be assessed retrospectively, governments and policy makers are forced to make decisions on the basis of mathematical models of other diseases and previous experiences by other countries taking different actions. In Spain, various models simulating the spread of infection and using different assumptions converge in a landscape of a high number of new cases within the next few weeks. Simulations have been done using the URV and UNIZAR models to predict the progression of the number of patients who will require admission into hospital intensive care units because of coronavirus disease 2019 (COVID-19) in three scenarios (appendix): scenario 1, no mobility restrictions; scenario 2, partial restriction of mobility (ie, movement to the workplace allowed for 30% of people); and scenario 3, complete restriction of mobility (ie, no workplace mobility allowed except for essential services). The model suggests that the actions taken to date, consistent with scenario 2, will be insufficient to prevent hospitals and intensive care units from being overwhelmed over the coming weeks. The foreseen collapse of the health system, along with the age distribution of the Spanish population (ie, 18% of people aged ≥65 years), suggests a potentially high mortality rate associated with COVID-19 in the country.... Published in The Lancet (March 26, 2020): https://doi.org/10.1016/ S0140-6736(20)30753-4
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