This is a frequently transmitted disease and in most cases it does not result in any pathology. It can, however, release a benign disease in the form of warts, or less commonly, different types of cancer. In women, HPV can cause cervical cancer.

What is HPV?

HPV is spread via direct skin to skin contact during sex, and not through fluids. In around 90% of cases it disappears spontaneously, but it can be transmitted whilst the virus is present.

HPV is classified in terms of whether or not there is a risk of cancer developing:

• Low risk: may cause benign genital warts or condyloma.
• High risk: up to 14 different types of high risk or congenital HPV have been described, of which the most common are types 16 and 18. These are responsible for 70% of cancers caused by this virus.

It should be said that it is possible to be infected with more than one type of HPV. In addition, persistent infection can result in developing cancer of the cervix, vulva, penis, anus or oropharynx.

Specifically, the virus initiates dysplastic changes in the epithelial cells which continue to evolve until they produce an invasive cancer. This is a progressive process and the time from infection until developing the disease can be up to twenty years.

Symptoms

Genital warts or small protuberances or groups of different sizes and shapes may appear in the area of the genitals.

In the case of cancer, there are no symptoms until it is very advanced. In the case of cervical cancer, symptoms show up as:

• Abnormal vaginal bleeding
• Pain in the lower abdomen, pelvis, back and legs
• Weight loss
• Pain during sexual intercourse

Who is affected by HPV?

In Catalonia, cancer of the womb occurs in 7.2 out of every 100,000 women per year (2003-2007). This represents 2.8% of all female cancers. Between the ages of 35-64 this figure rises to 16.1 cases for every 100,000 women. Furthermore, the risk of developing this disease for women who live to 75 is one in 106.

Anal cancer has an annual incidence rate of 1.8 cases for every 100,000 people, but in the case of men engaging in same-sex relations and infected with HIV, this rises to 70 or 128 cases for every 100,000.

Diagnosis

When there is evidence of warts, diagnosis is usually clinical or by biopsy. Cancer is detected by cytology tests, which allow anomalous changes in the cells to be seen before they develop. If the test comes back anomalous it can be complemented by a colposcopy that allows magnified examination of the cervix and samples to be taken.

HPV detection is the main component of a preventative strategy to detect the virus before it reaches the point of disease.

Typical treatment

There is no specific antiviral treatment for HPV.

In the case of warts, in most cases they can be eliminated through surgery, ointments or other treatments.

If cancer does develop, treatment will depend on the stage at which it is diagnosed. For example, if it is detected early in the cervix this can involve removing the damaged tissue, whilst in more advanced stages it may require a hysterectomy, radiotherapy or chemotherapy.

Prevention

The use of condoms is essential to prevent HPV. There is also highly effective vaccine used as a way to prevent cervical cancer. Regular cervical smear tests (Papanicolau test) are also carried out as a form of screening. This strategy, however, is changing due to the techniques used to detect the virus which, together with the smear test, are enabling the different stages of the disease to be monitored (acquisition, persistence, progression to precancerous lesions and invasion).

What is diphtheria?

The characteristic symptom of respiratory diphtheria is a greyish white membrane (pseudomembrane) covering the tonsils and pharynx. The membrane tends to be difficult to remove and in doing so the area bleeds easily.

Symptoms

The most common symptoms are:

• Fever, feeling generally unwell and respiratory obstruction.
• Neurological and cardiac complications in the most serious cases. These complications can lead to death.

Who does diphtheria affect?

Thanks to vaccination, there have been no cases diagnosed in Spain for over thirty years. In 2015, however, there was one case in a child who had not been vaccinated.

Diphtheria is transmitted through respiration or close physical contact with an infected person or a healthy person carrying the bacteria but who has never shown symptoms.

The incubation period is two to seven days and it can be spread from seven days before symptoms appear up to two or three weeks afterwards.

Diagnosis

Diagnosis is confirmed via microbial culture of clinical samples (swabs from the nasal mucosa, pharynx or pseudomembranes).

Typical treatment

Diphtheria antitoxin medication and an antibiotic such as penicillin G procaine must be given as soon as possible (in the first 48 hours after showing symptoms, without waiting for the laboratory diagnosis).

Prevention

Vaccination is the main measure to prevent diphtheria and is effective in 95% of cases. It must be periodically boosted as the effects of the vaccination do not last for ever.

Epidemiological monitoring and prophylaxis are essential to control the bacteria and to avoid secondary cases.

What is meningitis?

There are two types of meningitis:

• Bacterial meningitis is a serious disease requiring immediate medical attention. Three microorganisms are the cause of the disease. They are naturally present in the pharynx, where they are commensal, or “friendly”, bacteria. The disease can progress very quickly. This happens when these microorganisms invade the blood stream. Bacterial meningitis is spread through respiratory secretions, for example when we cough or kiss. People sharing a home are likely to be infected.
• Infectious or viral meningitis is caused by bacteria or a virus. It is the most common type of meningitis and is less serious than bacterial meningitis. The viruses most commonly associated with this disease in our environment are enteroviruses: herpes simplex type 1 and 2, the varicella zoster virus and the mumps virus. The evolution of viral meningitis is acute, benign and usually there are no lasting effects.

Symptoms

The most common symptoms are:

• sudden onset of high fever
• intense headache
• pain when moving the neck

Meningitis may also include nausea and vomiting, sensitivity to bright light, drowsiness, falling into a coma or convulsions.

The first symptoms of bacterial and viral meningitis are similar. However, bacterial meningitis is generally severe and can cause serious complications such as brain damage or learning difficulties.

In bacterial meningitis, the bacteria in the blood can give rise to another serious disease,septicaemia, which is the body’s generalized reaction to infection and which may have various consequences such as:

• changes to arterial pressure
• changes to clotting of the blood
• tissue damage
• multiple organ failure

In the most serious cases it can be fatal. In this case, the appearance of small spots on the skin is cause for alarm.

Who does meningitis affect?

Bacterial meningitis can be contracted by any age group but the elderly and young children are most at risk. In the last twenty years its epidemiology has changed significantly with the introduction of new vaccines linked to child vaccination programmes.

Whilst meningococcus is the main cause of bacterial meningitis around the world, in Spain meningococcal disease is not endemic, with an annual rate of fewer than 5 cases for every 100,000 people. Meningococcal meningitis may lead to death in 3-15 % of cases.

Many of the viruses that cause the disease are present worldwide and others are specific to particular regions.

Diagnosis

If meningitis is suspected, blood and cerebrospinal fluid (the liquid around the spinal cord and brain) samples will be analysed. Cerebrospinal fluid is obtained via lumbar puncture. Analysis will help confirm the disease and will identify the microorganism causing it.

Typical treatment

Most cases of infectious or viral meningitis improve without treatment in 7-10 days. However, it is very important that people with symptoms of meningitis receive immediate medical care to make a correct diagnosis of the disease, to determine the type of meningitis and to receive the right treatment.

In the case of bacterial meningitis, antibiotic treatment must be administered intravenously as soon as possible. Anti-inflammatories may also be used to treat any complications that may arise.

For the moment, the number of new cases has been reduced thanks to policies to eliminate the insect in countries where it is endemic, as well as thanks to screening programmes aimed at blood and organ donors and pregnant women. The future challenges to cure this disease are maintaining and increasing these measures in addition to developing new treatment evolution and response markers for patients in the chronic phase, and new drugs to treat the disease.

What is Chagas disease?

Chagas disease is endemic to Latin America and is a global health challenge due to migration from countries in the region. Transmission via insect is mainly found in Bolivia, which has the highest number of cases. There are also infections in north-west Argentina, Peru, Paraguay, Ecuador, Nicaragua and southern Mexico. Outside these areas it is more commonly transmitted from mother to child.

Symptoms

Most patients with Chagas disease do not show any symptoms, which makes it difficult to detect. The disease develops in two phases:

• Acute: there are no symptoms and this means it goes undetected or is confused with other diseases. After an incubation period of 7-10 days, the acute phase resembles a case of flu, so it usually goes unnoticed.
• Chronic: in 30-40% of cases the disease results in cardiac and/or gastrointestinal complications which may be serious and therefore require specific treatment.

Who is affected by Chagas disease?

This disease affects six to seven million people, but 60 million are estimated to be at risk of infection.  There are 11,000 cases in Catalonia.

Diagnosis

• In the acute phase (mainly in babies) the disease is diagnosed by detecting the parasite in the blood. Microscopy and molecular techniques (PCR) are used for this.
• In the chronic phase (when acquired in childhood), the disease is diagnosed by detecting antibodies in the serum. In this phase of the disease, molecular techniques work in cases where the disease has been reactivated or as a marker of the failure of a specific treatment.

Typical treatment

There are currently two drugs that are used to treat Chagas disease: Benznidazole and Nifurtimox. Specific treatment is needed to address any cardiac and/or gastrointestinal complications that may arise.

Prevention

Since 2011, Catalonia has implemented the “Protocol for screening and diagnosing Chagas disease in pregnant Latin American women and their babies”. This programme allows possible congenital cases to be detected, and at the same time actively screens blood and organ donations from donors.