Download the scientific days of the national institute of infectious diseases “prof

-11 T H EDITION OF-
THE SCIENTIFIC DAYS OF THE
NATIONAL INSTITUTE OF
INFECTIOUS DISEASES
“PROF.DR. MATEI BALŞ”
- ABSTRACT VOLUME ID in ID
or Identity Definition in Infectious Diseases
BUCHAREST, 14-16 OCTOBER 2015
ISSN 2457-8525
ISSN–L 2457-8525
PRESIDENT OF THE CONFERENCE
Prof. Dr. Adrian Streinu-Cercel
SCIENTIFIC COMMITTEE
Prof. Dr. Adrian Streinu-Cercel
Prof. Dr. Vlad Ratziu
Dr. Olivier Patey
Prof. Dr. Victoria Aramă
Dr. Mona Munteanu
Assoc. Prof. Dr. Monica Luminos
Assoc. Prof. Dr. Elisabeta Benea
Dr. Mariana Mărdărescu
Assoc. Prof. Dr. Alexandru Rafila
Lect. Dr. Ana Maria Tudor
Lect. Dr. Anca Streinu-Cercel
Lect. Dr. Mihai Săndulescu
Assist. Lect. Dr. Oana Săndulescu
ORGANIZING COMMITTEE
Dr. Sorin Petrea
Dr. Oana Săndulescu
Psih. Odette Chirilă
Dr. Mihaela Rădulescu
Daniela Dobrescu
Dr. Cătălin Tilişcan
Ec. Daniela Dumitraşcu
Dr. Anca Streinu-Cercel
Claudiu-Mihai Şchiopu
Dr. Mihai Săndulescu
Mariana Andreeana
Ruxandra Marin
Oral presentations
Wednesday, 14 October 2015
The unpredictability of influenza viruses - 20142015 flu season in Romania
Daniela Pițigoi1*, Carmen Maria Cherciu2, Mihaela
Lazar2, Alina Elena Ivanciuc2, Maria Elena Mihai2,
Cristina Tecu2, Rodica Popescu3, Odette Popovici3,
Emilia Lupulescu2
*[email protected]
1
Carol Davila University of Medicine and
Pharmacy, Bucharest, Romania
2
Cantacuzino National Institute for Research and
Development for Microbiology and Immunology,
Bucharest, Romania
3
National Centre for Transmissible Diseases
Surveillance and Control (CNSCBT), Romania
Background
The evolution of flu is very unpredictable because
the influenza viruses A and B types undergo
antigenic drift of hemagglutinin that plays an
important role in virus escape from host immune
defense and imposes annual re-evaluation of
vaccine composition. We aimed to investigate the
characteristics of influenza viruses circulating in
Romania during the season 2014-2015 and their
match with the vaccine strains.
Methods
We tested for the presence of influenza viruses or
for other respiratory viruses the clinical specimens
collected at national level between week 40/2014
and week 20/2015, from patients with influenzalike illness or severe acute respiratory infections. A
second rRT-PCR was performed on the HA gene
for determination of H1N1 pdm09 or H3N2
subtype. When influenza B viruses were detected, a
second rRT-PCR was performed for lineage
determination. Antigenic analysis was performed
by hemagglutination inhibition assay. Genetic
analysis was performed on the full HA gene.
Results
The first influenza virus (H3N2 subtype) was
detected in week 49/2014, the influenza epidemic
started in the week 4/2015, reached the peak in
week 9 and the last positive detection was
registered during week 18/2015. A total of 698
(51.3%) samples were positive from 1360
specimens tested in the National Influenza Centre.
A mixed virological aspect was seen all the season,
with a slow dominance of type A (55.7%) over type
B (44.3%) and a dominance of subtype H3N2
(63.2%) over H1N1 pdm09 (36.8%). A total of 111
strains were isolated, of which 42 (37.8%) from
hospitalized patients. A(H1N1)pdm09 viruses were
antigenically characterized as A/California/7/2009,
vaccine strain. In contrast, A(H3N2) and
B/Yamagata-lineage viruses were poorly
recognized by homologous antisera against vaccine
strains, A/Texas/50/2012 and
B/Massachusetts/02/2012 respectively, but
relatively well recognized by antisera raised against
vaccine strains recommended for South
Hemisphere (A/Switzerland/9715293/2013 and
B/Phuket/3073/2013). Genetically, all
A(H1N1)pdm09 viruses fell in group 6, subgroup
B. The strains A(H3N2) belonged to clades 3C.2
and 3C.3, while the vaccine strain A/Texas/50/2012
belonged to genetic subgroup 3C.1. All viruses type
B belonged to clade 3 B/Phuket/3073/2013, while
the vaccine strain belongs to clade 2.
Conclusions
This season the influenza activity was higher than
in the previous season, characterized by cocirculation of influenza A(H3N2), A(H1N1)pdm09
and B viruses and two drifted strains. The antigenic
and genetic data as well as epidemiological
surveillance are able to early capture the molecular
changes of the circulating influenza viruses and to
support vaccination programmes or antiviral
treatment conducting in improvement of patient
outcomes.
Major trends in antibiotic use in Romania
(2011-2014): quantity and quality indicators
Gabriel Adrian Popescu1,2*, Levente Mathias3
*[email protected]
1
Carol Davila University of Medicine and
Pharmacy, Bucharest, Romania
2
National Institute for Infectious Diseases "Prof.
Dr. Matei Balș", Bucharest, Romania
3
IMS Health Romania
Background
The use of antimicrobials had collateral damages as
post-antibiotic diseases (i.e. Clostridium difficile
infections – CDI) and the development of
antimicrobial resistance. Furthermore, data from
various regions indicated that up to half of
antibiotics prescribed are inappropriate. The
information on total national antimicrobial
consumption and the quality of antibiotic use can
3
be an important source for planning rational use
interventions.
Methods
We performed an analysis of national antibiotics
sales for a four-year interval, 2011-2014. Data were
provided by IMSHealth Romania, a marketing
research company; the consumption was measured
in DDD/1000 inhabitants/day. In order to compare
with other European countries and for the analysis
of quality of antibiotic consumption in community
we used data from ESAC Net, 2013 being the most
recent year included in this European database.
Results
The total consumption of antibacterials was large,
exceeding every year 30.5 DDD/1000inh/day, with
a maximum of 31.9 DDD/1000inh/day for 2013
(among the top five European countries in analysed
years). The most used group of antibiotic was
penicillins with 52-56.6% of total consumption;
cephalosporins, quinolones and macrolideslincosamides were the next groups in this order. A
significant increase registered broad spectrum
antibiotics used in community and in hospital:
cephalosporins, with a rate of 0.42
DDD/1000inh/day annually increase (R2=0.99) and
quinolones, with a rate of 0.112 DDD/1000inh/day
annually increase (R2=0.79). For 2013, the
quinolones consumption was the second in Europe
and the cephalosporin consumption was the third.
From hospital used antibiotics, carbapenems
(R2=0.69) and colistin (R2=0.94) had increasing
trends (explaining the emergence of XDR and PDR
strains of Klebsiella pneumoniae, Pseudomonas
aeruginosa and Acinetobacter). The usage of
antibiotics with greatest risk of Clostridium difficile
infection (quinolones, cephalosporins, carbapenems
and clindamycin) increased from 7.01
DDD/1000inh/day (2011) to 8.84
DDD/1000inh/day (2014), R2=0.98, representing
22.5% to 28.3% from total consumption of
antibiotics. Conversely, less colitogenic antibiotics
were less used as tetracyclines, 0.08
DDD/1000inh/day (R2=0.91) and aminoglycosides
(R2=0.77). The ESAC Net indicator for
broader/narrow spectrum antibiotic usage in
community increased from 6.45 (2011) to 11.88
(2014), R2=0.97.
Conclusions
Our analysis indicates a large level of antibiotics’
consumption in Romania. At the same time, the
quality of antibiotics usage is low, with an increase
of broad spectrum and salvage antibiotic
consumption, including high risk CDI inducers; the
restricted usage of these antibiotics is a necessary
part of strategies to curb antibiotic resistance
(especially XDR and PDR bacteria) and to decrease
the incidence of CDI.
Overview on bacterial pharyngitis in the first 6
months of 2015 in the National Institute for
Infectious Diseases “Prof. Dr. Matei Balș”
(NIID), Bucharest
Daniela Tălăpan1,2*, Olga Mihaela Dorobăț1,
George Jugulete1,2, Monica Luminița Luminos1,2,
Mădălina Merișescu1, Angelica Vișan1,2, Mariana
Mărdărescu1, Emilia Căpraru1, Smaranda Botea1,
Alexandru Rafila1,2
*[email protected]
1
National Institute for Infectious Diseases "Prof.
Dr. Matei Balș", Bucharest, Romania
2
Carol Davila University of Medicine and
Pharmacy, Bucharest, Romania
Background
Despite the fact that viral pharyngitis causes most
sore throats, streptococcal pharyngitis has similar
symptoms and should be rapidly diagnosed and
treated. Group A beta-haemolytic streptococci are
the most common cause of bacterial pharyngitis
and penicillin remains the drug of choice.
Methods
Between 1 January-30 June 2015, 6.621 pharyngeal
swabs were received in the Microbiology
Laboratory of NIID for culture and identification,
which remains the gold standard to diagnose the
streptococcal pharyngitis. These were processed
according to the laboratory standard procedures
and beta-haemolytic streptococcal colonies were
sub-cultured and further identified as A, C, G or F
Lancefield groups. Antibiotic susceptibility testing
to erythromycin was performed for any isolate;
clindamycin was added, if resistant.
Results
A total of 910 (13.74%) throat cultures were
positive for beta-haemolytic streptococci as
follows: 85.27% group A, 9.23% group C, 3.62%
group G and 1.86% group F Lancefield. The most
affected group age was 6-10 (40.87%), followed by
children below 6 years old (38.24%); other affected
age groups: 5.38% for 11-15 years old; 4.39% for
16-25 years old; 7.91% for 26-40 years old; 1.75%
for 41-50 years old and 1.42% for more than 50
years old. Group A streptococci was the most
common bacterial etiology except for two age
groups: 16-25 and over 40 years old, where nongroup A streptococci (C and G) was dominant (21
vs. 19 and 18 vs. 11). Overall resistance to
erythromycin was 17.47%, higher for group G
streptococci (21.21%) and lower for group C
streptococci (5.95%); group A streptococci were
18.94% resistant to erythromycin with 52.83%
inducible resistance to clindamycin.
4
Conclusions
Bacterial pharyngitis was diagnosed in 13.74% of
the cases. The dominant cause of streptococcal
pharyngitis remains group A streptococci (85.27%),
with 18.94% resistant strains to erythromycin.
Acknowledgement
This paper is partially supported by the Sectoral
Operational Programme Human Resources
Development (SOP HRD), financed from the
European Social Fund and by the Romanian
Government under the contract number
POSDRU/159/1.5/S/137390.
The resistance pattern of Gram-positive cocci in
Infectious Diseases Hospital Galați
Manuela Arbune1,2*, Miruna-Luminița
Drăgănescu1,2, Camelia Pintilie2, Alina Iancu1,2
*[email protected]
1
Medicine and Pharmacy Faculty, "Dunărea de Jos"
University Galați, Romania
2
Infectious Diseases Hospital Galați, Romania
Background
Gram-positive cocci (GPC) are usually commensal
organisms. Although they are generally susceptible
to a broad range of antibiotics, resistance has been
developed to many antimicrobial drugs.
Methods
We analyzed the resistance of GPC isolated in
Infectious Diseases Hospital Galați, during 2014.
The biological samples of the hospitalized patients
were collected according to the clinical data and we
performed bacteriological cultures. Antibiotic
susceptibility testing was determined using the disk
diffusion method, according to the Clinical and
Laboratory Standards Institute (CLSI 2014).
Interpretation of the results was based on the
inhibition of growth; strains are classified as
resistant (R), intermediate (I) or susceptible (S).
Results
From 3553 hospitalized patients, there were 334
GPC isolated: 72.4% Staphylococcus spp., 24.8%
Enterococcus spp. and 2.6% Streptococcus spp.
The majority of staphylococcal strains were
isolated from varicose ulcers (45.9%), pus (10.3%),
stool (9.5%), catheter (7.4%), blood cultures
(6.6%). The nasal swab is not routinely tested for
Staphylococcus spp., but it was requested in 8
patients. Methicillin resistance (MRS) was found in
43.3% isolates and multi-resistance in 35.1%. The
highest rate of MRS was found in the catheter
culture and the lowest in nasal swab culture. The
main antibiotic resistance rates were found for
penicillin 91.4%, erythromycin 76.4%,
clindamycin 56.8%, gentamycin 40.7%,
ciprofloxacin 36.6%. The majority of Enterococcus
spp. strains were from urine culture. The resistance
rates were: 5% nitrofurantoin, 28% penicillin, 30%
ampicillin, 34% gentamicin, 55% ciprofloxacin,
90% tetracycline. Streptococcus pneumoniae was
isolated from blood culture (2) and sputum (4).
Other Streptococcus spp. were found in varicose
ulcer, urine and conjunctiva secretion.
Streptococcus spp. were resistant to penicillin (5/9),
erythromycin (3/5), clindamycin (3/6),
clarithromycin (4/8), while all strains were
sensitive to linezolid, levo/moxifloxacin.
Frequently, the profile of patient with GPC is over
the age of 60, from urban area, obese or diabetic.
The bacteriological risks in males with varicose
ulcer are for Staphylococcus spp., while
Enterococcus spp. are mostly found in women with
urinary symptoms. Based on the diagnostic criteria
for colonization or infection, an estimated 63% of
cases over-used antibiotics in the management of
GPC.
Conclusions
Although GPC are often isolated in Infectious
Diseases Hospital Galați, they are rarely found in
invasive infections. Antibiotic resistance of GPC is
worrisome, especially for Staphylococcus spp. The
hospital's strategy for prudent antibiotic use is
considering rigorous selection of antibiotic
recommendation for GPC isolates.
Thursday, 15 October 2015
Coping with chronic HIV – A retrospective
study in the North-Eastern part of Romania
Alexandra Largu1,2*, Liviu Prisacariu2, Cristina
Nicolau2, Andrei Vâță1,2, Carmen Manciuc1,2
*[email protected]
1
“Gr.T.Popa” University of Medicine and
Pharmacy, Iași, Romania
2
"Sf. Parascheva" Infectious Diseases Clinical
Hospital, Iași, Romania
3
"Sf. Parascheva" Infectious Diseases Clinical
Hospital, Iași, Romania
Background
Society is slowly shifting its perspective on
HIV/AIDS, regarding it as a chronic disease. The
five stages of accepting a chronic illness are a
useful theory in evaluating an HIV-positive
5
patient’s condition and perhaps predicting
adherence to antiretroviral therapy.
Methods
We studied retrospectively psychological
evaluation records of patients hospitalized in the
HIV/AIDS Regional Centre Iași, between January
2013-June 2015. We selected data for patients
receiving at least 6 months of therapy. We
identified, from records of clinical interviews, the
stage of acceptance patients were in. We searched
for a connection between those and patients’
adherence to therapy, as declared by them.
Results
During the 30 month period, we evaluated 142 files
as follows: 61 in 2013, 53 in 2014 and 26 in 2015.
Patients were 52.5% men and 46.5% women.
Regarding HIV status, 31.03% of patients were in
stages A1, A2, B1, B2 of HIV infection, at the time
the files were filled in, while the majority (68.96%)
was in the AIDS stage (acquired immune
deficiency syndrome), with 42.24% of the total in
the final stage of the disease (C3). From patients’
interviews at the moment of the psychological
evaluation, 30% were oscillating between the
stages of denial and anger, 32% were in
negotiation, 18% in depression and only 20% had
fully accepted their disease. We found that the
patients with the most interruptions of therapy were
those in the first three stages of acceptance. In
some cases, the patients that seemed to be in the
stage of depression were also those accusing
“therapeutic fatigue” and giving up life. As
expected, patients in the stage of acceptance were
also the most adherent to therapy.
Conclusions
Evaluating the stage of acceptance of HIV/AIDS
the patient is in has proven to be a useful tool in
patient management from a psychological point of
view, towards coping with the disease. It is also
important in understanding the decisions patients
make regarding their adherence to therapy. Further
research may also involve statistical correlations
between the stages of acceptance and number of
interruptions, CD4, viral load or other markers of
adherence.
Acknowledgement
This paper was supported financially by the
project: Program de excelenta in cercetare
doctorala si postdoctorala multidisciplinara in
bolile cronice, contract nr.
POSDRU/159/1.5/S/133377, beneficiar U.M.F.
"Gr. T. Popa" Iasi, proiect cofinanţat din Fondul
Social European prin Programul Operaţional
Sectorial Dezvoltarea Resurselor Umane 20072013.
Factors associated with HIV stigma in Romania
Florin Lazar1*, Adrian Luca1, Iosif Marincu2
*[email protected]
1
University of Bucharest, Romania
Dr. Victor Babeş University of Medicine and
Pharmacy, Timişoara, Romania
2
Background
In an era of medical advances which turned HIV
into a chronic disease, stigma remains a challenge
for people living with HIV (PLHIV) in Romania,
discouraging them to be more socially active. The
aim of the study is to identify factors associated
with stigma, understanding the coping strategies
PLHIV use to adapt to stigma.
Methods
A cross-sectional survey using a self-reported
questionnaire was carried out between November
2014 and March 2015 among 252 adult PLHIV
aware of their status for at least 6 months. A global
score from HIV Stigma Scale (with 40 items,
scores: 40-160) represented the dependent variable.
Validated measures of quality of life (alpha= .934),
coping (alpha= .843), resilience (alpha= .943) and
depression (alpha= .946) were tested for
association with HIV Stigma Scale (alpha=.943).
Independent variables were subscales from the
above mentioned scales. A linear multivariate
regression was performed (adjusted r square of the
final model was: .49) to identify factors associated
with HIV stigma (mean 109.57, min. 57, max.
154).
Results
The most important predictors of stigma are: those
with a negative association: factor “social
resources” from Resilience Scale for Adults (ß
CI95%: -.374 [-1.532 - -.515], p<.000), the domain
“social relationships” from WHOQOL-HIV BREF
(ß CI95%: -.306 [-2.823 - .761], p<.001), followed
by those with a positive association, respectively
three factors from the Brief COPE Scale: selfblame (ß CI95%: .198 [.795 - 3.574], p<.002), use
of instrumental support (ß CI95%: .196 [.740 4.160], p<.005) and religion (ß CI95%: .181 [.451 3.357], p<.011).
Conclusions
Stigma negatively affects social resources for
resilience of PLHIV, hampering the quality of life,
but more specifically their social relationships. In
order to adjust to stigma, the coping strategies
developed are self-blaming for their condition in
this way internalizing the attitudes of the others, the
use of instrumental support available within their
social network (as a social support mechanism) but
also by turning towards religion. Professionals need
to better tackle the negative consequences of HIV
6
stigma by enhancing personal development of the
person which can create the premises for building
social resources and relationships, but also
supporting PLHIV to develop functional, adapted
coping strategies and not only internalize the public
blame.
Acknowledgement
This paper was co-financed from the European
Social Fund, through the Sectorial Operational
Programme Human Resources Development 20072013, project number POSDRU/159/1.5/S/138907
"Excellence in scientific interdisciplinary research,
doctoral and postdoctoral, in the economic, social
and medical fields -EXCELIS", coordinator The
Bucharest University of Economic Studies.
Neurological impairment in HIV-infected
children through vertical transmission
Rodica Ungurianu1*, Mariana Mardarescu1,
Cristina Petre1, Ruxandra Draghicenoiu1, Alina
Cibea1, Matei Carina1, Ioana-Alina Anca2,
Alexandra Mardarescu1
*[email protected]
1
National Institute for Infectious Diseases "Prof.
Dr. Matei Balș", Bucharest, Romania
2
The Institute for Mother and Child Protection
“Alfred Rusescu”, Bucharest, Romania
Background
The nervous system is a frequent target of HIV
infection. The consequences of the nervous system
involvement in HIV infection are serious. The true
evidence of the central nervous system
involvement is not known, although it is thought to
appear in most of HIV infected children and its
incidence in children is at least three times higher
than in adults. The rates of neurological
dysfunction in children with symptomatic HIV
infection were estimated at a range of 30 to 50
percent for HIV encephalopathy.
Methods
Retrospective study over a period of 10 years
(2006-2015). The study includes a total of 50 HIV
infected children with perinatally-acquired HIV,
from the Pediatric and Adolescents Department of
Immunodepression in The National Institute for
Infectious Diseases “Prof Dr Matei Balș”. The
children were evaluated in terms of psychosomatic
and neurological development, imagistic (MRI, CT
brain, transfontanellar ultrasound), CD4 monitoring
and HIV- RNA from blood and CSF.
Results
62% of the 50 children have neuropsychiatric
impairment of various degrees (HIV
encephalopathy). 75% of children diagnosed with
HIV encephalopathy manifest mental retardation,
cognitive deficit and impaired language
development which add: 15% cerebral palsy with
important motor deficit, 15% peripheral
neuropathy, 22% hypotonic syndrome.
Conclusions
Neurological disorders in children with HIV
infection include peripheral neuropathies (nerve
disorders that affect the limb or feet and hands),
myelopathy (disorders of the spinal cords), CNS
abnormalities, seizures and encephalopathy.
Development delays and regressions are also
important CNS–related problems in HIV infected
children. HIV encephalopathy is especially
common in HIV infected children who present in
early infancy and have rapid downhill course. The
risk of HIV encephalopathy is correlated directly
with the severity of HIV related symptoms and
depression of CD4 counts. ARV compliance in
families and children is the most important factor
in controlling neuropsychiatric manifestations and
ensuring proper development.
Cardiac abnormalities in children with perinatal
exposure to HIV infection
Mariana Mardarescu1*, Rodica Ungurianu1, Elena
Tanase2, Cristina-Roxana Petre1, Ruxandra NeaguDraghicenoiu1, Alina Cibea1, Ioana-Alina Anca2,
Mihai Mitran3, Carina Matei1, Georgiana Ionescu1,
Alexandra-Henriette Mardarescu1
*[email protected]
1
National Institute for Infectious Diseases "Prof.
Dr. Matei Balș", Bucharest, Romania
2
Institute for Mother and Child Care "Prof. Dr.
Alfred Rusescu"
3
Clinical Hospital for Obstetrics and Gynecology
“Prof. Dr. Panait Sarbu”
Background
A low incidence of HIV infection in children
(under 2% in Romania) is countered by a growing
incidence among adults, which is reflected on the
infant population, the majority of HIV infected
persons being at childbearing age. The issue that
we raise is based on a growing number of children
hospitalized with cardiac disease. Therefore, we
supposed that cardiac effects in children with HIV
infection or exposed to HIV are frequent.
Methods
Between January-June 2015, 43 children out of a
cumulative total of 93 children perinatally exposed
to HIV at national level, were kept under
surveillance in the National Institute for Infectious
Diseases “Prof. Dr. Matei Balș”, in accordance
7
with the National Protocol enclosed in the National
Registry of Pregnant Women-infected with HIV
and of perinatally exposed children. They were
assessed immunologically and virologically as well
as for possible birth defects through ultrasound
exploration at the National Institute for Mother and
Child Care “Alfred Rusescu”. Six children
(13.95%) exposed to HIV presented cardiac
pathology.
Results
All 6 children present both structural abnormalities
(heart defects - atrial septal defect, ventricular
septal defect, persistent arterial duct, transposition
of great arteries, ventricular hypertrophy or
valvular abnormalities) and functional (particularly
arrhythmias) with cardiac failure. In addition, one
child exposed to the mother’s i.v. drugs (heroin and
legal highs) associated other malformations, a
genetic consultation establishing the diagnosis of
gangliosidosis type I. In what concerns mothers’
clinical background: 4 out of 6 newly diagnosed
mothers lacked ART treatment while 2 (from the
Romanian cohort) discontinued treatment for more
than five years. According to the latest statistical
data presented by the Compartment for Monitoring
and Evaluation of HIV/AIDS Data in Romania,
48% of HIV positive women had CD4<500/cmm
and 50% of all new cases are detected at the
threshold of CD4<350/cmm. In addition, children
born to HIV infected mothers are exposed to HBV,
HCV, tuberculosis and i.v. drugs, thus cumulating a
suite of risk factors, resulting in multiorganic
impairment regardless of the exposed/infected
status.
Conclusions
Despite a low incidence of mother to child
transmission (below 2%), currently we have a large
number of HIV-positive women in childbearing
age, with a risky behavior (drug abuse,
promiscuity), some of them with low adherence to
ART during pregnancy and reluctance to access
specific health care services. Thus, the rate of
cardiac abnormalities in children exposed to HIV
infection is high with a possible underestimation of
these cases.
Clinical aspects in tuberculous meningitis
compared with cryptococcal meningitis
Raluca Elena Jipa1*, Eliza Manea1, Roxana Petre2,
Serban Benea1,3, Nicoleta Irimescu1, Diana Tanase1,
Andreea Florea3, Adriana Hristea1,3
*[email protected]
1
National Institute for Infectious Diseases "Prof.
Dr. Matei Balș", Bucharest, Romania
2
National Institute of Aeronautical and Space
Medicine “Gen. Dr. Aviator Victor Anastasiu”,
Bucharest, Romania
3
Carol Davila University of Medicine and
Pharmacy, Bucharest, Romania
Background
The aim of the study was to compare tuberculous
meningitis (TBM) in HIV infected patients with
TBM in HIV non-infected patients and
cryptococcal meningitis (CM).
Methods
Retrospective study between January 2012 - June
2015. We included patients diagnosed with TBM,
tested for HIV and HIV infected patients admitted
with CM. Patients were defined as having TBM
according to a consensus definition published by
Marais et al. [1]; CM diagnosis was established
upon positive India ink stain, culture and/or
cryptococcal antigen assay. Neurological staging
was made according to Medical Research Council
definitions [2]. We analysed demographic and
clinical data, cerebrospinal fluid (CSF) changes,
cerebral imaging and outcome.
Results
We identified 38 patients with TBM (14 HIV
infected, 24 HIV non-infected) and 18 patients with
CM. The mean age in HIV infected patients with
TBM was 31 (23-40) compared to 45 (35-59) in
HIV non-infected patients (p=0.004). There were
no statistically significant differences between
TBM in HIV infected and non-infected patients
regarding duration of symptoms before admission,
CSF changes and clinical data, except neurological
staging. Nineteen (79%) HIV non-infected patients
were in neurological stages II and III compared to 9
(64%) HIV infected patients with TBM (p=0.3,
OR[95%CI]=0.4[0.1-2.2]). Hydrocephalus was
more frequent in HIV infected patients (29%) than
in HIV non-infected patients (21%) (p=0.6,
OR[95%CI]=1.6[0.3-7.4]). Two (14%) HIV
infected patients died compared to one (4%) HIV
non-infected patient with TBM (p=0.5,
OR[95%CI]=3.8[0.3-46.6]). No statistically
significant differences were observed between HIV
infected patients with TBM and CM regarding
demographic, clinical data and CSF changes,
except duration of symptoms before admission, 6
(3-11) days in patients with CM vs. 16 (7-28) in
HIV infected patients with TBM (p=0.001) and
CSF/blood glucose ratio which was significantly
lower (0.302[0.225-0.332]) in HIV infected
patients with TBM compared to patients with CM
(0.428[0.335-0.530]) (p=0.033). The mean CD4
cell count was 25 (8-33) in patients with CM
compared to 100 (19-197) in HIV-infected patients
with TBM (p=0.001). Hydrocephalus was more
frequent in patients with CM (39%) than in patients
with TBM (29%) (p=0.4, OR[95%CI]=2.6[0.513]). Eight (44%) patients with CM died compared
8
to two (14%) HIV-infected patients with TBM
(p=0.1, OR[95%CI]=4.8[0.8-27.9]).
Conclusions
Clinical and laboratory data were similar in TBM
regardless HIV status, but the outcome was poorer
in HIV infected patients. CM appeared in a more
advanced HIV disease and had a poorer outcome.
References
1. Marais S, Thwaites G, Schoeman JF.
Tuberculous meningitis: a uniform case definition
for use in clinical research. Lancet Infect Dis.
2010;10:803-12.
2. Medical Research Council (1948). Streptomycin
treatment of tuberculous meningitis. Lancet 1:582596.
Prevalence of osteo-renal impairment in the
Romanian HIV cohort
Anca Streinu-Cercel1,2*, Oana Săndulescu1,2,
Gabriela Ceapraga2, Daniela Manolache2, Monica
Andreea Stoica2, Liliana Lucia Preoțescu1,2, Adrian
Streinu-Cercel1,2
*[email protected]
1
Carol Davila University of Medicine and
Pharmacy, Bucharest, Romania
2
National Institute for Infectious Diseases "Prof.
Dr. Matei Balș", Bucharest, Romania
Background
We have performed a study to evaluate the
prevalence of kidney disease and the changes in
bone mineral density in the Romanian cohort of
HIV-infected patients [1,2,3].
Methods
We performed dual-energy X-ray absorptiometry
(DXA) evaluation of the femur and lumbar
vertebrae, as well as laboratory tests including
standard serum panels and urinalysis in 72 patients
from the Romanian HIV cohort.
Results
The study included 72 patients, with a male:female
ratio of 1.8:1. The median (IQR) age was 38 (18)
years. Most of the patients had received one prior
antiretroviral (ARV) regimen (23, 31.9%) or over
three prior regimens (22, 30.6%), while only 3
subjects were at their first treatment regimen
(4.2%). At the time of evaluation, 28 (38.9%) had
undetectable HIV viral loads, 5 (6.9%) had viral
loads below the lower limit of quantitation, and the
rest of the patients had values ranging from 27 to
170,000,000 copies/mL. The median (IQR) CD4
cell count was 508 (380) cells/cmm, with a nadir
CD4 count of 387 (290) cells/cmm in the whole
group, in a range of 19-1190 cells/cmm. Twentyseven (37.5%) were current smokers, 2 (2.8%)
were ex-smokers and 40 (55.6%) were nonsmokers. The median (IQR) creatinine values were
0.9 (0.3) mg/dL, while the mean and standard
deviation (SD) for urea were 30±8.5 mg/dL.
Proteinuria was absent in 58 of the subjects
(80.6%). The mean±SD for 25-hydroxyvitamin D
were 18.8±10.8 ng/mL, situated in the insufficient
range. Only 6 patients (8.3%) had optimal serum
vitamin D levels, above 30 ng/mL. The mean±SD
T-score was -0.8±1.0 for L1-L4 vertebrae and 0.4±0.8 for the left femur. Four patients (5.6%) had
vertebral osteoporosis, and 11 (15.3%) had
vertebral osteopenia. None of the patients had
femoral osteoporosis, but 13 (18.1%) of them had
femoral osteoporosis.
Conclusions
We identified a relatively high prevalence of
asymptomatic osteopenia in the Romanian HIV
cohort, and a fairly low prevalence of kidney
involvement.
References
1. Streinu-Cercel A. Osteo-renal impairment in
HIV infection. Germs 2014;4:29.
2. Streinu-Cercel A, Săndulescu O, Șchiopu CM, et
al. Screening for osteo-renal involvement in the
Romanian HIV cohort. BMC Infect Dis.
2014;14:P65.
3. Streinu-Cercel A. HIV and bone mineral density.
Germs 2015;5:7.
Acknowledgements
1) Partially supported by the Osteo Renal Program,
AbbVie.
2) Partially supported by the Sectoral Operational
Programme Human Resources Development (SOP
HRD), financed from the European Social Fund
and by the Romanian Government under the
contract numbers POSDRU/159/1.5/S/137390.
Risk factors for low bone mineral density in
HIV infected males from Romanian cohort
Anca-Ruxandra Negru1*, Daniela-Ioana
Munteanu1, Raluca-Ioana Mihailescu1, Catalin
Tiliscan1,2, Ana-Maria Tudor1,2, Remulus Catana1,
Cristina Popescu1,2, Mihaela Radulescu1,2, Raluca
Nastase1, Ioan-Alexandru Diaconu1, Alina Orfanu1,
Irina Lapadat1, Irina Duport1, Violeta Molagic1,
Anca Leustean1, Ligia Ionescu1, Victoria Arama1,2,
Stefan-Sorin Arama2
*[email protected]
1
National Institute for Infectious Diseases "Prof.
Dr. Matei Balș", Bucharest, Romania
2
Carol Davila University of Medicine and
Pharmacy, Bucharest, Romania
9
Background
Although life expectancy of HIV infected patients
has significantly increased in the last years due to
the progresses made in the field of antiretroviral
treatment (ART), these patients present an
accelerated aging process, developing osteopenia
and osteoporosis at younger ages compared to the
general population. Loss of bone mineral density
(BMD) is associated with a higher risk for fractures
and important morbidity and medical costs.
Chronic inflammation, vitamin D deficiency and
ART are just a few causes responsible for bone
metabolism disorders in HIV infected patients. Our
objective was to investigate risk factors for low
BMD in HIV infected male patients from
Romanian cohort undergoing ART.
Methods
We present a cross-sectional study on 33 male HIV
infected patients form Romanian cohort,
undergoing ART. We analyzed patient data
regarding lifestyle, family and personal history and
we calculated the body mass index (BMI). Blood
samples were collected and analyzed for markers of
systemic inflammation: interleukin-6 (IL-6), C
reactive protein (CRP), tumor necrosis factor alpha
(TNF-alpha). BMD was assessed using whole body
dual energy X-ray absorbtiometry (DEXA). For
statistic analyses we used SPSS 21.
Results
Were enrolled 33 patients with a median age of 31
years (20.5, 39) of which 34.5% were smokers.
Median BMI was 24.2 kg/sqm (22, 27.4). Median
ART length was 44 months (22, 110). Thirty two
percent of patients had abnormal BMD: according
to T-score 25% had osteopenia and 7% had
osteoporosis. Regarding inflammation markers,
59%, 4.5% and 37.5% of patients had abnormal
values for TNF-alpha, IL-6 and hsCRP
respectively. We found no significant correlations
between the T-score and duration of ART or the
total number of antiretroviral combinations
received since the infection diagnosis. We found a
directly proportional correlation between T-score
and BMI (Spearman`s rho = 0.484, p-value =
0.004). There was no difference in T-score for
patients undergoing ART regimens with or without
protease inhibitors (p>0.005), or with or without
non-nucleosidic revers-transcriptase inhibitors
(p>0.005).
Conclusions
A significant number of HIV infected patients
develop BMD disturbances at young ages, having a
high risk for fractures which are associated with
important morbidity. This is the reason why we
consider screening of BMD using DEXA
mandatory in HIV infected patients, especially in
those with low BMI.
Acknowledgement
This paper is supported by the Sectoral Operational
Programme Human Resources Development
(SOPHRD), financed from the European Social
Fund and by the Romanian Government under the
contract number POSDRU/187/1.5/S/155420.
The prevalence of cardiovascular risk factors in
HIV-infected patients under antiretroviral
treatment at the National Institute of Infectious
Diseases „Prof. Dr. Matei Balș”
Elisabeta Otilia Benea1,2*, Liana Gavriliu1,2, Alina
Cozma1, Daniela Camburu1, Georgeta Ducu1,
Manuela Podani1, Roxana Dumitriu1,2, Șerban
Benea1,2
*[email protected]
1
National Institute for Infectious Diseases "Prof.
Dr. Matei Balș", Bucharest, Romania
2
Carol Davila University of Medicine and
Pharmacy, Bucharest, Romania
Background
Patients with HIV infection have an increased risk
of cardiovascular disease, caused by increased
prevalence of traditional factors of cardiovascular
risk, even with factors associated with HIV
infection and the effects of antiretroviral therapy.
Objectives: to identify the prevalence of major
cardiovascular risk factors in our patients.
Methods
We made a prospective evaluation of our patients
on antiretroviral treatment for at least 12 months.
We analysed demographic data (age, gender),
duration of HIV infection, duration of antiretroviral
therapy, BMI, presence of traditional
cardiovascular risk factors, current level of CD4
cells and HIV-RNA.
Results
Preliminary results were obtained in 208 patients.
The average age of patients was 39.8 years (19-79
years), with a balanced distribution between the
sexes (49% women vs. 51% men). The average
duration of HIV is 13.2 years (1-27 years) and the
median duration of antiretroviral therapy is 10.6
years 91-23 years). The prevalence of traditional
cardiovascular risk factors were: active smokers45.2% (94 patients), physical inactivity-61.5% (128
patients), hypertension-34.6% (72 patients),
diabetes-7.7% 96 patients), total cholesterol <200
mg/dL-42.8% (89 patients), HDL-cholesterol <40
mg/dL-60.1% (125 patients), LDL-cholesterol
<150 mg/dL-38.5% (80 patients), triglycerides≥250
mg/dL-48.6% (101 patients). In 20.7% of the cases
the current value of the CD4 was <350 cells/cmm
and 19.2% of the patients had detectable HIV-RNA
10
of last assessment; both factors are associated with
increased cardiovascular risk. In 37 patients
(17.7%) Framingham score was between 10-20%
and in 18 patients (8.7%) was ≥20%. In 106 cases
we found the presence of a major cardiovascular
risk factor in combination with antiretroviral
therapy lasting over 10 years, suggesting that these
patients had indication for investigations for
subclinical coronary atherosclerosis.
Conclusions
The prevalence of traditional cardiovascular risk
factors is increased to the 208 patients evaluated so
far. Complex and intensive measures are required
to reduce the risk of coronary heart disease. It also
requires adequate cardiological evaluation for
assessing the presence of subclinical
atherosclerosis in these patients.
Cardiovascular risk in HIV-infected patients on
ARV treatment
Irina Magdalena Dumitru1,2*, Roxana Carmen
Cernat1,2, Aurelia Hangan1,2, Valentina Cornenco2,
Claudia Fodor1, Eugen Dumitru2, Sorin Rugină1,2
*[email protected]
1
HIV/AIDS Regional Centre Constanța, Romania
Faculty of Medicine, “Ovidius” University,
Constanța, Romania
2
Background
The introduction of HAART has substantially
reduced mortality among HIV-infected population,
but cardiovascular diseases have become one of the
leading causes of morbidity and mortality. The
study objectives are to identify of cardiovascular
risk factors in HIV infected patients on
antiretroviral treatment and to compare the
cardiovascular risk in patients from cohort (aged
25-27) with cardiovascular risk in patients older
than 30 years.
Methods
A retrospective study conducted in HIV / AIDS
Regional Centre Constanta on a 207 HIV-infected
patients, 104 aged 25-27 years (group 1) and 103
older than 30 years (group 2).
Results
Out of 207 patients infected with HIV, a rate of
51.21% are women and 48.97% are men. In
relationship with comorbidities, hypertension,
obesity and diabetes are more frequent in group 2
(12 /1 patients, 24 /2 patients, 9 /0 patients) but
chronic hepatitis B and C and depression are more
frequent in group 1 (21/13 patients, 30/6 patients).
Dyslipidemia was more frequent in group 2 (total
cholesterol> 200 mg in 70 patients in comparison
with 25 patients in group 1 and
hypertriglyceridemia in 61 patients in comparison
with 40 patients in group 1). We noticed that out of
104 patients (group 1) 24% are smokers, 5%
alcohol consumers, and 2% are drug users and out
of 103 patients older than 30 years, 40.8% are
smokers, 25.2% alcohol consumers, and 2.9% are
drug users. In both groups the patients received
treatment with protease inhibitors in similar
percentages (68%). We calculated Framingham
score in all patients; 78 patients (76%) in group 2
had the Framingham score > 1 and only one patient
in group 1 (1%). 62.02% of cardiovascular risk
patients undergoing treatment with protease
inhibitors.
Conclusions
Of the 207 HIV-infected patients, 79 (38.16%) had
cardiovascular risk, more common in patients older
than 30 years. Cardiovascular risk was correlated
with: age, hypertension, diabetes, obesity,
dyslipidemia, smoking and alcohol consumption as
in the general population. Patients older than 30
years may be associated cardiovascular risk in case
of a long-term treatment with protease inhibitors
(over 10 years).
Pathological patterns at upper endoscopy
screening in HIV infected patients
Cristina Olariu1,2*, Magdalena Popa3, Adriana
Nurciu1
*[email protected]
1
National Institute for Infectious Diseases "Prof.
Dr. Matei Balș", Bucharest, Romania
2
Carol Davila University of Medicine and
Pharmacy, Bucharest, Romania
3
Elias University Emergency Hospital, Bucharest,
Romania
Background
HIV infected patients experience various symptoms
suggestive for upper digestive tract pathology.
Moreover, many of these patients have also
hepatitic viral infections that require careful
endoscopic examination for establishing the degree
of portal hypertension. There is an increasing
interest regarding the spectrum of upper digestive
lesions in the context of HIV, still there are few
studies published by now. We tried to establish a
pattern of lesions in HIV infected patients that
enables us to further investigate the upper
endoscopy role in the management of these
patients.
Methods
We analyzed the endoscopic appearance in a total
of 86 HIV-infected patients which underwent this
11
investigation between November 2012 and July
2015, disregarding the reason for the endoscopic
screening. The age in our cohort varied between 19
and 68 with an average of 34.45 years.
Results
Only 5 of the 86 patients (5.81%) showed no
pathological sign at the EDS (endoscopy). In the
rest of the 81 patients in our screening, at least one
pathological macroscopic finding was seen. The
most frequent lesion encountered in HIV infected
patients at the EDS screening is esophagitis
(30.23%). The second type of lesion seen in these
patients is represented by gastritis. According to
our analyses – 27.9% of the subjects had minimal
erythematous gastritis, while 17.44% had erosive
type gastritis. Regarding the duodenum, only
15.11% of our patients presented anomalies of this
segment at the EDS. The most common duodenal
pathology is represented by erosive duodenitis
(9.3%).
Conclusions
Upper digestive tract lesions are very common at
the EDS screening of the HIV infected patients.
The most affected segment seems to be the
esophagus, where esophagitis-type lesions are
frequently encountered. The second most frequent
lesion is represented by erosive gastritis. Also
minimal mucosal modifications (erythematous
gastritis) are commonly encountered but their
importance in the clinical picture remains obscure.
The duodenum is rarely involved as a demonstrable
source for the upper tract symptoms in HIV
infected persons.
Metabolic complications in elderly HIV positive
patients from South-East region
Miruna Draganescu1*, Manuela Arbune1, Camelia
Pintilie2, Alina Iancu2, Caterina Dumitru2, Nicoleta
Cireașă2
*[email protected]
”Dunărea de Jos” University, Galați, Romania
Infectious Diseases Clinical Hospital ”Sf. Cuv.
Parascheva” Galați, Romania
1
2
Background
The HIV epidemic evolves for more than thirty
years and the current trend is the growing number
of people aged 50 years and older. UNAIDS reports
that 10% of HIV positive adults are aged over 50
years, in low and middle-income countries.
Romania has a lower percentage of old patients
(6%) due to high proportion of young patients
infected between 1988-1992. Objectives: to
describe the prevalence and the profile of lipid
disorders in HIV positive adults over 50 years old
from Galați Clinical Infectious Diseases Hospital.
Methods
We conducted a cross-sectional study on 173 HIV
positive patients nosocomially and sexually
infected. Patients were stratified by age in 5 groups
(23-24, 25-29, 30-39, 40-49 and over 50 years old).
Information about total and HDL-cholesterol,
triglycerides, glucose blood levels, CD4-cells, and
HIV viral load were obtained from patient files.
Statistical analysis: MedCalc.
Results
173 patients aged from 20 to 81 years old (mean:
28 years), 45% men, 55% women (ratio 1:1.18)
were evaluated. Patients over 50 years old: 8.7%.
Mean CD4 684 cells/cmm vs. 518 cells/cmm in
patients over 50; mean viral load (VL) 151146
copies/mL vs 46723 copies/mL in patients over 50.
63% of patients had lipid abnormalities, with
different prevalence: women 74%, men 56%
(p=0.0476). Low HDL-cholesterol was the most
frequent lipid disorder (60%), mean value 43 mg%
with different prevalence between age groups: 70%
in 25-29 years old vs. 46% in 50 years old.
Inversely, triglycerides rose with age from 4% in
young patients to 50% in patients over 50. High
cholesterol had a 35% prevalence, rising with age
from 29% to 93% (p=0.0458). None of HIV
patients with high-cholesterol was currently on
statin treatment. Mean glucose level was 78 mg%.
No correlation between lipid disorder and CD4 or
VL levels was found.
Conclusions
Lipid abnormalities are frequent in HIV patients
with higher prevalence in older patients. The lipid
disorders profile is different with age: low HDLcholesterol is more frequent in young patients due
to old chronic HIV infection while high total
cholesterol and triglycerides are more frequent in
patients over 50 years old. No patient was currently
treated with statin ± fibrates for lipid abnormalities.
Increasing age brings new challenges for HIV
population and monitoring the lipid profile could
prevent further cardiovascular events. The current
study could be a starting point for monitoring the
evolution of lipid disorders over the time in people
ageing with HIV infection.
The efficiency of HAART regimens during 3
years treatment in HIV/AIDS infected patients
in the Republic of Moldova
Ina Bistritchi1*, Tiberiu Holban1, Constantin
Spinu2, Pavel Micsanschi1
*[email protected]
12
1
State Medical and Pharmaceutical University
“Nicolae Testemiţanu”, Chișinău, Republic of
Moldova
2
National Public Health Center, Republic of
Moldova
HAART regimen was obtained therapeutic success
both immunologically and virologically for 118
(79.2%) patients. Out of 118 patients, AIDS was
diagnosed for 86 (72.8%) patients.
Background
HIV/AIDS infection is one of the priority issues of
public health in Republic of Moldova. Despite the
efficiency of highly active antiretroviral therapy
(HAART), HIV/AIDS infection remains an
evolving infection for life. Appropriate therapeutic
approach allows prolonging and improving the
quality of life of HIV infected patients.
Methods
We assessed 149 naive patients with HIV/AIDS
who initiated HAART in 2011-2012 with
Zidovudine-Lamivudine-Efavirenz (I group),
Zidovudine-Lamivudine-Nevirapine (II group),
Tenofovir-Emtricitabine-Efavirenz (III group). The
average age of patients included in this study was
36.2±0.8 years and 2/3 of them were young people
30-39 years. All patients started HAART late, when
they were diagnosed with AIDS related diseases
and/or CD4<350 cells/cmm. The way of
transmission of HIV infection in 149 patients of the
study group was 87.3% (130) heterosexual and
12.7% (19) by injecting drug use.
Results
During 3 years on first-line HAART regimen, of
the total number patients, 9 patients died, 11
patients abandoned treatment and 11 patients had
treatment failure and were transferred to secondline HAART regimen. Patients who remained in
first-line regimen had success both
immunologically and virologically. Immunological
success was determined by the average of
CD4=427.7±38.9 cells/cmm (I group – 430.2±31.1
cells/cmm, II group – 427.2±48.9 cells/cmm, III
group – 425.8±36.8 cells/cmm). Virological
success was due to undetectable viral load for 95
patients (80.5%): I group – 35 (70%) patients, II
group – 41 (65.1%) patients, III group - 19 (70.4%)
patients. The spectrum of opportunistic infections
in the studied group was distributed as follows:
oropharyngeal candidiasis – 69 (58.5%) patients,
tuberculosis – 27 (22.9%) patients, wasting
syndrome – 14 (11.9%), Herpes Zoster, Kaposi's
sarcoma, HIV encephalopathy and esophageal
candidiasis – 2 (1.7%) patients, cerebral
toxoplasmosis – 1 (0.8%) patient. Concomitant 22
(18.6%) patients were detected with viral hepatitis
B, C.
Conclusions
This study showed that more than half (63.09%) of
HIV/AIDS – infected patients were detected late,
with the number of T-lymphocytes CD4<350
cells/µl, but during 3 years of continued first-line
Measurement of adherence to antiretroviral
therapy for HIV / AIDS infection
Mirandolina Prisca1*, Dana Negru2, Mariana Nagy3
*[email protected]
1
Vasile Goldis West University, Arad, Romania
Arad Public Health Department, Romania
3
Aurel Vlaicu University, Arad, Romania
2
Background
Lack of adherence to antiretroviral treatment
regimens has serious consequences for HIV/AIDS
patients, like failure to prevent viral replication and
increased risk of developing viral resistance. There
are severeal methods available for measuring
treatment adherence; these have different strengths
and weaknesses; there is no optimal measure of
adherence.
Methods
We have studied adherence to antiretroviral therapy
for 57 HIV/AIDS patients, using a single measure
of treatment adherence, which was their selfreports by completing a nine questions
questionnaire, referring to their confidence in
treatment efficiency, life quality and their daily
compliance in taking medication. Data were
processed using MedCalc, in order to establish if
there is any correlation in poor adherence and virus
load reduction, CD4 cells number, gender,
educational background, clinical stage of infection
and the time span between starting regimens and
adherence measurements.
Results
Arithmetic mean for age in our patients was 32,
extreme 8 and 74 years old. Gender distribution
was 71.4% men, 28.6% women. Clinical stage of
infection was: 39.3% C3, 30.4% B3, 10.7% C1,
10.7% B1, 5.4% C2 and 3.6% B2 stage. There was
significant negative correlation, p=0.0482, r=0.3363, between viral loads and CD4 values, which
means that 11% of the lowest CD4 values are due
to an increased viral load. Of the patients 22
described an adherence over 95%, which represents
38.6%. Arithmetic mean for adherence was
86.02%, extreme values of 38% - 96%, p<0.0001.
The best adherence was in women, 87.88%
compared to men, 85.22%. There was a significant
difference in adherence, p=0.0019, for clinical
stage, where patients in stage C3 had the best
13
median value of 88.54% in adherence compared to
B2 where value was 82%. There was a significant
difference for time span, p=0.0439, meaning that
the patients which had a poor adherence to
treatment could only difficultly exceed 8.125 years
of treatment while patients with higher adherence
could do that more than 8.778 years.
Conclusions
Poor adherence in 62.48% of HIV/AIDS patients is
a problem for medical staff, families and mainly for
the patients. New evidence suggests that adherence
interventions should be made in multidisciplinary
effort involving health care providers, social
support networks, family, and friends.
Tuberculosis and HIV infection
Simona Erscoiu2*, Ionut Popa1, Olivia Burcos1,
Maria Nica2, Emanoil Ceausu2, Gratiela Tardei1,
Olimpia Nicolaescu1
*[email protected]
1
Clinical Hospital of Infectious and Tropical
Diseases “Dr. Victor Babeș”, Bucharest, Romania
2
Carol Davila University of Medicine and
Pharmacy, Bucharest, Romania
Background
Mycobacterium tuberculosis (TB) and human
immune deficiency virus (HIV) infections are
major public health problems. In Romania, the
number of HIV-TB co-infected patients has
increased in recent years, mainly due to IV drug
users (IVDU). The overall aims of this study were
to analyze awareness of HIV and TB infection.
They were also to examine the care of HIV and TB
patients and to investigate the relationship between
these two infections.
Methods
We performed an observational descriptive,
retrospective, longitudinal study on a group of 86
patients. For this study we enrolled 86 HIVinfected patients between January 2013 to
December 2014 diagnosed with primary or
secondary tuberculosis, in Clinical Infectious
Diseases Section I of the Hospital for Infectious
and Tropical Diseases “Dr. Victor Babeș” in
Bucharest. Clinical, microbiological,
bacteriological and immunological and virological
diagnosis for HIV and TB were performed. BK
PCR sputum, pleural fluid, lymph node biopsies,
CSF, as bacterial cultures were carried. BK PCR
sputum, pleural fluid, lymph node biopsies, CSF, as
bacterial cultures were performed. After a positive
M. tuberculosis cultures, sensitivity tuberculosis
was made as Xpert MTB/RIF in patients with
MDR TB.
Results
The male/female ratio was 2.5/1, the median age
was 21 years, most patients coming from Bucharest
and with a very low educational level. In most
cases, mode of transmission was parenteral (51% IVDU), different from previous years when the
heterosexual route dominated. All IVDU had HCV
co infection. Only 8% of patients had HBV coinfection. TB infection was diagnosed after HIV in
57% of subjects, especially in IVDU. Pulmonary
TB dominated (60%), the majority of cases being
diagnosed in 2013. Clinical, radiologic, PCR
examination and subsequent cultures confirmed
TB. Immunologic status was very low, below 50
lymphocytes/mmc especially in IVDU, and higher
in most subjects nonIVDU. All patients received
first or second line TB treatment. Adherence was
not predicted so that the evolution of 29% patients
(majority IVDU) was MDR and 8.3% were XDR.
The abandonment of TB therapy was noted in 33%
of patients, the majority IVDU. ARV therapy was
applied in 70% of subjects, 45% registering an
increase in CD4 lymphocytes. There were 20
deaths, 85% being IVDU.
Conclusions
It requires the use of classical and modern methods
of the swift diagnosis of TB, HIV testing is
absolutely mandatory if TB is diagnosed. Social
and psycho assistance is essential in order to
increase compliance to both treatments, TB and
ARV.
Friday, 16 October 2015
Ebola preparedness – an European perspective:
training and networks
Bogdan Cîrciumaru1*, Steluţa Popovici2, Roxana
Matei2, Cătălin Apostolescu2
*[email protected]
1
Central Universitary Emergency Military Hospital
Dr Carol Davila, Bucharest, Romania
2
National Institute for Infectious Diseases "Prof.
Dr. Matei Balș", Bucharest, Romania
Background
The Ebola 2014-2015 West Africa outbreak,
produced initially a generalized panic; the
international response was delayed but successful,
as it contained the disease. Therefore, countries
should be prepared for the Highly Infectious
Diseases, as the immigration from Africa to Europe
boosted the last years.
14
Methods
The aim is to prepare the European countries for
the impact of Highly Infectious Diseases, by
training the medical staff and the general
population, providing countries with modern
facilities, were the best treatment is offered with
maximal safety, by “train the trainer” programs (as
ETIDE-European Training in Infectious Diseases
Emergencies), recommending the high level
biosafety procedures for the entire diagnostic
process or sustaining the development of the
isolation facilities: barrier, or strict-highly
infectious isolation-e.g. the EuroNHID (European
Network for Highly Infectious Diseases).
Results
This includes our experience into the training for
highly contagious diseases. The trainers were
prepared into the “Lazzaro Spallanzani” Italian
National Institute for Infectious Diseases, by a
multinational expert team (ETIDE); their task was
to organize courses and practical lessons (e.g. the
proper use of the Personal Protective EquipmentPPE) in their own countries. The Euro-NHID
network organized the high degree isolation
facilities in at least 16 European Countries, aiming
to achieve an acceptable level of biosecurity in
reference facilities all over Europe.
Conclusions
The West African Ebola outbreak stressed the
importance of a well trained staff, high degree
biosecurity levels for diagnosis, and appropriate
barrier facilities for highly infectious diseases. This
could only be achieved by the developing a
National Network for highly infectious diseases
connected with European and other International
ones.
Acknowledgements
To our colleagues from ETIDE, Euro-NHID, Matei
Balş Institute of Infectious Diseases, “Carol
Davila” Central Military Hospital from Bucharest,
“Lazzaro Spallanzani” National Institute of
Infectious Diseases, Rome, Italy.
Parvovirus B19: a neglected cause of lifethreatening illnesses in immunosuppressed hosts
Ruxandra Moroti1,2*, Simona Stancu1,5, Adina Ilie2,
Raluca-Ioana Mihailescu2, Viola Popov3, Camelia
Kouris2, Valeriu Gheorghita2,4, Cristian-Mihail
Niculae1, Raluca Maria Hrisca2,4, Serban Benea1,2,
Dragos Florea1,2, Letitia Toma2,6, Ioan-Alexandru
Diaconu1,2, Dan Coriu1,6, Adriana Hristea1,2
*[email protected]
1
Carol Davila University of Medicine and
Pharmacy, Bucharest, Romania
2
National Institute for Infectious Diseases "Prof.
Dr. Matei Balș", Bucharest, Romania
"Colentina" Clinical Hospital, Bucharest, Romania
4
"Carol Davila" Central Emergency University
Military Hospital, Bucharest, Romania
5
"Carol Davila" University Hospital, Bucharest,
Romania
6
Fundeni Clinical Institute, Bucharest, Romania
3
Background
Parvovirus B19 causes mild, usually self-limited
illnesses in immunocompetent host, as erythema
infectiosum in children and acute/chronic
polyarthritis in adults. By the age of 15,
approximately 50% of European and American
populations have IgG antibodies. In
immunocompromised hosts can produce lifethreatening conditions as transient aplastic crisis
(TAC), pure red cell aplasia, virus-associated
hemophagocytic syndrome; rarely encephalitis,
myocarditis, hepatitis and vasculitis.
Methods
We performed a retrospective analysis of cases
with parvoviral infections in adults (>16 years old)
admitted or consulted in a tertiary infectious
diseases hospital between January 2010 and July
2015. The diagnosis was based on serology (five
patients), viremia (qualitative/quantitative viral
DNA) in two patients and bone marrow biopsy
(BMB) in six patients.
Results
There were seven patients, five female and two
male, median age of 48 years (16-69) with
immunosuppressive conditions represented by HIV
infection (two patients), cancer or hematological
disease (two patients), autoimmune disease (two
patients) and chronic immunosuppressive treatment
for renal transplant (one patient). Six of them were
diagnosed in 2015. Except one case, all were acute
infections. Hematological findings included
marked anemia (Hgb~2-3g/dL) and moderate to
severe thrombocytopenia: TAC (five cases), pure
red cell aplasia (one case) and chronic persistent bicytopenia (one case). One patient developed
hemophagocytic syndrome. Clinical manifestations
included: encephalitis (3 cases), polyarthritis or
arthralgias, ecchymotic severe rash. Diagnosis was
suggested by BMB and confirmed by serologies
(IgM in acute infections) and/or by blood viral
DNA. All patients needed repeated blood
transfusions and three of them received IVIG. In
one renal transplant recipient, the first clinical
manifestations were subacute encephalitis,
arthralgias, multiple inexplicable large ecchymosis,
followed by moderate anemia and severe
thrombocytopenia and in the next several weeks the
development of hemophagocytic syndrome. The
parvovirus DNA was 86 millions of copies/mL in
this case and needed temporary cessation of
immunosuppressive agents along with IVIG and
15
repeated blood transfusions. All patients with acute
disease had slow favorable evolution with good
recovery. The patient with chronic severe bicytopenia received monthly blood transfusions and
the hematological improvements were temporary
and substitution-dependent.
Conclusions
Parvoviral infections must be considered in
immunosuppressed patients with severe
hematological and neurological acute impairments.
Despite the lack of a specific antiviral agent, the
diagnosis is capital since the management includes
controlling of immunosuppressive therapy (up to
treatment cessation) and immunoglobulins. By
ruling out other potential etiologies, some empirical
and possible aggressive treatments can be also
avoided.
0.00002). Patients who had received antibiotherapy
prior to confirmed infection with Clostridium
difficile originated primarily from the departments
of Gastroenterology - 17 cases (9%), Surgery - 12
cases (6.4%), Internal Medicine - 10 cases (5.3%),
Neurology - 9 patients (4.7%) and Diabetology - 7
patients (3.7%). Of the total number of patients
treated 28 (14.9%) presented one relapse, while 6
(3.2%) had at least two relapses.
Conclusions
Almost 50% of patients diagnosed with diarrhea
with Clostridium difficile, originating from the
community were more than 65 years old, compared
to 20% under 65 years of age. Antibiotherapy was a
risk factor in patients over 65 years old, being used
in 40,9% of cases, and only in 35.2% of subjects in
the age group under 65 years.
Clostridium difficile infection in elderly patients
The use of a chromatographic immunoassay in
the diagnosis of Clostridium difficile infection: is
it worth it?
Egidia Miftode1*, Codrina Bejan1, Cristina
Petrovici1, Laura Ghibu1, Radu Miftode1, Larisa
Irimita1, Catalina Bucur1
*[email protected]
1
“Gr.T.Popa” University of Medicine and
Pharmacy, Iași, Romania
Dragos Florea1,2*, Daniela Talapan1,2, Mihaela
Fratila1, Emil Neaga1, Gabriela Bodea1, Mariana
Constantin1, Alexandru Rafila1,2, Dan Otelea1,
Gabriel Adrian Popescu1,2
*[email protected]
1
Background
In recent years the prevalence of infection with
Clostridium difficile increased especially in
advanced ages, traditionally, surgical interventions
and antibiotherapy being the most common factors
involved in the development of colitis with
Clostridium difficile.
Methods
Our study aimed to compare the epidemiological,
clinical and evolutive aspects of patients with
Clostridium difficile colitis hospitalized in the
Infectious Diseases Clinic of Iași in 2014 according
to age under 65 years old and over. Of the 188
patients studied, 83 (44.2%) were over 65 years of
age. The patient data were processed by using
EPIINFO version 7.
Results
Infection with Clostridium difficile occurred after
therapy with antibiotics in 71 patients (37.7%), 34
being over 65 years of age (40.9%) and 37 under
65 years (p = 0.42), in surgical context for 19 cases
(10.1%) of which 8 (9.6%) were over 65 and 11
under 65 years (p = 0.84), 16 patients required
oncological therapy (8.5%), 10 being over 65 years
of age and 6 under 65 years old (12%) (p = 0.12).
Social origin could be established in 62 cases
(32.9%), with 41 cases over 65 years of age
(49.4%) and 42 cases under 65 (50.6%) (p =
National Institute for Infectious Diseases "Prof.
Dr. Matei Balș", Bucharest, Romania
2
Carol Davila University of Medicine and
Pharmacy, Bucharest, Romania
Background
A rapid and accurate diagnosis of Clostridium
difficile infection (CDI) is critical for patient
management and infection control. The objective of
the present study was to evaluate the clinical
usefulness of a chromatographic immunoassay that
detects C. difficile glutamate dehydrogenase
(GDH), toxins A and B as in the diagnosis of CDI.
Methods
A prospective study was performed in one hundred
non-duplicate patients admitted in June and July
2015 in our Institute, a tertiary level infectious
diseases hospital. Fecal samples were tested for the
presence of GDH, toxins A and B (C. difficile GDH
+ Toxin A+B CerTest, Biotec), toxin B gene (tcdB)
and binary toxin (cdtA, cdtB) genes (CDIF Xpert,
Cepheid). A CDI was diagnosed when a sample
was positive for tcdB and/or toxin A or B.
Results
Sixty-five samples were positive, either for tcdB
only (34 samples), for GDH and toxin A/B only (3
samples) or for all the markers (28 samples). The
rate of detection of toxin A/B was not statistically
significant associated with the detection of binary
16
toxin. In the studied group the sensitivity,
specificity, positive and negative predictive values
for the Xpert assay alone were 95.3% (CI95%
86.2-98.8), 100% (CI95% 87.6-100), 100%
(CI95% 92.7-100) and 92.1% (CI95% 77.5-97.9).
A two-step algorithm with the chromatographic
immunoassay used to exclude from PCR testing
both GDH and toxin B positive samples and GDH
negative samples would have a sensitivity of 72.3%
(CI95% 59.6-82.3). In a two-step algorithm with a
more stringent approach, which excludes from PCR
testing only GDH and toxin A/B positive samples,
the sensitivity would be 100% (CI95% 93.0-100)
with a reduction of 11% for reagent costs. The
increased sensitivity of this approach compared to
Xpert testing alone is the result of detection of
GDH and toxin A positive but toxin B and tcdB
negative samples in the analysed group.
Conclusions
In settings with a high prevalence of CDI, like the
studied group, the use of a chromatographic
immunoassay (GDH + toxin A+B CerTest, Biotec)
as a first step before PCR may provide a slight
benefit compared to Xpert testing alone in the
diagnosis of CDI.
Acknowledgements
Dragos Florea was supported by a
POSDRU/159/1.5/S/135760 CERO grant.
Clostridium difficile infection: predicting poor
outcome
January 2012 - April 2013. We analysed clinical
data, blood test changes, treatment and outcome.
Results
We identified 395 patients admitted with CDAD in
our hospital between January 2012 and April 2013.
The mortality rate was 8.9% (35 deaths). Almost all
deaths (97%) were recorded in patients with age
above 60 years. The average age was 76.8 years in
these patients compared to 63.1 years for the rest of
the group. 77.1% of the patients that died received
combination of drugs that included metronidazole,
vancomycin and tigecycline and 68,6% received
other concomitant systemic antibiotics
(carbapenem, cephalosporins, quinolones). Age
above 60 years, severe comorbidities, using at least
3 antibiotics before the onset of symptomatology
were associated with poor outcome and death. The
clinical and paraclinical parameters associated with
increased risk of death were: fever at admission in
hospital (37.5°C- 38.5°C), leukocytosis (above
16,000 cells/cmm), low serum albumins (below 2.5
g/L), high creatinine levels, positive procalcitonin.
Regarding treatment options, concomitant systemic
antibiotics usage was associated with poor
outcome. High values of ATLAS score (above 6)
were recorded for patients that died.
Conclusions
The ATLAS score with its components can be a
useful tool for predicting poor outcome for patients
with CDAD. Positive procalcitonin can be a
negative factor for the patients, probably reflecting
the intra-abdominal source for sepsis.
Serban Benea1,2*, Irina Crasmaru2, Dragos Florea1,
Eliza Manea1, Raluca Jipa1, Doina Antonica1,
Ruxandra Moroti1,2, Diana Tanase1, Gabriel Gaciu1,
Gabriel Popescu1,2
*[email protected]
The evaluation of the prognostic value of
procalcitonin, mean platelet volume and
neutrophil/lymphocytes ratio in sepsis
1
National Institute for Infectious Diseases "Prof.
Dr. Matei Balș", Bucharest, Romania
2
Carol Davila University of Medicine and
Pharmacy, Bucharest, Romania
Background
Treatment of Clostridium difficile infection (CDI)
is usually based on the severity of the disease.
Guidelines recommend using metronidazole for
mild to moderate CDI, vancomycin being the drug
of choice for severe and complicated disease. The
aim of the study was assess the severity of
Clostridium difficile associated diarrhea (CDAD)
and identify the factors that can predict and are
associated with a high risk of death.
Methods
We included patients admitted to the National
Institute for Infectious Diseases “Prof Dr Matei
Balș” with the diagnosis of CDAD between
Alina Orfanu1,2*, Cristina Popescu1,2, Anca
Leustean1, Catalin Tiliscan1,2, Mihaela
Radulescu1,2, Anca Negru1,2, Ioan Diaconu1,2, Ligia
Ionescu1, Alina Vornicu1, Angelica Tenita1, Victoria
Arama1,2, Stefan Sorin Arama1,2
*[email protected]
1
National Institute for Infectious Diseases "Prof.
Dr. Matei Balș", Bucharest, Romania
2
Carol Davila University of Medicine and
Pharmacy, Bucharest, Romania
Background
Sepsis represents a clinical pathology with high
incidence worldwide and is considered the main
cause of death in the ICUs. The rapid diagnosis and
prognosis of septic patients are extremely
important in order to establish an efficient
17
antibiotic therapy. For this purpose, several
biomarkers of inflammation were evaluated in the
last years, such as procalcitonin (PCT), mean
platelet volume (MPV) and neutrophil/lymphocytes
ratio (NLR). Objectives: the correlation of these
biomarkers with the patients’ outcome appreciated
through APACHE and APS (Admission Point
Score) scores.
Methods
This is a retrospective analysis of the septic
patients admitted in the 3rd Department of “Matei
Bals” Institute between January 2014 – July 2015
and the correlation of the inflammatory biomarkers
with elements suggestive for severity - number of
systemic inflammatory response syndrome (SIRS)
criteria, primary infectious focus, septic metastases,
organ failures and the two severity scores.
Inclusion criteria: at least 2 SIRS criteria and the
infection evidence (septic focus or positive blood
cultures). For statistical analysis we used SPSS 21.
Results
75 patients with a mean age 60.64 and a sex ratio
M:F=1.02:1 were included. The primary septic
focus was identified in 88% of cases: urinary
(32%), respiratory (24%), digestive (18.7%). The
etiology was found in 54.7% of patients: Gram
negative rods (65%) and Gram positive cocci
(35%). The most frequent germs incriminated were
E. coli (including ESBL) – 20% and
Staphylococcus (MSSA, MRSA, epidermidis) –
9.2% of cases. 14.6% of patients presented septic
metastases and in 44% of cases was identified at
least one organ failure: hematological (24%), renal
(13.3%), hepatic (9.3%) and respiratory (8%). 28%
of patients had 3 or 4 SIRS criteria. The mean
value of PCT at admission was 22.23 ng/ml and it
was statistically correlated with the negative
prognosis calculated through APS score (p=0.02).
MPV mean value was 8.57 fl and higher values
were statistically correlated with both APACHE
(p=0.02) and APS score (p=003). NLR mean value
(20.25) wasn’t correlated with any of the gravity
scores.
Conclusions
The prognostic role of PCT and VPM in sepsis was
demonstrated through the statistical correlation
with APACHE and APS scores of gravity. A high
value of NLR is a sign of bacterial sepsis, but it
wasn’t statistically associated with the severity.
Acknowledgement: This paper is supported by the
Sectoral Operational Programme Human Resources
Development (SOP HRD), financed from the
European Social Fund and by the Romanian
Government under the contract number
POSDRU/187/1.5/S/155420.
The estimated seroprevalence of hepatitis E
virus in Romania based on interim results of the
HEP-E study
Valeriu Gheorghiță1,2*, Anca Streinu-Cercel1,3,
Oana Săndulescu1,3, Alina Elena Barbu1, Mădălina
Popa1, Simona Elena Albu4, Florin Alexandru
Căruntu1,3, Adrian Streinu-Cercel1,3
*[email protected]
1
National Institute for Infectious Diseases "Prof.
Dr. Matei Balș", Bucharest, Romania
2
Central Universitary Emergency Military Hospital
Dr Carol Davila, Bucharest, Romania
3
Carol Davila University of Medicine and
Pharmacy, Bucharest, Romania
4
University Emergency Hospital of Bucharest,
Romania
Background
The natural history of the hepatitis E virus (HEV)
infection has dramatically changed since the
description of the chronic hepatitis cases in
immunosuppressed patients infected with genotype
3 of the HEV. Besides genotypes 1 and 2, two more
genotypes have been described, 3 and 4, restricted
to developed geographical areas in the world,
including Europe. The seroprevalence of HEV
infection in European countries is estimated to be
as low as 5% and as high as 52% in South-Western
France. However, up to this moment no HEV
seroprevalence data are available for Romania.
Methods
The main objective of the Hepatitis E
Seroprevalence (HEP-E) study is to define the
prevalence of serum HEV-IgG antibodies (HEVIgG-Ab) in the Romanian population. It is a crosssectional ongoing study, since January 2015, taking
place in the National Institute for Infectious
Diseases “Prof. Dr. Matei Balș”, Bucharest. The
sample size desired for the study is 1000 people.
The enrolment criteria are based on consecutive
selection of adult patients (over 18 years old)
attending our center for any medical reason. The
serum HEV-IgG-Ab determination was performed
by ELISA methods. Each blood test sample was
accompanied by an epidemiological questionnaire.
Results
We enrolled 164 patients with a median age of 39.5
years (IQR, 28-59). The male/female ratio was 0.6.
The geographical distribution of the selected
patients covered 25 counties, 72.5% (n=119) being
from urban areas with the highest representation for
Bucharest, respectively 39.6% (n=65). The serum
HEV-IgG-Ab prevalence in our population was
19.5% (n=32). The median value of the ELISA IgG
test results was 4.05 UI/mL (IQR, 1.47-7.35)
compared to cut-off value of 0.360 UI/mL. The
18
epidemiological characteristics of patients with
positive serum HEV-IgG-Ab were: urban area of
origin (71.8%), consumption of undercooked meat
or offal (59.3%), non-chlorinated water
consumption (31.2%), animal caretakers in the
household (28.1%) and history of travel through
Europe, especially France and Germany (28.1%).
However, we did not find statistically significant
differences between HEV-IgG Ab positive and
negative patients regarding epidemiological risk
factors for HEV infection.
Conclusions
Our data suggest that Romania is an endemic area
for HEV infection, the local seroprevalence ranking
as fourth in Europe after South-Western France
(52%), Czech Republic (27.8%) and Republic of
Moldova (24.7%) according to the existing data
published by WHO in 2010.
Acknowledgement
This study is financially and logistically supported
by the National Institute for Infectious Diseases
“Prof. Dr. Matei Balș”, Bucharest, Romania.
Preliminary study of IgG anti-hepatitis E virus
antibodies presence in patients of an infectious
diseases hospital from North-Eastern Romania
Andrei Vâţă1*, Daniela Porea2, Dragoş Aniţă2,
Daniela Leca1, Dănuţ Teodor1, Cătălina Mihaela
Luca1, Carmen Manciuc1, Gheorghe Săvuţa2,
Carmen Dorobăţ1, Adriana Aniţă2
*[email protected]
1
University of Medicine and Pharmacy “Grigore T.
Popa”, Clinical Hospital of Infectious Diseases
“Sfanta Parascheva”, Iași, Romania
2
University of Agricultural Sciences and Veterinary
Medicine, Faculty of Veterinary Medicine, Iaşi,
Romania
Background
Hepatitis E is an acute self-limiting disease,
endemic in developing countries, but reports of the
disease from industrialized countries are becoming
more frequent. There are few data regarding this
type of infection in Romania.
Methods
We prospectively studied a group of 51 subjects
(with or without signs of clinical disease) from the
Infectious Diseases Hospital “Sfanta Parascheva”
Iași, between February and June 2015. We analyzed
epidemiological, clinical data and laboratory test
results. For each subject we collected serum and
whole blood samples and qualitatively determined
the presence of IgG anti-hepatitis E virus (HEV)
antibodies using a third generation enzyme
immunoassay (Dia.Pro, Italy).
Results
Eight out of 51 patients (15.7%) were identified as
positive for IgG anti-HEV antibodies. The
seropositive patients were on average older than the
seronegatives (43 vs 33 years, p=0.08). Five of
them were males and the sex ratio (M/F) was
higher among the seropositives (1.7 vs 0.3,
p=0.07). There was no significant difference
between the two lots regarding their living
conditions (urban or rural), but a more frequent
contact to farm animals (pigs) was noted in the
seropositives (5/8 vs 21%). Two of the
seropositives had symptoms and liver enzymes
elevations typical of acute hepatitis (without
jaundice or other viral cause identified), one of
them being a young pregnant woman. No
difference in the average ALT and serum bilirubin
levels were noted in the asymptomatic patients,
according to their IgG anti HEV status. 2/8
seropositives vs 6/43 seronegatives had prior
unexplained, self-limited hepatocytolitic
syndromes.
Conclusions
Our preliminary results show that the human HEV
infection in not unusual in our region, its
prevalence being probably higher than previously
estimated. Most seropositive patients were middleaged men or older, with frequent contact to farm
animals. Further analysis will try to identify the
presence of IgM anti-HEV antibodies and to
determine the genotypes involved in human acute
HEV infection.
Online psychopathological assessment in chronic
hepatitis pathology
Ioana-Catrinel Cercel1*, Șerban Polli1, Anca
Streinu-Cercel1,2, Oana Săndulescu1,2, Adrian
Streinu-Cercel1,2
*[email protected]
1
National Institute for Infectious Diseases "Prof.
Dr. Matei Balș", Bucharest, Romania
2
Carol Davila University of Medicine and
Pharmacy, Bucharest, Romania
Background
Viral hepatitis can be associated with psychiatric
and/or personality disorders and therefore a
multiaxial clinical assessment, evaluating both
psychiatric and personality disorders, is needed.
Methods
Millon Clinical Multiaxial Inventory- III (MCMIIII) is a psychological tool that provides
19
information on psychopathological elements based
on the Diagnostic and Statistical Manual of Mental
Disorders, the 4th edition (DSM IV). This inventory
can be used in patients over 18 years old and it
includes 175 items with true or false answers, to be
completed during the course of about 24 to 30
minutes. The novelty consists of providing this
psychological tool, acquired under license, to
patients in an online format, available on mobile
devices. The inventory thus becomes an easy to use
self-administered instrument. At the end of the
assessment the results are processed automatically
and interpreted to generate a psychological profile.
This information is extremely important both for
the clinical psychologist, in order to have an
accurate image on psychopathological matters, and
for the doctors, to tailor a personalized treatment
approach for each patient.
Results
We have had 20 patients that received identification
codes in order to complete the inventory in an
online format. The response rate was 75% so we
assessed 15 patients, 6 women and 9 men with
hepatitis B or C, with range ages between 26-67,
with a median of 46±11.71 years. We identified
axis I disorders from DSM-IV, we found 3 subjects
with clinical syndromes and 4 subjects with
personality issues on axis II disorders. For 14 of
them MCMI-III indicated the presence of a
personality trait.
Conclusions
This easy to use mobile tool provides an image of
the psychological status, useful for the
multidisciplinary team to make the best choices in
terms of treatment and counseling. Importantly, this
method allows a psychological assessment of a
large number of patients in a short period of time as
it can be self-administered.
Serum visfatin in relation to liver disease in a
cohort of chronic hepatitis C patients
Mihaela Andreea Radulescu1,2*, Victoria Arama1,2,
Sorin Stefan Arama2, Cristina Popescu1,2, Daniela
Ioana Munteanu1, Raluca Ioana Mihailescu1,
Catalin Tiliscan1,2, Irina Duport1, Viorica Ispas1,
Adrian Streinu-Cercel1,2
*[email protected]
1
National Institute for Infectious Diseases "Prof.
Dr. Matei Balș", Bucharest, Romania
2
Carol Davila University of Medicine and
Pharmacy, Bucharest, Romania
Background
Recent studies emphasize the role of several
adipokines in chronic hepatitis C (CHC) disease
progression. Visfatin is an adipokine correlated to
liver fibrosis and portal inflammation in nonalcoholic fatty liver, although only a few studies
evaluated visfatin in CHC patients and their results
are contradictory. This study aimed to assess serum
visfatin in relation to liver disease in a cohort of
CHC patients.
Methods
We performed a non-interventional analysis in a
cohort of CHC patients, monitored in a tertiary
clinic in Bucharest, compared to 30 uninfected
controls. We excluded patients with diabetes
mellitus, HBV or HIV co-infections, inflammatory
and immuno-suppressive conditions, other chronic
liver diseases. We recorded demographic data,
body mass index, waist to hip ratio, lipid profile,
serum viral load, visfatin. Liver disease was
assessed by the non-invasive test Fibromax
(Biopredictive, France). Statistical analysis was
performed with SPSS (17.0 IBM, USA).
Results
117 CHC patients were included, with a median
age of 54 years (IQR 45-61) and sex ratio
M:F=0.54. Median viral load was 5.80 logUI/mL
(5.26-6.33). A high fibrosis score (F3-F4) was
found in 47 (41.2%) patients, a high activity index
(A2-A3) in 54 (47.3%) while 26 patients (22.8%)
had a high steatosis score (S2-S3) and 14 (12.2%)
had a high non-alcoholic steatohepatitis (NASH)
score (N2). Visfatin median was 546 ng/mL (349798) in CHC patients versus 533 ng/mL (247-711)
in the control group, p>0.05. In bivariate analysis
visfatin was slightly correlated with fibrosis score
(rho=0.162, p=0.05). In logistic regression the risk
of fibrosis was not influenced by serum visfatin,
although a visfatin value below the median limit
lowered the risk for advanced fibrosis (F>3) with
OR=0.38 (IC95%=0.16-0.94, p=0.037) and the risk
for cirrhosis (F4) with OR=0.36 (IC95%=0.140.92, p=0.034). Visfatin was not correlated to
activity and steatosis scores, but it was correlated to
NASH score (rho=0.270, p=0.014) in overweight
and obese patients (body mass index>25). Its
median was higher in those with severe
steatohepatitis when we compared patients with
extreme Nash scores (N0 vs N2) - 98.8 ng/mL
(59.7-117.0) versus 84.9 (0.67-0.103), p=0.014. In
logistic regression serum visfatin did not influence
NASH score.
Conclusions
In CHC patients high serum visfatin is correlated to
advanced fibrosis and steatohepatitis scores.
Further studies are necessary to evaluate if visfatin
directly contributes to fibrosis progression.
20
A short argument in favor of combination
therapies for chronic hepatitis B
Laura Iliescu1*, Letitia Toma1, Monica Berechet1,
Bogdana Ioana Pulhac1, Alina Tanase1, Carmen
Orban1
*[email protected]
1
Fundeni Clinical Institute, Bucharest, Romania
Occult hepatitis B virus reactivation in patients
with hematological malignancies under
biological therapy
Violeta Molagic1*, Cristina Popescu1,2, Catalin
Tiliscan1,2, Raluca Mihailescu1, Mihaela
Radulescu1,2, Angelica Tenita1, Victoria Arama1,2,
Stefan Sorin Arama2
*[email protected]
1
Background
At the moment, there are two approved types of
treatment for chronic hepatitis B virus (HBV)
infection: nucleotide/nucleoside analogues and
interferon; they have different action mechanisms
but neither monotherapy can obtain satisfying rates
of virus clearance (absence of serum HBs antigen
and seroconversion in the HBe system). Serum
HBs antigen (HBsAg) represents an important
serological marker of chronic B virus infection in
HBe antigen (HBeAg)-negative patients under
treatment. We aim to determine the rate of HBsAg
decline under different treatment regimens.
Methods
We studied a cohort of patients with HBeAgnegative/positive compensated CHB treated with
peginterferonum alpha 2a - 15 patients (3 epositive/ 12 e-negative) - group A, tenofovir
disoproxil fumarate (TDF) - 12 patients (2 epositive/ 10 e-negative) - group B and entecavir 18 patients (2 e-positive/ 16 e-negative) - group C
for at least 12 months. Stored serum samples taken
before and at 6 and 12 months of therapy were
tested for HBsAg, HBV-DNA and HBeAg.
Results
Before treatment, group A, B and C patients had a
mean value of HBV DNA 40000 IU/mL, 45000
IU/mL and 55000 IU/mL, HBsAg 3.5, 3.4 and 3.2
log10 IU/mL respectively. Virologic remission rates
at 12 months (HBV DNA undetectable by PCR)
were 6.66% in group A, 8.33% in group B and
5.55% in group C. Compared to before treatment,
levels of HBsAg decreased by a median of 0.06,
0.30 in group A, 0.04, 0.20 in group B and 0.035,
0.15 in group C at 6 and 12 months, respectively
(p<0.0030). No patient cleared HBsAg at 12
months of therapy
Conclusions
Although this study included a small number of
subjects, the results are not very different from
those in literature. The lack of HBV clearance with
any of these monotherapies suggests that a possible
drug combination may have a higher success rate.
National Institute for Infectious Diseases "Prof.
Dr. Matei Balș", Bucharest, Romania
2
Carol Davila University of Medicine and
Pharmacy, Bucharest, Romania
Background
HBV reactivation (HBV-R) is life-threatening in
patients with hematological malignancies (HM)
under biological treatment. HBV-R commonly
occurs in patients with HBsAg positive but also in
patients with HBsAg negative, HBcAb positive
with or without HBsAb (occult HBV infectionOBI). We aimed to evaluate the prevalence, clinical
characteristics and outcome of OBI reactivation
(OBI-R) in patients undergoing biological therapy
for HM.
Methods
We performed a cross-sectional study that included
patients with HM treated with rituximab containing
chemotherapy and at least one serological marker
of HBV infection. The patients were monitored in
3th department of National Institute of Infectious
Diseases between 2007 - 2014. Serum HBsAg, anti
HBc, HBsAb, ALT and HBV-DNA (by PCR) was
measured at baseline and during reactivation.
Results
We enrolled 53 HBV-infected patients: 37 (69.8%)
males and 16 (30.2%) females, with mean age
57.92±12 years. Forty four (83%) patients were
AgHBs positive and 9/53 patients (17%) had OBI:
five cases with only anti HBc positive and four
cases with HBsAb positive with the level at
baseline less than 50 IU/mL. Most of OBI patients
were males (6 cases) and older than AgHBs
positive patients with mean age 63.33±10.21 years
versus 56.82±12.24 years. Liver fibrosis (F) was
evaluated by Fibroscan in all OBI patients. They
had moderate fibrosis F1/F2. Seven patients had
non-Hodgkin lymphoma types (NHL) and 2 cases
had chronic lymphocytic leukemia (CLL). OBI-R
was recorded in 6/9 (66.7%) cases, all with
aggressive subtype of HM and a median of 5
rituximab cycles. Five patients developed HBVrelated hepatitis with ALT median value 1235 IU/L
(259-2897). The median HBV-DNA level at
reactivation was 100.00 IU/mL (IQR= 50,552,198
IU/mL). Entecavir therapy was started once OBI-R
was observed. None of the patients experienced
21
liver-related death. In two cases HBV-DNA level
was undetectable but anti HDV-IgG was positive
and HDV-RNA detectable at very high level. They
were treated with Peginterferon alpha 2 A. Two
patients died for HM complications, 2 had HM
remission and 2 had HM relapse.
Conclusions
HM patients with rituximab containing
chemotherapy have increased risk of OBI -R. HBV
screening, including anti-HBc is mandatory and
prophylactic antiviral therapy is recommended for
anti-HBc positive patients before biological
therapy. Patients with positive anti-HBc must be
screened for HDV infection before
immunosuppressive therapy in order to promptly
diagnosed and treat HDV reactivation.
Acknowledgement
Study supported by SOP HRD financed from ESF
and RG under contract number
POSDRU/187/1.5/S/155420.
The efficacy of entecavir in chronic HBV
hepatitis – a lifelong therapy
Cristina Popescu1,2*, Alina Orfanu1,2, Anca
Leustean1,2, Raluca Dulama3, Catalin Tiliscan1,2,
Violeta Molagic1,2, Mihaela Radulescu1,2, Raluca
Mihailescu1, Daniela Munteanu1, Raluca Nastase1,
Anca Negru1,2, Remulus Catana1, Viorica Ispas1,
Liliana Ion1, Ligia Ionescu1, Victoria Arama1,2
*[email protected]
1
National Institute for Infectious Diseases "Prof.
Dr. Matei Balș", Bucharest, Romania
2
Carol Davila University of Medicine and
Pharmacy, Bucharest, Romania
3
Infectious Diseases Hospital of Ploiești, Romania
Background
The treatment of HBV hepatitis can use both
nucleoside/nucleotide analogues with high genetic
barrier (NNA) and pegylated interferon. Virological
control during lifelong therapy is the main
advantage of NNA. Objectives: To estimate the
level of virological control and also the rate of
HBsAg loss and HBeAg seroconversion during
NNA therapy.
Methods
We performed a retrospective analysis of HBV
infected patients treated with entecavir in Third
Department of Matei Balș Institute, between 2008
and 2014. The main inclusion criterion was at least
12 months of entecavir therapy.
Results
In our Department were monitored more than 1500
HBV infected patients; 213 patients received
antiviral therapy and 149 patients received NNA.
129 patients met the inclusion criteria. The
demographic characteristics were: mean age47.32, sex ratio M:F=2.2:1, mean duration of
entecavir therapy – 32 months (between 12 and 60
months). Nineteen patients had positive HBeAg
(14.84%). The rate of virological control (defined
as undetectable viral load) was 77.34%. In 3 cases
virological failure was recorded and entecavir
therapy was stopped. Of 29 patients without
virological control, 21 had viral load around low
limit of quantification (LLQ) and 5 patients had
viral load > LLQ (the maximum value was
26000IU/mL). Of 19 patients with HBe Ag
positive, in 5 cases (26.31%) anti-HBe
seroconversion was obtained, after a mean period
of 36.4 months. The mean duration until viral load
was undetectable was 10.9 months. Of 29 patients
with detectable viral load, 12 received 12 months
of entecavir, 3 received 18 months of entecavir and
14 received more than 18 months of entecavir (one
patient had positive viral load after 60 months of
therapy). The value of initial viral load ranged
between 2400 IU/mL and 4 billion IU/mL, with a
mean value of 143862320 IU/mL. Only one patient
registered HBsAg loss, without anti-HBs
seroconversion (0.77%).
Conclusions
Entecavir had a good efficacy in patients with
chronic HBV hepatitis, even in patients with very
high viral load. The rate of virological control
during NNA therapy is almost 80% but lifelong
therapy is necessary.
The need for interferon-free treatments in
chronic hepatitis C
Laura Iliescu1*, Letitia Toma1, Bogdana Ioana
Pulhac1, Monica Berechet1, Alina Tanase1, Carmen
Orban1
*[email protected]
1
Fundeni Clinical Institute, Bucharest, Romania
Background
Chronic HCV infection is a major health issue
worldwide, with a severe impact both on patients
and national healthcare funds. Recent treatments
have shown excellent sustained virologic response
(SVR) rates; in a limited resources setting,
however, access to new therapies is almost
impossible and patients treated with standard
double therapy (peg- interferonum and ribavirin)
who do not achieve SVR are left with no
alternative. We aim to study the characteristics of
patients with genotype 1 chronic HVC hepatitis in
22
whom double therapy did not prove to be curative
and who should have access to newer treatments.
Methods
This is a retrospective observational study
including 620 patients with chronic HCV hepatitis
undergoing treatment with peg-interferonum and
ribavirin, admitted to our clinic from April 2013 to
October 2014. Patients are classified as responders,
relapsers and non responders according to the
guidelines. We present the characteristics of the
relapsers and nonresponders at the end of the
antiviral therapy.
Results
Out of the 620 patients, 56.46% were
nonresponders, 33.87% were relapsers and 9.67%
achieved SVR (the control group). Out of the
nonresponders, 75.36% stopped treatment after 12
weeks. The mean age in the cohort was 51.20
years. 56.45% of the patients were women. The
mean age of patients with SVR, nonresponse and
relapse was 41.66, 51.62 and 53.23 years,
respectively; the patients with SVR were
statistically younger than patients without SVR.
Mean ALT levels were significantly higher in
patients with relapse (102.52 IU/mL) compared to
nonresponders (62.4 IU/mL) and responders (38.41
IU/mL). Liver stiffness measured by Fibroscan also
differs between groups: nonresponders had a higher
degree of fibrosis (85.71% patients with F3-F4)
compared to relapsers (66.66% with F3-F4); only
33.33% of the patients with SVR had F3 fibrosis;
none had F4. There was no significant difference
between HCV-RNA levels after the treatment in
patients with relapse versus nonresponders.
Conclusions
The need for interferon free regimens does not
apply only to patients with F4 liver fibrosis, but
also to patients who fail to obtain SVR with the
current double therapy. In the end, we must
remember that cost reduction involves stopping the
progression of this disease to cirrhosis and liver
cancer and not limiting access to effective
treatments.
Tolerability and efficacy of 3-DAA regimens
with and without ribavirin in the treatment of
chronic hepatitis C in real-life settings
Anca Streinu-Cercel1,2*, Oana Săndulescu1,2,
Daniela Manolache2, Monica Andreea Stoica2,
Gabriela Ceapraga2, Liliana Lucia Preoțescu1,2,
Cătălina Udroiu2, Adrian Streinu-Cercel1,2
*[email protected]
1
Carol Davila University of Medicine and
Pharmacy, Bucharest, Romania
2
National Institute for Infectious Diseases "Prof.
Dr. Matei Balș", Bucharest, Romania
Background
The advent of highly-effective interferon-free
treatment options for chronic hepatitis C virus
(HCV) infection has redesigned the way we
manage hepatitis C. Given that data from
randomized-controlled trials are representative for
‘ideal’ settings and subjects, it is increasingly
important to transfer this information in the clinic
and to compare it with data from real-life settings.
Methods
Since September 2014 we have screened 41
subjects with chronic hepatitis C. We have treated
treated 40 of them with the 3-DAA regimen
(AbbVie, North Chicago, IL, USA) with and
without ribavirin in a compassionate study
approved by the Romanian National Agency for
Medicines and Medical Devices.
Results
The study group included 23 male (56.1%) and 18
female subjects. The distribution of IL28B
genotype was 25.9% CC, and equal proportions
(37%) CT and TT. Most (70.3%) of the subjects
had been nonresponders to prior therapy. The
median (IQR) baseline HCV viral load was
1134683 (2789067) IU/mL. At the end of
treatment, of the 16 subjects who completed
treatment to date, 12 had undetectable viral loads,
and 4 had viral loads below the lower limit of
quantitation (<12 IU/mL). However, at 12 weeks
post-treatment follow-up, all 16 subjects had
undetectable HCV viral load and were considered
cured. The mean and standard deviation of liver
stiffness as determined by shear waves
elastography were 11.6±5.3 kPa at baseline,
11.3±4.6 kPa at the end of 12 weeks of treatment,
and 10.2±4.3 kPa at 12 weeks of post-treatment
follow-up. The decrease in liver stiffness from end
of treatment to 12 weeks post-treatment was
statistically significant (p=0.030) with a small-tomoderate effect size (d=0.4337). Treatment
tolerability was good, with mild lymphopenia (16
cases, 40%), mild ribavirin-associated anemia (1
case), insomnia (2 cases), hyperglycemia (7 cases),
acute angiocholitis (1 case), pruritic rash (1 case),
intermittent headache (1 case), asymptomatic
overdose (1 case), attention issues (1 case).
Conclusions
The 3-DAA regimen displayed high effectiveness
and good tolerability in real-life settings.
Acknowledgement
AbbVie provided the 3-DAA regimen in a
compassionate study approved by the Romanian
National Agency for Medicines and Medical
Devices.
23
Characteristics of children respiratory viral
infections
Community-acquired sepsis – etiological,
therapeutical and outcome features
Constanta Angelica Visan1*, Anca Cristina
Draganescu1, Camelia Kouris1, Anuta Bilasco1,
Cristina Negulescu1, Magdalena Vasile1, Madalina
Merisescu1,2, Sabina Schiopu1, Endis Osman1,
Daniela Pitigoi1,2, Monica Luminos1,2
Brindusa Tilea1,2*, Nina Sincu1,2, Simona Teches1,2,
Ioan Tilea1,3
*[email protected]
1
National Institute for Infectious Diseases "Prof.
Dr. Matei Balș", Bucharest, Romania
2
Carol Davila University of Medicine and
Pharmacy, Bucharest, Romania
Background
Identifying the etiology of respiratory infections in
children is a priority in the National Institute for
Infectious Diseases “Prof. Dr. Matei Balș”. For
achieving this objective, we use Mari POC rapid
tests, that allow testing of eight types of respiratory
viruses (Influenza A and B, Parainfluenza 1, 2 and
3, Adenovirus, Metapneumovirus, Respiratory
Syncytial Virus) and the presence of Streptococcus
pneumoniae. Objectives: Establishing the etiology
of viral infections in children, in order to achieve
an adequate management and superior clinical
outcomes.
Methods
We tested children aged 0-14 years admitted in our
clinic with a diagnosis of acute respiratory
infection. Nasal exudates were collected and
immediately processed by the method MariPOC;
the results are available after 2 hours.
Results
Comparative analysis of the incidence of
respiratory viruses in the past two years has shown
predominance of influenza A in the 2013-2014
season, unlike the 2014-2015 season, when
influenza B was found in greater proportion. In
significant proportion were present respiratory
syncytial virus and metapneumovirus, which made
it possible to identify specific particularities. We
performed analysis of viral co-infections cases and
highlighted the importance of the presence of S.
pneumoniae.
Conclusions
MariPOC method represents a particularly useful
tool for the management of respiratory viral
infections in children, as it allows: etiological
diagnosis established within 2 hours, triage and
isolation of patients based on epidemiological
criteria, timely administration of antiviral therapy,
the study of the incidence and clinical
characteristics of the various respiratory viruses
affecting children in winter.
*[email protected]
1
University of Medicine and Pharmacy Tîrgu
Mureș, Romania
2
Clinical County Hospital Mureș, Romania
3
Emergency Clinical County Hospital Tîrgu Mureș,
Romania
Background
Systemic bacterial infections are major causes of
morbidity and mortality worldwide and of
admission to infectious disease and intensive care
units. This study evaluates the prevalence, etiology,
therapy and outcome of community-acquired sepsis
in a tertiary care Romanian hospital.
Methods
A retrospective observational study on 40 patients
with sepsis admitted in an infectious disease
department over a period of one year was
conducted. The incidence of sepsis, severe forms,
the etiological agent, its sensibility and evolution of
cases were evaluated. Vital signs (temperature,
heart rate, respiratory rate) and laboratory values
including white blood cell (WBC) count measured
at admission were registered to define systemic
inflammatory response syndrome and organ
dysfunction. The diagnosis of sepsis was confirmed
by the clinical and biological data: systemic
inflammatory response syndrome (SIRS), Creactive protein (CRP), procalcitonin (PCT),
dysfunctions of coagulation. In order to identify the
causative organism(s) at least two sets of blood
cultures were obtained and an automated microbial
detection system BacT/ALERT® system
(BioMerieux, USA) was used. Antibiotic
susceptibility testing was performed by disc
diffusion method. Empiric antimicrobial regimen
was initially initiated, afterwards adjusted
according to the stain’s susceptibility profile and
was reassessed daily. Other specific actions
(intravenous fluids, vasopressors, steroids,
respiratory support), were also performed.
Results
Majority of the cases were over 50 years old (85%)
compared with the rest of them less than 50 years
old (15%). Most of the patients were represented
by men (85%) compared with women (15%). The
underlying disease was: respiratory (47% of cases),
urinary (19% of cases), vascular (9% of cases), and
cutaneous (8% of cases), digestive and dental (3%
of cases) and unknown (8% of cases). The
pathogens agents were: Gram positive cocci
(52.5%), Gram negative bacilli (20%), Gram
24
negative cocci (5%), fungus (2.05%). 11 patients
(27.5% of all cases) with multiple co-morbidities
had an unfavorable evolution of sepsis, which
developed septic shock and multiple organ
dysfunction syndrome (MODS) and then multiple
system failure syndrome (MSOF).
Conclusions
Sepsis and septic shock were more frequent in
patients over 50 years old. In the sepsis etiology a
higher incidence of Gram positive cocci compared
with Gram negative bacilli was noticed. Several
independent factors (advanced age, infection with a
resistant organism and impaired host immune
status) were associated with both higher mortality
and resource utilization.
Pseudomonas aeruginosa strains collected from
a Romanian infectious diseases ward –
susceptibility profile and impact of
bacteriophages on adherence and biofilm
formation
Alina Cristina Neguț1,2*, Oana Săndulescu1,2, Anca
Streinu-Cercel1,2, Ioana Berciu1,2, Olga Dorobăț2,
Magdalena Lorena Andrei2, Veronica Ilie2, Dana
Mărculescu2, Mircea Ioan Popa1, Adrian StreinuCercel1,2
*[email protected]
1
Carol Davila University of Medicine and
Pharmacy, Bucharest, Romania
2
National Institute for Infectious Diseases "Prof.
Dr. Matei Balș", Bucharest, Romania
Background
Evaluated by the Centers for Disease Control and
Prevention (CDC) as SERIOUS on the threat level,
Pseudomonas aeruginosa infections become more
difficult to treat because of multidrug-resistance
[1]. CDC reports that 13% of healthcare-associated
P. aeruginosa infections are caused by multidrugresistant strains [2].
Methods
Between February 2014 and February 2015, we
collected data from 21 patients with P. aeruginosa
infections from the Adults II ward of the National
Institute for Infectious Diseases “Prof. Dr. Matei
Balș”, Romania. Following the protocol presented
in Neguț et al., GERMS 2014 [3], we assessed the
impact of Georgian phages in terms of
susceptibility and influence of binary phage
dilutions on adherence and biofilm formation.
Results
The study group had a 2:1 male:female ratio; the
most frequent sites of infections were urine and
skin (9/21 each). Antibiotic susceptibility was low,
33.3% for piperacillin, 35.3% piperacillintazobactam, 41.2% ceftazidime and 18.8%
meropenem, but 100% for colistin. Susceptibility to
phages was 57.1% for PYO and 52.4% for
INTESTI, with non-susceptibility to PHAGYO and
PHAGESTI. For 9 strains we performed the PYO
and INTESTI assays. All strains formed biofilm.
Surprisingly, only three of the strains displayed
higher biofilm optical densities compared to ATCC
27853 (Schroeter) Migula, while the other 6 strains
recorded lower optical densities. The highest
concentration of phages (1/2 dilution) inhibited
biofilm formation for 6 strains in the INTESTI
experiment (p=0.110) and 3 strains in the PYO
experiment (p=0.050). The lowest concentration of
phages had no statistically significant influence in
both experiments (p=0.110, p=0.326).
Conclusions
PYO and INTESTI phages appeared to influence
bacterial adherence to a certain extent but because
of the small sample number the results were not
statistically significant. To address this issue, we
will increase the number of strains tested. The pilot
data reported here show that P. aeruginosa has a
capacity for developing strong biofilm and that
susceptibility to phages is higher compared to most
antibiotics, suggesting the role of potential synergic
co-administration in hard to treat infections.
Acknowledgements
1. POSDRU/159/1.5/S/141531
2. Carol Davila University of Medicine and
Pharmacy, Young Researchers Grant, no
28341/2013
References
1. Streinu-Cercel A. Colistin in the management of
severe infections with multidrug resistant Gramnegative bacilli. Germs 2014,4:7-8.
2. CDC. Pseudomonas aeruginosa in Healthcare
Settings. Available at:
http://www.cdc.gov/hai/organisms/pseudomonas.ht
ml Accessed: 25 Jul 2015.
3. Neguț AC, Săndulescu O, Popa M, et al.
Experimental approach for bacteriophage
susceptibility testing of planktonic and sessile
bacterial populations - Study protocol. Germs
2014.4:92-6.
Evidence-based management of staphylococcal
infections
Oana Săndulescu1,2*, Coralia Bleotu3,4, Ioana
Mădălina Aldea3, Anca Streinu-Cercel1,2, Mariana
Carmen Chifiriuc4,5, Alexandru Rafila1,2, Daniela
Tălăpan1,2, Olga Dorobăț2, Alina Cristina Neguț1,2,
Ioana Berciu1,2, Adrian Streinu-Cercel1,2
*[email protected]
25
1
Carol Davila University of Medicine and
Pharmacy, Bucharest, Romania
2
National Institute for Infectious Diseases "Prof.
Dr. Matei Balș", Bucharest, Romania
3
Ștefan S. Nicolau Institute of Virology, Romanian
Academy, Bucharest, Romania
4
Faculty of Biology, University of Bucharest,
Romania
5
Research Institute of the University of BucharestICUB, Life, Environment and Earth Sciences,
Bucharest, Romania
Background
Staphylococcal infections are responsible for
important morbidity and disability, particularly
when associated with chronic wounds or
implantation of medical prostheses. We have
performed a study to determine the key
characteristics of staphylococcal species that drive
cyto-adherence and biofilm formation.
Methods
We have created a mathematical matrix for
predicting cyto-adherence and biofilm formation in
Staphylococcus spp. Cyto-adherence on HEp-2 cell
lines was assessed through Cravioto's adapted
method, and biofilm formation through
Christensen’s plate method. The results were
correlated with microbiological characteristics and
microscopic findings.
Results
Staphylococcal strains with high cyto-adherence
index (above 80%) have a 17-fold higher chance of
internalization (p=0.001), a 5-fold higher chance of
tetrad assembly (p=0.001) and of being resistant to
methicillin (p=0.010), and an 18-fold higher chance
of being susceptible to fosfomycin (p=0.004).
We have identified 3 key characteristics of
staphylococcal species that drive cyto-adherence
(p=0.000) and are inversely correlated with biofilm
formation (p=0.000): tetrad assembly, aggregative
adherence pattern and methicillin resistance. By
computing these parameters into a mathematical
matrix, we have generated an aggressiveness score
useful in the clinical management of
staphylococcal infections. A score of 0 indicates a
methicillin-susceptible strain. A score of 1 indicates
low cyto-adherence (57%) but high biofilm
formation (96%), a score of 2 is intermediate for
both parameters, and a score of 3 indicates high
cyto-adherence (90%) coupled with low biofilm
formation (65%).
Conclusions
The evidence-based management of staphylococcal
infections is facilitated by the clinical
implementation of this bench-to-bedside algorithm
that can predict cyto-adherence, biofilm and
internalization by computing easily-determined
strain characteristics such as tetrad assembly,
adherence pattern and methicillin susceptibility.
Acknowledgement This paper is partially
supported by the Sectoral Operational Programme
Human Resources Development (SOP HRD),
financed from the European Social Fund and by the
Romanian Government under the contract number
POSDRU/159/1.5/S/137390.
Antimicrobial susceptibility of E.coli isolated
from urinary tract and blood stream infections
and predictive factors for multidrug resistance
Roxana Petre1, Adriana Hristea2,3*, Raluca Elena
Jipa2, Andreea Serbu3, Anca F. Mocanu3, Alexandru
Rafila2,3, Daniela Talapan2, Oana Săndulescu2,3
*[email protected]
1
National Institute of Aeronautical and Space
Medicine “Gen. Dr. Aviator Victor Anastasiu”,
Bucharest, Romania
2
National Institute for Infectious Diseases "Prof.
Dr. Matei Balș", Bucharest, Romania
3
Carol Davila University of Medicine and
Pharmacy, Bucharest, Romania
Background
Bloodstream infections (BSI) and urinary tract
infections (UTI) are important causes of morbidity
and mortality in patients with healthcare-associated
infections (HCA), but also in patients with
community-acquired (CA) infections. Objectives:
(1) To describe the resistance patterns of E.coli
isolated from UTI and BSI and (2) to identify
characteristics associated with multidrug-resistance
(MDR).
Methods
We performed a study on E.coli strains isolated
from urine and blood from patients admitted to our
facility between July 2014 - June 2015. We
included patients for which clinical and
epidemiological data were available. MDR was
defined as resistance to three or more classes of
antimicrobial agents. We divided infections in CA
and HCA, where HCA infections included
significant recent (three months) healthcare
contact/procedures.
Results
We identified 91 patients with UTI (30% with
complicated UTI) and 54 with BSI. Patients with
UTI had a median age of 61 (IQR 45-73) years and
69 (76%) were female. Resistance to one, two, and
three classes of drugs was identified in 11 (12%),
19 (21%) and 32 (35%) cases, respectively. MDR
strains were isolated from HCA vs. CA infections
in 47% vs. 53% of cases (p=0.015). ESBL
26
production was identified in 20 (22%) strains.
Resistance to beta-lactams, fluoroquinolones,
aminoglycosides and sulfamethoxazole was 67%,
24%, 48% and 48% respectively. Patients with BSI
had a median age of 62 (IQR 52-77) years and 29
(54%) were female. The source of BSI included the
urinary tract in 31 (57%), gastrointestinal tract 6
(11%), respiratory tract 6 (11%), skin and soft
tissue 1 (2%) and unknown 10 (19%) patients.
Resistance to one, two, and three classes of drugs
was identified in 11 (20%), 11 (20%) and 16 (30%)
cases, respectively. MDR strains were isolated from
HCA vs. CA infections in 75% vs. 25% of cases.
(p=0.006) ESBL production was identified in 14
(26%) strains. Resistance to beta-lactams,
fluoroquinolones, aminoglycosides and
sulfamethoxazole was 67% 28%, 19% and 46%
respectively. We did not identify carbapenem
resistance. Prior hospitalization, recent urinary tract
infection and antimicrobials use were associated
with MDR both from UTI and BSI (p<0.005 for all
variables).
Conclusions
Antimicrobial susceptibility was similar for UTI
and BSI, except for aminoglycosides resistance,
which was higher in UTI. MDR was more frequent
in HCA than in CA BSI infections.
Acknowledgement
Carol Davila University of Medicine and Pharmacy
Young Researchers Grant 28.336/04.11.2013.
The diagnostic role of procalcitonin in acute Q
fever
Cristina Popescu1,2*, Alina Lobodan1,2, Anca
Leustean1, Raluca Dulama3, Anca Negru1,2,
Mihaela Radulescu1,2, Catalin Tiliscan1,2, Violeta
Molagic1, Irina Duport1, Alina Vornicu1, Cristina
Covaliov1, Roxana Gnaticov1, Ioan Diaconu1,
Gabriel-Adrian Popescu1, Stefan-Sorin Arama1,2,
Victoria Arama1,2
*[email protected]
1
National Institute for Infectious Diseases "Prof.
Dr. Matei Balș", Bucharest, Romania
2
Carol Davila University of Medicine and
Pharmacy, Bucharest, Romania
3
Ploiești Infectious Diseases Hospital, Romania
Background
Procalcitonin (PCT) is a marker which can
differentiate between infectious and non-infectious
SIRS. In sepsis caused by atypical bacteria, PCT is
often negative. In many cases of Q fever the only
sign is fever and sometimes the diagnosis is
difficult. Objectives: 1. to analyze the sensitivity
(Sn), specificity (Sp), negative predictive value
(NPV) and positive predictive value (PPV) of PCT
in Coxiella burnetii sepsis; 2. to establish which
conditions are associated with positive PCT in Q
fever.
Methods
Retrospective analysis of patients diagnosed with Q
fever between 2011 and 2014 in Matei Bals
Institute. The patients were divided into two
groups: group 1 with positive PCT and group 2
with negative PCT. We compared the two groups
for several clinical and biological parameters.
Results
From 89 patients with Q fever, PCT was measured
in 75 patients: in 14 patients PCT was positive and
in 61 was negative. The mean age was 50.05 years
(55.6 years in group 1 and 48.7 in group 2) and sex
ratio was M:F=1.58:1 (1.8:1 in group 1 and 1.54:1
in group 2). Sepsis criteria were met in 49 patients
(65.3%) - 27 with two SIRS criteria, 27 with 3
SIRS criteria and 5 with 4 SIRS criteria. SIRS
criteria were: fever – all the patients, tachycardia –
56 patients, polypnea -11 patients and leukocytosis
– 27 patients. Q fever involved one organ in 25
patients, 2 organs in 49 patients and 3 organs in one
patient. Q fever was manifested as: pneumonia in
63 patients, hepatitis in 56 patients and carditis in 6
patients. Statistical parameters of PCT for Coxiella
sepsis were calculated: Sp – 93.8%, Sb-26.5%,
NPV-29.4% and PPV-92.9%. The comparative
analysis between PCT positive and PCT negative
groups of patients showed which data are
associated with positive PCT: leukocytosis
>12000/cmm – p=0.0003, heart rate >90/min –
p=0.08, more than 3 SIRS criteria – p=0.0003 and
liver involvement in Q fever – p=0.036.
Conclusions
1. Although PCT is very specific for Q fever sepsis,
the sensitivity is very low (around 25%). 2. PCT
might be positive in Coxiella sepsis if the patient
has leukocytosis, hepatitis, tachycardia and more
than 3 SIRS criteria.
Acknowledgement
This paper is supported by the Sectoral Operational
Programme Human Resources Development (SOP
HRD), financed from the European Social Fund
and by the Romanian Government under the
contract number POSDRU/187/1.5/S/155420.
Retrospective validation of two scoring systems
for tuberculous meningitis in adults
Adriana Hristea1,2*, Roxana Petre3, Eliza Manea1,
Serban Benea1,2, Ruxandra Moroti1,2, Irina Panait1,
Gabriel Gaciu1, Raluca Elena Jipa1
*[email protected]
27
1
National Institute for Infectious Diseases "Prof.
Dr. Matei Balș", Bucharest, Romania
2
Carol Davila University of Medicine and
Pharmacy, Bucharest, Romania
3
National Institute of Aeronautical and Space
Medicine “Gen. Dr. Aviator Victor Anastasiu”,
Bucharest, Romania
Background
The delay in diagnosis and treatment is associated
with increased mortality in tuberculous meningitis
(TBM) Objective: retrospective validation of a
diagnostic score previously published (Hristea et al
Int J Tuberc Lung Dis, 2012), based on four
variables: duration of symptoms before admission
of ⩾5 days, presence of neurological impairment
(altered consciousness, seizures, mild focal signs,
multiple cranial nerve palsies, dense hemiplegia or
paraparesis), CSF /blood glucose ratio <0.5 and
CSF protein level >100 mg/dl against a consensus
definition and a scoring system comprising six
clinical criteria, five CSF criteria, five cerebral
imaging criteria and evidence of tuberculosis
elsewhere (Marais et al. Lancet Infect Dis 2010).
Methods
We retrospectively studied patients admitted to our
hospital between January 2012 and June 2015 with
TBM. Patients were classified according to the
consensus definition and scoring system published
by Marais, with points given for variables that were
present on admission. Patients were classified as
having probable TBM if they scored at least 10/12
points with/without cerebral imaging results, and
possible TBM if they had a diagnostic score of 6–9
when cerebral imaging is available, or 6–11 points
without cerebral imaging. According to the
simplified diagnostic score the probability of TBM
in a given patient ranged from 98% (95%CI 94–
100) when all four variables were present to 0%
when all variables were absent, ruling out TBM.
The cut-off for TMB was ≥ 6 points.
Results
Thirty-eight patients with TBM were identified,
median age of 29 years (24–39 years); 14 (37%)
were HIV-infected. Twenty-four (63%) patients had
microbiologically confirmed TBM with a positive
CSF culture for M. tuberculosis (11 patients),
positive commercial nucleic acid amplification test
(5 patients), or both tests positive (8 patients).
Thirty-six (95%) patients had CNS imaging
investigation. Hydrocephalus was present in 9/36
(25%), tuberculoma in 7/36 (19%) and vasculitis in
6/36 (17%) patients. Duration of symptoms before
admission of ⩾5 days was noted in 37 (97%);
presence of neurological impairment in 28 (74%);
CSF /blood glucose ratio <0.5 in 31 (82%); CSF
protein level >100 mg/dL in 32 (84%) patients.
Twenty (52.6%) patients with TBM would have
been classified as having probable and 18 (47.4%)
possible TBM according to the Marais scoring
system. The simplified diagnostic score based on
the four variables confirmed 35/38 (92%) cases,
95.8% of microbiologically documented and 85.7%
of probable/possible TBM cases.
Conclusions
A diagnostic score suitable for resource-limited and
high tuberculosis prevalence settings is a valuable
tool in clinical practice.
Assessing the fibrosis stage is still a crucial step
in the era of powerful drugs for HCV and HBV
Mona Munteanu1*
1
Noninvasive Diagnosis Unit, BioPredictive, PitiéSalpêtrière Hospital, Paris, France
*[email protected]
Thanks to non-invasive blood diagnosis panels
such as FibroMax and elastography, the entire
perception of the disease has been transformed in
such a way that the patient will get within 20
minutes the exact status of the illness, prognostic
information and predictability of treatment
response.
Despite efficient drugs with high rates of viral cure
(HCV) or viral suppression (HBV) lead to the
improvement of long-term prognosis of patients,
non-invasive evaluation of fibrosis remains
important for staging fibrosis and cirrhosis is still
an independent negative predictor for the response
rates.
HCV chronically infected patients with cirrhosis
had lower response rates to some second and even
third generation DAA containing therapy [1].
Sensitive biomarkers such as FibroTest-FibroMax
are extremely useful in cured HCV patients for
tracking the remaining risk of primary liver cancer
estimated to be about 5% at 10 years after HCV
sustained viral response, patients that are supposed
to not regress fibrosis. [2]. The presence of two or
more metabolic factors is a strong risk predictor of
non-regression of fibrosis after SVR. Biomarkers
such as FibroMax demonstrated to be an efficient
strategy for screening and prognosis in NAFLD –
risk subjects [3] and some of the HCV cured
patients have a metabolic profile continuing to
present an important risk of development of
fibrosis despite viral cure.
In HBV carriers, despite effective virus suppression
under NUC, the overall incidence of cirrhosis
increased, with a remaining 5.8% risk of HCC.
Predetermined cutoffs of FibroTest-ActiTest are
28
used to rank the severity of chronic hepatitis B
from inactive carrier status to three stages in
cirrhotics (F4.1-not decompensated, F4.2 –varices
not decompensated and F4.3-decompensated) but
also to follow-up fibrosis under analogues. 93% of
HBV carriers that developed HCC under efficient
viral suppression had fibrosis-progression during
repeated evaluation using FibroTest. [4]
Overall, clinicians have to continue to estimate
fibrosis dynamic despite viral cure (HCV) or viral
control (HBV), as fibrosis can progress in more
than 10% of patients.
References
1. JAMA 2014; 2. J Hepatol 2014; 3. Aliment
Pharm Ther 2014; 4. J Hepatol 2014.
29
Poster presentations
Epidemiological considerations on HIV in
Constanţa county. Aspects of geographical
distribution on HIV AIDS cases in territory.
Elements of the HIV AIDS infections
management with impact on environment
Iulia Gabriela Şerban1*, Sorin Rugină1,2
*[email protected]
Clinical Infectious Diseases Hospital of Constanța,
Romania
2
Faculty of Medicine, “Ovidius” University,
Constanța, Romania
1
Background
The theme chosen is representative of current
progress, expressing general public health services
in Romania, especially regarding HIV-AIDS
healthcare insurance, the specific elements of
management epidemiological HIV AIDS impact on
the environment. The main objective - We have
proposed organizing an existing case law database,
to elucidate the epidemiological process.
Methods
I followed the period 1987-30 June 2013,
highlighting some aspects of the geographical
distribution of HIV AIDS cases in the county of
Constanta.
Results
A database recorded in the period 1987 - 1993 was
analyzed. There were studied early 1728 AIDS HIV
cases detected in Constanta. The vast majority of
the population cohort came from public care and
pediatric wards, dystrophy centers, premature
infant surgery ward of Constanta County Hospital.
To these were added detected and diagnosed
children in other parts of the country (especially in
the west), sent to be supervised in various
international partnership programs. In 1990 a total
of 406 AIDS patients were reported, of which
73.153% of urban (N = 297) and 26.847% of rural
(N = 109). Of these, 35.961% from Constanta (N =
146 - urban hospital).
Conclusions
It has been required the role of epidemiologist - the
clinician community! Epidemiologic and
environmental management of Blood Transfusion
Unit. It has been required the environmental
specialist role (biology, engineering) in a hospital
for infectious diseases (fundamental role of
environmental science). The role of the
multidisciplinary team (biochemist, biologist,
epidemiology, infectious disease specialist,
hygienist, and psychologist, specialist in
environmental ethics and medical ethics, engineer)
is relevant. It highlighted the importance of
computer science, environmental ethics, Artificial
Intelligence, Engineering, Electrical and Electronic
Environmental Sciences, Epidemiological
Intelligence, Developmental Biology. The
importance of epidemiological monitoring RIS
(International Health Regulations) and GIS
(Geographic Information Systems) is fundamental.
Is fundamental the Environmental bioethics
education (fundamental civilizing factor, located at
the intersection of realistic sciences and
humanities), in compliance with best practice,
guides Bioethics Environmental, procedures,
ethical clinical principles and is important to
continue the education on environmental thematic,
ethical training, according with special literature.
Establishment of databases: valuable
epidemiological data on the environmental impact
(transmission, non healthy behaviors, iatrogenic)
The need to develop ethical behavior in
contemporary modern “transition” society (sexual
behavior – men having sex with men, heterosexual,
drug users, the MTCT - maternal fetal
transmission, environmental hygiene: beaches, road
and rail station transportation, social activities,
ethological changes).
Epidemiological elements on management of
nosocomial infections and hand hygiene in
Infectious Diseases Hospital from Constanta,
Romania. The nosocomial infections reported in
HIV AIDS department.
Iulia Gabriela Serban1*, Mărioara Neacşu1
*[email protected]
Clinical Infectious Diseases Hospital of Constanța,
Romania
1
Background
Nosocomial infections (NI) remain a cause of
disease worldwide. Motivation - The need to
monitor the emergence, development and evolution
of NI in the hospital environment. Raising the
psychological impact of NI in HIV AIDS
Compartment. Originality of the study - a
descriptive presentation made in the registers and
studied observation sheets was ordered into a
valuable loco-regional data base. The general
period is 2003 - 2015, focusing on the interval 2011
30
– July 2015. This paper aims to present some
epidemiological considerations on NI, based on a
complex retrospective epidemiological
investigations. Objectives - Reporting the NI from
Infectious Diseases Hospital, Constanţa Epidemiological elements on General Management
of the Hand Hygiene.
Methods
We performed an epidemiological analysis in the
reports on period 2003 – July 2015. We studied the
patient observation charts and NI from registries. We analyzed the use of soap and water-alcohol
solution.
Results
Graphical presentation of risk areas in hospital High-turnover of patients - graphics focused on
discharges of the patients, period 2011 - 2014 Graphical Communication, period 2003 - 2015 The duration of hospitalization and treatment,
period 2003 - 2015 - Analysis of nosocomial
infections by type of germs and frequency, period
2011 - 2015 - Examples - Nosocomial infections in
HIV AIDS Department - Epidemiological elements
on hand hygiene in Infectious Diseases Hospital,
Constanţa - Number of communications, internal
notes on the NI theme, addressed to hospital
departments, 2011 - 2014 - The number of
epidemiological surveys performed between 2012 –
2014. The low incidence of NI, compared to
international studies, means possible
underreporting in hospital, but best practical care
and close monitoring.
Conclusions
NI are an important cause of morbidity and
mortality and increase the cost of medical care. The
Plan for preventing the NI and for medical staff
training is designed to stimulate awareness of the
importance and timeliness of the topic, supervision,
monitoring and evaluation of the NI. The SPCIN
Nucleus – fundamental role in surveillance,
prevention and control of nosocomial infections.
Through the development of the complex
epidemiological system, active surveillance and
control of the NI, through infectious therapy,
psycho-sociological counseling and motivation of
the adherence, focused on HIV-AIDS, Romania in
general and Constanţa in particularly, is an
European model and beyond.
Elements of epidemiological surveillance
focused on Clostridium difficile infections in the
Infectious Diseases Clinical Hospital, Constanta,
period 25 June 2014 – 25 March 2015
Iulia Gabriela Serban1*, Roxana Carmen Cernat1
*[email protected]
Clinical Infectious Diseases Hospital of Constanța,
Romania
1
Background
International, national and local importance of
Clostridium difficile infection (CDI). Theme
chosen is approaching a current difficulties of
clinical epidemiology Objectives - CDI reporting in
Hospital, for a period of 9 months.
Methods
We conducted an epidemiological analysis of the
CDI reported in period June 2014- March 2015. We
studied observation charts of each patient and CDI
books of SPCIN (Surveillance, prevention, control
of nosocomial infections).
Results
We are presenting graphics of the: - Suspected CDI
hospitalized. Distribution according to age groups,
gender (F/M), calendar month of hospitalizations,
place of origin. Seasonal and quarterly variations CDI confirmed, complicated, relapse. Contact with
another CDI case. - Previous administration of
antibiotics. Combinations of antibiotics. Number of
cures of antibiotic therapy. - History of
Immunosuppression, IPP therapy, Surgery in the
last 2 weeks
Conclusions
1. Of the total of 60 suspected CDI, there are CDI
confirmed 47 (78.33%): F(30)>B(17),
U(34)>R(13). 2. Of the total of 47 CDI confirmed
(100%) there are: - 3 (6.38%) CDI confirmed
complicated: F(2)>M(1), U(2)>R(1), with
diagnosis Septic toxic condition (3), from which 1
case with “Toxic Megacolon. Ascites” - 10
(21.27%) are CDI with relapse: M(7)>F(3),
U(7)>R(3). - 46 (97.87%) are cases CDI
hospitalized in the last year: F(30)>M(16),
U(33)>R(13). - 18 (38.30%) are CDI confirmed
who performed treatment with IPP. - 4 (8.51%) are
CDI confirmed by colonoscopy with
pseudomembranous colitic aspects: F(2)=M(2),
U(3)>R(1) – accessibility of urban! 3. Of the total
of 46 CDI confirmed hospitalized in the last year,
according to the criterion “Last discharge”: under 4
weeks (40 - 86.95%)> 4 – 12 weeks (4 - 8.69%) >
over 12 weeks (2 - 4.05%) 4. CDI confirmed –
history of: Surgery in the last 2 weeks (2) Contact
with another CDI case (3). Immunosuppression - 1
case: M – U, HIV.Total – 6 cases - 12.76% of the
total of 47 CDI confirmed. 5. Hospitals where
patients CDI confirmed were hospitalized are
different (County Hospital - 19 F – 63%, 11 M –
37%). 6. Previous antibiotic therapy: 1 antibiotic
was used in 11 (23.40%) cases and combination of
antibiotics in 36 (76.60%) cases. In 30 (63.82%)
cases there have been multiple courses. The
necessity of monitoring the risk factors in the case
of CDI.
31
Epidemiological elements focused on
management of Clostridium difficile infections in
Clinical Hospital of Infectious Diseases,
Constanța, period 25 June 2014 – 25 June 2015
Iulia Gabriela Serban1*, Andra Elena Petcu1
*[email protected]
Clinical Infectious Diseases Hospital of Constanța,
Romania
1
Background
Approached theme is important for accurate
epidemiological management elements of the
Clostridium difficile infections (CDI), within health
service in Romania, is relevant to the organization,
operation and development of health services
systems Argument - Mode of knowledge selforganization, opportunity to build new
understanding, analysis and epidemiological
interpretation Methodological training opportunity,
argument, issuing suggestions, practical proposals,
elaboration developing strategies of perspective
now is a professional context of personal interest.
Epidemiological measures to limit local epidemic
evolution. Objectives - Reporting the CDI from 1
year period (25 June 2014 - 25 June 2015) in the
Infectious Diseases Clinical Hospital, Constanta. Updating database.
Methods
We reviewed the CDI documentation of one year.
Results
There are 88 cases suspected CDI hospitalized distribution according to gender (50F –
56,81%/38M – 43,18%), from which 66 (75%)
CDI confirmed. There are 3 CDI confirmed with
complications, 14 CDI relapses, 60 cases with
admission in hospital in the last year. Previous
administration of antibiotics in the last 3 months in
64 situations. 1 case with just one antibiotic, 46
cases with combinations of antibiotics. Number of
cures of antibiotic therapy was different (1 cure /
26 cases, 2 cures / 14 cases, 3 cures / 16 cases, 4
cures / 8 cases). History of cytostatin therapy in 3
situations, Proton pump inhibitors treatment in 20
cases. CDI confirmed by colonoscopy with
pseudomembranous colitis aspect in 5 cases.
Conclusions
Considered the model of care in every hospital. We
do not move the patient, we move us around.
Prevention - restriction of antibiotic use. Wash
hands (no alcoholic gel) with liquid soap and water,
gloves, probiotics (Bifidolactobacillus,
Saccharomyces) Limiting the development of CDI
- national guide, public education, limitation the
interpersonal transmission. Multi Interventional
Strategy - Epidemiological measures of hospital
control - individual room, patients group, dedicated
staff, contact isolation, disinfection – continuous,
terminal, rescue vehicles - request buttons, linens,
beds, tables, telephones, walls. Disinfection, with
correct dilution: detergent disinfectant - quaternary
ammonium salts, chlorine disinfection - sodium
hypochlorite 10% surfaces, and terminal
disinfection - peracetic acid, hydrogen peroxide.
Perioperative prophylaxis 24 hours (one dose 30-60
minutes before) Programs of good practice in the
field of antibiotics use in the hospital. Antibiotic
Guide updated with data from Romania. Isolation
stops after 3 days of normal stool. Microbiome
fecal transplant.
A case of tularemia glandular form in Republic
of Moldova
Ina Bistritchi1*, Liviu Iarovoi1, Tiberiu Holban1,
Lilia Cojuhari2
*[email protected]
1
Department of Infectious Diseases, Parasitology
and Tropical Medicine Nicolae Testemițanu State
University of Medicine and Pharmacy, Chișinău,
Republic of Moldova
2
Department of Infectious Diseases, Faculty for
Continuing Medical Education, Nicolae
Testemițanu State University of Medicine and
Pharmacy, Chișinău, Republic of Moldova
Background
Tularemia is a rare infectious pathology caused by
the bacterium Francisella tularensis, which is nonmotile. It can present different clinical forms, with
involvement of lymph nodes, lungs and other
internal organs. Glandular tularemia is also rare,
and it is clinically similar to the ulceroglandular
form, except without the development of a skin
ulcer. It is acquired through the skin, and may not
require a scratch or abrasion. In the Republic of
Moldova, cases of tularemia are rarely reported.
Thus, since 1991, only six human tularemia cases
were registered. Out of which, 4 cases were
registered in 1994, 1 case in 2009 and the 6th is
described here.
Case report
We present a case of a 48 years man hospitalized to
Clinical Infectious Disease Hospital "Toma Ciorbă"
with a diagnosis of respiratory infection. The
patient was admitted with asthenia, fever, pain on
swallowing, dry cough, myalgia, pain in the
eyeballs, left axillar lymphadenopathy. After 2 days
without fever, on antibiotic treatment with
ceftriaxone and metronidazole, the temperature
increased to 37.9°C; objective data: hyperemia of
32
throat, dry cough, persistent painless left axillar
lymphadenopathy and epidemiological data infected wound left thumb, in his household has
cattle, pigs, rabbits and sometimes he observed
rats. Local axillary bubonic description - size
approximately 1 cm x 2 cm, painless, non-stick,
soft, unilaterally on the left. Combination of this
two antibiotics was continued 7 days and
concomitant was positive ELISA test for tularemia:
IgM – 3.488 U/mL (N˂0.41 U/mL), IgG – 1.877
U/mL (N˂0.47 U/mL); blood culture was negative
and we confirmed patient with tularemia glandular
form. Patient was hospitalized for 21 days, out of
which he was treated for 7 days with ceftriaxone
and metronidazole without improving the general
condition, with persistent fever and after positive
tularemia test; treatment was continued 14 days
with ciprofloxacin and gentamicin. On the second
antibiotic combination ciprofloxacin and
gentamicin fever gradually normalized, affected
lymph node decreased in size being about 0.5 cm x
0.5 cm, other clinical signs remitted. Prolonged
evolution of the disease and prolonged
hospitalization was due to the difficulty of
diagnosis.
Conclusions
Considering that currently tularemia is a rare
disease, it is difficult to establish the diagnosis and
thus causing difficulty in determining treatment
regimens.
Severe Anemia in AIDS. Case report.
Mihai Olariu1*, Adina Ilie1, Cristina Olariu1,2,
Camelia Dobrea2,3, Didona Vasilache3, Adriana
Nurciu4
*[email protected]
1
National Institute for Infectious Diseases "Prof.
Dr. Matei Balș", Bucharest, Romania
2
Carol Davila University of Medicine and
Pharmacy, Bucharest, Romania
3
Fundeni Clinical Institute, Bucharest, Romania
4
University Emergency Hospital of Bucharest,
Romania
Background
Many times, HIV-infected patients are anemic.
Anemia is seen in 80 percent of patients at some
point in their course. Causes range from ineffective
hematopoiesis to significant hemolysis.
Case report
We present a case of a 28 year old, occasional drug
user, who was diagnosed in November 2014 with
HIV and coinfection with HBV and HCV. At that
time the patient had a normal blood count, CD4 14
cells/cmm, without inflammatory syndrome and the
viral load was 19675 copies/mL. From November
to May 2015 the patient was treated with
Lamivudine/Zidovudine and Lopinavir/r. In May
2015 blood count showed severe anemia with
macrocytosis (hemoglobin 4.8g/dL) and leukopenia
(1.4x103/µL) with neutropenia (0.864x103/µL),
CD4 11 cells/cmm, and we considered that all these
changes were due to antiviral therapy. We
administered two units of packed red blood cells
and changed antiviral therapy with
Abacavir/Lamivudine and Raltegravir. After one
month, on June 30, the patient came back with
arthralgia, tachycardia, dyspnea, pallor, with
hemoglobin 2.9g/dL, leukopenia and the marker for
hemolytic anemia was negative. We administered
three units of packed red blood cells and performed
a bone marrow biopsy. Histopathological exams
show many erythroblasts with prominent nuclear
inclusions, which are characteristic of parvovirus
B19 infection. We performed serology for
parvovirus B19. Patient was treated initially with
cortisone and then with intravenous immune
globulin and hemoglobin increased to 7.3g/dL.
Conclusions
Pure red cell aplasia in human parvovirus B19
infection have occurred in HIV-infected patients
with advanced immunosuppression. Most cases of
pure red cell aplasia have occurred prior to the
availability of potent antiretroviral therapy. We
must always search for a human parvovirus B19
infection in patients with immunodeficiency and
severe anemia.
Epidemiological management in Clinical
Infectious Diseases Hospital of Constanţa,
Romania
Iulia Gabriela Serban1*, Stela Halichidis2, Claudia
Cambrea2
*[email protected]
Clinical Infectious Diseases Hospital of Constanța,
Romania
2
Faculty of Medicine, “Ovidius” University,
Constanța, Romania
1
Background
Constanta is an important town from Romania and
“Clinical Hospital for Infectious Diseases” is one
of the most famous in S-E Europe, a reference
hospital in our region, with recent renovations and
facilities financed by the Ministry of Health, Local
Council and World Bank, which allowed assisting
patients at high standards; specialist care are made,
with a focus on epidemics, food poisoning, for the
33
tourists, especially during the summer, rabies
prophylaxis, infectious diseases treatment, tropical
imported diseases for the travelers and sailors,
Center of Excellence for HIV patients - currently:
cooperation with Baylor on HIV – AIDS, Travel
Medicine– Summer School: medical subjects about
pilgrimages, tourism, cruising and camps, general
epidemiological surveillance - influenza, digestive
diseases, West Nile... It is a certified hospital
according to Quality Management System ISO
9001 / 2008 and the epidemiologist was responsible
for quality management. It is the only accredited
hospital in the city, according to the Standards of
the National Commission for the Accreditation of
Hospitals. Laboratory quality meets national
standards. High patient turnover in the clinic.
Methods
We presented: - risk areas of the hospital,
calculated according to the scale of national
surveillance Guide on nosocomial infections. chronologically the nosocomial infections reported,
length of stay and duration of treatment. We
quantified the number of communications, internal
notes on nosocomial infections, hospital
departments addressed, in the period 2011-2014.
We showed the number of patient satisfaction
questionnaires completed between 2011 - 2013, the
number of epidemiological surveys carried out in
2012 - 2014 and epidemiological investigation with
conclusions and recommendations.
Results
There were 676 epidemiological internal
communications addressed to hospital departments
in 2012, 665 in 2013, 486 in 2014, 392 in the first 6
months of 2015. During 2014 - the mortality rate
was 0,3%, we registered one respiratory viral
nosocomial infection, were 35258 consultations
and 6919 hospitalized patients. In the first 6 months
of 2015 were 3782 hospitalized patients, 16318
consultations and 25051 days of hospitalization.
Conclusions
All insured hospitalized patients benefit of free of
charge medical investigations and treatment,
according to the hospital’s own procedures,
protocols - that respect medical standards, the
national and international practice guidelines,
improving the patient assistance for a better
evolution of the health condition.
Nephrotic syndrome in a patient with HBV
chronic hepatitis
1
Fundeni Clinical Institute, Bucharest, Romania
Background
Chronic HBV hepatitis is known to be associated to
different types of nephropathies, including
membranoproliferative glomerulopathy and IgA
nephropathy. Also, antiviral treatment (entecavir)
increases the risk of renal affections. However, a
clear diagnosis in case of renal disease associated
with chronic HBV hepatitis can be established only
by kidney biopsy.
Case report
We describe a rare case of nephrotic syndrome
caused by an association of IgA nephropathy and
Alport syndrome in a 37 years old woman with
chronic HBV infection. We underline the
importance of histopathological analysis of kidney
biopsy, crucial not only for diagnosis but for
attentive screening of family members. The patient
presented for persistent proteinuria (over
4000mg/24 hours). She had been diagnosed with
chronic HBV hepatitis in 2003, with nephrotic
syndrome at diagnosis. She had been treated with
lamivudine for 2 years, then entecavir, and
azathioprine. The nephrotic syndrome persisted,
therefore she was referred to our clinic for further
evaluation and treatment. Laboratory tests showed
no signs of liver cytolysis, DNA-HBV
undetectable, HBeAg negative, normal renal
function, proteinuria 4.2g/24 hours. Liver biopsy
performed before initiating treatment with
lamivudine revealed a Knodell score of 10moderate inflammation. We performed kidney
biopsy. Optical microscopy revealed numerous
lipid-laden foam cells (marker of Alport syndrome)
in the interstitium. Ultrastructural studies by
electron microscopy showed important changes in
the glomerular basement membrane (GMB):
alternation between increased and reduced
thickness of GMB with splitting of the lamina
densa, electrondense deposits in the mesangium.
Podocytes showed diffuse effacement of foot
processes. Immunofluorescence microscopy
showed deposits of IgA in the glomeruli. We started
pulse therapy with methylprednisolone and after
the first administration urinary protein levels
decreased to 3.9g/24 hours.
Conclusions
To our knowledge there has been no other case
report of associated HBV infection, Alport
syndrome and IgA nephropathy. Choosing the right
therapeutic approach to combine
immunosuppression and antiviral treatment is the
key of good outcome of the patient.
Letitia Toma1*, Bogdana Ioana Pulhac1, Monica
Berechet1, Laura Iliescu1
*[email protected]
34
Clinical and biochemical manifestation of the
acute C viral hepatitis in Republic of Moldova
Lilia Cojuhari1*, Victor Pantea1, Gheorghe
Placinta1, Valentin Cebotarescu1, Liviu Iarovoi2,
Viorica Cotos3
*[email protected]
cm in all patients (100%) and splenomegaly –
2.0±0.2 cm in 27 patients (45.8%).
Conclusion
Acute hepatitis C virus affects both sexes, being
more frequent in men, and is manifested through
acute onset in the icteric form, moderate form
being characterized clinically by the dyspeptic,
asthenic, and biochemical syndrome through the
ALT activity increase and bilirubin.
1
Department of Infectious Diseases, Faculty for
Continuing Medical Education, Nicolae
Testemițanu State University of Medicine and
Pharmacy, Chișinău, Republic of Moldova
2
Department of Infectious Diseases, Parasitology
and Tropical Medicine Nicolae Testemițanu State
University of Medicine and Pharmacy, Chișinău,
Republic of Moldova
3
Clinical Infectious Diseases Hospital ”Toma
Ciorbă”, Chișinău, Republic of Moldova
Background
The World Health Organization reports that 3% of
the globe’s population has had HCV infection and
that there are more than 170 million chronic
carriers at risk of liver cirrhosis and/or liver cancer.
Methods
In this study were included 59 patients with acute C
viral hepatitis who were hospitalized in the Toma
Ciorbă Clinical Infectious Diseases Hospital aged
from 45.3±0.6 years. The analysis parameters: age,
sex, clinical manifestation, liver size, disease level,
total bilirubin, ALT, prothrombin.
Results
The largest share of damage can be seen in the 3039 age range - 22 (37.3±6.3%) cases, followed by
the 40-49 age group - 19 (32.2±6.1%) cases.
Transmission pathways: after various medical
interventions (dentistry, surgery) were infected 27
(45.8±6.5%) patients, intravenous drug - 13
(22.0±5.4%) patients, about habitual - 6
(10.2±3.9%) patients, after transfusion of blood
derivatives - 3 (5.1±2.9%) patients, after tattoos - 2
(3.4±2.4%) patients. 8 (13.6±4.5%) patients of
infection pathway has not been determined. Acute
C viral hepatitis in the both sex has been observed:
women – 25 (42.4±6.4%), men – 34 (57.6±6.4%).
The disease more frequently is manifested in icteric
form in 39 (66.1%) patients, anicteric form in 20
patients (33.9%). Depending on the severity of the
disease most commonly has been average form 83.1% cases, severe form – 6.8% and mild form –
in 10.1% cases. Acute C viral hepatitis includes
asthenic, dyspeptic and althralgic syndrome.
Biochemical investigations: increased level of
bilirubin 132.1±16.01 mkmol/L, ALT constitutes
10.80±0.61 mmol/h/L and thrombinic index –
77.10±1.26%. Hepatomegaly constitutes 3.5±0.16
Varicella complicated by thrombocytopenia case report
Oana Obretin1*, Augustin Cupsa2, Maria
Marinescu1, Lucian Giubelan2
*[email protected]
“Victor Babeș” Clinical Hospital of Infectious
Diseases and Pneumology, Craiova, Romania
2
University of Medicine and Pharmacy Craiova,
Romania
1
Background
Chickenpox may be complicated by
thrombocytopenia, more common in adults than in
children; platelet count is usually above
25,000/cmm, bleeding events are rare in these
cases. The literature discusses both about
immunologic mechanisms and non-immune
mechanisms responsible for the low platelet count.
Case report
We present a male patient, 5 years old, hospitalized
in Craiova in May 21, 2015 in Infectious Diseases
Victor Babeș Hospital for fever associated with a
polymorphic exanthema elements (patches,
papules, vesicles), disseminated evolving “in
waves” 6 days before the admission. He was
diagnosed with varicella and acyclovir antiviral
treatment was started, 200mg, 4 times daily. At 3
days of treatment he developed small hematomas in
right tibia, right iliac crest and retroauricular. The
complete blood count performed revealed severe
thrombocytopenia (2000 / mm3). We decided to
transfer the patient to the Institute for Infectious
diseases “Matei Balș” in Bucharest to address the
platelet deficit. There positive IgM anti VZV were
detected, HIV ELISA test was negative and
immunoelectrophoresis and levels of complement
C3, C4 were normal. During hospitalization he
received platelet concentrate izogrup, izoRh150mL - 2 administrations, corticosteroids and
acyclovir antiviral treatment continued 800mg/day,
3 days, with favorable outcome of platelet count
and gradual remission of purpuric lesions, the
patient is discharged on 31 May.
35
As mechanisms of occurrence of
thrombocytopenia, are immune causes (chronic
autoimmune thrombocytopenia, autoimmune
thrombocytopenia associated with collagen disease,
certain drugs, post-transfusion purpura) and non
immune causes (bacterial and viral infections). In
the case of our patient immunoelectrophoresis and
levels of C3, C4 were within normal limits, which
does not tilt to an immune cause. Rapid
administration of thrombocyte, prevent the onset of
complications of thrombocytopenia
(gastrointestinal bleeding or cerebral), described in
the literature.
Conclusions
Severe thrombocytopenia associated with varicella
in children is a rare complication, but can be lifethreatening, through the possible bleeding as
cerebral bleeding, which is the most severe
complication in children. Effective collaboration
between doctors led to favorable resolution of the
case described.
A rare case of ocular filariasis with recurrent
episodes of acute anterior uveitis
Alexandra Elena Sarbu1, Sanda Popa1,2, Cristian
Bengus1, Emanuela Dumea1, Andrei Anghelie1,
Clara Matei3, Maria Isabela Sarbu4*, Mircea
Tampa3,4, Simona-Roxana Georgescu3,4
*[email protected]
1
Department of Ophthalmology, "I Care Clinic",
Bucharest, Romania
2
Department of Ophthalmology, Emergency Eye
Hospital, Bucharest, Romania
3
Department of Dermatology, "Carol Davila"
University of Medicine and Pharmacy, Bucharest,
Romania
4
Department of Dermatology, "Victor Babeș"
Hospital of Infectious Diseases, Bucharest,
Romania
Background
Intraocular filariasis is rare in humans but frequent
in animals. Zoonotic filarias are nematodes
belonging to the Filarioidea superfamily.
Dirofilaria are the most frequent nematodes
affecting humans and are transmitted by bloodfeeding arthropods. It usually manifests as larva
migrans or subcutaneous nodules and only rarely
affects the eye.
Case report
We report the case of a 56 year old female,
Caucasian patient from the urban area who
addressed our clinic for blurred vision and
conjunctival hyperemia. Her family history was
unremarkable. The disease had occurred
approximately 37 years before when the patient
presented urticarial lesions with intensely positive
patch tests for all tested antigens. After several
months she presented with blurred vision,
conjunctival hyperemia and pain in her right eye
and was diagnosed with acute anterior uveitis and
treated with antibiotics, anti-inflammatories and
mydriatic agents. She presented recurrent episodes
of uveitis in both eyes ever since. The patient
permanently moved to Costa Rica four years later
where she was diagnosed with ocular filariasis..
Peripheral blood smear examination was performed
in Costa Rica and was positive for Dirofilaria,
Strongyloides stercoralis and Toxocara canis.
Ocular examination of the right eye showed
pupillary seclusion occlusion and keratic
precipitates. Visual acuity was hand movement
perception for the right eye and 60/60 for the left
eye. Ocular ultrasound revealed no involvement of
the posterior pole. She was treated with
diethylcarbamazine, ivermectin and albendazole as
well as corticosteroids. Despite the treatment, the
patient presented yearly re-occurrences of the
disease which required high doses of prednisolone
and anti-parasitic agents.
Conclusions
Even though the disease was diagnosed in Costa
Rica, the affliction was probably acquired in
Romania as the symptoms occurred four years
before the patient departed. While very few cases
of filariasis were documented in our country so far,
the incidence of the disease is increasing in other
European countries. We therefore suggest that
ocular filariasis should be suspected in cases of
recurrent anterior uveitis of unknown etiology.
Acknowledgement
This paper is partly supported by the Sectorial
Operational Programme Human Resources
Development (SOPHRD), financed by the
European Social Fund and the Romanian
Government under the contract number POSDRU
141531.
Acute hepatic failure. Comatose chronic viral
hepatitis B. Acute viral hepatitis E. Case
presentation.
Adelina-Raluca Marinescu1*, Alexandru Crișan2,
Narcisa Nicolescu2, Virgil Musta2, Voichița
Lăzureanu2, Luci-Cecilia Rotar1, Ruxandra Laza2
*[email protected]
Dr. Victor Babeş Clinical Hospital of Infectious
Diseases and Pneumology, Timişoara, Romania
1
36
Dr. Victor Babeş University of Medicine and
Pharmacy, Timişoara, Romania
2
Background
Acute hepatic failure is a rare condition
representing the quick deterioration of the hepatic
function with the alteration of the mental status and
the emergence of hemorrhagiparous syndrome in
individuals previously considered healthy. This
pathology remains topical because of its high risk
of morbidity and mortality.
Case report
We present the clinical case of a male 56 year-old
patient, from the rural area, a shepherd, with
multiple comorbidities, admitted into Clinic II of
the Infectious Diseases and Pneumophtisiology
“Victor Babeș”, Timișoara, with the diagnosis of
chronic viral hepatitis B. Acute infection with
hepatic virus E has stimulated the emergence of
acute hepatic failure in a patient with chronic
infection with virus B. Afterwards, the members of
the patient’s family (wife and 2 children) have also
been found out to be asymptomatic carriers of B
virus.
Conclusions
The concomitant infection with hepatic virus B and
E (rare in our days) proves the uniqueness of the
case, with an unfavorable response to the treatment,
despite the complex paraclinical investigations. It is
notable the fact that, even though there is the
possibility of performing the serologic
investigation in the case of hepatic virus E
infection, it is currently underestimated in our
country, because in many of these situations, this
pathology does not fit into the diagnosis algorithm
of hepatic conditions.
diversity of the etiologic agents and the seriousness
of the clinical manifestations. In infants and small
children the symptomatology is more severe,
therefore imposing a quick diagnosis and,
implicitly, an appropriate therapy.
Methods
The work contains a cross-observational
retrospective study, performed on 458 children
admitted in Clinic II of the Hospital for Infectious
Diseases and Pneumophtisiology “Victor Babeş”,
Timișoara, during May 2014 – April 2015.
Results
Acute diarrhea represented 30% of the total of
admitted children (1569 children). The highest
acute diarrhea morbidity has been registered in
children aged 0-2. From the multitude of pathogen
agents, a significant part (61%) has remained
undiagnosed. The distribution of the identified
etiologies has been in decreasing order: Rotavirus
(120), Salmonella (42), E. coli (6), Giardia lamblia
(6), Shigella (2), Candida (1). Average seriousness
clinical forms predominated.
Conclusions
Within the last years the number of Rotavirus
diarrheic diseases has increased, whereas the
number of bacterial etiology diarrheic diseases,
such as Shigella and E. coli, has certainly
decreased. Because of the large number of
uncertain etiologies, an improvement of the
bacteriologic results’ accuracy is necessary. Stand
to be discussed the diagnosis possibilities of other
viral infections, as well as those of some bacteria
that cannot be diagnosed routinely at the moment.
Acute bacterial meningoencephalitis. Subdural
collections. Case presentation.
Clinico-aethiologic considerations in acute
diarrhea at children
Narcisa Nicolescu1*, Alexandru Crișan1, Voichița
Lăzureanu1, Virgil Musta1, Adelina-Raluca
Marinescu2, Mihaela Stanca Pleș3, Ruxandra Laza1
Ruxandra Laza1*, Alexandru Crișan1, Narcisa
Nicolescu1, Voichița Lăzureanu1, Virgil Musta1,
Amelia Blescun2, Adelina-Raluca Marinescu3
*[email protected]
Dr. Victor Babeş University of Medicine and
Pharmacy, Timişoara, Romania
2
Dr. Victor Babeş Clinical Hospital of Infectious
Diseases and Pneumology, Timişoara, Romania
3
Emergency Clinic Hospital County "Pius Brînzeu"
Timişoara, Romania
1
*[email protected]
Dr. Victor Babeş University of Medicine and
Pharmacy, Timişoara, Romania
2
“Dr. Teodor Andrei” Lugoj County Hospital,
Lugoj, Romania
3
Dr. Victor Babeş Clinical Hospital of Infectious
Diseases and Pneumology, Timişoara, Romania
1
Background
Acute diarrhea is one of the important public health
problems because of its high incidence, the
Background
Bacterial meningites represent another infectious
pathology current problem despite the progress
made, especially within the last years. At sucklings
and small children the diagnosis is even more
difficult, especially if there are other associated
pathologies as well.
37
Case report
We present to you the case of a male 3 year-old
suckling, admitted between 27.05-19.06.2015, into
the Hospital for Infectious Diseases and
Pneumophtisiology “Victor Babeş”, Timisoara,
with the following diagnosis: 1. Acute bacterial
meningoencephalitis; 2. Bilateral fronto-parietotemporal subdural collections; 3. Cranial post
traumatic status; 4. Mixed anemia; 5.
Thrombocytosis; 6. Minor tricuspid regurgitation;
7. minimal pulmonary regurgitation. The suckling
has been transferred to the Neurology clinic for the
draining of the subdural collections. The suckling’s
evolution was slowly favorable, with ulterior NPI
dispensation and Pediatric Cardiology.
Conclusions
At sucklings and small children, the
symptomatology is more atypical, which represents
a hindrance in establishing the diagnosis of
meningitis. The bulginess of the fontanelle
represented an essential alarm signal in the
presented case. Cranial trauma, even if minor,
combined with other factors can sometimes
generate complications in this small age group. The
imagistic intake, respectively the cerebral MRI, has
been essential in establishing the diagnosis, with a
benefic collaboration of various specialty branches
of medicine. Key words: meningoencephalitis,
fontanelle’s bulginess, subdural collections.
Recurrent bacterial meningitis in a patient with
transethmoidal nasal meningoencephalocele
Liana-Catalina Gavriliu1,2*, Otilia-Elisabeta
Benea1,2, Loredana Lazar1
*[email protected]
1
National Institute for Infectious Diseases "Prof.
Dr. Matei Balș", Bucharest, Romania
2
Carol Davila University of Medicine and
Pharmacy, Bucharest, Romania
Background
Recurrent bacterial meningitis is a less common
clinical entity, but it poses more serious diagnostic
challenges and it often requires extensive tests in
order to determine any underlying pathology.
Case report
We present the case of a 27 year-old patient with a
history of Waldeyer’s ring non-Hodgkin
lymphoma, for which he was treated, cured and
dismissed from hematological follow-up for 10
years and a history of 3 episodes of bacterial
meningitis: 13, 9 and 7 years previously, who
presented to the emergency room in march 2015
with symptoms compatible with meningitis.
Cerebrospinal fluid (CSF) exam established the
diagnosis of bacterial meningitis. CFS Gram
staining showed gram-positive diplococci. The CSF
cultures were negative. The patient was started on
Ceftriaxone and Vancomycin, Dexamethasone 0.5
mg/kg and symptomatic treatment. Serologic test
for HIV was negative. Immunoglobulin A,G, M and
complement levels were normal. Chest and sinus
X-ray exams were unremarkable. Ear-nose-throat
exam didn’t reveal abnormal structures, rhinorrhea
or otorrhea. The brain magnetic resonance revealed
a bony defect at the right cribriform plate,
continued with a small sac into the right nostril,
between the nasal septum and the right nasal
cornet. The patient was treated for 14 days. He was
discharged in the 16th day and he was referred to a
neurosurgical clinic for the treatment of the
anatomical defect.
One of the anatomical abnormalities leading to
recurrent bacterial meningitis is
encephalomeningocele. According to the literature
data, it is usually present in pediatric patients and
the correct diagnosis of the predisposing condition
of the recurrent meningitis is often delayed for
many years. Our patient had the first episode of
meningitis at the age of 14 and the gap between the
first episode of bacterial meningitis and the
diagnosis of the predisposing condition was 13
years. Another issue that we took into consideration
in our patient was the vaccination against
Streptococcus pneumoniae, Neisseria meningitidis
and Haemophilus influenzae. This approach is
recommended in some cases of recurrent bacterial
meningitis, although it is questionable in the cases
secondary to anatomical abnormalities. Due to the
fact that the patient was going to be subjected to
the surgical repair of the anatomical defect, we
decided not to proceed with the vaccination.
Conclusions
This case emphasizes the fact that anatomical
abnormality should also be carefully assessed in
adult patients with recurrent meningitis, its closure
being essential in order to prevent further episodes
of bacterial meningitis.
Antimicrobial resistance of Staphylococcus
aureus strains isolated from blood in INBI
“Prof. Dr. Matei Balș” in 2014
Liana-Catalina Gavriliu1,2*, Otilia-Elisabeta
Benea1,2
*[email protected]
1
National Institute for Infectious Diseases "Prof.
Dr. Matei Balș", Bucharest, Romania
38
2
Carol Davila University of Medicine and
Pharmacy, Bucharest, Romania
Background
Increasing antimicrobial resistance of
Staphylococcus aureus (SA) is a concerning
problem all over the world. According to the latest
European Antimicrobial Resistance Network
(EARS-Net) report, Romania reports an increasing
number of methicillin-resistant Staphylococcus
aureus (MRSA) strains isolated from invasive
infections. We analyzed the antimicrobial
resistance of SA strains isolated from blood in 2014
in the National Institute for Infectious Diseases
(INBI) “Prof. Dr. Matei Bals”.
Methods
We analyzed the antimicrobial susceptibility tests
of SA strains isolated from blood between January
1st-december 31st 2014 and between January 1stdecember 31st 2010, in INBI “Prof. Dr. Matei
Bals”. We compared the evolution of the resistance
between these two periods. The statistical analysis
was performed using the Fisher exact test. p<0.05
was considered statistically significant.
Results
We identified 51 strains of SA isolated from blood
in 2014: 92.15% penicillin-resistant, 64.7% MRSA,
68.62% resistant to macrolides, 64.7% resistant to
tetracycline, 5.88% resistant to ciprofloxacin,
1.96% resistant to rifampicin, 9.8% resistant to
gentamicin, 0% resistant to trimethoprimsulfamethoxazole. From the 33 strains of MRSA,
87.87% were resistant to macrolides, 84.84%
resistant to clindamycin, 87% resistant to
tetracycline, 9.09% resistant to ciprofloxacin and
gentamicin, 3.03% resistant to rifampicin. We
found no resistant strains to trimethoprimsulfamethoxazole, vancomycin or linezolid. We
identified 58 strains of SA isolated from blood in
2010: 91.37% penicillin-resistant, 56.89% MRSA,
47.36% resistant to macrolides, 42.30% resistant to
tetracycline, 15.51% resistant to ciprofloxacin,
12.96% resistant to rifampicin and to gentamicin.
From the 33 strains of MRSA, 53.12% were
resistant to macrolides, 15.62% resistant to
clindamycin, 53.57% resistant to tetracycline,
21.21% resistant to ciprofloxacin and 20.69%
resistant to gentamicin, 20.69% resistant to
rifampicin. We found no resistant strains to
trimethoprim-sulfamethoxazole, vancomycin,
linezolid. Comparing these two periods we found:
statistically insignificant increase in MRSA
(p=0.43). Among the MRSA we found increasing
resistance to macrolides (p=0.02), clindamycin
(p=0), tetracycline (p=0.008) and a decreasing
resistance to trimethoprim-sulfamethoxazole
(p=0.08), rifampicin (p=0.05), gentamicin
(p=0.28).
Conclusions
1. The number of SA strains isolated from blood
were similar: 58 in 2010, 51 in 2014 2. The
percentage of MRSA strains increased statistically
insignificant between 2010-2014, from 56.89% to
64.7%. Our data are similar to those reported to
EARS-Net by our country (64.5% in 2013) 3.
Between 2010-2014 we found a statistically
significant increase of the resistance to macrolides,
clindamycin, tetracycline and a statistically
insignificant decrease of the resistance to
trimethoprim-sulfamethoxazole, rifampicin and
gentamicin. 4. We didn’t find any strains resistant
to vancomycin and linezolid.
Milker's nodules: differential diagnosis
challenges
Mircea Tampa1,2, Maria Isabela Sarbu2*, Madalina
Mitran2, Cristina Mitran2, Clara Matei1, Monica
Costescu1,2, Ilinca Nicolae2, Vasile Benea2,
Simona-Roxana Georgescu1,2
*[email protected]
1
Department of Dermatology, "Carol Davila"
University of Medicine and Pharmacy, Bucharest,
Romania
2
Department of Dermatology, "Victor Babes"
Hospital of Infectious Diseases, Bucharest,
Romania
Background
Milker's nodule is a skin infection caused by a
Parapoxvirus. It is a common zoonosis affecting
cattle worldwide. Humans are infected through
direct contact with infected cattle or contaminated
meat. It is an occupational disease affecting
milkers, veterinarians and butchers. Case report
We report the case of a 54 year old male, Caucasian
patient from the urban area who addressed to our
hospital for multiple, bluish, tender nodules located
on both hands. The lesions had occurred
approximately two weeks before, initially as
erythematous macules which then turned into
papules and nodules. The patient worked as an
engineer in the urban area. A thorough anamnesis
revealed that he had spent his vacation at a farm
but the patient denies having had direct contact
with any of the animals. However, he does admit
having had contact with fresh cow meat that he had
personally prepared. The patient was otherwise
healthy. The local examination revealed multiple,
bluish, tender nodules, some of them covered by
crusts, located on the palms and lateral aspect of
the fingers. One of the lesions was ulcerated. A
total blood count was performed and was within
39
normal range. Syphilis tests were negative, as was
the tuberculin skin test. The differential diagnosis
included pyogenic granuloma, pyoderma, giant
molluscum contagiosum, keratoacanthoma.
However, all these lesions tend to be solitary. Orf
was also excluded as the patient denied having had
any contact with sheep, goats or their meat. A
biopsy was taken from one of the lesions and
showed irregular acanthosis, papillary dermal
edema and mixed inflammatory infiltrate. Based on
the clinical features, anamnesis and
histopathological examination the patient was
diagnosed with milker's nodules. Since the disease
is self-limited he only received symptomatic
treatment and the lesions resolved after
approximately one month.
Conclusions
Milker's nodule is an occupational disease which
usually occurs in milkers, veterinarians or butchers
after direct contact with the infected animals or
fresh meat. It rarely affects people outside these
professional categories. Therefore, a thorough
anamnesis is required in establishing the correct
diagnosis.
Acknowledgement
This paper is partly supported by the Sectorial
Operational Programme Human Resources
Development (SOPHRD), financed by the
European Social Fund and the Romanian
Government under the contract number POSDRU
141531.
Prevalence of MRSA and their genetic
characterization among microbial strains
isolated from leg ulcers in dermatological
patients
Mihaela Georgescu1,2,3*, Irina Gheorghe2,3, Marcela
Popa2,3, Florin Constantin Ghiaţău1, Mariana
Carmen Chifiriuc2,3
*[email protected]
1
Central Universitary Emergency Military Hospital
Dr Carol Davila, Bucharest, Romania
2
University of Bucharest, Faculty of Biology,
Microbiology Department, Romania
3
Research Institute of the University of Bucharest ICUB, Romania
Background
Infections play an important role in the delayed
healing of leg ulcers. The majority of chronic leg
wounds presents signs of infections and are one of
the main reasons for admission in the hospital.
Various reports in the literature suggest that most of
the isolated bacterial strains belong to
Staphylococcus spp., with the predominance of
Staphylococcus aureus. SCCmec (staphylococcal
cassette chromosome mec) is a mobile genetic
element characterized by the presence of two
complexes, i.e. mec, containing the mecA gene and
ccr, responsible for the mobility of mecA and of
other resistance or virulence genes.
Methods
A total number of 83 bacterial strains were isolated
from 63 patients with leg ulcers, admitted in the
period December 2014 – June 2015 in the
Dermatology Department of SUUMC Dr Carol
Davila, Bucharest. The isolates were identified by
using the conventional biochemical tests. We used
PCR to determine the presence of the following
genes responsible for antibiotic resistance profiles:
mecA, SCC mec V1J, ccr, type IVa.
Results
From the total of bacterial isolates, 28 were
Staphylococcus spp. strains, out of which 10 were
methicillin-resistant Staphylococcus aureus
(MRSA), 11 methicillin-susceptible Staphylococcus
aureus and 7 were coagulase-negative
staphylococci. PCR was further used to detect the
essential genetic components of SCCmec. The
molecular analysis of the MRSA isolates revealed
the following SCCmec elements: 6 of the 10
MRSA isolates were positive for mecA gene,
correlated with the presence of cif2 gene; 4 strains
exhibited the SSC mec typeIVa, which is the
signature of the community acquired MRSA
isolates (the rest of the MRSA isolates could not be
subtyped) and 1 isolate harbored the ccr gene.
Conclusions
The obtained results have shown that the MRSA
strains isolated from chronic leg ulcers belong to
the SCCmec type IVa. The phenotypic methicillin
resistance is not always correlated with the
presence of mecA gene, but some of the SCCmec
cassette elements are always present in the resistant
strains.
Tuberculosis in a patient with psoriasis vulgaris
on anti TNF α therapy – a case report
Mihaela Georgescu1*, Anton Mihai Ţilea1, Marcela
Poenaru1
*[email protected]
1
Central Universitary Emergency Military Hospital
Dr Carol Davila, Bucharest, Romania
Background
Anti tumor necrosis factor (TNF) α therapy for
psoriasis vulgaris implies an increased risk of
infection. The 3 anti TNF α drugs approved in
40
Romania have different degrees of safety regarding
tuberculosis.
Case report
A 46 years old patient known with psoriasis
vulgaris from 1998 which had different systemic
treatment and without other comorbidities was
eligible for biological therapy. The patient began
therapy with Infliximab in September 2009,
(5mg/kg – 4fl [400mg] 0, 2, 6 weeks followed by
4fl/8 weeks). In February 2011 the patient received
the last intravenous perfusion with Infliximab. In
April 2011, coming for the regular Infliximab
perfusion, the patient complained of dyspnea,
fatigability, weight loss, 37-37.9 degrees Celsius.
The pulmonary X-ray revealed pleurisy. The
echocardiography showed pericarditis. The direct
examination of the sputum demonstrated acidalcohol resistant bacilli (BAAR). The diagnosis of
tuberculosis with pericarditis and pleurisy was
established. The patient received the following
treatment: hydrazide and ethambutol (for 6 months)
and Prednisone 0.5 mg/kg. In June 2011 the
diagnosis of tuberculosis was confirmed by growth
on Löwenstein selective medium. In October 2011
the patient presented to our department in psoriatic
erythrodermia. She was given Acitretin 30 mg per
day and underwent ultraviolet light therapy with a
maximum dose of 6 j/cm². The patient failed to
sustain a remission. In May 2012 the patient began
therapy with Etanercept 50mg x2/weeks sc for 4
months, then 50mg/week sc. So far the patient has
not shown any signs of tuberculosis.
Conclusions
Etanercept shows a better safety profile compared
with Infliximab regarding infection with
Mycobacterium tuberculosis.
Case report
Female patient, age 26, from urban area, pet shop
employee, no significant personal pathologic
antecedents, was admitted in Clinic II of the
Hospital for Infectious Diseases and
Pneumophtisiology “Victor Babeş” Timisoara,
between 02.07.2015-09.07.2015, with high fever,
chills, predominant nocturnal sweat, dry cough,
headache, myalgia, nausea and vomiting,
symptomatology which appeared 2 weeks before
coming to the clinic. The positive diagnosis of
psittacosis was established through positive
serology and radiologic investigation, corroborated
with the patient’s job; in the diagnosis algorithm of
the fever syndrome have been included atypical
pneumonias as well.
Conclusions
A well-led anamnestic examination, joined with
careful succession of high utility paraclinical
investigations allowed stating a diagnosis of
infectious pathology atypical for the geographic
area we live in. Having a scarce and non-specific
symptomatology, psittacosis remains an alert
respiratory pathology, especially through the
endemo-epidemic character it can have..
Acute atypical pneumonia. Case presentation.
Objectives: To emphasize the importance of
preventing Mycobacterium tuberculosis infection in
general population, due to the outcome of the
disease by itself and its complications.
Case report
A 63-year-old man was referred for audiovestibular investigations form an infectious disease
hospital for hearing loss and severe walking
problems after previous tuberculosis meningitis one
year ago. Bed-side neuro-otological evaluation and
audiometry revealed bilateral lesion of the inner
ear, with secondary hearing impairment and
disequilibrium. Bacterial meningitis with
associated cranial nerve involvement is a severe
complication of the primary infection and after the
initial acute phase, patients still have important
functional impairments. This is true also in this
patient since tuberculosis meningitis and VIIIth
nerve bilateral lesion has severe negative effects
even after one year from the acute episode.
Cochlear nerve lesions determined permanent
Luci-Cecilia Rotar1*, Alexandru Crișan2, Narcisa
Nicolescu2, Adelina-Raluca Marinescu1, Ruxandra
Laza2
*[email protected]
Dr. Victor Babeş Clinical Hospital of Infectious
Diseases and Pneumology, Timişoara, Romania
2
Dr. Victor Babeş University of Medicine and
Pharmacy, Timişoara, Romania
1
Background
Pneumonia can most frequently emerge
aerogenically, by sepsis hematogenic
dissemination, but also by aspiration of secretions
(neurologic conditions, comas, elder people) and
by iatrogenic maneuvers (oro-tracheal intubation,
bronchoscopy).
Non-infectious sequelae of the tuberculous
meningitis
Madalina Georgescu1*
*[email protected]
1
Institute of Phono-Audiology and ENT Functional
Surgery, Bucharest, Romania
41
bilateral severe hearing loss. Even though the
patient is wearing a hearing aid, the verbal benefit
is limited due to the cerebral lesions provoked by
the meningitis. Bilateral vestibular nerve lesions
cannot be centrally compensated so the physical
and functional consequences of this bilateral deficit
are very difficult to overcome. After one year from
the onset of the vestibular lesions, the patient still
has severe walking problems since he did not have
appropriate treatment from the onset of the lesion,
enhanced now by the fact that he had a tibia
fracture in one leg. We included the patient in a
complex rehabilitation program, with specific
vestibular rehabilitation exercises, in order to
improve his static and dynamic equilibrium. The
aim is to increase the patient quality of life, to
regain his independence for walking and daily
activities.
Conclusions
Mycobacterium tuberculosis infection is,
unfortunately, very frequent in Romania nowadays.
Meningeal involvement, with or without
pulmonary tuberculosis lesions is common for the
Infectious Disease units, so a thorough evaluation
of patients with Mycobacterium tuberculosis
infection is mandatory in order to define the lesions
and to recommend the appropriate management
protocol as soon as possible and benefit of the best
neuroplasticity period.
Evolutional morbidity particularities of viral
infections preventable by vaccination in Dolj
County
Livia Dragonu1,2*, Dan Dumitru Hurezeanu1,2,
Ludmila Prunariu3, Irina Niculescu1,2, Florentina
Dumitrescu1,2, Andreea Cristina Stoian1, Lucian
Giubelan1,2
*[email protected]
1
University of Medicine and Pharmacy Craiova,
Romania
2
“Victor Babeș” Clinical Hospital of Infectious
Diseases and Pneumology, Craiova, Romania
3
County Public Health Department Dolj, Romania
Background
Prophylactic vaccination is a health protection
measure which has considerably altered the
morbidity of some infections faced by humanity in
previous centuries. The national vaccinations
calendar in Romania includes prophylactic
immunization against the following viral
infections: hepatitis B, poliomyelitis, measles,
rubella, mumps. The specific prevention through
vaccination against varicella-zoster virus is not part
of the routine immunization program. The study’s
objectives target the morbidity evolution of these
viral infections in Dolj County in relation to the
application of specific prophylaxis.
Methods
A retrospective analysis (range 1994-2014) of
morbidity by acute viral hepatitis B, poliomyelitis,
measles, rubella, mumps and chickenpox was
performed. The data from the Department of
Statistics and County Public Health Department
was used. The morbidity was expressed by the
number of new cases of the disease reported
annually at 100,000 inhabitants.
Results
The incidence of morbidity by measles has fallen to
an average of 1.62 0/0000 endemic level with
increases of epidemic caused by the accumulation
of receptive mass during the 1997-1998 period
(120 0/0000). The incidence of rubella has
presented multiannual variations (between 0.27 and
192 0/0000) with a maximum level in 2012. The
introduction of vaccination has led to a significant
decrease of mumps infection morbidity (from 161.1
0/0000 to 1.12 0/0000) after 2006. Poliomyelitis
has not registered any cases. Regarding acute viral
hepatitis type B, after the introduction of
vaccination, morbidity has registered a steady
evolutionary downward trend from 36.8 0/0000
(1995) to 2.8 0/0000 (2014). In the absence of
prophylactic immunization, chickenpox has
presented an ascending morbidity trend that ranged
between 82 0/0000 and 405 0/0000.
Conclusions
The specific prophylaxis has resulted in significant
decreases of morbidity and even eradication of
viral infection can be achieved under the
circumstances of optimum vaccination coverage.
The clinical surveillance and the seroprevalence
studies identify in time the dangers of the restoring
transmission of infectious agents among the
receptive population.
Cytomegalovirus acute viral hepatitis in an
immunocompetent host
Andreea Stefania Asiminoaei1*, Corina Itu1
*[email protected]
1
Clinical Hospital of Infectious Diseases, ClujNapoca, Romania
Background
Cases of viral hepatitis have been rarely
incriminated to β-herpetoviridae. In acute viral
hepatitis the main viruses that cause liver disorders
are HAV, HBV and HCV. When the tests are all
42
negative, apart from autoimmune and toxic
hepatitis there are those caused by the
β/herpetoviridae families. We present a middleaged woman with acute cytomegalovirus hepatitis.
Case report
We reviewed all medical data regarding this case. A
57 year old woman from a rural area, is examined
by the general practitioner for fatigue and sore legs.
She noticed darker urine and pale stools. The
routine tests shows a high level of liver enzymes
and the patient is sent to Cluj-Napoca for further
investigations. It must be mentioned that she had
no underline disease but her son underwent
treatment for viral hepatitis B. The patient
complained of upper abdominal pain and was
referred to the Gastroenterology and Hepatology
Institute, where after performing blood tests and an
ultrasound to exclude a gallbladder stone blockage
the patient was transferred to our hospital. The test
results revealed acute hepatitis with high level of
TGP and TGO, cholestasis and mild
hyperbilirubinaemia. The immunologic tests were
negative for IgM HAV, IgM HBc, Ag HBs, antiHCV, HIV. The IgG CMV was nonreactive and the
IgM CMV was reactive. During the hospitalization
period she accused only fatigue and sore legs,
without dyspeptic syndrome. The patient received
Ampicillin 5 days and supportive therapy, liver
protectors, amino acids, antacids, and antispastic
therapy. After 2 weeks the clinical and laboratory
examinations were good, with the decrease of the
liver enzymes. Upon discharge the IgG CMV was
reactive with a count of antibodies of 52UA/mL.
Conclusions
Cytomegalovirus hepatitis is rare in an
immunocompetent host and the infection is usually
subclinical. The diagnosis was sustained by
seroconversion. The case had a good outcome
without antiviral therapy.
Contraceptive behavior among long survivors,
nosocomially HIV-infected women in Galati
County
1
1
Miruna Draganescu *, Manuela Arbune , Mirela
Modrigan2
determined a long survival. Girls from this cohort
are now young women thinking to make a family
of their own. Although they received over the time
contraceptive counselling and free condoms, little
is known about the result of these actions. The
objective of this study was to describe the sexual
and contraceptive behavior.
Methods
Eligible participants from Day Care Clinic,
currently on HAART were consenting interviewed
about sexual and contraceptive behavior. Clinical
and biological stage of HIV infection, HAART
adherence were provided from patient file. For
statistical analysis we used MedCalc.
Results
83 (60.5%) nosocomially HIV-infected women of
137 at reproductive age were selected; the mean
age 23.8 years, median CD4=598cells/cmm,
median number of life-time partners 2 (2-11). 24%
are rrhoma ethnic, 42% have minimal instruction
level, 12% have no instruction at all, 46% have
medium and high level of instruction, 13% are
legally married, 34% have children. Among
contraceptive methods 53% use condoms, 2.5% use
other methods, 25.5% use no contraceptive method,
19% have no sexual activity. Almost a quarter
(24%) had at least one abortion for an unwanted
pregnancy; abortion was more frequent among
women with more than 2 partners (p=0.047) and
minimal instruction level.
Conclusions
For the majority of women counselling and free
condoms induced a safe sexual practice. Almost a
quarter of nosocomially HIV-infected women did
not use any contraceptive method, despite
counselling and condoms available at no cost and
had at least one abortion. Low level of instruction
correlates to an increasing number of children and
lack of contraceptive method use. Intensive
counselling is a challenge that we have to take for a
safe sexual behavior and eradication of abortion
among these women.
Aspects of Clostridium difficile colitis in patients
hospitalized within the surgical wards (a
prospective study)
*[email protected]
Victoria Birlutiu1,2*, Alina Lidia Stan2, Rares
Mircea Birlutiu3, Maria Igna2
”Dunărea de Jos” University, Galați, Romania
Infectious Diseases Clinical Hospital ”Sf. Cuv.
Parascheva” Galați, Romania
*[email protected]
1
2
1
Background
Universal access to highly active antiretroviral
therapy (HAART) of nosocomially HIV-infected
children born between 1988-1992 in Romania, has
“Lucian Blaga” University Sibiu, Faculty of
Medicine Sibiu, Romania
2
Academic Emergency Hospital Sibiu, Romania
3
“Foișor” Hospital for Orthopedics, Traumatology
and Osteoartiular TB Bucharest, Romania
43
Background
The change in the epidemiology of Clostridium
difficile infection (CDI) during the last years, with
an increase in incidence, is a reality associated with
healthcare services. A review of surgical patients
was rarely performed. We performed a prospective
study of factors associated with CDI in hospitalized
patients within the surgical departments of the
Academic Emergency Hospital Sibiu, Romania
between August 2013 and July 2015.
Methods
We analyzed the cases of CDI that were diagnosed
in the surgical departments summarizing 126 cases.
We analyzed the risk factors, the comorbidities and
the type of surgery related with CDI.
Results
Of the total number of CDI cases hospitalized
n=335, a number of 126 cases were associated with
the surgical services (36.72%). There were 59
confirmed cases in general surgery department, 14
with cholecystectomy, 10 with interventions
performed on colon, 9 cases were associated with
surgeries performed for gastric cancer, 6 cases with
appendectomy, 5 cases with inguinal/femoral
hernia surgery and 3 cases of eventration after
abdominal interventions. 7 cases were associated
with gastro-intestinal interventions and pancreatitis,
5 cases of minor interventions on the thyroid gland
or in the cervical region. 17 cases presented a
relapse, of which 5 were associated with
cholecystectomy and other 3 patients with post
cholecystectomy syndrome. 6 cases were
associated to skin and soft tissue infections or limb
amputations. From the vascular surgical
department, 8 cases associated CDI and
angioplasty. 10 cases were hospitalized in the
neurosurgical department. In either of the
department of urology and the department of
orthopedics 17 cases were diagnosed with CDI. 9
cases were from the Gynecology department and 2
cases presented CDI after caesarian surgery. The
most common comorbidities were cardiovascular
(74 patients), malignancies (33), gastric ulcer (20),
diabetes mellitus (14) and chronic renal failure
(10). Most patients received antibiotic treatment
(112), followed by the therapy for suppressing
secretion of gastric acid (70) and non steroid or
steroid antiinflamatories (65). Of the antibiotics
that were administered, the most used were
aminopenicillins with beta-lactamases inhibitors
(55) fallowed by 2nd and 3rd generation of
cephalosporins (46) and fluoroquinolones (45).
Conclusions
Surgical services were responsible for 36.72% of
the cases of CDI. In particular the most problematic
are surgeries performed in the general surgery
department, associated with antibiotics and therapy
for suppressing secretion of gastric acid. We
encountered a relapse rate of 31.48%.
The effectiveness of the fecal microbiota
transplant based on the experience of the
Academic Emergency Hospital Sibiu.
Victoria Birlutiu1,2*, Adrian Gheorghe Boicean1,2,
Rares Mircea Birlutiu3
*[email protected]
1
“Lucian Blaga” University Sibiu, Faculty of
Medicine Sibiu, Romania
2
Academic Emergency Hospital Sibiu, Romania
3
“Foișor” Hospital for Orthopedics, Traumatology
and Osteoarticular TB Bucharest, Romania
Background
Clostridium difficile infection (CDI) is a serious
public health issue responsible for the annual
illnesses of 8/100,000 inhabitants and over 29,000
deaths; the increasing incidence being attributed to
usage of antibiotics, immune suppressed status,
chronic conditions, age over 65 years, surgical
interventions and antibiotic treatment, gastric acid
inhibitors, anti-inflammatory drugs, cytostatic
therapy and prolonged hospitalization. CDI may be
associated to a severe evolution, sepsis or death in
2-7% of cases (15% caused by hypervirulent
strains). The risk of relapse at 30 days after the first
episode CDI is 25%, 40% after the first relapse and
60% after the third episode.
Methods
Considering the challenges that the CDI treatment
involves and the increased number of hospitalized
and managed cases in the Academic Emergency
Hospital Sibiu, Romania, we performed fecal
microbiota transplant (FMT) in cases with CDI
recurrence, to evaluate the cure rate defined as the
presence of normal stools at 30 and 90 days after
the FMT.
Results
FMT was performed in the Internal Medicine
Department I Sibiu, from January to July 2015 in
42 patients with CDI, 8 male patients and 32
women patients. 34 patients had over 65 years.
With one exception, all the patients were multihospitalized patients with multiple comorbidities
like: cardiovascular disease (37 cases), digestive
disorders (cirrhosis associated with HCV,
diverticulitis, colonic polyps, chronic gastritis and
gastroduodenal ulcer, and so on in 15),
malignancies (4), 8 patients associated
chemotherapy for hematological malignancies,
diabetes (10) or renal impairment (8). 10 patients
underwent recent surgery (8 cholecystectomies and
2 interventions for gastric cancer and perforated
diverticulitis) and one case of femoral neck fracture
recently discharged from the orthopedic
department. Other risk factors included: antibiotic
44
treatment, 24 patients received therapy for
suppressing secretion of gastric acid, inflammatory
drugs (16). 57.14% of patients were at their second
relapse, 38% at their third episode of CDI and
4.77% of patients at their fourth relapse. 40 patients
presented normal bowel transit movements, both at
30 days and 90 days from the FMT (95.24%) and
only 2 cases required to repeat the FMT.
Conclusions
The FMT represents a method of therapy with a
high efficacy (in our study 95.24%) for the cases
with CDI recurrence in patients over 65 years with
comorbidities (cardiovascular, digestive, diabetes,
renal impairment and hematologic diseases) or
recent surgical intervention.
Acute rotavirus infection complicated with
cerebellitis and aphasia in a child – case
presentation
Gheorghita Jugulete1,2*, Adina Stancescu2, Cristina
Popescu2, Luminita Marin1,2, Magdalena Vasile2,
Virgil Ionescu2, Endis Osman2, Madalina Maria
Merisescu1,2
*[email protected]
1
Carol Davila University of Medicine and
Pharmacy, Bucharest, Romania
2
National Institute for Infectious Diseases "Prof.
Dr. Matei Balș", Bucharest, Romania
Background
Acute rotavirus infection represents a health
problem both worldwide and nationally, especially
in children under 5. Currently, due to polymorphic
clinical manifestations of the disease in children,
many authors describe the concept of rotaviral
disease. Frequently reported extra-intestinal
manifestations comprise of respiratory,
neurological, hepatic, cutaneous, renal and
hematological manifestations.
Case report
We present the case of a 8 year old child admitted
in the 9th Pediatric Department of the National
Institute for Infectious Diseases “Prof. Dr. Matei
Balș” between 25.04-15.05.2015, with the
diagnosis of acute rotavirus infection complicated
with cerebellitis and aphasia. Diagnosis was
established based on epidemiological criteria (2
siblings with the same infection), clinical criteria
(fever, vomiting, abdominal pain, diarrhea, gait
abnormalities, aphasia) and laboratory criteria
(Rotavirus testing in stool samples and CSF). Also,
diagnosis was supported by other investigations
such as EEG and brain MRI. Onset of illness took
place 5 days prior to admission with fever,
vomiting, abdominal pain and diarrhea, and
afterwards drowsiness, lack of appetite, gait and
speech abnormalities (bradylalia, bradypsyhia and
aphasia). Upon admission, the child presented with
an altered general state, was feverish, pale, and
drowsy with speech and gait abnormalities. Based
on epidemiological, clinical and laboratory data,
the diagnosis of acute rotavirus infection was
established. Also, the neurological consult with
EEG and brain MRI highlight associated
complications: cerebellitis and aphasia. Under
treatment with dexamethasone, cerebral depletives,
i.v. human immunoglobulins, B vitamins and
Cerebrolysine, evolution was slowly favorable. 4
weeks after onset, the patient was cured but with a
slight intellectual disability.
Conclusions
Infection with rotavirus can present in various
clinical forms, ranging from mild to severe with
complications. Although rare, neurological
complications are severe and can pose a high risk
of sequelae and death in the absence of proper
treatment.
Incomplete Kawasaki disease in a child with IgA
deficiency- Case presentation
Gheorghita Jugulete1,2*, Adina Stancescu2, Cristina
Popescu2, Luminita Marin1,2, Endis Osman2,
Madalina Maria Merisescu1,2
*[email protected]
1
Carol Davila University of Medicine and
Pharmacy, Bucharest, Romania
2
National Institute for Infectious Diseases "Prof.
Dr. Matei Balș", Bucharest, Romania
Background
Kawasaki disease represents an array of symptoms
caused by an autoimmune mechanism,
characterized by prolonged fever, inflammatory
syndrome and multi-system involvement:
mucocutaneous, cardiovascular, gastrointestinal,
hepatic and renal.
Case report
We present the case of a 1 year old female child,
admitted in 9th Pediatric Department of the
National Institute for Infectious Diseases “Prof. Dr.
Matei Balș” between 17.07 – 27.07.2015, with the
diagnosis of acute febrile syndrome. Complex
investigations were performed (hematological,
biochemical, virological and bacteriological)
alongside chest radiographs, cardiac and abdominal
ultrasound, myelogram as well as specialty consults
(ophthalmology, cardiology, rheumatology and
otorhinolaryngology). Onset of illness took place 8
45
days prior to admission with fever, lack of appetite,
abdominal pain and diarrhea. The child was first
admitted in a Pediatric clinic where conjunctival
hyperemia and slight hepatosplemegaly were
noticed. Because the febrile syndrome persists
despite broad spectrum antibiotic treatment and
corticosteroids, with rising titers of inflammatory
markers, the child is transferred in our clinic. Based
on clinical and laboratory data, alongside with
interdisciplinary consults (which exclude a
lymphoproliferative disorder, sepsis and systemic
illness), the diagnosis of incomplete Kawasaki
disease is established. Treatment with human
immunoglobulins is instituted for 5 days, with a
favorable outcome (cessation of fever and
inflammatory syndrome). Also, specific
immunological tests reveal a selective IgA
deficiency in a child with no relevant medical
history.
Conclusions
Kawasaki disease is a condition which can have a
severe outcome with complications such as
coronary involvement that can lead to death. In our
case, the coronary involvement was minimal,
although the incomplete clinical aspect could have
led to delay in diagnosis and proper treatment. The
IgA deficiency could be an important trigger of the
disease. Although rare, Kawasaki disease remains a
frequent cause of prolonged fever associated with
inflammatory syndrome in the absence of a proven
infection.
Methods
Retrospective descriptive study of HIV infected
adults diagnosed with PJ pneumonia hospitalized in
HIV adult department of Dr Victor Babeș Hospital
during 01.01.2011-30.07.2015. Case confirmation
was carried out by RT-PCR or specific coloring
bronchoalveolar lavage. Statistical analysis was
performed with t-test and chi-square test.
Results
During 1.1.2015-30.7.2015 there were registered
23 patients with PJ pneumonia, of which 17 were
HIV new cases (73%) with average age 39 years,
predominantly men (60%). Testing factors
associated with death in PJ pneumonia in HIV
adults were found with statistical semnification the
following variables: HIV viral load at diagnosis
(p=0.024), oxygen saturation measured at
admission (p=0.050), distance in days between HIV
diagnosis and PJ pneumonia (p=0.016), associated
comorbidities (p=0.002) and corticosteroid
treatment (p=0.034). The mortality rate was
39.14%. 12 cases (52%) were confirmed by RTPCR for PJ from sputum or bronchoalveolar
lavage.
Conclusions
Pneumonia with PJ still has a high mortality rate.
Early detection and treatment of HIV infection
could prevent this opportunistic infection.
Suspicion of PJ pneumonia by other medical
specialties from the first contact of the patient with
medical system could lead to better outcome.
Prognostic factors in Pneumocystis jiroveci
pneumonia in HIV infected adults
Splenic abscess – difficulty of diagnosis
Amelia Blescun1*
1
1
Olivia Burcos *, Filofteia Banicioiu Cojanu ,
Simona Erscoiu1,2, Ionut Popa1, Cristina Pãtru1,
Tatiana Stoicev1, Maria Nica2, Andreea Todiran1,
Graţiela Ţârdei1, Emanoil Ceauşu1,2, Daniel
Chirita1
*[email protected]
1
Clinical Hospital of Infectious and Tropical
Diseases “Dr. Victor Babeș”, Bucharest, Romania
2
Carol Davila University of Medicine and
Pharmacy, Bucharest, Romania
Background
Pneumonia with Pneumocystis jirovecii (PJ)
represents the second opportunistic infection as a
mortality rate even in the highly active
antiretroviral therapy era. Objectives: to determine
factors associated with exitus in pneumonia with
PJ.
*[email protected]
1
“Dr. Teodor Andrei” Lugoj County Hospital,
Lugoj, Romania
Background
The splenic abscess is rarely encountered in
pathology – being identified in 0.05-0.7% of
autopsies, this percentage being influenced by the
country developing these statistics. Common
clinical signs are fever and pain in the abdomen,
usually in the upper part.
Case report.
The patient, 72 years old, with diabetes mellitus,
treated with oral antidiabetic agents is admitted on
the day of the disease onset with fever 40 degrees
C and fainting. At admission examination: patient
is scarcely cooperating, is hardly responding to
verbal stimuli, rhythmic cord, left basal rales, SaO2
83%, relaxed abdomen. Paraclinic: neutrophilic
leukocytosis, metabolic imbalance, the thoracic
46
radiography reveals a fine clouding of the left lung
field. It is interpreted as sepsis with pulmonary
starting point. Therapy with piperacillintazobactam is established. Under treatment with
antibiotics (three days) fever reappears, the patient
is still hardly cooperating. Lumbar puncture is
performed – CSF normal. CT for abdomen and
pelvis with contrast is performed, detecting splenic
abscess and thrombosis in the lower branch of the
right pulmonary artery. Surgery is proposed (with a
high surgical risk DSA IV E), but the family
requests discharge, the patient dying at home after
five days.
Conclusions
Basal pneumonia not responding to therapy can
sometimes hide an infectious abdominal process in
the upper part even without any obvious abdominal
signs. A favorable evolution of the splenic abscess
cannot be achieved only by treatment with
antibiotics, surgical intervention in due and good
time being beneficial and a saving solution in many
cases.
References
1. Ng KK, Lee TY, Wan YL, et al. Splenic Abscess:
diagnosis and management.
Hepatogastroenterology 2002;49(44):567-71.
2.Ghidirim G, Rojnoveanu G, Mişin I, Gagauz I,
Gurghiş R. Splenic abscess--etiologic, clinical and
diagnostic features. Chirurgia (Bucur).
2007;102(3):309-14.
3. Losanoff JE. Splenic abscess.
www.medscape.com
Infections during pregnancy are not associated
with atopic dermatitis – a cross-sectional study
in Romanian population
Mihaela Panduru1*, Nicolae Mircea Panduru1
Methods
This was a cross-sectional study performed on
1007 subjects, aged from two months to 18 years
within 5 southern counties of Romania. All data
were obtained from standardized questionnaires
distributed in schools and kindergartens. The
questionnaire comprised two parts: the first part
which contained the ‘core’ questions of the ISAAC
(International Study of Asthma and Allergies in
Childhood) questionnaire and a second part
containing questions regarding the factors involved
in atopic dermatitis development. The prevalence
of infections during pregnancy was compared
between subjects with and without atopic
dermatitis using a chi square test. The association
between infections during pregnancy and atopic
dermatitis was assessed using the simple binary
logistic regression followed by multi-parametric
logistic regression. The data analysis was made
with MedCalc software, version 12.1.3.0.
Results
The analysis showed a prevalence of atopic
dermatitis of 9.5%. In addition, 14.6% (n =14)
patients with atopic dermatitis had infections
exposure during pregnancy compared with 12.1%
(n=110) of those without atopic dermatitis
(p=0.58). The simple binary logistic regression
showed that infections exposure during pregnancy
was not associated with the atopic dermatitis
occurrence (OR=1.24; p=0.48). The multiparametric logistic regression confirmed that
infections in intrauterine life were not associate
with atopic dermatitis (OR=0.54; p=0.15), when
adjusted for paternal history of allergy (OR=1.69;
p<0.0001) and the trimester of antibiotic exposure
(OR=1.63; p=0.007).
Conclusions
The study showed no association between atopic
dermatitis and infections exposure during
pregnancy in this Romanian population.
*[email protected]
1
Carol Davila University of Medicine and
Pharmacy, Bucharest, Romania
Background
Atopic dermatitis represents the first manifestation
of atopic march preceding allergic rhinitis and
asthma. Identifying possible risk factors for atopic
dermatitis may prevent the development of the
disease and the atopic march. Although the hygiene
hypothesis suggested that early exposure to
infections could stimulate the immune system and
prevent atopic dermatitis, there are also
contradictory studies. In this context, the aim of our
study was to investigate the association between
intrauterine infections exposure and atopic
dermatitis occurrence, in Romanian children.
Some clinical peculiarities of imported malaria
in the Republic of Moldova
Valentin Cebotarescu1*, Victor Pântea1, Gheorghe
Plăcintă1, Lilia Cojuhari1, Petru Paveliuc1, Oleg
Dmitriev2, Ion Chiriac2
*[email protected]
1
State Medical and Pharmaceutical University
“Nicolae Testemiţanu”, Chișinău, Republic of
Moldova
2
Toma Ciorbă Clinical Hospital for Infectious
Diseases, Chișinău, Republic of Moldova
47
Background
European countries annually recorded 10-12
thousand cases of imported malaria. The
geographical location of Moldova, intense relations
with different countries with unfavorable situation
in malaria, increased migration, climatic
conditions, inadequate performance of prophylactic
measures determine the development of malaria
epidemic process.
Methods
In the study we included 122 patients with malaria,
hospitalized in the Toma Ciorbă Clinical Infectious
Diseases Hospital. The analysis parameters were:
age, sex, clinical manifestation, therapy.
Results
The results of this study showed that there is a
predominance of malaria in males- 94% cases,
people aged from 40 to 60 years- 62%. Among
those aged 20-40 years malaria occurs in 36%
cases. All cases of malaria were imported, 80% of
whom traveled to Sudan. 59% of patients received
chemoprophylaxis with mefloquine for the period
of their stay in endemic area. Most cases were
actively detected through examination of the
patients on their return to Moldova. In most cases
(95%) patients were diagnosed malaria caused by
P. falciparum. The P. vivax and P. ovale malaria
infections were rarely encountered (2% and 3%
respectively). Malaria evolved with mild severity in
67% cases and had a medium severity in 29.5%
patients. The most common symptom was fever in
64% of cases with a various frequency of other
symptoms: chills, sweating, headache, general
weakness, fatigue, hepatosplenomegaly. Blood
samples revealed leukocytosis in 37% patients and
accelerated sedimentation rate in 36% with
moderate changes in liver function tests, increased
alanine transaminase and total bilirubin in 23% and
26% patients accordingly. The diagnosis of malaria
was confirmed by parasitological method with
minimal parasitemia in most patients (93%) and
moderate parasitemia (++) only in 7% patients.
Treatment was effective in monotherapy with
artemisin derivatives in 33.6% cases and two
antimalarials were required in 65.6% patients. Only
0.8% patients required a second course of treatment
related to persistent parasitemia.
Conclusions
Among 122 patients in our survey prevailed mild
and medium forms of imported malaria, determined
by P. falciparum coming from Africa; 59% of the
cases received the chemoprophylaxis. Clinical
signs were suggestive in 64% of patients while
36% of patients were afebrile with minor clinical
symptoms. The diagnosis was confirmed in all
patients by parasitological method, with the
prevalence of minimal parasitemia. Treatment was
effective in all cases and only 0.8% required a
repeated course of treatment.
Genetic characterization of Cryptosporidium
spp. infections in humans in Romania
Ionela Mirela Neagoe1,2*, Lidia Lazar2,3, Andreea
Toderan4
*[email protected]
1
Cantacuzino National Institute for Research and
Development for Microbiology and Immunology,
Bucharest, Romania
2
Carol Davila University of Medicine and
Pharmacy, Bucharest, Romania
3
Colentina Universitary Hospital, Bucharest,
Romania
4
Clinical Hospital of Infectious and Tropical
Diseases “Dr. Victor Babeș”, Bucharest, Romania
Background
Cryptosporidium infection is a worldwide parasitic
cause of diarrhea in both immunocompromised and
immunocompetent patients, being firstly identified
in 1985 in Romania. However, the genetic
Cryptosporidium profile, especially in developing
countries, is still poorly known. The aim of the
present study was to establish the
genotypes/species and subtypes of
Cryptosporidium among hospitalized Romanian
patients with diarrhea enteritis and their clinicoepidemiological significance.
Methods
During 2006-2011 period, stool specimens from
1940 Romanian patients with digestive complains,
admitted in three clinical hospitals from Bucharest,
have been collected. Diagnosis was carried out by
microscopic detection of Cryptosporidium oocysts
using acid fast staining and enzyme immunoassay
testing for specific antigens. The molecular
characterization of the genotypes/species of
Cryptosporidium was conducted using PCR with
subsequent restriction fragment length
polymorphism (RFLP) analysis of the small
subunit rRNA gene (SSU rRNA). Subtyping was
performed by PCR targeting the 60kDa
glycoprotein gene (gp60) and sequence analysis.
Results
An overall of 49 (2.52%) human cryptosporidiosis
cases were detected and a subset of thirty-six
isolates of Cryptosporidium were submitted for
DNA typing. Based on the combined genotyping,
two species of Cryptosporidium were identified
belonging to C. parvum and C. hominis in 20
(56%) and 16 (14%) of the isolates, respectively.
Sequence analysis of the polymorphic gp60 gene
revealed five subtype families, two C. parvum (IIa
and IId) and three C. hominis (Ia, Ib and Id). In the
allele family IId, the sequence polymorphism was
higher by detecting at least three different genetic
48
variants. The most cases were reported for the
subtype families Ib and IId (ratio 11:13). Subtypes
IIdA16G1 and IIdA22G1a identified in this study
exhibited a 100% homology with sequences of
isolates derived from infected calves, lambs and
goats. Among C. hominis allele families, the
subtype IbA10G2 was commonly detected. The
subtypes of C. hominis reported in this study were
never identified previously in Romania.
Conclusions
This study showed that C. parvum infections are
slightly dominant and subtype families Ib and IId
are more common among the Romanian
investigated patients. Close phylogenetic
relationship between certain C. parvum subtypes
suggest a potential zoonotic transmission and
support further research work.
Second-line treatment effectiveness for HIVinfected patients failing first-line therapy in the
Republic of Moldova
Pavel Micsanschi1*, Tiberiu Holban1,2, Constantin
Spînu1,2, Ina Bîstrițchi1, Angela Nagîț3, Svetlana
Popovici3
*[email protected]
1
Faculty for Continuing Medical Education,
Nicolae Testemițanu State Medical and Pharmacy
University, Chișinău, Republic of Moldova
2
National Public Health Center, Republic of
Moldova
3
Hospital of Dermatovenerology and
Communicable Diseases, Chișinău, Republic of
Moldova
Background
The emergence of drug resistance is a major threat
in effectiveness of antiretroviral treatment both
globally and in the Republic of Moldova. Recently
we can observe an increasing number of patients
who need a second-line antiretroviral therapy after
failure of first-line treatment among HIV-infected
persons. We performed a critical assessment of the
outcomes of second-line antiretroviral therapy are
particularly relevant in settings where monitoring
strategies may be inadequate.
Methods
In this study we included 34 patients who
corresponded with the immunological and clinical
criteria for antiretroviral treatment failure and were
initiated on second-line therapy (tenofovir/
abacavir /zidovudine/ emtricitabine/ lamivudine/
lopinavir/ ritonavir) in 2011-2015. Included
patients were aged between 23-69 years (38.7±0.3
years). Second-line antiretroviral treatment was
defined for individuals who either failed first-line
antiretroviral therapy (HIV RNA viral load
measurement >400 copies/mL after 5 months).
Results
At the initiation of second-line antiretroviral
treatment approximately 2/3 of patients had viral
load >100,000 copies/mL. All the 34 patients who
were confirmed with failure of first-line
antiretroviral therapy were initiated the second-line
treatment. After that, 30 patients had HIV RNA <
25 copies/mL at 5 months from the initiation of
therapy but four of them responded more difficult
to treatment. Out of all patients included in the
study, 28 patients were detected with CD4 counts
<350 cells/cmm, out of which 20 patients were
detected with CD4 counts <200 cells/cmm and 8
patients of them were detected with CD4 counts
<50 cells/cmm that is associated with increased risk
for morbidity or death. The duration from initiation
of first-line antiretroviral treatment until failure and
initiation second-line antiretroviral therapy was
also significantly different for each patient but the
median time was 4.14 years (interquartile range: 110 years).
Conclusions
In spite of the fact that the majority of patients with
HIV and treatment failure had viral load >100,000
copies/mL and the average CD4 cell count was
201.61 cells/cmm, second-line antiretroviral
treatment was successful. Our study outcomes
support the need for early identification of first-line
treatment failure to improve second-line ART
outcomes.
Chlamydia pneumoniae infection – atypical
manifestations
Nicoleta Negrut1*
*[email protected]
1
Faculty of Medicine and Pharmacy, University of
Oradea, Romania
Background: Chlamydia pneumoniae is an
intracellular Gram negative bacterium that causes
acute respiratory disease. Clinical manifestations of
infection can be mild or asymptomatic, but it may
be more severe in adults.
Case report
A 60 year-old patient presented fever, headache,
vomiting, abdominal upper right quadrant pain. The
physical examination revealed hepatomegaly and
pulmonary rales. Paraclinical: inflammatory
syndrome, elevated liver enzymes, normochromic
normocytic anemia, thrombocytosis, Chlamydia
pneumoniae IgM = 1.5 (positive), IgG = 20 AU/mL
49
(negative) – ELISA test. Chest radiography showed
an infiltrate located in the pulmonary right lower
lobe. Under antibiotics, hepatoprotective and antiinflammatory drugs complete resolution of the
clinical manifestation appeared in one week.
Correction of the liver enzymes, anemia and
thrombocytosis remitted in three weeks.
Conclusions
Hepatitis and thrombocytosis are rare
complications of Chlamydia pneumoniae infection.
Prevention of recurrent Clostridium difficile
infection
Nicoleta Negrut1*
*[email protected]
1
Faculty of Medicine and Pharmacy, University of
Oradea, Romania
Background
Recurrence of Clostridium difficile disease (CDD)
can appear in 20% of the correct treated cases.
Methods
The aim of the study was to determine recurrences
of active CDD, in the first 90 days after initial
episode. Inulin (10 g daily) was given to the
patients in the study group, for a period of 90 days,
after initial treatment with Vancomycin
/Metronidazole. The program IBM SPSS statistics
version 22 was used for analysis of the data.
Results
During 1 year (01.03.2014-01.03.2015), 67 patients
with CDD were enrolled in the study. In the first 90
days of the initial episode of CDD, diarrhea
recurred in 11.76% (4) of the cases in the study
group (n = 33) and 32% (11) of patients in the
control group (n = 34) (p = 0.048, chi-square test).
Conclusions
Treatment with prebiotics may decrease the number
of relapses in the case of CDD.
Circulating HPV genotypes in Romania
Oana Săndulescu1,2*, Cristina Vasiliu1,3, Simona
Elena Albu1,3, Anca Streinu-Cercel1,2, Irina
Hanganu1, Adrian Streinu-Cercel1,2
*[email protected]
1
Carol Davila University of Medicine and
Pharmacy, Bucharest, Romania
2
National Institute for Infectious Diseases "Prof.
Dr. Matei Balș", Bucharest, Romania
3
Department of Obstetrics and Gynecology,
University Emergency Hospital of Bucharest,
Romania
Background
Infections with human papillomavirus (HPV) are
often subclinical but associate a potentially high
risk for development of cervical cancer. Given the
advent of effective vaccines, we considered it
important to perform HPV genotyping in a subset
of female patients monitored in the Department of
Obstetrics and Gynecology, University Emergency
Hospital of Bucharest, Romania.
Methods
We performed HPV genotyping through
polymerase chain reaction in 33 female patients
positive for HPV cervical infection. In parallel,
epidemiological data was collected and colposcopy
and Pap smear were performed in the University
Emergency Hospital of Bucharest.
Results
The mean age and standard deviation were
36.6±8.9 years, and five of the patients (15.2%)
were postmenopausal. Eight of them (24.2%) had
infection with low-risk strains, 21 (63.6%) with
high-risk strains, and 5 (15.2%) with strains that
were not classified into these two categories. HPV
genotype 16 was present in 10 cases (30.3%) while
genotype 18 was identified in 2 cases (6.1%).
Seven of the patients (21.2%) had concomitant
infection with multiple (2, 3, or 4) HPV strains.
High-risk and low-risk HPV strains were identified
in similar proportions in patients below 30 years
old (6/9, 66.7% high-risk and 4/9, 44.4% low-risk)
compared with patients above 45 years old (4/6,
66.7% high-risk and 2/6, 33.3% low-risk), p=1.000
for both comparisons. Colposcopy results were
computed into high Swede scores (5-8) and high
Reid colposcopic index (5-8) in 8 cases (24.2%).
Only 3 of the patients (9.1%) had no cellular atypia
on Pap smear, 4 (12.1%) had inflammatory
changes, 13 (39.4%) had atypical squamous cells of
undetermined significance (ASCUS), 9 (27.3%)
had low-grade squamous intraepithelial lesions
(LSIL) and 4 (12.1%) had HSIL (high-grade
squamous intraepithelial lesions). All patients with
inflammatory changes or with HSIL on Pap smear
had infection with high-risk HPV strains (p=0.375)
but not with low-risk HPV strains (p=0.407).
Conclusions
The relatively small sample size in this study did
not allow the identification of statistically
significant differences in colposcopy or Pap smear
results according to HPV genotype, but we have
identified an important prevalence of high-risk
HPV strains in female patients, suggesting the need
for further testing, counselling, and vaccination in
the female population.
50
Physico-mathematical modeling elements,
retrospective and prospective, for formulating
some epidemiological considerations on HIV AIDS in Constanta, Romania
Iulia Gabriela Serban1*, Liviu Serban2
*[email protected]
Clinical Infectious Diseases Hospital of Constanța,
Romania
2
BMW, Munchen, Germany
1
Background
1. The Epidemiology offer great potential to
algorithm, physico-mathematical modeling,
statistical interpretations. 2. The physicist’s role in
the multidisciplinary team, in physicomathematical-statistical modeling, algorithmic,
epidemiological, qualitative interpretation,
phenomenological, physical and philosophical,
mathematical results obtained, is important!
Methods
We conducted three studies on epidemiological
elements of HIV- AIDS in Constanta County comparing the periods: 1987-1993, 2008-2012 and
the first 6 months of 2013. We had associated, on
factorial mode, certain epidemiological categories
and we calculated, statistically and mathematically,
various sizes. We have interpreted the qualitative
results.
Results
Establish the working algorithms, mathematicalphysical models that find their echo in
epidemiology. It is fundamental the thinking
specialized in physics, expressed by mathematical
algorithms, with qualitative interpretation and
application in epidemiology, the study design
choice. First study: V=96.40% - variability of the
lot, 1987-1989 subgroup homogenous (V = 3o%).
1987-1989 cohort (N = 1438), the average degree
of dispersion (sigma-0.7722953), Pearson's
coefficient of variation of 31.86694%. OR =
99.76471 exposed, unexposed OR = 4, OR =
24.94118> 1. The exposure is a risk factor.
Sensitivity = 98.148%, specificity = 32%. Second
study: increasing the number of survivors is found
with Mantel Haenzel method, estimate Odds Ratio
(OR = 0.08829). Third study - Reduced number of
patients of this study not allow formal conclusions.
We are in a retrospective modeling phase, focused
on past -epidemiological events, with highlighting
interpretations on causation.
Conclusions
1. The importance of using prospective modeling,
foresight, to foreshadow the expected impact clinical medical, economic, social,
epidemiological. Role in the correct collection of
epidemiological data and the development of a
specific model focused on Constanta geographic
region. 2. Future advances in environmental quality
management, hospital especially, with applications
for measures of organization and epidemiological
isolation. The strategic decisions on short and long
term increases the quality of medical act and public
health, the favorable impact on social and the
economic benefits (reduced medical costs). 3. The
need to use predictive models and mathematical physical projection in epidemiology, useful in
collecting data, understanding of disease
transmission, in interpreting trends observed, in
assessing the impact of specific interventions, in
strategies for disease prevention planning. 4. The
physico-mathematical modeling elements,
retrospective and prospective, are important to
formulate epidemiological considerations on HIV AIDS in Constanta, Romania.
The usefulness of metronidazole for the
treatment of non-severe Clostridium difficile
infection (CDI)
Gabriel Adrian Popescu1,2*, Alice Atomoaie1,
Florentina Paraschiv1, Daniela Bunescu1, Madalina
Simoiu1, Adrian Abagiu1, Georgeta Preda1, Florin
Duna1
*[email protected]
1
National Institute for Infectious Diseases "Prof.
Dr. Matei Balș", Bucharest, Romania
2
Carol Davila University of Medicine and
Pharmacy, Bucharest, Romania
Background
A few antibiotics are used for CDI treatment; oral
metronidazole remains in the very recent ESCMID,
ACG and Romanian guidelines the preferred
treatment for non-severe initial disease and,
controversial, for the first recurrence of CDI.
However, it is a concern about decreased clinical
efficacy of metronidazole for CDI, possibly related
to emergence of more resistant strains of
Clostridium difficile; the aim of our study was to
evaluate the efficacy of oral metronidazole in a
patient population with high prevalence of C.
difficile ribotype 027.
Methods
We analysed the record files of patients admitted
with CDI in the 6th Department of Infectious
Diseases of NIID Matei Balș from January through
June 2015. The patients were stratified according to
severity of disease and the rank of the CDI episode
(initial, first or multiple recurrences). Severity
assessment included comorbidities, creatinine
blood level and ATLAS score. The relation between
outcome and antibiotic treatment was analysed for
51
non-severe initial disease or first recurrence of
CDI.
Results
Fifty-four patients were admitted for CDI during
the study period. The diagnosis of non-severe
initial CDI was established for 19 patients and 11
patients had a non-severe first recurrence; other 24
patients were diagnosed with severe CDI (n=21) or
multiple recurrences (n=3). The treatment for nonsevere initial disease or first recurrence patients
included oral metronidazole (n=15) and oral
vancomycin as first option or after metronidazole
discontinuation (n=17, one patient with
metronidazole failure and another with
metronidazole side effects). The treatment with
metronidazole and vancomycin resulted in clinical
cure obtained in 86.7% CI95% (62.1; 96.3) and
93.8% CI95% (71.7; 98.9), respectively (p= .51).
The time to diarrhoea resolution was 5.69 ±1.14
days in metronidazole group and 5.53±1.33 days in
vancomycin group (p=.85) No statistical
differences were registered in comorbidities or
mean age (57.3 ± 20.3 years – metronidazole group
vs. 59.3±23.2 years – vancomycin group); the only
significant difference was the preference for
vancomycin in first recurrence CDI (10 cases with
vancomycin versus one patient with
metronidazole).
Conclusions
Our findings suggest that metronidazole retains the
efficacy for the treatment of non-severe CDI, at
least for the initial disease.
Profile of critically ill patient with infectious
disease
Irina Niculescu1,2*, Florentina Dumitrescu1,2, Livia
Dragonu1,2, Andreea Cristina Stoian1, Lucian
Giubelan1,2, Augustin Cupsa1,2, Iulian
Diaconescu1,2, Dan Hurezeanu1,2, Mirela Ciucu2
*[email protected]
1
University of Medicine and Pharmacy Craiova,
Romania
2
“Victor Babeș” Clinical Hospital of Infectious
Diseases and Pneumology, Craiova, Romania
Background
Infectious diseases (ID) are a major cause of death
worldwide; acute pneumonia is an important cause
of morbidity and mortality, occupying the 3rd
position after myocardial infarction and stroke;
severe sepsis and septic shock, infection-induced
syndromes have an increasing incidence and high
mortality requiring a rapid diagnosis and an
appropriate therapeutic attitude. Objectives: to
establish the profile of critically ill patient with ID.
Methods
Retrospective study (January-June 2014) on 2437
patients hospitalized in Infectious Diseases Clinics
of "Victor Babes" Hospital Craiova. The case
definition of critically ill patient with ID was as
follows: patients having at least one of: organ
failure, severe sepsis, septic shock, or severe
pneumonia (CURB-65≥4).
Results
We identified 153 critically ill patients with ID.
General data of the study lot: the median age was
67 (IQR: 16-95) years, sex ratio M:F=0.91, with a
slight predominance of rural patients (52.94%). The
repartition of study lot by age groups was: over 65
years old-52.94% of patients, between 45-65 years
old-24.18%, under 35 years old-18.30% and
between 35-45 years old-4.57%. Other associated
conditions was identified in 86.93% of patients
(one or combinations) as follows: chronic
cardiovascular diseases-41.01% of patients,
pulmonary-10.60%, renal-10.14%, liver-9.22%,
diabetes-8.76%, HIV infection-5.53%, cancer5.99%, alcoholism-4.61%, neuropsychiatric-3.68%,
pregnancy-0.46. ID was: pulmonary infections
(67.32%), gastrointestinal (19.61%), liver (3.92%),
renal (3.92%), neurological (2.61%), skin and soft
tissue (1.96%), cardiovascular (0.65%). The
etiology has been identified in 28.11% of cases, as
follows: gram-positive cocci (27.91%), gramnegative bacilli (25.58%), Mycobacterium
tuberculosis (23.26%), hepatitis B virus (11.63%),
Clostridium difficile (9.30%), Toxoplasma gondii
(2.32). The distribution of patients by case
definition of critically ill patients with ID was:
organ failure-51.63%, severe sepsis 36.60%, severe
pneumonia (CURB-65≥4)-6.54% and septic shock5.23%. Deaths were recorded in 3.92%,
unfavorable outcome-in 18.30% (transferred to
intensive care units).
Conclusions
The profile of critically ill patients with ID is as
follows: elderly patient associated comorbidities,
most commonly chronic cardiovascular diseases,
presenting most frequently pulmonary or
gastrointestinal infection caused by gram-positive
cocci or gram-negative bacilli and most often
developing organ failure or severe sepsis with poor
prognosis.
The clinical and paraclinical peculiarities of
patients with Lyme disease treated in “Toma
Ciorbă” Infectious Disease Hospital
Ion Chiriac1*, Tiberiu Holban2
*[email protected]
52
1
Toma Ciorbă Clinical Hospital for Infectious
Diseases, Chișinău, Republic of Moldova
2
State Medical and Pharmaceutical University
“Nicolae Testemiţanu”, Chișinău, Republic of
Moldova
very important point in informing general
practitioners, cardiologists, rheumatologists and
dermatologists of the possibility of first LD
presentation as illnesses treated by them.
Background
As Lyme disease (LD) is becoming more frequent
worldwide, climate changes and broad openings are
all together contributing to increasing number of
Lyme disease (LD) cases in the Republic of
Moldova. There are a lot of controversies about
chronic LD diagnosis and length of treatment. This
disease has a huge burden on most national health
services.
Methods
We analyzed the clinical and paraclinical
peculiarities, evolution, treatment and outcomes in
39 patients suffering from acute LD in the Clinic of
Infectious Disease ”T.Ciorbă”, Chișinău, Republic
of Moldova. The diagnosis was established based
on presenting clinical data, epidemiological
findings and was confirmed by ELISA serology lab
detecting anti Borrelia burgdorferi (Bb) IgM
antibodies within 22-28 days interval from tick
bite.
Results
In the study group, 24 patients were women and 36
men with the age ranging from 15 to 60 years - on
average 38.5 years of age. In 37 the tick bite was
present prior to the disease start. Among women
the interval from tick lesion until first symptoms
(incubation period) was 13.42 days whereas in men
it was 14.5 days. The most commonly noticed
symptom was erythema migrans (EM) in 66%
cases, followed by arthralgia and myalgia in 64%,
local burning sensations in 58%, headache in 46%
and fever in 30% of cases accordingly. EM
syndrome and joint pain was more frequently
presented by women than men. Only 3 patients had
minor abnormalities in liver function tests. Among
39 analyzed patients in 25 (64.1%) the diagnosis
was confirmed by detecting IgM anti-Bb. Patients
were hospitalized for a 12.3 days period in average
for men and 10.6 days - for women. For the
treatment we used ceftriaxone 1g, i/v BD or
doxycycline 100 mg BD given orally for 12 days.
In all cases treatment proved to be effective and the
outcomes favorable.
Conclusions
The highest incidence of LD was in May and July
and the infection was more common among women
– in 61% cases. EM primary lesion was noticed in
66% cases, arthralgia and myalgia in 64% cases,
local burning sensations in 58%, headache in 46%
and fever in 30% cases. There is a necessity of
enhancing antiepidemic measures and possibly
including LD in notified diseases list. There is a
The antimicrobial resistance of Staphylococcus
aureus strains isolated in Matei Bals Institute
Cristina Popescu1,2, Anca Leustean1*, Carmen
Dragu2, Alexandru Rafila1,2, Olga Dorobat1,
Daniela Talapan1,2, Mona Popoiu1, Alina
Lobodan1,2, Raluca Mihailescu1, Catalin Tiliscan1,2,
Mihaela Radulescu1,2, Gabriel -Adrian Popescu1,2,
Iulia Caragea1, Constanta Zamfirache1, Adriana
Manea1, Victoria Arama1,2
*[email protected]
1
National Institute for Infectious Diseases "Prof.
Dr. Matei Balș", Bucharest, Romania
2
Carol Davila University of Medicine and
Pharmacy, Bucharest, Romania
Background
The antimicrobial resistance of Staphylococcus
aureus (SA) increased in the last years. Romania is
one of the European countries with high incidence
of methicillin resistant SA (MRSA). The local
epidemiological data regarding antimicrobial
resistance are very important in order to make a
correct empirical therapy. Objectives: 1.To evaluate
the antimicrobial resistance of SA and to establish
which therapeutic options remain active in SA
infections; 2.To evaluate the trend of SA resistance.
Methods
We made a retrospective analysis of SA strains
isolated in Matei Bals Institute in 2013. We
compare the data with the results of a previous
study (MART study, 2008-2010).
Results
In 2013 were isolated 371 strains of SA: 57% from
skin/ soft tissue infections (SSTI), 23% from blood
culture (BC), 9% from respiratory tract infections
(RTI) and 11% from other foci. MRSA prevalence
was 51%. The resistance level of SA strains was:
30.1% for clindamycin, 53.2% for macrolides,
21.7% for rifampin, 19% for fluoroquinolones,
54.3% for cyclines, 25% for gentamycin, 0.8% for
trimethoprim/sulfamethoxazole. There were no
isolated resistant strains of SA for vancomycin and
linezolid. Resistance level was different according
to the site of the infection. From SSTI the level of
MRSA was 53.4%, higher than BC (46.8%) or RTI
(50%). The resistance to macrolides was: 47.4% for
BC, 53.3% for RTI and 56.5% for SSTI. The
resistance to clindamycin was: 51.3% for BC,
significantly higher than SSTI -23.2% or RTI –
53
16.7%. The same situation was recorded for
rifampin: 34.6% resistance for BC versus 24.1%
for RTI and 15.3% for SSTI. The fluoroquinolones
resistance was higher for the strains isolated from
RTI (26.7%) versus BC (13%) and SSTI (20%). We
also recorded a high level of resistance for
cyclines: 49.4% for blood culture, 53.3% for RTI
and 56.5% for SSTI. Comparing to 2008-2010
period, The resistance level increased for all
antimicrobials: for oxacillin from 36.3% to 51%,
for doxycycline from 47.3% to 54.3%, for
clindamycin from 12% to 30.1%, for rifampin from
12.4% to 21.7% and for fluoroquinolones from
8.5% to 13.9%.
Conclusions:
Glycopeptides, linezolid and
trimethoprim/sulfamethoxazole remain very active
against SA and might be used as empirical therapy
in SA severe infection. The antimicrobial resistance
level of SA increased for all other tested
antimicrobials. More than half of SA strains were
MRSA. We also found a high level of resistance to
macrolides and cyclines (>50%). This worrying
situation became a real public health problem.
Tigecycline in the treatment of Clostridium
difficile associated diarrhea
Eliza Manea1*, Irina Lapadat1, Serban Benea1,2,
Ruxandra Moroti1,2, Raluca Jipa1, Irina Panait1,
Sorinela Diaconu1,2, Adriana Hristea1,2
*[email protected]
1
National Institute for Infectious Diseases "Prof.
Dr. Matei Balș", Bucharest, Romania
2
Carol Davila University of Medicine and
Pharmacy, Bucharest, Romania
Background
The incidence and severity of Clostridium difficile
(CD) infections have increased over the past
decade. Tigecycline is a broad spectrum antibiotic,
active against a number of drug-resistant organisms
and it has also shown in vitro activity against CD.
Our aim was to analyze the differences between
patients with CD associated diarrhea (CDAD)
treated with tigecycline, in monotherapy or in
association with oral vancomycin versus those
treated with vancomycin.
Methods
We performed a retrospective cohort study on
adults admitted in our institution between
September 2014-February 2015 for CDAD. We
included the patients in whom all data were
available to calculate the Atlas severity score and
those who received at least 3 days of tigecycline.
Results
We identified a total of 167 CDAD episodes in 150
patients. Thirty five (23%) patients received
tigecycline (group 1) and the median duration of
treatment with tigecycline was 9 days (IQR=6-13).
The 115 patients treated with vancomycin only
(group 2) had a median duration of treatment of 13
days (IQR=8-16). Median age 69 years) for both
groups and gender distribution, 15 (43%) male in
group 1 and 45 (47%) in group 2 were similar. A
concomitant systemic infection was identified in 19
(54%) patients in group 1 versus 39 (30%) patients
in group 2 (p=0.006, OR=2.83, 95%CI=1.32-6.07).
Forty six (28%) patients had recurrences of CDAD,
without significant association between the two
groups: 9 (26%) in tigecycline group versus 37
(32%) in vancomycin group (p=0.78). During the
study period we noted 17 relapses and 5 (41%) of
the patients with recurrences received tigecycline
versus 30 (22%) of the patients without
recurrences. The median Atlas severity score was 4
(IQR: 3-5) for the patients in group 1 versus 3
(IQR=2-4) for patients in group 2 (p<0.001). The
median length of hospitalization was 17 days
(IQR=12-23) in tigecycline group versus 14 days
(IQR=9-17) in vancomycin group, without
significant difference between the two groups. We
noted a favorable outcome in 28 (80%) in group 1
vs 121 (92%) in group 2 (p=0.048, OR=0.36,
95%CI=0.13-1.02).
Conclusions
Tigecycline was used in patients with more severe
forms of CDAD (a higher Atlas severity score).
These patients, due to the severity of the disease,
had a poorer outcome. Most patients in group 1 had
another concomitant systemic infection. The
relapse rate of CDAD did not differ between the
two groups. The use of tigecycline did not prevent
the recurrences.
The antimicrobial resistance of Pseudomonas
aeruginosa strains isolated in “Matei Bals”
Institute
Cristina Popescu1,2*, Loredana Tutuianu2,
Alexandru Rafila1,2, Olga Dorobat1, Ioana Badicut1,
Smaranda Botea1, Alina Borcan1,2, Alina Orfanu1,2,
Anca Leustean1, Daniela Munteanu1, Raluca
Nastase1, Violeta Moagic1, Catalin Tiliscan1,2,
Mihaela Radulescu1,2, Mirela Dinu1, Raluca
Popescu1, Doina Cristea1, Gabriel-Adrian
Popescu1,2, Victoria Arama1,2
*[email protected]
1
National Institute for Infectious Diseases "Prof.
Dr. Matei Balș", Bucharest, Romania
54
2
Carol Davila University of Medicine and
Pharmacy, Bucharest, Romania
Background: Pseudomonas aeruginosa (PA)
antimicrobial resistance represents a serious
problem of public health. Antimicrobial
stewardship programs which can improve the
patients’ outcome need a good understanding of
local epidemiology of antimicrobial susceptibility.
Mortality rate in Pseudomonas aeruginosa
infections depends on appropriateness of empiric
antimicrobial therapy Objectives: to evaluate the
antimicrobial resistance of PA strains isolated in
our laboratory and to evaluate the trend of
resistance between 2008 and 2013
Methods
Retrospective analysis of antimicrobial resistance
of PA strains isolated in 2013 in Matei Bals
microbiological laboratory. The data were
compared with the resistance reported in MART
study during 2008-2010.
Results
In 2013 237 strains of PA were isolated: 38.8%
from skin and soft tissue infections (SSTI), 32.1%
from urine, 15.2% from respiratory tract infections
(RTI), 9.7% from ocular and ear secretions and
4.2% from blood (by blood culture). Overall, the
level of PA resistance was more than 50% for the
majority of antimicrobials: piperacillin-tazobactam
– 54.6%, ticarcillin-clavulanate – 79.4%,
ceftazidime – 52.9%, cefepime – 56.2%,
fluoroquinolones – 52.7%, fosfomycin – 76.4%.
Only the resistance to colistin (1.5%), antipseudomonas aminoglycosides (45.5%) and
carbapenems (44% for imipenem and 39.5% for
meropenem) were below 50%. The resistance to
aminoglycosides was 20% for PA isolated from
blood culture, 41.6% for PA isolated from SSTI and
65% for PA isolated from urine culture. The
resistance to cephalosporins was 30% for PA
isolated from blood culture, 53% for PA isolated
from SSTI and 64.45% for PA isolated from urine
culture. The resistance to carbapenems was 35.2%
for PA isolated from SSTI, 45% for blood culture
and 53.3% for urine culture. The trend of PA
resistance between 2008-2010 and 2013 was: for
piperacillin-tazobactam from 45.8% to 54.6%, for
cephalosporins from 48.3% to 52.9%, for
imipenem from 43.4% to 44.1%, for meropenem
from 55.8% to 39.5%, for amikacin from 39.1% to
45.3%, for fluoroquinolones from 55.7% to 52.7%
and for colistin from 3% to 1.5%.
Conclusions
1. For the majority of antimicrobials the PA
resistance increased. 2. For fluoroquinolones and
meropenem the PA resistance decreased (after a
stewardship program introduced in Matei Bals
Institute in 2012). 3. The level of resistance was
very high for the majority of antimicrobials. Only
colistin remains a good option in infections with
PA.
Persistent pruritic dermatitis in an HIV-infected
late presenter patient
Iosif Marincu1*, Patricia Poptelecan1, Valeria
Bică1, Livius Tirnea1, Rodica Lighezan1
*[email protected]
Dr. Victor Babeş University of Medicine and
Pharmacy, Timişoara, Romania
1
Background
The persistent cutaneous modifications that are
resistant at the dermatological therapy can be an
important clue in the detection of an undiagnosed
HIV infection. We present the case of a patient with
generalized and persistent pruritic dermatitis that
evolved in the background of a HIV infection.
Case report
The patient is a 34 years from the rural area,
unmarried, that presented unspecific cutaneous
modifications with tendency to extend, and
resistant pruritus at the prescribed medication. The
patient interrupted his studies in the VIIIth grade
and he is employed as an unqualified worker in a
company that produces cables. He remained
without his parents at the age of 14, he is living
with a male partner for almost 3 years. In the last
months, the cutaneous maculo-papular
erythematous-congestive lesions extended on the
face, upper limbs, chest, abdomen, buttocks and
lower limbs, accompanied by upsetting pruritus.
The patient was admitted in the DermatoVenerology Clinic in Timisoara. The blood tests
performed raised the suspicion of HIV infection,
and the patient was sent in the Clinic of Infectious
Diseases for further investigations. The positive
diagnosis was established based on clinical
elements (nonspecific generalized pruritic and
persistent cutaneous rash, weight loss, anorexia,
asthenia). The physical examination data (macules,
erythematous-congestive papules with cutaneous
lesions due to the scratching, whitish persistent
deposits on the tongue, enlarged and painless
laterocervical, axillar and groin lymph-nodes),
accompanied with the laboratory data (the
leukocyte count (WBC), erythrocyte sedimentation
rate (ESR), C reactive protein (CRP), fibrinogen,
lingual swabs, ELISA test for HIV Ab, Western
blot test, viral load (VL), CD4 count, etc.). From
the blood tests we highlight: WBC=14340/µL,
ESR=100 mm/1h, CRP=43.23 mg/L,
Fibrinogen=6.27 mg%. The chest radiography and
55
the electrocardiogram were normal. The culture of
the lingual swab using Sabouraud medium isolated
Candida albicans. The results of the virological
and immunological tests (HIV Ab=positive,
Western blot HIV test positive, VL=153,234
copies/mL, CD4=7 cell/µL) allowed the diagnosis
of AIDS, stage C3. The patient had multiple male
sexual partners, accepting the status of men having
sex with men. All formalities were made in order to
declare the case and establish the antiretroviral
therapy. The patient's current partner was also
confirmed with HIV infection.
Conclusions
The presence of unspecific cutaneous lesions that
are difficult to classify for a definite diagnosis
require an effective interdisciplinary collaboration
in order to detect as early as possible the patients
with HIV.
The fatal evolution of a patient with A/H1N1 flu
and recently diagnosed HIV infection
Iosif Marincu1*, Patricia Poptelecan1, Valeria
Bică1, Livius Tirnea1, Rodica Lighezan1
*[email protected]
Dr. Victor Babeş Clinical Hospital of Infectious
Diseases and Pneumology, Timişoara, Romania
1
Background
Immunocompromised patients are people at highrisk for the viral infections. We present the case of
a patient with A/H1N1 flu, complicated with
bronchopneumonia and severe acute respiratory
failure on the background of a newly diagnosed
HIV infection.
Case report
A 26 years old female patient, living in the rural
area, married, was admitted in the Intensive Care
Unit from the Infectious Diseases Clinic Timisoara
presenting fever, sweats, dyspnea at rest and dry
cough. The positive diagnosis was established
based on the clinical elements (fever, weight loss,
cough, anorexia, asthenia), the physical
examination data (broncho-alveolar disseminated
rales, dyspnea, tachypnea), laboratory data
(leukocyte count (WBC), erythrocyte
sedimentation rate (ESR), C reactive protein
(CRP), fibrinogen, tongue swabs, throat swabs,
blood culture, sputum culture, ELISA test for HIV
Ab, Western blot test, PCR for influenza) and the
results of the paraclinical investigations (chest
radiography, fibrobronchoscopy). The assessment
of PCR was performed in the National Flu
Reference Centre Laboratory, Bucharest. From the
blood tests we highlight WBC=13240/µL, ESR=25
mm/1h, CRP=32.83 mg/L, Fibrinogen=3.77 mg%,
chest X-ray confirmed pneumonic lesions
disseminated on both lung areas, with tendency to
confluence. The RT-PCR test results confirmed the
presence of flu virus A/H1N1. The lingual swab
culture on Sabouraud medium isolated Candida
albicans. The fibrobronchoscopy revealed
bilaterally congested bronchial mucosa, and
infiltrated with mucous and puss deposits that can
be partially aspired after a lavage with saline. All
bronchi are permeable and with preserved ciliary
motility. After 3 hours from the admittance, the
patient requires endotracheal intubation and
mechanical ventilation (decreasing SpO2,
hypoxemia). After two days, the general condition
of the patient alters, the Astrup parameters indicate
severe hypoxemia with increasing CO2 and
respiratory acidosis. Under an intensive treatment
with Imipenem/cilastatine, Vancomycin,
Oseltamivir, Fluconazole, corticosteroids,
mucolytics, bronchodilators, analgesics,
antipyretics, diuretics, opioid and miorelaxants,
electrolyte and caloric rebalancing solutions, the
evolution was severe and the patient died.
Afterwards, the results of the biological lab tests
(HIV Ab positive, Western blot HIV positive) have
confirmed the HIV infection that until then was
undiagnosed. Subsequently, her husband was also
diagnosed with HIV infection.
Conclusions
Patients with HIV infection and flu may develop
severe complications, life-threatening, that require
rigorous clinical and therapeutical monitoring in
the specialized intensive care units.
Infectious endocarditis due to Streptococcus
anginosus in a patient with mitro-aortic
insufficiency and diabetes
Iuliana Alexandra Caramangiu1*, Ovidiu Rosca2,
Monica Cialma2, Sorina Mitrescu1, Oana Saceanu1,
Andreea Ardeleanu1, Iosif Marincu2
*[email protected]
Dr. Victor Babeş Clinical Hospital of Infectious
Diseases and Pneumology, Timişoara, Romania
2
Dr. Victor Babeş University of Medicine and
Pharmacy, Timişoara, Romania
1
Background
Patients with diabetes and mitro-aortic
insufficiency represent a risk group for developing
infectious endocarditis. We intend to approach a
clinical case of infectious endocarditis due to
Streptococcus anginosus, who presented a
56
favorable evolution, despite the complications that
occurred in the case of an infectious endocarditis.
Case report
We present the case of a 61 years patient, known
with newly diagnosed diabetes, hypertension,
rheumatic mitral insufficiency, rheumatic aortic
insufficiency, who was hospitalized in the Clinic of
Infectious Diseases “Victor Babes “ Hospital
Timisoara. Symptoms started two days before
admission, with malaise, fever (39°C), shiver,
nausea, skin rash on palms and plants with
erythematous patches form, conscious, respiratory
balanced, hemodynamic: Blood pressure=167/90
mmHg, heart rate=108 bpm. Based on the clinical
outcomes associated with biological samples
(number of leukocytes, erythrocyte sedimentation
rate (ESR), C reactive protein (CRP), serum
glucose, blood culture) and the results of laboratory
investigations (cardiac ultrasound) we established
diagnosis of endocarditis with Streptococcus
anginosus. During hospitalization, the patient
received treatment with: ceftriaxone1g, 2x2g/day
(36 days), ciprofloxacin 100 mg f, 2x4 f/day (3
days), then, levofloxacin 500 mL 1 fl/day (32
days), levofloxacin 250 mg, 1 tb/day (32 days),
paracetamol 100 mL 1 fl/day when required,
ranitidine f, 1 f/day, fraxiparine 0,4 mL, 2x1
syringe/day, infusion solutions with NaCl 0,9% 500
mL 1 fl/day, ringer solution 500 mL 1 fl/day and
insulin therapy according to the recommended
schedule. On admission we performed biological
investigations which revealed: marked leukocytosis
(21300/µL), increased ESR (95 mm/h),
hemoglobin=9.3 g/dL, CRP=121.49 mg/L,
glucose=218 mg/dL. Cardiac ultrasound revealed:
mitral regurgitation grade I/II, pseudotumoral mass
(vegetation) attached to the non-coronary cusp of
1/1.5 mm, mobile, aortic regurgitation grade III,
tricuspid regurgitation grade II. After treatment is
initiated, the patient became afebrile with good
general condition. Biological: L=9530/µL, ESR=75
mm/h, CRP=26.39 mg/L, serum glucose=126
mg/dL. Ultrasound revaluation states: little
vegetation remaining in the left aortic valve, aortic
regurgitation grade III with regurgitation process
85 mmHg, mitral regurgitation grade II, slightly
lower hypokinesia. It has solving surgical
indication about a year.
Conclusions
Detection of infectious endocarditis in diabetic
patients, requires therapeutic clinical monitoring
rigorous associated with interdisciplinary
collaboration with infectious disease specialists,
diabetologists and cardiologists.
Acute viral hepatitis E outside endemic areas
Nina-Ioana Șincu1,2*, Brîndușa Țilea1,2, Anca Meda
Georgescu1,2, Cristina Gîrbovan1,2, Erzsebet Iringo
Zaharia Kezdi1,2, Andrea Incze1,2, Magdolna Fejer2,
Andreea Bodea1,2, Lucia Carmen Chiriac1,2
*[email protected]
1
University of Medicine and Pharmacy Tîrgu
Mureș, Romania
2
Clinic of Infectious Diseases I Tirgu Mures,
County Clinical Hospital Mures, Romania
Background
Acute viral hepatitis E is most frequently
encountered in endemic areas in South-East Asia,
Africa and Central America, while sporadic cases
are also reported in European and North-American
countries, mostly in travelers returning from
endemic regions. The main route of infection is
fecal-oral transmission, by contaminated water,
food or other environment elements.
Case series
We analyze three cases of acute viral hepatitis E
registered in 2015 in Romanian patients with no
recent voyages to endemic areas for hepatitis E
virus infection. All patients have been hospitalized
in the Clinic of Infectious Diseases I Tirgu Mures,
Romania. All three patients – one male and two
female were adults: 33 – 51 years-old, from urban
area. All patients denied voyages outside Romania
during the previous 12 months, as well as contact
with a traveler returning from an endemic area for
hepatitis E virus infection. Two patients
represented an intra-familial infection (husband and
wife). All patients presented with digestive
symptoms: nausea, vomiting, loss of appetite,
followed by jaundice, emission of hyperchrome
urine and discolored stool. Laboratory analysis
revealed elevated liver enzymes 1700 – 3500 IU/L
and hyperbilirubinemia. Serological tests ruled out
acute viral hepatitis A, B and C – anti-hepatitis
virus A IgM antibodies, HBs antigen and antihepatitis C virus antibodies were all negative. Antihepatitis E virus IgM antibodies were positive,
establishing the diagnosis of acute viral hepatitis E.
One female patient developed a prolonged
cholestatic form. No patient developed severe
forms of illness. None of the two female patients
was pregnant, as risk factor for severe forms. All
patients received hepatotropic agents, symptomatic
therapy and rehydration, while being isolated in
hospital conditions. Clinical outcome was good in
all three cases, with clinical and biological
improvement within 2-3 weeks from onset. The
epidemiologic link could not be established in any
of these cases.
57
Conclusions
The appearance of acute viral hepatitis E cases
outside endemic areas, in patients with no
epidemiologic risk factors for this illness, should
raise a question mark regarding the real – possibly
underestimated – prevalence of this infection in our
country and its means of transmission.
Aspects of infection with Clostridium difficile in
children
Mirela Indries1*
Radiographic and laboratory findings in the
elderly with pulmonary tuberculosis
Madalina Irina Mitran1, Cristina Iulia Mitran1,
Mircea Tampa1,2, Simona Roxana Georgescu1,2,
Maria Isabela Sarbu1, Octavian Costin Ioghen2*,
Mircea Ioan Popa2
*[email protected]
1
Clinical Hospital of Infectious and Tropical
Diseases “Dr. Victor Babeș”, Bucharest, Romania
2
Carol Davila University of Medicine and
Pharmacy, Bucharest, Romania
*[email protected]
1
Faculty of Medicine and Pharmacy, University of
Oradea, Romania
2
Clinical Infectious Diseases Hospital of Oradea,
Romania
Background
The increasing prevalence of infections with
Clostridium difficile (ICD) in the last 4 years in our
country will inevitably increase morbidity in
children, although Clostridium difficile (CD)
colonizes more than 50% of children under 1 year.
The CDC estimates that annually there are about
17,000 ICD in children between 1 and 17 years,
with no differences between genders, most between
12 and 23 months. Objectives: This study sought to
assess ICD in children in our service and risk
factors of this condition in children.
Methods
This is a retrospective analysis of cases of
Clostridium difficile infection in children over a
period of 15 months, admitted to the Infectious
Diseases Section Oradea. We excluded all cases
where data were not sufficient to support the
diagnosis of ICD (CD toxin negative).
Results
During study period there were 113 cases of
patients with ICD. Of these, only 6.19% were
children aged 2 months to 10 years. Most of the
children had between 4-5 years. The main driver
remains and antibiotics in children, but more than
2/3 of children from the community ICD, unlike
adults where the ICD have 2/3 of nosocomial
aspect. Prematurity, artificial nutrition and anemia
were other factors in the case of a relapse in an
infant of two months.
Conclusions
In recent years there has been an upward trend in
the prevalence of ICD among children, mostly
between 1 and 4 years.
Background
Pulmonary tuberculosis (TB) is an important health
issue, in Romania. The elderly represent a group at
risk for TB often overlooked. Immunosenescence
leads to impairment of the immune response, which
increases the risk of latent TB reactivation. Even
more numerous studies have shown that elderly
patients present diagnostic and therapeutic
peculiarities.
Methods
We retrospectively analysed data on the
radiological appearance and laboratory findings for
70 patients aged ≥65 years, diagnosed with
pulmonary TB, from January 2009 to December
2011.
Results
Most patients included in the group were new TB
cases (91.4%). Radiologically the lesions were
most commonly located in the upper lung lobes
(right lobe 18.6%, left lobe 21.4%, both upper
lobes 14.3%). Extensive pulmonary lesions
involving the two lungs were noticed in 21.4% of
the patients. The caseous lesions were most
frequently seen (44.3%), followed by ulcerated
(41.4%) and cavitary (40.0%) lesions. Fibrosis was
identified in 12.9% of the patients. Acid-fast bacilli
(AFB) smear was negative in 22.9% of the cases. A
percentage of 12.9% of the patients received a
different diagnosis on admission. Laboratory
findings revealed leukocytosis (28.6%),
neutrophilia (37.1%), lymphopenia (60%) and
anemia (37.1%)
Conclusions
Radiographic findings in the elderly consisted of
extensive caseous, ulcerated and cavitary lesions.
Lymphopenia was the most common abnormality
of the blood count. The negative AFB smear,
frequently observed among elderly patients, may
lead to a delayed or mistaken diagnosis.
58
Resistance pattern of multi-drug resistant
strains of Mycobacterium tuberculosis
the recommendations regarding the TB prevention
and control is an absolute necessity.
Cristina Iulia Mitran1, Madalina Irina Mitran1,
Mircea Tampa1,2, Simona Roxana Georgescu1,2,
Maria Isabela Sarbu1, Mihaela Roxana Huhu2*,
Mircea Ioan Popa2
Severe form of varicella, complicated with acute
respiratory distress syndrome and
bronchopneumonia. Case presentation
*[email protected]
Csep Andrei Nicolae1*
1
Clinical Hospital of Infectious and Tropical
Diseases “Dr. Victor Babeș”, Bucharest, Romania
2
Carol Davila University of Medicine and
Pharmacy, Bucharest, Romania
Background
Multi-drug resistant tuberculosis (MDR-TB) is a
major concern in the medical community, its
incidence being on the rise. Knowledge about the
drug resistance pattern of Mycobacterium
tuberculosis strains plays an essential role in
prescribing an appropriate treatment, especially in
the absence of rapid techniques for the assessment
of resistance to anti-TB drugs.
Methods
We collected data regarding the susceptibility to
anti-TB drugs of 158 MDR strains of
Mycobacterium tuberculosis, isolated during 20092011. We analysed susceptibility to first and second
line anti-TB drugs (isoniazid INH, Rifampicin RIF,
Ethambutol EMB, Streptomycin SM, Ethionamide
ETH, Cycloserine CS, Para-aminosalicylic acid
PAS, Ofloxacin OFL, Kanamycin KM).
Results
Of the 158 MDR strains analysed, 62.7% were
resistant to all first line anti-TB drugs available. A
small percentage (8.7%) showed resistance only to
INH and RIF. There were a larger number of strains
resistant to the INH + RIF + SM association
(23.4%), than to the INH + RIF + EMB association
(5.1%). We identified that 44.9% of the strains
exhibit resistance to at least one second line antiTB drug, most of isolates being resistant to KM
(23,4%), followed by OFL (8,2%) and ETH (7%).
The majority of the strains were resistant to an
increased number of anti-TB drugs. Most of them
were resistant to four anti-TB drugs (38.6%) but
strains resistant to seven or eight anti-TB drugs
(1.3%) were also identified.
Conclusions
MDR strains of Mycobacterium tuberculosis
display an increased resistance to first line anti-TB
drugs. That is a signal for the application of antiTB drug susceptibility testing as often as possible.
Extension of resistance to second line anti-TB
drugs narrows the therapeutic options. Until new
anti-TB drugs are discovered the implementation of
*[email protected]
1
Faculty of Medicine and Pharmacy, University of
Oradea, Romania
Background
One of the most important complications in
varicella was acute pneumonia.
Case report
We hereby present the case of a 33 year old female
from an urban medium, who was admitted in May
2015 at the Infectious Disease department, County
Hospital Oradea, complaining of altered general
status, fever, chills, productive cough, mixed
dyspnea (SaO2=88%), with a diagnosis of varicella
manifested by papulovesicular eruptions, followed
by a generalized pustular rash. On the second day
of admission, the dyspnea was aggravated
(SaO2=77%). From a paraclinical point of view,
there was a marked leukocytosis (22.000/cmm)
with neutrophilia (89%), and increased markers of
inflammation- CRP 303 mg/dL, ESR 55/110
mm/hr. The chest x-ray described an aspect of
ARDS, reason for which the patient was transferred
in the Intensive Care Unit. Under treatment with
Acyclovir 500 mg t.i.d and Ertapenem 1g q.d, the
general status of the patient remained altered. The
SaO2 decreased up to 40-45%, requiring ventilation
with CPAP for 10 days. After 4 days of treatment,
the dose of Acyclovir was increased to 750mg t.i.d
and Amikacin 500mg t.i.d was introduced. After 7
days of treatment, the general status of the patient
improved slightly. The control chest x-ray
described an aspect of bronchopneumonia.
Treatment with antibiotic was continued with
Acyclovir 750mg t.i.d for 7 more days together
with Meropenem 1g t.i.d + Vancomycin 250mg
t.i.d for 14 days.
Conclusions
Treatment with Acyclovir i.v at an increased
dosage, associated with carbapenem and
aminoglycoside, and later with glycopeptide was
effective in this case.
59
Acute pneumonia with Morganella morgannii
Csep Andrei Nicolae1*
*[email protected]
1
Faculty of Medicine and Pharmacy, University of
Oradea, Romania
Background
Morganella morgannii was first isolated from the
feces of infants with acute enterocolitis. The aim of
this paper is to study a particular case of acute
pneumonia with bacteria that mostly affects male
and female urogenital tract.
Case report
We hereby present the case of a 58 years old female
patient coming from a rural medium, who
presented at the Infectious Diseases Clinic in
Oradea in January 2015 for a febrile syndrome
lasting about 10 days. Her family doctor treated her
with Augmentin 1g b.i.d for 5 days, followed by
Clarithromycin 500 mg b.i.d, with the fever still
persisting. On admission the patient had the
following symptoms: 38,50C fever, chills, chest
pain, productive cough, urinary frequency
(pollakiuria). Laboratory findings: leukocytosis
(15,450/cmm) with lymphocytosis, hepatic
cytolysis syndrome (ALAT 75 U/L, ASAT 71 U/L).
The chest X-ray described bilateral accentuated
pulmonary markings, and the sputum culture
isolated Morganella morgannii bacteria. Symptoms
persisted despite treatment with Ceftriaxone 2 g
b.i.d + Gentamicin 80 mg b.i.d. After the result of
the sputum culture, a combination of:
Cefoperazone / Sulbactam 2g b.i.d + Ciprofloxacin
400 mg b.i.d was administered. Inflammatory
markers and clinical signs improved after 12 days
of treatment.
Conclusions
The association of fluoroquinolone with a thirdgeneration cephalosporin in combination with a
beta-lactamase inhibitor was effective in the
eradication of Morganella morgannii infection.
Antimicrobial resistance and nosocomial
infections
Dana Negru1*, Teodora Olariu2, Mariana Nagy3
*[email protected]
1
Arad Public Health Department, Romania
Arad Vasile Goldis West University, Romania
3
Arad Aurel Vlaicu University, Romania
2
Background
Acquired antimicrobial resistance is a major
problem, Intensive Care Units patients being
particularly at risk for nosocomial infections as a
result of mechanical ventilation, use of invasive
procedures and their immunocompromised status.
Inadequate antibiotic therapy is associated with
poor outcome and emergence of bacterial
resistance.
Methods
We have used descriptive and analytical statistics in
describing antimicrobial resistance and its
consequences in nosocomial infections registered
in 2014 in Arad County, using also MedCalc and
SPSS 17.0 for Windows.
Results
There were 254 nosocomial infections reported in
2014. Arithmetic mean for age was 60, extreme
values being less than 1 year - 95 years old. Even if
the patients gender distribution was equal, Relative
Risk for death was 1.496 times higher for men
compared to women, p= 0.0228. According to
wards where these patients were treated, Relative
Risk for death was 6.92 times higher in Intensive
Care Units compared to others. According to the
site of infection, the most frequent infections were:
enterocolitis 29.4%, urinary tract infections 20.4%,
nosocomial pneumonia 20%, wound infections
16.6%. The most frequent involved germs in
nosocomial infections were: Clostridium difficile
(29.9%), Pseudomonas aeruginosa (11.9%),
Acinetobacter baumannii (8.4%), Klebsiella
pneumoniae (8.4%), E coli (7.7%) and
Staphylococcus aureus (7.7%). Odds ratio for
deaths in cases where Acinetobacter baumannii
was present was 3.8 times higher compared to
nosocomial due to Clostridium difficile, p = 0.0101.
Antimicrobial resistance registered to more than
three classes of antimicrobials was for:
Acinetobacter baumannii 100%, Pseudomonas
aeruginosa 61.29%, Klebsiella pneumoniae
95.83%, Staphylococcus aureus 75%, p<0.0001.
Resistance to more than six classes of
antimicrobials was recorded in 45.45% of
Acinetobacter baumannii isolates, 15% of E coli,
37.50% of Enterobacter spp, 37.50% of Klebsiella
pneumoniae, 32.26% of Pseudomonas aeruginosa
isolates, p<0.0001. Antimicrobial resistance to
cephalosporins third-generation, aminoglycosides
and carbapenems exceeded the national average for
E coli, Klebsiella pneumoniae and Pseudomonas
aeruginosa. Resistance to fluoroquinolones
exceeds the national average only for E coli.
Additional hospitalization for patients with
associated infections was significantly increased
over 10 days, p<0.0001 in the presence of
multiresistant germs.
60
Conclusions
Nosocomial infections with resistant germs is a
huge menace to patient safety. We are facing
situations where infected patients cannot be treated
adequately because the responsible bacterium is
totally resistant to available antibiotics.
The therapeutic management of a patient with
psoriasis vulgaris and chronic infection with
hepatitis B virus: can the combination of
etanercept and entecavir be the solution?
Anca Raducan1*, Maria-Magdalena Constantin1,2,
Traian Constantin2,3
*[email protected]
1 nd
2 Clinic of Dermatology, Colentina Clinical
Hospital, Bucharest, Romania
2
Carol Davila University of Medicine and
Pharmacy, Bucharest, Romania
3
Urology Department, “Prof. Dr. Th. Burghele”
Clinical Hospital, Bucharest, Romania
Background
The aim was to assess the risk-benefit relation of
anti-TNF therapy used concomitantly with antiviral
therapy with entecavir in a patient with moderatesevere psoriasis and chronic hepatitis B, in the light
of recent studies underlining the increased risk of
viral reactivation in patients treated with anti-TNF
agents.
Case report
We present the case of a 38 years old patient,
diagnosed 18 years ago with psoriasis, who
presented with large erythematous-squamous
infiltrated plaques, with clearly outlined borders,
covered with thick, white, easily detachable scales,
located on extensor surfaces (elbows, forearms,
dorsal aspects of the hands, knees, shins),
abdomen, as well as finger and toe nails
involvement (subungual hyperkeratosis, distal
onycholysis, pitting, “oil spot”). Also the patient
suffered from knees and elbows arthralgia and
morning joint stiffness. A skin biopsy was
performed confirming the diagnosis of psoriasis
and paraclinical investigations showed positive
AgHBs, positive AcHBs, positive AgHBe, negative
IgG antiHVD, PCR ADN-VHB=2341650. Results
In this context, the patient was diagnosed with
moderately severe psoriasis vulgaris (PASI Psoriasis Area and Severity Index =24,3; DLQIDermatology Life Quality Index = 25), chronic
HBV hepatitis with positive AgHBe. The
therapeutic algorithm included the start of the antiTNF therapy with etanercept 2 x 50 mg/week
combined with entecavir, an antiviral treatment
administered continuously since the diagnosis of
the HBV hepatitis, with hepatic function and viral
load monitored. He reached PASI 75 in the 12th
week and registered a significant drop in DLQI and
viral load (below the detection limit of 20
copies/ml) but without changes of the viral
markers. After the first 3 months of treatment with
etanercept he passed to the dose of 50 mg/week
combined with entecavir 0.5 mg/day, which he
continued until week 36, when psoriasis lesions
cleared out (PASI=0,6; DLQI=0) with no adverse
effects and no proof of HBV viral replication or
changes of the viral markers.
Conclusions
In conclusion, by presenting this case we wish to
emphasize that the use of etanercept in a patient
with psoriasis and hepatitis B is a successful
therapeutic alternative, which may be used safely
concomitantly with the administration of entecavir
and the regular monitoring of the viral load and of
the hepatic function tests.
Highschool students survey on awareness of
HIV and acceptance of HIV infected persons
Anca Raducan1*, Maria-Magdalena Constantin1,2,
Rodica Olteanu1, Alexandra Zota1, Traian
Constantin2,3, Irina-Magdalena Dumitru4,5, Sorin
Rugina4,5
*[email protected]
1
2nd Dermatology Clinic, Colentina Clinical
Hospital, Bucharest, Romania
2
“Carol Davila” University of Medicine and
Pharmacy, Bucharest, Romania
3
Urology Department, “Prof. Dr. Th. Burghele”
Clinical Hospital, Bucharest, Romania
4
Infectious Diseases Hospital, Constanța, Romania
5
Infectious Diseases Department, “Ovidius”
University, Constanța, Romania
Background
The aim of the study was to assess teenagers
awareness concerning HIV infection and
acceptance of HIV infected persons.
Methods
We performed a study among 119 sexually active
high school students, 61.34% males and 38.65%
females, aged 16 -17 years old, who were asked to
complete a 23 items questionnaire designed to
evaluate their knowledge on HIV prevention and
transmission, sexual behavior and to which extent
they would accept a HIV infected person in their
entourage.
Results
When asked which is the first word that comes to
mind when they hear HIV/AIDS, 36.97% teenagers
answered “death”, 20.16% wrote “sex”, and
61
16.80% “incurable disease”, while other answers
included: sexually transmitted disease, fear, drugs,
self-destruction. Out of 119 students, 19 teenagers
(15.96%) have begun their sexual life (73.68%
males, 26.31% females), 36.84% at the age of 14,
36.84% after 14 years, and 26.31% before 14 years,
most of them having more than one sexual partner
(68.42% more than 4 partners), and preferring
vaginal and oral intercourse. The preferred method
of contraception and protection among the
participants was the use of condoms. Also, 74.78%
high school students have correctly answered
multiple choice questions concerning the
transmission route for HIV, yet 59.63% teenagers
believe they should receive more information on
sexually transmitted diseases. Furthermore, 89.07%
of all participants to the study have not been
vaccinated against HPV. Regarding HIV infected
persons, 34.45% of high school students in the
present study would not accept HIV positive
persons in their entourage, 40.33% stated that it
would depend on the HIV infected persons
behavior, while only 25.21% were willing to accept
HIV positive persons.
Conclusions
This study indicates that while most students are
aware of the risks for HIV infection, they report
sexual activity at early age, multiple partners and
lack of HPV vaccination. Furthermore, the degree
of acceptance of HIV infected persons is low in this
category, which is a matter of high concern.
Facultative anaerobic bacteria involved in the
etiopathogeny of abscesses in oral and
maxillofacial region
Gabriela Bancescu1*, Adrian Bancescu1
*[email protected]
maxillofacial region presented to the Oro-MaxilloFacial Surgery Department of the U.M.F. “Carol
Davila”, Bucharest, during 2013-2014.
Methods
The identification of the 50 stored strains of
facultative anaerobic bacteria (isolated from:
vestibular abscesses, palatal abscesses, sublingual
space abscesses and submandibular space
abscesses) at genus and species level was based on
conventional methods and API systems
(BioMérieux, Marcy-l’Etoile, France): the Rapid
ID 32 STREP and ID 32 STAPH system,
respectively.
Results
Thirty-five isolates of this facultative anaerobic
strains collection were oral streptococci and they
belonged either to the anginosus group (13 strains
of S. anginosus and 4 strains of S. constellatus) or
to the mitis group (17 strains of S. oralis and only
one strain of S. mitis). The rest of the facultative
anaerobic bacteria were identified as staphylococci,
as follows: 2 strains of S. aureus, 11 strains of S.
epidermidis and 2 strains of S. haemolyticus.
Conclusions
The facultative anaerobic microorganisms isolated
were only strains of Gram-positive cocci and the
predominating species were S. anginosus and S.
oralis. Identification at species level contributes to
a better understanding of the etiopathogenical
aspects concerning the oral and maxillofacial
infections.
Acknowledgement
This study was part of the internal research plan for
2013-2015 of the Microbiology Department,
Faculty of Dentistry, and Epidemiology
Department, Faculty of Medicine, U.M.F. “Carol
Davila”, Bucharest. Dr. Mihai Dumitru, a graduate
student of the Faculty of Dentistry, U.M.F. “Carol
Davila”, Bucharest, contributed partially to the
microbiological investigation of these strains. No
conflicts of interest to declare.
1
Carol Davila University of Medicine and
Pharmacy, Bucharest, Romania
Background
The oral and maxillofacial infections are mainly
mixed infections, which involve both aerobic and
anaerobic microorganisms. The bacterial isolation
and identification are not commonly performed in
such infections, being considered too timeconsuming. The aim of this study was to identify at
species level a collection of 50 facultative
anaerobic bacteria stored in ultrafreezer at the
laboratory of the Microbiology Department,
Faculty of Dentistry, University of Medicine and
Pharmacy (U.M.F.) “Carol Davila”, Bucharest.
These strains had been isolated from pus samples
collected by needle aspiration from 35 subjects
among patients with abscesses in the oral and
Determinants of staphylococcal virulence in
commensal and clinical strains
Oana Săndulescu1,2*, Coralia Bleotu3,4, Ioana
Mădălina Aldea3, Anca Streinu-Cercel1,2,
Alexandru Rafila1,2, Daniela Tălăpan1,2, Olga
Dorobăț2, Mariana Carmen Chifiriuc4,5, Alina
Cristina Neguț1,2, Ioana Berciu1,2, Adrian StreinuCercel1,2
*[email protected]
1
Carol Davila University of Medicine and
Pharmacy, Bucharest, Romania
2
National Institute for Infectious Diseases "Prof.
Dr. Matei Balș", Bucharest, Romania
62
Ștefan S. Nicolau Institute of Virology, Romanian
Academy, Bucharest, Romania
4
Faculty of Biology, University of Bucharest,
Romania
5
Research Institute of the University of BucharestICUB, Life, Environment and Earth Sciences,
Bucharest, Romania
3
Background
Staphylococci are able to synthesize a multitude of
virulence factors, such as surface proteins,
cytotoxins, superantigens, enzymes, etc. Given the
fact that complex regulation systems drive
staphylococcal virulence, we have performed a
study to evaluate the different parameters that
influence the expression of virulence factors in
commensal and clinical strains [1,2].
Methods
Seventy-six staphylococcal strains were inoculated
on dedicated solid media in order to assess the
expression of hemolysins, caseinase, amylase,
lipase, esculin and lecithinase. The bacterial strains
were isolated from asymptomatic nasal carriage
(n=36) and hard-to-treat infections (n=40).
Results
Most of the bacterial strains in this study (65
strains, 85.5%) expressed 4, 5 or 6 of the evaluated
virulence factors. Hemolysis was present for 50/76
(65.8%) of the strains (20 strains displayed αhemolysis and 30 β-hemolysis), and it was
correlated with tetrad cell arrangement (p=0.038).
Caseinase expression was positive in 73/76
(96.1%) of the strains, and high expression was
correlated with internalization (p=0.004) and
marked cyto-adherence (p=0.007). Amylase
production was expressed by 42/76 (55.3%) of the
strains, at minimal (95.2%) and moderate levels
(4.8%), but was not correlated with other strain
characteristics. Lipase production was expressed by
65/76 (85.5%) of the strains, and was associated
with high cyto-adherence (p=0.031). Esculin
expression was identified in 53/76 (69.7%) of the
strains mostly at low levels (67.9%), and was
higher in S. aureus (p=0.009) and cyto-adherent
strains (p=0.001). Lecithinase expression was
positive in 70/76 (92.1%) of the strains, and was
higher in strains displaying internalization
(p=0.000), marked cyto-adherence (p=0.001), and
tetrad cell arrangement (p=0.009).
Conclusions
The expression of enzymatic virulence factors in
Staphylococcus spp. may be correlated with strain
characteristics such as tetrad cell arrangement,
internalization, or cyto-adherence.
Acknowledgement
This paper is partially supported by the Sectoral
Operational Programme Human Resources
Development (SOP HRD), financed from the
European Social Fund and by the Romanian
Government under the contract number
POSDRU/159/1.5/S/137390.
References
1. Sulla F, Bussius DT, Acquesta F, Navarini A,
Sasagawa SM, Mimica MJ. Vancomycin minimum
inhibitory concentrations and lethality in
Staphylococcus aureus bacteremia. Germs
2015;5:39-43.
2. Lucia Preoţescu L, Streinu-Cercel O. Prevalence
of nasal carriage of S aureus in children. Germs
2013;3:49-51.
Genetic characterization and phylogenetic
analysis of human influenza A (H3N2) viruses in
two consecutive seasons
Mihaela Lazar1,2, Alina Ivanciuc1,2*, Gheorghe
Necula1,3, Emilia Lupulescu1
*[email protected]
1
Cantacuzino National Institute for Research,
Bucharest, Romania
2
Faculty of Biology, University of Bucharest,
Romania
3
Horia Hulubei National Institute for R&D in
Physics And Nuclear Engineering, Bucharest,
Romania
Background
Influenza A(H3N2) viruses have circulated
worldwide since 1968. The constantly evolving
A(H3N2), is the dominant subtype in most seasonal
influenza epidemics causing high rates of
morbidity and mortality. Genetic variability in the
hemagglutinin (HA) gene of influenza viruses
results in the emergence of new strains, potentially
with increased pathogenicity. The aim of this study
was to investigate the molecular evolution and
vaccine strain match of the A(H3N2) influenza
viruses, having been circulated throughout the
population of Romania in two seasons, 2013/14
and 2014/15.
Methods
As part of virological surveillance of influenza in
Romania respiratory specimens were collected
from patients with influenza-like illness during the
2013/14 and 2014/15 influenza seasons.
Sequencing and phylogenetic analysis using
maximum-likelihood method of the HA gene
amino acid sequences (1650 nt) were performed to
characterize the H3N2 circulating strains.
Results
Analysis of hemagglutinin gene revealed several
amino acid substitutions in comparison to the
hemagglutinin of the A/Texas/50/2012 vaccine
strain. The HA gene accumulated substitutions at
the amino acid positions 128, 138, 142, 145, 159,
63
160, 225, 276, 311, 326. Phylogenetically, the HA
gene sequences from 19 Romanian samples from
2013/14 season were included in subsets 3C.2
(representative strain A/Stockholm/1/2013) and
3C.3 (A/Samara/73/2013), distinct subsets from
A/Texas/50/2012 which belongs to the 3C.1. The
subset, 3C.2 and 3C.3 have a substitution at
position 159, which has shown to be one of seven
positions responsible for the major antigenic
changes between 1968 and 2003 A(H3N2). During
the 2014/15 season a total of 21 influenza A(H3N2)
viruses were analysed: 7 viruses represented a new
drifted A(H3N2) type, cluster 3C.3a
(A/Switzerland/9715293/2013), 8 belonged to
another cluster, 3C.2a (A/Hong Kong/5738/14),
antigenically low reactor cluster, and 6 viruses
belonged to 3C.3b, vaccine-like subset
(A/Newcastle/22/2014).
Conclusions
Genetic characterization of the influenza viruses
A(H3N2) in two consecutive seasons highlighted
considerable variability in their HA sequences and
gives an indication of the molecular evolution of
this virus. Surveillance of genetic changes in the
HA gene during seasonal influenza epidemics
could provide indication of emerging clusters.
Relaunch of bacteriophage therapy in Romania
– case presentation
Alina Cristina Neguţ1,2*, Maria Magdalena Moţoi1,
Anca Streinu-Cercel1,2, Oana Săndulescu1,2, Adrian
Streinu-Cercel1,2, Mircea Ioan Popa2
*[email protected]
1
National Institute for Infectious Diseases "Prof.
Dr. Matei Balș", Bucharest, Romania
2
Carol Davila University of Medicine and
Pharmacy, Bucharest, Romania
Background
Staphylococcus aureus is considered a dangerous
pathogen not only because of its high resistance
profile but also because of the capacity of forming
biofilm and intracellular invasion [1].
Case presentation
A 37 year-old female with morbid deformity of the
spine and multi-allergic status presented in our
clinic in October 2014 for cellulitis of the back
with purulent secretion and loss of substance with
onset dating back 6 months. At one year old the
patient had been diagnosed with spinal sarcoma
and underwent surgery and radiotherapy with
complete tumor removal. Consequently, the patient
developed important kyphoscoliosis and required
the implantation of two rods for sustaining the
spine and correcting the disorder. Over the years
she had another 10 spinal surgeries, the last one
being performed in Ankara in November 2013.
Before presenting to our clinic, the patient had
received treatment with cefuroxime with
persistence of the purulent secretion. At admission
the patient had normal leukocytes, mild
inflammatory response, and cultures positive for
methicillin-susceptible S. aureus from the back
ulcer with over 90% neutrophils on the smear.
Upon cutaneous allergy testing for ciprofloxacin,
clindamycin, oxacillin, teicoplanin, linezolid and
vancomycin, she was allergic to all drugs. We
evaluated the strain’s susceptibility to
bacteriophages [2]; PYO and INTESTI phages
displayed activity (Eliava BioPreparations, Tbilisi,
Georgia). Having the local bioethics committee
approval and the patient’s signed informed consent
for bacteriophage therapy, we initiated local
therapy with INTESTI phages together with oral
cefuroxime. The cultures became negative after
three days of treatment and at discharge the
purulent secretion was absent. She continued
combined therapy for a total of 3 months, when she
received plastic surgery for covering the loss of
substance with latissimus dorsi flap. Three months
after her surgery the local site and the lab tests
remain in normal range.
Conclusions
In hard to treat infections caused by multidrugresistant bacteria, biofilm formation, intracellular
invasion, metal prosthesis, hard to sterilize sites,
antibiotics might need an adjuvant factor for
destroying the bacteria. Bacteriophages can be a
solution, and further in vitro and in vivo studies are
needed.
References
1. Sulla F, Bussius DT, Acquesta F et al.
Vancomycin minimum inhibitory concentrations
and lethality in Staphylococcus aureus bacteremia.
Germs 2015;5:39-43.
2. Neguț AC, Săndulescu O, Popa M, et al.
Experimental approach for bacteriophage
susceptibility testing of planktonic and sessile
bacterial populations - Study protocol. Germs
2014;4:92-6.
Acknowledgements
1. POSDRU/159/1.5/S/141531
2. Carol Davila University of Medicine and
Pharmacy, Young Researchers Grant, no
28341/2013
Septic cutaneous emboli associated with a severe
case of Klebsiella pneumoniae liver abscess
syndrome (KLAS)
Florentina Paraschiv1*, Alina Borcan1,2, Mihai
Lazar1,2, Gabriel Adrian Popescu1,2
64
*[email protected]
1
National Institute for Infectious Diseases "Prof.
Dr. Matei Balș", Bucharest, Romania
2
Carol Davila University of Medicine and
Pharmacy, Bucharest, Romania
Background
In the last years, Klebsiella pneumoniae liver
abscess syndrome (KLAS) emerged outside SouthEastern Asia and several cases already been
reported in Romanian patients.
Case report
A 58-years- old female with diabetes mellitus was
transferred in Matei Balș National Infectious
Diseases Institute with high fever and confusion
after a two days hospitalization with antibiotic
treatment in another hospital from Bucharest.
Physical examination and laboratory tests revealed
meningitis, unilateral visual loss, septic skin emboli
and MODS (septic shock, renal dysfunction and
disseminated intravascular coagulation). The
abdominal ultrasound retrieved a large liver abscess
and KLAS diagnosis was confirmed after the
isolation of a hypermucoviscous strain of K.
pneumoniae from septic skin lesions. However, the
blood cultures and CSF culture remain negatives
for bacterial agents. The patient evolution was
favorable after abscess percutaneous drainage and
antibiotic treatment with ceftriaxone (latter
switched to oral amoxicillin-clavulanate, 1g tid).
Conclusions
This report supports the possibility of KLAS in our
country, including some cases with most salient
metastatic complications of this syndrome:
meningitis and uveitis. We emphasize the benefit to
sample each septic focus in patient with severe
infections, especially if an antibiotic treatment has
been started.
Epidemiological and clinical features of acute
hepatitis A in adults in Brasov area
Maria Elena Cocuz1,2*, Ligia Rodina2, Iuliu Gabriel
Cocuz3
*[email protected]
1
Faculty of Medicine, Transilvania University,
Brașov, Romania
2
Infectious Diseases Hospital, Brașov, Romania
3
University of Medicine and Pharmacy Tîrgu
Mureș, Romania
Background
Acute viral hepatitis A is a worldwide public health
problem, spread by fecal-oral transmission, highly
contagious, often favored by inadequate food and
personal hygiene conditions. Adult clinical forms
are varied, often medium and rare severe, but the
disease cause high costs for hospitalization
(treatment and isolation). Hepatitis A is a vaccinepreventable disease. Aims: To analyze some
clinical and epidemiological features of acute
hepatitis A in adults, in order to improve the
prevention and the management of the disease.
Methods
Retrospective study on a group of 73 adult patients
hospitalized with acute hepatitis A in the Infectious
Diseases Hospital of Brașov in the period JanuaryDecember 2014. We analysed epidemiological
aspects (age and gender of patients, urban or rural
origin, seasonality of the hospitalizations), clinical
aspects (onset types, clinical forms), laboratory
aspects (cholestasis, hepatic cytolysis, bilirubin).
Results
Number of admission for acute hepatitis A in adults
increased over the last 4 years, from 19 cases in
2011 to 106 cases in 2014. The group of the 73
analysed patients presented the following
epidemiological and clinical features: age groups
more affected 18-25 years and 26-35 years (63%
cases), frequency almost equal male-female (48%52%); 59% of patients came from urban area;
frequently hospitalizations in September (19.17%
cases) and October (27.39% cases). Digestive onset
was found in 98.63% patients, associated with
fever in 42.46% cases; 94.52% of the clinical forms
were medium and only 5.48% severe. Jaundice was
present to 93.15% patients and cholestasis to
71.23% of them. The values of ALT were higher
than 2000 IU/l in 46.57% cases and bilirubin over 5
mg/dl to 57.16% patients.
Conclusions
Incidence of acute hepatitis A in adult patients is
low but persistent in the Brașov area, with current
trend to increase. In 2014 the illnesses prevailed in
young adults, especially from urban areas. The
digestive onset often associated with fever and
medium forms of the disease were dominant, with
cholestasis in a large proportion of cases.
Vaccination of adults against hepatitis A can be a
solution for decreasing the incidence of disease.
Aspects of Clostridium difficile infection in
Second Department of the Infectious Diseases
Hospital Galati
Liliana Baroiu1*, Mihaela Camelia Vasile1, Nicușor
Baroiu2, Miruna Drăgănescu2
*[email protected]
65
1
2
Infectious Diseases Hospital Galați, Romania
”Dunărea de Jos” University of Galați, Romania
Background
The incidence of Clostridium difficile infection
(ICD) in our department has doubled in the period
01.12.2014-01.06.2015 (75 cases) than 01.12.201301.06.2014 (34 cases) and 01.06.2014-30.11.2014
(39 cases), while in the month of June 2015 aims to
double the average of the last semester (20 cases in
June /12.5 average/month). Purpose: To evaluate
the prevalence of ICD associated risk factors,
treatment response, relapse rate and duration of
hospitalization.
Methods
Retrospective study based on statistical analysis of
encoded data from the dossiers of the patients
hospitalized with ICD in the period 01.06.201430.07.2015. We analysed: demographic data (age,
sex, residence), data on risk factors, comorbidities,
ATLAS score, treatment, evolution and relapses.
Results
There were 97 patients admitted in study diagnosed
with ICD. 55 women (56.7%), 42 men (43.29),
average age 63 years (5-86), 71 in urban areas
(73.19%). Positive diagnosis was established on the
basis of immunochromatographic tests for
detection in stool: toxin A-5 patients, toxin A+B-83
patients, toxin B-2 patients, only positive GDH-2
patients. Score severity: 47 patients ATLAS 0-1, 36
patients ATLAS 2-3, 12 patients ATLAS 4-5, 4
patients ATLAS 6-7. Risk factors: hospitalization in
the last 28 days-76 patients (78.35%), recent
antibiotic therapy 61 patients (62.88%), use of PPI
16 patients (16.49%), abdominal surgery-13
patients (13.4%), age over 60, 68 patients (70.1%)
and comorbidities: immunosuppression 31 patients
(31.95%) (cancers, diabetes, autoimmune diseases),
consumptive and debilitating chronic diseases 46
patients (47.42%) (liver cirrhosis, chronic hepatitis,
chronic obstructive lung disease, renal failure,
cardiac failure, stroke and dementia), invasive
medical procedures 23 patients (23.71%) (recent
surgery and colonoscopy), tuberculosis on
treatment 5 patients (5.15%). The treatment was
performed with Metronidazole 23.89%,
Vancomycin 62.83%, Metronidazole +Vancomycin
13.27%, Tygacil 0.88%. Relapses: 15 patients at
first relapse (15.46%), 1 patient with three
recurrences (1.03%). Mean hospitalization days:
10.84, above the average value of the hospital.
Conclusions
The study confirms the prevalence of risk factors
mentioned in the literature and frequency signals
the presence of: recent hospitalizations, invasive
medical procedures, immunosuppression and
chronic consumptive / associated debilitating. The
multiple combination of these risk factors
prompted the need for prolonged treatment and
hospitalization of patients admitted in the study.
Current clinical and epidemiological aspects of
acute hepatitis A in children in Brasov area
Ligia Rodina1*, Felicia Constandis1, Nicoleta
Ceposu1, Maria-Elena Cocuz1,2
*[email protected]
Infectious Diseases Hospital, Brașov, Romania
Faculty of Medicine, Transilvania University,
Brașov, Romania
1
2
Background
Acute hepatitis A is an infectious and contagious
disease, that mainly affects children, transmitted
interpersonal by fecal-oral route, favored by
agglomerations and poor hygiene. In children the
disease is usually asymptomatic or mild. Hepatitis
A is preventable by vaccination. Aims: To analyze
some current epidemiological and clinical aspects
in acute hepatitis A in children and evaluation of
specific vaccination opportunity in order to
decrease the frequency of disease.
Methods
Retrospective study on 413 pediatric patients
hospitalized in Infectious Diseases Hospital of
Brasov during January-December 2014. We
analysed some epidemiological aspects (age,
gender, urban-rural origin of the patients,
seasonality of the hospitalizations), clinical aspects
(onset types, clinical forms of the disease),
laboratory aspects (hepatic cytolysis, bilirubin,
cholestasis, prothrombin concentration).
Results
The number of admission for acute hepatitis A in
children gradually increased from 2011 to 2014
(2011 – 14 cases, 2012 – 75 cases, 2013 – 113
cases, 2014 – 413 cases). Cases of hepatitis A
hospitalized in 2014 were characterized by: the
most affected age group was 3-7 years (45% cases),
male-female frequency 54%-46%, urban-rural
frequency 20%-80%; frequently hospitalizations in
September (29.54% cases) and October (16.95%
cases); digestive onset in 98% cases; 88.86% of the
clinical forms were medium, with jaundice in
62.47% patients and cholestasis in 17.92% cases;
prothrombin concentration was decreased below
50% in 17.43% children.
Conclusions
Incidence of acute hepatitis A in children is
persistent in the Brasov area, with current trend to
increase. Hospitalized cases in 2014 were
numerous, especially from rural areas. The
digestive onset and medium forms of the disease
were dominant, with cholestasis in a significant
66
number of cases. For decreasing the number of
illnesses and hospitalizations for hepatitis A we
consider that routine childhood vaccination is
required.
Nosocomial infections: a permanent challenge
Cristina Vasiliu1,2, Ana Bădănoiu2*, Anca StreinuCercel1, Oana Săndulescu1, Simona Elena Albu1,2
*[email protected]
1
Carol Davila University of Medicine and
Pharmacy, Bucharest, Romania
2
Department of Obstetrics and Gynecology,
University Emergency Hospital of Bucharest,
Romania
prevalence in our study was only 1%, which means
that this entity is still under-diagnosed and underreported. The study identified some risk factors and
the most common pathogens, providing necessary
data for an effective infection control program. The
study also revealed the necessity for
implementation of guidelines for NI.
Thyroid disorders in HIV infected patients case series and review of the literature
Manuela Arbune1,2*, Teodora Dragomir-Ananie1
*[email protected]
1
"Dunarea de Jos" University from Galați
Infectious Diseases Hospital Galați
2
Background
Nosocomial infections (NI) are a challenge for
modern medicine: they are a major cause of
morbidity and mortality in hospitals and are
associated with high costs. Only recently have they
been correctly defined and reported and their true
prevalence in our hospitals is not known. The aim
of our study was to observe the magnitude and
characteristics of NI in a department of surgical
gynecology in an University Hospital.
Methods
We performed a retrospective observational study
evaluating the nosocomial infections diagnosed in
the department of Gynecology in the Emergency
University Hospital Bucharest between 01.07.2014
– 01.07.2015.
Results
In the above interval, 1748 patients underwent
different surgical procedures and 16 developed NI
(1%). The major sites affected were surgical
wounds (11 cases), followed by blood stream
infections (2 cases), gastrointestinal infections (one
case) and peritonitis (one case). The main etiologic
agents associated with these NI were E. coli (5
cases), methicillin-resistant Staphylococcus aureus
(4 cases), followed by Enterococcus spp. (2 cases),
Acinetobacter spp. (one case) and Clostridium spp.
(one case). Each patient had at least one risk factor
for NI and the most commonly encountered were
arterial hypertension, obesity, and chronic renal
failure with hemodialysis. All patients were treated
with antibiotics according to antibiograms when
the pathogenic agent was identified and with broad
spectrum antibiotics when the incriminated germs
were not identified. The hospitalization time varied
from 7 to 40 days with a mean value of 18 days. In
most of the cases, NI were present in patients with
major surgical procedures and advanced age.
Conclusions
The prevalence of NI in various European countries
shows rates between 3.5% and 11.6%. The
Background
Human Immunodeficiency virus (HIV) infection is
associated with endocrine dysfunction. Increased
prevalence of various thyroid disorders in HIV
patients has been reported, especially after highly
active antiretroviral therapy.
Case reports
Five patients from Galați (Romania) with HIV and
thyroid disorders are reported. Case 1 is a 60 years
old women, with history of polinodular goiter,
thyroid carcinoma suspicion, surgical
thyroidectomy and substitution treatment with Lthyroxin. She was diagnosed with hepatitis B virus
(HBV), HIV - CDC stage B3. First line of HAART
was failed and needs to choose another
combination. Case 2 is a 26 years old boy with
nosocomial pediatric HIV infection - CDC stage
C2. He was experienced in 9 HAART combinations
during 17 years. He developed progressive
lipoatrophy, dyslipidemia and osteopenia. In the
last year he was diagnosed with hypothyroidism
with L-thyroxin treatment. Case 3 is a 26 years old
girl with pediatric nosocomial infection, with coinfection HBV and HIV - CDC stage C3. She
developed Basedow - Graves’ disease from the age
19, probably related to immune reconstruction with
consequent autoimmune thyroiditis after HAART.
Case 4 is a 52 years old women, co-infected with
HBV and HIV CDC stage - C3. Severe
neurocognitive disorders related to JC virus and a
thyroid node have been concomitant diagnosed.
Baseline euthyroidia was changed after 2 months of
HAART, because she developed a toxic adenoma
of the thyroid. Case 5 is a neonate myxedema in a
baby-girl, with perinatally exposure to HIV. His
mother was 25 years old and she has a treatment
history with 6 HAART combinations in the last 10
years. All cases illustrate different thyroid disorders
related to HIV and HAART. Co-infection HIVHBV was identified in 4/5 cases with thyroid
67
dysfunctions. Females represent 4/5 cases.
Interactions of antiretroviral drugs and thyroid
hormones pathways or thyroid drugs are discussed,
reporting to the review data from the literature.
Conclusions
These case reports demonstrate the difficulties to
manage HIV infection from the perspective of
thyroid co-morbidities. Screening for thyroid
function of newly diagnosed HIV patients should
be considered by the national guideline for HIV
monitoring and by the insurance services from
Romania.
Urogenital candidiasis after penian
subcutaneous self-injections with nonconventional expanders
Carmen Giuglea1,4*, Crenguta Coman1, Silviu
Marinescu3,4, Ruxandra Moroti2,4
600mg/day, along with urinary catheter removal in
the first day, with an initial rapid favorable course:
skin healing, normal urogenital functions,
disappearing of urethral discharge, diminishing of
inguinal adenopathies. After the antifungal agent
cessation, there was an insidious increasing of
inguinal lymph nodes sizes, which began to be
tender and developed necrosis. Imagery of the
pelvic area was normal. An obvious immune deficit
was ruled out (HIV-negative, T lymphocytes CD4
count lower but in normal range and normal level
of gamma globulins). With a second longer
antifungal cure – Fluconazole 400mg daily, 3
months, the recovery was complete.
Conclusions
Identification and correct treatment of a superposed
infection permit a proper healing in this case with a
compromised surgical outcome. In uro-genital
fungal infections there is need for long course
antimicotic treatment.
*[email protected]
1
Clinical Emergency Hospital “Sf Ioan", Bucharest,
Romania
2
National Institute for Infectious Diseases "Prof.
Dr. Matei Balș", Bucharest, Romania
3
Clinical Emergency Hospital “Prof. Dr. Bagdasar
Arseni”, Bucharest, Romania
4
Carol Davila University of Medicine and
Pharmacy, Bucharest, Romania
The importance of a multidisciplinary team in
the management of recurrent, treatment nonresponsive tonsillitis – case presentation
Ana-Maria Blănaru1*, Alina Cristina Neguţ1,2,
Alina Hristu1, Luminiţa Bradu1, Anca StreinuCercel1,2, Maria Magdalena Moţoi1, Mihai Olariu1,
Adrian Streinu-Cercel1,2
*[email protected]
Background
Unfortunately, injecting all kinds of foreign
substances in the penian area is a frequent habit
among young males and represents a relatively
large source of penile defects for plastic surgeon
practice. This procedure is commonly followed by
tumefaction and a various degree of skin necrosis
that requires surgical treatment, meaning
debridement and skin grafting.
Case report
We described a case of a young patient (16 years
old) who had injected vaseline, a non-conventional
expander used quite rarely, in his penian area for an
augmentation effect and who subsequently
developed massive tumefaction and skin necrosis.
After two procedures of surgical debridement and
skin grafting, along with large spectrum antibiotics,
his local evolution was unfavorable, with persistent
penian cellulitis, skin graft lysis, dysuria, minimal
urethral discharge, mild pelvic pain and inguinal
lymph nodes enlargement. He was addressed to
infectious diseases department, where he was found
to be infected with Candida albicans and Candida
parapsilosis, isolated from skin lesions, urethral
secretions, urine culture and urinary catheter. Both
species were Fluconazole susceptible. He received
an initial 21 days treatment with Fluconazole
1
National Institute for Infectious Diseases "Prof.
Dr. Matei Balș", Bucharest, Romania
2
Carol Davila University of Medicine and
Pharmacy, Bucharest, Romania
Background
Rosai-Dorfman disease (RDD) is a rare pathology,
with about 650 cases reported since the first
presentation in the medical literature in 1969 and it
is characterized by overproduction and
accumulation of histiocytes in the lymph nodes,
including cervical ones [1]. The diagnosis of RDD
is made on biopsy with identification of S100 and
CD68 markers.
Case presentation
We present the case of a vaccinated 14-year-old
boy who presented three episodes of high fever,
sore throat, asthenia and bilateral latero-cervical
swelling over the course of 5 months. The last
episode had started three days before admission
and persisted despite treatment with nonsteroidal
anti-inflammatory drugs (NSAIDs).
The clinical exam revealed fever, important
submandibular and cervical lymph nodes of high
consistency, sensitive to touch, relatively immobile
on the plans above and underlying, discrete
68
hyperemic pharynx, discreet hyperemic and
hypertrophic tonsils, covered by pseudomembranes, hepatomegaly and splenomegaly.
The lab reports showed leukocytosis with
neutrophilia, moderate inflammatory syndrome,
hyperuricemia and negative IgM and IgG Epstein
Barr serology.
The pathology was initially labeled as acute
tonsillitis and we initiated extended-spectrum
antibiotics (ertapenem 1g/day) and NSAIDs, with
no response after 72 hours. Because the first
episode had responded to corticosteroid therapy, we
considered a hematologic disorder as differential
diagnosis and we requested a consult. We
performed neck MRI which described numerous
cervical lymph nodes, 7-31 mm in diameter,
hepatic and hilar lymphadenopathy (below 1 cm)
and tonsillar hypertrophy. A lymph node biopsy
was performed and it revealed CD68 positive
marker. So, Rosai-Dorfman disease diagnosis was
established. During the febrile episodes, the patient
received intravenous paracetamol, as per
hematologist recommendations. Five months later,
the patient is afebrile, with no lymphadenopathy
and with no other symptoms.
Conclusions
Acute tonsillitis is a common pathology, usually
having viral or bacterial etiology.
A recurrent tonsillitis non-responsive to therapy
needs further investigations and a hematological
consult.
This is a rare disease. Studies suggest that it affects
more often males rather than females and children;
adolescents or young adults are more susceptible.
RDD is not a life threatening disease, but in 5% to
10% of patients, the progressive evolution may
require surgical treatment, steroids, and/or
chemotherapy [2].
References
1. National Organization for Rare Disorders. RosaiDorfman Disease. Accessed on 31 July 2015.
Available at: https://rarediseases.org/rarediseases/rosai-dorfman-disease/
2. Komaragiri M, Sparber L, Santos-Zabala ML,
Dardik M, Chamberlain R. Extranodal Rosai–
Dorfman disease: a rare soft tissue neoplasm
masquerading as a sarcoma. World J Surg Oncol.
2013;11:63.
Quality of life among people living with HIV in
Romania – between stigma, coping and
resilience
Florin Lazar1*, Adrian Luca1
Background
Romania has a group of long-time survivors of
people living with HIV (PLHIV), whose quality of
life (QoL) is little known from studies. Our aim
was to identify the factors associated with the
quality of life of PLHIV.
Methods
Adult PLHIV recruited online, from clinics and
NGOs filled in a self-reported questionnaire
(N=252, November 2014 – March 2015). In
multivariate linear regression the dependent
variable was computed (29 items) from the six
domains of WHOQOL-HIV BREF (Physical,
Psychological, Level of Independence,
Environment, Social relationships, Spirituality).
Independent variables were subscales extracted
from validated scales: HIV Stigma Scale (alpha:
.943), Brief-COPE (alpha: .843), Resilience Scale
for Adults (alpha: .943) and CESD-R (alpha:.946).
The final linear model has an adjusted R square of
.765.
Results
A better quality of life are more likely to have those
with a positive perception of the future (ß CI95%:
.343 [.767 1.662], p<.000), without fatigue
symptoms of depression (ß CI95%: -.326 [-3.385 1.599], p<.000), those with a more positive
perception of self (ß CI95%: .195[.305 1.344],
p<.002), who are less concerned with the public
attitudes about PLHIV (ß CI95%: -.154 [-.372 .050], p<.011), those who use instrumental support
(ß CI95%: .138 [.297 2.328], p<.012), accept their
HIV condition (ß CI95%: .127[.387 3.449],
p<.015), use positive reframing (ß CI95%:
.120[.156 2.404], p<.026) but not active coping as
strategy (ß CI95%: -.109[-2.302-.063], p<.039).
Conclusions
QoL is a complex concept, associated with coping,
resilience and affected by depression and stigma
dimensions such as “fatigue” and “concerns over
the attitudes of the public about PLHIV”. Health
and psychosocial professionals need to address
these factors negatively influencing QoL and
enhance the positive perspective of the future, of
the self and encourage them to see the “half full”
side, accept their status and use the available
instrumental support.
Acknowledgement
This paper was co-financed from the European
Social Fund, through the Sectorial Operational
Programme Human Resources Development 20072013, project number POSDRU/159/1.5/S/138907
"Excellence in scientific interdisciplinary research,
doctoral and postdoctoral, in the economic, social
and medical fields -EXCELIS", coordinator The
Bucharest University of Economic Studies.
*[email protected]
1
University of Bucharest, Romania
69
Thyroid elastography in patients with chronic
viral hepatitis C
Oana Săndulescu1,2*, Anca Streinu-Cercel1,2,
Monica Andreea Stoica2, Daniela Manolache2,
Aniela Bodac1, Adrian Streinu-Cercel1,2
*[email protected]
1
Carol Davila University of Medicine and
Pharmacy, Bucharest, Romania
2
National Institute for Infectious Diseases "Prof.
Dr. Matei Balș", Bucharest, Romania
Background
Thyroid stiffness is increased in various nodular
pathologies, and shear-waves elastography may
play an important role in differentiating benign
from malignant thyroid nodules [1]. However, there
is an acute lack of data regarding thyroid stiffness
in patients with chronic infection with hepatitis C
virus (HCV). As new treatment options for
hepatitis C become available [2], it is important to
choose the patients that benefit most from
interferon-free treatment, and thyroid evaluation
could prove important in this scenario.
Methods
Using Aixplorer (SuperSonic Imagine, Aix-enProvence, France), we performed thyroid shearwaves elastography in patients with chronic HCV
infection and in a control group of subjects without
viral hepatitis.
Results
We evaluated 42 patients with chronic HCV
infection and 20 control subjects. The mean age
and standard deviation were 50.6±11.2 years in the
HCV group and 44.9±10.4 years in the control
group. All patients in the HCV group had chronic
infection with HCV genotype 1b. The mean and
standard deviation for thyroid stiffness were
slightly higher (25.0±10.1 kPa) in the HCV group
compared with the control group (21.1±8.2 kPa),
but the differences were not statistically significant
due to the relatively small sample size (p=0.145).
We identified thyroid nodules in 11 patients
(26.2%) in the HCV group and in 2 (10.0%)
controls (p=0.192). Thyroid stiffness was
significantly higher in patients with thyroid nodules
(28.3±10.4 kPa) than in those without nodules
(22.4±9.1 kPa, p=0.048) and in patients with
thyroid disease (30.1±11.9 kPa) than in those
without (22.4±8.5 kPa, p=0.019). Thyroid stiffness
was not statistically associated with patient age
(p=0.243), IL28B genotype (p=0.221), timespan
since diagnosis of HCV infection (p=0.157), liver
stiffness (p=0.371), necroinflammatory activity on
ActiTest (p=0.659), ALT (p=0.716), AST
(p=0.662), thrombocytes (p=0.412), fibrinogen
(p=0.767), cholesterol (p=0.396), triglycerides
(p=0.479), fasting plasma glucose (p=0.457), TSH
(p=0.881), FT3 (p=0.985), or FT4 (p=0.434).
Conclusions
We identified a slightly higher thyroid stiffness in
patients with chronic HCV infection compared with
the control group. To reach statistical significance,
we intend to increase the study sample size.
Elastography appears to be a good predictor of
thyroid nodules or disease, regardless of the
presence or absence of viral infection.
References
1. Sebag F, Vaillant-Lombard J, Berbis J, Griset V,
Henry JF, Petit P, Oliver C. Shear wave
elastography: a new ultrasound imaging mode for
the differential diagnosis of benign and malignant
thyroid nodules. J Clin Endocrinol Metab
2010;95:5281-8
2. Streinu-Cercel A. Hepatitis C in the interferonfree era. Germs 2013;3:114.
Management of acute maxillary sinusitis after
sinus bone grafting procedures with
simultaneous dental implants placement
Lucian Chirilă1,2, Cristian Rotaru3,4, Iulian
Filipov4,5, Mihai Săndulescu1,3*
*[email protected]
1
Carol Davila University of Medicine and
Pharmacy, Bucharest, Romania
2
“Dan Theodorescu” Clinical Hospital of Oral and
Maxillo-Facial Surgery, Bucharest, Romania
3
Dental Concept Studio, Bucharest, Romania
4
MINEC Romania
5
Opera Dental, Bucharest, Romania
Background
Dr. Tatum first described sinus lift procedure in
1974 and it has proven to be a predictable
procedure. The complications of this surgical
procedure are reported in the literature to be low,
and can include acute maxillary sinusitis, scattering
of the grafting material in the sinus cavity, wound
dehiscence and Schneiderian membrane
perforations. We aimed to evaluate the rate of acute
maxillary sinusitis after sinus lift procedures and
the appropriate management strategies.
Methods
Between 2013 and 2015, 245 dental implants were
placed in 116 patients (76 males and 40 females)
with concomitant bone augmentation of the
maxillary sinus floor. The sinus lifting procedure
was bilateral in 35 patients and unilateral in 81
patients (a total of 151 sinuses).
Results
Maxillary sinusitis occurred in 5 patients (4.3%).
The clinical signs of infection were: headache,
70
locoregional pain, cacosmia, inflammation of the
oral buccal mucosa and rhinorrhea or unilateral
nasal discharge. A mucosal fistula was observed
during inspection in one patient. The management
included only the removal of the grafting material
in 3 patients, in 1 patient the grafting material was
removed together with all the implants, and in 1
patient only 2 implants and the grafting material
were removed, 1 implant being left in place. The
inflammatory sinus mucosa was also removed in all
patients, the sinus cavity was irrigated with
metronidazole solution and an antibiotic therapy
was prescribed for 10 days with clindamycin and
metronidazole. All signs of infections disappeared
within 5 to 7 days and normal sinus function and
drainage was restored.
Conclusions
Although sinus lift is regarded as a safe and reliable
technique, acute sinusitis is a possible complication
which has to be managed immediately in order to
reduce the risk of further complications like
pansinusitis, osteomyelitis of the maxillary bone,
spreading of the infection in the infratemporal
space or orbital cavity. To minimize risk, caution
must be taken with all the steps of the procedure,
but the risk for developing acute sinusitis appeared
to be higher in patients with an obliterated ostium,
chronic conditions of sinus membrane and when a
large bone graft volume was placed, impairing
maxillary sinus clearance.
Secondary bone infections in oral
bisphosphonates patients – a rising issue
Lucian Chirilă1,2, Cristian Rotaru3,4, Iulian
Filipov4,5, Mircea Baldea2, Mihai Săndulescu1,3*
*[email protected]
1
Carol Davila University of Medicine and
Pharmacy, Bucharest, Romania
2
„Dan Theodorescu” Clinical Hospital of Oral and
Maxillo-Facial Surgery, Bucharest, Romania
3
Dental Concept Studio, Bucharest, Romania
4
MINEC Romania
5
Opera Dental, Bucharest, Romania
Background
Bisphosphonates are antiresorptive and
antiangiogenic medication used in the management
of metastatic osteolytic bone lesions originating
from breast, prostate, pulmonary cancer and
multiple myeloma, but also in postmenopausal
osteopenia/osteoporosis and in other rare diseases
of the bone (osteogenesis imperfecta, Paget’s
disease, etc.). Bisphosphonates can be administered
orally or parenterally. Although bisphosphonates
treatment has clinically proven benefic effects and
it enhances the quality of life in both cancer and
osteoporosis patients, it can also induce specific
necrosis of the maxillary bones. This clinical
condition is known as bisphosphonate-related
osteonecrosis of the jaw (BRONJ) or more actual
medication-related osteonecrosis of the jaw
(MRONJ) as the AAOMS position paper update
2014 recommends. Although it is more frequent in
cancer patients receiving intravenous
bisphosphonates (0.9-12%), it has an increasing
incidence in low-grade risk patients receiving oral
bisphosphonates for osteoporosis treatment.
MRONJ staging includes 4 stages, but in stages 2
and 3 secondary bone infection is present. The
most commonly involved bacteria are Actinomyces
spp., but some studies have described the presence
on the exposed bone of a complex biofilm formed
of bacteria, fungi and viruses.
Methods
We evaluated between January 2012 and June 2015
63 patients (23 male and 40 female) with
osteonecrosis of the jaw (ONJ) with associated
bone infection.
Results
Out of the total number of patients with ONJ, 11
(17.4% – 10 female and 1 male) were diagnosed
with stage 2 and 3 MRONJ caused by oral
bisphosphonates treatment. The oral antiresorptive
medication was prescribed for osteoporosis in 9
(14.2%) patients and for bone metastases in 2. One
of the risk factors for MRONJ is the duration of
treatment, which was between 1 and 8 years, with
an average of 3.81 years. The lower jaw was more
frequently affected (8 cases) than the upper jaw (3
cases). The number of patients with MRONJ
induced by oral medication related to the semesters
of the evaluation period indicates an increase in the
last 3 semesters (9 patients) compared to the first 3
semesters (2 patients).
Conclusions
The increase in the number of patients with
secondary bone infections caused by oral
bisphosphonates treatment may be due to the
increase in the total duration of the treatment, but
also to the increased number of patients receiving
this type of medication. The lack of prevention
when starting oral bisphosphonates treatment and
the neglecting of early signs of disease may further
increase the incidence of MRONJ.
Clinico-epidemiological aspects of flu in children
from Constanta between 2013 -2015
Ana Maria Iancu1*, Maria Margareta Ilie1, Dalia
Sorina Carp1, Simona Claudia Cambrea1,2
*[email protected]
71
Clinical Infectious Diseases Hospital of Constanța,
Romania
2
Faculty of Medicine, “Ovidius” University,
Constanța, Romania
1
Background
The annual surveillance of influenza cases is very
important to identify circulating influenza virus
strains. It is also performed in order to inform
about the severity, impact and timing of seasonal
epidemics, and to detect any emerging influenza
viruses.
Methods
It is a retrospective study, based on the data
obtained from database software of the Clinical
Hospital of Infectious Diseases from Constanta and
on the observation charts of hospitalized children in
our clinic during the cold season 2013-2015. The
specimens used were nasopharyngeal swabs and
the detection of influenza virus was made by using
nucleic acid amplification tests (RT-PCR)
Results
We noticed that during this period 675
nasopharyngeal swabs, collected in patients of all
ages, were positive. The annual distribution of
influenza cases was: 2013 -169 cases (17 casesinfluenza A, 122 cases - influenza AH1, 5 casesinfluenza AH3, 25 cases – influenza B); 2014 – 147
cases (24 cases – influenza AH1, 108 cases –
influenza AH3, 15 cases - influenza B); 2015 – 359
cases (56 cases – influenza A, 27 cases – influenza
A subtype H1N1, 276 cases –influenza B). From all
cases, 213 were isolated from children between 1
and 14 years of age, with the next distribution by
age: 1-4 year – 51 cases, 5-10 years – 106 cases,
11-14 years – 56 cases. Influenza A was more
common in age group 1-4 years, while influenza B
was more frequent in children older than 5 years. In
terms of gender distribution, 53,5% of cases were
diagnosed in boys. All cases occurred in
unvaccinated children. Influenza A was more
common during cold season 2013 and 2014, while
influenza B was frequently in last season, 2015.
Most cases occurred in Mars, representing 43.66%
from all cases. The onset was variable, with
respiratory symptoms or with digestive and
respiratory complaints or with myalgia. The main
complications were pneumonia, meningismus and
myositis.
Conclusions
According to the data from literature, in the last
cold season, influenza B predominated in children.
It generally causes milder disease than type A, so
no SARI was diagnosed in children. Influenza
represents a significant public health threat, so it is
important to perform vaccination in all groups of
population including children.
Could rifaximin be an ally in the prevention of
Clostridium difficile infection recurrences?
Violeta Molagic1*, Catalin Tiliscan1,2, Cristina
Popescu1,2, Cristina Dragomirescu1, Irina Duport1,
Irina Lepadat1, Raluca Nastase1, Mihaela
Radulescu1,2, Raluca Mihailescu1, Daniela
Munteanu1, Anca Negru1, Alina Lobodan1, Cristina
Covaliov1, Victoria Arama1,2
*[email protected]
1
National Institute for Infectious Diseases "Prof.
Dr. Matei Balș", Bucharest, Romania
2
Carol Davila University of Medicine and
Pharmacy, Bucharest, Romania
Background
Clostridium difficile infection (CDI) remains an
increasingly common hospital-associated diarrhea.
Recurrence of symptoms is one of the greatest
challenges of CDI management. There is still no
effective therapy to prevent CDI recurrences.
Rifaximin is a rifamycin-based non-systemic
antibiotic with a negligible impact on the intestinal
microbiome and in-vitro activity against
Clostridium difficile. We aimed to assess the
efficacy of rifaximin in prevention of CDI
recurrences.
Methods
We enrolled all CDI patients admitted to the Adulti
III department of Prof. Dr. Matei Bals National
Institute of Infectious Diseases, Bucharest between
July 2014 - July 2015. We report our experience
with rifaximin added at conventional treatments
(metronidazole and/or vancomycin) and as
sequential therapy following vancomycin in
patients to prevent CDI recurrences.
Results
We included 110 patients with a mean age
62.37±18 years. Male/female ratio was 0.52.
Clostridium difficile 027 strain was identified by
PCR in all patients. Most of them (53.6%)
presented with an initial CDI episode, the rest
having one (25%) or more recurrences (2-5)
(9.3%). The median ATLAS score was 2 (IQR=1;7)
Most patients (76.36%) had previously received
antibiotic therapy, most frequently cephalosporins
(19.1%) and fluoroquinolones (15.5%). There were
nine (8.2%) deaths, of which only three cases are
due CDI complications (toxic megacolon).
Rifaximin 800mg/day for 14 days was added at
conventional treatment in 54/110 cases (49%) to
reduce the risk of bacterial translocation. The
patients who received rifaximin have more
comorbidities, severe hypoalbuminemia (median
2.90g/dL), lymphopenia (median 0.7 X 109
/L),elevated C-reactive protein (median 62.7mg/L)
and were older with mean age 65.98±17.91 years
72
versus 58.98±17.66 years for patients without
rifaximin (p=0.044). There were no statistical
differences between patients with rifaximin versus
patients without rifaximin regarding the CDI
outcomes or recurrences (p=0.971). In 9 cases (8%)
we used serial therapy with vancomycin, followed
by rifaximin 800 mg/day for 14 days or 60 days.
This scheme was used in four patients with more
than one CDI recurrences and in five patients after
first CDI episode. All patients had no further
diarrhea episodes after stopping rifaximin
treatment.
Conclusions
Rifaximin may be an alternative for some patients
to reduce the risk of CDI recurrences. It still needs
randomized trials to evaluate the efficacy of
rifaximin in the treatment of CDI.
Cutaneous myiasis – unwanted souvenir from
Peru
Violeta Molagic1*, Carmen Chiotan1, Ramona
Barac2, Carmen Cretu2, Raluca Popescu1, Adrian
Streinu-Cercel1,2, Victoria Arama1,2
*[email protected]
1
National Institute for Infectious Diseases "Prof.
Dr. Matei Balș", Bucharest, Romania
2
Carol Davila University of Medicine and
Pharmacy, Bucharest, Romania
Background
Myiasis is defined as the infestation of live human
and vertebrate animals by larvae of the order
Diptera. Myiasis can cause a broad range of
infections and is classified in: cutaneous, enteric,
ophthalmic, nasopharyngeal, auricular, oral,
urogenital. In cutaneous myiasis the common sites
for lesions are the scalp, face, forearms, and legs
for the myiasis causing Dermatobia hominis, and
the trunk, buttocks and thighs for Cordylobia
anthropophaga. Cutaneous myiasis is seen more
frequently in travelers from South America or
Africa countries.
Case report
We present the case of a 57 years old female
admitted in May 2015 to Adults 3 Department of
Prof Dr Matei Balș National Institute of Infectious
Diseases with preseptal cellulitis diagnosis. She has
acute upper eyelid erythema, swelling and severe
pain on left eye. Three weeks prior her admission
she was in Peru where she was bitten by an insect
on the eyelid left eye and presents local pruritus.
After five days shows discrete erythema and edema
with local worsened after several days and with
severe pain. She reach ophthalmologist and
receives local treatment with dexamethasone and
antibiotics eyewash and later Augmentin 1 gX2/day
for 4 days. Because the local sign did not improve
she was admitted in our clinic. Eye exam revealed
patients with periorbital edema, erythema and
increase in local hyperemia but without proptosis,
ophthalmoplegia or visual impairment. Laboratory
studies were normal and the culture from eye swab
was negative. The patient received iv. treatment
with Ertapenem 1 g/day + Vancomycin 2 g/day,
Fluconazole i.v and non-steroidal antiinflammatory but later was added Dexamethasone
iv. She was referred daily for ophthalmologist exam
and local treatment. After 4 days the eyes could be
opened but the pain and foreign body sensation
persisted. She was refer again to the
ophthalmologist were a funnel containing live larva
was found under the cilia and the larva was surgical
removed. The local evolution quickly resolved with
non-steroidal anti-inflammatory and the patients
was discharge with favorable local outcome. The
parasitological examination diagnosed cutaneous
myiasis caused by Dermatobia hominis.
Conclusions
Because of an increase in international travel,
physicians are more likely to encounter myiasis
today. In many cases it can be misdiagnoses. A
good travel history and interdisciplinary
collaboration is a key to the proper diagnosis and,
ultimately, the treatment of cutaneous myiasis.
Symptomatic congenital CMV infection - case
report
Monica Luminița Luminos1,2, Anca Cristina
Drăgănescu1*, Anuța Bilașco1, Angelica Vișan1,2,
Magdalena Vasile1, Diana Slavu1
*[email protected]
1
National Institute for Infectious Diseases "Prof.
Dr. Matei Balș", Bucharest, Romania
2
Carol Davila University of Medicine and
Pharmacy, Bucharest, Romania
Background
Congenital CMV infection remains an important
subject because it is the most common congenital
infection in newborns and also a major cause of
sensorineural hearing loss and neurological
disability with long-term impact in children. Even
if most newborns are asymptomatic, approximately
10% will develop sensorineural hearing loss in the
first 5 to 7 years of life. Antiviral therapy is
recommended in the first 30 days of life for
symptomatic CMV infection that includes CNS
disease and severe focal organ disease: anemia,
neutropenia, refractory thrombocytopenia,
hepatitis, colitis, pneumonia and myocarditis.
Isolating the virus in urine samples within the first
73
3 weeks of life establishes whether the CMV
infection is congenital or acquired after birth.
Case report
We present the case of a premature newborn with
symptomatic congenital CMV infection with
neurological, hematologic, hepatic involvement
and sensorineural hearing deficiency. The medical
history of the newborn was really relevant:
maternofetal infection with group B Streptococcus
for which she received treatment with penicillin;
transfontanellar ultrasonography and cerebral MRI
had shown evidence of grade 3 periventricular
hemorrhage and cerebral micro calcifications. We
started treatment using ganciclovir (12 mg/kg/day)
in two divided doses for 20 days. The treatment
was stopped because of toxic phenomena (anemia,
severe increase in urea, hypoglycemia, important
hepatic cytolysis syndrome and progressive
cholestasis syndrome. After resolution of toxic
phenomena, we decided to continue treatment with
valganciclovir (16 mg/kg/day po in two divided
doses) for 3 weeks. The evolution was favorable in
time with clinical recovery of neuromotor
development, mild sensorineural hearing
deficiency, normalization of liver and kidney
function; the very low levels of viral load in serum
and urine and negative in the CSF made us stop the
treatment. The level of viremia was measured with
quantitative CMV DNA PCR. Following
discontinuation of therapy, the infant is still
monitored for evidence of long-term effects of
CMV such as: hearing loss, intellectual disability,
eye disease and dental disease.
Conclusions
The first-line antiviral agents for congenital
symptomatic CMV infection are ganciclovir and
valganciclovir. The main benefit of taking antiviral
therapy in the first 30 days after birth is the
prevention of hearing disorders. In the absence of
clinical evidence of disease progression, studies
have shown that a rise in viremia alone is not a
criterion to continue treatment for more than 6
weeks.
Acute myocarditis, recurrent fever, septic shock
and monocytosis in an apparently
immunocompetent patient
Maria-Sabina Tache1*, Aida Roxana Agurida1,
Alina Cristina Negut1,2, Maria Magdalena Motoi1,
Luminita Mariana Bradu1, Anca Streinu-Cercel1,2,
Adrian Streinu-Cercel1,2
*[email protected]
1
National Institute for Infectious Diseases "Prof.
Dr. Matei Balș", Bucharest, Romania
2
Carol Davila University of Medicine and
Pharmacy, Bucharest, Romania
Background
Acute myelogenous leukemia can present itself
with a mosaic of signs and symptoms before it is
diagnosed.
Case report
A 37 year-old male in apparently good health,
developed fever, chills and toothache three weeks
prior to the admission to our clinic. He presented to
the dentist where he underwent endodontic therapy
and received the indication of amoxicillin/
clavulanic-acid that he could not take because of
gastric intolerance. A few days later his clinical
state worsened and he was admitted to the
Cardiology department with the diagnosis of acute
myocarditis. He received cefoperazone and
levofloxacin therapy with apparently favorable
evolution. At discharge fever, chills and altered
clinical state reappeared alongside with abdominal
pain and diarrhea. Nine days afterwards he was
admitted to the Intensive Care Unit department
with the diagnosis of septic shock and he received
meropenem and linezolid therapy with the decline
of fever and diarrhea remission. The patient was
transferred to our clinic the following day with a
satisfactory general state, afebrile, without palpable
lymph nodes, with balanced cardiovascular and
respiratory functions, without abdominal pain but
with hepatosplenomegaly. The lab reports showed
leukocytosis with monocytosis, anemia with
macrocytosis, thrombocytopenia, acute
inflammatory syndrome and coagulation disorders.
Hemocultures, HIV testing, hepatitis markers and
Borrelia serology were all negative, quantiferon
testing was positive, tongue scraper cultures
identified Candida spp. The patient received
meropenem, linezolid, levofloxacin and
fluconazole treatment for fifteen days with clinical
and paraclinical improvement. On the day of
discharge he presented syncope, followed by
vomiting, abundant perspiration and pallor. The
patient developed pain in the right lumbar region,
diarrhea, fever and chills. An abdominal computed
tomography (CT) scan revealed an inflammatory
infiltration of the cecum and the neighboring
peritoneum. Colonoscopy identified ulcerative
proctosigmoiditis. We suspected a hematological
disorder and bone marrow biopsy was taken and it
demonstrated 16-17% leukemic myeloblasts. He
was transferred to a Hematology hospital. The
diagnosis was acute myelogenous leukemia and the
patient started the induction followed by
consolidation chemotherapy and in July 2015 he
underwent bone marrow transplant with favorable
evolution.
Conclusions
More and more often complicated cases must be
evaluated in a multidisciplinary team. In this case
the recurrent fever and chills, leukocytosis, anemia,
thrombocytopenia, hepatosplenomegaly, cecum
74
inflammatory infiltration, the acute myocarditis and
the septic shock could have dual cause: infectious
disease and acute myelogenous leukemia.
An atypical presentation of secondary syphilis
Mihaela Anca Benea1*, Serban Nicolae Benea2,
Simona Roxana Georgescu3, Adriana Hristea2,
Vasile Benea3, Mircea Tampa3, Otilia Benea2,
Ruxandra Moroti2
established. Ceftriaxone treatment was continued
for a total of 7 days. After that two doses of 2.4
million IU of benzathine penicillin were
administered one week apart. The evolution was
favorable with no fever and gradual normalization
of the laboratory tests (except VDRL and TPHA);
the patient was discharged.
Conclusions
We consider this to be an atypical presentation of
secondary syphilis as acute hepatitis is uncommon
and the pancreatic reaction is even more unusual.
*[email protected]
1
Sana Medical Centre, Bucharest, Romania
2
”Dr. M. Bals” National Institute for Infectious
Diseases, Bucharest, Romania
3
”Dr. V. Babes” Clinical Hospital for Infectious and
Tropical Diseases- Dermato-venereology
Department, Bucharest, Romania
Background
Secondary syphilis reflects the hematogenous
dissemination of the spirochetes after the resolution
of the primary lesion. It is associated with countless
different exanthemas and enantems and it was
known as the great imitator. Secondary syphilis can
also produce systemic changes by affecting the
lymph nodes, kidneys, spleen, CNS and very rarely
the liver.
Case report
We are presenting the case of a 31 years old male
patient who addressed the infectious diseases clinic
accusing fever, chills, aqueous rhinorrhea, dry
cough, odynophagia and generalized adenopathies.
The symptoms first appeared one month prior and
four days before the hospitalization he experienced
pain in the right hypocondrium and a maculopapular eruption involving the torso that later
generalized. He self-medicated with NSAIDs. The
patient’s medical history was irrelevant for the
case. The clinical examination revealed a
generalized, erythematous maculo-papular
eruption, lymphadenopathy and no other
abnormalities. The laboratory tests showed
leukocytosis with neutrophilia, inflammatory
syndrome, hepatocytolysis syndrome (3 times the
normal values), incomplete cholestasis syndrome,
pancreatic reaction (4 times the normal values).
The diagnosis at this stage was of acute cholangitis
with pancreatic reaction and ceftriaxone iv 2g/day
was initiated. Because of the roseola-like
exanthema we performed a VDRL and TPHA test
which came back positive two days later; the HIV
testing was negative. At a more detailed history the
patient remembered having an ulcerated, selflimited, painless lesion on the glans penis two
months before followed by an erythematous
eruption. The diagnosis of secondary syphilis was
Superpositions of the pathological and clinical
diagnosis in HIV neurological involvement
Ioan-Alexandru Diaconu1*, Laurentiu Stratan2,
Victoria Arama1,2, Luciana Nechita4, Ruxandra
Moroti1,2, Alexandra Diaconu3, Anca Negru1, Alina
Lobodan1, Daniela Adriana Ion2
*[email protected]
1
National Institute for Infectious Diseases "Prof.
Dr. Matei Balș", Bucharest, Romania
2
Carol Davila University of Medicine and
Pharmacy, Bucharest, Romania
3
"Marius Nasta" Pneumoftiziology Institute,
Bucharest, Romania
4
Colentina Clinical Hospital, Bucharest, Romania
Background
Romania has had little research on its own
population of neurohistopathological aimed
complications arising from infection with the
human immunodeficiency virus 1 (HIV-1). Our
study aims HIV central neuropathology through
post-mortem histopathological examination,
immunohistochemistry and immunofluorescence in
correlation with clinical diagnoses issued ante
mortem.
Methods
The analysed material consisted entirely of human
brain tissue collected during autopsies performed in
the Pathology Department of the Colentina Clinical
Hospital, Bucharest, over 18 years (01.1993 –
12.2011) from 33 HIV+ patients hospitalized in the
National Institute of Infectious Diseases Prof. Dr.
Matei Bals. All cases were examined in parallel by
two pathologists and quantified as common criteria,
thereby ensuring a uniform evaluation for all the
material studied.
Results
The group of 33 HIV-positive patients was created
over 18 years and show marked heterogeneity, both
in age, variety of diagnoses, treatment, as well as
immunological status. From the group of 33 HIVinfected patients whose brain tissue was examined
post-mortem histopathology, 14 received
75
antiretroviral therapy, 4 of them for a shorter period
than 5 months. The most common general ante
mortem clinical diagnoses were bronchial
pneumonia, oropharyngeal candidiasis,
meningoencephalitis, pulmonary tuberculosis and
HIV encephalopathy. The most common
neurological histopathological diagnoses were:
hyperemia with edema, cryptococcal
meningoencephalitis and HIV encephalopathy. In
the non-cART branch, the top neurological
histopathology diagnoses were hyperemia with
edema (6 cases), non-specific meningoencephalitis
(3 cases) and cryptococcal meningoencephalitis (3
cases). The most frequent diagnosis in the cART<5
months branch was HIV encephalopathy (2 cases),
while in the cART>5 months branch we had
Toxoplasma meningoencephalitis (3 cases),
hyperemia with edema (2 cases) and cryptococcal
meningoencephalitis (2 cases). Hyperemia and
edema was discovered in 8 of the 33 patients, 2
being treated with antiretroviral therapy, and 6 not
treated.
Conclusions
The results outline an overview of new viral
activity in the brain and a series of questions about
the long term effects of persistent infection at this
level. We found that the clinical diagnosis, despite
modern methods of imaging and serological
investigation, is inconsistently superpositioned with
the neurohistopathological diagnosis, considering a
heightened difficulty in the differential diagnosis
within the plethoric HIV neurological pathology,
with a 40% cases of partial or total clinical
misdiagnosis in comparison with the
histopathological findings.
Acknowledgment
This article has been written as part of the project
”Cercetarea doctorală şi postdoctorală prioritate a
învăţământului superior românesc (Doc-Postdoc)”
(Doctoral and Post-doctoral Research as a Priority
in the Romanian High Educational System)
POSDRU/159/1.5/S/137390.
Complicated cases of chickenpox in children in
2015
Monica Luminos1*, Anca Draganescu1, Angelica
Visan1, Ancuta Bilasco1, Endis Osman1, Camelia
Kouris1, Sabina Schiopu1, Diana Slavu1, George
Jugulete1, Madalina Merisescu1
*[email protected]
1
National Institute for Infectious Diseases "Prof.
Dr. Matei Balș", Bucharest, Romania
Background
Chickenpox is an extremely contagious disease
frequent in children, that usually resolves without
any severe complications. In some cases
chickenpox can complicate with pneumonia,
encephalitis, cutaneous abscesses and even death.
Methods
We present the situation of all chickenpox cases
admitted in The National Institute of Infectious
Diseases ”Prof. Dr. Matei Bals” during 01.01. 2015
– 01.07.2015. Also, we present three severe cases
of chickenpox complicated with cutaneous sepsis.
Diagnosis was established based on clinical,
epidemiological and laboratory criteria.
Results
During the mentioned period, we have registered a
number of 62 cases of chickenpox admitted in our
clinic. All of them were complicated cases. The
most frequent complications were represented by
bacterial superinfections (58%), pneumonia
(19.6%) and varicella encephalitis (4.4%). Out of
all patients, 3 children presented cutaneous sepsis,
with multiple cutaneous abscesses, which required
surgical treatment. The isolated bacteria were
Streptococcus pyogenes strains. All the cases
evolved favorably under adequate antibiotic
treatment. We have registered one death in a child
with chickenpox and newly diagnosed acute
lymphoblastic leukemia.
Conclusions
Lately we have observed a rise in bacterial
superinfections in chickenpox cases due to
immunodeficiency caused by the illness. The most
frequent isolated bacteria involved in
superinfection was Streptococcus spp. The total
number of complicated cases was significant in our
clinic, which is why we highly recommend VZV
vaccination in all school aged children.
The role of PLEX-ID in diagnosis of
Staphylococcus spp. infections in children – case
presentation
Mădălina Merișescu1*, George Jugulete1, Anca
Drăgănescu1, Anuța Bilașco1, Angelica Vișan1,
Camelia Kouris1, Magda Vasile1, Endis Osman1,
Sabina Șchiopu1, Bianca Bizera1, Dragoș Florea1,2,
Adrian Streinu-Cercel1,2, Monica Luminos1,2
*[email protected]
1
National Institute for Infectious Diseases "Prof.
Dr. Matei Balș", Bucharest, Romania
2
Carol Davila University of Medicine and
Pharmacy, Bucharest, Romania
76
Background
Staphylococcal infections are usually determined
by Staphylococcus aureus, but in particular
situations such immunodeficiency, existence of
gateways or invasive medical devices, severe forms
of Staphylococcus epidermidis or coagulase
negative staphylococcus infections can occur.
Case report
We want to present in this paper 2 cases. The first
case is a 7 year old boy with no relevant medical
history, admitted in the Pediatric Intensive Care
Unit of National Institute of Infectious Diseases
„Prof. Dr. Matei Bals” with the suspicion of acute
meningitis. The clinical examination revealed
clinical signs of meningitis and the presence of a
sacral dermal sinus. The second case, was
represented by a 2 years old child known with
aplastic anemia. In the first case the lumbar
puncture confirmed the acute bacterial meningitis
diagnosis. Cultures and biochemical analysis of
CSF were performed. The PLEX-ID test was
positive for Staphylococcus epidermidis in a few
hours. An MRI scan confirmed the presence of a
sacral dermal sinus and the absence of two
intervertebral discs. Later on, the CSF cultures
confirmed the Staphylococcus epidermidis
infection. In the second case the diagnosis was
established with PCR from a blood sample. The
result was positive for Staphylococcus aureus in a
couple of hours. Treatment was established based
on the antibiogram and evolution was favorable in
both cases.
Conclusions
The particularity of the case was the child’s
apparent normal state of health until the age of
seven with a sacral dermal sinus. In order to avoid
future episodes of meningitis, surgery was
performed to close the sinus. Staphylococcus
epidermidis determined an acute bacterial
meningitis in a patient with a dermal sinus, which
was quickly diagnosed through PLEX-Id in the first
case. The particularity of the second case was the
pre-existent aplastic anemia that predisposes to
Staphylococcus infections.
Background
From 40 to 90 per cent of new HIV infection are
associated with symptomatic illness. Identifying
patients in the initial stage of HIV infection is
essential for initiating early antiretroviral therapy
and especially for preventing the spread of disease.
The clinical manifestations of acute retroviral
infection (or primary HIV infection) usually appear
within 3 to 6 weeks after initial exposure. The most
common signs and symptoms include fever (8090%), fatigue (70-90%), morbilliform eruption (4080%), headache (30-70%), lymphadenopathy (4070%), pharyngitis (50-70%), myalgia and arthralgia
(50-70%), aseptic meningitis (24%), retro-orbital
pain, oral and/or genital ulcers (5-20%), gastrointestinal symptoms etc. As many symptoms are
nonspecific, without a high degree of suspicion, the
diagnosis can frequently be missed. The most
characteristic muco-cutaneous manifestations
include a maculopapular (morbilliform) or
papulosquamous (resembling to secondary
syphilis) eruption, oro-pharyngeal and/or genital
ulceration and oro-pharyngeal or genital
candidiasis. The severity and the duration of the
primary HIV infection may have prognostic
implications; severe and prolonged symptoms are
correlated with rapid disease progression.
Case presentation
We present the case of a 43 years old man who
presented to the dermatology department for
several painful genital ulcerations accompanied by
inguinal lymphadenopathy. These ulcerations
occurred few days before, being related by the
patient to local trauma. The patient does not
associate other clinical manifestations. Laboratory
investigations for syphilis (VDRL, TPHA effectuated in dynamics) and genital herpes were
negative, as bacteriological and assay for anti-HIV1/2 antibodies. Instead p24 antigen was revealed in
plasma. Based on these data we established
diagnosis of genital ulcers in acute retroviral
syndrome. The genital ulceration last for two
weeks. The patient was referred to the infectious
disease department for biologic and immunologic
evaluation and treatment of HIV infection.
Acute retroviral infection – a case presentation
Surgical intervention versus antibiotic use in
acute appendicitis
Vasile Benea1*, Simona Roxana Georgescu1,
Mircea Tampa1, Mihaela Anca Benea1, Diana
Leahu1, Cristina Raileanu1, Serban Benea2
Răzvan Vasile Stoian1,2, Daniel Ion2, Simona Elena
Albu1,2*, Roxana-Elena Viezuină2, Dan Nicolae
Păduraru2
*[email protected]
*[email protected]
1
Clinical Hospital of Infectious and Tropical
Diseases “Dr. Victor Babeș”, Bucharest, Romania
2
National Institute for Infectious Diseases "Prof.
Dr. Matei Balș", Bucharest, Romania
1
Carol Davila University of Medicine and
Pharmacy, Bucharest, Romania
2
University Emergency Hospital of Bucharest,
Romania
77
The main mechanism involved in triggering the
appendiceal inflammation is the obstruction of its
lumen. According to the contemporary data, to the
inflammatory process in the appendix, various
factors contribute, therefore, acute appendicitis is a
polyetiologic disease. Various theories have been
developed, such as the infectious one (Aschoff,
1908), the mechanical (Dieulafoy), the chemical
theory, cortico- visceral (NN Elanski, 1955) etc.
The infectious theory relates to the enteral or
hematological infection and sustains that its
confinement in appendix lining triggers a
nonspecific inflammatory process. There is an
unanimous agreement in considering the infectious
and the obstructive factors as determinants of
appendicular inflammatory process. Our study was
conducted over a period of 5 years, and evaluated a
number of 73 cases, planned to make an analysis of
the cases in which it was decided in delaying
surgery care in terms of remission or improvement
of the acute symptoms determined by antibiotics.
Depending on the obtained data, the clinic state of
the patient, laboratory investigations and close
cooperation with the infectious disease doctor, an
antibiotic administration protocol has been
established. Laboratory examinations were used
sequentially. The results advocate for rational and
selective antibiotics in patients who had a favorable
outcome after 24 hours after starting antibiotic.
Prophylaxis and therapeutic strategies in
postoperative infections
Daniel Ion2, Răzvan Vasile Stoian1,2, Simona Elena
Albu1,2*, Roxana-Elena Viezuină2, Dan Nicolae
Păduraru2
*[email protected]
1
Carol Davila University of Medicine and
Pharmacy, Bucharest, Romania
2
University Emergency Hospital of Bucharest,
Romania
Infections occurred after surgical interventions may
cause pain, unfavorable outcome in terms of
postoperative wound healing and require
continuous antibiotic treatment, and postoperative
care in the Surgery Clinic. These kind of situations
cause an increase of the hospitalization period,
increased costs of hospitalization, and can cause
serious surgical complications such as sepsis,
multiple organ failure or even the patient’s death.
Postoperative suppuration remains the most
common and most feared complication of this kind
of surgical interventions, so there have been
proposed a variety of measures to prevent it. Our
study is trying to make an analysis of this
redoubtable complication, but controllable in terms
of precise knowledge of the pathogen agent
involved, noting that any bacterial contamination is
not necessarily followed by an established
infection. Depending on this parameters,
prophylaxis with antibiotics, antibiotic targeted
strategy with aseptic and antiseptic rules associated
with preoperative preparation and postoperative
wound care, can lead to the patient’s and
physician’s therapeutic success. The presented
study refers to a number of 53 cases of
suppurations or postoperative wound infections in
the last 5 years in which therapeutic efficiency was
achieved through close collaboration between the
surgeon and the infectious disease doctor. During
the process there were followed: patient’s risk
factors for infection, methods of infection
prevention, caution in choosing the correct dosage
of the antibiotic before and after surgery. All these
data are major factors in determining the
therapeutic decision, and draws attention to
extremely favorable results from interdisciplinary
collaboration.
Influenza virus associated with acute transverse
myelitis in children
Monica Luminos1*, Madalina Merisescu1, Anca
Draganescu1, Angelica Visan1, Ancuta Bilasco1,
Sabina Schiopu1, Endis Osman1, Camelia Kouris1,
Bianca Bizera1, George Jugulete1
*[email protected]
1
National Institute for Infectious Diseases "Prof.
Dr. Matei Balș", Bucharest, Romania
Background
Involvement of the CNS in influenza virus
infection are a relatively rare and serious
complication, but since the 2009 H1N1 pandemic
an increase in the neurologic complications
associated with influenza virus infections has been
described.
Case report
We report a series of cases of H1N1-associated
with acute transverse myelitis among the pediatric
population of Romania. During the winter of 20142015, three cases of acute transverse myelitis were
addressed to “The National Institute for Infectious
Diseases "Prof. Dr. Matei Bals" – Pediatric
Department. Along with classic influenza
symptoms, the patients also had walking
disturbances and progressive neurologic alteration.
The etiological diagnosis was made using the
mariPOC test and then confirmed by RT-PCR. Two
cases were associated with the A H1N1 infection
and one with the influenza B virus. Immediate IRM
studies were performed which ruled out
78
compressive myelopathies and described diffuse,
inflammatory lesions. After, lumbar punctions were
performed the markers of inflammation were found
to be positive in the cerebrospinal fluid. Antiviral,
antibiotic and intravenous corticoid therapies were
used, in association with kinetotherapies. Slow but
sustained recovery was obtained in all three cases.
None of the patients had neurological sequelae at
the end of the treatment.
Conclusions
Influenza virus associated transverse myelitis is an
extremely severe complication of the disease that
highlights once again the importance of extensive
vaccination programs, and must be rapidly
considered in the differential diagnosis of patients
with influenza-like illness and neurological
impairment.
A complicated case of nosocomial infection with
multiple bacterial pathogens: Staphylococcus
hominis, Serratia marcescens, Enterobacter
cloacae and Pseudomonas aeruginosa – case
presentation
Ramona Ștefania Popescu1,2*, Rodica Bacruban2,
Madalina Selagea2, Adrian Streinu Cercel1,2
*[email protected]
1
Carol Davila University of Medicine and
Pharmacy, Bucharest, Romania
2
National Institute for Infectious Diseases "Prof.
Dr. Matei Balș", Bucharest, Romania
Background
Nosocomial infections are defined as acquired in
the hospital by a patient admitted for a reason other
than that infection. This is why they are also called
“hospital-acquired infections”. Examples of most
frequent nosocomial infections are: urinary tract
infections, central line-associated bloodstream
infections, lower respiratory tract infections and
surgical wounds infections.
Case report
A 74 year-old patient was referred to our clinic for
the treatment of Clostridium difficile diarrhea
diagnosed using a toxin A/B test. Five weeks
earlier she underwent laparoscopic surgery for a
gastrointestinal stromal tumor (GIST), with
subsequent treatment with ceftriaxone under which
she developed diarrhea refractory to oral
vancomycin. Due to her altered health status she
was treated in the Intensive Care Unit with no
clinical improvement. At admission she was
afebrile, bedridden, pale, with generalized edema,
purulent discharge at the abdominal surgical site
and at the central venous catheter (CVC) insertion
site, right leg necrotic wound after dopamine
infusion, with great weight loss and malaise.
Laboratory tests revealed normal leukocyte count,
anemia, biological inflammatory syndrome,
electrolyte imbalance, low albumin level,
cholestasis. Polymerase chain reaction (PCR) for
C. difficile was negative. The cultures identified
Pseudomonas aeruginosa from the surgical site, P.
aeruginosa plus Serratia marcescens from the
CVC insertion site and S. marcescens plus
Enterobacter cloacae from the necrotic wound.
Blood cultures obtained from the catheter identified
methicillin-resistant Staphylococcus hominis. We
initiated treatment according to antibiogram results
with meropenem 1g TID and teicoplanin 800mg
loading dose then 400mg QD for 10 days. With the
appropriate antibiotic and supportive treatment,
daily wound cleansing and progressive
kinetotherapy the patient fully recovered with no
residual impairment. C. difficile infection was ruled
out by repeated negative PCR testing, and diarrhea
resolved only with symptomatic treatment.
Conclusions
Intensive care is a risk factor for antibiotic-resistant
bacteria. Nosocomial infections are a major
challenge to patient safety and are associated with
increased morbidity, mortality and additional
financial costs.
Acknowledgement
This paper is partially supported by the SOP HRD,
financed from the European Social Fund and by the
Romanian Government under the contract numbers
POSDRU/159/1.5/S/137390.
Cardiac damage in Lyme disease
Isabela Loghin1*, Eduard Nastase1, Catalina Luca1,
Carmen Dorobat2
*[email protected]
1
“Gr.T.Popa” University of Medicine and
Pharmacy, Iași, Romania
2
Infectious Diseases Hospital “Sf Parascheva”, Iași,
Romania
Background
Lyme disease, acute zoonosis, produced by
Borrelia burgdorferi spirochete, through the tick of
the Ixodes species, describe in multisystemic
clinical spectrum cardiac determination, such as
myocarditis (5-8%), arrhythmias, atrioventricular
block (90%), congestive heart failure, or cardiac
syncope, that can lead to sudden death. Diagnosis
requires corroboration of clinical and
epidemiological anamnestic data of borreliosis like
previous tick bite, erythema migrans or
neurological involvement, with
electrocardiographic abnormalities and symptoms
such as chest pain, palpitations, syncope and
dyspnea in combination with laboratory exams,
79
serological tests, and echocardiography, which
often establish the diagnosis. In literature it is
shown that 4 of 10 patients with untreated Lyme
disease can develop carditis. Etiological treatment
involves antibiotic therapy (amoxicillin) and in
systemic forms - Penicillin G, or third generation
Cephalosporins. Routine therapy and screening
patients with idiopathic dilated cardiomyopathy is
of limited utility and should be reserved for
patients with clear history of Lyme disease, tick
bite, or serological enlightening test.
Methods
Retrospective study conducted from January 2012 July 2015 on 32 confirmed cases of Lyme disease
patients with cardiac manifestations, hospitalized in
Infectious Diseases Hospital Iasi. Positive
diagnosis was established based on clinical and
laboratory data, emphasizing the IgM antibody
titers by ELISA and Western-blot subsequent
confirmation; cardiac damage evidenced by ECG
and echocardiography.
Results
From the experience of our clinic number of
confirmed cases increased from 2012 until today,
especially in the summer months. Mostly the cases
were from urban areas with a relatively equivalent
sex distribution, and the cardiac damage has been
reported in 7 cases. Most experienced arrhythmias
block of varying degrees, with reversible evolution
under appropriate treatment. One case has
presented myocarditis, the patient complaining by
chest pain, palpitations, anxiety, dyspnea; the ECG
highlighting the reduction in amplitude of tracing
complexes, ST depression, T wave flattened. The
therapy was instituted quickly, depending on
cardiac injury. Thus, in patients with minor cardiac
events, the antibiotherapy was instituted with
amoxicillin, and in patients with severe cardiac
disease was chosen Ceftriaxone, for 21 days, with
further favorable development. Corticosteroid
therapy was used in complicated cases with
myocarditis.
Conclusions
Given the fact that the number of confirmed cases
of Lyme disease with cardiac damage is increasing
is necessary a good knowledge of this pathology in
order to establish a specific antibiotherapy. The
clinical cardiac manifestations in patients with
Lyme disease are benign but rare cases of death
being reported.
Lyme disease in Romania - clinical and
epidemiological features, 2010-2014
Teodora Ionescu1*, Adrian Matei2, Daniela
Pitigoi3,4, Maria Nitescu3,4, Alexandru Rafila3,4,
Odette Popovici5
*[email protected]
1
Clinical Emergency Hospital “Sf. Ioan”,
Bucharest, Romania
2
Institute of Oncology "Prof. Dr. Al. Trestioreanu"
Bucharest, Romania
3
Carol Davila University of Medicine and
Pharmacy, Bucharest, Romania
4
National Institute for Infectious Diseases "Prof.
Dr. Matei Balș", Bucharest, Romania
5
National Centre for Transmissible Diseases
Surveillance and Control (CNSCBT), Romania
Background
Climate changes and human-induced changes in
the environment, among other factors, have greatly
influenced the geographic and temporal distribution
of vectors as well as the incidence rate of several
vector-borne diseases in the past decades. In this
context, the surveillance and control of Lyme
disease became of both European and national
interest. The objective of our study was to describe
clinical and epidemiological features of Lyme
disease in Romania during 2010-2014.
Methods
In Romania, all health care providers are required
to report nominally each case of Lyme disease
since 2007. In 2010 a nationwide surveillance
system was introduced using a specifically
designed methodology. Cases are currently reported
and confirmed according to a case definition that
includes clinical criteria (differentiated by stage of
infection) in addition to epidemiological and
laboratory criteria. Based on the epidemiological
analysis performed by the National Center for
Communicable Disease Surveillance and Control,
we developed a synthesis of the epidemiological
and clinical features of Lyme disease during the
last five years of enhanced surveillance.
Results
Between 2010-2014 a total of 4999 suspected cases
of Lyme disease were reported in Romania, of
which 2376 (47.5%) were considered real cases
(confirmed+probable). The average incidence rate
of the disease was 2.2 per 100 000 inhabitants, with
a peak in 2012 (4.2%ooo). Average gender and agespecific incidence was higher in women (2.5%ooo)
and in the age group 50-59 years. A higher
incidence rate was observed in urban areas (2.7%
ooo). The counties with the highest average
incidence were Sibiu (28.5%ooo), Alba (10.7%
ooo) and Botosani (10,1% ooo). Only two counties
(Covasna and Ialomita) did not report any case
during this period. Most cases (79%) presented
acute manifestations. Erythema migrans was
diagnosed in 79% of cases with acute
manifestations. Tick bite was reported for 71% of
cases. No death was reported.
Conclusions
Sustained surveillance is particularly important for
evaluating disease trends in Romania and
80
contributing to the Emerging and Vector-borne
Diseases Programme in Europe. Physicians should
improve their knowledge regarding the clinical
manifestations, correct diagnosis and treatment of
Lyme disease. Raising awareness among the
general population on how to prevent or manage
tick bites and recommending early presentation to a
doctor in case of acute symptoms represent
essential public health measures. In high incidence
counties vector control measures are required.
Centre of Pediatric Neuro-Psychomotor Clinical
Rehabilitation „Dr Nicolae Robanescu”.
Conclusions
The rapid diagnosis of CNS infection with HSV is
important because of the potential morbidity and
mortality associated with HSV encephalitis.
Acyclovir treatment should be initiated in all
patients with suspected herpetic encephalitis. In the
case of our patient, earlier treatment improved the
chances of a good recovery.
A case of severe herpes simplex encephalitis in a
baby girl
Risk factors for Clostridium difficile infection in
children: a case-control study
Monica Luminos1,2*, Anca Cristina Draganescu1,
Anglica Constanta Visan1,2, Magdalena Vasile1,
Madalina Maria Merisescu1,2, Cristina Mihaela
Negulescu1, Endis Osman1, Sabina Schiopu1, Diana
Slavu1, Anuta Bilasco1
Raluca Tripon1*, Mihaela Sabou1, Cristina
Cismaru1, Adriana Slavcovici1
*[email protected]
Iuliu Haţieganu University of Medicine and
Pharmacy, Cluj-Napoca, Romania
1
*[email protected]
1
National Institute for Infectious Diseases "Prof.
Dr. Matei Balș", Bucharest, Romania
2
Carol Davila University of Medicine and
Pharmacy, Bucharest, Romania
Background
Herpes simplex virus type 1 (HSV-1) is the most
common cause of viral fatal encephalitis worldwide
(20%) with an annual incidence of 1/250 000 –
1/500 000 in industrialized country. The infection
arises in all age groups, with one-third of all cases
occurring in children and adolescents. Herpes
simplex virus encephalitis (HSVE) is caused by the
infection of the central nervous system (CNS) by
HSV that could have a devastating clinical course
and a potentially fatal outcome particularly without
etiological treatment. A delay of 48 hours or more
in starting acyclovir is associated with poor
outcome.
Case report
We present a case of 6 month- old girl admitted to
the Pediatric Intensive Care Unit at the National
Institute for Infectious diseases “Prof. Dr. Matei
Bals” for fever, vomiting, focal and generalized
seizures, hypotonia and altered mental status.
Clinical data correlated with laboratory findings for
cerebrospinal fluid specimens (detection of herpes
simplex virus DNA by PCR), brain magnetic
resonance imaging and electroencephalogram
established the diagnosis of herpes simplex virus
encephalitis. Early etiological treatment with
Acyclovir was started associated with
anticonvulsant drugs, antiedema therapy and
physical therapy, with good clinical outcome and
partial neurological recovery. After her discharge,
the girl continued her physiotherapy in the National
Background
Clostridium difficile infection (CDI) incidence in
hospitalized children has increased over the past
decade and disease has been reported in the
community, particularly in young children aged 1-5
years. Several CDI risk factors have been wellestablished in the adult population, including prior
antibiotic use, exposure to C. difficile in healthcare
settings, and chronic underlying conditions.
Increasing community-acquired CDI in children
requires further evaluation of the importance of
these risk factors. The aim of the present study is to
identify the risk factors for C. difficile infection in
children.
Methods
A retrospective case-control study was performed
at the Teaching Hospital of Infectious Diseases
Cluj-Napoca, between January 2011 and July 2015,
which included children between the ages of 0-18
years. The mean age was 7.8 for Campylobacter
and 7.27 for CDI. We defined cases of CDI as the
occurrence of diarrhea (≥3 loose stools per day)
with a positive test for C. difficile toxin and no
other identified causes of diarrhea. Cases with CDI
were randomly matched (1:5) to a control pediatric
population selected from children with
Campylobacter jejuni diarrhea during the same
period of time.
Results
Fourteen children with CDI were compared with 72
children with Campylobacter jejuni diarrhea. Risk
factors for severe disease included leukocytosis
(>15,000/cmm), number of diarrhea stools per day
(>10) and receipt of 2 antibiotic classes in the 30
days before infection (mostly second and third
generation cephalosporin and
81
amoxicillin/clavulanic acid). The presence of blood
and mucus in stool samples was significantly
associated with CDI (OR 20.8, 95% CI 1.19-362, p
=0.001). Logistic regression analysis demonstrated
that immunosuppression (tumors, corticotherapy,
immune deficit), proton-pump inhibitors and
antibiotic exposure within 30 days were
independent CDI predictors (OR= 12.3, 95% CI
2.06-78; OR= 28, 95% CI 2.87-280; respectively
OR=6, 95% CI 1.71-21.5). The inflammation
markers were elevated in both groups. No
statistically significant differences in clinical
presentation were observed between patients.
Conclusions
The usage of proton-pump inhibitors, antibiotics
and immunosuppression were identified as CDI
risk factors.
Pancytopenia in HIV-infected infants
Georgiana Elena Ionescu1*, Elena Tanase2,
Mariana Mardarescu1, Rodica Ungurianu1, IoanaAlina Anca2, Giorgiana Dediu3
*[email protected]
1
National Institute for Infectious Diseases "Prof.
Dr. Matei Balș", Bucharest, Romania
2
The Institute for Mother and Child Protection
“Alfred Rusescu”, Bucharest, Romania
3
Bucharest Clinical Emergency Hospital
Background
Due to the increasing number of children
perinatally exposed to HIV in Romania (43
children exposed out of a cumulative total of 49,
registered in 2015) the diagnosis and treatment of
the infant's pancytopenia are two entities that raise
many questions.
Case report
In this context we present the case of a 2 months
old infant, female, originated from an
uninvestigated pregnancy, rang III, gestational age37 weeks, birth weight-2750g, Apgar 9, born by Csection, breast fed for a month. She is hospitalized
for generalized petechiae, piston movement of the
head and green soft faces. The starting point was
three days before being diagnosed with
micropetechiae, initially at the foot, and then
generalized petechiae, for which it was decided to
make the hospitalization in a Pediatric Clinic,
where she was diagnosed with severe anemia and
thrombocytopenia, hepatic cytolysis syndrome and
where she is tested positive on an HIV Elisa test.
From the family history it results that her mother
has been HIV infected from the age of 27, stopped
taking the antiretroviral therapy hence with no
prophylaxis for MTCT. The patient has a 14 year
old brother infected with HIV and a sister who died
at the age of nine due to AIDS related causes. The
clinical report outlined: severe general condition,
generalized petechiae, respiratory rate: 60/min, Sat
O2: 95-96%, without rales, irregular ventricular
rate: 160-200/min, systolic murmur grade I-II/VI,
adeno-hepato-splenomegaly. The patient was
investigated through ultrasound, namely:
transfontanellar ultrasound which was normal,
echocardiography revealed an atrial septal defect,
with normal sizes cavities while the abdominal
ultrasound revealed hepato-splenomegaly, portal
hypertension and severe ascites. Laboratory
investigations revealed anemia and severe
thrombocytopenia, hepatic cytolysis syndrome,
inflammatory biological syndrome, positives
antibodies IgM and IgG for cytomegalovirus, CD4:
626 cells/cmm, HIV-RNA: >10,000,000 c/mL.
Treatment: there were administrated: red blood
cells, broad-spectrum antibiotic, antifungal,
diuretic, proton pump inhibitors.
Conclusions
Pancytopenia in a three months old patient is a
medical urgency that has to be treated in an
intensive care unit. Diagnosis, treatment and
prophylaxis of an HIV infected woman can prevent
mother to child transmission of HIV and help avoid
severe complications in children perinatally
exposed to HIV.
Streptococcus pneumoniae susceptibility to
antibiotics
Andreea Cristina Stoian1*, Augustin Cupșa1,
Constantin Bănică2, Florentina Dumitrescu1,
Lucian Giubelan1, Cristina Roskanovic2, Lucia
Godeanu2, Loredana Ionescu2, Irina Niculescu1
1
University of Medicine and Pharmacy Craiova,
Romania
2
“Victor Babeș” Clinical Hospital of Infectious
Diseases and Pneumology, Craiova, Romania
*[email protected]
Background
Antibiotic therapy is the key to successful
treatment, which is why is needed a constant
monitoring of antibiotic sensitivity of the involved
bacteria. Objectives: Streptococcus pneumoniae’s
phenotype analysis of antibiotics sensitivity at the
HIV seronegative adults.
Methods
Retrospective and comparative study between the
period 2007-2010 and 2011-2014, realized in
Infectious Diseases Hospital of Craiova, on the
82
evolution of S. pneumoniae’s sensitivity. We
considered multiresistant strains those that showed
resistance of at least 3 different antibiotics.
Differences were considered statistically significant
for a threshold of p <0.05 and the regression
coefficient (R).
Results
In 2007-2010, there were 234 strains identified of
Str. pneumoniae with the following rates of
sensitivity: ceftriaxone 84.61%, moxifloxacin
97.43%, linezolid 97.43%, trimethoprimsulfamethoxazole 50.84%, vancomycin, 97.43%,
erythromycin 70.94%, rifampicin 92.73%,
penicillin 39.31%, teicoplanin 100%. In the period
2011-2014 there were identified 327 Str.
pneumoniae strains, with the following rates of
sensitivity to antibiotics: ceftriaxone 44.26%,
cefotaxime 96.55%, ceftaroline 100%, ofloxacin
91.97%, moxifloxacin 100%, oxacillin 30.67%,
linezolid 96.3%, chloramphenicol 86.15%,
trimethoprim-sulfamethoxazole 68.66%,
vancomycin 95.31%, clarithromycin 84.76%,
ertapenem 47.62%, clindamycin 81.33%, rifampin
95.45%, tetracycline 44.44%. The sensitivity
evolution of S. pneumoniae to ceftriaxone recorded
a downward trend (R² = 1), and at trimethoprimsulfamethoxazole an ascending one (R² = 1).
Multiresistant strains were observed in 61 cases
(18.66%) in 2011-2014 versus 23 cases (9.83%) in
2007-2010; p = 0.0039.
Conclusions
We registered the following changes in the
phenotype of sensitivity to antibiotics of Str.
pneumoniae: reduction of sensitivity to ceftriaxone,
increasing to trimethoprim-sulfamethoxazole, and
the high prevalence of multiresistant Str.
pneumoniae in the 2nd period of the study. The
sensitivity to vancomycin, linezolid, moxifloxacin,
rifampicin was maintained increased and average
for macrolide (erythromycin, clarithromycin).
Cross-sectional study on quality of life in women
living with HIV and barriers to healthcare
access
Anca Streinu-Cercel1,2,*, Mariana Mărdărescu2,
Sorin Rugină3,4, Otilia Elisabeta Benea1,2, Simona
Erscoiu1,5, Victoria Nicuțari6, Augustin Cupșa7,
Oana Săndulescu1,2, Adrian Streinu-Cercel1,2
1
Carol Davila University of Medicine and
Pharmacy, Bucharest, Romania
2
National Institute for Infectious Diseases "Prof.
Dr. Matei Balș", Bucharest, Romania
3
Infectious Diseases Hospital, Constanța, Romania
4
Infectious Diseases Department, “Ovidius”
University, Constanța, Romania
5
Clinical Hospital of Infectious and Tropical
Diseases “Dr. Victor Babeș”, Bucharest, Romania
6
Hospital of Infectious Diseases, Ploiești, Romania
7
University of Medicine and Pharmacy Craiova,
Romania
Background
We performed a cross-sectional international study
(ELLA) to observe the population and disease
characteristics, the barriers to care and quality of
life for women living with HIV in different
countries across the globe. In this paper we
communicate the country data concerning the
barriers to healthcare of the women living with
HIV in Romania.
Methods
This observational cross-sectional study described
the demographic distribution of women living with
HIV, their reproductive choices, HIV disease
characteristics and comorbidities, the prevalence of
barriers to healthcare according to the frequency of
HIV care, the availability of antiretroviral (ARV)
regimens, use of ARV guidelines, and the
adherence to reported guidelines
Women consenting to participate in this crosssectional epidemiological research agreed to sign
the Site Data Recording Form which captures data
about the site, services available and standard of
care for HIV-1 infected patients. Patients were
asked to complete 4 questionnaires. The Barriers to
Care Scale (BACS) was one of the instruments
used for evaluating patient-reported outcomes.
Descriptive statistics were used to summarize the
data.
Results
Out of the 1931 women living with HIV that
participated in the study, 200 were from Romania.
The mean age was 31.6 (standard deviation: 10.3).
Community HIV/AIDS stigma was considered a
major barrier to access to healthcare by 44.5% of
the participating women, with more than 13%
difference when comparing with other Central and
Eastern Europe (CEE) countries. One third of the
women from Romania considered the lack of
supportive/understanding work environments a
major problem, while only one fourth of the
patients from the other CEE shared the same
opinion. Lack of employement opportunities was
considered a major problem by 49.5% of the
Romanian women living with HIV, unlike other
CEE countries were this percentage was only
22.9%. Community HIV/AIDS knowledge was
evaluated as a relevant barrier to healthcare access
by the women living with HIV in Romania; 59.5%
83
of them reported it as being either somewhat of a
problem or a major problem that they had to face.
Conclusions
We have identified important differences regarding
patient-reported barriers to healthcare in Romania
compared with other CEE countries. Our findings
can contribute to the design of country-specific
management strategies for women living with HIV
in Central and Eastern Europe.
The HPV cervical pathology induced at the
seropositive woman
Mihai Mitran1*, Carmen Georgescu1, Sorin Puia1,
Andreea Velișcu1
1
Clinical Hospital of Obstetrics and Gynecology
“Prof. Dr. Panait Sîrbu” Bucharest
*[email protected]
Objective
Highlighting the major role of HPV/HIV
coinfection in the cervical oncogenesis
Although the HPV infection (especially the one
with high-risk roots) is well-known as a decisive
factor in the cervical oncogenesis, the increased
presence of a coinfection at the HIV positive
women is demonstrated in our research to be a
major risk factor.
Methods
The complex examination of the patients - clinical
and colposcopical examination, the cytological test
Babes-Papanicolau, the selection of the HIV
infected patients for the HPV-DNA testing.
Conclusions
The incidence of the HPV roots with HR and
implicitly of the oncogenic risk at this group of
patients is higher due to the socio-material
conditions, level of education and the sexual
practices
Acknowledgement
„This paper was co-financed from the European
Social Fund, through the Sectorial Operational
Programme Human Resources Development 20072013, project number POSDRU/159/1.5/S/138907
"Excellence in scientific interdisciplinary research,
doctoral and postdoctoral, in the economic, social
and medical fields -EXCELIS", coordinator The
Bucharest University of Economic Studies”.
The childbirth at the HIV positive pregnant
woman – update. The experience of the Clinical
Hospital of OG “Prof.Dr.Panait Sîrbu”
Bucharest
Mihai Mitran1,*, Ioana Roșca1, Sorin Puia1,
Marcela Șerban1, Carmen Georgescu1, Mariana
Mărdărescu2
1
Clinical Hospital of Obstetrics and Gynecology
“Prof. Dr. Panait Sîrbu” Bucharest
2
National Institute for Infectious Diseases "Prof.
Dr. Matei Balș", Bucharest, Romania
*[email protected]
Background
Since 1992, the Clinical Hospital of Obstetrics and
Gynecology “Prof. Dr. Panait Sîrbu” Bucharest has
been the medical unit to consult, record and
monitor pregnancies, births and miscarriages
associated with transmittable diseases- including
HIV positive patients- from Bucharest, SAI and the
surrounding counties, as the hospital has the
necessary professional expertise and intrahospital
networks.
In time, within the “Prof. Dr. Panait Sârbu” Clinic,
we have systematized and implemented an
obstetric protocol for the prevention of HIV
vertical transmission.
Methods
The aim of this protocol has been to reduce the
HIV vertical transmission rate from 30-35 %, the
value in 2000, to 2-3%, the rate recorded in the
European developed countries.
Starting from the primordial objective to decrease
mother-to-child vertical transmission rate, we
established the cesarean section as the method of
delivery for all HIV positive women, at 37-38
weeks, on intact membranes, outside labor. The
result was a significant decrease in the number of
HIV positive babies.
Results
The results of the past 7 years have been most
encouraging, with a 0 rate of vertical transmission
through cesarean section, and an 23.63%
transmission for vaginal delivery.
Conclusions
Attentive monitoring of pregnancy by the
obstetrician in cooperation with the Infectious
Diseases specialist, delivery by cesarean section,
complex antiretroviral therapy for both mother and
child and ablactation have been the main means
hrough which a spectacular decrease in HIV
vertical transmission has been achieved.
84