Search

Imported tropical diseases are constantly present in Romania, as well as in all nonendemic European countries. The diagnosis is sometimes difficult due to the rarity of these diseases in our country; the epidemiological risk factors are important for approaching the diagnosis. [ABSTRACT FROM AUTHOR]

Influenza prevention through the seasonal flu vaccine in elderly population remains an efficacious method, in spite of the fact that not always the vaccine confers enough protection in the elderly. In current literature reviews it has been demonstrated that antibody response to the flu vaccination in the elderly is significantly lower than in young population, with an ever-lower response in the people over 75 years old. The aim of this study is to evaluate the efficiency of influenza vaccination in elderly population from Bucharest, in three observational studies that have run in three different seasons: 2006/07; 2007/08 and 2010/11. In this way, we have analyzed the vaccine response through measuring some serological parameters: the rate of increasing of antibody geometric mean, seroprotection and seroconversion, for each vaccine component (H1, H3 and B), in accordance with accepted criteria of European Medicines Agency (EMA) for age group ≥ 60 years. Also, we have compared the immune response in subgroups of young elderly (60-74 years) versus old elderly (≥75 years), for bringing new clarifications in relationship between age impact and vaccine response. Values lower than threshold recommended by EMA was obtained in season 2007/08 in seroprotection and seroconvertion for strain B/Malaysia and in the season 2010/11 in seroprotection for strain B/Brisbane, suggesting that the immune response for these vaccine components were inadequately in the elderly. In all three seasons there were respected EMA criteria (at least one parameter per strain to be in recommended limits), so by using serological endpoints, vaccinations in the elderly were efficacious in all three seasons. Age subgroup analyze has found no significant statistic differences in immune response in any season. [ABSTRACT FROM AUTHOR]

A young female 18 years old was admitted in ‟Victor Babes„ Infectious Disease Hospital in Bucharest complaining of occipital headache that started 10 days ago. She also had fever, nausea, photophobia, neck stiffness in the last 3-4 days. A month ago she received unspecified antibiotic treatment for medium right otitis, followed by clinical improvement. The lumbar puncture performed at admission showed increased level of proteins with pleocytosis. In hospital she received antibiotics, corticosteroids and symptomatic therapy. Her status improved, therefore after 10 days she was discharged by request. At home her condition worsened with mental status alteration and generalized headache. She was readmitted in hospital 2 weeks after, with altered consciousness, decreased reactivity, but without fever. Emergency CT scans showed firstly subdural empyema, with brain abscess that formed nearby in a few days. Finally the patient was transferred in neurosurgical department and operated with spectacular outcome, both clinically and imagistic, also receiving antibiotics according with the antibiogram. The authors discuss several features of the localized intracranial infections. They emphasize the major role of taking a good history in diagnosis, also the importance of a complete investigation, including neuroimagistic exams, for patients with meningitis syndrome. [ABSTRACT FROM AUTHOR]

Background: A quite consistent number of reports from medical literature are bringing evidences that sustain that outdoor air pollution is modulating the respiratory morbidity's frequency. Design and objective: Study based on the cohort of hospitalized patients aiming to describe associations between the risk factor represented by exposure to atmospheric pollutants and frequency of hospitalization for lower acute respiratory tract infections (LARTI) in patients, with residency in Bucharest municipality, during the cold season 2007-2008. Methods: In the study have been enrolled patients admitted to "Dr. Victor Babes" infectious and tropical diseases hospital from Bucharest. In the period October 2007 to May 2008, the levels of nitrogen dioxide (NO2), carbon monoxide (CO), sulfur dioxide (SO2), ozone (O3) and particulate matters with the air diameter < 10 microns (PM10), daily measured in the atmosphere of Bucharest municipality were stratified in two classes of exposure: (a) ubiquitous exposure (£ 75 percentile) and (b) overexposure (> 75 percentile). Through conditional logistic regression it was compared the risk of overexposure to the considered pollutants in the day of hospitalization and also in other two control days, one situated at 2 weeks before and the other at 2 weeks after the day hospitalization; each enrolled patient was his/her own control. Results: The analysis of distribution of each considered pollutant's daily air level revealed normally distributed curves for O3 and SO2 but multimodal ones in case of NO2, CO and PM10. The case-crossover study showed that, in the day of hospital admission the risk of overexposure was significantly (p< 0.05) higher, for the following pollutants: NO2 [Odds ratio (OR): 1.50; 95% Confidence Interval (95%CI: 1.18-1.91], CO (OR: 1.43; 95%CI: 1.10-1.85), and PM10 (OR: 1.39; 95%CI: 1.14-1.71), that are the pollutants detected with excessive values ("picks") of daily air levels. Conclusions: During the winter season 2007-2008, in Bucharest municipality, the excess of hospitalization for LARTI was highly correlated to overexposure to NO2, CO and PM10 air levels.The results of the study are important by societal perspective as them are scientifically motivating the need for implementation of programs aiming to improve the Bucharest's atmospheric air quality. [ABSTRACT FROM AUTHOR]

Orientation - An unusuall rising, above the expected limits, and with a clear epidemic trend, in the viral meningitis reported cases weekly frequencies, has been observed during the 2007 year's routine summer West Nile neuroinfection surveillance, conducted in Bucharest. As the confirmatory tests for West Nile etiology were constantly negative it was supposed that the outbreak might be of enteroviral origin, and consequently the investigation of this etiology was decided and performed. Objectives - (a) outbreak description and (b) analysis of outbreak's management Methods - enteroviral ethiology was ascetained through WHO recommended cultural technique in 310 clinical specimens sampled from 155 patiens. The prevalence of viral meningitis cases caused by the enterovirus ECHO serotype 4 (EV-4) has been used in order to describe the outbreak course in time (calendar weeks) and also in demographic terms (age groups) respectively. For the outbreak management analysis the following was taken in consideration: (a) laboratory technique used for cases' etiology investigation, (b) nature and number of clinical specimens cultured, (c) validity of case definition used for cases' enrolment in virological tests and (d) interventions taken to control the pathogen transmission. Results - the existence of an aseptic meningitis outbreak was confirmed through significant (p< 0.05) overpassing in 2007 of the expected weekly frequences in 12 (57%) out of a set of 21 consecutively weeks (starting with the week 19) during which surveillance has been conducted; viral meningitis cases affected all ages groups over one year, but mainly the older children and young adults. EV-4 etiology has been associated with the clinical picture in 36 (23.2%) of the 155 patients with at least one cultured clinical specimen. In time prophile, the prevalence of EV-4 infection evolved sequencially, the positivity rate being significantly higher (RR: 2.49) in the last half of the outbreak. In demographic terms the highest EV-4 isolation rate was found in the 1-6 years old age group (39%), and it decreased steadly with older ages. EV-4 has been isolated from 78 (24.2%) out of 310 clinical specimens; the isolation rate ranged from 24.3% (CSF) to 29.4% (throat swab) (p>0.05). The most proliphic combination of clinical specimens was CSF + throat swab (31.3%), although this rate was not significantly higher then those associated to CSF only. Correlation between the number of clinical specimens (1-4) sampled from a single patient and the isolation rate counted for only 8%. Predictive positive value and specificity of the clinical case definition provided, were both of modest values (23.9% and 11.3% respectively). Case investigation suggested (OR: 2.94; p > 0.05) an association between recent eating of unwashed fruits/vegetables and EV-4 positivity. Conclusions - the viral meningitis otbreak has been provoked by EV-4 and apparently involved all ages, except infants. The value of the outbreak management was shaded primarly by using the cultural technique selected for etiology investigation all along the duration of episode's evolution, i.e. byond the time when the enteroviral etiology had been indubitably demonstrated up the serotype level. Recommendations - In the future viral meningitis outbreaks an adequate management should be based primarly on molecular methos of diagnosis. [ABSTRACT FROM AUTHOR]

The Rotavirus infection represents a worldwide major public health problem through the high level of contagiousness and through the socio-economic problems it creates by affecting in the same way children from poor and rich countries alike. The present article represents a 2 year case control study that was made in „Dr Victor Babes" Hospital of Infectious and Tropical Diseases, Bucharest, during 01.01.2009 - 31.12.2010. The idea of the study appeared after our observations of the increasing numbers of cases with acute diarrheic disease admitted and of their rotaviral etiology. The data was obtained by studying the admittance papers of the patients with the diagnosis of acute rotaviral enteritis (CIM 10 A08.0). The diagnosis was made using the Rotavirus antigen in the stool of the patients using Vikia-rota-adeno kits. Results: in the studied period we have identified 692 cases of infection with Rotavirus, with a slightly higher females affected (1.14/1), the mean age of the patients was of 35 months, the majority of the patients coming from an urban environment. The time frame from the symptoms inset to the time of admittance was, in average, of 44h. Most frequently the first symptom was vomiting, followed by diarrhea and fever. At the time of admittance 94% of patients presented with dehydration signs and 56.7% also had extra digestive symptoms. The average period of hospitalization was of 4.5 days. Out of the studied cases, 20% could be labeled as nosocomial. No death was registered. Conclusions: in the last years we have witnessed an increase in the incidence of acute diarrheic disease, especially Rotavirus related, with a high number of cases (1676/year in only one pediatric unit, 3085 in the whole hospital). Due to high contagiousness, especially in young children and to difficulties in preventing transmission, this disease will continue to represent a public health problem. [ABSTRACT FROM AUTHOR]

Although the European recommendations include the use of new antiviral drugs for the treatment of hepatitis C, in Romania the current treatment remains interferon plus ribavirin. First generation viral protease inhibitors (i.e. boceprevir, telaprevir), which have raised the chances of obtaining viral clearance in up to 70% of infection cases produced by genotype 1 isolates, have not been introduced yet as standard treatment in our country. The success of these new antivirals is limited by the occurrence and selection of resistance mutations during therapy. We set-up a molecular study aiming to detect any resistance mutations to boceprevir and telaprevir harbored by hepatitis C isolates infecting Romanian patients naïve to viral protease inhibitors. Since these new antivirals are efficient and approved for genotype 1 infection, viral samples were genotyped following a protocol previously developed by our research group. We analyzed by both population sequencing and molecular cloning and sequencing the NS3 protease region of hepatitis C virus isolates infecting patients which were not previously exposed to boceprevir and telaprevir. All the analyzed samples were subtype 1b and resembled the samples collected in recent years from Romanian patients. Molecular cloning followed by sequencing showed great intra-host diversity, which is known to represent the source of isolates with different resistance phenotypes. Both population sequencing and molecular cloning followed by clone sequencing revealed two boceprevir resistance mutations (T54S and V55A), respectively, a telaprevir resistance mutation (T54S) in the sequences obtained from a patient with chronic hepatitis C. To our knowledge, this is the first study indicating the existence of pre-treatment resistance mutations to boceprevir and telaprevir in hepatitis C virus isolates infecting Romanian patients.

Aim: Testing antibiotic resistance of bacterial strains (compulsor, reported for EARSS surveillance) isolated from patients hospitalised for systemic infection in the "Dr. V. Babe" Hospital for Infectious and Tropical Diseases during 01.01.2005-11.11.2009, for a dynamic evaluation and for the surveillance of resistance emergence for certain classes of antibiotics., Material and Methods: Bacterial isolation: BacT/ALERT system; strain identification in classic and automated system (ATB Expression. VITEK 2C): antibioresistance: disk-difussion method (NCCLS 2005--CLSI 2009), MIC (E-Test, ATB/ Expression, VITEK 2C). Screening of ESBL-producing strains performed with double disk-difussion method (DDD). Reference strains used: S. aureus ATCC 25923, S. pneumoniae ATCC 49619, E. coli A TCC 25922, Enterococcus fiecalis ATCC 29212., Results: During the studied period, 245 bacterial strains have been isolated, identified and tested (Staphylococcus aureus / 70, Streptococcus pneumoniae / 61, Enterococcus faecalis / 18, Enterococcus faecium / 5, Neisseria meningitidis / 18, E. coli / 73). out of 166 hemocultures and 79 cerebrospinal fluids / CSF. The average incidence of MRSA strains in systemic infections was 34.28%. 44.28% of the S. aureus strains were resistant to erythromycin, 17.14% to cyprofloxacyne, 15.71% to rifampicine, 14.49% to gentamycine. No strain resistant to vancomycine and linezolide. Streptococcus pneumoniae presented an average high resistance to penicillin G of 11.47%. and a 1.63% resistance to third generation cephalosporines. 0% resistance to vancomycine and rifampicine. 7/ 18 Enterococcus faecalis strains and 4/5 Enterococcus faecium strains presented high level resistance to gentamycine (CN 120 microg/disk) and no strain was resistant to vancomycine, teicoplanin or linezolid. The 18 Neisseria meningitidis strains were all sensitive to beta-lactams, macrolides, fluoroquinolones and cloramphenicol. For the 73 Escherichia coli strains, the average incidence of ESBL-producing isolates was 10.95%, the average resistance to ampicillin was 58.90%, to gentamycine--13.88% and to cyprofloxacin--20.83%. No strain resistant to carbapenemes and amikacine., Conclusions: For the systematic surveillance of antibiotic resistance there is a need for a harmonised protocol of data gathering and strain selection and the rigurous implementation of correct evaluating methods for antibiotic resistance in the microbiology laboratory. Carbapenemes. glycopeptides and oxazolidinones still present a major effectiveness in the first intention treatment of systemic infections.

Accurate genotyping of hepatitis C virus (HCV) has clinical implications for treatment orientation and epidemiological impact in tracing the contamination sources. The aim of the study was to compare a genotyping assay by restriction fragment length polymorphism (RFLP) in the HCV 5'untranslated region (5'UTR) with sequencing in the 5'untranslated and NS5B regions. One hundred and three samples, collected between 2004 and 2006 from chronically infected patients with HCV, were tested with the 5'UTR and NS5B protocols. Of the total number of the samples tested by the 5'UTR-RFLP assay (n=103) the HCV subtype could be inferred by this method for 92 samples, by 5'UTR sequencing for 16 samples out of 23 tested (n=23) and by using the NS5B sequencing for all the samples tested (n=34). Our results showed that the HCV genotype distribution in Romania is: 1b--86.4%, 1a--10.7% and 4a--2.9%. In conclusion, RFLP screening in the 5'UTR is a convenient method for HCV genotyping and discrimination between 1b and non-1b genotypes but has a poor resolving power for subtyping and evaluation of the transmission routes. Sequencing in NS5B region is more adapted than RFLP and sequencing in 5'UTR for subtyping and epidemiological investigation.

Objective: Assessment of the short-term association between exposure to outdoor air pollution and hospitalization for lower respiratory tract infections (LRTI) in the Bucharest municipality'spopulation., Materials and Methods: Relation exposure--health effect has been explored through linear regression upon time series, where the independent variable was represented by daily levels of nitrogen dioxide (NO), carbon monoxide (CO), sulfur dioxide (SO2) and ozone (O3) from atmospheric air of Bucharest municipality whereas the dependent variable has been represented by daily frequency, by age groups, of Bucharest municipality residents, hospitalized during the year 2007for LRTI (ICD-10 codes: J12-J22)., Results: In the year 2007, through linear regression we found high correlations (p < 0.01) between the following variables: (a) daily atmospheric concentrations of NO2, CO and SO2, (b) daily frequencies of hospitalizations for LRTI by age group and (c) daily air levels of three of the above mentioned pollutants and the age-specific frequencies of patient hospitalization for LRTI. The O3 daily air levels have been correlated (p < 0.01) only with the daily air levels of SO2 and CO but wasn't correlated to NO2 air level or with the health effect studied, Conclusions: in the Bucharest municipality, the study demonstrated robust associations between the atmospheric pollutants' levels and daily frequencies of hospital admissions for LRTI. Through inference the results suggests that the interventions for environment control which will result in decreasing of the pollution level with NO2, CO and SO2 might be associated with decreasing the frequency of hospitalization for LRTI and consequently with preserving the resources allocated for health.