Search

Introduction. Treatment with peg-interferon (Peg-IFN) and ribavirin in patients with chronic hepatitis C (CHC) represents current standard therapy, although it is accompanied by multiple side effects. Objectives. The present study aims at analysing the prevalence and etiology of acute bacterial infections in patients with CHC who are following peg-interferon and ribavirin combination therapy. Patients and methods. We have retrospectively investigated the medical records of 62 patients with CHC who were managed at the Hospital of Infectious Diseases in Timisoara, Romania. We have included in the study the patients who presented detectable HCV RNA, normal or increased alanine aminotransferase levels, histological rate ≥ 1, fibrosis and were aged ≤ 65 years. All patients were treated with Peg-IFN α-2α (Pegasys, Roche), 180 μg/week and ribavirin (Copegus, Roche, 1 tablet = 200 mg), 1000-1200 mg/day (1000 mg/day for patients under 75 kilos and 1200 mg/day for patients over 75 kilos) for 48 weeks. The patients have been evaluated monthly clinically and biologically and different explorations were carried out in selected cases in accordance to the disease management protocol. Results. In the study group, 22 (35.5%, male=10, female=12) patients with acute bacterial infections were diagnosed as follows: 5 patients with staphylococcal infections, 3 with urinary infections, 3 with acute bronchitis, 2 with bacterial pneumonia, 3 with acute sinusitis, 4 with acute tonsillitis and 2 with acute angiocholitis. The development of acute bacterial infections in our study group was associated with an advanced stage of liver fibrosis (F3-F4 - 16 patients), neutropenia (N-II - 11 patients), anemia (AII - 16 patients) and advanced thrombocytopenia (TII - 18 patients). Conclusions. The high prevalence (35.5%) of acute bacterial infections in patients with chronic hepatitis C treated with Peg-IFN and ribavirin requires a rigorous clinical, laboratory and therapeutic monitoring of the patients during this period. [ABSTRACT FROM AUTHOR]

Hydatid cyst of a solitary congenital kidney is a rare entity because of the small percentage of cases with renal hydatidosis and the reduced number of cases with this renal anomaly. We report a case presenting this extremely rare combination and having a favorable outcome. The diagnosis was confirmed based on an association of imagistic techniques and positive serology. The case was managed using a minimal invasive surgical technique (PAIR) that reduced the operative risks. Additionally, an antihelminthic agent (albendazole) was administered. To our knowledge, this is the first case with such comorbidity and treated through percutaneous approach., (Copyright © 2014 Hainan Medical College. Published by Elsevier B.V. All rights reserved.)

Echinococcosis or hydatid disease is a parasitic zoonosis acquired by humans through ingestion of viable helminthic eggs of Echinococcus sp. with their food. A hydatid cyst of the spleen is a rare condition, commonly reported in 0.5-8% of patients with echinococcosis. We aim to describe herein an interesting and rare case of splenic hydatid disease diagnosed in a 34-year-old female patient residing in a rural area from Romania, a country endemic for this disorder. The therapy consisted of total splenectomy, and the postsurgical evolution was favorable.

This study aims to compare the epidemiological, clinical, and laboratory aspects of cystic echinococcosis (CE) in children with those of adults from western Romania, and to determine the specifics of this disease in the younger population. The medical records of the patients diagnosed with CE and hospitalized during 2004-2010 in four western Romanian counties were retrospectively investigated. Overall, 82 children (mean age, 10.8 years) and 369 adults (mean age, 48 years) were diagnosed with CE during the study period. The yearly detection rate was 3.1/100,000 children and 3.4/100,000 adults. The incidence rate registered a peak in children aged 5-14 years (4.4/100,000) and adults aged 60-69 years (5/100,000). Female to male ratio was 1.6:1 in pediatric cases and 1.2:1 in adults. CE was almost twice more frequent in rural areas (4.4/100,000 children and 4.9/100,000 adults) as compared to urban regions (2.3/100,000 children and 2.6/100,000 adults). Hepatic cysts were found more frequently than pulmonary cysts, at a ratio of 3.6:1 in children and 12.8:1 in adults. Most of the cases had no complications (91.5% of children and 87% of adults). Children had higher eosinophil count (7%) and erythrocyte sedimentation rate (ESR) (29.7 mm/h) as compared with adults (eosinophil count, 5.3%, p<0.001; ESR, 22.4 mm/h, p=0.001). The active transmission of the parasite in western Romania is demonstrated by the high incidence of CE in children. Long-term prevention of this disease may be reached through joined legislative efforts focused on the registration of dogs, home slaughter of sheep and swine, veterinary control in abattoirs, destruction of infected materials, and restriction of dogs' access to vegetable gardens and children's parks.

The purpose of this study is to bring new and important data regarding the epidemiology of ascariasis, enterobiasis and giardiasis in the Romanian largest county during a 14-year period. We have performed a retrospective collection and analysis of the available information provided by the general practitioners to the Statistics Department database of the Timis County Public Health Authority. The mean annual incidence of the studied parasitic diseases during 1993-2006 was the following: 194 cases per 100,000 inhabitants (range: 90-304) for ascariasis, 777 cases per 100,000 inhabitants (range: 417-1241) for enterobiasis and 1076 cases per 100,000 inhabitants (range: 93-1770) for giardiasis. Noteworthy is that Romania reported 90.8% of the total cases of giardiasis at the European Union's level during 2006-2008. The general trend of the incidences throughout the studied period was constant for ascariasis (R(2)=0.192, p=0.1), showed no statistically significant variation (R(2)=0.025, p=0.6) for enterobiasis and was upward for giardiasis (R(2)=0.6, p=0.001). Intestinal parasitoses represent an important public health concern in Romania due to the extremely high incidence rates reported. Special attention should be paid to the young population (0-14 years), where the negative disease consequences on children's health and their educational process may be traced for a long-term. Therefore, efficient educational programs and campaigns should be timely implemented., (Copyright © 2012 Elsevier B.V. All rights reserved.)

This article reports for the first time data regarding trichinellosis in sacrificed animals (domestic pigs and wild boars) inspected during the period from January 1998 to November 2011 in the largest of the Romanian counties. The data were collected from the Veterinary Public Health Department of Timis County. A total of 5,586,431 domestic pigs on farms, 609,325 pigs in private households, and 823 wild boars were examined during the study period. The results indicated that 681 domestic pigs (0.01%) on farms and 407 pigs in private households (0.07%) were found to be infected with Trichinella. Regarding wild boars, infection was detected in only 4 animals (0.5%). Although no infected animals have recently been identified during routine examinations (2009-2011), human outbreaks continue to occur yearly, and the main factors for these include improper handling by the population.

Cystic echinococcosis (CE) is a major parasitosis in Romania, a country where in the past at least one person from 45.5% of its localities underwent surgery for this disease. This survey aimed to provide new epidemiological and clinical data regarding human cases of CE in a western Romanian county. We have retrospectively investigated the medical records of the patients with CE hospitalized during the period of 2004-2010 in the surgical sections of Arad County. A total of 79 patients aged 5-88 years (mean age: 35.9±20.1 years) were diagnosed with CE during the study period. The average yearly incidence was 2.4 cases per 100,000 inhabitants, and the majority of the patients (29.1%) were aged 0-19 years. Most of the adult cases (≥18 years) were people with limited formal education (laborers) (45.6%). The analysis for trend showed an overall decrease in the affected persons over the study period (R(2)=0.66, p=0.026). Hepatic localizations of the hydatid cysts predominated within the study group (73.4%). Only 21.5% of the diseased presented complications and the mean length of hospital stay was 16.2±10.9 days. Eosinophilia of at least 10% of the leukocyte value occurred in 14% of cases and leukocytosis was noticed in 24.1% of patients. Although the rates of CE cases have decreased in Arad County (Romania), this parasitic disease continues to be a concern for public health services and requires the implementation of more stringent prophylactic measures.

Malaria is a major problem for European travelers to endemic regions. In Romania during 1980-2007 approximately 20 imported cases were detected annually. The aim of our short communication is to present 2 interesting cases of imported malaria detected in Western Romania. The first patient was a 20-year female who traveled to India and acquired an infection with Plasmodium vivax (P. vivax). The second patient, a 60-year female, contracted an infection with Plasmodium falciparum (P. falciparum) during a trip to Ghana; the evolution of the disease was severe with many complications and the patient finally died. The cases presented revealed the difficulties in establishing a correct diagnosis of malaria in a non-endemic country, consequences of an incomplete taken anamnesis. Travel history should always represent a mandatory part of a well conducted investigation. At the same time, we must underline the importance of a correct and complete prophylaxis prior to every departure to tropical countries., (Copyright © 2012 Hainan Medical College. Published by Elsevier B.V. All rights reserved.)

This review aims to investigate, from a historical point of view, the roots of the Trichinella pathogens and the disease they produce, beginning from the times first recorded in the Bible and continuing until the scientific mysteries of the pathogen were finally unveiled. Our journey sheds light on "strange" epidemics developing before the discovery of the parasite and bearing a clinical similitude to trichinellosis; it follows the controversies that erupted after the nineteenth century discovery of the parasite and the subsequent official outbreaks, and then examines the pioneering methods used for its visualization. Finally, it tries to reveal the possible relationship of trichinellosis with the arts. Furthermore, it seems that the saga of the helminth, "destined to remain with us, both in nature and in the laboratory," will continue to haunt and fascinate scientists from both developing and developed countries, as they try to answer new questions about the parasite's "evil" nature.

Purpose: To analyze the epidemiological and clinical characteristics of human cystic echinococcosis (CE) in two Romanian counties, of which one is known from a previous survey as hyperendemic, whereas in the other no extensive studies have been undertaken so far., Methods: Retrospective investigation of the medical records of the patients diagnosed with this condition and hospitalized during 2004-2010 in Caras-Severin and Hunedoara counties., Results: A total of 190 patients aged 5-88 years (44.3±21.8 years old) were diagnosed with CE. More than one fifth of cases (21.1%) were younger than 19 years old, indicating active transmission of the disease. The yearly average incidence was 3.3 cases/100,000 inhabitants. The highest incidence was registered in patients aged 60-69 years (6.2 cases/100,000 inhabitants), regardless of their gender. Liver involvement occurred in 84.7% of patients. One fifth of the cases (20%) presented complications. Normal values of the eosinophil counts and leukocyte counts predominated within the study group. The length of the hospital stay varied between 1 and 65 days with a mean of 13.1±9.5 days., Conclusions: CE has a significant burden in this part of Romania, and continues to be a public health concern. Consequently, better implementation of preventive measures and extensive informative campaigns for the population are mandatory., (Copyright © 2011 Elsevier B.V. All rights reserved.)

Romania reported the highest incidence of trichinellosis in the world in 2004, and the figures continue to be high. This report aims to bring new information regarding 2 foci of trichinellosis that occurred in the winter of 2011 in a western Romanian region. Data were collected from the outbreak reports and hospitalization documents of the patients diagnosed with this condition. Of 22 patients admitted to hospitals, the medical records were available in 20 cases. The mean age of the study group was 37.4±13.6 years (range: 3-56) with most of them (n=7; 35%) aged 30-39 years old. The majority of the patients (n=19; 95%) were adults (≥18 years old), males (n=13; 65%) and rural inhabitants (n=13; 65%). Mylagia represented the most common clinical symptom (n=17; 85%). All but one of the patients had benign and moderately severe courses of the disease. The mean eosinophil counts and leukocyte counts were 17±10.7% and 10,162.4±3798.4 cells/mm(3), respectively. Re-emergence of trichinellosis in this region has deep roots in the population's ancestral customs and education. To limit the occurrence of the disease, new and efficient public health strategies should be designed and implemented in the nearest future., (Copyright © 2011 Elsevier B.V. All rights reserved.)

This case report focuses on hydatidosis, one of the most important parasitic zoonoses in Romania. We describe an interesting paediatric case of an eight-year old boy from a rural region presenting with a both giant and life-threatening pulmonary cyst (that was successfully managed) and a hepatic cyst. Noteworthy are the negative consequences of this disorder on children's health and development as a result of prolonged hospitalizations, surgical interventions and chemotherapy.

As travel has become easier and faster, the rate of tropical infections across the world is expected to increase; more students working abroad are going to encounter these diseases more often. Disorders of parasitic etiology play an important role in travel and tropical medicine. The aim of our study was to assess the preclinical students' knowledge regarding parasitic diseases, tropical and travel medicine in the broad context of their professional background. A total of 346 Romanian medical students completed a 13-item questionnaire on the above-mentioned topics. In order to allow for complex evaluation, the questionnaire also included items related to their extracurricular training as well as their future perspectives. The majority of the students (97.7%) declared they had prior knowledge (before studying parasitology) of malaria. Most of the responders (90.2%) knew that a journey in (sub)tropical regions requires adequate prophylactic measures. About a quarter of those interviewed (26.4%) would agree to practice tropical medicine after graduation. They were mainly interested in helping people from underdeveloped countries regardless of remuneration (52.7%). The majority of students (59.8%) wished to practice clinical medicine. It has been observed that fewer than 5% of the questioned students had ever read a scientific paper or book in the field of tropical medicine. English was the most commonly spoken foreign language (92.8%), and 99.1% of students had at least intermediate computer skills. Finally, 71.6% of students would choose to practice the specialty of travel medicine if it were available in Romania. The implementation of appropriate measures towards the globalization of medical teaching in Romanian universities should represent an important issue in this new millennium, in which borders between various nations are starting to fade; otherwise the next generations of physicians will lose the chance to gain wider experiences and share the international influences on health., (Copyright © 2011 Elsevier B.V. All rights reserved.)

Objectives: This report aims to assess the epidemiological characteristics of imported malaria in Romania in the context of international travel increase, and to compare them with the data reported by other European countries., Methods: Data on malaria cases were provided by the National Centre for Surveillance and Control of the Communicable Disease, whereas the data regarding international travels to and from Romania were retrieved from the Romanian Statistical Yearbook., Results: The number of Romanian citizens who traveled to Africa in 2007 increased by over 600% as compared to the previous year. During the years 2008-2009, 25 cases of imported malaria were registered in Romania, with no fatalities. All patients were male and most of them (84%) acquired the infection in Africa. Plasmodium falciparum was involved in 68% of cases. The majority of the affected patients (41%) were aged 31 to 40 years. Labor was the main reason for traveling (72%), and 92% of cases took either partial or no chemoprophylaxis., Conclusion: The continuous growth of professional and leisure voyages to malaria-endemic regions may lead to a dramatic increase of imported cases, especially if prophylactic measures are not strictly followed.

Trichinella sp. larvae are released from the intestine and usually migrate through the liver into the general circulation. Nevertheless, hepatic involvement does not represent a leading feature of human trichinellosis. This narrative systematic review focuses exclusively on hepatic complications of trichinellosis and includes a brief overview and analysis of selected cases reported in the literature. Our major goals were to gather important data to understand the substrate of trichinous liver injury and to provide helpful clinical hints for practitioners. To our knowledge, this is the first international review dedicated to this topic. Thirty two cases were detailed enough to allow pooled analysis. The mean age of the analyzed group was 30.5±17 years old with most cases aged 19 to 29 years (29%). Hepatomegaly was noticed in 34.4% of cases, hypoalbuminemia in 40.6%, and hypoproteinemia in 34.4%. Our systematic analyses demonstrated that hepatic complications were mainly evidenced in fatal cases of trichinellosis (65.6%). The most frequent necroptic findings were parenchymatous and/or fatty degeneration of the liver (59.4%). Although less discussed in the literature than other complications, hepatic involvement should be considered more carefully because of its significant consequences on protein metabolism and liver function. Difficult to be revealed intra vitam, hepatic involvement may represent an additional concern to the classical clinical picture of trichinellosis and other life-threatening complications, especially in severe cases of infection. Consequently, physicians should be aware of any possible liver involvement to ensure adequate management of their patients.

Objectives: The aim of this report was to provide concise epidemiological data regarding a recent reemergence of West Nile virus (WNV) in the human population of Romania simultaneously with the threatening occurrence of this condition in other European countries. Also, we attempted to present a brief synopsis of the past situation regarding WNV infections in this country., Materials and Methods: Data were collected from the National Centre for Surveillance and Control of the Communicable Disease, Bucharest. Additionally, supplementary information was extracted from the reports provided by the Romanian Ministry of Health., Results: As of September 30, 2010, 50 confirmed cases of human infections with WNV have been registered in Romania. The median age of patients was 59.5 years (range: 12-81 years). Male patients predominated (68%, p < 0.001) and 52% of cases were rural inhabitants. The fatality rate was 10% (p < 0.0001). Deceased patients were aged over 65 years and had a positive history for chronic disorders. A detailed anamnesis revealed that none of the infected individuals used substances intended to remove mosquitoes around or inside their homes or skin repellents., Conclusions: Our article adds important data to the European map of WNV infections. Also, it highlights the particular conditions (ecological and climatic) as well as improper habits regarding the maintenance and transmission of WNV in the environment and provides appropriate indicators for individual risk assessment.

In 2007, Romania, the largest southeastern European country, reported the highest notification rate of botulism cases in the European Union (0.18 per 100,000 inhabitants), which was 18 times higher than the reported rate in the United States (0.01 per 100,000 inhabitants). This report aims to analyze published and unpublished surveillance data on foodborne botulism in Romania from 1980 to 2009 in the context of political and economical changes that occurred in the former communist countries. The mean annual incidence rate of botulism cases was significantly lower during the late communist period, 1980-1989 (0.06±0.03 cases per 100,000 inhabitants), than during the years 1990-1999 (0.1±0.04 cases per 100,000 inhabitants, p=0.01) and 2000-2009 (0.12±0.04 cases per 100,000 inhabitants, p<0.01). The highest incidence rates were registered in 1998 and 2007 (0.18 cases per 100,000 inhabitants), whereas the lowest incidence rate was registered in 1983 (0.02 cases per 100,000 inhabitants). The disease was usually associated with the consumption of home prepared meat products (mainly raw sausages, smoked-dried meat). Most of the laboratory-confirmed cases tested positive for type B toxin (99%). During 2007-2009, the incidence was particularly high in northwestern and western Romania (0.5 and 0.3 cases per 100,000 inhabitants, respectively). The fatality rate was 60% before 1995 and decreased to 12.2±8.5% during 1999-2009. The general ascending trend of infection rates throughout the period studied demonstrates the need for the implementation of correct public health and educational measures to fully prevent this severe disease.

Cardiovascular complaints represent the most important complications of trichinellosis and are particularly evident in the moderate and severe courses of the disease. An overview of 17 epidemiological studies on trichinellosis (including 5268 cases) indicated that cardiovascular events occurred in 26% of patients (range: 1.5%-75%). This narrative systematic review focuses exclusively on the cardiovascular involvement of trichinellosis and includes a brief overview and analysis of selected cases reported in the literature. Our primary goal was to increase the awareness of infectious diseases specialists, cardiologists, and general practitioners about these major complications and their possible fatal outcomes. To our knowledge, this is the first international review of this topic. Eighty-nine cases were detailed enough to allow pooled analysis (in terms of sex, age, source of infection, clinical characteristics, outcome, and routine laboratory parameters). The mean age of the analyzed group was 36.8±14.7 years (range: 3-80), with most cases in the age group of 18-29 years (25.8%, n=23). Males slightly predominated (53.9%), and pork was responsible for 91.2% of the infections. Electrocardiographic (ECG) changes represented the most common findings (80.9%). The mean eosinophil count was 25.9%±18.9% (range: 1-76). Heart failure significantly predominated in patients who died (p=0.047), whereas ECG abnormalities were reported more frequently in those who made complete recovery (p<0.0001). Because of their life-threatening character (our systematic analysis detected a case fatality ratio of 22.5%), we believe that cardiovascular complications must be considered in any patient suspected or diagnosed with trichinellosis. At the same time, practitioners should be able to establish the correct diagnosis in a timely manner and to make the best decision toward the management of these cases. Additionally, public health services located in endemic regions must be perpetually aware of this condition and must implement efficient prophylactic measures.

Cystic echinococcosis (CE) has represented a leading parasitic disease in Romania since 1862 when the first case was detected. Following the extremely high number of human and animal cases registered in 1995, Romania was framed in the forefront of Europe and among the first countries worldwide. This review aims to overview and analyze important data concerning CE in Romania from a pediatric point of view. To fulfill these goals, we focused on information provided by major epidemiological studies and rare/unusual case presentations. CE represents a serious concern for both public health services and the society, mainly because of prolonged hospitalization and convalescence periods. Moreover, the situation is much more problematic in children because physical, psychical, or intellectual impairments may impact negatively on their developmental and educational progress. The management of the disease consumes considerable healthcare resources estimated at about 1500-2000 United States Dollar (USD) for each uncomplicated case and approximately double for the complicated ones. A systematic analysis of data framed important epidemiological characteristics that may be useful when assessing individuals at risk: children (0-19 years old) represented 22.1% of the total number of cases, patients aged 13 years were most frequently affected (p < 0.0001), male patients and rural inhabitants predominated (p = 0.01 and p < 0.0001, respectively), and pulmonary involvement was detected most frequently (p < 0.0001). Considering the immense burden of this disease in Romania, emphasis should be given to the wide-scale implementation of effective prophylactic measures toward its eradication. Among them, education of the population plays an important role and should begin in early childhood.

Objectives: The main aim of this report was to present the epidemiological, clinical, laboratory, and therapeutic aspects of a series of patients admitted to a reference hospital from Romania and found to be infected with intestinal nematodes. Additionally, we attempted to overview, for the first time in the international literature, the most relevant data regarding diseases caused by these helminthes in Romania., Patients and Methods: We have retrospectively investigated the medical records of patients admitted at Victor Babes Hospital of Infectious Diseases in Timisoara (Timis County) who presented infections with intestinal nematode helminthes between 1971 and 2007., Results: Forty-two patients were found to be infected with intestinal nematode worms, with the predominance of Enterobius vermicularis (42.8%). The mean age of patients in this series was 23.5 ± 16.4 years. Women were affected in 66.7% of cases and inhabitants of urban regions in 71.4% of cases. Of this series, 57.2% of patients were adults and most of them were people with limited formal education belonging to the low social class. Overall, abdominal pain was most frequently detected (59.5%) and the mean eosinophil count was 8.2% ± 10.9% (range 1%-56%). Piperazine was administered in most of the cases (33.3%)., Conclusions: Infections with intestinal nematodes are less frequently diagnosed in hospitalized patients despite that they are quite common in the Romanian population. To further limit their occurrence, public health measures and informative campaigns for the whole population should be implemented.

Objectives: This study aims to analyze the epidemiology of syphilis, gonorrhea and genital chlamydial infections in Romania during 1980-2009 when radical changes occurred during transition from a communist regime to a democratic society., Methods: Surveillance data was retrieved from the National Center for Surveillance and Control of the Communicable Disease in Romania and the World Health Organization., Results: The mean annual incidences of syphilis, gonorrhea and genital chlamydia infections in Romania were 25.2 ± 15 cases per 100,000 inhabitants (1980-2009), 33.2 ± 26.6/100,000 (1980-2009) and 0.3 ± 0.4/100,000 (1994-2009), respectively. Although the infection rates for syphilis followed a significant ascending trend over the study period (p < 0.001), they declined dramatically since 2002 (p < 0.001). There was a significant decrease in gonorrhea-affected persons over the study period (p < 0.0001), while genital chlamydia infections registered a general ascending trend (p = 0.02) with insignificant decrease since 2006., Conclusions: The declining trend of syphilis and gonorrhea infections in the general population especially during the last years is very encouraging but should not challenge the amount of resources dedicated to sexually transmitted infections. Consequently, compelling strategies and policies based mainly on education of the population should be put forth in order to advance efficient prevention., (Copyright © 2011 The British Infection Association. Published by Elsevier Ltd. All rights reserved.)

Letters-to-the-editor represent an important characteristic of scientific interchange especially because the initial peer-review may not fulfill the qualitative control of a manuscript. On the other hand, it is well known that such publications are accepted easier than regular ones and may be a gateway for authors without outstanding scientific merits to input their names in high impact factor journals. A letter-to-the-editor (intended as a commentary to one of our works) allowed us to discover a very peculiar and unexpected fact for the medical literature, worthy to be shared with the worldwide scientific community.

Intestinal parasitic diseases such as enterobiasis, giardiasis, and ascariasis are detected most frequently in Romania, but their importance is definitely surpassed by trichinellosis, cystic echinococcosis, and toxoplasmosis. Malaria was common until its eradication in 1963, and only imported cases are reported nowadays. The aim of this review was to bring together essential data on the epidemiology and history of human parasitoses in Romania. Information on 43 parasitic diseases was collected from numerous sources, most of them unavailable abroad or inaccessible to the international scientific community. Over time, Romanian people of all ages have paid a significant tribute to the pathogenic influences exerted by the parasites. Sanitary and socio-economical consequences of the parasites diseases have great negative impact on the quality of life of affected individuals and the overall well-being of the population. Implementation of efficient public health measures and informative campaigns for the masses as well as changing the inadequate habits that are deeply rooted in the population are mandatory for cutting successfully this Gordian knot.

Neurological involvement may occur in 0.2%-52% of cases with trichinellosis, generally in the most severely affected patients. This review focuses on neurotrichinellosis and includes a brief overview of selected cases reported in the literature. Our primary goal was to increase the awareness of infectious diseases specialists, neurologists, and general practitioners about these major complications with possible fatal outcome. Seventy seven of the cases, for which enough details were available, have been pooled for statistical analysis. The mean age of the investigated group was 34.6 ± 16.8 years. Patients with both focal and diffuse manifestations predominated (55.8%), and they were significantly older (40 ± 15.5 years old) than those who presented solely focal (28.9 ± 17.8 years old; p = 0.03) or diffuse lesions (27.9 ± 15.3 years old; p = 0.007). In most of the cases (59.7%), complete recovery was reported, whereas 23.4% of cases had sequelae and 16.9% of the patients died. Patients who died had significantly lower eosinophil counts (13.8% ± 14%) when compared with those who made complete recovery (28.7% ± 18%; p = 0.015) and the cases with sequelae (35% ± 17.9%; p = 0.006). To sum up, trichinellosis must be considered in the differential diagnosis of any patient with encephalitis or other central nervous system malady of ambiguous etiology.

Introduction: This study aims to evaluate and compare the epidemiologic, laboratory, clinical, and therapeutic aspects of trichinellosis in child and adult populations residing in Western Romania., Patients and Methods: We have retrospectively investigated the medical records of patients with trichinellosis hospitalized between 1996 and 2005 in 5 infectious diseases hospitals located in 4 Western Romanian counties., Results: Trichinellosis was diagnosed in 1344 patients, of whom 348 were children (26%) and 996 were adults (74%). The annual average incidence was 8.4 cases per 100,000 in children and 7.7 cases per 100,000 in adults. The mean ages for the children and adults were 11 ± 4.4 years and 38.1 ± 14.2 years, respectively. Myalgias and complications of trichinellosis were detected less frequently in children who also had lower eosinophil counts, leukocyte counts, and erythrocyte sedimentation rates compared with those for adults. Albendazole and mebendazole had comparable efficacies in adult patients; however, albendazole proved to be a better choice than mebendazole for the treatment of children., Conclusions: Trichinellosis occurs commonly among inhabitants of Western Romania. Although the general trend of decline in the incidence of trichinellosis cases cannot be used as a statistical predictor of future improvement, it provides encouragement and demonstrates the need for the implementation of correct public health and educational measures to fully prevent and eradicate trichinellosis in Western Romania.

Mihai Eminescu, the first great Romanian poet and a defining figure in Romanian culture, may be situated among the most important romantic bards of his times--Byron, Novalis, Holderlin, Hugo, Lamartine, and Leopardi. He was born to a family affected by tuberculosis and predisposed to mental disorders. Although Eminescu may have suffered from bipolar disorder and may have been killed by iatrogenic mercury poisoning, erysipelas, head trauma, or endocarditis, his final illness and death continue to be associated with the most stigmatized disease of those times, syphilis. This historical review addresses the pros and cons of arguments about the diseases from which Eminescu may have suffered, as well as their causes and consequences. The key question is whether syphilis was the disease that led to Eminescu's death. After reviewing medical hypotheses, we conclude that he suffered from bipolar disorder and died from mercury poisoning, an inadequate treatment administered as the result of an inaccurate diagnosis (syphilis). Hospitalized in inappropriate places and treated by incompetent physicians, he suffered not only physical, but moral, distress and died prematurely. According to a letter he sent to a friend, he rightly considered himself a sacrificed man.

Besides cardiac and neurological complications of trichinellosis, renal involvement is the most important as regards the cases published and discussed in literature and is generally characteristic of the severe forms of the disease. This article focuses exclusively on the renal disturbances that may occur in this parasitic illness and includes a synopsis of published cases. Our primary goal was to increase the awareness of infectious diseases specialists, nephrologists, and general practitioners about these complications with possible fatal outcome. To our knowledge, this is the first international review dedicated to this topic. Cases for which enough details were available have been analyzed, and the results indicated that the mean age of the affected patients was 31.6 years, with a slightly male predominance (56.2%). The fatality rate was 26.1%. Proteinuria was detected in 84.8% of cases, hematuria in 30.4%, and casts were observed in urine specimens from 23.9% of patients. Renal failure was evidenced in 8.7% of patients, whereas renal lesions were found by biopsy or necropsy in 43.5% of cases. Of the routine laboratory parameters that are relevant for trichinellosis, mean eosinophil count was 32.2% and mean leukocyte count was 17,312 cells/μL. Finally, we emphasize on the necessity of establishing an early and correct diagnosis of trichinellosis to avoid later and severe complications. Additionally, implementation of public health and food safety prophylactic measures against the disease must represent an immediate priority for the affected regions.

Malaria was common in Romania until largely successful campaigns of the 20th century. Researchers Ioan Cantacuzino, George Zotta, and Mihai Ciuca carried out important early contributions to the understanding of malarial endemo-epidemic situation in Romania. The malarial endemy registered a peak in 1942 with an incidence of 1218 cases per 100,000 inhabitants as a result of the disastrous effects of the Second World War. In the following years the incidence increased from 421.5 cases per 100,000 inhabitants in 1944 to 735.1 cases per 100,000 inhabitants in 1946. A Malaria Commission was formed in February 1947 with the mission to reorganize the fight against malaria in Romania based on international guidelines. Following the adoption of proper malarial eradication methods, namely coverage of endemic areas by spraying of residual insecticides, associated with chemotherapy and, eventually, chemoprophylaxis with synthetic products, and by surveillance, indigenous cases disappeared rapidly, relapsing cases were much reduced, and imported and induced cases remained constant or even increased slightly, probably due to the increase in traffic and in the use of blood transfusions. No indigenous cases have been registered in Romania since 1962. In 1963 the Romanian authorities declared malarial eradication in the territory to the World Health Organization.

The saga of malaria parasites precedes the history of humans. Malaria has always been part of the rising and decline of nations, of wars and of upheavals. People of ancient times attributed the malarial manifestations to supernatural influences. Myths about demons responsible for fevers and efforts to bring them under control were often mentioned in ancient articles and attested archaeologically. More than 4 millennia were required until malaria was finally demystified. From the ancient Chinese Canon of Medicine to Ronald Ross' milestone discovery, the humanity struggled to face one of the most debilitating diseases of mankind. This essay assesses the history of malaria from ancient mysteries until it was demystified. Its sections describe the attempts of humans from different times to understand and defeat malaria through supernatural practices, religious rites and medicine, and also their efforts mirrored in art and literary masterpieces.

Epidemiological and clinical characteristics of the first cases of infection with the novel influenza A (H1N1) variant virus [A(H1N1)v] admitted to a reference hospital in Western Romanian from mid-June to mid-July 2009 are overviewed. Of 74 suspected cases, 7 were laboratory confirmed. All patients were either Romanian citizens, or people originating from Romania and established overseas. The median age was 13 years and the mean length of hospital stay was 7.7 days. Cough (n = 6) and fever (n = 4) were the most commonly reported symptoms, and all cases made complete recovery. Early diagnosis and management of H1N1 flu was not problematic for the infectious disease specialists. Because many Romanians established overseas come yearly to visit their relatives, special attention must be addressed to the international flight passengers.

A trichinellosis outbreak occurred in early 2008 in two villages in Timis County, Romania, due to consumption of pork from an infected animal. The infective species, detected by multiplex polymerase chain reaction, was Trichinella spiralis (Isolate Code ISS 1951). This report presents an extensive characterization of the outbreak using the documents of the epidemiological investigation and the medical charts of the hospitalized patients. Fifteen people consumed pork from the same backyard pig, which was slaughtered in the household without veterinary inspection of the meat. Among them, five patients presented clinical forms of the disease and were hospitalized. The analysis within this report includes only the hospitalized cases that were serologically confirmed. The mean age of the patients was 33.4 years. The common symptoms presented by these patients included headache, eyelid and lower limb edema, myalgia, fever, diarrhea, and nausea. Eosinophil counts ranged between 5.5% and 52%. Favorable outcomes were achieved for the patients using antihelminthic therapy. As an important public health concern, trichinellosis outbreaks reinforce the need to urgently implement veterinary and educational programs. Identification of T. spiralis in this case strengthens the supposition that it is one of the most frequently spread species in Romania.

Objectives: Cardiovascular disturbances are reported as major trichinosis complications, and myocarditis is the most frequent of them. Previous Romanian surveillances on prevalence of cardiac involvement indicated a rate of 30%–50%. The present study aimed to overview the clinical and the main epidemiological characteristics of persons from western Romania found to have trichinosis and cardiac involvement., Patients and Methods: Hospitalization documents of individuals with trichinosis and cardiac complications admitted at the Hospital of Infectious Diseases in Timisoara, Romania, were retroactively investigated. Patients were residents of three Romanian counties and were hospitalized between 1990 and 2001., Results: Twenty-eight patients, found to have trichinosis, presented cardiac involvement. Of the study group, six patients (21.4%) died during hospitalization and their necropsy revealed the diagnosis of myocarditis. For the remaining patients, myocarditis was only suspected and cardiac abnormalities were mainly evidenced by electrocardiography. The mean age of the patients was 38 years (range, 3–80 years) and there were 18 male patients (64.3%). Repolarization disturbances predominated and myalgia was the most common symptom. The mean eosinophil value of the study group was 16.9% (range, 2–70%)., Conclusions: Cardiac involvement represented and still continues to be a major complication in Romanian patients. According to its potentially lethal outcome, myocarditis must be considered in such patients even when specific symptoms are missing. Prophylactic measures are also very important and should be based especially on health education programs for the masses.

Over the years, pork was the most frequent source of human trichinellosis in Romania. Cases generally occurred in foci, family, and group clusters and were rarely aggregated in extensive outbreaks. A study regarding the social consequences of trichinellosis in humans concluded that 84.8% of the patients diagnosed with the condition required an average of 53 days of sick leave. Cardiac complications are the most frequent causes of significant health status impairment. "Pig's alms," a specific custom representing the thanksgiving meal offered to relatives, friends, or neighbors who participated in the slaughtering process may be a very good source of infection with Trichinella parasites, leading to unfortunate consequences, especially when animals are not veterinary tested. Beside pork, other concerns for acquiring the disease are represented by game meat and horsemeat, the latter was introduced in public consumption in 2001. Although in Romania Trichinella sp. infection was documented for the first time in horses in 1993, no consequent human cases were detected at that time. Numerous trichinellosis outbreaks involve individuals from the gipsy community, most of whom are very poor, illiterate, unemployed, and live in unsanitary conditions raising backyard pigs without any compliance with hygienic rules. Measures aimed at limiting the spread of the infection in humans and animals should be widely available to be known, understood, and adequately applied by the great mass of pig breeders, hunters, and consumers.

Leishmaniasis, a parasitic infection listed by the World Health Organization among the 6 most important tropical diseases, is endemic in approximately 88 countries worldwide, with a global estimate of 350 million individuals at risk. The present report aims to review the imported cases of leishmaniasis reported in retrospective studies or described as clusters or single interesting cases. It is apparent that some European countries considered as premier tourist attractions export leishmaniasis: Greece, France, Italy, Spain, Portugal, Croatia and Turkey. Travelling and exploring the New World countries, especially the Amazonian jungle and the archaeological ancient sites, is a continuous challenge, with a risk of acquiring various tropical infections. Imported leishmaniasis has occurred in individuals who have gone to work abroad in improper conditions, without being aware of the risk of severe vector-borne infections. Exported cases are carried by refugees and immigrants from endemic developing countries. Extended military operations are a further source of imported cases. In the new millennium, the import and export of leishmaniasis continue to be of major concern for public health services worldwide as a result of increased mobility.