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Introducere. Coxiella burnetii este agentul etiologic al febrei Q, o zoonoză care încă ridică semne de întrebare - „Query”. Anterior clasificată drept Rickettsie, C. burnetii este o bacterie obligatoriu intracelulară înalt infecţioasă, ale cărei principale rezervoare animale sunt bovinele, ovinele şi caprinele. Transmisă în mod obişnuit prin inhalarea aerosolilor contaminaţi în timpul parturiţiei animale, febra Q se poate manifesta ca boală febrilă autolimitată, pneumonie sau hepatită. Cu toate acestea, în anumite circumstanţe, există posibilitatea evoluţiei către o formă cronică, implicând predominant valvele cardiace preexistent lezate sau vasele de sânge. Diagnosticul este uzual stabilit serologic, iar Doxiciclina reprezintă cea mai frecventă alegere de antibioterapie. Obiective. Scopul acestui studiu este de a analiza cadrul clinic şi de laborator care a condus la diagnosticul de febră Q acută, respectiv cronică, regimurile de tratament aplicate şi evoluţia consecutivă în cadrul grupului de pacienţi definit mai jos. Materiale şi metode. Lucrarea de faţă reprezintă un studiu observaţional descriptiv bazat pe un lot de 24 de pacienţi internaţi în clinica noastră în anul 2018 şi diagnosticaţi cu febră Q acută sau cronică, probabilă sau confirmată. Au fost incluşi bolnavi de ambele sexe, indiferent de vârstă, sub condiţia respectării definiţiei de caz a CDC, integrând modificările serologice în contextul clinic compatibil cu tabloul bolii. Rezultate şi concluzii. Un cadru epidemiologic sugestiv a fost identificat în puţine cazuri. Dintre cei 24 de bolnavi cu vârste curpinse între 34 şi 80 de ani, dintre care doar două au fost femei, 22 au experimentat febră Q acută, manifestată predominant ca o combinaţie de penumonie şi hepatită (9 cazuri, 41%). Doar două cazuri de infecţie acută au fost confirmate serologic. Acuze frecvente au fost febra (în toate situaţiile), frisoanele, cefaleea şi greaţa. Numai 28% dintre pneumoniile confirmate imagistic au fost acompaniate de tuse seacă, în timp ce doar 21% dintre hepatite au asociat icter. Biologic, leucocitoza s-a corelat mai slab cu activitatea bolii acute, în timp ce toţi pacienţii au exprimat un răspuns inflamator (prin proteina C reactivă) moderat-crescut. Având în vedere latenţa sosirii rezultatelor dozării anticorpilor specifici, decizia de iniţiere a tratamentului a fost bazată pe considerente clinice, antibioterapia constând în Doxiciclină, singură sau în combinaţii menite să acopere un spectru mai larg, dat fiind caracterul obişnuit nespecific al simptomelor şi suspiciunea clinică iniţial mică pentru febră Q. Evoluţia a fost favorabilă în toate cazurile. Privitor la cei doi pacienţi cu febră Q cronică, manifestată ca endocardită cu hemoculturi negative, dintre care doar una confirmată potrivit definiţiei CDC, ambii prezentau valvulopatii constituite premergător, în absenţa unui istoric de infecţie acută cu C. burnetii. În primul caz, sub antibioterapie empirică pentru EI (Ceftriaxonă şi Vancomicină), a survenit insuficienţa cardiacă acută şi s-a impus protezarea valvulară chirurgicală, urmând ca titrul înalt de IgG fază I ce aducea confirmarea diagnostică să fie ulterior obiectivat. Celui de-al doilea bolnav i-a fost administrată şi Doxiciclina în combinaţie terapeutică, evoluând favorabil pe parcursul internării. [ABSTRACT FROM AUTHOR]

Introduction. Coxiella burnetii is the etiological agent of Q fever, a zoonosis that is still subject of „Query”. Formerly classified as a Rickettsia, C. burnetii is a highly infectious obligate intracellular bacteria, whose main animal reservoirs are cattle, sheep and goats. Commonly following transmission through inhalation of aerosols containing the pathogen spread during animal parturition, Q fever may present as a self-limited febrile illness, pneumonia or acute hepatitis. Nevertheless, the possibility of evolving towards a chronic form exists under certain circumstances, mainly involving previously affected heart valves or blood vessels. Diagnosis is usually serologically based and Doxycycline represents the most frequent choice of antibiotherapy. Objectives. The aim of this study is to analyse the clinical and laboratory settings that led to diagnosis of acute or chronic Q fever, the treatment regimens applied and consecutive outcome within the group of patients defined below. Materials and methods. The present paper represents an observational descriptive study performed on a group composed of 24 patients admitted in our hospital along 2018 and diagnosed with confirmed or probable acute or chronic Q fever. Both male and female subjects regardless of their age were included, under the condition of meeting the CDC case definition, by integrating the serological results into the clinical context. Results and conclusions. A suggestive epidemiological frame was rarely proven. Out of the 24 subjects with ages between 34 and 80 years old, of which only 2 were women, 22 had acute Q fever, manifested mostly as a combination of atypical pneumonia and hepatitis (9 cases, representing 41. Only 2 of the acute Q fever cases had a confirmed diagnosis. Frequent complaints were fever (all cases), chills, headaches and vomiting. Only 28% of the radiologically confirmed pneumonias were accompanied by dry cough, whilst only 21% of the hepatitis cases associated jaundice. Biologically, although leukocytosis was more weakly correlated with acute disease activity, all patients exhibited a moderate to high inflammatory response (through C reactive protein). Considering the latency of specific antibodies' dosage results, the decision of initiating treatment was based on a clinical support. Antibiotherapy consisted of Doxycyclin, alone or in combinations meant to cover a larger spectrum, given the usually nonspecific symptoms and the initially low clinical suspicion for Q fever. Clinical evolution was favorable in all cases. Regarding the two patients with chronic Q fever, manifested as blood culture-negative endocarditis, of which only one was confirmed according to the CDC definition, both had presented valvular lesions before developing IE and had no history of acute infection with C. burnetii. In the first case, under empirical infective endocarditis agents (Ceftriaxone and Vancomycin), acute heart failure and necessity of surgical replacement of the affected valve occurred, only afterwards being followed by the elevated phase I IgG level that brought diagnostic confirmation. Meanwhile, the second patient did receive a combination with Doxycycline, followed by favorable clinical evolution during admission. [ABSTRACT FROM AUTHOR]

Infectious meningitis is a serious medical problem that can be fatal if treatment is delayed. Objectives. There are presented clinical and laboratory aspects of patients with suspected meningitis, presented and hospitalized during 2014-2017 at Hospital for Infectious and Tropical Diseases Dr V. Babes Bucharest. Clinical and paraclinical variables that show statistically significant differences depending on the etiology of meningitis have been identified. Methods. Patients who showed signs and symptoms according to the case definition would be included in the study. Clinical and laboratory values were recorded in a database which was then processed to identify statistically significant differences between the group of patients with suspicion only but subsequently not ill against the group of confirmed, and also among different subgroups within the confirmed. Results. Of the 97 cases of infectious meningitis included within 3 years, 53 cases (55%) were viral, 31 (32%) bacterial, one case of fungal meningitis and 12 cases of tuberculous meningitis. [ABSTRACT FROM AUTHOR]

Cavitary lung lesions may pose complex problems in terms of differential diagnosis as their etiological spectrum includes: - Necrotizing infections (pneumonia, pulmonary tuberculosis, fungi and parasites abscesses) - Non-infectious diseases: (lung cancer with necrosis, infected cavitating pulmonary infarction, vasculitides, collagenoses with lung cavity by immunological mechanism, the suction of a foreign body intrabronchially, congenital lung malformations, pneumoconiosis excavated etc). We present three clinical cases with similar radiological images or multiple formations lung cavity fluid level but with different diagnoses and etiologies: Staphylococcus aureus strain MRSA sepsis, echinococcosis with multiple sites and pulmonary tuberculosis secondary caseous-cavitary form. Selected all three cases, standard chest radiography was the basic investigation lung disease diagnosis, but accurate diagnosis requires performing other investigative methods. [ABSTRACT FROM AUTHOR]

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]

Perinatal transmision of viral hepatitis B is the main way of transmission in the high endemic regions, with a prevalence of ≥8%. The age at which a person becomes infected with HBV is the main factor determining the outcome, and the development of chronic hepatitis B is frequent in perinatal infected children, as much as 90%. Thus, evaluating the risk for infection and using the right prophylactic measures are the most important elements to prenent perinatal transmission of HBV. Although the vaccination and the specifi c imunoglobulines are already used, new methods are needed to prevent all cases. [ABSTRACT FROM AUTHOR]

Acute hepatitis C is an insufficient studied disease because unspecific clinical manifestations, diagnostic difficulties and limited epidemiological data. High rate of development of chronic C hepatitis, rapid progression to cirrhosis and hepatocellular carcinoma are sufficient arguments for an early treatment of acute hepatitis C. Interferon treatment of acute hepatitis C is highly efficient, fact proved by the SVR (sustained virological response) up to 94-98% in the studies of patients treated with conventional interferon or pegylated interferons. The absence of a standard therapy lead to necessity to analyse all this studies and to elaborate several treatment recommendations. The available data at this moment points to a therapy with pegylated interferon alpha-2a or alpha-2b, with 12-24 weeks duration, initiated in the first 12 weeks after acute onset of hepatitis. [ABSTRACT FROM AUTHOR]

Introducere. Utilizatorii de droguri injectabile reprezintă o categorie aparte de pacienţi, la care patologia infecţioasă, inclusiv endocardita infecţioasă, este mult mai frecventă. În România, în 2016 existau aproximativ 21.000 de utilizatori de opiacee (www.ana.gov.ro). În afară de opioide, există şi etnobotanicele şi, de asemenea, o tendinţă în creştere de administrare a amfetaminelor pe cale injectabilă. Material şi metode. Vom prezenta cazul unui tânăr consumator de droguri diagnosticat în clinica noastră cu endocardită infecţioasă de valvă mitrală nativă. Particularităţile constau în tipul de valvă afectată şi implicarea unei tulpini de stafilococ auriu meticilino-sensibil (la un pacient cu multipli factori de risc pentru infecţie cu tulpini multirezistente). Rezultate. Evoluţia clinică este ondulantă, deoarece apar diferite complicaţii, dar, după 54 de zile de spitalizare, este externat, ulterior beneficiază de intervenţie chirurgicală valvulară şi se întoarce în clinica noastră pentru tratament antibiotic de consolidare. Concluzii. Acesta este un caz de infecţie severă la un utilizator de droguri injectabile, cu numeroase caracteristici care indică o potenţială evoluţie nefavorabilă. Tratamentul antibiotic adecvat, asociat cu alte măsuri medicale complementare, a condus la rezultatul favorabil în cazul acestui pacient tânăr. [ABSTRACT FROM AUTHOR]

Background. Injecting drug users are a particular category of patients, where infectious pathology, including infectious endocarditis, is much more common. In Romania, in 2016 there were about 21,000 opioid users (www.ana.gov.ro). Besides opioid drugs, there are also ethnobotanics and a growing trend of injecting amphetamines. Material and methods. We present the case of a young drug user diagnosed in our hospital with infected mitral valve infectious endocarditis. Particularities consist of the type of affected valve and the involvement of a strain of methicillin-sensitive aureus staphylococcus (in a patient with multiple risk factors for infection with multi-resistant strains). Results. Clinical evolution is with many ups and downs because different complications occur, but after 54 days of hospitasization he is out, then valvular surgery takes place and he returns to our clinic for the antibiotic consolidation treatment. Conclusions. This is a case of severe infection in an IDU, with many features indicating a posible negative evolution. Proper antibiotic treatment, associated with other complementary medical interventions, conducted to the favorable uotcome of this young patient. [ABSTRACT FROM AUTHOR]

Introduction. Strongyloidiasis in a parasitic diseases determined by the intestinal nematode Strongyloides stercoralis. In most cases, this disease is asymptomatic, but the immunocompromised patients can develop severe forms like hyper infestation and disseminated strongyloidiasis. There severe forms of the disease are associated with bacteremias with gastrointestinal microorganisms which can determine infectious complication anywhere in the body. Bacterial meningitis is the most common complication of this kind. Case presentation. We present you the case of a 78 years old patient who initially presented in another hospital for suddenly installed aphasia. He was clinical and paraclinical evaluated and the suspected diagnosis was acute meningoencephalitis, so he was transferred in our hospital. This is a case about a patient with an immunocompromised status determined by recent infection with SARS-CoV-2 who was hospitalized and received prolonged corticosteroid therapy. The clinical examination performed at the admission shows a patient with mediocre general status, partially cooperative, partially time-spatial oriented and to one’s own person, discreet neck stiffness, anxious-depressive mood, with acute respiratory failure. A coproparasitological examination is performed which reveals the presence of filariform larvae of Strongyloides stercoralis in the stool. Also, a parasitic PCR test from a stool sample is positive for Strongyloides stercoralis. These clinical and paraclinical findings corroborated with those found in the cerebrospinal fluid examination establish the diagnosis: acute bacterial meningoencephalitis secondary to disseminated strongyloidiasis. During the disease’s evolution, he is confirmed with a new infection with SARS-CoV-2. He receives antiviral treatment, antiparasitic treatment, antibiotic treatment and symptomatic treatment. The evolution of the disease is favorable. Conclusions. The immunocompromised status of the patient determined the evolution of the infestation with Strongyloides stercoralis to a severe form complicated with acute bacterial meningoencephalitis. The difficulty in establishing the diagnosis of strongyloidiasis is represented by the fact that Romania is a non-endemic country for the infection with this parasite. [ABSTRACT FROM AUTHOR]

Introduction. Chronic hepatitis C is an important cause of morbidity in Romania. Standard therapy at this moment is PegInterferon and Ribavirin, for a maximum duration of 48 weeks. Side effects caused by this treatment add to the reasons for which the patients have a low rate of success. Material and methods. Prospective study on 83 patients with chronic hepatitis C, treated at "Dr. Victor Babes" Hospital from November 2012 to October 2013, included in the research project PCCA PN II-2012/No 88/07.2012 (HepGen). Results. Side effects in the studied group were weight loss in 51% of cases, depression in 23% of cases and hematologic side effects at 4, 12 and 24 weeks of treatment. In the study group, the mean hemoglobin dropped from 14.2 g/dL (baseline), to 11.2 g/dL (week 24 of treatment), the mean neutrophil count dropped from 3,330/cmm (baseline) to 1619/cmm (week 24 of treatment). Conclusions. The number of patients that develop side effects is higher as the treatment progresses, altering the quality of life and the outcome. [ABSTRACT FROM AUTHOR]

Introduction. COVID-19 is associated with a significant incidence of bacterial and fungal superinfections and with the exacerbation of pre-existing infections, representing a diagnostic and therapeutic challenge. Case presentation. A 64-year-old woman, confirmed with COVID-19 by the SARS-CoV-2 antigen test, is hospitalized accusing fatigue, nausea, watery stools, cough and vertigo started 10 days ago, aggravated 4 days before the presentation. It also reports recurrent episodes of otalgia and otorrheic pluriantibiotic treatment in the last 2 months. From the personal pathological antecedents we remember: hypothyroidism, dyslipidemia, hypertension, ischemic heart disease, history of deep vein thrombosis (DVT) and secondary pulmonary thromboembolism, in chronic anticoagulant treatment. Pathological clinical signs at admission: bilateral basal crackling rales. Biologically, inflammatory syndrome is detected, and radiologically, interstitial-alveolar infiltrates in the lower lung fields. On day 3 of hospitalization, the patient shows purulent secretion in the right external auditory canal and the ENT consultation confirms chronic suppurative otitis media in acute onset. Bacteriological examination of otic secretion reveals Aspergillus niger. Antiviral treatment with Remdesivir is initiated, antibiotic therapy initiated at home with Azithromycin is continued for one day, then escalated to Ceftriaxone i.v. (in the context of clinical-paraclinical aggravation), systemic corticotherapy, anticoagulation with Dalteparin in the prophylactic regime of DVT, systemic treatment with Voriconazole p.o. (according to the antifungal program) and topical (local) with a slow favorable evolution. Conclusions. The association of COVID-19 with otitis with Aspergillus is a rare and particular clinical picture. [ABSTRACT FROM AUTHOR]

Introduction. Although SARS-CoV-2 infection is more common in adults, many cases have been reported in the pediatric population. Case presentation. An 8-month-old infant from twin pregnancy, confirmed with COVID-19, is hospitalized with nasal obstruction, serous rhinorrhea, rare cough and watery stools. The epidemiological link is known, both the parents and the maternal grandparents of the infant being confirmed with COVID-19. Biologically, he presented with thrombocytosis and discrete inflammatory syndrome, and the lung radiograph did not show any lesions. At the same time, the twin sister was hospitalized, who presented a similar symptomatology, with a negative SARS-CoV-2 PCR test, but the lung radiograph showed specific lesions of COVID-19. During hospitalization, 2 more SARS-CoV-2 PCR tests were performed, but with negative results. The evolution of the twins was favorable under symptomatic treatment, respectively antibiotic and symptomatic treatment. Conclusion. SARS-CoV-2 infection may be asymptomatic, especially in infants and newborns, and has a lower prevalence. [ABSTRACT FROM AUTHOR]

Introduction. Viral hepatitis is still a challenge for the medical world and research over the past decades has been aimed at discovering viable methods of prevention, diagnosis and treatment . Material and methods. Data analysed from 73 patients from ”Dr. Victor Babeș” Clinical Hospital of Infectious and Tropical Diseases and ”Dr. Victor Babeș” Private Medical Clinic, both from Bucharest. Results. Fibroscan assessment showed that patients predominantly have F2, F3, F4 Metavir fibrosis stage while FibroTest showed F3, F4 stage of fibrosis. It was observed a decrease in fibrosis stage after DAA treatment comparative to values before treatment (5.622 kPa average post-treatment comparative to 11.49 kPa before treatment, statistically significant with p value < 0.001). Chronic infection with hepatitis C virus is considered a risk factor for atherosclerosis correlated with a higher cardiovascular risk compared to the general population. Monitoring patients prior to and after DAA treatment is an efficient method to detect early vascular changes that could lead to thrombotic and/or cardiovascular events. Conclusions. Measurement of the IMT index by doppler ultrasound in pateints with hepatitis C virus infectionmay constitute a method of identification the endothelial dysfunction or atherosclerosis and may help to establish cardiovascular risk. Elimination of hepatitis C virus is the target of ongoing international programmes but the extrahepatic effects of persistent infection, early diagnosis and appropriate treatment should not be neglected. [ABSTRACT FROM AUTHOR]

In this retrospective unicenter study we aimed to outline the key features of the first 100 cases of COVID-19 hospitalized in our clinic after designation of it as front line unit for hospitalization of these cases. Thus, the average age of cases was 44.7 years (SD: 15.9) and the prevalence of female was 57.4%. By age groups, prevalence of young patients (7.8%) was significantly (p < 0.05) lower than the prevalence of adult patients (77.2%). The most prevalent occupation (31.7%) was healthcare worker. The most frecvent exposure to source of infection was represented by attending healthcare facilities (44.6%), followed by having contact with COVID-19 confirmed/suspect case (30.7%), and recent international travel (18.8%). Of the 30% of cases in which at least one health precondition was recorded the most prevalent (13.9%) of such condition was chronic cardiovascular disease including high blood presure. In regard with severity, to note that 6 patients died within 14 days of hospital admission, all fatalities have occurred in very old patients and 83.3% of them had chronic kidney disease. In the end, we express the hope that data outlined in this paper will help for better management of COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

Pandemia COVID-19 a pus lumea medicală în faţa multor provocări privind diagnosticul şi opţiunile terapeutice. Prezentăm trei cazuri de pacienţi proveniţi din grupe de vârstă diferite, la care am identificat modalităţi evolutive particulare, din punct de vedere clinic şi al investigaţiilor de laborator. Pentru evaluarea riscului de evoluţie gravă la internare, am utilizat un calculator dezvoltat de Universitatea din Guangzhou, bazat pe 10 parametri clinici şi paraclinici, iar apoi am comparat rezultatele obţinute cu evoluţia pacienţilor. Din analiza cazurilor prezentate, am constatat afectări organice persistente, care vor impune urmărirea acestora pe termen lung. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic has challenged the medical world in many ways regarding diagnosis troubles and therapeutic options. In this paper, we will present three cases of patients from different age groups, in which we identified specific ways of evolution, from both clinically and laboratory data point of view. We used a critical evolution risk estimation calculator at admission and compared the results with the subsequent evolution of patients. From the analysis of the presented cases, we found persistent organic damage that will require their long-term follow-up. [ABSTRACT FROM AUTHOR]

Cunoştinţele legate de manifestările din infecţia SARS-CoV-2 se îmbogăţesc permanent pe măsură ce apar tot mai multe raportări legate de boală. Anosmia, care nu fusese legată de infecţia SARS-CoV-2 la începutul pandemiei, prin dovezile apărute, a devenit ulterior un simptom important al bolii. În lucrarea prezentată, am studiat corelaţii între acest simptom şi contextul patologic complex al pacienţilor. Utilizând tehnici statistice, am demonstrat că anosmia poate fi considerată un predictor independent pentru prelungirea perioadei de infecţie şi, implicit, de spitalizare la pacienţii din lotul studiat. [ABSTRACT FROM AUTHOR]

Knowledge about the manifestations of SARS-CoV-2 infection is constantly enriching as more reports of the disease appear. Anosmia, which had not been linked to SARS-CoV-2 infection at the beginning of the pandemic outbreak, later became, through evidence, an important symptom of the disease. In the presented paper we studied the correlation between this symptom and the complex pathological context of patients. Using statistical analysis we demonstrated that anosmia can be considered an independent predictor for the extended period of hospitalization in patients in the study group. [ABSTRACT FROM AUTHOR]

În Spitalul Clinic de Boli Infecţioase şi Tropicale „Dr. Victor Babeş”, primii pacienţi cu COVID-19 au fost internaţi în luna martie 2020. Dintre cei 20 de pacienţi, 11 au fost de sex masculin si 9 de sex feminin. Pacienţii au avut vârste cuprinse între 3 şi 56 de ani. 8 pacienţi au locuit sau călătorit în afara României in perioada de incubaţie a bolii. Cele mai frecvente simptome au fost febra, tusea seacă şi dificultăţi respiratorii. 2 pacienţi au prezentat forme severe de boală ce au necesitat transfer în secţia de terapie intensivă. Radiologic, 18 pacienţi au prezentat afectare pulmonară interstiţială. Toţi pacienţii au avut evoluţie favorabilă. [ABSTRACT FROM AUTHOR]

In March 2020, the first patients diagnosed with COVID-19 were hospitalized in the Infectious and Tropical Diseases Clinical Hospital „Dr. Victor Babes”. Of the 20 patients, 11 were male and 9 were female. Patients were aged between 3 to 56 years. 8 patients traveled outside Romania during the incubation period of the disease. The most common symptom cluster encompassed the respiratory system: fever, cough and shortness of breath. 2 patients presented severe forms of disease that required transfer to the intensive care unit. Radiologically, 18 patients had interstitial lung damage. All patients had a favorable evolution. [ABSTRACT FROM AUTHOR]

Până în prezent, infecţia SARS-CoV-2 a afectat întreaga populaţie a globului, înregistrând o creștere alarmantă a numărului de cazuri, dar și a deceselor. Principala expresie clinică a COVID-19 este pneumonia, pentru evaluarea acesteia fiind necesară o caracterizare imagistică a leziunilor pulmonare atât prin radiografie toracică, cât și prin tomografie computerizată a toracelui. Diverse studii efectuate pe grupuri de pacienţi au relevat faptul că examinarea CT este mai precisă în diagnosticarea leziunilor pulmonare la debutul simptomelor, dar și înaintea acestora. Cele mai frecvente leziuni au fost multiple, bilaterale, periferice, în câmpurile pulmonare inferioare. Aspectul variază adesea între condensare alveolară și aspectul de sticlă măcinată. De asemenea, date relevante din studii subliniază posibilitatea existenţei unor aspecte patologice precoce pe imaginile CT, care nu implică expresia clinică. Astfel, se poate afirma că ambele investigaţii sunt cruciale în evaluarea impactului noii infecţii cu coronavirus asupra parenchimului pulmonar, dar și în ghidarea managementului terapeutic. [ABSTRACT FROM AUTHOR]

Currently, SARS-CoV-2 infection has affected the entire population of the globe, registering an alarming increase in the number of cases, but also in deaths. The main clinical expression of COVID-19 is pneumonia, for its evaluation being necessary an imaging characterization of lung lesions both by chest radiography and by computed tomography (CT) of the chest. Various studies performed on groups of patients revealed that CT examination is more accurately in diagnosing lung lesions at the onset of symptoms, but also before it. The most common lesions were multiple, bilateral, peripheral, in the lower lung fields. The appearance often varies between alveolar consolidation and groundglass. Also, the data from the relevant studies emphasize the possibility of the existence of early pathological aspects on CT acquisitions, which do not involve clinical expression. Thus, it can be stated that both investigations are crucial in assessing the impact of the new coronavirus infection on the lung parenchyma, but also in guiding therapeutic management. [ABSTRACT FROM AUTHOR]

Background. Proiectul HepCare Europe, cofinanţat de Comisia Europeană, a avut ca scop crearea şi implementarea unui model de management al VHC (screening, evaluare şi tratament) adresat pacienţilor ce provin din populaţiile vulnerabile. Ideea de bază a proiectului a fost creşterea accesului acestor pacienţi la servicii medicale integrate, prin implicarea cadrelor medicale din comunitate. Scopul acestui studiu a fost să evalueze caracteristicile socio-demografice şi clinice ale pacienţilor coinfectaţi HIV/VHC comparativ cu cei monoinfectaţi cu VHC înrolaţi în Proiectul HepCare Europe, în cadrul Spitalului Clinic de Boli Infecţioase şi Tropicale „Dr. Victor Babeş” din Bucureşti. Metode. Studiu prospectiv efectuat la pacienţii cu anticorpi anti-VHC pozitivi (prin teste rapide orale), ce au fost evaluaţi la Spitalul „Dr. Victor Babeş” din Bucureşti, România (SVB), în perioada aprilie 2016 - aprilie 2019. Caracteristicile socio-demografice şi clinice ale pacienţilor au fost comparate în funcţie de statusul de coinfectat HIV. Analiza statistică a datelor s-a realizat folosind programul SPSS versiunea 20.0. Rezultate. Screening-ul pentru hepatita cronică cu virus C s-a realizat la 525 de pacienţi, dintre care 230 (43,8%) au avut rezultat pozitiv. Majoritatea erau tineri, de sex masculin (85,2%) şi utilizatori de droguri injectabile (92,2%). 168 de pacienţi (73,0%) au fost evaluaţi la spi tal, din care 41,6% erau coinfectaţi HIV. Evaluarea gradului de fibroză hepatică s-a realizat pentru 82,1% dintre pacienţi, aproape o treime fiind identificaţi cu fibroză hepatică avansată (27,5%). ARN-VHC în plasmă a fost efectuat pentru jumătate din pacienţii luaţi în evidenţă, 80,9% din aceştia având încărcătură virală detectabilă. 24 de pacienţi au iniţiat tratamentul cu agenţi antivirali direcţi, din care 22 au obţinut răspuns viral susţinut, iar 2 au fost nonresponderi (utilizatori de droguri infectaţi cu genotip 3 ce nu au primit tratament cu regim pangenotipic). Infecţia HIV s-a asociat cu lipsa locuinţei (p < 0,0001), consumul de droguri injectabile (p = 0,001), consumul de etnobotanice în asociere cu opioidele (p < 0,0001), utilizarea de ace la comun (p < 0,0001) sau consumul de alcool (p < 0,0001). Valoarea mediană a limfocitelor CD4 la diagnostic a fost de 483/μl (IQR 290, 646), iar valoarea mediană a încărcăturii virale HIV în plasmă a fost de 2.74 log10copii/ml (IQR 1,27, 4,67). Încărcătura virală VHC în plasmă a fost semnificativ mai mare la pacienţii coinfectaţi HIV/VHC (p = 0,047). Concluzii. Coinfecţia HIV/VHC a fost frecventă la pacienţii ce provin din populaţiile vulnerabile. Infecţia HIV a fost asociată cu multipli factori de risc şi încărcătură virală VHC plasmatică mai ridicată. Barierele socio-economice şi accesul redus la tratamente pangenotipice cu agenţi antivirali direcţi (DAA) au limitat semnificativ iniţierea tratamentului la aceşti pacienţi. Acesta este primul studiu pilot din România despre managementul pacienţilor cu hepatită C care provin din populaţiile cheie. [ABSTRACT FROM AUTHOR]

Background. HepCare Europe was a project co-funded by the European Commission with the scope to create and implement a model of HCV management (screening, linkage to care, treatment) for patients from key populations, through outreaching the community and to offer integrated primary and secondary care services. The aim of this sequential research inside the project was to evaluate the socio-demographic and clinical characteristics of HIV/HCV co-infected patients enrolled in HepCare Europe Project at Bucharest clinical site and to compare them to HCV-mono-infected patients. Methods. Prospective study on patients who tested positive for HCV antibodies (using rapid oral tests), part of them being linked to care at "Dr. Victor Babes" Clinical Hospital Bucharest, Romania (SVB), between April 2016 and April 2019. Socio-demographic and clinical characteristics of patients linked to care were compared according to their HIV status. Statistical analysis was performed using SPSS vs. 20.0. Results. A total of 525 patients were screened for HCV antibodies using rapid oral tests, out of which 230 (43.8%) tested positive. Almost all of them were young males (85.2%) and injecting drug users (IDUs) (92.2%). 168 patients (73.0%) were linked to care, with 41.6% being coinfected with HIV. Liver fibrosis assessment was performed in 82.1% patients, almost a third of them having advanced liver fibrosis (27.5%). Plasma HCV-RNA was performed for half of the patients linked to care and 80.9% were detectable. Directing acting antivirals (DAA) treatment was initiated in 24 patients out of which 22 achieved SVR (sustained virological response) and 2 were non-responders (IDUs with genotype 3 treated with non-pan genotypic regimens). HIV-infection was associated with homelessness (p<0.0001), injecting drug use (p=0.001), NPS (new psychoactive substances) use in combination with opioids (p<0.0001), needle sharing (p<0.0001) and alcohol abuse (p<0.0001). The median CD4 cell count (/μl) and median plasma HIV-RNA (log10copies/ml) were 483 (IQR 290, 646) and 2.74 (IQR 1.27, 4.67), respectively. HCV-RNA was significantly higher in HIV/ HCV co-infected patients (p=0.047). Conclusions. HIV/HCV co-infection was high among patients from key populations. HIV infection was associated with multiple risk factors and higher HCV-RNA. Socio-economic barriers and the lack of pan genotypic DAAs limited the treatment and outcomes in this group. This is the first pilot study on managing patients with HCV from key population in Romania. [ABSTRACT FROM AUTHOR]

Introduction. SARS-CoV-2 virus infection affects all age groups. In children, the infection mainly causes asymptomatic or mildly symptomatic forms of the disease, regardless of their immune status. Case presentation. We describe the case of a 7-year-old male child, known to have Fanconi anemia, scheduled for bone marrow transplantation. The patient comes from a family outbreak of COVID-19, which is why he was tested for SARS-CoV-2 infection. He is asymptomatic at the time of admission to our clinic. The clinical examination performed at the time of admission shows a patient in good general condition, afebrile, with pale skin and mucous membranes, without respiratory changes. Para-clinically, severe neutropenia, severe normochromic normocytic anemia and severe thrombocytopenia are detected, for which transfusions of erythrocyte mass and platelet mass are performed. Due to the immunocompromised status, antibiotic therapy is instituted. If necessary, symptomatic treatment is administered. The evolution is favorable, and the SARS-CoV-2 RT-PCR control test is negative on the eighth day of hospitalization. Conclusions. Immunocompromised status is not a major risk factor for severe COVID-19 in children. [ABSTRACT FROM AUTHOR]

A female child, 1 year-old and 2 months, diagnosed with multiple neurological conditions, including myelomeningocele and operated hydrocephalus, was diagnosed with SARS-CoV-2 in October 2020 and hospitalized in our clinic. At the time of the onset of the disease, the patient had a febrile episode, laboratory blood tests showed a slightly increased biological inflammatory syndrome, and mixed pneumonia was described radiologically. Thus, antibiotic treatment was initiated, with laboratory tests and control imaging within normal limits after several days of admission. Being an institutionalized child, according to the epidemiological recommendations of that time, she was hospitalized in our clinic during the 14 days of the illness. Thus, on the 15th day of the disease she was discharged, with negative SARS-CoV-2 control RT-PCR, with good general condition, afebrile over 10 days. [ABSTRACT FROM AUTHOR]

Infecţia cu virusul hepatitei C a atras atenţia cercetătorilor începând cu anul 1970. Cu o istorie nu foarte îndelungată, infecţia cu virusul hepatitei C reprezintă încă o problemă de sănătate publică la nivel mondial, afectând aproximativ 3% din populaţia globului. Modelele experimentale au furnizat date preţioase privind înţelegerea replicării virale. Infecţia cronică cu virus C este în general o boală lent progresivă, caracterizată de persistenţa inflamaţiei la nivel hepatic şi corelată cu apariţia cirozei la aproximativ 20% dintre pacienţi după 20-30 de ani de infecţie. Hepatita cu virus C reprezintă încă o problemă de sănătate publică, însă progresele făcute în privinţa monitorizării şi tratamentului pacienţilor infectaţi sunt cu adevărat notabile şi au îmbunătăţit remarcabil perspectivele asupra acestei boli. [ABSTRACT FROM AUTHOR]

The infection with hepatitis C virus has drawn attention to researchers from 1970. Nowadays, hepatitis C virus infection is a global public health issue, affecting approximately 3% of the global population. Experimental models provided vital data on the understanding of viral replication. Chronic infection with hepatitis C virus is generally a progressive lent disease characterized by the persistence of inflammation in the liver and correlated with the cirrhosis in about 20% of patients after 20-30 years of infection. Hepatitis C virus is still a public health threat, but progress in monitoring and treatment of infected patients is truly noticeable and has remarkably improved the prospects for this disease. [ABSTRACT FROM AUTHOR]

Era antiviralelor cu acţiune directă a schimbat complet tabloul infecţiei cronice cu virusul hepatitei C. Ratele de răspuns virusologic susţinut au depăşit procentul de 90%, dar au apărut alte provocări: persistenţa bolii hepatice, complicaţiile pe termen lung, monitorizarea după vindecare. Noile tratamente au adus avantajul posibilităţii tratării unui număr mai mare de pacienţi (pacienţii cirotici, inclusiv cei cu boală decompensată, cei coinfectaţi HCV-HIV şi cei cu boală renală cronică dializaţi). Experienţa utilizării noilor tratamente este încă scurtă, dar există unele recomandări generale în ceea ce priveşte supravegherea pe termen lung. Acest review îşi propune să discute atât monitorizarea, cât şi evoluţia clinică a acestor pacienţi după obţinerea RVS. [ABSTRACT FROM AUTHOR]

The era of oral direct antivirals has completely changed the picture of chronic hepatitis C. The rates of sustained virological response overpassed the 90% percentage, but new challenges are coming: the persisting liver disease, the complications on long term, the follow up. The new treatment came with the advantage of increased number of patients that can be treated (cirrhotic patients including the ones with advanced disease, the co-infected patients HCV-HIV, the patients with end stage renal disease). The experience with these drugs is relatively short, but there are some general recommendations for the post-treatment surveillance. This review discusses the recommended follow-up and the clinical findings in patients, after obtaining SVR (sustained virological response). [ABSTRACT FROM AUTHOR]

Background. Severe immunosuppression caused by various types of surgical procedures, such as ureteral catheterization, can increase the risk of tuberculosis (TB) reactivation and can be involved in the appereance of disseminated TB (1). Pseudomonas aeruginosa is the third most common organism, after Escherichia coli and Proteus mirabilis, isolated from patients with urinary tract infections in the hospital setting. Despite the progress made in the research field of antibiotics, mortality and morbidity associated with this etiology are still increased (2). Miliary TB is a form of disseminated TB that can be fatal in the absence of an early diagnosis and treatment. This form of disease mainly affects young immunosuppressed patients, and has a higher prevalence in women (1,3). Materials and methods. We present the case of a 25 year-old female, who was admitted at Victor Babes Clinical Hospital for Infectious and Tropical Diseases for a postdiscectomy tuberculous spondylodiscitis (T11- T12). The hospital admission was for two reasons: to treat the post surgery wounds super infected with methicilin-resistant Staphylococcus aureus and Pseudomonas aeruginosa and secondly, to obtain a bacteriological confirmation for the tuberculous spondylodiscitis (at T11-T12) in order to start an anti-tuberculous drug regimen. Results. After the diagnosis and treatment initiation with meropenem, colistin, vancomycin and anti-tuberculous drugs the outcome of the patient was favorable. The clinical, bacteriological and radiological parameters normalized after one month of therapy. Conclusions. When a infection is bacteriologically confirmed, early antibiotic susceptibility testing and treatment are essential for the prevention of serious local and systemic complications associated with surgical procedures. [ABSTRACT FROM AUTHOR]

Introduction. In the history of his usage, by the 1850`s, Lithium was first used for the treatment of the gout. As mania and melancholia were included in the same diagnostic group, Lithium started to be used for the treatment of mental disorders. Nowadays, Lithium is still used in the bipolar disorder and as adjuvant in depression, schizophrenia, schizoaffective disorder and for the control of child aggressiveness. Methods and objective. Reporting a case of Lithium Intoxication in a patient with infection and chronic treatment with Lithium Carbonate. Objectives. Reporting a case of Lithium Intoxication in a patient with streptococcal angina infection and chronic treatment with Lithium Carbonate. Conclusion. Lithium intoxication may be rare in medical practice because of rare usage of Lithium therapy and strict monitorization of serum concentration. In this case, the tonsillar infectious accompanied by fever, impossibility of proper oral hydration and impairment of renal functions were the initial trigger of the pathological mechanism of intoxication syndrome. Secondary, the excretion of Lithium decreased and the low serum volume led to high blood concentration of Lithium. Later on, the gastrointenstinal impairment which appeared slowly added to the vicious circle which involved hydration, excretion and serum concentration of Lithium producing and intoxication syndrome. [ABSTRACT FROM AUTHOR]

Introduction. Coronavirus disease 2019 (COVID-19) frequently leads to asymptomatic or mild infectious disease evolution in children. Case presentation. We present the case of a 3 year old girl, known with acute lymphoblastic leukemia in chemotherapy treatment at that time. She had an asymptomatic form of COVID-19 but with important paraclinical changes. The evolution was favorable under the treatment initiated with antibiotics, corticotherapy, gastric protector and symptomatic treatment if necessary. Conclusion. Management of children with COVID-19 and other comorbidities remains a challenge given the few data currently in the literature. [ABSTRACT FROM AUTHOR]

Infective endocarditis is a diagnostic challenge with a variety of clinical forms, acute or subacute onset and severe complications by septic embolism or manifestations of immune response with production of antigenantibody complexes. We present a 63-year-old adult case, diagnosed with chronic renal failure, a month before admission to „Dr. Victor Babeş“ Clinical Hospital of Infectious and Tropical Diseases and transferred with suspicion of bacterial endocarditis on native valve. Diagnosis is confirmed by presence of two major Duke criteria: echocardiographic demonstrated valvular involvement, and identifi cation of the pathogen agent - Streptococcus mutans in blood cultures. After completing four weeks of antibiotic treatment, surgical intervention was required. Surgery has been performed, and prosthetic valve in mitral position was used. The patient returns to the clinic for antibiotic treatment (consolidation) for two weeks. After the patient has been discharged, he neglected cardiology treatment administration, leading to a hemorrhagic stroke and irreversible cardiopulmonary arrest. The specific feature of the case lies in the fact that kidney damage was the main onset event of subacute bacterial endocarditis. [ABSTRACT FROM AUTHOR]

Objectives: 1 Assessment of incidence for enteric pathogenic strains of E. coli in a samples of patients with diarrheal syndrome, with or without concomitant HIV infection. Methods: The study included 410 isolates of E. coli, from hospitalised patients, between 1st Jan 2006-31 June 2007. The classical methodology was based on isolation, phenotypic identification and serological testing. Microscopic examination, macroscopic aspects and epidemiological data were used for obtaining an oriented stool culture for E. coli/ STEC. All strains of E. coli isolated in pure culture were analyzed through multiplex PCR in INCDMIC. Results: We identified 410 strains of E. coli: 369 HIV(-) and 41 HIV(+), the most ones at the age group 0-4 years: 74,3% cases. The molecular tests showed 5,12% atypical EPEC (eae gene), 0,7% typical EPEC (bfp and eae genes), 2,7% atypical STEC/VTEC (with one gene or association of 2-3 genes: eae, stxI, stxII, mdh), 0,2% typical STEC/EHEC (all 4 genes), 4,4% EAEC (agg gene). There were no enteric pathogenic strains of E. coli isolated from HIV (+) patients. Conclusions: 1. Pathotyps of E. coli was confirmed by genotypical methods, only in HIV(-) patients; in HIV(+) patients, ADS occurred by other non-infectious pathophysiological mechanisms of SIDA. [ABSTRACT FROM AUTHOR]

Nosocomial infections represent a challenging issue for post-surgical intensive care units (ICU). We investigated the etiology and the antibiotic (AB) resistance profiles în 40 post-surgery patients (general surgery, neuro-surgery, orthopedics, neonates, and burns). These patients were hospitalized in the intensive care wards of Victor Babes Hospital during 01.01.2005 - 15.05.2006, after acquiring nosocomial infections in various surgery clinics în Bucharest. Seventy samples were obtained and analyzed from surgical wounds, CSF, blood, urine, broncho-alveolar aspirate etc. We isolated 100 bacterial strains: S. aureus (28%), Enterobacteriaceae (28%), P. aeruginosa (22%) A. baumannii (12), C. albicans (7%) and others (3%). Twenty strains of meticylin resistant S. aureus showed 0% resistance to vancomycin, teicoplanin and linezolid. Eighteen extended spectrum beta-lactamases secreting enterobacterial strains (K. pneumonie, Enterobacter spp, E. coli, P. mirabilis) were sensitive to carbapenems. Seven out of 22 strains of P. aeruginosa were multi-drug resistant (MDR), showing no sensitivity to each of the AB class in the disc diffusion method. Eleven strains of A. baumannii were carbapenem resistant and colistin sensitive. These data suggest that routine schemes of AB have a high risk of selecting resistant strains în post-surgery ICU, and should be abandoned or replaced by better preventive strategies. Glicopeptides, carbapenemes and colimicine are the first line AB to be used în MDR nosocomial infections. [ABSTRACT FROM AUTHOR]