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We describe a series of severe neuroinvasive infections caused by Toscana virus, identified by real-time reverse transcription PCR testing, in 8 hospitalized patients in Bucharest, Romania, during the summer seasons of 2017 and 2018. Of 8 patients, 5 died. Sequencing showed that the circulating virus belonged to lineage A. [ABSTRACT FROM AUTHOR]

We characterized influenza B virus-related neurologic manifestations in an unusually high number of hospitalized adults at a tertiary care facility in Romania during the 2014-15 influenza epidemic season. Of 32 patients with a confirmed laboratory diagnosis of influenza B virus infection, neurologic complications developed in 7 adults (median age 31 years). These complications were clinically diagnosed as confirmed encephalitis (4 patients), possible encephalitis (2 patients), and cerebellar ataxia (1 patient). Two of the patients died. Virus sequencing identified influenza virus B (Yam)-lineage clade 3, which is representative of the B/Phuket/3073/2013 strain, in 4 patients. None of the patients had been vaccinated against influenza. These results suggest that influenza B virus can cause a severe clinical course and should be considered as an etiologic factor for encephalitis. [ABSTRACT FROM AUTHOR]

Background: An overall prevalence rate of HCV infection in Romanian adult population was recently estimated to be 3.23%. The proportion of treated patients with chronic hepatitis C in our country has never been assessed. Aims: 1) to analyze the quality and quantity of antiviral therapy delivery; 2) to determine the proportion of patients being annually and ever treated with antiviral therapy in Romania and 3) to identify barriers against treatment of HCV infected-population in Romania. Results: The number of annually treated patients remained relatively stable between 2002 and 2007 (1,813 patients treated with pegylated interferon and ribavirin in 2002 and 2,446 in 2007). There was a doubled increase in reimbursed treatment in 2008 and 2009 (4,503 and respectively 4,701 treated patients) due to a special campaign organized to increase awareness and prevention of HCV transmission. The median time to therapy approval varies from county to county; overall it is 10.23 months. A total number of 25,318 patients with chronic C hepatitis were treated between 2002-2009, corresponding to a cumulative proportion of 4.1% of the prevalent cases of HCV infection treated in Romania until 1st January 2010. The main limiting factor of access to antiviral therapy for hepatitis C in Romania remains the lack of funds. Conclusions: This is the first analysis of the nationwide practice for treatment of hepatitis C in Romania. Increased public health efforts are required to improve access to antiviral therapy for hepatitis C in Romania. [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]

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]

A letter to the editor is presented regarding the suitability of HIV/HCV coinfected patients in Romania for HCV treatment.

Background: Due to a recent alarming increase in the number of HIV-HCV co-infected patients in Romania. Objectives: A cross sectional study was conducted to assess the baseline predictors of liver disease evolution. Patients and Methods: 83 HIV-HCV co-infected patients, untreated for HCV infection, were evaluated for viral replication, liver fibrosis (estimated by a noninvasive marker - FIB4), and plasma levels of IP-10 (interferon-gamma inducible protein 10) - a cytokine associated with an unfavorable outcome of HCV infection. Results: The median value for HCV viral load was high (6.3 log10 IU/mL), 98.8% of the patients were infected with HCV genotype 1. Although 53% of the patients received antiretroviral therapy (cART), only 31.8% of these achieved undetectable HIV levels. HCV viral load was significantly higher in patients with AIDS (6.4 vs. 6.1 log10IU/mL; P = 0.04), and in those naïve for cART (6.5 vs. 5.9 log10 IU/mL; P = 0.04). Severe fibrosis was directly correlated with immunosupression (56% vs. 17.4%, P = 0.03), HCV replication (6.1 vs. 4.9 log10IU/mL P = 0.008), and IP-10 median values (312 vs. 139 pg/ml, P=0.008). A serum IP-10 level higher than 400 pg/mL was significantly associated with FIB-4 median values (4.09 vs. 1.7, P = 0.004), HCV viral load (6.4 vs. 6.1 log10 IU/mL, P = 0.02) and ALT level (206.8 vs. 112.4 IU/L, P = 0.05). Conclusions: An important part of the HIV-HCV co-infected patients had negative baseline predictors for the evolution of HCV infection; their therapeutical management must be conducted with special attention towards adherence and potential overlapping drug toxicities. High concentrations of plasma IP-10 are reliable markers for the severity of liver disease. [ABSTRACT FROM AUTHOR]

Introduction. Chronic HCV infection represents a public health problem in Romania, with a prevalence of 3.23-4.56%, and more than 5,000 patients on the waiting lists for antiviral therapy. Aim: To perform an evaluation of the severity of chronic HCV infection genotype 1b, and a quantification of patients with a low viral load, in order to quantify the number of patients who may be considered for shortened treatment duration. Material: Histological assessment and viral load were performed in 1,220 consecutive patients from the waiting list for antiviral therapy in 2009. The severity of chronic hepatitis was assessed by histological evaluation (the necrotic-inflammatory index - Metavir and the fibrosis score - Metavir). Viral load was measured by PCR and 400,000UI/ml and 600,000UI/ml were defined as thresholds for low versus high viral load We assessed the influence of age, sex, and viral load on necro-inflammatory activity and fibrosis. Results: The mean age of the patients included was 48 ±10.69 years and females predominated (58%). Many of them (60%) were in stage F3, with a high potential for disease progression in the next 10 years (necro-inflammatory activity was moderate to severe in over 90%). Almost half of the patients had low viral load, below 600,000 copies/ml. The viral load was significantly associated with the age (p< 0.001) and sex (p< 0.001) of the patients. Conclusion: Chronic HCV hepatitis in patients on the waiting lists for antiviral therapy in Romania has a high severity with important predictable consequences on the duration of life, complications and treatment costs. The strategy of shortening the duration of treatment would be beneficial for almost 50% of the patients. [ABSTRACT FROM AUTHOR]

Background: Direct antiviral agents (DAA) showed very good results in terms of efficacy and safety in clinical trials, but real-life data are still needed in order to confirm this profile., Material and Methods: In Romania, through a nationwide government-funded programme in 2015-2016, approx.5800 patients with virus C cirrhosis received fully reimbursed DAA therapy with OBV/PTV/r+DSV+RBV for 12 weeks. We analysed a national prospective cohort enrolling the first 2070 patients, all with genotype 1b. The only key inclusion criteria was advanced fibrosis (Metavir stage F4) confirmed by Fibromax testing (or liver biopsy/Fibroscan). Efficacy was assessed by the percentage of patients achieving SVR 12 weeks post-treatment (SVR12)., Results: Forty patients stopped the treatment because of hepatic decompensation (1.9%), 21 stopped because of other adverse events and one was lost to follow-up. This cohort was 51% females, mean age 60 years (25÷82), 67% pretreated, 70% associated NASH, 67% with severe necro-inflammation (severity score 3-Fibromax), 37% with comorbidities, 10.4% with Child Pugh A6, 0.5% B7. The median MELD score was 8.09 (6 ÷ 22). SVR by intention-to-treat was reported in 1999/2070(96.6%), 55/2070 failed to respond. Liver decompensation was statistically associated in multivariate analysis with platelets< 10 5 /mm 3 (P = .03), increased total bilirubin (P < .001), prolonged INR (P = .02), and albumin<3.5 g/dL (P = .03)., Conclusions: OBV/PTV/r+DSV+RBV proved to be highly efficient in our population of cirrhotics with a 96.6% SVR. Serious adverse events related to therapy were reported in 61/2070(2.9%), most of them liver decompensation (1.9%), related to hepatic dysfunction, and lower platelet count., (© 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Chronic hepatitis B is widespread and represents an important cause of morbidity and mortality due to the evolution to cirrhosis and hepatocellular carcinoma. This study was designed to improve the national laboratory surveillance of hepatitis B virus (HBV) infection, focusing on genomic analysis of isolates from Romanian patients. Sera from ten patients with HBV were collected and analyzed. Phylogenetic analysis was conducted on a DNA fragment spanning almost the entire genome. The occurrence of mutations was assessed for each open reading frame in the viral genome. Phylogenetic analysis revealed five isolates belonging to genotype A (subgenotype A2) and other five clustering with genotype D strains (subgenotype D1). Two patients treated with lamivudine were found to carry isolates harboring rtM204V lamivudine resistance mutation. An HBV isolate displaying a lamivudine complex resistance pattern, rtM204I in conjunction with rtL180M and rtA200V, was found in a lamivudine naïve patient. All samples harbored sA105P substitution, usually found in HBIg therapy escape isolates. Three of the studied strains were simultaneously displaying T1753, T1762 and A1764 mutations which in vitro induce enhanced genome replication and reduction of HBeAg expression. The sequence obtained from a patient with decompensated liver cirrhosis presents a novel type of insertion consisting of nine nucleotides between positions 260 and 261 in the X gene. Despite the small number of samples, our findings suggest the need to determine the drug resistance pattern for each patient before taking a therapeutic decision and also highlight the necessity of knowing the real level of drug resistance among HBV strains circulating in Romania.