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WNV and USUV are closely related epornitic flaviviruses transmitted by Culex mosquitoes which can cause febrile and neurodegenerative disease in humans. The impact of both viruses on public health has increased in the recent decades. Aim: The aim of the study was to evaluate the seroprevalence of WNV and USUV in hospitalized patients from eastern Romania who did not show symptoms corresponding to the case definition. Methods: Human blood samples from the hospitalized patients were collected in 2015 and from April to September 2019 in Iasi County, Romania. The samples were screened by ELISA for anti-WNV IgG, IgM, and anti-USUV IgG antibodies. Results: A cumulative seroprevalence of 3.4% was recorded for anti-WNV IgG antibodies and 9.1% for anti-WNV IgM. No sample was positive for anti-USUV antibodies. Conclusion: The cumulative seroprevalence observed provides support for the consideration of WNV as being endemic in the east of Romania. The absence of anti-USUV antibodies may be related to cross-reactivity and cohort size, thus, USUV should be considered in clinical practice and become an objective for active surveillance in Romania.

Summary: Background: Data on risk factors for carbapenem-resistant Enterobacterales (CRE) with wider applicability are needed to inform preventive measures and efficient design of randomised trials. Methods: An international matched case-control-control study was performed in 50 hospitals with high CRE incidence from March 2016 to November 2018 to investigate different aspects of infections caused by CRE (NCT02709408). Cases were patients with complicated urinary tract infection (cUTI), complicated intraabdominal (cIAI), pneumonia or bacteraemia from other sources (BSI-OS) due to CRE; control groups were patients with infection caused by carbapenem-susceptible Enterobacterales (CSE), and by non-infected patients, respectively. Matching criteria included type of infection for CSE group, ward and duration of hospital admission. Conditional logistic regression was used to identify risk factors. Findings: Overall, 235 CRE case patients, 235 CSE controls and 705 non-infected controls were included. The CRE infections were cUTI (133, 56.7%), pneumonia (44, 18.7%), cIAI and BSI-OS (29, 12.3% each). Carbapenemase genes were found in 228 isolates: OXA-48/like, 112 (47.6%), KPC, 84 (35.7%), and metallo-β-lactamases, 44 (18.7%); 13 produced two. The risk factors for CRE infection in both type of controls were (adjusted OR for CSE controls; 95% CI; p value) previous colonisation/infection by CRE (6.94; 2.74–15.53;

While traveling by plane, passengers and pilots live in a controlled, partially isolated, heated and filtered microclimate in order to provide them comfort and safety. However, due to the large number of people / m3 of air and because of the sometimes unpredictable airflow that carry germs, the passengers present an important risk especially for infectious diseases with airborne transmission; the transmission of tuberculosis, influenza, measles, MERS, SARS, and the new SARS-2-CoV in this context has been widely proven and described. Vector-borne diseases are another threat because they can travel (especially mosquitoes) in the luggage or clothes of passengers and can spread diseases such as malaria, Chikungunya fever or yellow fever at long distances. The multi-drug resistant bacteria spreading in the case of repatriated travelers after hospitalizations abroad represents another problem. Even in the absence of a truly in-flight disease transmission, air travel nowadays represents a way to spread diseases such as Ebola, SARS or animal and wildlife-related infections between different countries or even continents. Disinfection, disinsection, the use of more efficient methods of air filtering in the cabin, the strict control of the passengers at check-in and check-out represent protecting measures against these risks, whose efficiency remains to be proven.

Introduction. Hepatitis E is an acute liver disease caused by E hepatitis virus (HEV), representing a global public health problem comparable with other transmissible infections. Aim. The purpose of this paper is to present the epidemiological, clinical, biological and evolutive aspects of HEV infection. Material and method. An estimated 20 million infections are annually reported worldwide with higher prevalence rates recorded in South-East Asia (over 60% of infections and over 65% of HEV related deaths). In Romania the incidence of HEV in 2009 was 12%, the frequency of infection being limited to the anti-HEV specific IgG antibodies seroprevalence. Results. HEV transmission is predominantly by digestive tract (especially contaminated water) but also by blood, plasma, organ transplant. The incubation period ranges from 21 to 45 days, onset of gastrointestinal simptoms, fever, influenza-like syndrome, asthenia, skin rush, weight loss, abdominal pain, dehydration. The state period is characterized by sclero-tegumentary jaundice (75% cases), skin pruritus, steathoresis, dark urine and pale stools. HEV can cause extrahepatic manifestations (neurological, renal lesions, pancreatitis and haematological disturbencies). Farmacological treatment of HEV infection includes Peg-Inf, Ribavirin and also newest DAAs agents. Discussions. In most patients hepatitis E causes a self-limited disease that lasts for several weeks. Acute infection is generally asymptomatic and is caused by genotype 1 in young people, while genotypes 3 and 4 generally affect immunosuppressed patients. Chronic infection is caused by genotypes 3 and 4 in immunosuppressed pacients (transplanted, HIV-positive and haematological patients) and has a lower incidence and mortality. Evolution of viral hepatitis E may be severe and fulminant due to acute liver failure. A recombinant vaccine approved in China in 2011 opens up prospects for the specific prevention measures in areas identified as being at risk to limit the consequences of hepatitis E virus infection in the general population and exposed groups. Conclusions. Hepatitis E management involves the therapy of chronic infection in immunosuppressed patients, the extrahepatic manifestations and also acute severe HEV infections.

The purpose of this research was to improve the epidemiological data on HEV infection in the human population in Romania. The analysis targeted hospitalized subjects with acute hepatitis (n = 94) of unknown etiology from the Infectious Diseases Regional Hospital in Iasi. Moreover, patients without liver disease (n = 40) from a different county hospital located in Eastern Romania were included. The presence of HEV infection and first characterization of human HEV strains was determined using serological and molecular assays. The apparent HEV seroprevalence varied between 29.16% (95% CI, 16.31–42.03) and 32.5% (95% CI, 17.98–47.02) according to patient grouping. Molecular analysis enhanced the detection of two HEV isolates, that clustered in subtype HEV-3c, the most commonly identified subtype in Europe. Identification of acute hepatitis E cases, together with the first detection and molecular characterization of human HEV in Romania represent the originality attributes of the present study.

Background. Pseudomonas aeruginosa is a dangerous, hard to treat pathogen, due to an increasing frequency of resistance to multiple antibiotics. This susceptibility pattern is influenced by multiple factors and it frequently has a regional or local character, different for each hospital or intensive care unit. Methods. We analysed and compared the characteristics of 62 patients and their isolated P. aeruginosa strains, treated in the “Sfânta Parascheva” Infectious Diseases Hospital of Iasi City between January and December 2011 (Group 1 – 25c) and between January and December 2016 (Group 2 – 37c). The susceptibility was tested by disk diffusion test; CLSI standards were used. Results. The median age was higher in group 2 (63 years) vs group 1 (52 years, p=0.04), more men were affected in both groups (59.2 vs 57.5%). In group 2 the strains were isolated from urine (50%), sputum (17.5%), wound secretions (15%), blood cultures (10%) or central venous catheters (7.5%); more than half may be of nosocomial origin; the infection mainly occurred in patients with significant comorbidities, long-term hospitalization (median - 15 days), ICU care or mechanical ventilation. We did not find a significant increase in the resistance rates in group 2 for the tested antibiotics; they remain high for almost every drug: 55 vs 60% for imipenem, 70 vs 62% for meropenem, 31 vs 41.7% for ceftazidime, 68 vs 75% for ciprofloxacin, 50 vs 42.8% for gentamicin, 63.6 vs 45.8% for amikacin, 46 vs 30% for piperacillin-tazobactam. All isolates were susceptible to colistin. The share of MDR isolates was slightly higher in group 2 (52 vs 61%, p=0.4). The treatment of these infections was difficult, with an average duration of 15 days; 20% of patients died. Conclusions. In our hospital, P. aeruginosa infections appeared predominantly in elderly patients, often in association with medical care, were associated with multidrug resistance to anti-biotics and sometimes had a guarded prognosis. The antibiotic susceptibility rates did not vary significantly in the two time intervals that we analysed.

Infectious diseases have accompanied human development from the earliest times and have often influenced it greatly. Although they were considered “an endangered species” in the second half of the 20th century, they continue to pose a serious threat to individual or public health. Diagnosis technique improvement, climate changes, increased population mobility and vaccine cover decrease are only some of the factors that have contributed lately to the occurrence and fast spreading of new pathogens or to the re-emerging of diseases already considered historical. Most of these infectious agents (Zika, Ebola, Chikungunya, MERS, SARS, new influenza viruses), for which there are few therapeutic resources, were the cause for regional or global epidemic outbreaks, which generated concern among healthcare professionals and often panic in the population, as well as significant economic losses. The international and medical communities joined their forces and got financially and logistically involved, sometimes paying with their own lives, in fighting these new threats. The fast understanding of the epidemiological process, pathogenesis and development of diagnosis and prevention methods has often helped limit the spread of emerging diseases and has laid the grounds for their future control.

Objectives: We aimed to determine the prevalence of oropharyngeal manifestations in HIV infected patients. Materials and methods: A retrospective study on 824 patients found in the evidences of the Infectious Diseases Clinic in Iasi, diagnosed in different stages of HIV infection and admitted to hospital between January the 1 st and December the 31st of 2010. Results: Oropharyngeal manifestations appeared in less than half of all patients (43.4%), the majority of which were between 15 and 24 years old (66.3%). The most frequent lesion was oral candidiasis 72.19%, followed by gingivostomatitis 72 cases (20.24%), infections with herpes virus 13 cases (3.65%), aphthous stomatitis 11 cases (3,08%), Kaposi’s sarcoma 2 cases and hairy leukoplakia 1 case. Oral lesions were associated mostly with the degree of imunosupresion and the level of CD4 cells. Conclusions: The degree of imunosupresion correlates significantly with the manifestations of oral infections, especially in patients suffering from candidiasis and with Kaposi’s sarcoma. The oral lesions with the highest frequency spotted by our study were oral erythematous candidiasis and gingivostomatitis.