Search

BackgroundA novel coronavirus (SARS-CoV-2) causing coronavirus disease (COVID-19) was detected at the end of 2019 in China. There are many COVID-19 studies in progress however, little is known about the course of COVID-19 in people living with HIV (PLWH). The aim of our study was to describe epidemiology and clinical characteristics of PLWH diagnosed with COVID-19 reported form Central and Eastern European Countries.MethodsOn-line survey was sent to Euroguidelines in Central and Eastern Europe (ECEE) Network Group. Analysis included all confirmed COVID-19 cases between March 11 and June 26 2020 among PLWH in 12 countries: Albania, Belarus, Bosnia and Herzegovina, Bulgaria, Czech Republic, Estonia, Hungary, Lithuania, Poland, Romania, Russia, and Serbia.ResultsIn total 34 cases were reported. The mean age of those patients was 42.7 years (IQR = 35.8-48.5) and most of the patients were male (70.6% vs 29.4%). The mean CD4+ T-cell count prior COVID-19 diagnosis was 558 cells/mm3 (IQR = 312-719) and HIV RNA viral load (VL) was undetectable in 18 of 34 (53%) cases, the data about most recent HIV RNA VL was not available in three cases (8,8%). Comorbidities were observed in 19 (55.9%) patients, mostly cardiovascular disease (27,8%), and in 10 (29.4%) patients had coinfection, mostly chronic hepatitis C (87.5%). The clinical course of COVID-19 was asymptomatic in 4 (12%) cases, mild disease without hospitalization was reported in 11 (32%) cases. Stable patients with respiratory and/or systemic symptoms have been documented in 14 (41%) cases; 5 (15%) patients were clinically unstable with respiratory failure. Full recovery was reported in 31 (91%) cases, two patients died. In one case the data was not available.ConclusionThis study from 12 countries in Central and Eastern Europe region indicates no alarming signals of increased morbidity or mortality from COVID-19 among HIV-positive persons there is a need for further research.

BackgroundTuberculous meningitis (TBM) represents a diagnostic and management challenge to clinicians. The“Thwaites’ system” and “Lancet consensus scoring system” are utilized to differentiate TBM from bacterial meningitis but their utility in subacute and chronic meningitis where TBM is an important consideration is unknown.MethodsA multicenter retrospective study of adults with subacute and chronic meningitis, defined by symptoms greater than 5 days and less than 30 days for subacute meningitis (SAM) and greater than 30 days for chronic meningitis (CM). The “Thwaites’ system” and “Lancet consensus scoring system” scores and the diagnostic accuracy by sensitivity, specificity, and area under the curve of receiver operating curve (AUC-ROC) were calculated. The “Thwaites’ system” and “Lancet consensus scoring system” suggest a high probability of TBM with scores ≤4, and with scores of ≥12, respectively.ResultsA total of 395 patients were identified; 313 (79.2%) had subacute and 82 (20.8%) with chronic meningitis. Patients with chronic meningitis were more likely caused by tuberculosis and had higher rates of HIV infection (P P P ConclusionBoth criteria can be helpful in distinguishing TBM from bacterial meningitis, but only the Lancet consensus scoring system can help differentiate TBM from meningitis caused by fungal, viral and unknown etiologies even though significant overlap occurs and the overall diagnostic accuracy of both criteria were either poor or fair.

Introduction: Leptospirosis is a zoonotic spirochetal disease with global importance, which continues to have a major impact on public health in developing countries. The prevalence of the disease is much higher in males. The objectives of this study were: to give some data and to share our experience with human leptospirosis in Albania; to describe the prevalence regarding to the role of gender in the prevalence of human leptospirosis; to make a gender specific analysis of the clinical manifestations in patients diagnosed and treated for leptospirosis in our service and to make a review of literature related to this hypothesis. Methodology: We reviewed the epidemiologic data, risk factors and differences in clinical presentation between males and females’ patients with leptospirosis. These data are analysed from hospitalized patients. Diagnosis of leptospirosis was established based on clinical presentation, epidemiological data and subsequently confirmed serologically by Anti-Leptospira IgM antibodies through ELISA test. Results: Between 2005-2016, 233 cases of confirmed leptospirosis were analysed. Males were 208 (89.27%) and 25 of patients (10.72%) were females in ratio 9:1 p < 0.001. The highest prevalence was observed in the 45-64 age groups. Overall mortality was found to be 8.58%, 19 were males and one female p < 0.001. Conclusions: There is a much higher prevalence of leptospirosis in middle aged men. Mortality rate seems to be similar in males and females. While the difference in prevalence may be related to exposure to risk factors, further investigation is necessary to study gender-based genetic and immunological predisposition.

Objective: To describe the clinical, laboratory, microbiological, and echocardiographic findings in four intravenous drug users with endocarditis hospitalized and followed in our Infectious Disease Service, a tertiary university hospital as well as to determine the efficacy of medical treatment. Methods: From a database of 35 subjects with endocarditis during five years, we made a retrospective analysis of data for four cases between the age of 24-33 years old which were intravenous drug users. Results: Infective endocarditis was encountered in four drug users with positive blood cultures (Staphylococcus aureus was present in all the cases), vegetations in the tricuspid native valve in ultrasound, high fever (more than 38oC). The four cases were male and the mean age was 29 years (range 24-33 years). Three out of the four cases presented with pulmonary involvement and only one with femoral and popliteal vein thrombosis. Two out of four cases had acute renal and hepatic failure and only one had acute cutaneous vasculitis. Transesophageal Echocardiography (TEE) was also performed in two cases. For all of them medical management consisted of antibiotic therapy and two out of them underwent surgery because of the persistence of valvular vegetations after antibiotic therapy. The prognosis was good with 0% mortality. Conclusion: Infective endocarditis should be considered in the differential diagnosis of intravenous drug users presenting with various clinical scenarios. Echocardiography remains the main modality and should be used serially to facilitate early diagnosis. The successful management of a complicated case often requires the close cooperation of an infectious disease physician, a cardiologist, an addiction physician and occasionally a cardiac surgeon.

There is a lack of nursing studies that are specifically focused on assessing and caring for people living with HIV / AIDS to improve their quality of life. Little is known about the current situation regarding the care of persons living with HIV / AIDS.This cross-sectional, descriptive and analytical study will try to identify the assessment of nursing care in order to promote a better understanding of nursing care. A structured self-administered questionnaire administered from April 30 to June 15, 2014, was used for data collection.The participants were 55 patients, whose average age was 33.3 ±7.98 years, ranging from 20 to 55 years of age, out of which 24 (43.6%) of patients were female, while 31 (56.4% of them were males). They had different socioeconomic and educational levels. Regarding the biological dimension of nursing care, despite a positive trend in patient care estimation, differences between individual patient groups are observed based on the educational level.So patients with secondary and higher education are more likely to positively assess nursing care by the biological dimension versus 8-year-old patients. While with the psychological dimension and with other dimensions such as spiritual, social, stigmatization and discrimination there is no statistically significant relation between the socio-demographic characteristics of patients.Among the 5 dimensions, it is noticed that patients have evaluated less positively stigma, discrimination, compared to other dimensions. So patients are noticed a dissatisfaction with the fact that they are treated by nurses at the time of health care. The Nursing School to increase the development and implementation of quality research should identify the feelings, experiences, experiences and meanings of HIV/AIDS patients on nursing care. HIV / AIDS is a growing risk of modern times, requiring long-lasting research and research.

Introduction: Pancreatitis is a rare complication of hemorrhagic fever with renal syndrome (HFRS). The causative agents of HFRS are hantaviruses, which belong to the genus Hantavirus, family Bunyaviridae. The purpose of this study was to evaluate cases of acute pancreatitis (AP) in patients with HFRS at the Service of Infectious Diseases, Tirana, Albania. Methodology: In this retrospective study, clinical and laboratory data was obtained from 36 patients with confirmed HFRS, between January 2011 and December 2016. The diagnosis had been confirmed by a positive enzyme-linked immunosorbent assay (ELISA) for IgM or IgG antibodies to hantavirus. Results: The average patient age was 39.7 ± 14.1 years with a range of 15-59 years. From 36 HFRS patients, four (11.1%) were found to have AP, all were male. Abdominal pain was the most common symptom and an increase in amylase and lipase was observed in all four patients. Abdominal computed tomography (CT) indicated pancreatitis with surrounding edema, necrosis and hemorrhage. In this study, the total mortality was 11.1% (4/36), while mortality in patients with AP was 25% (1/4). Conclusions: The results indicate that AP is a serious complication of HFRS, with a poor prognosis. Increased awareness of AP in clinicians and assessment of amylasemia or lipasemia in patients with HFRS should be considered, especially in endemic areas where a rapid diagnosis is crucial for a positive outcome.

Hemorrhagic fever with renal syndrome is presented with so many different clinical symptoms. It can present mild form of the disease or the severe symptoms. We reported two cases with HFRS, at pregnant women, ended with pregnancy interruption. Both of them had nearly the same age, both 16 weeks pregnant. They presented with fever, malaise, muscle pain and headache. They were febrile when presented at the hospital, hypotensive, hyperemia on the face. They complained about oligo-anuria too. One of them continued to be hypotension, despite the supportive therapy she had an abortion after 8 hours. The other patient had the abortion on the 4 th day of hospitalization. The diagnose was set based on the clinical, epidemiological findings and the serological positive confirmation for IgM Hantavirus by enzyme-linked immunosorbent assay and immunofluorescence assay IFA. The abortion is a rare complication of HFRS in pregnancy. The symptoms are not specific. Early diagnosis and appropriate management are necessary to improve the maternal and fetal outcome. J Microbiol Infect Dis 2017; 7(4):198-201

Background: WNV causes 1.4% of all central nervous system infections and is the most common cause of epidemic neuro-invasive disease in humans. Objectives: Our main objective was to investigate retrospectively West Nile virus neuroinvasive disease (WNND) cases hospitalized during 2010–2017 and identified factors that can influence prognosis. Study design: We documented the demographic, epidemiologic, clinical and laboratory data of WNND and identified factors that can influence prognosis. The data were recruited through Infectious Diseases International Research Initiative (ID-IRI), which serves as a network for clinical researches. Results: We investigated 165 patients with WNND in 10 countries from three continents. 27 patients died and the mortality rate was 16.4%. In an univariate analysis age, congestive heart failure, neoplasm and ischemic heart disease (p < 0.001), neuropsychiatric disorders (p = 0.011), chronic hepatitis (p = 0.024) and hypertension (p = 0.043) were risk factors for death. Fatal evolution was also correlated with ICU addmission, disorientation, speech disorders, change in consciousnes, coma, a low Glasgow coma score, obtundation, confusion (p < 0.001), history of syncope (p = 0.002) and history of unconsciousness (p = 0.037). In a binomial logistic regresssion analysis only age and coma remained independent prediction factors for death. We created an equation that was calculated according to age, co-morbidities and clinical manifestations that may be used to establish the prognosis of WNND patients. Conclusions: WNND remain an important factor for morbidity and mortality worldwide, evolution to death or survival with sequelae are not rare. Our study creates an equation that may be used in the future to establish the prognosis of WNND patients. © 2019 Elsevier B.V., PN-III-P1.2-PCCDI-2017-0005/2018, “The research of the Romanian patients was funded through CCCDI-UEFISCDI project PN-III-P1.2-PCCDI-2017-0005/2018, Romania.”

OBJECTIVES. There is currently an urgent need to harmonize hepatitis standards of care for HIV-positive patients across Europe. The HIV epidemic in Central and Eastern Europe has often been driven by injecting drug use, therefore a higher rate of co-infection with HCV and HBV is expected in this region. We have investigated the epidemiological prevalence and treatment availability for end-stage liver disease in HIV/HCV/HBV coinfections in countries represented in the ECEE Network Group. METHODS. The Euroguidelines in Central and Eastern Europe (ECEE) Network Group was initiated in February 2016 to compare standards of care regarding HIV infection in the region. Information about HIV/HCV/HBV co-infections and the availability for end-stage liver disease treatment for HIV-positive patients were collected through on-line surveys. The respondents were ECEE members from 16 countries of the region. The information on co-infection prevalence was sourced from WHO, national HIV programmes, articles published in international journals, single clinic reports, and personal information in ten of the participating countries (62.5%). RESULTS. The HIV/HCV co-infection rate was from 3% to 99%. The range of reported of HIV/HBV coinfection percentages was 2.3% to 40%. HIV/HCV/HBV co-infection ranged from 0% to 9%. Regarding treatment for end-stage liver disease, liver transplantation was an available option for HIV-positive patients in only three countries (19%). CONCLUSION. Our findings revealed only a limited number of treatment options for the end-stage liver disease in HIV-positive patients for the vast majority of Central and Eastern European countries. There are gaps in epidemiological surveillance in this region. It appears there are many differences in the number of co-infected patients among Central and Eastern European and neighboring countries, but there is no unification of information sources.

Post-kala-azar dermal leishmaniasis (PKDL) is a complication of visceral leishmaniasis (VL) that most frequently occurs after an episode of VL caused by Leishmania donovani. In this case report, we present a 21-year-old male patient with persistent skin lesions and recurrent visceral leishmaniasis (VL) due to Leishmania infantum. The patient did not respond to multiple lines of anti-leishmanial treatment (including Liposomal amphotericin B and miltefosine) and later died from cerebral lesions presumed to be secondary to persistent VL.

Background Crimean-Congo hemorrhagic fever is a tick-borne disease described in more than 30 countries in Europe, Asia, and Africa. Albania is located in the southwestern part of the Balkan Peninsula. In 1986, the first case of Crimean-Congo hemorrhagic fever was registered, and cases of patients with hemorrhagic fever are rising, and most of them present in a serious condition, when the mortality rate is very high. In districts like Mirdite, Lezhe, Gjirokaster, Skrapar, Erseke, and Kukes, there is delineated human-to-human transmission. Case presentation We report the case of a 32 year-old Albanian woman from a rural area of Albania. She was hospitalized at the Infectious Diseases Service, for a severe influenza-like illness of 4 days duration. Our patient had been bitten by a tick while working in her garden. She presented with nausea, vomiting, headache and muscle pain. A physical examination found a high fever of 40 °C, an enlarged liver, petechia, and vaginal bleeding; flapping tremor and fetor hepaticus were found as a sign for hepatic encephalopathy; and confusion and disorientation were observed in her neurological examination. Her platelet and white blood cell counts were very low, while her aspartate aminotransferase and alanine aminotransferase levels were very high. She was transferred to the intensive care unit because of her worsening condition. Serological and C-reactive protein test results for Crimean-Congo hemorrhagic fever were positive. She was treated with oral ribavirin and discharged with normal parameters. Conclusions People in high-risk professions in the endemic areas should be informed and trained on the risk of Crimean-Congo hemorrhagic fever as a matter of urgency. Vaginal bleeding is not always a gynecological problem. In Albania, these places are the mountainous areas, so people who have traveled to these areas and who have symptoms after a tick bite are advised to contact their doctors.

Mondelli, Mario U/0000-0003-1811-3153; Leblebicioglu, Hakan/0000-0002-6033-8543; Soriano, Vicente/0000-0002-4624-5199; Ruta, Simona/0000-0002-2492-6073; Lazarevic, Ivana/0000-0001-6795-1378; Harxhi, Arjan/0000-0001-8518-7377 WOS: 000364572800020 PubMed: 26166544 The prevalence and management of chronic hepatitis B virus (HBV) infection differ among European countries. The availability and reimbursement of diagnostics and drugs may also vary, determining distinct treatment outcomes. Herein, we analyse differences in medical facilities for the care of patients with chronic HBV infection across Europe. A survey was sent to the members of the ESCMID Study Group for Viral Hepatitis, all of whom are experts in chronic HBV infection management. The comprehensive survey asked questions regarding hepatitis B surface antigen (HBsAg) prevalence, the availability of diagnostics and drugs marketed, and distinct clinical practice behaviours in the management of chronic HBV infection. World Bank data were used to assess the economic status of the countries. With 16 expert physicians responding (69%), the HBsAg prevalence rates were 5%) in Albania and Iran. Regarding the availability and reimbursement of HBV diagnostics (HBV DNA and liver stiffness measurement), HBV drugs (interferon, lamivudine, tenofovir, and entecavir), HBV prophylaxis, and duration of HBeAg-positive and HBeAg-negative HBV infection, the majority of high-income and middle-income countries had no restrictions; Albania, Iran and Serbia had several restrictions in diagnostics and HBV drugs. The countries in the high-income group were also the ones with no restrictions in medical facilities, whereas the upper-middle-income countries had some restrictions. The prevalence of chronic HBV infection is much higher in southern and eastern than in western European countries. Despite the availability of European guidelines, policies for diagnostics and treatment vary significantly across European countries. Clinical Microbiology and Infection (C) 2015 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

Background: In Albania the incidence of people with both TB and HIV is small; however, it is a category that should not be neglected. Objective: The main aim of the study is to assess the characteristics of TB in the HIV/AIDS patients. Methods: During 2004-2015 years are studied 77 HIV/AIDS patients with pulmonary complications from which in all resulted 27 (32.2%) cases of TB, 23 (85.2%) cases as pulmonary tuberculosis and 4 (14.2%) cases as generalized tuberculosis. Results: The average age of the subjects with pulmonary TB and generalized TB was respectively 48.1 ± 9.8 and 47.8 ± 10.2 years, males –22 (95.7%) and 2(50%), smokers – 21 (91.3%) and 4 (100%), urban residents 16 (69.6%) and 3 (75%), unemployed – 9 (39.1%) and 1 (25%). Period of knowing HIV infection was respectively 6.2 ± 2.2 and 4 ± 2.2 years, period of ART treatment - 5.3 ± 2.8 and 2.9 ± 3. According to the count of CD4 cellules, 6 (26.1%) patients with pulmonary TB resulted with 200-999 cells/ml, 8 (34.8%) - with 100-199 cells/ml and 9(39.1%)

Ghaydaa, Shehata/0000-0002-3631-893X; Radic, Ljiljana Betica/0000-0002-8778-106X; Silva-Pinto, Andre/0000-0002-2077-3356; Cascio, Antonio/0000-0002-1992-1796; Bossi, Paolo/0000-0003-0135-0224; Stebel, Roman/0000-0001-6922-4465; Namani, Sadie/0000-0002-2411-8623; Chan, Phillip/0000-0002-4071-4409; Hargreaves, Sally/0000-0003-2974-4348; Artuk, Cumhur/0000-0003-0827-990X; Harxhi, Arjan/0000-0001-8518-7377; Larsen, Lykke/0000-0002-4113-4182; Uysal, Serhat/0000-0002-4294-5999 WOS: 000407582200010 PubMed: 28397100 Risk assessment of central nervous system (CNS) infection patients is of key importance in predicting likely pathogens. However, data are lacking on the epidemiology globally. We performed a multicenter study to understand the burden of community-acquired CNS (CA-CNS) infections between 2012 and 2014. A total of 2583 patients with CA-CNS infections were included from 37 referral centers in 20 countries. Of these, 477 (18.5%) patients survived with sequelae and 227 (8.8%) died, and 1879 (72.7%) patients were discharged with complete cure. The most frequent infecting pathogens in this study were Streptococcus pneumoniae (n = 206, 8%) and Mycobacterium tuberculosis (n = 152, 5.9%). Varicella zoster virus and Listeria were other common pathogens in the elderly. Although staphylococci and Listeria resulted in frequent infections in immunocompromised patients, cryptococci were leading pathogens in human immunodeficiency virus (HIV)-positive individuals. Among the patients with any proven etiology, 96 (8.9%) patients presented with clinical features of a chronic CNS disease. Neurosyphilis, neurobrucellosis, neuroborreliosis, and CNS tuberculosis had a predilection to present chronic courses. Listeria monocytogenes, Staphylococcus aureus, M. tuberculosis, and S. pneumoniae were the most fatal forms, while sequelae were significantly higher for herpes simplex virus type 1 (p < 0.05 for all). Tackling the high burden of CNS infections globally can only be achieved with effective pneumococcal immunization and strategies to eliminate tuberculosis, and more must be done to improve diagnostic capacity.

Objective: As HIV/AIDS prevalence rises in Eastern Europe, assessment of local epidemics in the bordering Central European region, especially South Eastern Europe, is vital in order to meet treatment and prevention needs. Understanding current medical and social needs and barriers to care experienced by HIV-positive patients in these regions may provide insight into how to best respond to the local epidemics, increase patients' access to treatment, and reduce loss to follow-up. Design: This study assesses the patient characteristics, barriers to care, and current medical and social needs of HIV-positive patients in Albania. Semi-structured interviews were used in this cross-sectional study. Methods: We interviewed 79 of 85 patients (93% response rate) followed at the University Hospital Center of Tirana (UHCT) HIV/AIDS Ambulatory Clinic, which represented the majority of patients under HIV care in Albania during 2009. Results: The local HIV epidemic seems to be comprised mainly of heterosexual men who have spent an average of 3.6 years abroad. The vast majority of patients under care at UHCT HIV/AIDS Ambulatory Clinic had experienced barriers to care associated with social stigma (97.4%), lack of knowledge of HIV medical care (76.6%), and medical provider's lack of knowledge of HIV (70.9%). Social needs of the patients were also overwhelmingly unmet (90.0-95.7%). Conclusions: In addressing HIV/AIDS in Albania, it will be crucial to educate the healthcare sector in ways to identify and address barriers to care and current medical and social needs of HIV-positive patients.

Context: Dermatologic diseases are common in the human immunodeficiency virus (HIV)-infected population. Cutaneous manifestations of HIV disease may result from HIV infection itself or from opportunistic disorders secondary to the declined immunocompetence due to the disease. Aims: The aim of this study is to determine the pattern of c0utaneous manifestations in HIV in an adult HIV Clinic in Tirana. Subjects and Methods: This is a retrospective study including 355 HIV-positive patients with cutaneous manifestations who referred to the Ambulatory Clinic for HIV/AIDS, at the Infective Service and Dermatology Service of University Hospital Centre “Mother Theresa,” Tirana, Albania over the period 2008–2015. Results: The mean age of patients was 43.08 (±11.8) years, with a range 15–79 years. Two hundred and forty-seven (69.6%) of patients were male and 108 (30.4%) female. Male-to-female ratio is 2.3:1. The study found a significant trend of increasing incidence of dermatological pathologies with increasing stage of the disease. Fifty-five (15.5%) of patients with cutaneous lesions were in Stage 1, 132 (37.2%) in Stage 2, and 168 (47.4%) in Stage 3 (P < 0.001). As for the HIV transmission method, the majority of patients (71%) were infected through heterosexual contact, followed by homosexual contact (16.3%), blood transfusion (3.4%), injecting drug user (2.3%), while for 7% of patients the mode of transmission was unknown. Conclusions: Early recognition of the cutaneous manifestation can help in better management of HIV infection in resource-poor setting, as it can indicate the progression of the disease and underlying immune status.

Objectives The objective of this paper is to summarize the outcomes of the Euroguidelines in Central and Eastern Europe (ECEE) conference held in Warsaw in February 2016. The main aim of this conference was to facilitate a discussion on European AIDS Clinical Society (EACS) guidelines implementation across the region and neighbouring countries and to present the current obstacles in benchmarking HIV care in Europe. Methods During a 2-day meeting, there were country-based presentations using a predefined template so as to make the data comparable and focus the discussion. Areas covered were country epidemiology, surveillance, national strategy for treatment and prevention, standards of care, access to care and treatment availability. Each participant filled in a questionnaire investigating HIV guidelines usage per country. Results In total, 16 Central and Eastern Europe (CEE) and neighbouring countries were represented at the conference: Albania, Armenia, Belarus, Croatia, Czech Republic, Estonia, Georgia, Hungary, Lithuania, Moldova, Poland, Romania, Russia, Serbia, Slovakia and Turkey. EACS guidelines version 7.1 were used in 14 (87%) countries. In 11 (69%) countries, national guidelines were available, of which eight had been recently updated. Half of the countries declared that they use World Health Organization (WHO) and Department of Health and Human Services (DHHS) guidelines, over one-third the European Centre for Disease Prevention and Control (ECDC) HIV testing guidelines and one in five the International Antiviral Society−USA (IAS-USA) Panel guidelines from 2012. Conclusions Participants declared their will to promote the widespread use of EACS guidelines for HIV infection in the CEE region and neighbouring countries by signing the Warsaw Declaration. They also emphasized the need to increase publishing of data from national cohorts in that region.

WOS: 000364000400001, PubMed ID: 26538030, Background: Tuberculous meningitis (TBM) caused by Mycobacterium tuberculosis resistant to antituberculosis drugs is an increasingly common clinical problem. This study aimed to evaluate drug resistance profiles of TBM isolates in adult patients in nine European countries involving 32 centers to provide insight into the empiric treatment of TBM. Methods: Mycobacterium tuberculosis was cultured from the cerebrospinal fluid (CSF) of 142 patients and was tested for susceptibility to first-line antituberculosis drugs, streptomycin (SM), isoniazid (INH), rifampicin (RIF) and ethambutol (EMB). Results: Twenty of 142 isolates (14.1 %) were resistant to at least one antituberculosis drug, and five (3.5 %) were resistant to at least INH and RIF, [multidrug resistant (MDR)]. The resistance rate was 12, 4.9, 4.2 and 3.5 % for INH, SM, EMB and RIF, respectively. The monoresistance rate was 6.3, 1.4 and 0.7 % for INH, SM and EMB respectively. There was no monoresistance to RIF. The mortality rate was 23.8 % in fully susceptible cases while it was 33.3 % for those exhibiting monoresistance to INH, and 40 % in cases with MDR-TBM. In compared to patients without resistance to any firstline drug, the relative risk of death for INH-monoresistance and MDR-TBM was 1.60 (95 % CI, 0.38-6.82) and 2.14 (95 % CI, 0: 34-13: 42), respectively. Conclusion: INH-resistance and MDR rates seemed not to be worrisome in our study. However, considering their adverse effects on treatment, rapid detection of resistance to at least INH and RIF would be most beneficial for designing anti-TB therapy. Still, empiric TBM treatment should be started immediately without waiting the drug susceptibility testing.

Background: Highly active antiretroviral therapy (HAART) treatments, particularly those comprising protease inhibitors have been demonstrated to cause, in a majority of HIV-infected individuals, a metabolic syndrome (lipodystrophy/lipoatrophy, dyslipidemia, type 2 diabetes mellitus, insulin resistance) that may be correlated to with an augmented risk of cardiovascular disease. A cautious division in several groups of the cardiovascular risk of HIV infected people under HAART is required as said by the most current medical principles. Aim/methods: The aim of this review is to investigate the metabolic problems of treatments used to cure HIV infection. Results: They imply that HAART-linked lipodystrophy may be the outcome of adipocyte alteration engaging changeable mixtures of apoptosis, imperfect lipogenesis, and amplified metabolic action in diverse adipose body regions. In this survey, multivariate analysis made known that, between the inspected parameters, apo C-III was the single element powerfully connected with the incidence of lipodystrophy. Conclusion: Fat relocation may lead the progress of metabolic barriers in HIV-contaminated subjects getting HAART. The strictness of these metabolic deviations enhances with rising harshness of lipodystrophy, and they are related with an elevated threat of cardiovascular incidents: around 1.4 cardiac episodes per 1000 years of treatment regarding the Framingham result. Even if several surveys have revealed that the consume of glitazones for the cure of HIV-related lipodistrophy leads to an improvement in insulin resistance, contrasting results propose that additional labor is required . DOI: 10.5901/mjss.2015.v4n1p153

Injection drug users in Tirana, Albania and St. Petersburg, Russia were recruited into a study assessing HIV-related behaviors and HIV serostatus using Respondent Driven Sampling (RDS), a peer-driven recruitment sampling strategy that results in a probability sample. (Salganik M, Heckathorn DD. Sampling and estimation in hidden populations using respondent-driven sampling. Sociol Method. 2004;34:193-239). This paper presents a comparison of RDS implementation, findings on network and recruitment characteristics, and lessons learned. Initiated with 13 to 15 seeds, approximately 200 IDUs were recruited within 8 weeks. Information resulting from RDS indicates that social network patterns from the two studies differ greatly. Female IDUs in Tirana had smaller network sizes than male IDUs, unlike in St. Petersburg where female IDUs had larger network sizes than male IDUs. Recruitment patterns in each country also differed by demographic categories. Recruitment analyses indicate that IDUs form socially distinct groups by sex in Tirana, whereas there was a greater degree of gender mixing patterns in St. Petersburg. RDS proved to be an effective means of surveying these hard-to-reach populations.

Background Crimean-Congo hemorrhagic fever (CCHF) virus causes severe disease in humans with a mortality reaching 30%. A CCHF outbreak took place in Albania in 2003. As in other viral hemorrhagic fevers cytokines may be involved and play a role in the pathogenesis and outcome of the disease. Objectives To investigate the levels of TNF-α, sTNF-R, IL-6 and IL-10 in serum samples obtained from laboratory confirmed CCHF cases and relate them to the severity of the disease. Study design A study population of 51 was divided into three groups: group A, consisting of PCR-positive cases; group B, consisting of PCR-negative and serology-positive cases; group C, consisting of doubly negative cases. Concentrations of serum TNF-α, sTNF-R, IL-6 and IL-10 were measured during the illness. Results High levels of all cytokines tested were present in one fatal case. Statistically significant differences between the groups were obtained for TNF-α and IL-6: TNF-α was detected in 3 cases in group A, and in none of the other groups, while IL-6 was elevated in 10/16 patients in group A, 4/9 in group B, and 4/26 in group C. sTNF-R was not significantly different for the three groups. High concentration of IL-10 was detected only in the fatal case. Conclusions TNF-α and IL-6 are the cytokines most often detected during a CCHF viral infection. TNF-α was associated with the severe form of CCHF, while IL-6 was elevated in both severe and mild cases.

WOS: 000353295400011, PubMed ID: 25634680, Predicting unfavorable outcome is of paramount importance in clinical decision making. Accordingly, we designed this multinational study, which provided the largest case series of tuberculous meningitis (TBM). 43 centers from 14 countries (Albania, Croatia, Denmark, Egypt, France, Hungary, Iraq, Italy, Macedonia, Romania, Serbia, Slovenia, Syria, Turkey) submitted data of microbiologically confirmed TBM patients hospitalized between 2000 and 2012. Unfavorable outcome was defined as survival with significant sequela or death. In developing our index, binary logistic regression models were constructed via 200 replicates of database by bootstrap resampling methodology. The final model was built according to the selection frequencies of variables. The severity scale included variables with arbitrary scores proportional to predictive powers of terms in the final model. The final model was internally validated by bootstrap resampling. A total of 507 patients' data were submitted among which 165 had unfavorable outcome. Eighty-six patients died while 119 had different neurological sequelae in 79 (16 %) patients. The full model included 13 variables. Age, nausea, vomiting, altered consciousness, hydrocephalus, vasculitis, immunosuppression, diabetes mellitus and neurological deficit remained in the final model. Scores 1-3 were assigned to the variables in the severity scale, which included scores of 1-6. The distribution of mortality for the scores 1-6 was 3.4, 8.2, 20.6, 31, 30 and 40.1 %, respectively. Altered consciousness, diabetes mellitus, immunosuppression, neurological deficits, hydrocephalus, and vasculitis predicted the unfavorable outcome in the scoring and the cumulative score provided a linear estimation of prognosis.

Sphingomonas paucimobilis, is a yellow-pigmented, aerobic, non-fermentative, gram negative motile bacillus. S. paucimobilis which is widely found in nature and hospital environments rarely cause serious or life threatening infections. It’s rarely isolated from clinical specimens but it is associated with a great variety of infections in both healthy and immunocompromised people. In this report we present two cases with infection due to S. paucimobilis. One of them was systemic blood stream infection and one focal infection. One was immunocompetent and the other with diabetes mellitus for more than ten years. Both of them were community acquired infection due S. Paucimibilis. These cases are reported to emphasize that S. paucimobilis should be kept in mind as a community acquired infection. We present the first cases of Sphingomonas paucimobilis in Albania one of which is a spondylodiscitis in immunocompetent patient and include updated literature concerning infections by this microorganism.

WOS: 000345825900004, PubMed ID: 24849547, We aimed to provide data on the diagnosis of tuberculous meningitis (TBM) in this largest case series ever reported. The Haydarpasa-1 study involved patients with microbiologically confirmed TBM in Albania, Croatia, Denmark, Egypt, France, Hungary, Iraq, Italy, Macedonia, Romania, Serbia, Slovenia, Syria and Turkey between 2000 and 2012. A positive culture, PCR or Ehrlich-Ziehl-Neelsen staining (EZNs) from the cerebrospinal fluid (CSF) was mandatory for inclusion of meningitis patients. A total of 506 TBM patients were included. The sensitivities of the tests were as follows: interferon- release assay (Quantiferon TB gold in tube) 90.2%, automated culture systems (ACS) 81.8%, Lowenstein Jensen medium (L-J) 72.7%, adenosine deaminase (ADA) 29.9% and EZNs 27.3%. CSF-ACS was superior to CSF L-J culture and CSF-PCR (p

Introduction: The possibility of an HIV/AIDS epidemic in southeastern Europe (SEE) is not improbable. Thus, an understanding of the current issues surrounding HIV/AIDS care, specifically antiretroviral therapy (ART) adherence, in countries within SEE is critical. This study was conducted to determine the ART adherence characteristics of Albania’s HIV-positive population. Methodology: This cross-sectional study reports initial demographic and adherence characteristics of patients receiving HIV/AIDS treatment in Albania. Retrospective review of pharmacy medications dispensed supplemented reported adherence behavior. Further, an adherence index was utilized to explore adherence more thoroughly. Results: Patient-reported adherence and pharmacy review showed adherence levels of 98.9±4.4% and 97.7±4.7%, respectively. Assessment by adherence index revealed an index level of 91.7±6.7. Factors associated with a score of < 95 on the adherence index were: being partnered (OR = 0.29, 95% CI = 0.09 – 0.98), history of depression (OR = 0.24, 95% CI = 0.08 – 0.76), increased number of barriers to care (OR = 0.80, 95% CI = 0.66 – 0.97), and increased number of current social and medical needs (OR = 0.72, 95% CI = 0.58 – 0.91). Conclusions: Interventions aimed at reducing barriers to care, addressing current medical and social needs, and treating mental health issues may help improve adherence to ART in patients with HIV/AIDS in Albania. With little known about HIV/AIDS in SEE, this study provides guidance on how SEE countries can help prevent a possible rise in the prevalence of HIV given the close link of ART adherence and spread of HIV.

Due to the ease of cross-continent spread of infectious diseases, the 2009 influenza AH1N1 (H1N1) affected many countries. This observational prospective study looked at Albanian patients admitted with 2009 H1N1 at the ICU of the Department of Infectious Diseases at the University Hospital Center of Tirana, from November 2009 to March 2010. Demographic data, symptoms, comorbidities, and clinical outcomes were collected from each patient. The number of days spent in the ICU was recorded for each patient along with their radiological and laboratory findings, and outcome at discharge. Critical illness occurred in 31 patients admitted with confirmed 2009 H1N1. The median age of patients was 35 years. Five (16.1%) patients required endotracheal intubation; noninvasive oxygen therapy (NIV) was used in 15 (48.4%) patients via nasal tube; and continuous positive airway pressure (CPAP) and pressure support ventilation (PSV) oxygen masks were used in 11 (35.5%) patients. All patients were treated with oseltamivir. Four patients admitted and treated did not survive. Critical illness in the setting of 2009 H1N1 admitted in the ICU predominantly affected young adults. NIV could play a role in treating 2009 influenza H1N1 infection-related hypoxemic respiratory failure that was associated with severe hypoxemia, pneumonia, requirement for prolonged mechanical ventilation, and the frequent use of antiviral therapy.

Though the HIV/AIDS epidemic in Southeastern Europe is one of low reported prevalence, numerous studies have described the pervasiveness of medical providers' lack of knowledge of HIV/AIDS in the Balkans. This study sought to culturally adapt an instrument to assess medical providers' knowledge of and attitudes towards HIV/AIDS in Albania. Cultural adaptation was completed through development of a survey from previously validated instruments, translation of the survey into Albanian, blinded back translation, expert committee review of the draft instrument, focus group pre-testing with community- and University Hospital Center of Tirana-based physicians and nurses, and test-retest reliability testing. Blinded back translation of the instrument supported the initial translation with slight changes to the idiomatic and conceptual equivalences. Focus group pre-testing generally supported the instrument, yet some experiential and idiomatic changes were implemented. Based on unweighted kappa and/or prevalence adjusted bias adjusted kappa (PABAK), 20 of the 43 questions were deemed statistically significant at kappa and/or PABAK ≥0.5, while 12 others did not cross zero on the 95% confidence interval for kappa, indicating their probable significance. Subsequently, an instrument to assess medical providers' knowledge of and attitudes toward HIV/AIDS for an Albanian population was developed which can be expanded within Albania and potentially to other countries within the Balkans, which have an Albanian-speaking population.

During the spring and summer of 2001, an outbreak of eight cases of Crimean-Congo hemorrhagic fever (CCHF) occurred in Albania. The epidemiological investigation, the clinical presentation of the cases, and the course of the disease are described. Seven of the cases were laboratory confirmed. A nosocomial infection and a cluster of cases within a family were observed. Genetic analysis of the CCHF virus strain that caused the outbreak showed that it was clustered together with other European CCHF virus strains except the Greek one (strain AP92). The Greek strain, which forms an independent clade, differed from the causative strain by 25.3% at the nucleotide level.

Introduction: Acinetobacter baumannii is a causative agent of nosocomial infections; it is very difficult to identify and treat, which is a good explanation for its high lethality. Aim: To introduce the case of a patient with infective endocarditis of a prosthetic mitral valve caused by Acinetobacter baumannii, who survived this infection. The patient is a 65-year-old female. She came to the emergency room on April 10, 2012 with high fever, chills, dyspnea and clinical features of encephalopathy. Her anamnesis showed a surgical intervention of the mitral and aortic valves, one month ago. TEE revealed small hypoechogenic vegetations in the mitral valve. Three weeks after the hospitalization, the patient underwent another intervention, which consisted of another replacement of the mitral and aortic valves. The blood cultures were negative, while the cultures of the valves evidenced the growth of Acinetobacter baumannii. The bacteria was resistant to ampicillin, augmentin and imipenem. The patient was treated with imipenem in the beginning, but after the antibiogram she was treated with more effective antibiotics, such as piperacillin– tazobactam and ciprofloxacin. The patient had good response to this treatment (temperature normalized after 7 days, and TTE showed no verrucas after 6 weeks of therapy). The patient is presently in good condition according to periodic clinical and imaging follow up.

To the Editor: Crimean-Congo hemorrhagic fever (CCHF) is a severe viral disease transmitted to humans by tick bite or contact with blood, excreta, or tissues of infected patients or livestock. The disease is endemic in many African, Asian, and European countries. Sporadic cases or outbreaks have been observed in the Balkan Peninsula (1–5). Prompt diagnosis of the disease is essential for preventing human-to-human transmission. Reverse transcription–PCR (RT-PCR) is the detection method of choice in first days of illness and in severe cases with no antibody production. In recent years, real-time RT-PCR approaches have been described for detection and quantification of CCHF virus (6–8). However, no information is available on viral RNA concentration in patients. We describe a real-time RT-PCR for detection and quantification of CCHF virus, present the results of its use with clinical samples, and report the relationship between viral load and severity and outcome of CCHF. We tested 29 serum samples from Albanian patients with suspected CCHF or their contacts who were living in a CCHF-endemic area of Albania. Serum samples were collected during 2003–2006 and categorized into 3 groups. Group A contained samples from 11 patients with CCHF confirmed by a conventional RT-nested PCR (9). Group B contained samples from 5 patients who had negative RT-nested PCR results and positive serologic results. Group C contained samples from 15 persons who were from the same region as the CCHF patients but who did not have any clinical symptoms of CCHF and had negative PCR or serologic results. One set of primers and 1 probe were designed to amplify an 84-bp genome region of the S RNA segment of CCHF virus on the basis of European sequences (Balkan and Russian strains available in GenBank): primers CCEuS 5′-TGACAGCATTTCTTTAACAGACATCA-3′ and CCEuAs 5′-AAACACGGCAGCCTTAAGCA-3′, and probe 5′-TCGCCAGGGACTTTATATTCTGCAAGG-3′. A 25-μL reaction was conducted in a LightCycler (Roche, Indianapolis, IN, USA) with 10 mmol/L of each deoxynucleotide triphosphate, 600 nmol/L of each primer, 200 nmol/L of probe, and 3 μL of RNA. Cycling conditions were 50°C for 30 min and 95°C for 15 min, followed by 45 cycles at 95°C for 15 s and 58°C for 30 s. A quantification curve was constructed with 10-fold serial dilutions of in vitro–transcribed CCHF virus RNA. Positive results were obtained up to a dilution of 10−12, which corresponds to ≈45 virus genome equivalents (geqs) per reaction. Twelve samples had positive results: all 11 samples in group A and 1 in group B (Table). Results for the remaining samples in groups B and C were negative. Levels of tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), IL-10, and a 60-kDa soluble receptor of TNF were previously measured in most of the samples in this study (10), and their values are shown in the Table. Table Epidemiologic, molecular, and clinical data for 12 Albanian patients with suspected Crimean-Congo hemorrhagic fever, 2003–2006* Viral loads ranged from 14 × 106 to 28.99 × 106 geqs/reaction. The highest level was observed in the patient who died (23/03). High loads were observed in all primary case-patients (23/03, 82/03, 178/04, 252/06) except for patient 154/04, from whom a sample was obtained 18 days after onset of disease. All primary case-patients had severe disease with high fever and clinically apparent hemorrhage. All secondary case-patients, except patient 34/03, were contacts of the patient who died (24b/03, husband; 25b/03, brother-in-law; 50/03 and 52/03, cousins; 56/03, sister-in-law; 40/03, son of sister) and had symptoms of disease ≈1 week after the death of patient 23/03. Viral load of secondary case-patients was