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Urinary tract infection is one of the most common infections in clinical practice and represents a frequent reason why patients present to the general practitioner. Empirical antibiotic treatment could solve a part of the uncomplicated infections, but it is necessary to also consider its negative effects, such as increasing the antimicrobial resistance and the number of recurrent infections. Moreover, different prophylactic techniques proved to be useful and have good results, which supports their use. [ABSTRACT FROM AUTHOR]

Infectious diseases can develop severe complications or even death, therefore introducing vaccination can be considered one of the most important medical breakthroughs. Immunization programs considerably decreased morbidity and mortality due to infectious diseases, especially in children. Among the diseases that significantly affected the population were included measles, mumps and rubella. Measles is particularly serious because of the complications it can cause both on short and long term. Mumps is severe because it can evolve with meningitis and to measles particular attention should be paid, not only because of its frequent complications, but also because of the manifestations in pregnant women (congenital rubella). Lately, the vaccine coverage has decreased, and in order to remediate this, a very important role is attributed to the health professionals. [ABSTRACT FROM AUTHOR]

The production of carbapenemases is one of the most important mechanisms that lead to carbapenem resistance. At the same time, the carbapenemases present on extracromosomial genetic material (plasmids) are transmitted between various bacteria. Although the genes Klebsiella, Enterobacter and Escherichia are most commonly involved in infections, the identification of carbapenemases in other genes may be very important for controlling infections. In this article, we will review a recent study published in the Morbidity and Mortality Weekly Report, which evaluated the production of carbapenemases in enterobacteria belonging to genes less commonly involved in clinical practice. All strains of enterobacteria transmitted to the Center for Disease Control (CDC) in Atlanta and the Public Health Laboratory of the Minnesota Health Department (MDH) from 1 January 2014 to 30 September 2017 were screened for the identification of five carbapenemases (KPC, NDM, OXA-48, IMP, and VIM). Among these, the results for the genera Klebsiella, Enterobacter and Escherichia were excluded. CDC received 1039 EPC-RC isolates during the study, of which 63 (6.1%) of the infrequently identified genera. Over the same period, 149 (12%) of the 1241 CREs were producing carbapenemases. Although in small numbers, isolates from more infrequent genera of enterobacteria that produce carbapenemases may be an important reservoir for dissemination to other bacteria. Additionally, we will add suggestions for current, cost-effective methodological solutions that can improve the knowledge of carbapenemase production in our country. [ABSTRACT FROM AUTHOR]

Globally, more than 50% of HIV infected people are women. HIV infection in women has its particularities, especially because of pregnancy and because of the adverse effects of antiretroviral therapy. Heterosexual contact is the most frequent way of HIV transmission in women. Some gynecological infections like vaginal candidiasis seem to be more persistent and more severe as compared to uninfected female patients. Also, HIV infected women have a higher risk for cervical dysplasia and cancer as compared to uninfected women. The risk of mother-to-child transmission of the virus has dropped significantly in the last decades because of the implementation of routine HIV screening testing in pregnancy, counseling regarding prevention and the large access to antiretroviral treatment. Today, because of the diversity of the therapeutic options and using good prophylactic measures, HIV infected women can have a normal life. [ABSTRACT FROM AUTHOR]

One of the main concerns of the medical community during the COVID-19 pandemic has been the management of the immunosuppression accompanying the disease, particularly in ICU (Intensive Care Unit) patients. More recently, the focus has shifted towards the management of the persistent immunosuppression post-acute COVID-19 and its complications. The rate of healthcare-associated infections (HAIs) had been declining before the pandemic, but has since started to increase once more. Due to multiple factors - unnecessary antibiotherapy, disorganized medical facilities, inadequate personal protection equipment etc. - there have been increasing reports of coinfections and secondary infections with multidrug-resistant bacteria in COVID-19 patients. We present a case report of a patient with no history of clinically overt immunosuppression before developing critical SARS-CoV-2 pneumonia. The patient had no need for antibiotic treatment during his hospitalization and was discharged in a stable state, being consequently readmitted multiple times for different healthcare-associated multidrug-resistant infections, over time developing other hospital-related complications. The case raises a discussion about the bidirectional relationship between post-COVID immunosuppression and the possible inadvertent excess in antibiotic therapy that has accompanied the pandemic. [ABSTRACT FROM AUTHOR]

Food poisoning outbreaks comprise a large group of diseases that occur sporadically or epidemic, caused by ingestions of contaminated food with pathogenic microorganisms and / or their toxins. Staphylococcal food poisoning are caused by ingestion of preformed enterotoxins in foods by certain strains of staphylococci, most commonly Staphylococcus aureus and represent one of the most common forms of food toxinosis. In Romania, Staphylococcus aureus ranks second after Salmonella spp., in the etiology of food poisoning, the real incidence of this disease being statistically underestimated. Staphylococcal food poisoning history begins many years before, the first descriptions of diseases, with epidemic episodes arising from the consumption of food, dating from 1860-1880 period. Microorganisms or preformed toxins represents a special threat to public health due to their pathogenicity, facility to spread and their potential as bioterrorism agents. Public health system has a critical role in preventing and controlling food poisoning outbreaks. This involves an active surveillance both locally and nationally, which requires a close collaboration between clinicians, epidemiologists and laboratory physicians [ABSTRACT FROM AUTHOR]

The number of pulmonary and extrapulmonary infections due to nontubercuious mycobacteria (NTM) is increasing worldwide in the immunocompromised patients and immunocompetents ones. Treatment decisions taken by the clinicians depends by the clinical symptomatology at presentation, Rx chest radiography and isolation of NTM by the laboratory. The differentiation between NTM and M. tuberculosis complex (MTC) depend also on mycobacterioiogy laboratory. The management of infections due to NTM include antibiotic therapy, surgical resection or only observation and must be done for a relatively long period of time. [ABSTRACT FROM AUTHOR]

SARS-CoV-2 infection increases the risk of multi-organ systemic complications and venous and arterial thromboembolism. The development of vaccines has proven to be an effective method to combat severe forms of infection. Adverse effects reported after COVID-19 vaccination consisted of local injection site reaction, fatigue, myalgia, or fever as well as sporadic cases of vaccine-induced thrombotic immune thrombocytopenia, especially viral vector vaccines. Objectives: The aim of the study was to evaluate the repeated dose toxicity of a candidate vaccine against SARS- CoV-2, a test in which several parameters were analyzed, including coagulation factors. Materials and methods: The test included 120 rats, of both sexes, divided into six groups (main group, recovery group and control group) at which the human dose, 10X human dose and 1 control adjuvant were tested. The vaccine was administered intranasally, 4 times every two weeks. The final day was after the last administration to the main group and another 30 days from the last administration to the recovery group. On day 0 and the final day, blood was collected for hematological, biochemical, immunological examinations and coagulation tests (Fibrinogen, Prothrombin Time-PT, Activated Partial Thromboplastin Time-aPTT and Thrombin Time-TT). Results: Fibrinogen, in the case of all groups, increased on the final day, except for females from the recovery groups where this parameter decreased by 25%. PT, aPTT and TT, regardless of group or sex, had low values compared to the initial time of the study. On day 0, the values of the coagulation factors were homogeneous, the fibrinogen being between 155- 347mg / dL, PT 25.5-57.8 sec, aPTT 61.9-120 sec and TT values of 53-60 sec. On the final day, the group analysis also showed unit values. Fibrinogen increased between 90-116%, PT decreased by 48-71%, aPTT decreased by 59-80%, and TT had values lower by 10-14% compared to the initial day. Conclusions: Increased fibrinogen associated with decreased PT and aPTT is common in human clinical pathology. Fibrinogen, PT, aPTT and TT are the standard parameters of blood clotting assessed in toxicity tests. The results obtained in the study represent a preliminary phase which, corroborated with the results of the other tests, supports the conclusion that the candidate vaccine does not have toxicological potential, the coagulation factors not being influenced after its repeated administration. [ABSTRACT FROM AUTHOR]

Staphylococcus aureus, one of the most important human pathogens, secretes an impressive number of virulence factors that may cause a range of community or nosocomial infections with varying severity as well as toxinoses. The main function of the toxins is to inhibit the host immune response against S. aureus, but each toxin exerts specific biological functions, responsible for particular manifestations. So far there have been identified over 20 staphylococcal enterotoxins that are part of the superantigens family. Staphylococcal enterotoxin B, the most intensively studied of these, is involved frequently in the production of food poisoning. Staphylococcal enterotoxin B is part of the group B of bioterrorism agents classified by CDC (Centers for Disease Control and Prevention), being easily to spread and difficult to diagnose/identify in the initial stages. [ABSTRACT FROM AUTHOR]

Patients with diabetic ulcers of the lower limbs may suffer from infectious complications and due to this damage, the result may lead to amputation or death. Providing proper care, on several levels, for the diabetic foot is an effective measure to decrease the rates of amputation, which have unfavorable economic and social outcomes. Through screening, the prevention can be achieved. Moreover, an early diagnosis based on the evaluation of risk factors can lead to a prompt treatment, suppressing therefore the progression of the lesions. [ABSTRACT FROM AUTHOR]

Hypertension represents a risk factor for the cardiovascular diseases. Depending on the presence of a known etiology, hypertension is essential or secondary. In case of essential hypertension, lately there have been proposed several theories, such as genetic predisposition, lifestyle, and infectious etiology. The pathogens most commonly studied are Chlamydia pneumoniae, Cytomegalovirus, Helicobacter pylori and hepatitis A. Through endothelial dysfunction, molecular mimicry, the activation of renin-angiotensin-aldosterone system or some secreted substances, germs manage to induce changes, which may contribute to the onset of hypertension. Therefore prevention and proper treatment of infections may decrease the risk of developing cardiovascular diseases including hypertension. Correct treatment of hypertension involves, besides non-pharmacological and drug therapy, the identification of potential modifiable causes, such as renal artery fibromuscular dysplasia, pheochromocytoma, coarctation of the aorta and others. [ABSTRACT FROM AUTHOR]

Uncontrolled growth of multidrug-resistant pathogens becomes an important public health problem, due to their ability to develop life-threatening disease. The decrease in the number of newly discovered antibiotics is an incentive for prioritizing the introduction of new agents into modern medical practice. The history of bacteriophages dates back 100 years, when they were discovered by Frederick Twort; subsequently they were used worldwide until the introduction of antibiotics. Later, they continued to be used by the former Soviet Union countries. The chapter on bacteriophages reopens nowadays because of their long term applicability in some countries and the new interest manifested by the USA and Western Europe, having the potential to become a rescue therapy for patients with limited therapeutic options. [ABSTRACT FROM AUTHOR]

Hidradenitis suppurativa (HS) is a chronic inflammatory disease affecting intertriginous skin areas of young adults. Although HS was historically defined as an infectious disease, the role of microorganisms in its pathogenesis is now controversial. We investigated the lesion microbiota of a recently diagnosed 24-year-old male patient with axillary HS, who shared features of the metabolic syndrome. The microbiological analysis of the patient's lesion was indicative of colonization with bacteria including aerobes - Staphylococcus (S.) aureus, S. lugdunensis, S. epidermidis, anaerobes - Anaerococcus (A.) octavius, and microaerophiles - Cutibacterium (C.) acnes; this last one was also isolated in monoculture from a patient's healthy skin control sample. In vitro antibiotic susceptibility evaluation revealed Methicillin-resistant S. aureus (MRSA) and highly susceptible S. lugdunensis and S. epidermidis. Profiles of A. octavius and C. acnes showed that both strains were susceptible to Vancomycin, Clindamycin, Doxycycline and Linezolid; the anaerobe was Benzylpenicillin-resistant and Tetracycline and the microaerophile was intrinsically Metronidazole-resistant. We conclude that the intralesional microbial diversity in this case shows low variety of species and similarities to healthy skin microbiota, although the presence of S. aureus, particularly MRSA, S. lugdunensis or C. acnes - frequently involved in chronic skin pathologies - may be relevant for the disease severity. MRSA carriage in the patient's lesion represents a significant epidemiological risk for the healthcare environment. Antibiotic treatment in the early stages of HS should be administered with caution. Extended studies of HS microbiota could identify relevant colonization patterns for the outcome of the disease and offer important keys for selecting personalised, efficient therapeutic schemes. [ABSTRACT FROM AUTHOR]

Objectives: Detection of carbapenemase-producing Enterobacterales (CPEs) is sometimes difficult with AmpC-hyperproducing Enterobacterales (AHEs), as they may falsely be classified as CPEs. Here, we present a rapid Carbapenem Inactivation Method (rCIM) optimized for AmpC producers (rCIM-A) that allows rapid and easy discrimination between AHEs and CPEs.Methods: Enterobacterales (n = 249), including natural AmpC producers, AHEs, CPEs and non-carbapenemase-producing carbapenem-resistant control strains were evaluated, using Carba NP, rCIM and rCIM-A. The rCIM-A differs from the rCIM by the addition of cloxacillin (400 μg/mL) to the initial antibiotic incubation step.Results: The rCIM-A yielded a sensitivity and specificity of 84.26% (95% CI: 76.00%-90.55%) and 99.29% (95% CI: 96.11%-99.98%), respectively, while those of the rCIM were 86.11% (95% CI: 78.13%-92.01%) and 80.85% (95% CI: 73.38%-86.99%), respectively; those of Carba NP were lower at 84.04% (95% CI: 75.05%-90.78%) and 91.37% (95% CI: 85.41%-95.46%), respectively, due to indeterminate results. The rCIM-A was capable of discriminating between AHEs and true CPEs, but still failed to identify OXA-23-producing Proteus mirabilis isolates and remained only partially reliable for identifying IMI-like producers and a few MBL (2 NDM-1, 1 LMB-1, 1 TMB-1 and 1 IMP-13) producers. One chromosomally encoded AmpC variant, MIR-10, gave repeatedly positive results using all three tests and was thus considered a false positive.Conclusions: Specificity for AHEs greatly improved with the rCIM-A without altering the test performance for the other resistance mechanisms. It may replace the rCIM as a cheap, easy, rapid and accurate CPE detection test. [ABSTRACT FROM AUTHOR]

Antibiotic resistance is a growing phenomenon and a cause of global concern due to the widespread use and misuse of antibiotics in humans and animals. The main goal of this study is the identification of risk factors for infection with resistant bacteria. Materials and methods. A number of 61 patients were enrolled in this study and their charts were analyzed regarding their history of chronic disease, immunosuppression or prior antibiotic use. Results. Odds ratio for each potential risk factor was analyzed and the values of p and confidence interval were calculated using Fisher's t test. Discussions. Prior antibiotic use appears to be a risk factor for both resistant and multi-drug resistant bacteria infection, a finding which is in concordance with existing literature and fundamental research. [ABSTRACT FROM AUTHOR]

Recent research has highlighted the role of oxidative stress in the pathogenesis of HPV-related lesions, especially in neoplastic diseases. Oxidative stress and chronic inflammation are the most important cofactors that HPV requires to persist and induce a malignant process. Data on the role of oxidative stress in benign lesions associated with HPV infection, such as genital and non-genital warts, is scarce and further research is needed. We have determined markers of oxidative stress in the serum of 26 patients with palmoplantar warts and 28 healthy subjects. We have investigated representative markers for the four main molecular targets of oxidative stress, nucleic acids - 8-hydroxy-2'-deoxyguanosine (8-OHdG), lipids - 4-hydroxynonenal (4-HNE), carbohydrates - pentosidine, and proteins - thiol-disulfide homeostasis parameters (TDHP): total thiol (TT), native thiol (NT), and disulfides (DS). The serum levels of oxidative stress markers, 4-HNE, 8-OHdG, and pentosidine, were statistically significantly higher in patients with warts in comparison to the control group (p < 0.01). Regarding TDHP, we have found that TT levels were statistically significantly higher in the patient group compared to the control one (p < 0.05). Even though NT and DS levels were reported to be higher in the patient group compared to the control one, no statistical significance was established (p > 0.05). Our results show enhanced oxidative stress damage in patients with palmoplantar warts and provide valuable data in understanding the molecular mechanisms involved in the pathogenesis of HPV infection. To the best of our knowledge, this is the first study to evaluate both 4-HNE and pentosidine in patients with palmoplantar warts. [ABSTRACT FROM AUTHOR]

Chronic infections represent an important burden on the healthcare system and have a significant impact on the patients' quality of life. While Staphylococcus spp. are commensal bacteria, they can become pathogenic, leading to various types of infections. In this study we aimed to characterize the virulence profiles of staphylococcal strains involved in difficult-to-treat skin and soft tissue infections, from both phenotypic and genotypic points of view. Phenotypic ability of the strains to secrete soluble virulence factors was assessed by a culturing dependent assay and their capacity to develop biofilms on inert substrate was screened by an adapted crystal violet microtiter method. We also tested the presence of several virulence genes by PCR. Most of the studied strains were isolated from purulent secretions of acne lesions and frequently secreted two or three soluble virulence factors. Most frequently secreted soluble virulence factors were caseinase (89%), lipase (71%) and lecithinase (67%). Almost half of the strains produced a well-represented biofilm. The molecular characterization showed the presence of the genes cna, hlg, clfA, and clfB. Staphylococcal strains that produce difficult-to-treat skin and soft tissue infections seem to be characterized by an enhanced ability to produce different soluble virulence factors and to develop biofilms in vitro. Further studies need to be developed in other Staphylococcus spp. infections in order to confirm this hypothesis. [ABSTRACT FROM AUTHOR]

Background: The present study aims the characterization of antibiotic resistance phenotypes and encoding genes in bacterial strains isolated from some Romanian aquatic fishery lowland salted lakes. Material/Methods: This study was conducted on 44 bacterial strains, mainly belonging to species used as microbiological indicators of fecal pollution isolated from four natural fishery lakes. All strains were tested for their antibiotic susceptibility by disk diffusion method. Simplex and multiplex PCR were performed to identify the β-lactams antibiotic resistance genes (blaNMD, blaOXA−48, blaVIM, blaIMP, blaCTX−M, blaTEM), sulfonamides (Sul1, Sul2), tetracyclines (TetA, TetB, TetC, TetD, TetM), aminoglycosides (aac3Ia), vancomycin (VanA, VanB, VanC), macrolides (ermA, ermB, ermC) as well as the plasmid-mediated quinolone resistance (PMQR) markers (QnrA, QnrB, QnrS), and class 1 integrons (Int1, drfA1-aadA1). Results: The Enterococcus spp. isolates exhibited phenotypic resistance to vancomycin (35 %) and macrolides (erythromycin) (75 %); from the vancomycin – resistant strains, 5 % harboured VanA (E. faecalis), while the erythromycin resistant isolates were positive for the ermA gene (E. faecalis − 10 %, E. faecium − 5 %). The Gram- negative rods (GNR) exhibited a high level of resistance to β-lactams: cefuroxime (63 %), cefazolin (42 %), ceftriaxone (8 %), ceftazidime and aztreonam (4 % each). The genetic determinants for beta-lactam resistance were represented by blaCTX−M−like (33 %), blaNDM−like and blaIMP−like (8.33 %) genes. The resistance to non-β-lactam antibiotics was ascertained to the following genes: quinolones (QnrS − 4.16 %); sulfonamides (Sul1–75 %, Sul2–4.16 %); aminoglycosides (aac3Ia − 4.16 %); tetracyclines (tetA – 25 %, tetC − 15 %). The integrase gene was found in more than 50 % of the studied strains (58.33 %). Conclusions: The cultivable aquatic microbiota from fishery lakes is dominated by enterococci and Enterobacterales strains. The GNR strains exhibited high levels of β-lactam resistance mediated by extended spectrum beta-lactamases and metallo-β-lactamases. The Enterococcus sp. isolates were highly resistant to macrolides and vancomycin. The high level and diversity of resistance markers, correlated with a high frequency of integrons is suggesting that this environment could act as an important reservoir of antibiotic resistance genes with a great probability to be horizontally transmitted to other associated species from the aquatic sediments microbiota, raising the potential zoonotic risk for fish consumers. [ABSTRACT FROM AUTHOR]

In Romania, cervical cancer is the second most frequent neoplasm among women of 15 to 44 years of age, mainly due to a lack of prevention efforts. The purpose of this study is to assess the current knowledge and attitude towards HPV infection and immunization among medical students. Such information is vital in order to properly assess the current shortcomings of our medical system in the struggle of lowering cancer incidence. A cross-sectional questionnaire-based study was carried out in 2016 and in 2018 on a total of 1,133 participants (median age of 21.9 years, 572 students in 2016 and 562 in 2018). No statistical differences between males and females regarding knowledge of HPV vaccine were found (chi-square 0.046, df = 1, p = 0.83). Moreover, between the 2016 and the 2018 groups, no noticeable changes in HPV awareness and information were observed (2016: chi-square: 0.003, df = 1, p = 0.955; and 2018: chi-square: 0.061, df = 1, p = 0.805). Even though the participants have noted reliable media and medical staff as their main sources of information, our study revealed poor general knowledge, no improvement in perception, and a lack of prophylactic action. [ABSTRACT FROM AUTHOR]

In the context of SARS-CoV-2 infection, the identification of a vaccine has become vital for stopping the pandemic. The consortium formed by the OncoGen Center and the Cantacuzino Institute (CI) evaluates a candidate vaccine whose vaccine component is represented by a combination of peptides specifically recognized by the 2 components of the adaptative immune system. Each new vaccine must undergo mandatory tests, even if they are currently accelerated or overlapping, with the consent of the European Medicines Agency (EMA). One of the tests relates to repeated dose toxicity. The aim was to setup a protocol for repeated dose toxicity testing in rats, the results of which would allow the transition to the clinical phase I dossier. The protocol was designed based on EMA guidelines for vaccine safety testing and rat-human translation. The proposed human dose, route of administration and repeat administration were taken into account. Clinical signs, immunological and biochemical parameters will be analysed. Histological examination will be performed on 34 organs. The protocol was approved by the ethics committee of the CI and authorized by the competent authority. In order to evaluate the repeated dose toxicity of a vaccine candidate against COVID-19, we propose a robust, replicable, effective and translational study protocol. [ABSTRACT FROM AUTHOR]

Introduction: It is estimated that one in five pregnant women is affected by depression and the consequences of undiagnosed and unaddressed depression are detrimental for the future mother, her baby and ultimately the entire family unit [1]. Hepatitis B virus (HVB) infection is one of the TORCH infections (toxoplasmosis, other -HVB, etc., rubella, cytomegalovirus, herpes viruses), known as major contributors to prenatal infantile mortality and morbidity [2]. Case report: We report the case of a pregnant woman with multiple risk factors for depression, who was diagnosed during pregnancy with chronic HBV infection. Her personal background cumulated with her psychosocial situation led to severe depression late in the pregnancy which was recognised and addressed by the medical team involved in her care. Depression in pregnancy is reported to be associated with a risk for premature birth, intrauterine growth restriction and non-optimal neuromotor development; hence a new diagnosis of an infection associated with possible foetal complications was likely the last factor added to already a fragile psychic. The newborn had intrauterine growth restriction and received appropriate prophylactic measures to prevent HBV infection. The authors would like to emphasize that the role of the medical team involved in the care of pregnant women should not limit to delivering a healthy baby but the team should look into mother's psychological health as early recognition of depression impact the course of both medical and emotional health of the entire family. Furthermore, the authors are taking the opportunity to raise awareness among medical professionals in regard to the possible outcomes of a new diagnosis of infection in pregnancy on the psychological status of the pregnant woman. [ABSTRACT FROM AUTHOR]

Lately, the microbiome has received increasing attention, being a research theme frequently addressed in multiple studies. Through the new techniques and establishment of novel protocols, especially in the field of molecular biology, together with the results from in vitro, in vivo preclinical and clinical studies carried out on an impressive number of patients with various pathologies, scientists have established ample associations between the microbiome composition and certain cancers or the treatment response. In some types of cancer, the role of microorganisms has been incriminated, which by their presence can activate certain signaling pathways or produce some metabolites that ultimately affect the cellular functioning. For some microorganisms such as Fusobacterium nucleatum or toxigenic Bacteroides fragilis in colorectal cancer, the possible mechanisms of action have been already described. Despite this fact, numerous studies are still needed in order to determine whether bacterial presence triggers the neoplastic process or the gut microbial abundance in affected patients is the result of other changes taking place. The identification of specific microorganisms in people from high-risk groups, those with early stage or advanced/metastatic cancer or the ones with inadequate response to treatment, could represent the beginning of a novel approach in the field of cancer prevention, diagnosis and therapy. [ABSTRACT FROM AUTHOR]

Mother-to-child transmission of viral blood bome diseases (BBD) may be prevented with efficient measures of prophylaxis. Some of the most frequent viruses involved in mother-to-child transmission are HBV, HIV and HCV. Our main objectives were to assess the mother-to-child transmission of BBD - HBV, HCV and HIV, to evaluate the risk factors associated with these viruses transmission in a hospital from Romania, especially in childbearing women diagnosed at the moment of birth, along with defining the importance of midwives. We conducted a retrospective, descriptive study, from January 2017 to December 2018 at a District Hospital for Obstetric Gynecology in Romania. A total of 7,020 childbearing women were monitored. Only 73 childbearing women presented BBD (61 HBV infections, 7 HCV infections and 5 HIV infections). Mother-to-child transmission rate of BBD was 12.32% (N=9 newborns) and the most frequent BBD transmitted to newborns was HIV infection. There were no cases of HBV mother-to-child transmission. The most important risk factors for transmission of abovementioned viral infections were found to be episiotomy, cervical rupture and early membrane rupture. There is a need for joint effort of all healthcare providers including the midwives in order to improve the control of BBD transmission from pregnant women to their newborns. [ABSTRACT FROM AUTHOR]

Spondyloarthritis (SpA) is a group of associated chronic systemic inflammatory immune-mediated rheumatic diseases affecting axial and peripheral joints and entheses. The aim of the present study was to identify what parameters are useful to determine in order to better understand the correlation between the disease activity/severity and the microbiological results/immune status against intestinal and/or urogenital pathogens. Microorganisms known to trigger SpA, including Klebsiella spp., Yersinia spp., Salmonella spp., Campylobacter spp. and Chlamydia spp., were analyzed in various specimens (stool, urine, synovial fluid and serum) collected from 27 randomly selected SpA patients and 26 healthy controls using a combined direct and indirect approach relying on conventional culture technique and nucleic acid-based assays together with serological testing by ELISA. Although Escherichia coli derived from phylogroup A prevailed in the gut microflora of the patients and controls, differences were observed regarding the representatives of the other phylogroups with a higher prevalence of E.coli members of phylogenetic group B1 in the stool specimens of patients. Antibodies against the targeted species were detected in SpA patients and controls, and the serological profiles of the former were more diverse and complex. In conclusion, the detection of anti-bacterial antibodies combined with other specific laboratory investigations should be more extensively used to monitor SpA patients in association with their symptoms and in order to determine and administer more effective therapeutics. [ABSTRACT FROM AUTHOR]

Lichen planus (LP) is an immune-mediated inflammatory disease that particularly affects the skin and mucous membranes. Its etiology remains elusive, however some trigger factors, including viral or bacterial antigens, drugs and metals, have been postulated. There is a higher prevalence of hepatitis C virus (HCV) infection among patients with LP, with some geographical variations. HCV is an enveloped RNA virus that belongs to the Flaviviridae family and in most instances causes chronic liver infections. It has been hypothesized that HCV may contribute to LP development, but the link between the two disorders is not fully understood. It is still debatable whether HCV leads to the occurrence of LP lesions directly by replication inside the infected cells or indirectly by activating immunological pathways. Molecular studies have revealed HCV RNA in specimens collected from patients with LP. The autoimmune theory was also suggested given that several studies have revealed viral replication and immune response activation associated with autoantibody synthesis. The aim of this review is to summarize the main potential mechanisms involved in the association between LP and HCV infection. Understanding the link between the two disorders may shed some light on the pathogenesis of LP, which is a challenging issue. [ABSTRACT FROM AUTHOR]

Oral squamous cell carcinoma (OSCC) is the most common tumour of the oral cavity, associated with significant morbidity and mortality. It is a multifactorial condition, both genetic and environmental factors being involved in its development and progression. Its pathogenesis is not fully elucidated, but a pivotal role has been attributed to inflammation, strong evidence supporting the association between chronic inflammation and carcinogenesis. Moreover, an increasing number of studies have investigated the role of different mediators of inflammation in the early detection of OSCC. In this review, we have summarized the main markers of inflammation that could be useful in diagnosis and shed some light in OSCC pathogenesis. [ABSTRACT FROM AUTHOR]

Despite significant advances in antiretroviral treatment (ARV) and HIV infection prevention, about 400 children worldwide are still diagnosed daily with HIV infection, most cases due to perinatal transmission. It is estimated that the knowledge and rigorous application of prophylactic measures to reduce the vertical transmission of infection would significantly reduce this risk to less than 1%. We report the case of a 5 months old infant coming from a pregnancy with HIV risk and multiple risk factors for transmission of the vertical infection, who did not receive postnatal testing and treatment. The diagnosis was established during infancy, falling into the AIDS stage by cytomegalovirus (CMV) disease with retinal sequelae occlusion. ARV treatment was initiated late, but from the moment of diagnosis, requiring further changes due to drug interactions, lack of availability and resistance to TARV. Although the patient’s progression was marked by severe comorbidities: sequelae of CMV disease, mixed HIV and CMV encephalopathy, pulmonary tuberculosis, repetitive respiratory and digestive opportunistic infections, the evolution of immunological parameters was slowly favorable under treatment. Proper implementation of prophylactic measures in the newborn and the pregnant woman could have significantly reduced the risk of HIV transmission to the patient, with a high probability that she would not have been infected. The case reported reflects the failure of strategies to prevent HIV / AIDS infection in pregnant women and newborns; conclusions must be drawn to avoid similar situations. [ABSTRACT FROM AUTHOR]

Human immunodeficiency virus (HIV) infection continues to be an important public health issue. Immunosuppression is responsible for the development of much comorbidity among HIV-infected patients. Of these, malignancies play an important role in the prognosis of the disease. Cancers diagnosed in HIV-infected patients can be divided into two main categories: AIDS-defining cancers and non-AIDS-defining cancers. In the second category, skin cancers represent an important subgroup, the most common being basal cell carcinoma, squamous cell carcinoma and melanoma. [ABSTRACT FROM AUTHOR]

Human papillomavirus (HPV) is a small double-stranded DNA virus with tropism for epithelial cells. To this date, over 150 genotypes are known and are classified into two major groups, low-risk and high-risk strains, depending on the ability of the virus to induce malignant transformation. The host's immunity plays a central role in the course of the infection; therefore, it may not be clinically manifest or may produce various benign or malignant lesions. The pathogenic mechanisms are complex and incompletely elucidated. Recent research suggests the role of chronic inflammation and oxidative stress (OS) in the pathogenesis of HPV infection and the associated carcinogenic processes. Chronic inflammation induces OS, which in turn promotes the perpetuation of the inflammatory process resulting in the release of numerous molecules which cause cell damage. Reactive oxygen species exert a harmful effect on proteins, lipids, and nucleic acids. Viral oncogenes E5, E6, and E7 are involved in the development of chronic inflammation through various mechanisms. In addition, HPV may interfere with redox homeostasis of host cells, inducing OS which may be involved in the persistence of the infection and play a certain role in viral integration and promotion of carcinogenesis. Knowledge regarding the interplay between chronic inflammation and OS in the pathogenesis of HPV infection and HPV-induced carcinogenesis has important consequences on the development of new therapeutic strategies. [ABSTRACT FROM AUTHOR]

Background: Cystic echinococcosis is a neglected zoonotic infection that is distributed worldwide and prioritised by WHO for control efforts. The burden of human cystic echinococcosis is poorly understood in most endemic regions, including eastern Europe. We aimed to estimate the prevalence of abdominal cystic echinococcosis in rural areas of Bulgaria, Romania, and Turkey.Methods: We did a cross-sectional ultrasound-based survey that recruited volunteers from 50 villages in rural areas of Bulgaria, Romania, and Turkey. These villages were in provinces with annual hospital incidence of cystic echinococcosis within the mid-range for the respective countries. All people who attended a session were allowed to participate if they agreed to be screened. Abdominal ultrasound screening sessions were hosted in public community structures such as community halls, primary health-care centres, schools, and mosques. Lesions were classified using an adapted WHO classification. We reported the prevalence of abdominal cystic echinococcosis adjusted by sex and age through direct standardisation, using the country's rural population as a reference.Findings: From July 1, 2014, to Aug 3, 2015, 24 693 individuals presented to screening sessions and 24 687 underwent ultrasound screening. We excluded a further six indivduals due to missing data, leaving 24 681 people in our analysis. Abdominal cystic echinococcosis was detected in 31 of 8602 people screened in Bulgaria, 35 of 7461 screened in Romania, and 53 of 8618 screened in Turkey. The age and sex adjusted prevalence of abdominal cystic echinococcosis was 0·41% (95% CI 0·29-0·58) in Bulgaria, 0·41% (0·26-0·65) in Romania, and 0·59% (0·19-1·85) in Turkey. Active cysts were found in people of all ages, including children, and in all investigated provinces.Interpretation: Our results provide population-based estimates of the prevalence of abdominal cystic echinococcosis. These findings should be useful to support the planning of cost-effective interventions, supporting the WHO roadmap for cystic echinococcosis control.Funding: European Union Seventh Framework Programme. [ABSTRACT FROM AUTHOR]

Over the last decade, chronic wounds such as venous or arterial ulcers, diabetic foot ulcers, pressure sores, and nonhealing surgical wounds were brought into the spotlight of the medical community, due to their increasing prevalence and to their significant economic burden. Vascular impairment represents the main cause of chronic ulceration, while the infection is the most frequent complication. Chronic infections persist and progress despite an adequate antimicrobial regimen and are typically caused by mono- or polymicrobial biofilms. The persistent bacterial colonization of the wound, as well as the longterm use of antibiotics predispose to the development of nosocomial infections with resistant strains, with the risk of life-threatening septic complications, especially in immunocompromised individuals. In this article, we perform a thorough literature review, in order to answer the main controversies regarding the involvement of planktonic and/or biofilm bacteria in the healing process of chronic wounds. Furthermore, we aim to analyse the utility of antimicrobial treatment in non-healing wounds, and to establish its main end-points, for the optimal benefit of the patients. [ABSTRACT FROM AUTHOR]

Wound healing involves a complex interaction between immunity and other natural host processes, and to succeed it requires a well-defined cascade of events. Chronic wound infections can be mono- or polymicrobial but their major characteristic is their ability to develop a biofilm. A biofilm reduces the effectiveness of treatment and increases resistance. A biofilm is an ecosystem on its own, enabling the bacteria and the host to establish different social interactions, such as competition or cooperation. With an increasing incidence of chronic wounds and, implicitly, of chronic biofilm infections, there is a need for alternative therapeutic agents. Nanotechnology shows promising openings, either by the intrinsic antimicrobial properties of nanoparticles or their function as drug carriers. Nanoparticles and nanostructured coatings can be active at low concentrations toward a large variety of infectious agents; thus, they are unlikely to elicit emergence of resistance. Nanoparticles might contribute to the modulation of microbial colonization and biofilm formation in wounds. This comprehensive review comprises the pathogenesis of chronic wounds, the role of chronic wound colonization and infection in the healing process, the conventional and alternative topical therapeutic approaches designed to combat infection and stimulate healing, as well as revolutionizing therapies such as nanotechnology-based wound healing approaches. [ABSTRACT FROM AUTHOR]

Objectives: Fast and accurate diagnostic tests to identify carbapenemase-producing Enterobacteriaceae (CPE) are mandatory for proper antimicrobial therapy and implementing infection control measures. Here, we have developed a rapid Carbapenem Inactivation Method (rCIM) for CPE detection. Methods: The rCIM consists of the incubation of a potential carbapenemase producer with meropenem discs and use of the resulting supernatant to challenge a susceptible indicator strain. Growth of the indicator strain is monitored using a nephelometer. The performances of the rCIM were compared with theCIM and Carba NPtests using a collection of 113 well-characterized carbapenem-resistant enterobacterial isolates, including 85 carbapenemase producers and 28 non-carbapenemase producers. In addition, rCIM was compared with the Carba NP test and PCR sequencing in a prospective analysis of 101 carbapenem-resistant enterobacterial isolates addressed to the French National Reference Center for Antimicrobial Resistance in July 2017. Results and discussion: The rCIM correctly identified 84/85 carbapenemase producers and 28/28 non-carbapenemase producers, yielding a sensitivity of 99% and a specificity of 100%, slightly higher than the CIM and Carba NP test. In the prospective validation study, the rCIM showed a sensitivity and specificity of 97% and 95%, respectively. Two cephalosporinase-hyperproducing Enterobacter cloacae gave false-positive results, whereas an IMI-17-producing Enterobacter asburiae gave a false-negative result. The result was, however, positive when the isolate was grown on selective antibiotic-containing media. Conclusions: The rCIM is a rapid (less than 3 h), cheap and accurate test for the detection of CPEs, which can be implemented in low-resource settings, making it a useful tool for microbiology laboratories. [ABSTRACT FROM AUTHOR]

HPV infection affects a significant number of individuals in the general population. HPV is a DNA virus with tropism for skin and mucous membranes; up to date, more than 200 types have beeen identified. HPV infection causes various disorders, cutaneous and anogenital warts accounting for a large number of cases. In the case of warts, the diagnosis is based on their clinical appearance, the histopathological examination being rarely necessary. Many therapeutic modalities, with variable efficacy, are available. Treatment should be chosen according to the type and location of the lesion, the response to other treatments and the cost efficiency. In addition to conventional therapies (keratolytic agents, cryotherapy), modern therapies such as photodynamic therapy and immunotherapy have been developed, the results being encouraging. [ABSTRACT FROM AUTHOR]

Irritable bowel syndrome (IBS) is a chronic condition characterized by abdominal pain and changes in bowel habits. Traditionally, it has been regarded as a multifactorial functional disorder of visceral hypersensitivity. In its pathogenesis, stress was playing an important role. Nowadays, there are more and more evidences for the role of intestinal microbiota in the pathogenesis of IBS. Therefore, irritable bowel syndrome became today as an accumulation of chronical symptoms, dominated by pain and irregular bowel habits, but resulting from the alteration of the intestinal microbiota, being closely correlated with changes in the parietal immune response and increased sensitivity of the intestinal wall. Following this paradigm shift, new therapeutic options should be considered. [ABSTRACT FROM AUTHOR]

Introduction. Resistance to carbapenems represents a public health across the world. Screening for carbapenem resistance can be done starting from the antibiogram, but confirmatory methods are usually performed in reference centers. Methods for rapid identification of carbapenemase activity are required to empower laboratories to detect carbapenemases and raise signals for infectious disease physicians, antibiotic stewardship teams and hospital hygiene specialists. Materials and methods. Eppendorf tubes containing Klebsiella pneumoniae strains with carbapenemase activity (KPC-1, NDM-1, OXA-48) and others with no carbapenemase activity (K. pneumoniae ATCC 700603 and E. coli ATCC 25922), as well as positive and negative controls were incubated at 37 °C with varying concentrations of Meropenem. After incubation, samples were spun down until a pellet formed and the supernatant was used to challenge an exponentially growing E. coli culture. This second culture was followed with nephelometric measurements every half hour. Experiments were carried out in three technical replicates. The statistical analysis was done with R (version 3.3.3) and graphs generated in RStudio (version 1.0.136) with ggplot2 (version 2.1.0). Mann Whitney U Test with the assumption of independent samples was used to analyse the results. Results. The doses of Meropenem were chosen after dose ranging experiments and multiple incubation times (from 30 minutes to two hours) were tested in order to evaluate the robustness of the method. In the cases where the antibiotic was first incubated with strains that had carbapenemase activity, the growth of Escherichia coli ATCC 25 922 was non-hindered, matching that of controls. In the absence of carbapenemase activity and in the case of negative controls, the growth indicator strain was inhibited. Statistically significant differences were identified for 0.3, as well as a 0.5 McFarland index as early as 1.5 hours total work time. Conclusions. The discovery of carbapenem resistance has direct clinical, as well as epidemiological implications. Among the mechanisms implicated in resistance to carbapenems, the presence of a carbapenemase is one of the most worrying from an epidemiological standpoint. This new tool we describe herein can be performed in all clinical microbiology laboratories, with no extra expense (as opposed to CarbaNP and BlueCarba tests). [ABSTRACT FROM AUTHOR]

Introduction. Many epidemiological, clinical and experimental studies have sugested a possible role of infectious agents in the etiopathogenesis of lichen planus. In this paper, the authors performed a retrospective analysis for the presence of hepatitis B (HBV) and C (HCV) viruses in patients with lichen planus, between 2004-2016. Material & Method. The serological screening was realised for 157 patients with lichen planus in order to detect anti-HCV antibodies and HBs antigen. In the case of a positive result for anti-HCV antibodies, confirmatory tests were performed. Results. Among patients with lichen planus diagnosed based on clinical and histopathological aspects, it was found that 12 patients were infected with HCV (7.6%), 4 patients were infected with HBV (2.6%) and 1 patient with HBV/HCV coinfection (0.6%). Conclusions. Based on these results, the authors do not consider that hepatitis viruses play an essential role in the pathophysiology of lichen planus. However it should be noticed the high percentage of cases of HCV infection among these patients. Early identification and treatment of these infections in patients with lichen planus could influence in a positive way the course of the cutaneous disease. [ABSTRACT FROM AUTHOR]

The gut microbiota is an important part of the body, it has numerous functions and at the same time, through the imbalances that occur at its level, is involved in some pathologies. The gut microbiota composition begins to be established even before birth. Further, it is influenced by various factors such as mode of delivery, feeding, breastfeeding or with formula milk. At around 2-3 years, the microbiota stabilizes and resembles with the one of an adult. Changes may occur in the adult period also, either due to the type of food, vegetarian or not, hypo- or normocaloric, because of the medications, or because of the environment where he lives. The microbiota has different roles, from the synthesis of compounds to the intervention in the metabolism of substances, endo- or exogenous. The alteration that may arise in the functioning of the microbiota affects many systems. Studies reveal imbalances of the gut microbiota in various diseases such as ankylosing spondylitis, Alzheimer's disease and others. [ABSTRACT FROM AUTHOR]

The increased incidence of Clostridium difficile associated diarrhea and the severity of diarrhea caused by enterohemorrhagic Escherichia coli involve the need of greater attention from the health professionals dealing with these infections. They are required to detect the disease on time, to diagnose, treat appropriately and implement preventive measures to limit outbreaks. C. difficile colonizes the intestinal tract after the normal microbiota at that level has been modified during sistemic antibiotic therapy. This pathogen causes pseudomembranous colitis, actually one of the most common nosocomial infections, too. Enterohemorrhagic E. coli, a Shiga-like toxin-producing strain, causes bloody diarrhea and its complications become extremely serious in children and elderly people (hemolytic-uremic syndrome). For the both forms of severe diarrhea, based on last data published, issues related to epidemiological data, clinical manifestations, diagnosis and treatment will be reviewed. [ABSTRACT FROM AUTHOR]

In daily practice physicians meet with different situations in which they must use their knowledge and in order to make the best possible choices, it is necessary for them to know the new findings and at the same time to practice continuously. The sources of information most commonly used are the textbooks, journals, particularly those available on the internet, or information obtained from various conferences, but very important, besides knowledge and experience, are the discussions with colleagues. The way they choose the information is influenced by the availability, how easy can be obtained, especially its quality and how useful it is for medical practice. Infecțio.ro readers mentioned that its scientific level is high or very high, providing information with an important applicability in their daily practice. They were especially interested in clinical cases presented, but also in the original studies and synthesis. In terms of graphics, this was considered to be professionally done or very professional. Continuing medical education is a good way to maintain a high level for the offered medical services. Lately, it is increasingly obvious how important is the way it addresses doctors and also the information transmitted. [ABSTRACT FROM AUTHOR]

The increasing burden of invasive biofilm-related staphylococcal infections has led to a dire need for new agents to prevent biofilm formation. Bacteriophages may hypothetically alter a biofilm through several mechanisms, including induction of depolymerizing enzymes and lysis of persistent bacteria. We have assessed the influence of commercially available bacteriophage cocktails on Staphylococcus spp. clinical strains viability and biofilm formation. We analyzed 83 staphylococcal strains from patients consecutively admitted to a Romanian infection reference center from October 2014 through May 2015; the strains were characterized by phenotypic and genetic tools for their resistance and virulence features and for their phyliation. Experiments were performed in triplicate. Methicillin-susceptible strains were significantly more susceptible to all tested phages: 1.7-fold higher susceptibility for PYO, 1.4-fold for INTESTI, 2.9-fold for PHAGYO, 2.7-fold for PHAGESTI and 3.9-fold for STAPHYLOCOCCAL; t030 strains were significantly more susceptible to PYO and INTESTI compared with t127 strains. We identified a significant decrease in biofilm formation in the presence of both low and high PYO and INTESTI concentrations (P < 0.001). In conclusion, Staphylococcus strains from Romania displayed fairly good susceptibility to commercially available bacteriophages. We have also ascertained there is phage-driven in vitro inhibition of biofilm formation, the results potentially impacting prevention of prosthetic infections. [ABSTRACT FROM AUTHOR]

Antimicrobial resistance (AMR) represents a growing public health problem worldwide. Infections with such bacteria lead to longer hospitalization times, higher healthcare costs and greater morbidity and mortality. Thus, there is a greater need for rapid detection methods in order to limit their spread. The ESKAPE pathogens (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa and Enterobacter spp.) are a series of epidemiologically-important microorganisms of great concern due to their high levels of resistance. This review aimed to update the background information on the ESKAPE pathogens as well as to provide a summary of the numerous phenotypic and molecular methods used to detect their AMR mechanisms. While they are usually linked to hospital acquired infections, AMR is also spreading in the veterinary and the environmental sectors. Yet, the epidemiological loop closes with patients which, when infected with such pathogens, often lack therapeutic options. Thus, it was aimed to give the article a One Health perspective. [ABSTRACT FROM AUTHOR]

Introduction: Respiratory tract infections (upper and lower) represent one of the most frequent problems that lead to community medical visits, according to official data. In the hospital environment, the treatment of infections requiring inpatient care needs to be carried out in accordance with institutional guidelines, adapted to local antimicrobial resistance patterns. Information about the spectrum of bacterial resistance is often absent. Materials and methods: A retrospective study of the antibiogram registry of the Bacteriology Laboratory of the “Marius Nasta” National Institute of Pneumophtysiology (NIP) in Bucharest. The most frequent microorganisms isolated from pulmonary samples of adult inpatients in 2015 were analyzed. Results: The resistance of Staphylococcus aureus, Streptococcus pneumoniae, Haemophilus spp., Klebsiella spp., Escherichia coli, Acinetobacter baumannii, and Pseudomonas aeruginosa was analyzed. We reported the total number of isolates, the number of analyzed isolates (the ones that come from patients who meet the inclusion criteria) and the absolute and proportion figures for resistant, intermediate and sensitive strains. Resistance is described for each of the microorganisms. Special cases of resistance (like methicillin resistant staphylococci and carbapenem resistant enterobacteriaceae; CRE) have been highlighted because of the need to monitor their evolution over time as well as the importance to approach them systemically (prevention and treatment). Discussions: The spectrum of resistance varies according to the ward where the patient was cared for. The isolates from the medical wards were, in general, less resistant than those from the ICU/surgery wards. Conclusions: Due to the high variability in the spectrum of bacterial resistance of the most frequent isolates from medical practice, heightened attention is required in choosing the appropriate empiric antibiotic coverage and adherence to sampling and diagnostic procedures. The present article helps to better characterize the epidemiology of infections and antibiotic resistance in the “Marius Nasta” Institute; it identifies the difficulties faced in gathering and analyzing the data and can be considered as a reference point to improve medical practice policies with regards to the use of antibiotics. [ABSTRACT FROM AUTHOR]

Travelers' diarrhea (TD) is the most common condition seen among people who are travelling, especially from developed to developing countries, its prevalence reaching almost 70%. Even though, in most cases, TD is a non-aggressive, self-limited disease and there are effective treatment methods available, prevention measures are worth being taken, because, by controlling the risk of infection and its post-infectious complications, the traveler's health would not be affected either during the trip, or after. TD prevention consists in three main types of measures, often requiring a combination of all of them adjusted to the destination and traveler's risk factors: education on food and beverage safety/hygiene, chemoprophylaxis and immunoprophylaxis. Because bacterial infection is the most frequent cause of TD (up to 90%), it becomes rationale, not only for curative, but for prophylactic purposes too, the usage of a non-absorbable bactericide wide spectrum antibiotic like Rifaximin-α which also has a low rate of resistance patterns. Due to its pharmacokinetic and pharmacodynamics advantages along with its favorable results from several clinical trials, Rifaximin-α is now probably the best and safest prophylactic (but curative, too) option in case of TD. [ABSTRACT FROM AUTHOR]

Significant progress has been made in the therapy of hepatitis C, but many things are still unknown about its pathogenesis. The course of hepatitis C is influenced by both host and virus characteristics. More and more studies highlight the role of oxidative stress in the pathogenesis of hepatitis C. Core protein plays a key role in the generation of reactive oxygen species. In addition, the most important complications of the infection, cirrhosis and hepatocellular carcinoma, seem to be related to the presence of oxidative stress. In this context antioxidants could be a useful adjuvant therapy. [ABSTRACT FROM AUTHOR]

Influenza is a contagious respiratory illness caused by influenza virus types A, B or C. Clinical manifestations are nonspecific, such as fever, cough, sore throat, headache, myalgia, symptoms identified in other respiratory infections as well. For these reasons the clinical diagnosis could be difficult. Evolution is usually mild, but certain groups of people such as the elderly, pregnant women or people with associated comorbidities are at risk to develop complications. Antiviral treatment is recommended especially to people from the risk groups, the ones hospitalized, the ones with a severe evolution, and the ones with complications or risk of developing complications. The best way to prevent influenza remains annual vaccination. The components of the vaccine are chosen based on reports from previous seasons on circulating influenza virus types and their mode of transmission. [ABSTRACT FROM AUTHOR]

Travellers' diarrhea is one of the most frequent diseases, which affects 30-70% of the persons who are travelling from high developed to less developed areas, its prevalence depending on the region and season. The risk of developing this condition involves both the host's susceptibility, but also its behaviour; for example, younger people and those with achlorhydria or immunocompromised persons are more prone to this pathology than the general population. Also, the consumption of certain food, insufficiently prepared or improperly stored or cooked can be the source of the pathogen. The clinical manifestations have an abrupt onset and are most commonly represented by diarrhea with or without blood, abdominal pain, nausea and sometimes fever. Taking into consideration the often short period of the travelling and the fast symptom onset, a rapid diagnosis could be only clinically established, based on epidemiological circumstances and clinical patient features. Due to a very frequent bacterial etiology (80-90%), the treatment consists of empirical administration of antibiotics associated with symptomatic medication and hydroelectrolyte rebalancing formulas which all together shorten the healing process. Recommended antibiotics are those less absorbable or the non-absorbable ones, like rifaximine-α. [ABSTRACT FROM AUTHOR]

Introduction: Vaccines represent one of the most effective and cost-saving public health interventions. Still, this measure continues to be underused all over the world. Immunization averts an estimated 2 to 3 million deaths every year from diphtheria, tetanus, pertussis (whooping cough), and measles. Although globally the proportion of children who receive recommended vaccines has remained steady for the past few years, we observed during our clinical practice that the vaccination coverage in Romania might be lower than the needed immunization rate. The objective of this study is to test this hypothesis and to highlight the causes of low vaccination rates in Romania. Materials and methods: We collected data regarding different variables such as vaccination status, living area, mothers' age from the patient charts of all the infants (278) hospitalized in the Clinical Hospital “Dr Victor Gomoiu” during a three-month period (1st of August - 31st of October). We determined the frequencies and analysed the differences between vaccinated and unvaccinated children regarding the above mentioned variables using EpiInfo 7.1.5.2. Results and discussion: Of the 278 infants, 15 (5.9%) were excluded because of missing data, 194 (69.79%) were completely vaccinated and 69 (24.8%) were unvaccinated or incompletely vaccinated. We found that unvaccinated or incompletely vaccinated infants are more likely to have adolescent mothers than vaccinated children (24.64 % compared to 10.82%). Children who live in rural areas have lower immunization rates. In our study, we observed that vaccination rate is higher among children living in urban areas (78.8%) than among children living in rural areas. Conclusions: The immunization rate in Romania is lower than the recommended immunization rate. Child neglect, difficulty to reach health providers, and lack of information could be some of the causes. Whether the true responsible for this issue is the children's caregiver, the Health Ministry, or both, immunization coverage represents an important public health issue and it should be further and thoroughly investigated in the search for a solution. [ABSTRACT FROM AUTHOR]

Cases of multidrug resistant tuberculosis are on the rise in many regions; therefore prevention programs are fundamental to reduce the incidence of tuberculosis. Knowledge of the risk factors and understanding of the mechanisms which underlie the acquired resistance of Mycobacterium tuberculosis strains can contribute to the implementation of prevention and control strategies. This paper reviews the main risk factors and mechanisms involved in the acquisition of resistance to first and second line anti-tuberculosis drugs. [ABSTRACT FROM AUTHOR]