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Introduction: The COVID-19 pandemic has disproportionately affected patients with preexisting comorbidities, particularly dialysis patients. The aim of this study was to determine predictors of mortality in this population. Methodology: We conducted an observational, retrospective, cohort study collecting data from pre and post-vaccine from the electronic medical records of a single dialysis center at Hygeia International Hospital Tirana, Albania. Results: Of 170 dialysis patients, 52 were diagnosed with COVID-19. The prevalence of COVID-19 infection in our study was 30.5%. The mean age was 61.5 ± 12.3 years and 65.4% were men. The mortality rate in our cohort was 19.2%. Mortality rates were higher in patients with diabetic nephropathy (p < 0.04) and peripheral vascular disease (p < 0.01). Elevated C- reactive protein (CRP) (p < 0.018), high red blood cell distribution width (RDW) (p < 0.03), and low lymphocyte and eosinophil counts, were found to be risk factors for severe COVID-19 disease. ROC analysis identified lymphopenia and eosinopenia as the strongest predictors of mortality. After the vaccine administration, the mortality rate in the vaccinated population was 8%, in contrast to the 66.7% mortality rate that was found in the unvaccinated group (p < 0.001). Conclusions: Our study revealed that risk factors for the development of severe COVID-19 infection were RDW, low lymphocyte and eosinophil counts, elevated levels of CRP. Lymphopenia and eosinopenia were determined as the most important predictors of mortality, in our cohort. Mortality was notably lower among vaccinated patients.

Brucellosis remains a public health problem in many Mediterranean countries. In this work are presenting data of human brucellosis clinics and treatment in a sample of hospitalized patients. Methods: All patient charts at regional hospital in Gjirokastra, Albania were systematically reviewed, during the period 2016-2021. All hospitalized patients with a laboratory confirmed diagnoses of brucellosis were included in the study. Variables of interest were clinical symptoms, clinical course and treatment provided. Sub-acute brucellosis was defined as clinical persistence of 3-12 months while cases with clinical symptoms persisting for ≥12 months were defined as chronic brucellosis. Results: 79% of the 86 patients were male and residing in rural areas. Fever, profuse sweating and arthralgia were the most common clinical signs. Around 70% of the brucellosis patients showed all these three symptoms. Despite a systematic tendency for more frequent presence of high fever, increased sweating and arthralgia on younger patients we could not find statistically significant differences among demographic categories. 18.6% of cases presented persistence of clinical signs after at least 3 months from the moment of the diagnoses. Almost 7% of the cases were classified as chronic cases. 75.6% of all patients were treated with a combination of doxycycline and ceftriaxone antibiotic regime. Conclusions: The massive use of a cephalosporin in treatment of brucellosis cannot be justified and may reflect a larger problem related to population awareness and health provider attitudes concerning antibiotic use in Albania. The results of this study may assist future interventions to improve brucellosis case management at hospitals or primary health care level as well as national measures at a larger scale for control of the disease.

Highlights • What’s new? • Currently there is no evidence for a different course of COVID-19 in HIV(+) patients. • This is the first report on COVID-19 among HIV(+) persons in Central and Eastern Europe. • Earlier reports suggested that some antivirals may suppress SARS-CoV-2 replication. • We analyzed a series of 34 cases of HIV and SARS-CoV-2 coinfection. • We found that HIV-related factors are not associated with the course of COVID-19. • Our analysis suggests that antiretrovirals may be associated with the course of COVID-19., Background There is currently no evidence suggesting that COVID-19 takes a different course in HIV-positive patients on antiretroviral treatment compared to the general population. However, little is known about the relation between specific HIV-related factors and the severity of the COVID-19 disease. Methods We performed a retrospective analysis of cases collected through an on-line survey distributed by the Euroguidelines in Central and Eastern Europe Network Group. In statistical analyses characteristics of HIV-positive patients, asymptomatic/moderate and moderate/severe course were compared. Results In total 34 HIV-positive patients diagnosed with COVID-19 were reported by 12 countries (Estonia, Czech Republic, Lithuania, Albania, Belarus, Romania, Serbia, Bosnia and Herzegovina, Poland, Russia, Hungary, Bulgaria). Asymptomatic courses of COVID-19 were reported in four (12%) cases, 11 (32%) patients presented with mild disease not requiring hospitalization, moderate disease with respiratory and/or systemic symptoms was observed in 14 (41%) cases, and severe disease with respiratory failure was found in five (15%) patients. The HIV-related characteristics of patients with an asymptomatic/mild course of COVID-19 were comparable to those with a moderate/severe course of COVID-19, except for the use of non-nucleoside reverse transcriptase inhibitors (NNRTIs) in cART regimen (0.0% vs. 31.6% respectively, p = 0.0239). Conclusions In our analyses HIV viral suppression and immunological status were not associated with the course of COVID-19 disease. On the contrary the cART regimen could contribute to severity of SARS-CoV-2 infection. Large and prospective studies are necessary to further investigate this relationship.

Background Meningitis and ventriculitis due to Pseudomonas aeruginosa are uncommon. They are commonly secondary hospital-onset and typically related to neurosurgical procedure. Previous studies have shown P. aeruginosa to be responsible for 1%–18% of nosocomial meningitis cases. Both treatment failure and relapses are known to occur, and the recorded mortality is high, approaching 80% in some studies. Objectives We report a case of P. aeruginosa meningitis in a 26-year-old woman following spinal anaesthesia for caesarean section, its clinical characteristics, treatment challenges in the era of high generation antibiotics and the outcomes. Results A 26-year-old woman was hospitalized after 1 week of her third child delivery by caesarean section with spinal anaesthesia and 3 days after high fever and headache. Lumbar puncture was performed immediately, and leucocyte cell count was 723 cell/dL with 94% segmented neutrophils. CSF glucose was very low, and protein was 420 mg/dL. P. aeruginosa was isolated and it was susceptible to all antibiotics of standard panel. Cranial and lumbar region CT scans were normal. We modified empirical treatment and started ceftazidime and gentamicin. Three days after de-hospitalization in improved condition, she had high fever and strong headache and came back to hospital. We started treatment with imipenem and ciprofloxacin and 2 months after we performed several lumbar punctures, cranial MRIs and changed different antibiotic regimens with third generation cephalosporins, aminoglycosides, carbapenems and colistin; her clinical situation such as headache and fever and CSF did not show any sign of improvement. Susceptible P. aeruginosa was isolated each time we examined her CSF. She decided to leave the hospital and 2 weeks after her headache worsened and a convulsive attack happened. The cranial MRI showed hydrocephaly and a white precipitate (pus) in the left lateral ventricle. An extraventricular drain helped to resolve hydrocephaly and intraventricular colistin was injected until CSF was sterilized. After 1 month she was in a very good condition and a ventriculo-peritoneal shunt was placed. Conclusions P. aeruginosa meningitis was associated with some treatment difficulties. Even after an early nosological and microbiological diagnosis and an appropriate choice of antibiotics, based on bacterial meningitis treatment criteria and antibiogram, we couldn't eradicate the bacteria from CSF. To achieve success in this nosocomial infection from a not careful asepsis, sometimes a prolonged antibiotic and local treatment with intraventricular or intrathecal therapy is needed.

BACKGROUND AND AIMS Leptospirosis is an endemic, globally widespread zoonotic disease caused by pathogenic spirochetes of the genus Leptospira. It presents with high clinical variability, with a constellation of symptoms ranging from a mild, nonspecific, self-limiting febrile syndrome to acute liver failure, acute kidney injury, coagulopathy and respiratory involvement. Acute kidney injury (AKI) is a common complication and generally presents as nonoliguric and hypokalemic. The aim of this study was to delineate potential predictors of mortality in Leptospirosis. METHOD We conducted a prospective, observational, single-center study in the span of 5 years, from 2010 to 2015. Patients enrolled in the study had an age at presentation >14 years and were hospitalized for longer than 24 h with a conclusive diagnosis of Leptospirosis. Baseline patient characteristics, including demographic, clinical and laboratory data were collected. Definitive diagnosis was established through serology assay, using the indirect-ELISA test to detect positive Leptospira IgM and IgG. Fisher's exact test was used to identify predictors of mortality during the course of the infection. RESULTS A total of 119 consecutive patients diagnosed with Leptospirosis were enrolled during a 5-year period, 92% were males. Mean age at presentation was 48.8 ± 14.9 and 41.5 ± 19.8 years for males and females, respectively. Mortality in our cohort was estimated to be 9% (10 patients). Urine output and bilirubin levels were found to be the most significant predictors of mortality. Fischer's exact test determined urine output at a cut-off value of 400 mL/24 h as the strongest predictor of mortality (P CONCLUSION Our study defined oliguria as the most significant predictor of mortality in patients with severe Leptospirosis, closely followed by bilirubin levels on admission. Other predictors to consider include creatinine levels on admission, nadir platelet count and age at presentation. Incorporating predictors of mortality, from the outset, in treatment algorithms of Leptospirosis, will promote a more timely diagnosis and the development of more specific management guidelines, enabling clinicians to provide personalized treatment plans, potentially impacting the prognosis, morbidity and mortality rates in these patients.

Introduction: The COVID-19 pandemic has been challenging time for medical care, especially in the field of infectious diseases (ID), but it has also provided an opportunity to introduce new solutions in HIV management. Here, we investigated the changes in HIV service provision across Central and Eastern European (CEE) countries before and after the COVID-19 outbreak. Methods: The Euroguidelines in Central and Eastern Europe Network Group consists of experts in the field of ID from 24 countries within the CEE region. Between 11 September and 29 September 2021, the group produced an on-line survey, consisting of 32 questions on models of care among HIV clinics before and after the SARS-CoV-2 outbreak. Results: Twenty-three HIV centers from 19 countries (79.2% of all countries invited) participated in the survey. In 69.5% of the countries, there were more than four HIV centers, in three countries there were four centers (21%), and in four countries there was only one HIV center in each country. HIV care was based in ID hospitals plus out-patient clinics (52%), was centralized in big cities (52%), and was publicly financed (96%). Integrated services were available in 21 clinics (91%) with access to specialists other than ID, including psychologists in 71.5% of the centers, psychiatrists in 43%, gynecologists in 47.5%, dermatologists in 52.5%, and social workers in 62% of all clinics. Patient-centered care was provided in 17 centers (74%), allowing consultations and tests to be planned for the same day. Telehealth tools were used in 11 centers (47%) before the COVID-19 pandemic outbreak, and in 18 (78%) after (p = 0.36), but were represented mostly by consultations over the telephone or via e-mail. After the COVID-19 outbreak, telehealth was introduced as a new medical tool in nine centers (39%). In five centers (28%), no new services or tools were introduced. Conclusions: As a consequence of the COVID-19 pandemic, tools such as telehealth have become popularized in CEE countries, challenging the traditional approach to HIV care. These implications need to be further evaluated in order to ascertain the best adaptations, especially for HIV medicine., Research Development Foundation in Hospital for Infectious Diseases, The study has been funded by research grant issued by the Research Development Foundation in Hospital for Infectious Diseases.

Objectives: The aim of this international multicentre study was to review potential drug- drug interactions (DDIs) for real-life coadministration of combination antiretroviral therapy (cART) and coronavirus disease 2019 (COVID-19)-specific medications. Methods: The Euroguidelines in Central and Eastern Europe Network Group initiated a retrospective, observational cohort study of HIV-positive patients diagnosed with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Data were collected through a standardized questionnaire and DDIs were identified using the University of Liverpool's interaction checker. Results: In total, 524 (94.1% of 557) patients received cART at COVID-19 onset: 117 (22.3%) were female, and the median age was 42 (interquartile range 36-50) years. Only 115 (21.9%) patients were hospitalized, of whom 34 required oxygen therapy. The most frequent nucleoside reverse transcriptase inhibitor (NRTI) backbone was tenofovir disoproxil fumarate (TDF)/tenofovir alafenamide (TAF) with lamivudine or emtricitabine (XTC) (79.3%) along with an integrase strand transfer inhibitor (INSTI) (68.5%), nonnucleoside reverse transcriptase inhibitor (NNRTI) (17.7%), protease inhibitor (PI) (13.7%) or other (2.5%). In total, 148 (28.2%) patients received COVID-19-specific treatments: corticosteroids (15.7%), favipiravir (7.1%), remdesivir (3.1%), hydroxychloroquine (2.7%), tocilizumab (0.6%) and anakinra (0.2%). In total, 62 DDI episodes were identified in 58 patients (11.8% of the total cohort and 41.9% of the COVID-19-specific treatment group). The use of boosted PIs and elvitegravir accounted for 43 DDIs (29%), whereas NNRTIs were responsible for 14 DDIs (9.5%). Conclusions: In this analysis from the Central and Eastern European region on HIV-positive persons receiving COVID-19-specific treatment, it was found that potential DDIs were common. Although low-dose steroids are mainly used for COVID-19 treatment, comedication with boosted antiretrovirals seems to have the most frequent potential for DDIs. In addition, attention should be paid to NNRTI coadministration.

Introduction: People living with HIV (PLWH) are at higher risk of poorer COVID-19 outcomes. Vaccination is a safe and effective method of prevention against many infectious diseases, including COVID-19. Here we investigate the strategies for national COVID-19 vaccination programmes across central and eastern Europe and the inclusion of PLWH in vaccination programmes. ----- Methods: The Euroguidelines in Central and Eastern Europe Network Group consists of experts in the field of infectious diseases from 24 countries in the region. Between 1 November 2020 and 19 March 2021 the group proceeded an on-line survey consisting of 20 questions. ----- Results: Twenty-two countries (out of 24 invited) participated in the survey and 20/22 countries in the period between December 2020 and March 2021 had already started their COVID-19 vaccination programme. In total, seven different vaccines were used by participating countries. In 17/21 countries (81%), vaccinated persons were centralized within the national registry. In 8/21 countries (38%) PLWH were prioritized for vaccination (the Czech Republic, Greece, Hungary, Lithuania, Montenegro, Romania, Slovakia, Slovenia) and the Czech Republic, Greece and Serbia had put in place national guidelines for vaccination of PLWH. In 14/20 countries (70%) vaccination was only provided by designated centres. Eighteen respondents (18/21; 85.7%) reported that they planned to follow up HIV patients vaccinated against COVID-19, mainly by measuring antibody levels and checking COVID-19 incidence (11/21; 52.3%). ----- Conclusions: This survey-based study suggests that there are significant differences in terms of prioritizing PLWH, the types of vaccines used, vaccination coverage, and the development and implementation of a vaccination programmes within the region. Regardless of heterogenicity and existing barriers within the region, systematic vaccination in PLWH should have the highest priority, especially in those with severe immunodeficiency, risk factors, and in the elderly, aiming for prompt and high vaccination coverage.

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: The SARS-CoV-2 pandemic has hit the European region disproportionately. Many HIV clinics share staff and logistics with infectious disease facilities, which are now on the frontline in tackling COVID-19. Therefore, this study investigated the impact of the current pandemic situation on HIV care and continuity of antiretroviral treatment (ART) supplies in CEE countries. Methods: The Euroguidelines in Central and Eastern Europe (ECEE) Network Group was established in February 2016 to review standards of care for HIV in the region. The group consists of professionals actively involved in HIV care. On March 19, 2020 we decided to review the status of HIV care sustainability in the face of the emerging SARS-CoV-2 pandemic in Europe. For this purpose, we constructed an online survey consisting of 23 questions. Respondents were recruited from ECEE members in 22 countries, based on their involvement in HIV care, and contacted via email. Results: In total, 19 countries responded: Albania, Armenia, Belarus, Bosnia and Herzegovina, Bulgaria, Croatia, Czech Republic, Estonia, Georgia, Greece, Hungary, Lithuania, Macedonia, Poland, Republic of Moldova, Russia, Serbia, Turkey, and Ukraine. Most of the respondents were infectious disease physicians directly involved in HIV care (17/19). No country reported HIV clinic closures. HIV clinics were operating normally in only six countries (31.6%). In 11 countries (57.9%) physicians were sharing HIV and COVID-19 care duties. None of the countries expected shortage of ART in the following 2 weeks; however, five physicians expressed uncertainty about the following 2 months. At the time of providing responses, ten countries (52.6%) had HIV-positive persons under quarantine. Conclusions: A shortage of resources is evident, with an impact on HIV care inevitable. We need to prepare to operate with minimal medical resources, with the aim of securing constant supplies of ART. Non-governmental organizations should re-evaluate their earlier objectives and support efforts to ensure continuity of ART delivery. © 2020 The Authors, ECEE Network Group: Afonina L (Russia), Alexiev I (Bulgaria), Antonyak S (Ukraine), Antonyak S (Ukraine), Balayan T (Armenia), Bednarska A (Poland), Begovac J (Croatia), Bolokhadze N (Georgia), Bukovinowa P (Slovakia), Burkacka E (Poland), Bursa D (Poland), Caplinskas S (Lithuania), Chkhartishvili N (Georgia), Dragovic G (Serbia), Goekengin D (Turkey), Harxhi A (Albania), Higersberger J (Poland), Holban T (Moldova), Horban A (Poland), Jevtovic D (Serbia), Jilich D (Czech Republic), Karpov I (Belarus), Kase K (Estonia), Kowalska JD (Poland), Krasniqi V (Kosovo), Ladnaya N (Russia), Lakatos B (Hungary), Marczy?ska M (Poland), Mardarescu M (Romania), Mat?osz B (Poland), Matulyte E (Lithuania), Matulionyte R (Lithuania), Mulabdic V (Bosnia-Herzegovina), Oprea C (Romania), Otelea D (Romania), Paciorek M (Poland), Panteleyev A (Russia), Papadopoulos A (Greece), Podlasin B (Poland), Podlekareva D (Denmark), Rukhadze (Georgia), Ruutel K (Estonia), Sedlacek D (Czech Republic), Simonovic Babic J (Serbia), Skrzat-Klapaczynska A (Poland), Sluzhynska M (Ukraine), Sta?czak J (Poland), Stevanovic M (Macedonia), Strashimirov D (Bulgaria), Streinu-Cercel A (Romania), Tetradov S (Romania),Tomazic J (Slovenia), Turcanu O (Rep. of Moldova), Vassilenko A (Belarusia), Vasylyev M (Ukraine), Verhaz A (Bosnia-Herzegovina), Yurin O (Russia), Yancheva N (Bulgaria), Zab?ocka H (Poland)

Objectives: Pre-exposure prophylaxis (PrEP) for HIV infection is an important intervention for control of the HIV epidemic. The incidence of HIV infection is increasing in the countries of Central and Eastern Europe (CEE). Therefore, we investigated the change in PrEP use in CEE over time. Methods: The Euroguidelines in Central and Eastern Europe (ECEE) Network Group was initiated in February 2016 to compare standards of care for HIV and viral hepatitis infections in CEE. Data on access to PrEP were collected from 23 countries through online surveys in May–June 2017 (76 respondents) and in November 2018–May 2019 (28 respondents). Results: About 34.2% of respondents stated that tenofovir/emtricitabine (TDF/FTC) was licensed for use in their country in 2017, and 66.7% that it was licensed for use in 2018 (P = 0.02). PrEP was recommended in national guidelines in 39.5% of responses in 2017 and 40.7% in 2018 (P = 0.378). About 70.7% of respondents were aware of “informal” PrEP use in 2017, while 66.6% were aware of this in 2018 (P = 0.698). In 2018, there were 53 centres offering PreP (the highest numbers in Poland and Romania), whereas six countries had no centres offering PreP. The estimated number of HIV-negative people on PreP in the region was 4500 in 2018. Generic TDF/FTC costs (in Euros) ranged from €10 (Romania) to €256.92 (Slovakia), while brand TDF/FTC costs ranged from €60 (Albania) to €853 (Finland). Conclusions: Although the process of licensing TDF/FTC use for PrEP has improved, this is not yet reflected in the guidelines, nor has there been a reduction in the “informal” use of PrEP. PrEP remains a rarely used preventive method in CEE countries. © 2020 British HIV Association, ECEE Network Group: L. Afonina (Russia), I. Alexiev (Bulgaria), S. Antonyak (Ukraine), S. Antonyak (Ukraine), T. Balayan (Armenia), A. Bednarska (Poland), J. Begovac (Croatia), N. Bolokhadze (Georgia), P. Bukovinowa (Slovakia), E. Burkacka (Poland), D. Bursa (Poland), S. Caplinskas (Lithuania), N. Chkhartishvili (Georgia), G. Cholewi?ska-Szyma?ska (Poland), G. Dragovic (Serbia), D. Goekengin (Turkey), A. Harxhi (Albania), J. Higersberger (Poland), T. Holban (Moldova), A. Horban (Poland), D. Jevtovic (Serbia), D. Jilich (Czech Republic), I. Karpov (Belarus), K. Kase (Estonia), J. D. Kowalska (Poland), V. Krasniqi (Kosovo), N. Ladnaya (Russia), B. Lakatos (Hungary), M. Marczy?ska (Poland), M. Mardarescu (Romania), B. Mat?osz (Poland), E. Matulyte (Lithuania), R. Matulionyte (Lithuania), V. Mulabdic (Bosnia-Herzegovina), C. Oprea (Romania), D. Otelea (Romania), M. Paciorek (Poland), A. Panteleyev (Russia), A. Papadopoulos (Greece), B. Podlasin (Poland), D. Podlekareva (Denmark), N. Rukhadze (Georgia), K. Ruutel (Estonia), D. Salemovic (Serbia), D. Sedlacek (Czech Republic), J. Simonovic Babic (Serbia), A. Skrzat-Klapaczynska (Poland), M. Sluzhynska (Ukraine), J. Sta?czak (Poland), M. Stevanovic (Macedonia), D. Strashimirov (Bulgaria), A. Streinu-Cercel (Romania), S. Tetradov (Romania), J. Tomazic (Slovenia), O. Turcanu (Rep. of Moldova), A. Vassilenko (Belarusia), M. Vasylyev (Ukraine), A. Verhaz (Bosnia-Herzegovina), O. Yurin (Russia), H. Zab?ocka (Poland) and N. Yancheva (Bulgaria). Conflicts of interest: The authors report no potential conflicts of interest. Financial disclosure: The study was sponsored by the Research Development Foundation of the Hospital for Infectious Diseases via an unrestricted research grant., The study was sponsored by the Research Development Foundation of the Hospital for Infectious Diseases via an unrestricted research grant. Financial disclosure

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

Introduction: Despite the fact that there has been a steady rise in new infections rate since the first reported case in 1993, Albania remains a low prevalence country. This was the first cascade study for Albania. The aim was to construct a cascade of care for newly human immunodeficiency virus (HIV)-diagnosed individuals in 2016 in Albania. Material and methods: This retrospective descriptive study was conducted at the HIV/AIDS Ambulatory Clinic, Infectious Disease Service, University Hospital Centre of Tirana. Medical records of patients diagnosed and enrolled in care in 2016 were retrospectively screened and data on gender, age, HIV clinical stage, CD4+ T cell count, viral load measurement, and treatment history, with antiretro-viral treatment (ART) and adherence to treatment were collected. Results: Out of 127 new HIV cases reported, 100 (78.7%) entered care. The median age was 39 years (range, 20-75 years; male, 82%). Seventy one percent started ART within a median of 56 days (range, 1-317 days) from diagnosis, 34 (47.9%) patients received tenofovir disoproxil fumarate/emtricitabine + efavirenz (EFV), and 27 (38%) zidovudine + lamivudine + EFV. Among those who started ART, 19.7% were late presenters and 54.9% were very late presenters. Viral load after initiation of ART was assessed in 25 cases, with 56% of patients achieving an undetectable HIV-RNA. Conclusions: A large proportion of people living with HIV were lost at each step of the cascade. Efforts in Albania should be focused on scaling up HIV testing, promoting adherence to ART, improving access to diagnostics, and better ART regimens as well as proper monitoring of therapy.

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.

The objective of this study was to update a 2011 survey, conducted on behalf of the ESCMID Study Group for Antibiotic Policies (ESGAP), studying the availability of old but clinically useful antibiotics in North America, Europe and Australia. This follow-up survey was performed in 2015 in 40 countries among specialists from the pharmaceutical, infectious diseases and microbiology sectors in North America, Europe and Australia in order to assess the availability through usual marketing processes of 36 systemic antibiotics (addition of 3 antibiotics compared with the 2011 survey) selected for their ability to treat infections caused by resistant bacteria and their unique value for specific criteria. The questionnaire was sent by e-mail to national contacts belonging to ESGAP and ReAct networks. In all, 39 of the 40 countries participated in this survey. The number of available antibiotics differed considerably from one drug to another as well as from one country to another (e.g. 7 antibiotics available in Estonia, 24 in France). Overall, 25/36 selected antibiotics were marketed in 20/39 countries or less. From 2011 to 2015 (data available for both periods in 37 countries for 33 antibiotics), the number of available selected antibiotics increased in 13 countries and decreased in 17. In conclusion, despite the ongoing bacterial resistance crisis, the situation regarding the availability of ‘forgotten antibiotics’ has worsened since 2011. Urgent measures are needed to ensure better availability of these antibiotics on a global scale as a conservation measure to ensure sustainable and responsible use of antibiotics., peer-reviewed

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%)

WOS: 000432658100022, PubMed ID: 29550449, Objectives: The aim of this survey was to describe the current status of HIV care in the countries of Central and Eastern Europe and to investigate how close the region is to achieving the UNAIDS 2020 target of 9090-90. Methods: In 2014, data were collected from 24 Central and Eastern European countries using a 38-item questionnaire. Results: All countries reported mandatory screening of blood and organ donors for HIV. Other groups subjected to targeted screening included people who inject drugs (PWID) (15/24, 62.5%), men who have sex with men (MSM) (14/24, 58.3%), and sex workers (12/24, 50.0%). Only 14 of the 24 countries (58.3%) screened pregnant women. The percentages of late presentation and advanced disease were 40.3% (range 14-80%) and 25.4% (range 9-50%), respectively. There was no difference between countries categorized by income or by region in terms of the percentages of persons presenting late or with advanced disease. The availability of newer antiretroviral drugs (rilpivirine, etravirine, darunavir, maraviroc, raltegravir, dolutegravir) tended to be significantly better with a higher country income status. Ten countries reported initiating antiretroviral therapy (ART) regardless of CD4+ T cell count (41.7%), five countries (20.8%) used the threshold of, AIDS and STI Society-Turkey; Gilead SciencesGilead Sciences, The authors would like to thank Mike Youle and Ben Collins for encouraging them to develop this survey. This study was supported by an unconditional grant from the AIDS and STI Society-Turkey and Gilead Sciences.