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Background and Aims Methods Results Conclusions Chronic hepatitis delta represents a major global health burden. Clinical features of hepatitis D virus (HDV) infection vary largely between different regions worldwide. Treatment approaches are dependent on the approval status of distinct drugs and financial resources.The Hepatitis Delta International Network (HDIN) registry involves researchers from all continents (Wranke, Liver International 2018). We here report long‐term follow‐up data of 648 hepatitis D patients recruited by 14 centres in 11 countries. Liver‐related clinical endpoints were defined as hepatic decompensation (ascites, encephalopathy and variceal bleeding), liver transplantation, hepatocellular carcinoma or liver‐related death.Patient data were available from all continents but Africa: 22% from Eastern Mediterranean, 32% from Eastern Europe and Central Asia, 13% from Central and Southern Europe, 14% from South Asia (mainly Pakistan) and 19% from South America (mainly Brazil). The mean follow‐up was 6.4 (.6–28) years. During follow‐up, 195 patients (32%) developed a liver‐related clinical event after 3.5 (±3.3) years. Liver cirrhosis at baseline and a detectable HDV RNA test during follow‐up were associated with a worse clinical outcome in multivariate regression analysis while patients receiving interferon alfa‐based therapies developed clinical endpoints less frequently. Patients from South Asia developed endpoints earlier and had the highest mortality.The HDIN registry confirms the severity of hepatitis D and provides further evidence for HDV viraemia as a main risk factor for disease progression. Hepatitis D seems to take a particularly severe course in patients born in Pakistan. There is an urgent need to extend access to antiviral therapies and to provide appropriate education about HDV infection. [ABSTRACT FROM AUTHOR]

The ongoing coronavirus disease 2019 (COVID-19) outbreak was declared a pandemic by the World Health organization in early March 2020. The disease typically presents with viral respiratory symptoms that could progress to acute respiratory distress syndrome. Emerging evidence suggests different possible dermatologic manifestations of COVID-19, including: acral lesions (pernio-like, pseudo-chillblain), vesicular eruptions, macular and papular exanthema, urticaria, livedoid, purpuric and petechial rashes. However, specific skin manifestations of the COVID-19 disease have not yet been clearly established and the relationship between the appearance of skin lesions and SARS-CoV-2 infection is still unclear. These highly variable skin changes could represent a direct consequence of the viral infection, an immunological response to viral nucleotides, adverse reactions to drugs frequently used for the treatment of COVID-19, or other disorders. In a global effort to comprehend the exact cutaneous features of COVID-19, several international dermatological societies have initiated nationwide studies to analyze COVID-19 cutaneous manifestations during this pandemic. This paper represents a literature review of the scientific data available on the clinical characteristics and symptoms of the cutaneous manifestations associated with COVID-19. Such findings are extremely useful in establishing if dermatological manifestations in COVID-19 patients could harbor a diagnostic significance and subsequently be used as prognostic factors for outcomes of COVID-19. [ABSTRACT FROM AUTHOR]

Listeria monocytogenes is the pathogen responsible for one of the most common zoonosis spread through contaminated food. It is characterized by a high capacity to withstand poor environmental conditions and to form biofilm. In general population it is most often a food-born infection, but it affects especially pregnant women, newborns, elderly and immunosuppressed persons, causing meningoencephalitis in these patients, and rarely, cardiac or osteoarticular conditions etc. Over time, both sporadic and outbreaks with broad geographic distribution have been described in Africa, Europe, or in the United States of America. Over the last 3 years, Europe has faced an increased number of cases of listeriosis, spread due to frozen vegetables (especially corn). Using molecular tests, serotype IVb with the ST6 multilocular sequence was identified as prevalent during this outbreak. The contamination source is a Hungarian company that packed and sold frozen vegetables on the market. The infectious strain persisted despite cleansing and disinfection measures. It was subsequently spread to other European Union (EU) countries. Even if the frozen vegetables were largely distributed in Europe (including Romania), and the strain was isolated in more countries, human listerios linked to these strains were registered only in 5 states. Considerable efforts are being made in order to try to stop the spread of this outbreak by improving the hygiene, disinfection and control measures, and by withdrawing potentially contaminated products from the market. [ABSTRACT FROM AUTHOR]

Infectious meningitis is a serious medical problem that can be fatal if treatment is delayed. Objectives. There are presented clinical and laboratory aspects of patients with suspected meningitis, presented and hospitalized during 2014-2017 at Hospital for Infectious and Tropical Diseases Dr V. Babes Bucharest. Clinical and paraclinical variables that show statistically significant differences depending on the etiology of meningitis have been identified. Methods. Patients who showed signs and symptoms according to the case definition would be included in the study. Clinical and laboratory values were recorded in a database which was then processed to identify statistically significant differences between the group of patients with suspicion only but subsequently not ill against the group of confirmed, and also among different subgroups within the confirmed. Results. Of the 97 cases of infectious meningitis included within 3 years, 53 cases (55%) were viral, 31 (32%) bacterial, one case of fungal meningitis and 12 cases of tuberculous meningitis. [ABSTRACT FROM AUTHOR]

In this retrospective unicenter study we aimed to outline the key features of the first 100 cases of COVID-19 hospitalized in our clinic after designation of it as front line unit for hospitalization of these cases. Thus, the average age of cases was 44.7 years (SD: 15.9) and the prevalence of female was 57.4%. By age groups, prevalence of young patients (7.8%) was significantly (p < 0.05) lower than the prevalence of adult patients (77.2%). The most prevalent occupation (31.7%) was healthcare worker. The most frecvent exposure to source of infection was represented by attending healthcare facilities (44.6%), followed by having contact with COVID-19 confirmed/suspect case (30.7%), and recent international travel (18.8%). Of the 30% of cases in which at least one health precondition was recorded the most prevalent (13.9%) of such condition was chronic cardiovascular disease including high blood presure. In regard with severity, to note that 6 patients died within 14 days of hospital admission, all fatalities have occurred in very old patients and 83.3% of them had chronic kidney disease. In the end, we express the hope that data outlined in this paper will help for better management of COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

Varicella-zoster virus infection (VVZ) is an important cause of morbidity, with global spread, which causes two distinct clinical forms of disease: varicella and shingles. Primary infection with VVZ during pregnancy can have important consequences for both maternal and fetal health. Epidemiological data shows that vaccination significantly reduced the number of VVZ infections in both mothers and fetuses. Vaccination strategies vary according to the individual at risk (maternal, fetal, newborn, child), the moment with the highest infection risk (first-trimester of pregnancy, last trimester of pregnancy or postnatal) and the duration of the protective immunity after vaccination. The most common complication of chickenpox during pregnancy is varicella pneumonia that is manifested through cough, dyspnea, fever and tachypnoea. The effects of VVZ on the fetus can be: congenital varicella syndrome, premature or spontaneous abortion, neonatal varicella. Congenital varicella was first described in 1947. Spontaneous abortion rates, premature births and intrauterine death are not higher in pregnant mothers with chickenpox compared to those not infected. Neonatal infection results from the transmission of VVZ from mother to fetus during the perinatal period. [ABSTRACT FROM AUTHOR]

In the last 15 years Clostridium difficile infection became a typical new emergent threat worldwide. Our aim was to describe the risk factors associated with fatal outcome of Clostridium difficile associated disease (CDAD) cases treated in 2012 in "Dr Victor Babes" Infectious and Tropical Diseases Hospital, a 450 beds teaching clinic from Bucharest, Romania. Methods: Retrospective cohort study - the case records of hospitalized patients in the year 2012, presenting with diarrhea and that tested positive for C difficile through toxin A and B assays were reviewed. Data collected through chart review of CDAD were demographic and clinical. A Charlson comorbidities index score was allocated to each case. An EpiInfo data base was fed with demo and clinical data - software's facilities were used for univariate analysis (Chi square) and also for logistic regression. Results: In study were included all 326 hospitalization episodes with a discharge diagnosis of CDAD in 2012. Overall, 30 of the 326 CDAD patients (9.2%) versus 289 of the 18636 non-CDAD patients (1.55%) died during their hospital stay, resulting in a relative risk of pre-discharge death of 5.93 (4.14-8.50) for CDAD patients, a CDAD attributable risk of death of 7.65 per 100 patients and a CDAD attributable fraction of 83.15 % (70.1-86%). Unconditional logistic regression retained as fatal outcome predictors the following: (a) a Charlson comorbidity index score >3: (OR: 3.03; CI 95%: 1.21-7.54), (b) ICU stay: (OR: 15.81; CI 95%: 4.47-55.89) and (c) age >64 years: (OR: 2.95; CI 95%: 1.15-7.69). Conclusions: Our findings add to the understanding of Clostridium difficile fatal outcome and they have implications for prevention and therapy - the case fatality of 9.2% underlines the importance of the increased efforts in CDAD prevention. [ABSTRACT FROM AUTHOR]

Urticaria is a common and complex disease, with a profound negative impact on the socio-economic quality of life, involving direct and indirect increased costs. According to studies, the prevalence of urticaria exceeds 20%. The authors have proposed to assess the impact of Helicobacter pylori infection on the response to antihistamine treatment in patients with chronic idiopathic urticaria. Helicobacter pylori eradication was associated with increased efflcacy of the antihistamines treatment in CIU patients. Eradication of Helicobacter pylori infection can lead to improvement of symptoms, even if it has no direct role in the etiology of chronic idiopathic urticaria. [ABSTRACT FROM AUTHOR]

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

It is known that immune function decreases with age. There is the possibility that changes in the immune system to be a critical predisposing factor in the aging process; defining the immunological dysfunctionality in the elderly can add a new insight into the aging mechanisms. Getting older, there are alterations in the acquired immunity, especially in cells of the immune system T and B lymphocytes. Less scientifically proved are alterations in the innate immunity (dendritic cells, macrophages, polymorphonuclear leucocytes and complement) and in the mucosal immunity. [ABSTRACT FROM AUTHOR]

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

Introduction. Although SARS-CoV-2 infection is more common in adults, many cases have been reported in the pediatric population. Case presentation. An 8-month-old infant from twin pregnancy, confirmed with COVID-19, is hospitalized with nasal obstruction, serous rhinorrhea, rare cough and watery stools. The epidemiological link is known, both the parents and the maternal grandparents of the infant being confirmed with COVID-19. Biologically, he presented with thrombocytosis and discrete inflammatory syndrome, and the lung radiograph did not show any lesions. At the same time, the twin sister was hospitalized, who presented a similar symptomatology, with a negative SARS-CoV-2 PCR test, but the lung radiograph showed specific lesions of COVID-19. During hospitalization, 2 more SARS-CoV-2 PCR tests were performed, but with negative results. The evolution of the twins was favorable under symptomatic treatment, respectively antibiotic and symptomatic treatment. Conclusion. SARS-CoV-2 infection may be asymptomatic, especially in infants and newborns, and has a lower prevalence. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic has challenged the medical world in many ways regarding diagnosis troubles and therapeutic options. In this paper, we will present three cases of patients from different age groups, in which we identified specific ways of evolution, from both clinically and laboratory data point of view. We used a critical evolution risk estimation calculator at admission and compared the results with the subsequent evolution of patients. From the analysis of the presented cases, we found persistent organic damage that will require their long-term follow-up. [ABSTRACT FROM AUTHOR]

Knowledge about the manifestations of SARS-CoV-2 infection is constantly enriching as more reports of the disease appear. Anosmia, which had not been linked to SARS-CoV-2 infection at the beginning of the pandemic outbreak, later became, through evidence, an important symptom of the disease. In the presented paper we studied the correlation between this symptom and the complex pathological context of patients. Using statistical analysis we demonstrated that anosmia can be considered an independent predictor for the extended period of hospitalization in patients in the study group. [ABSTRACT FROM AUTHOR]

In March 2020, the first patients diagnosed with COVID-19 were hospitalized in the Infectious and Tropical Diseases Clinical Hospital „Dr. Victor Babes”. Of the 20 patients, 11 were male and 9 were female. Patients were aged between 3 to 56 years. 8 patients traveled outside Romania during the incubation period of the disease. The most common symptom cluster encompassed the respiratory system: fever, cough and shortness of breath. 2 patients presented severe forms of disease that required transfer to the intensive care unit. Radiologically, 18 patients had interstitial lung damage. All patients had a favorable evolution. [ABSTRACT FROM AUTHOR]

Currently, SARS-CoV-2 infection has affected the entire population of the globe, registering an alarming increase in the number of cases, but also in deaths. The main clinical expression of COVID-19 is pneumonia, for its evaluation being necessary an imaging characterization of lung lesions both by chest radiography and by computed tomography (CT) of the chest. Various studies performed on groups of patients revealed that CT examination is more accurately in diagnosing lung lesions at the onset of symptoms, but also before it. The most common lesions were multiple, bilateral, peripheral, in the lower lung fields. The appearance often varies between alveolar consolidation and groundglass. Also, the data from the relevant studies emphasize the possibility of the existence of early pathological aspects on CT acquisitions, which do not involve clinical expression. Thus, it can be stated that both investigations are crucial in assessing the impact of the new coronavirus infection on the lung parenchyma, but also in guiding therapeutic management. [ABSTRACT FROM AUTHOR]

• The patient was a 42-year-old male shepherd. • Anthrax meningoencephalitis with brain abscess was successfully treated. • Polymerase chain reaction: Bacillus anthracis cerebrospinal fluid, cutaneous lesions. • Magnetic resonance imaging: meningeal enhancement, multiple intraparenchymal lesions. • Magnetic resonance imaging at day 22 showed left parietal lobe lesion compatible with abscess. Bacillus anthracis is a sporulating gram-positive rod whose main route of entry into the human body is cutaneous. Anthrax meningitis is usually fulminant and fatal. We present here a successfully treated case of anthrax meningoencephalitis complicated with brain abscess. The patient was a shepherd, with disease onset 7 days prior to hospital admission with fever, chills, occipital headache, and vertigo, followed by right hemiplegia, motor aphasia, agitation and coma. He had cutaneous lesions with black eschar on the limbs, which was a clue (along with his occupation), for diagnosis suspicion. The polymerase chain reaction for B. anthracis DNA was positive in both cerebrospinal fluid and cutaneous lesions. The cerebrospinal fluid was compatible with bacterial meningitis without being haemorrhagic. Magnetic resonance imaging showed meningeal enhancement and multiple intraparenchymal heterogeneous lesions with an important haemorrhagic component in the left parietal lobe, surrounded by vasogenic oedema with maintenance, 22 days later, of the left parietal lobe lesion, having a ring contrast enhancement and a central diffusion restriction, compatible with an abscess. From admission, he was intensively treated with combined large-spectrum antibiotics; this could be the most valuable factor in the successful outcome. [ABSTRACT FROM AUTHOR]

The infection with hepatitis C virus has drawn attention to researchers from 1970. Nowadays, hepatitis C virus infection is a global public health issue, affecting approximately 3% of the global population. Experimental models provided vital data on the understanding of viral replication. Chronic infection with hepatitis C virus is generally a progressive lent disease characterized by the persistence of inflammation in the liver and correlated with the cirrhosis in about 20% of patients after 20-30 years of infection. Hepatitis C virus is still a public health threat, but progress in monitoring and treatment of infected patients is truly noticeable and has remarkably improved the prospects for this disease. [ABSTRACT FROM AUTHOR]

Background. Injecting drug users are a particular category of patients, where infectious pathology, including infectious endocarditis, is much more common. In Romania, in 2016 there were about 21,000 opioid users (www.ana.gov.ro). Besides opioid drugs, there are also ethnobotanics and a growing trend of injecting amphetamines. Material and methods. We present the case of a young drug user diagnosed in our hospital with infected mitral valve infectious endocarditis. Particularities consist of the type of affected valve and the involvement of a strain of methicillin-sensitive aureus staphylococcus (in a patient with multiple risk factors for infection with multi-resistant strains). Results. Clinical evolution is with many ups and downs because different complications occur, but after 54 days of hospitasization he is out, then valvular surgery takes place and he returns to our clinic for the antibiotic consolidation treatment. Conclusions. This is a case of severe infection in an IDU, with many features indicating a posible negative evolution. Proper antibiotic treatment, associated with other complementary medical interventions, conducted to the favorable uotcome of this young patient. [ABSTRACT FROM AUTHOR]

Pregnant and recently postpartum women with influenza are more likely to develop severe illness and die than the general population, based on data from seasonal influenza and from the influenza pandemics of 1918 to 1919, 1957 to 1958, and 2009 to 2010. The increased severity of influenza in pregnant and recently postpartum women is thought to be related to normal physiologic changes that occur during pregnancy. For example, heart rate and oxygen consumption increase and lung capacity decreases. Because of the increased severity of influenza in pregnancy and the postpartum period, inactivated influenza vaccine is recommended for these women, regardless of trimester of pregnancy. In addition, pregnant and postpartum women with suspected or confirmed influenza should receive prompt empiric treatment with an appropriate antiviral medication. [ABSTRACT FROM AUTHOR]

The era of oral direct antivirals has completely changed the picture of chronic hepatitis C. The rates of sustained virological response overpassed the 90% percentage, but new challenges are coming: the persisting liver disease, the complications on long term, the follow up. The new treatment came with the advantage of increased number of patients that can be treated (cirrhotic patients including the ones with advanced disease, the co-infected patients HCV-HIV, the patients with end stage renal disease). The experience with these drugs is relatively short, but there are some general recommendations for the post-treatment surveillance. This review discusses the recommended follow-up and the clinical findings in patients, after obtaining SVR (sustained virological response). [ABSTRACT FROM AUTHOR]

With the introduction of direct acting antivirals in the therapeutic armamentarium of hepatitis C (HCV), policy makers have set criteria for treatment eligibility. In Romania, the combination of ombitasvir/paritaprevir/ritonavir and dasabuvir is reimbursed for F4 fibrosis on liver biopsy/Fibromax, or F3 with contraindication to interferon (IFN). Our aim was to assess treatment eligibility and discordance between serological, elastometric and imaging evaluation of fibrosis in a cohort of patients with HCV. We evaluated both newly diagnosed and previously known HCV patients with advanced fibrosis, from our database, during a period of 7 months, between November 1st, 2015 and May 31st, 2016. Clinical, biological, ultrasound, elastography and endoscopy data were collected. Altogether 146 patients were assessed for treatment eligibility. Among them, 61% were females, with a mean age of 60 ± 8 years. Regarding treatment status, 52.5 % were naive, 27.4% nonresponders, 17.81% relapsers and 2.74% intolerant to bitherapy. 54.8% had elevated alpha-fetoprotein and were checked by advanced imaging for exclusion of hepatocellular carcinoma (HCC) - of them, 8 were diagnosed with HCC. On ultrasound, almost 1/2 patients had dilated splenoportal axis and at endoscopy 42% had esophageal varices. Transient elastography (Fibroscan) was done in 88/146 patients: 82.95% were F4, 1.14% F3-F4, 9.09% F3 and 6.82%

Introduction. Starting with 2016 Romania had to face an alarming measles outbreak due to the continuous poor vaccination coverage. The outbreak associated an increased number of complications and deaths. Materials and methods. We performed a retrospective study, on a group of patients with measles, admitted to „Dr. Victor Babes“ Hospital. Epidemiological data, clinical characteristics and the results of the biological samples were obtained from the patient's medical records between January 2016 and December 2017. Results. Out of the 632 patients, 341 (53.9%) were males. Most of them (39.2%) were children, between 1 and 4 year-old, while 19.6% were infants. A quarter of the patients (31.3%) had familial contact with a measles case. The vaccination history was unknown in 44.3% cases; almost half of the patients (47.1%) were unvaccinated. Almost all of them developed viral complications, 84.1% being diagnosed with interstitial pneumonia. Bacterial pneumonia was diagnosed in 15.0% cases, out of which 45.2% were also associated with respiratory failure. Six patients required transfer to the pediatric intensive care unit for respiratory support and 2 died. Other complications were: laryngitis 8.2%, otitis 12.0% of the cases. Also 61.77% of the patients were diagnosed with enterocolitis. There was no case complicated with encephalitis. 101 (15.9%) patients developed liver cytolysis, while dyselectrolytemia was present in 94 (14.8%) cases. Conclusions. The number of patients diagnosed with measles during the last years registered an alarming increase, especially in children under 4 year old, with a high number of complications. We consider it mandatory to apply the vaccination program to ensure an optimal vaccine coverage, useful both in stopping the current outbreak and in preventing future outbreaks. [ABSTRACT FROM AUTHOR]

Abstract: Background & Aims: Chronic hepatitis D (delta) is a major global health burden. Clinical and virological characteristics of patients with hepatitis D virus (HDV) infection and treatment approaches in different regions world‐wide are poorly defined. Methods: The Hepatitis Delta International Network (HDIN) registry was established in 2011 with centres in Europe, Asia, North‐ and South America. Here, we report on clinical/ virological characteristics of the first 1576 patients with ongoing or past HDV infection included in the database until October 2016 and performed a retrospective outcome analysis. The primary aim was to investigate if the region of origin was associated with HDV replication and clinical outcome. Results: The majority of patients was male (n = 979, 62%) and the mean age was 36.7 years (range 1‐79, with 9% of patients younger than 20 years). Most patients were HBeAg‐negative (77%) and HDV‐RNA positive (85%). Cirrhosis was reported in 48.7% of cases which included 13% of patients with previous or ongoing liver decompensation. Hepatocellular carcinoma (HCC) developed in 30 patients (2.5%) and 44 (3.6%) underwent liver transplantation. Regions of origin were independently associated with clinical endpoints and detectability of HDV RNA. Antiviral therapy was administered to 356 patients with different treatment uptakes in different regions. Of these, 264 patients were treated with interferon‐a and 92 were treated with HBV‐Nucs only. Conclusions: The HDIN registry confirms the severity of hepatitis delta but also highlights the heterogeneity of patient characteristics and clinical outcomes in different regions. There is an urgent need for novel treatment options for HDV infection. [ABSTRACT FROM AUTHOR]

Abstract: Background: Direct antiviral agents (DAA) showed very good results in terms of efficacy and safety in clinical trials, but real‐life data are still needed in order to confirm this profile. Material and methods: In Romania, through a nationwide government‐funded programme in 2015‐2016, approx.5800 patients with virus C cirrhosis received fully reimbursed DAA therapy with OBV/PTV/r+DSV+RBV for 12 weeks. We analysed a national prospective cohort enrolling the first 2070 patients, all with genotype 1b. The only key inclusion criteria was advanced fibrosis (Metavir stage F4) confirmed by Fibromax testing (or liver biopsy/Fibroscan). Efficacy was assessed by the percentage of patients achieving SVR 12 weeks post‐treatment (SVR12). Results: Forty patients stopped the treatment because of hepatic decompensation (1.9%), 21 stopped because of other adverse events and one was lost to follow‐up. This cohort was 51% females, mean age 60 years (25÷82), 67% pretreated, 70% associated NASH, 67% with severe necro‐inflammation (severity score 3‐Fibromax), 37% with comorbidities, 10.4% with Child Pugh A6, 0.5% B7. The median MELD score was 8.09 (6 ÷ 22). SVR by intention‐to‐treat was reported in 1999/2070(96.6%), 55/2070 failed to respond. Liver decompensation was statistically associated in multivariate analysis with platelets< 105/mm3(P = .03), increased total bilirubin (P < .001), prolonged INR (P = .02), and albumin<3.5 g/dL (P = .03). Conclusions: OBV/PTV/r+DSV+RBV proved to be highly efficient in our population of cirrhotics with a 96.6% SVR. Serious adverse events related to therapy were reported in 61/2070(2.9%), most of them liver decompensation (1.9%), related to hepatic dysfunction, and lower platelet count. [ABSTRACT FROM AUTHOR]

We report the first two cases of imported Zika virus (ZIKV) infection in Romanian patients returning from areas with ongoing outbreaks and challenges for laboratory diagnostic; first one with a classical pattern of acute flaviviral infection and the second one with an interesting pattern of a secondary flaviviral (ZIKV) infection in a yellow fever-vaccinated child living abroad in an endemic area. [ABSTRACT FROM AUTHOR]

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

Introduction. In the history of his usage, by the 1850`s, Lithium was first used for the treatment of the gout. As mania and melancholia were included in the same diagnostic group, Lithium started to be used for the treatment of mental disorders. Nowadays, Lithium is still used in the bipolar disorder and as adjuvant in depression, schizophrenia, schizoaffective disorder and for the control of child aggressiveness. Methods and objective. Reporting a case of Lithium Intoxication in a patient with infection and chronic treatment with Lithium Carbonate. Objectives. Reporting a case of Lithium Intoxication in a patient with streptococcal angina infection and chronic treatment with Lithium Carbonate. Conclusion. Lithium intoxication may be rare in medical practice because of rare usage of Lithium therapy and strict monitorization of serum concentration. In this case, the tonsillar infectious accompanied by fever, impossibility of proper oral hydration and impairment of renal functions were the initial trigger of the pathological mechanism of intoxication syndrome. Secondary, the excretion of Lithium decreased and the low serum volume led to high blood concentration of Lithium. Later on, the gastrointenstinal impairment which appeared slowly added to the vicious circle which involved hydration, excretion and serum concentration of Lithium producing and intoxication syndrome. [ABSTRACT FROM AUTHOR]

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

Introduction: Chronic hepatitis C cases diagnosed in Romania were mostly related to unsafe parenteral treatments and blood transfusions; HCV genotype 1b was prevalent. During the last decade, an increasing number of HCV infections was reported among people who inject drugs (PWID). The aim of the current study was to test if this epidemiological shift triggered a diversification of the circulating viral strains. Methodology: HCV genotypes were determined by reverse hybridization in 130 HCV-infected PWID (87.7% males; mean age 27.9 ± 6.7 years, injecting drugs for 8.1 ± 4.8 years). Results: HIV-HCV co-infection was diagnosed in 80.8% of the subjects and 26.9% were HIV-HCV-HBV triple infected. Active HCV viral replication was present in 104 PWID (80%), more frequently in those HIV-co-infected (91.4% vs. 52% in HCV mono-infected, and 77.148.5% in HIV-HCV-HBV triple-infected, p = 0.0001). Non-1b genotypes were prevalent (54.8%), with subtype 1a the most commonly detected (24%), followed by genotypes 3a (14.4%) and 4 (7.7%). Mixed infections with genotypes 1a and 1b were found in nine subjects (8.7%). There was no difference in the genotypes frequencies based on HIV or HBV co-infection status, length of drug usage, or associated risk factors (tattoos, piercing, detention). Conclusion: The continuous surveillance of HCV genotypes in PWID from Romania will add valuable information to the overall European epidemiological picture, with important therapeutic implications. [ABSTRACT FROM AUTHOR]

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

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

• Prognosis of unfavorable outcomes in West Nile virus neuroinvasive infection. • The relative risk for death by age. • Encephalitis, meningoencephalitis, meningitis. • Glasgow coma score was correlated with evolution to death. • Risk score was calculated according to age, co-morbidities, clinical manifestations. WNV causes 1.4% of all central nervous system infections and is the most common cause of epidemic neuro-invasive disease in humans. 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. 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. 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. 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. [ABSTRACT FROM AUTHOR]

Introduction In the last years, we observed an alarming increase in the number of newly diagnosed HIV infected intravenous drug users (IDUs) co-infected with hepatitis viruses or with severe bacterial infections. The aim of our study was to assess the incidence, the demographic and clinical characteristics of IDUs diagnosed with HIV, HCV and tuberculosis (TB). Materials and Methods Prospective study on HIV infected IDUs with HCV and TB admitted in a single centre between January 2009 and April 2014. Data were compared to a group of HIV infected IDUs without TB. Statistical analysis was performed using Graphpad Prism 4.01. Results Out of 450 HIV infected IDUs, 134 (29.7%) were diagnosed with HIV, HCV and TB. TB incidence among IDUs increases from 0% in 2009 to 30.2% in 2013. The TB coinfected patients had a mean age at diagnosis of 30 [15-56] years; were in majority males, 106 (84.4%); from urban areas, 120 (89.5%); and had significantly lower education level (85% vs 68.3%, p<0.0001) and higher rates of unemployment (80% vs 55%, p<0.0001) than those without TB. The median CD4 cell count was lower in the TB versus non TB IDUs (143 vs 472/mm3, p<0.0001). TB infected IDUs tend to be more frequently late presenters (59.7 vs 24.6, p<0.0001) and to have advanced HIV disease (47.7 vs 7.59%, p<0.0001) than those without TB. TB cultures were positive in 64 (47.7%) patients, 3 (2.2%) had multidrug resistant TB and 2 (1.5%) had extended drug resistance. Disseminated and/or extrapulmonary TB was diagnosed in 51 patients (38%). The overall mortality rate was higher in TB compared to non TB IDUs (19.4% vs 8.2%, p=0.0007), disseminated TB being associated with the most severe immunosuppression (median CD4 cell count 42/mm3) and the highest mortality rate (27.4%). Conclusions The incidence of TB in HIV/HCV coinfected IDUs was high and rose over the time. TB infection was more frequent in patients with severe immunosuppression and the mortality rate was higher in IDUs with disseminated and/or extrapulmonary disease. IDUs are important candidates for acquiring and transmitting HIV infection, viral hepatitis and TB, being difficult to control due to their high-risk behaviours. Strengthening of HIV transmission prevention strategies, particularly in identified risk groups, is mandatory. [ABSTRACT FROM AUTHOR]