Antiretroviral Therapy Switch in HIV-Infected Adults from a Regional HIV/AIDS Center in NE Romania.

Background and Objectives: Antiretroviral therapy (ART) has revolutionized the management of HIV infection, transforming it from a once-debilitating disease to a chronic, manageable condition. However, challenges such as treatment resistance, medication side effects, and long-term tolerability persist, prompting the exploration of novel therapeutic approaches. We aimed to highlight the characteristics and related comorbidities of HIV/AIDS cases in which the antiretroviral therapy was modified. Material and Methods: A cross-sectional clinical investigation was conducted on adults diagnosed with HIV/AIDS who were hospitalized at the "St. Parascheva" Clinical Hospital of Infectious Diseases in Iasi in the Northeastern region of Romania. The timeframe under investigation was 1 January 2023 to 30 June 2023. Results: In the Northeastern part of Romania, from a total of 1692 patients in the active records, there were a total of 148 recorded cases of antiretroviral therapy switch in HIV-infected patients. The main reason for the ART switch was the simplification of the ART regimen (82 cases, 55.40%), viro-immunological failure (16 cases, 10.66%), other disturbances correlated to the ART regimen, dyslipidemia (34 cases 22.97%), depression (3 cases, 2.02%), suicide attempt (1 case, 0.67%), new situations, including the appearance of pregnancy (3 cases 2.02%), and tuberculosis (9 cases, 6.08%). ART before the switch was represented by protease inhibitors that accounted for 84 cases (56.75%) of the ART switch. Following the therapy switch, integrase inhibitor-based ART single-tablet regimens accounted for 43.91% (65 cases) of all changeovers, with non-nucleoside reverse transcriptase inhibitor regimens coming in second, in 63 cases, 42.66%. Conclusions: ART switch as an experimental therapy offers a promising approach to optimizing HIV treatment outcomes. By focusing on viral suppression and immune reconstitution, addressing treatment challenges, and exploring novel ARV agents, ART switch strategies aim to improve the overall health and well-being of individuals living with HIV.

Profile of Newly Diagnosed Patients with HIV Infection in North-Eastern Romania.

Background and Objectives: Human immunodeficiency virus infection and the acquired immunodeficiency syndrome (HIV/AIDS) pandemic are unquestionably the most serious public crisis of our time. Identifying, preventing, and treating HIV-associated comorbidities remains a challenge that must be addressed even in the era of antiretroviral therapy. Materials and Methods: In this study, we aimed to characterize the aspects of newly diagnosed patients with HIV/AIDS, during 2021-2022 in Northeastern Romania. We reviewed the frequency and associated comorbidities of these patients in correspondence with national and global results. Results: Our study found that of all newly diagnosed HIV cases (167 cases-74 cases in 2021 and 98 cases in 2022), 49.70% were diagnosed with HIV infection and 50.30% had AIDS. Based on sex correlated with the CD4+ T-lymphocyte level, the most affected were males, with a lower CD4+ T-lymphocyte level overall. The average HIV viral load was 944,689.55 copies/mL. Half of males had an abnormal ALT or AST (39.53% and 49.61%); as for the females, less than a quarter had an increased value of ALT or AST, respectively (18% and 26%). The most frequent co-infections were as follows: oral candidiasis (34.73% of patients), hepatitis B (17.37% of patients), and SARS-CoV-2 infection (8.38%), followed by hepatitis C (6.39%), tuberculosis (TB), syphilis, toxoplasmosis, Cryptococcus, Cytomegalovirus infections. Males were more affected than females, with a higher percentage of co-infections. The prescribed antiretroviral treatment focused on a single-pill regimen (79.04%) to ensure adherence, effectiveness, and safety. Therefore, 20.96% had been prescribed a regimen according to their comorbidities. Conclusions: Our study found a concerning rise in the incidence of HIV in 2022 compared to that in 2021 in Northeastern Romania, because of the rise in post-SARS-CoV-2 pandemic addressability. Advanced immunodeficiency and the burden of opportunistic infections characterize newly diagnosed HIV patients. The physicians should keep in mind that these patients may have more than one clinical condition at presentation.

NEW PERSPECTIVES IN THE DIAGNOSIS AND THE TREATMENT OF CHILDHOOD FEBRILE EXANTHEMAS.

A child with a febrile exanthema is a complex medical problem involving diagnostic challenges, epidemiological threats and a great concern for the parents and any physician, should be prepared to deal with it. Many of the classical ones (measles, rubella, chickenpox) have now a decreased incidence due to a high vaccine coverage, which makes even harder for the physician to establish an early diagnosis. To the untrained eye most of them are difficult to differentiate. Their prompt recognition is necessary in order to manage them adequately and to prevent spreading of the disease.

Diagnostic and prognostic value of presepsin in the emergency department.

UNLABELLED: Sepsis syndrome is a common situation and has devastating implications on health care systems worldwide. Biomarkers may have an important role to highlight the presence, absence or severity of sepsis. MATERIAL AND METHODS: Retrospective study is conducted on a group of 95 suspected sepsis patient (0.16%) out of a total of 56,996 patients that were presented in the Emergency Department/Emergency County Hospital "St. Spiridon" from Iasi during 01.01.2012-01.12.2012. The study aims to establish the following: the incidence of sepsis diagnosis, analysis of prognostic factors, relationship between the presepsin value and clinical outcome. RESULTS: In men, there was a distribution of cases between the age of 22 years up to 89 years with an average confidence interval between 59.32 and 67.23 years, and the distribution of cases varies among women from age of 40 years up to 93 years, with an average confidence interval between 65.53 and 75.47 years The most frequent primary source of infection is localized at the pulmonary level, in a total of 21.1%, followed by abdominal location occurring in a total 14.7%. Area under the curve in ROC curve analysis regarding mortality showed significant values of area for presepsin (0.859), leukocytes (0.790), traumatic injuries association (0.761) and the presence of gastrointestinal history. CONCLUSIONS: Presepsin has diagnostic value, early prognostic value and is an early marker of mortality in septic patients. Trauma associated with severe systemic infection leads to an increase in mortality.

Lymphoma in an HIV-positive patient.

HIV/AIDS is considered to be revealing of oncological diseases, of which most frequent are lymphomas. The main causes for this type of disease are non-adherence and non-compliance to antiretroviral therapy (ART). We are hereby presenting a clinical case of lymphoma in an HIV-infected adult, with non-adherence for 30 months. In such a case the interdisciplinary collaboration with the hematologist was essential for the patient's survival.

Responsibility and expectations in antiretroviral therapy--patients' versus doctors' perspective.

AIM: This paper aims to uncover what patients really expect form ART, and also what infectious diseases doctors expect from a patient's ART regime, thus exploring an important side of adherence to ART. MATERIAL AND METHODS: From July to November 2014 we have conducted a qualitative study regarding both patients' and doctors' expectations form the ART. We interviewed 30 patients and 4 doctors. We used semi-structured interviews that were conducted in the Psychosocial Compartment of the HIV/AIDS Regional Center in Iasi. RESULTS: The patients we interviewed came from all 6 counties in the Moldova area. Age varied from 16 years to 59 years; 55% were female and 45% male. 30% came from a rural area. The most common expectations that patients have regarding ART are: "to help me live", "not to make me feel sick", "to be easy to take (not to big, not a lot)", "not to show on the outside what I have on the inside". The infectious diseases doctors that we interviewed work in the HIV/AIDS Regional Center in Iasi. Their expectations regarding an ART regimen for patients were: "to reduce HIV viral load", "to increase CD4 cell count" and "to have minimal impact on the proper functioning of other organs". Patients consider themselves the only factors responsible for their own ART adherence in 56.6% of cases; 20% consider the doctor to be responsible for their adherence, 16.6% feel that their family, friends, and spouse are responsible, and 6.6% (2 patients) couldn't answer. Infectious diseases doctors considered that patients are 100% responsible for adhering to the antiretroviral therapy. CONCLUSIONS: In order to assure adherence to the ART it is important to explore both the doctor and the patient's perspective and to find ways to find a common ground in building a healthy relationship.

The HIV-positive patient in intensive care--psychological profile.

AIM: This paper aims to outline the profile of HIV-positive patients in intensive care, in terms of psycho-emotional and vital parameters. MATERIAL AND METHODS: We evaluated the HIV-positive patients that required intensive care (IC), from January 2011 to December 2013, in the HIV/AIDS Regional of the "Sf. Parascheva" Infectious Diseases Clinical Hospital Iasi. RESULTS: From January 2011 to December 2013, the HIV/AIDS Regional Centre in Iasi recorded 2649 hospitalizations, of which 0.67% (18 cases) required intensive medical care. Of these 10 were males and 8 females, aged between 24 and 65 years with a median of 24 years. There were 29 deaths (1.09% of all hospitalizations), 11 of which in intensive therapy (38% of all deaths)--7 men and 4 women. CD4 counts in persons requiring IC care were between 1 and 112/mm3, and most naive patients who died were late-presenters. The main diseases diagnosed were pulmonary tuberculosis and pneumocystosis, the main cause of death being multiple organ failure. The duration of hospitalization ranged between 4.5 and 30 days. Treatment success rate was correlated with the CD4 and biological status: liver and renal failure, respiratory failure, meningeal coma, hypoproteinemia, diselectrolitemia. From a psychological perspective, patients that arrived in the intensive care showed a history of non-compliance and non-adherence, a personality structure often marked by a lack of respect for them, indifference or ignorance regarding the factors that generate well-being. CONCLUSIONS: HIV-positive patients in the position of requiring intensive care showed a marked immunological collapse due to abandonment of therapy or late detection.

The psycho-emotional profile of the HIV-positive naïve patient.

AIM: The paper aims to outline the naïve HIV-positive patient's profile, in terms of feelings and emotions post-diagnosis. MATERIAL AND METHODS: The evaluation took place from January 2011 to December 2013 in the Psycho-social Assistance Office of the "Sfânta Parascheva" Infectious Diseases Hospital in Iasi. We evaluated 146 patients newly diagnosed with HIV infection, both in terms of immunological and virusological and from a psychological perspective, using the Hamilton Anxiety Scale (HAMA), Beck Depression Inventory II (BDI) and the clinical interview. RESULTS: In a period of 3 years (January 2011 - December 2013) we registered in the HIV/AIDS Regional Center in Iasi, 146 new cases of HIV infection in adults, with distribution by years as follows: 46 in 2011, 45 in 2012, 55 in 2013; 39 cases were in Iasi, 39 in Suceava, 26 in Botosani, 18 in Neamt 18, 16 in Bacau and 6 in Vaslui. Of these, 51 were women and 95 men, aged between 24 and 46 years. From the immunological point of view, 11% of patients had values of CD4 > 500 (16 patients), 47% between 500 and 100 (69 patients) and 42% < 100 (61 patients). From a psychological perspective, the clinical interview revealed a state of fear in 68.5% of cases (fear of death, fear of complications, fear of other people's reaction to the diagnosis), confusion in 62% of cases (in terms of diagnosis, the mode of infection, the future), anger in 27% of cases (against the source of infection, against themselves, against God or divinity), guilt and self-blame in 7% of cases. Beck Depression Inventory (BDI) revealed moderate depression in 14% of patients; mild depression in 27% of patients and 58% of patients presented no symptoms of depression. Regarding the anxiety scale HAMA, in 54% of cases it showed mild anxiety, average anxiety in 28% of cases, 14% severe anxiety and 3% (4 cases) very severe anxiety. CONCLUSIONS: Patients newly diagnosed with HIV are a vulnerable population with a specific psycho-emotional profile. Multidisciplinary knowledge--in medical, psycho -emotional and social terms--of the patient's characteristics and needs helps to support adherence to the antiretroviral therapy and improve the quality of life.

Interdisciplinary correlations regarding the clinical and paraclinical evaluations in HIV-positive pregnant women.

UNLABELLED: HIV infection in pregnancy has an increasing prevalence due to the effectiveness of antiretroviral therapy. The risk of HIV vertical transmission varies between 15-20 % in European women who do not breastfeed and 25-40% in African mothers who breastfeed. The most important predictive factor of the vertical transmission is maternal plasma HIV viral load. Vertical transmission can be largely prevented by prenatal screening, perigestational ART, an adapted obstetrical attitude and exclusively artificial feeding of the infant. MATERIAL AND METHOD: The study included 36 HIV-positive pregnant women, between 2012-2014, at age of 25-32 years. RESULTS AND DISCUSSIONS: It has been found that the birth weight was less than 2,700 grams in all newborns of HIV-positive pregnant women or those with advanced disease (AIDS) and, also, they received an APGAR score less than 7. The primordial desideratum is to decrease the rate of mother-fetus vertical transmission, thus the caesarian section has been established as the birth method in all HIV-positive pregnant women after 38 weeks of amenorrhea, on intact membranes, outside labor, resulting in halving the percentage of HIV-positive children. A very important role belongs to the interdisciplinary collaboration between the obstetrician and the infectious diseases specialist during the pregnancy, but also during the postpartum period. The role of the obstetrician is present in all the moments of pregnancy evolution. The HIV-positive pregnant woman is included in the group of high risk pregnancies.

Hepatorenal dysfunction in sepsis: epidemiological, clinical and laboratory aspects.

UNLABELLED: The major impact of sepsis-induced multiple organ dysfunction on healthcare system in the European Union was estimated at 90.4 cases per 100000 inhabitants, compared to 58 per 100000 for breast cancer. The association of organ dysfunctions in terms of both the number of dysfunctions and the degree of organ dysfunction is the most powerful predictor of death in sepsis. AIM: To find medical and statistical correlations in hepatorenal dysfunction in sepsis patients. MATERIAL AND METHODS: This retrospective study included 117 patients diagnosed with sepsis at the Iasi Infectious Diseases Hospital, patients who presented liver/renal and other organ dysfunctions. The clinical, etiological, and laboratory data, and APACHE II prognostic scores were analyzed. The data were processed using SPSS version 16.0. RESULTS: The etiological agents were Gram positive as well as Gram negative bacteria, and 40% of sepsis patients with hepatic/kidney dysfunction presented hepatorenal syndrome. CONCLUSIONS: Over one-third of patients with sepsis-related hepatorenal dysfunction had a creatinine clearance of less than 30 ml/min, and we found statistical correlations between serum creatinine and APACHE II score. There were no statistically significant differences between the survival curves of patients with hepatorenal syndrome and those with sepsis-related hepatorenal dysfunction.

Clinical-epidemiological trends of herpes zoster: a 5-year study.

UNLABELLED: Herpes zoster (shingles) is a neurocutaneous viral disease, in recent years its incidence increasing throughout the world. AIM: To study the incidence of herpes zoster among Iasi county patients requiring hospital admission and to analyze the clinical and epidemiological features and socioeconomic status of the study group. MATERIAL AND METHODS: Retrospective study of 158 patients admitted to the largest clinical dermatology department in North-eastern Romania, the Clinical Dermatology Department of the Iasi "Sf. Spiridon" University Emergency Hospital. The study was conducted over a period of five years and included the analysis of epidemiological data, socioeconomic status, clinical forms of disease, associated diseases, pathology reports for skin biopsy fragments, administered treatment, and disease course. RESULTS: This study confirms that shingles is not a sex-specific disease, the female/male ratio being 1.22: 1. Most patients belonged to the age group 70-80 years, accounting for about 35% of all patients, followed by the age group 60-70 years (24.6% of cases). A slight increase in the number of cases was recorded in autumn and summer in patients living in rural areas. 1.3% of the cases were diagnosed both with the disseminated form of disease, and complications (eczematization, bacterial superinfection, skin necrosis). 7.6% of patients presented additional skin disorders (pityriasis versicolor, impetigo, psoriasis vulgaris, mucocutaneous candidiasis), which raised the suspicion of an immune deficiency predisposing to shingles. The absence or late initiation of specific antiviral therapy correlated with prolonged hospital stay up to 4-6 days. We found an association between the erythematous form of shingles and young age, while the hemorrhagic or necrotic forms were present in the elderly and/or ill patients. The course was favorable and the length of illness was significantly shortened when the treatment adequate to the clinical form was administered. Associated comorbidities (essential hypertension 38.6%, dyslipidemia 24.6%, diabetes, mellitus 9.49%, chronic venous disease, other skin diseases) represent a factor complicating the development of herpes zoster by the cumulative stress the body is exposed to. CONCLUSIONS: The main statistically significant epidemiological data in the study group are: older age (over 60 years), associated diseases (which by the marked imbalances induced in the body increase the risk of varicella zoster virus reactivation) intense psychological stress. The following parameters did not change the risk of developing shingles: area of origin, sex, the season at disease onset, number of hospital days, and administered treatment. Early diagnosis and treatment of this disease is important for maintaining a good quality of life, to avoid complications, to limit the extent of the disease and its transmission to others.

Efficacy and safety of darunavir (Prezista(®)) with low-dose ritonavir and other antiretroviral medications in subtype F HIV-1 infected, treatment-experienced subjects in Romania: a post-authorization, open-label, one-cohort, non-interventional, prospective study.

INTRODUCTION: The aim of the study was to assess the safety and efficacy of darunavir (Prezista(®)) used in subtype F human immunodeficiency virus - type 1 (HIV-1) infected, antiretroviral therapy (ART)-experienced patients in Romania in routine clinical practice. METHODS: This was a post-authorization, open-label, one-cohort, non-interventional, prospective study conducted at multiple sites in Romania to assess efficacy (CD4 cell count, viral load, and treatment compliance) and safety ([serious] adverse events, clinical laboratory evaluation, and vital signs) of darunavir in combination with low-dose ritonavir (DRV/r) and other antiretroviral (ARV) medications in subtype F HIV-1 infected subjects in naturalistic settings. Seventy-eight subjects were recruited by 9 investigational sites and received 600/100 mg DRV/r twice daily. RESULTS: Treatment with DRV/r administered with other ARV medications resulted in the expected, statistically relevant improvement of CD4 cell count and viral load in subjects eligible for such treatment. In addition, adherence to treatment was high and the treatment-emergent safety profile observed during this study was consistent with the established safety profile of darunavir. CONCLUSION: DRV/r administered in combination with other ARV medications in subtype F HIV-1 infected subjects in naturalistic settings proved to be an effective and safe treatment in Romania. TRIAL REGISTRATION: NCT01253967.

Epidemiological and laboratory features of chronic hepatitis B cases in the interval 2010-2013.

UNLABELLED: HBV virus infection is an important public health problem because of its huge transmission potential, and severe evolution to cirrhosis or liver cancer. AIM: Analysis of the epidemiological and laboratory features of chronic hepatitis B virus infection. MATERIAL AND METHODS: The patients with chronic hepatitis B admitted to the "Sf. Parascheva" University Hospital for Infectious Diseases in the interval: January 1st, 2010 - December 31st were analyzed. RESULTS: Patients age was 18 to 66 years with a prevalence of middle-aged males. Most patients came from urban areas. Alanine aminotransferase (ALAT) levels were elevated, without significant differences between HBeAg-positive and HBeAg-negative patients, the elevated ALAT levels being associated with the increased prevalence of fibrosis. HBeAg-positive patients had viral loads above the threshold of 2,000/l in 34 cases (89.5%), and below 2,000 IU/l in only 10.5% of cases, and the majority (88%) of HBeAg-negative patients presented high viral load levels. The prevalence of stage F2-F4 liver fibrosis was 63.4% in the HBeAg-negative patients with viremia > 25,000 IU/l compared to 55.2% in the HBeAg-positive patients. The correlation between the level of viral load and fibrosis shows that there are significant differences between viremia and the status of HBeAg-positive or negative patients. Increased viral load was correlated with increasing prevalence of fibrosis, significant in HBeAg-negative patients, and the increasing fibrosis prevalence was correlated with low viral load. CONCLUSIONS: The correlation between viral load and fibrosis shows that there are significant differences between viral load and the status of HBAg-positive or negative patients.

Influence of antibiotic therapy prior to admission on the efficacy of classical methods for the diagnosis of meningococcal disease.

AIM: To assess the influence of preadmission antibiotic therapy on the results of the classical methods for bacteriological confirmation of meningococcal disease (MD). MATERIAL AND METHODS: Retrospective study of the MD cases diagnosed in the "St. Parascheva" Universitary Clinical Infectious Diseases Iasi between 1994 and 2011. RESULTS: The etiological diagnosis was made by identifying the meningococcus in the CSF (cerebrospinal fluid) in 71.9% of the 323 patients and by blood culture in 8%. Preadmission antibiotic therapy received 39% of the patients, thus the sensitivity of test was significantly reduced: direct examination from 64.6% to 43.2% (p < 0.001), cultures from 55.9% to 27.2% (p < 0.001), and latex-agglutination from 84.6% to 58.8% (p = 0.003). The rate of positive CSF decreased from 82.1% to 56% (p < 0.001). Preadmission antibiotic therapy significantly increased the ratio of cases in which meningococcus was not detected in CSF by any of the classical methods (44% compared to 17.9% in the cases without prior treatment). The proportion of cases in which meningococcal isolation was done by two methods decreased from 38.5% to 19.2%, and of those by all three methods from 16.9% to 5.6% (p < 0.001). Preadmission antibiotic therapy also decreased the rate of positive blood cultures from 14.7% to 3.5% (Fisher's exact test, p = 0.009). CONCLUSIONS: Antibiotic treatment prior to admission significantly decreases the percentage of patients with MD in which meningococcal isolation can be done; this requires the use of a more sensitive diagnosis method (ex. qPCR).

Characteristics of co infection with hepatitis B virus among Romanian patients infected with human immunodeficiency virus.

AIM: To determine the epidemiological and viroimmunological features and outcome of HIV/HBV-co infected patients cared in the lasi HIV/AIDS Regional Center. MATERIAL AND METHODS: This retrospective study included 252 patients diagnosed with HIV infection and associated hepatitis B virus (HBV) infection assessed at the Hospital of Infectious Diseases in the interval 2000-2013 and treated with antiretroviral drugs active against both HIV and HBV. RESULTS: The prevalence of HIV/HBV co infection was 19.9%. A slightly higher frequency of this co infection was found among males (53.2%); most patients belonged to age group 20-29 years (86.5%), mean age was 25.56 years. The predominant route of transmission was parenteral (58.5%), followed by heterosexual transmission (40.1%). The mean CD4 cell count was 246.20 cells/mm3, in over 41% of cases CD4 count ranging from 200 to 499 cells/mm3. The mean HIV plasma viral load was 142,906 copies/ml. ALT levels varied between 10-323 IU/l, average 49.90 IU/l, over 65% of subjects having pathological levels. In 21.8% of the cases, total cholesterol was very high, and in 16.8% of the patients the serum triglyceride levels were below the reference range (160 mg %). CONCLUSIONS: Our results suggest that HIV-positive patients, chronic hepatitis B infection has a high incidence, especially in younger age groups and is correlated with significant degrees of immunosuppression.

Clinical features and evolution of organ dysfunctions in sepsis.

UNLABELLED: In sepsis, the systemic inflammatory response is adapted to the etiologic agent and the increase in the level of mediators is associated with organ dysfunction. Currently, a rapid assessment of patient ability to develop an adequate immune response is not possible, the response mechanisms being similar in the context of different etiological agents. AIM: To find statistical arguments for the evolution of laboratory parameters in sepsis patients. MATERIAL AND METHODS: This retrospective study included 90 patients diagnosed with sepsis. The clinical, etiological, and laboratory data, and Carmeli and APACHE II prognostic scores were analyzed. The data were processed using SPSS version 16.0. RESULTS: The causative agents was identified in 16 cases; organ involvement and systemic response varied, and no statistical correlations were found between the inflammatory syndrome parameters and Carmeli or APACHE II prognostic scores or identification of the causative agent. CONCLUSIONS: Statistical correlations were found between maximum blood glucose levels and the presence of organ dysfunction in the studied sepsis patients. No correlations were found between sepsis severity and the presence of anemia or thrombocytopenia, or between fever syndrome and inflammatory syndrome.

Viral meningitis admitted to an infectious diseases hospital: a retrospective case series.

UNLABELLED: Given its epidemic potential and development of severe forms of disease, viral meningitis (VM) is a serious public health problem. AIM: to characterize the main clinical, epidemiologic features, the etiology and treatment of VM cases admitted to the Iasi Infectious Diseases Hospital, in 2012. MATERIAL AND METHODS: We retrospectively analyzed the medical records of the patients admitted for viral meningitis at the Iasi "St. Parascheva" Infectious Diseases Hospital in the interval January 1- December 31, 2012 (98 cases). The etiologic diagnosis was made by determining the IgM/IgG antibodies against Coxsackie virus and/or West Nile virus in blood/CSF. RESULTS: There was a fourfold increase in the number of cases as compared to the average for the years 2009-2011. Most cases (73.5%) were children aged 1 to 14 years. 61.8% of patients were males, 51.7% from urban areas. The most common symptom was headache (85.7%), followed by fever (77.6%), and vomiting (66.3%). Neck stiffness was absent in 28.6% cases. In43.5% of the 39 patients serologically investigated a Coxsackie virus infection was confirmed and 1/20 was positive for West Nile virus; three varicella-zoster virus infections and one mumps infection were diagnosed clinically. 68.3% of the patients received first-line antibiotic treatment. CONCLUSIONS: The illness mainly affected children, fever and neck stiffness being sometimes absent. The etiology was known in 22.4% of cases; enter viruses being the most frequent causative agent. Most patients received antibiotic therapy. The course was favorable in all cases.

Pseudomembranous colitis associated with a triple therapy for Helicobacter pylori eradication.

Helicobacter pylori (H. pylori) is one of the most common chronic bacterial infections in humans, affecting half of world's population. Therapy for H. pylori infection has proven to be both effective and safe. The one-week triple therapy including proton pump inhibitor, clarithromycin, and amoxicillin or metronidazole is still recommended as a first-line treatment to eradicate H. pylori infection in countries with low clarithromycin resistance. Generally, this therapy is well-tolerated, with only a few and usually minor side effects. However, rare but severe adverse effects such as pseudomembranous colitis have been reported, Clostridium difficile (C. difficile) infection being the main causative factor in all cases. We report the cases of two women who developed pseudomembranous colitis after a 1-wk triple therapy consisting of pantoprazole 20 mg bid, clarithromycin 500 mg bid, and amoxicillin 1 g bid to eradicate H. pylori infection. A limited colonoscopy showed typical appearance of pseudomembranous colitis, and the stool test for C. difficile toxins was positive. Rapid resolution of symptoms and negative C. difficile toxins were obtained in both patients with oral vancomycin. No relapse occurred during a four and eleven-month, respectively, follow up. These cases suggest that physicians should have a high index of suspicion for pseudomembranous colitis when evaluate patients with diarrhea following H. pylori eradication therapy.

Bacterial meningitis during sepsis in diabetic patient.

UNLABELLED: The aim of the study was to evaluate the etiology, clinical features and outcome in diabetic patients with bacterial meningitis, as a nervous system determination during invasive infections. MATERIAL AND METHODS: In a retrospective study, conducted over a period of three years, we have analyzed clinical and etiological aspects of 445 patients over 18 years old, diagnosed with sepsis of known (positive cultures from normally sterile sites) or suspected etiology (positive cultures from pus), 95 of them being included in the diabetic group. RESULTS: Bacterial meningitis was diagnosed in 16 of 95 diabetic patients (16.8%) and 43 of 350 (12.3%) non-diabetic patients (chi2 = 0.98; GL = 1; p = 0.322). Among the multiple co morbidities associated in diabetic patients, as suggested by a higher Charlson score (5.44 vs. 3.25) (p = 0.001), the most common underlying condition was chronic liver disease (31.3% vs. 25.6%) (p = 0.916). The isolation of the microorganism concurrently from cerebro-spinal fluid and other sites (blood cultures and pus) was more frequently encountered in diabetics. The clinical picture was dominated by altered consciousness (68.8% vs. 23.3%) (p = 0.003), while fever was less present (37.5% vs. 88.4%) (p = 0.0003). The most frequently involved microorganism in the etiology of meningitis was S. aureus (31.3 vs. 23.3%) (p = 0.771) and Gram negative bacilli: E. coli (12.5% vs. 4.7%) (p = 0.629) and Klebsiella spp. (12.5% vs. 9.3%) (p = 0.902). CONCLUSIONS: Altered consciousness was more frequent in diabetic patients group (68.8% vs. 23.3%) (p = 0.003) where the absence of fever at admission was a more common finding than in non-diabetic septic patients with meningitis (37.5% vs. 88.4%) (p = 0.0003).

Antibiotic prophylaxis in retrograde ureteroscopy: what strategy should we adopt?

BACKGROUND: Retrograde ureteroscopy as a minimally invasive treatment of ureteral calculi can be complicated by the occurrence of urinary tract infections. Fever is considered the main indicator of such postoperative complications and we aimed to study its incidence in patients with and without preoperative antibiotic prophylaxis. METHODS: We included all patients who underwent retrograde ureteroscopy for ureteric stones in the Iasi and Tg Mures Urology Clinics from 2009 to 2012. Data were statistically analyzed using the EpiInfo 7 software. Indicative of a statistically significant difference was a p value <0.05. RESULTS: We recorded fever in a total of 108 cases, accounting for 22.83% of all subjects in the study. Group 1 included patients who received antibiotic prophylaxis; 48 of 147 (32.65%) were febrile, compared with Group 2 (no antibiotic prophylaxis), where we recorded febrile syndrome in 60 (18.40%) cases, p=0.0009. Comparing the two groups based on calculus size, for stones with diameters of 0.6-0.8 cm 38.71% of patients were febrile in Group 1, compared with 10.88% in Group 2 (p=0.0008). Secondary ureterohydronephrosis did not statistically influence the frequency of fever in any of the studied groups. CONCLUSION: Less than half of all febrile patients had positive urine cultures, which may point to other causes, such as noninfectious factors (aseptic kidney inflammation). This study did not prove the efficiency of preoperative antibiotic prophylaxis; however, based on the clinical experience of the past 120 years, infectious complications are known to be associated with urological maneuvers and prophylaxis could be indicated.