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.

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.

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.

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).

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.

Diagnostic approaches in infective endocarditis.

UNLABELLED: Infective endocarditis is a true systemic infection and a life-threatening disease associated with high mortality. AIM: To evaluate the problems that occur during making the diagnosis of infective endocarditis, in order to highlight the need of other diagnostic prospects. MATERIAL AND METHODS: Retrospective study using clinical, microbiological, and echocardiographic findings from 45 patients admitted to the Iasi Infectious Diseases Hospital in the interval January 2007 - January 2011. RESULTS: A positive diagnosis of infective endocarditis was made based on Duke Criteria. Inflammatory syndrome revealed leukocytosis with neutrophilia in 42% of the patients. In 91% of the cases fever syndrome was present. Blood cultures were positive in almost 45% of the cases, and the identified etiologic agents were Staphylococcus spp., Streptococcus spp., Achromobacter spp., Klebsiella spp., Enterococcus spp., E. coli. In 95% of the patients, the echocardiographic appearance was a major criterion for diagnosis. Associated diseases were most often present with rebound on the course. Cardiac complications occurred despite treatment and re-evaluations. Ten percent of our cases required transfer to cardiology and cardiac surgery units. CONCLUSIONS: Microbiologic diagnosis was mainly based on cultured-dependent methods that often fail because of previous antibiotic therapy or the involvement of fastidious microorganism. In this case, advances in molecular diagnostics have yielded new tools (polymerase chain reaction - PCR techniques) to diagnose this disease.

Infective endocarditis in non-HIV immunosuppressed patients.

UNLABELLED: Infective endocarditis is a septic illness with sudden or insidious onset that causes heart lesions or aggravates the preexisting ones; during its course it can affect other organs, mortality being high. AIM: To identify non-HIV immunosuppressed patients with infective endocarditis, namely those with associated diabetes, hepatitis, cancer, or old age with multiple comorbidities, and to assess the nosocomial risk by Carmeli score. MATERIAL AND METHODS: This is a retrospective study using epidemiological, clinical, laboratory and treatment data from 56 patients admitted to and diagnosed with infective endocarditis at the lasi Infectious Diseases Hospital in the interval January 2008 - May 2012. To these patients we looked for non-HIV immunosuppressed character, having in their pathology association diabetes, chronic hepatitis, malignancy, or other comorbidities. RESULTS: From the infective endocarditis patients, 92.8% were found non-HIV immunosuppressed, 25% of them presenting renal failure, and 21.1% having diabetes. The most common Carmeli score obtained was score 2 in 57.1% of the cases. In these patients, the most frequent etiologic agent of infective endocarditis was Enterococcus faecalis (16%), followed by Staphylococcus aureus (10.7%). CONCLUSIONS: It was noted that in addition to endocardial damage due to the multiple etiologic agents involved, non-HIV immunosuppression in these patients plays an important role. The association of Carmeli score in patients diagnosed with infective endocarditis is significant, especially in case of adequate therapy initiation for a right treatment of this pathology.

Antibiotic therapy in severe sepsis in HIV-positive patients.

Severe sepsis has become one of the most frequent causes of hospitalization in intensive care units for patients diagnosed with HIV infection. The difficulty in setting a sepsis diagnosis in HIV-positive patients led to the systematic exclusion of these patients from studies on sepsis, which limited the understanding of its impact on the evolution of the disease. Our study aims to evaluate the etiology of sepsis in immunocompromised HIV-positive patients and the evolution after antibiotic therapy. 30 patients diagnosed with HIV infection and sepsis, admitted to our clinic between January 2008 and April 2012, were followed. Severity of illness, time since diagnosis, CD4 count, antiretroviral treatment, incidence of severe sepsis, and organ dysfunctions were registered. Patients were between 1 and 61 years of age, most of them were classified into stages B2, B3 and C3, requiring hospitalization for a period ranging from 14 to 28 days, with an average of 16.7 days and a median of 18 days, while 8 required monitoring in the intensive care unit. In about 40% of cases, the starting point was an infection of the lower respiratory tract, but also of the upper urinary tract and skin infections. Evolution and mortality in sepsis associated with HIV/AIDS infection depend on the presence of organ failure and are less influenced by the level of immunodepression, complex antibiotic therapy being the cornerstone in controlling patients.

Dyadic adjustment in HIV sero-concordant and sero-discordant couples.

AIM: The HIV infected population in Romania is at an age when engaging in a serious relationship is more and more an issue. Dyadic adjustment is the process which most couples go through, in their attempt to form a steady relationship. It is represented by important changes that appear in one's perception of himself and the significant other. Dyadic adjustment can be measured by a series of parameters--couple's satisfaction, couple's consensus, couple's cohesion and expressing emotions. MATERIAL AND METHODS: We conducted a study on 60 young men and women (30 male, 30 female). Of these, 45 are in evidence at the lasi Regional Center (22 male, 23 female), the other 15 being their uninfected parteners (8 male, 7 female). They were evaluated using the Dyadic Adjustment Scale, developed by Graham B. Spanier. RESULTS: Most couples enrolled in this study (50%) were sero-concordant (both partners were HIV-positive -15). 26% of couples were made-up an HIV-positive female and a non-infected male, and 24% were made-up of a non-infected female and an HIV-positive male. The median age was 23 years, 33.4% of them came from rural areas. Average schooling level was 6 primary classes, with extremes between two classes of primary and higher education. Only 50% of patients had a job, while the rest had no stable job and were not employed, 33.4% came from broken families or foster care. 100% of HIV infected patients are in active therapy, poliexperimented. Most patients have 5-6 treatment regimens (45%), with a maximum of 8-9 regimens. Most of the couples enrolled (83.3%) were not married, as our study evolved only 5 married couples. The relationship length varied between 4 moths and 15 years. The Dyadic Adjustment Scale revealed high scores in couple's consensus and cohesion for both concordant and discordant couples. In couples where both partners are HIV-positive, the DAS revealed average scores for all four areas of dyadic adjustmet. In Couples where one partner is HIV-positive, and the other is not infected, low scores were seen in emotional expression and in the couple's satisfaction. CONCLUSIONS: The HIV infection affects an individual's life and his adjustment to a couple in the sense that a series of factors changes the couple's dynamic--physical and emotional changes specific to the infection and AIDS, ARV treatments' side-effects, the care for the uninfected partner, and preventing HIV transmission through intercourse. All these elements lower the level of dyadic adjustment and increase the level of stress in individuals that are part of an HIV couple.

Clinical features and course of bacterial meningitis in children.

AIM: To analyze the clinical features and course of and to define the risk factors for bacterial meningitis in children. MATERIAL AND METHODS: Retrospective study of 100 cases of bacterial meningitis in patients aged 0-18 years admitted to the Iasi Infectious Diseases Hospital between 2005 and 2010. RESULTS: We found a clear prevalence in male children (58%) from rural area (67%), with the highest incidence in the age group 2-5 years. A significant percentage of patients (43%) had previous hospitalization, condition which is known as predisposing factor for bacterial meningitis, the most common being ear infections (20%) and height and weight deficit (9%). 71% of patients were admitted within the first 48 h. The most common onset clinical manifestations were fever (84%), vomiting (70%), signs of meningeal irritation (59%), somnolence (23%), loss of appetite (19%), and coma in 5% of patients. In 36% of cases CSF was opalescent with moderate pleocytosis (35%); in 29% of patients CSF albumin level ranged between 0.7-1.0 g, the majority presenting normal glycorahia (71%). In only 21% of cases the microbial agent was identified (pneumococcal and meningococcal etiology, 8% and 6%, respectively). The course was generally favorable, and mortality rate was low (5%). Complications occurred in 3% of patients consisting in hydrocephalus and brain abscess. CONCLUSIONS: Bacterial meningitis remains a disease with potentially severe course. Clinical onset, most commonly atypical in children, requires differential diagnosis at the time of admission in order to initiate the most appropriate antibiotic therapy.

Tuberculous meningitis--clinical and epidemiological considerations (a retrospective study 2008-2011).

UNLABELLED: Tuberculous meningitis represents one of the most severe forms of tuberculosis and is often a difficult diagnostic and therapeutic problem. The objective of this study is to analyze the cases of tuberculous meningitis in our region. MATERIAL AND METHODS: We retrospectively analyzed 76 observation sheets of patients aged 4 months to 84 years, diagnosed with tuberculous meningitis, admitted to Infectious Diseases Hospital Iasi during 2008 to 2011. RESULTS: Tuberculous meningitis has affected mostly males (65.7%). Only a small proportion of patients (23.68%) had tuberculosis in their personal history. 26.2% were diagnosed also with other localization of tuberculosis (mostly pulmonary). Fever was identified in only 43.4% of cases; 40% of patients had an altered conscience at admission. The outcome was favorable in all cases. CONCLUSIONS: Tuberculous meningitis predominantly affects males, almost equally affects patients with other focuses of TB and those with a history of tuberculosis disease.

Severe invasive listeriosis--case report.

Listeriosis is a rare food borne infection which, in the invasive form, presents as bloodstream infection, central nervous system infection, materno-fetal infection, or focal infection. Certain immunosuppressive conditions have been identified as risk factors for severe invasive disease. The invasive forms of listeriosis are associated with a high case fatality rate. We present the case of a 62-year-old male with an unremarkable medical history admitted to the Iasi Infectious Diseases Hospital for fever. headache, ataxia, and diplopia. Physical examination revealed high temperature, confusion, relative bradycardia, and signs of meningeal irritation. Laboratory test showed leukocyt osis with neutrophilia. pathological CSF findings (high WBC count with predominance of neutrophils, low glucose and high protein levels), increased liver enzymes (ALAT, ASAT, AP, gammaGT), and important renal impairment (normal levels at presentation). No abnormalities at chest x-ray, cranial CT and abdominal ultrasound. CSF and blood cultures were positive for Listeria monocytogenes. Under antibiotics (ampicillin and ciprofloxacin), the course was marked by respiratory failure requiring mechanical ventilation, coma, hypotension, tachycardia. and death 12 days after admission. The particularity of this case consists in the association of the two classical forms of invasive listeriosis, meningitis and bacteriemia, with a focal infection. acute hepatitis, and a course marked by multiple organ dysfunction syndromes and exitus in a previously apparently healthy individual.

Diagnosis of meningococcal infection by QPCR: detection and quantification of DNA / Neisseria meningitidis.

We present the case of a patient with clinical signs of meningococcemia and negative bacterial culture. Microbiological diagnosis was possible only by testing with real time PCR technique the cerebrospinal fluid and blood samples. Both pathologic samples were positive for Neisseria meningitidis by this rapid and sensitive diagnostic method.

Side effects of antiviral therapy in hepatitis C virus infection-sarcoidosis - case report.

Standard therapy in chronic hepatitis C virus infection is still a combination of peginterferon alfa2a/2b and ribavirin for 48 weeks. As of side effects, there are organic side effects, such as hematologic disorders, and functional side effects, reflected in the quality of life of hepatitis C patients. Up to 30% of the patients develop specific side effects such as headache, fever, fatigue. Sarcoidosis, known as a granulomatous disease of uncertain cause, is an uncommon finding in this category of patients. This cause-effect relation is accounted for by the convergent action of peginterferon and ribavirin of stimulating type 1 T helper cells and reducing type 2 helper T cells activation. We present the case of male patient known with chronic hepatitis C who developed pulmonary sarcoidosis following antiviral therapy. The first manifestation of the disease was unexplained fever accompanied by pulmonary tract disease. The diagnosis was established by immunophenotyping in bronchial aspirate

[Metabolic syndrome in HIV-infected patients with favorable response to antiretroviral therapy]. / Sindromul metabolic la pacientul infectat HIV cu raspuns favorabil la tratamentul antiretroviral.

AIM: The assessment of the metabolic syndrome prevalence, as defined by the American Heart Association/The US National Cholesterol Education Program Adult Treatment Panel, (AHA/NCEP III updated), has been made in 68 polyexperimented HIV infected patients that received antiretroviral therapy over 24 months and who have a favorable viroimunologic response (undetectable plasmatic viral load). MATERIALS AND METHODS: this cross-sectional analytical study has been carried out on a cohort of 68 patients clinically and paraclinically monitored at the HIV/AIDS Department. RESULTS: The response to antiretroviral therapy clinically and paraclinically evaluated after two years from the initiation of the novel HAART scheme has been favourable in all the 68 patients. Only 4 (0.58%) of the patients fulfill the criteria of the metabolic sindrome definition. The statistical analysis does not indicate an increase in the risk of the metabolic syndrome development in these polyexperimented patients, where the clinical symptoms connected with the lipodistrophic syndrome with lipoatrophy are preponderent, associated with different types of antiretroviral drugs. CONCLUSIONS: The metabolic syndrome criteria are not applicable in the case of HIV infected patients (infected in the first year of life), polyexperimented at HAART therapy with favourable viroimmunologic response.