Clinical manifestations in the West Nile virus outbreak.

During the summer of 1996 an unusual clustering of meningoencephalitis cases was recorded in the Capital City, Bucharest, and in some areas from South-East Romania. After an initial suspicion of an enteroviral etiology was discarded, the West Nile etiology was confirmed by specific antibodies demonstration through hemagglutination-inhibition and ELISA tests. This study included 251 patients with the diagnoses of West Nile acute encephalitis (166 cases), acute meningitis (57 cases) and acute febrile disease (33 cases). The patients' age ranged from 1 to 89 years (mean 51.1 years). The most frequent clinical manifestations were: fever (95.7% of cases), cephalalgia (92.6%), stiffness of the neck (89.1%), vomiting (62.5%), marked asthenia (46.5%), myalgia (28.9%). In addition, patients with encephalitis exhibited: alteration of consciousness (89.2% of cases), tremor of extremities (40.4%), ataxia (44%), paralysis (15.1%). The fatality rate was 15.1% in acute encephalitis, 1.8% in acute meningitis and 0% in the acute febrile disease.

[Pharyngitis produced by Arcanobacterium haemolyticum]. / Faringite produse de Arcanobacterium haemolyticum.

Arcanobacterium haemolyticum (A.h.) was recovered from 0.43% of throat cultures of 3715 patients with sore throat, scarlatina and various skin rash. In a 57.90% patients A.h. was the only bacterial pathogen isolated, while in the remainder beta-haemolytic streptococci, Haemophilus and S. aureus were also detected. beta-haemolytic streptococci were much more frequent than A.h. in the throat cultures (26.83%). All A.h. strains were of the smooth type based on colony morphology and the ability to ferment sucrose. The strains were susceptible to penicillins, cephalosporins, erytromycin and resistant to trimethoprim-sulphamethoxazole. Pharyngeal injection in 89.47% and exanthem in 78.90% were the most common signs present to the patients.

Serodiagnosis of tuberculous meningitis by enzyme-linked immunosorbent assay (ELISA).

IgG antibodies against glycolipids and proteins isolated from M. tuberculosis and BCG suspension were determined by ELISA in sera, in CSFs and in serum and CSF paired samples, from patients with tuberculous meningitis and from healthy control subjects. With specificities between 90 and 94% for the antigens used, we obtained senitivities of 75% for Pr-ELISA, 60% for G1-ELISA and 35% for BCG-ELISA. As specific antibodies were detected in serum and CSFs, only one sample is enough to perform the test. We concluded that Pr-ELISA and G1-ELISA could be used as a supporting test in TBM diagnosis, especially when repeated bacteriological methods failed to prove the presence of tubercle bacilli and in cases without evidence of pulmonary tuberculosis.

Evaluating the minimum active concentrations of penicillin G and V and of retard forms in clinical conditions.

Following several signals indicating the inefficiency of the clinical treatment with various penicillin preparations in some cases, we decided to study the seric penicillin concentrations in the patients hospitalized in the "V. Babes" Hospital of Infectious Diseases, after administration of the various Romanian made forms of penicillin currently used in the therapy of streptococcal infections and in the prophylaxis of the sequelae of these infections. The data obtained on groups exceeding 30 persons by using two methods of determining the penicillin concentrations the dilutions and the diffusimetric methods revealed protective penicillin seric levels satisfactory for penicillin G and Efitard, according to the present treatment schemes. After 5 days from Moldamin administration only 45.4% of children and 43.3% of adults were found to have satisfactory penicillin concentrations. The administration of penicillin V reaches active penicillin concentrations in terms of the dose administered. The paper points out only one of the causes which together with others (such as beta-lactamase production and tolerance), contribute to the unsuccessful treatment with various forms of penicillin.

Virological investigations in adults with acute pneumonia.

Virological investigations (immunofluorescence reactions and isolation attempts with pharyngeal exudate specimens, as well as serological tests) were performed in 110 adult patients with pneumonia. Viral or inframicrobial agents were involved in 70 (63.7%) of the cases, either alone (27 cases) or in association with bacteria (43 cases). Parainfluenza and adenoviruses were most frequently encountered both in the cases with mixed (viral + bacterial) and in those with strictly viral pneumonia. Mycoplasma pneumoniae accounted for 11% of the cases; the role of chlamydial and rickettsial germs was insignificant.