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.

[Treatment of acute peritonitis. Results in County Hospital Suceava with 317 cases ]. / Evaluari asupra rezultatelor obtinute în terapia peritonitelor acute. Experienta pe 317 cazuri clinice în Spitalul Judetean Suceava.

UNLABELLED: The aim of this study was to identify prognostic factors for morbidity, mortality and long term outcome and to analyze the different management modalities for acute diffuse peritonitis. MATERIAL AND METHOD: A clinical retrospective study was carried out on a series of 317 cases with acute peritonitis; admitted in the General Surgery Department, Hospital of Suceava, between 2006-2009. RESULTS: There were 212 men (67%) and 105 women (33%) aged between 1 and 89 years. Preoperative concomitant disease was present in 31% of patients: cardiac disease was most common. The most common etiology was acute appendicitis in children 74 of cases (27.6%). Overall, 44 patients died during hospitalization. The cause of death was sepsis and multiple organ failure in 30 patients; malignancy in 8 patients and cardiac failure in 6 patients. Source control at the initial operation was possible in 282 of the patients (89%), of those 28 patients (9%) needed re-intervention. In 32 patients (10%), source control was not possible at the initial operation. CONCLUSION: This study emphasis the importance of prompt surgical treatment and shows the impact of adapting antibiotic treatment.

[Importance of enteral nutrition support in necrotic hemorrhagic pancreatitis]. / Contributii la cunoasterea importantei suportului nutritional enteral în pancreatita acuta necrotico-hemoragica.

UNLABELLED: A clinical retrospec tive study was carried out on a series of 68 cases with acute pancreatitis, admitted in the General Surgery Department, Suceava County Hospital, between 2006-2009. RESULTS: A number of 50 men (73.5%) and 18 women (26.5%), aged between 29 and 69 was studied. Enteral nutrition (EN) with naso-jejunal tube placed by endoscopy was used in 55.8% of cases; naso-gastric tube in 20 patients; total parenteral nutrition (TPN) in 10 patients (14.7%). Average duration of nutrition was 15.5 days. Pancreatic complications were observed in 7 patients (70%) from the TPN group comparatively with only 11 (18.9%) in the EN group. There were no significant differences in mortality but significant in hospital costs. CONCLUSIONS: The EN support should be the preferred way of nutrition support in patients with acute pancreatitis, because it is associated with a lower incidence of infection and a reduced hospitalization.

[Analysis of 62 cases of nosocomial staphylococcal meningitis admitted to the Iasi Hospital of Infectious Diseases over a period of 21 years]. / Analiza asupra a 62 de cazuri de meningita stafilococica nosocomiala internate în Spitalul de Boli Infectioase Iasi într-o perioada de 21 de ani.

AIM: To analyze the clinical features, evolution and treatment of nosocomial staphylococcal meningitis admitted to Hospital of Infectious Diseases Iasi between 1988 and 2007. MATERIAL AND METHOD: The data were gathered from the archive of Hospital of Infectious Diseases Iasi. We studied the clinical and laboratory features of 62 cases of nosocomial staphylococcal meningitis admitted in the study period. RESULTS: The development of nosocomial meningitis was subsequent to interventions on the central nervous system for haematoma, ventriculo-peritoneal shunts, tumors, spinal anesthesia. The symptoms were fever, headache, stiff neck and vomiting. The etiological agents were: Staphylococcus aureus 37 in cases and coagulase negative staphylococci in 25 cases. The treatment was according to their susceptibility rates, using systemic quinolones and ceftazidime or colymicin. The evolution was favorable in 52 patients and unfavorable in another 10. CONCLUSION: Nosocomial staphylococcal meningitis remains a serious condition due to the fact that the etiological agents are resistant to the classical antistaphylococcal antibiotics and increasingly resistant to methicillin.

[Clinical aspects of tuberculous meningitis in children]. / Aspecte clinico-evolutive ale meningitei tuberculoase la copil.

UNLABELLED: The aim of the study was to investigate the particularities of the clinical manifestation and evolution of tuberculous meningitis at children. MATERIAL AND METHOD: The study was made between January 2000 and December 2008 in Clinic of Infectious Diseases IaSi and Emergency County Hospital ,,Sf. Ioan cel Nou" Suceava on a group of 169 children with tuberculous meningitis. RESULTS: The majority (78.1%) of patients had poor socio-economic conditions and 22.4$ had a family TB contact. The onset of the symptoms was atypical in infants and small children with fever associated with digestive, neurological or pulmonary manifestations. The admission in hospital was delayed in 56.8% of patients and 39.05% had a severe general status with coma. The positive diagnosis was based on cytological and biochemical features of CSF, results of QuantilFERON. TB Gold, pulmonary images, family TB contact and evolution under anti-tuberculous therapy. We observed a high rate of complications represented by hydrocephaly (28.9%). 18 patients died (4 infants), the cause of dead being meningeal coma or complications. CONCLUSION: The diagnosis of tuberculous meningitis at children remains a problem because of the atypical clinical manifestation, the delay of initiating the therapy causing high mortality and frequent complications.

[The utility of QuantiFERON TB Gold for diagnosing tuberculous meningitis in children]. / Utilitatea testului quantiFERON TB gold in diagnosticul meningitei tuberculoase la copil.

MATERIAL AND METHODS: We performed QuantiFERON-TB Gold in Tube (QFT-G) in blood and CSF at 40 children diagnosed with TB meningitis and at 39 children with non TB meningitis, admitted between October 2006 and December 2009. RESULTS: The CSF analyses were suggestive for TB at 27 patients and only 14 had positive culture. The sensitivity of QFT-G in CSF was 72.72% and 69.44% in blood; specificity 96.96% in CSF and 89.18% in blood; the positive predictive value was 96% in CSF and 86.2% in blood; negative predictive value was 78.04% in CSF and 75% in blood. The sensitivity of TST was 61.76% and specificity 82.05%. The sensitivity of the culture from CSF was only 35%. The sensitivity and specificity of QFT-G was higher than TST and culture and better in CSF than in blood. CONCLUSIONS: The determination of alpha-interferon in serum and CSF is useful diagnostic marker of tuberculosis who could improve the management of TB meningitis.

[Study of nosocomial bacillary meningitis admitted in the Clinic of Infectious Diseases Iasi on a 20 years period]. / Studiu asupra meningitei nosocomiale cu bacili gram- negativi internate in Clinica de Boli Infectioase Iasi pe o perioada de 20 de ani.

AIM: To analyze the clinical features, etiology and evolution of nosocomial bacillary meningitis admitted to the Clinic of Infectious Diseases Iasi between 1988 and 2007. MATERIAL AND METHOD: The data were gathered from the archive of the Clinic of Infectious Diseases Iasi. We studied the clinical and laboratory features of 28 cases of nosocomial bacillary meningitis admitted in the study period. RESULTS: The development of nosocomial meningitis was subsequent to interventions on the central nervous system for hematoma, ventriculo-peritoneal shunts, tumors, rah anesthesia. The symptoms were fever, headache, stiff neck and vomiting. The etiological agents were: Acinetobacter spp--35.71%, Pseudomonas spp.--25%, Klebsiella pneumoniae--17.85%, Escherichia coli--14.28%, and mixed etiology, in 3.57% of the cases each. The treatment was according to their susceptibility, using systemic quinolones and ceftazidime or colymicin. The evolution was favorable in 13 patients and unfavorable in another 15. CONCLUSION: Nosocomial meningitis caused by Gram negative bacilli is a severe infection, with diverse etiology, which raises therapeutical problems due to antibiotic resistance and a high mortality rate.

[Antimicrobial resistance profile of E. coli and Klebsiella spp. from urine in the Infectious Diseases Hospital Iasi]. / Profilul de rezistenta al E. coli si Klebsiella spp. din infectii urinare in Spitalul de Boli Infectioase Iasi.

UNLABELLED: The increasing frequency of extended-spectrum beta-lactamases (ESBLs) producing Enterobacteriaceae among nosocomial and community-acquired infections is an important problem for both microbiologists and clinicians, because of the difficulty in correctly detecting, reporting and treating such infections. RESULTS: In the Clinical Hospital of Infectious Diseases Iasi the most frequent etiological agents of urinary tract infections were: E. coli - 64%, Klebsiella spp. 11% and Enterococcus spp - 5%. The resistance rate of E. coli and Klebsiella spp. was 41% and 60%, respectively to amoxicillin-clavulanic acid, 29.6% and 72.5%, respectively to third generation cephalosporins, 26% and 24%, respectively to ciprofloxacin. The most active antimicrobial agents against cephalosporins resistant strains of E. coli and Klebsiella spp were carbapenems (susceptibility rate 99% and 94%, respectively) and colimycin (susceptibility rate 89% and 83%, respectively).

[Cross-sectional study of leptospirosis cases admitted to the Iasi Clinic of Infectious Diseases over a 5-years period]. / Studiu transversal asupra leptospirozelor internate in Spitalul Clinic de Boli Infectioase Iasi pe o perioada de 5 ani.

UNLABELLED: Leptospirosis is a zooantroponosis manifested as an infection with a severe evolution, with liver and renal failure and haemoragic manifestation. The aim of the study was to present the epidemiologic, clinic and therapeutical aspects of 100 cases of leptospirosis admitted in the clinic of Infectious Diseases of Iasi, during 5 years (2002-2006). MATERIAL AND METHOD: The diagnostic was based on the clinical-biologic study and risk factors with febrile syndrome, mialgic syndrome, headache, meningial, liver and renal failure and hematological syndromes, with the serologic evidence of serotypes of leptospirosis. RESULTS: All the patients were serologic confirmed with leptospirosis. Leptospirosis is an emergent disease with the possibility of severe evolution in some forms, with lever and renal failure.

[Leptospirosis in children. Clinico-biological and therapeutic aspects for the cases hospitalised between 1992-2005]. / Leptospiroza la copil. Aspecte clinico-biologice si terapeutice pentru cazurile internate in perioada 1992-2005.

UNLABELLED: The aim of the study is that of showing the prevalence of the disease in childhood in our county. MATERIAL AND METHOD: We studied the observation files of the patients admitted in our unit in between 1992 and 2005 comprised in the 0-15 year old age bracket, noticing all the epidemiological, clinical and therapeutic aspects. RESULTS: In the above mentioned period, 16 patients from the 0-15 year old group (3.12% of all the patients suffering from leptospirosis) were admitted in our clinic. Male (93.75%) and suburban area (60%) were dominant; 11-15 year old group was represented in 87.5% cases; the prevalence was observed during the summer (11 cases) and during 1999 (6 cases); the meningeal signs were noticed in 5 cases and jaundice for 3 children; the most frequent agent was L. icterohaemorrhagiae--7 cases. The etiological treatment was performed for 14 cases with betalactamines for 7.4 days in average; no lethal cases were noticed. CONCLUSIONS: In the case of Iasi County, leptospirosis is a clinico-biological entity considered in the diagnosis of the jaundice, meningeal and febrile syndromes in children.

[Varicella-zoster infection--extreme clinical aspects]. / Infectia cu virusul varicelo-zosterian aspecte clinice extreme.

UNLABELLED: Infections with the varicella-zoster (VZ) virus are a constant of our everyday practice. The aim of the present study is that of underlining unusual aspects of the infection with the VZ virus--primary infection in adults and herpes zoster in children. If varicella, or chickenpox, has been traditionally considered a childhood disease, nowadays, an increased number of adults are affected by primary infections. On the contrary, more and more children present the secondary form of the infection, which appears as herpes zoster, a disease usually diagnosed in adults. MATERIAL AND METHODS: We studied the observation papers of adult patients with varicella, hospitalized in our clinic during 2004-2005 and we analyzed the herpes zoster manifestations in non-HIV children, diagnosed with the disease during the same period of time. RESULTS: During 2004-2005, 34 adult patients were diagnosed with varicella, while 10 children presented herpes zoster. 16 of the adults with varicella were 25-34 years old. One of the children with herpes zoster was less than one year old. All the adults with varicella were treated with acyclovir; in 14 cases, the therapy was supplemented with rifampicin. All the children with herpes zoster came from rural areas. The pathology that determined the decrease of general immunity was represented by neoplasia (3 cases), malnutrition and rickets (2 cases), associated infectious pathologies--bronchopneumonia (3 cases). CONCLUSIONS: Varicella in adults has an increased incidence, which is underestimated, in our opinion. Its loud clinical manifestations impose the therapy with acyclovir. Herpes zoster in children reveals significant subsidiary pathologies and a depressed immune system that impose special medical care and many days of hospitalization.

[Clinical study of acute diarrhea caused by rotavirus]. / Studiu clinic privind diareea acuta determinata de rotavirusuri.

To establish the implication of Rotavirus in acute diarrhea of babies and children. Prospective study on 164 patients aged between 1 month and 3 years with acute diarrhea, admitted in the Clinical Hospital of Infectious Diseases Iasi between 01.01.2005 - 31.03.2005. Rotavirus cause the illness in 30 patients (18.29%). The disease was more prevalent among children with dystrophy or with other comorbidities like: iron-deficiency anemia, intestinal parasitosis, rhinopharyngitis, pneumococcal meningitidis. In seven cases the infectious was considered to be nosocomial. During the illness patients also accused other symptoms, while in order of frequency were: common respiratory infection (13.3%), nausea and vomiting (40%), maculopapular eruption and intestinal pneumonia (16.6%), acute pharyngitis (10%). In this study latex agglutination confirmed the diagnosis. Vomiting and diarrhea led in all cases to moderate or severe dehydration. Appropriate rehydration was necessary but only in 12 cases was made through intravenous access with: Ringer lactate, isotonic sodium chloride solutions. Most children recovered with in 5 days.

[Antibacterial treatment: perspectives]. / Terapia antibacteriana: perspective.

The aim of this paper is to search new antibacterial molecules for an efficient therapy. Thus the researches look for new categories of antibacterial molecules that will solve the current and future therapy problems, some of them being already used, others are still evaluated. Among these there are the new antibiotics (streptogramine, oxazolidinone, fluorochinolone and lipopeptides), enzymatic inhibitors (PDF), tubular peptides--nanotubes, cytokines pro- and anti-inflammatory drugs and preparations obtained through genetic engineering (anti-stress molecules, medicines that inhibit the lipid metabolism of the macro-organisms persisting in macrophages or gene mutation pca A, that enables the immunologic recognition of'the tubercle bacillus).

[Epidemiologic and clinical aspects of acute hepatitis B in the past decade]. / Aspecte epidemiologice si clinice ale hepatitei acute B în ultimul deceniu.

To study the clinical and epidemiological aspects of acute B hepatitis during the last 11 years. We retrospectively studied 1712 patient files, admitted in the Department of Infectious Diseases Iasi, with acute B hepatitis between 1992-2002. The majority of the patients (69%) had an urban origin. Teenagers and young adults were predominantly affected (59% had between 15 and 34 years). A point of entry of the pathogen was identified only in 20% of the patients. The mean incubation period was 4 month. 24% of the patients had a prolonged form of the disease (over 30 days of jaundice). A fulminant evolution was noted in 1.2% of cases. Extrahepatic involvement was described in 25% of the patients. The global mortality was 1.15%. The number of patients with acute B hepatitis decreased by half during the last 11 years.

[Cutaneous and oral manifestations in HIV-infected children and adults--169 cases]. / Manifestari cutaneo-mucoase în infectia HIV/SIDA. Consideratii pe 169 de cazuri.

UNLABELLED: The aim of the study was to evaluate cutaneous and oral manifestations in infected HIV patients. MATERIALS AND METHODS: We retrospectively analyzed 169 cases admitted in Infectiouse Disease Department of Iasi in 2001-2002 period. RESULTS: Cutaneous and oral manifestations were: candidiasis (99 cases), herpes virus infectious (36 cases), scabies and straphylococcal/streptococcal skin disease (26 cases), prurigo nodularis, psoriasis and verruca vulgaris (9 cases). Children of 0-13 year old group was 75.73 percent. Classification of HIV infection was related with CD4 count for 166 cases. Twelve cases with oral pharyngitis candidiasis, scabies and streptococcal skin diseases was 2-3 recurrent episodes of manifestations. Etiotrop treatment was associated with HAART therapy. CONCLUSIONS: Cutaneous and oral manifestations are occurred frequently in HIV infected patients, with a various etiology, but the severity, persistence and its evolution did not evaluate.

[Fungal infection in AIDS patients. Consideration for 10 cases]. / Infectia fungica la bolnavii cu SIDA consideratii pe 10 cazuri.

Clinic, etiologic and therapeutic study of fungic infection in AIDS patients. The retrospective clinical study of the 10 AIDS patients admitted between 01.01.1994 and 31.12.2000 in Infectious Diseases Clinical Hospital of Iasi. The majority of the cases (7) were registered in the last 3 years: 4 children and 6 adults. HIV infection was known only for 4 patients according to their history, and for the other 6 patients this diagnosis was made concomitantly of fungic infection diagnosis. The disease onset was insidious in 7 cases (2 children and 5 adults) being characterized by manifestations of nervous system involvement and consciousness disturbances (6 cases). The etiological diagnosis was established for alive patients by cerebrospinal fluid culture and hemocultures and Cryptococcus neoformans was isolated for 9 patients and Candida to another one. Fungic infection lead to meningeal injuries to 6 patients and the systemic one in for 4 patients. Although, under antifungical and antiretroviral therapy, the disease was lethal for 4 patients. The fungic infection recrudesces in AIDS patients, possessing systemic or/and meningeal manifestation, long evolution that can be lethal for a lot of them.

[Leptospirosis-clinico-biological and therapeutical aspects-study of 256 cases]. / Leptospiroza--aspecte clinico-biologice si terapeutice (studiu pe 256 cazuri).

Leptospirosis is a zooantroponosis manifested as an infectious disease with a severe evolution, with liver and renal failure and hemorrhagic manifestation. The aim of this study was to present the clinico-biological investigation and the therapeutical aspects of 256 cases of leptospirosis admitted in the Infectious Diseases Hospital Iasi during 4 years (1998-2001). The diagnosis was based on the study of clinico-biological and therapeutical parameters (risk factors, fever, mialgia, headache, algic, eruptive, meningeal, hepatorenal, hemorrhagic syndromes with the serological evidence of the serotypes of leptospirosis); most of the cases were registered in 1998 (23% cases), in adults (31.2%) and male (75.22%). All the patients were serologic confirmed with leptospirosis (RAL and RFC), and L. icterohaemorhagiae was isolated most frequently. The standard anti-leptospirosis treatment was administered with favorable evolution; 6 deaths were registered from the severe forms of the disease. The leptospirosis is an emergent disease with the possibility of severe evolution in some forms, with liver and renal failure.

[Hemophilus influenzae meningitis- the experience of infectious diseases department between 1984-2001]. / Meningita cu Haemophilus influenzae--experienta Clinicii de Boli Infectioase Iasi in perioada 1984-2001.

Our paper presents a clinico-biological and therapeutical study of the cases admitted in Infectious Diseases Hospital between January 1984-December 2001. We studied the records of all the patients that suffered from meningitis with Haemophilus influenzae. In above mentioned period 40 cases of Haemophilus influenzae meningitis was admitted; 6 patients (15%) died. A number of 13 cases was registered for the first five years, mainly in the childhood-32 cases (80%) for infants. Bacteriological diagnosis was made by bacterioscopia for 16 patients, bacteriological cultures-30 patients, latex test, performed in the last five years, in 8 cases. In patients who died, the bacteriologic culture was positive in 5 cases and bacterioscopia in 4 cases. The therapy was performed in resonance with antibiograme results for the involved strains. The Haemophilus influenzae meningitis is an acute and severe disease of the childhood, with an important risk of death, despite the rigorous therapeutical measures.