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).

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.

[Etiological aspects of acute gastroenteritis--a ten-year review (1.01. 2001-31.12.2010)]. / Aspecte etiologice ale bolii diareice acute--consideratii pe cazurile internate în Clinica de Boli Infectioase Iasi în perioada 1.01. 2001-31.12.2010.

UNLABELLED: Acute gastroentritis is one of the most common diseases in humans, and continues to be a significant cause of morbidity worldwide. AIMS: To determine the bacterial pathogens associated with gastroenteritis in patients admitted to the Iasi Infectious Diseases Hospital in the last ten years. MATERIAL AND METHODS: A total of 40481 stool samples were examined using conventional methods. RESULTS: Bacteria were found in 7.36% of cases, and parasites in 9.64%; 83% of the cases were viral, micotic, or disbiotic. The bacterial etiology was dominated by Salmonella spp. (58.34%), Shigella spp. (27.08%), Yersinia enterocolitica 03 (8.53%), Campylobacter spp. (1.31%), other bacterial pathogens (EPEC, Aeromonas hydrophilla/caviae/sobria, Plesiomonas shigelloides, Bacillus cereus, Staphylococcus aureus, etc) being detected in 3.74% of the cases. Of the Salmonella species, group B (51.99%) followed by group D (45.23%) were most common. Shigella sonnei and Shigella flexneri were found in almost the same proportion (49.45% and 49.70%, respectively); Shigella boydii was isolated in only 0.85% of cases. The trend of gastroenteritis caused by bacterial pathogens is decreasing: from 355 cases in 2001 to 105 cases in 2010; three peaks have been recorded in 2002, 2005 (when Salmonella typhi was isolated in a patient), and 2008 (469, 409, and 252 cases, respectively). Bacterial gastroenteritis affected both sexes almost equally (122 males and 118 females). The most affected age groups were: 0 - 4 years, 15 - 24 years, 5 - 14 years and 25 - 39 years. CONCLUSIONS: Laboratory investigations are essential in determining the etiology of gastroenteritis. Its unpredictable incidence justifies the human and material efforts aimed at controlling the spread of potentially epidemic acute gastroenteritis.