Emergence of concurrent infections with colistin-resistant ESBL-positive Klebsiella pneumoniae and OXA-23-producing Acinetobacter baumannii sensitive to colistin only in a Romanian cardiac intensive care unit.

We report the emergence and analysis of a cluster of concurrent infections/colonisations with colistin-resistant Klebsiella pneumoniae and OXA-23 carbapenemase-producing Acinetobacter baumannii in patients who had undergone cardiac surgery. We describe the emergence of colistin-resistant K. pneumoniae harbouring blaCTX-M-15, blaSHV-11, blaOXA-1, blaTEM-1 beta-lactamases and aac(6')-Ib-cr fluoroquinolone resistance. Colistin-resistant K. pneumoniae infections (pneumonia, wound infection, urinary tract infections and bacteraemia) occurred in critically ill patients previously treated with colistin for post-surgery infections with carbapenem-resistant Pseudomonas aeruginosa and/or A. baumannii. Although the cause of death could not be directly attributed to a single pathogen, three patients co-infected/colonised with K. pneumoniae, P. aeruginosa and/or A. baumannii died, whilst a fourth patient who had a mono-microbial infection with colistin-resistant K. pneumoniae only survived. The use of mobile intubation equipment in patients that shared the same ward, the clustering of cases over a short period of time, as well as the pulsed-field gel electrophoresis (PFGE) data all suggest cross-contamination between patients, either through equipment or by staff contact transmission. This report presents the 'worst-case scenario' where concurrent infection/colonisation with pathogens exhibiting resistance to different types of last-resort antimicrobials occurred in some of the most debilitated intensive care unit (ICU) patients.

[Cervugid ovules in cervico-vaginal infections and cervix uteri precancerous conditions treatment]. / Tratamentul infectiilor cervico-vaginale si a starilor precanceroase ale colului uterin cu Cervugid-ovule.

UNLABELLED: This medicine was authorized by the National Drug Agency (ANM, Bucuresti) in 2001. PURPOSE: To evaluate the effectiveness and the tolerance to Cervugid-ovules, a preparation that combines the polyvalent local antiinflammatory action of chloramphenicol, metronidazole and nystatin with the effect of hydrocortisone acetate, an unspecific anti-inflammatory agent; they all are embedded in a Lipex-403, semisynthetic fat. MATERIALS AND METHODS: The evaluation of 500 patients ages between 15 and 85 years with genital infections, registered in the files of "Cl. II Obst. and Gynecology" of the Cuza-Voda Hospital from Iasi has been studied. We studied the subjective manifestations (local discomfort and pelvic pains, local burning and dryness,vulvovaginal itching and dyspareunia) and objective manifestations (vaginal and cervical secretion, the cytotest performed and colored though the Papanicolaou method and reported in the Bethesda system). RESULTS AND DISCUSSION: Healing of the subjective symptoms in 98%, healing of the leukorrhea--as a main objective symptom--in 95%; The Bethesda system cytotest was one of the inflammatory type in the most of the cases and there wew found in 85 cases: 6 ASCUS, 41 LSIL, and 37 HSIL. The use of Cervugid had a healing response in most of the cases when used in acute and chronic cervico-vaginal inflammatory processes. Cervugid may be considered as an important agent in the treatment of the precancerous affections af the cervix uteri on the following reasons: zhe cure of the infections caused by chlamydia, involved in the etiology of cervical neoplasms, the cure of the HPV infection under episome form, classified in the Bethesda system within the ASCUS, AGUS or LSIL classes. When the cytotest was in the HSIL class, a conization in the LLETZ method was performed. CONCLUSIONS: Cervugid is conceived for those three main categories of pathogenic factors related to the etiology of cervico-vaginitis: microbia germs, protozoa and mycosis. In addition, it is active on chlamydia and mycoplasms, always sensitive to chloramphenicol therapy. That is why Cervugid with in local administration is indicated in the microbial, trichomoniasis and mycotic vaginitis caused by one category of pathogenic agents or by associated forms, in cervicitis, in the pelvic inflammatory processes (pelvic congestion, metritis, adnexitis, and inflammatory processes associated with benign or malignant tumors of the genital apparatus). The results obtained proved that Cervugid is highly effective medicine.

Venous ulcer infection caused by Arcanobacterium haemolyticum.

A. haemolyticum has been described as an unusual pathogen causing pharyngotonsillitis and extra pharyngeal infections like ulcerative lesions infection mainly in patients with underlying condition (peripheral vascular disease, diabetes, alcoholism). A case of A. haemolyticum venous leg ulcer infection is reported in a 66 year-old diabetic male patient. Bacteriological diagnosis is based on conventional culture technique. But, due to its coryneform appearance and time growing, it is probably underreported.

[Erysipelothrix rhusiopathiae bacteremia in a child with acute leukemia]. / Bacteriemie cu Erysipelothrix rhusiopathiae la un copil cu leucemie acuta.

The systemic infections caused by E. rhusiopathiae and reported in literature are very rare, majority evolving with endocarditis. The authors present a child with acute leukemia, to whom the blood culture during a high temperature episode allows to isolate this bacterium, without valvular lesions. The case is interesting because of the arisen bacteriological diagnosis problems and because of the pathogenic aspects of the infection. An animal source contact being absent, we took in account the intestinal carriage which, under the profound depression of the defence (the underlaying disease and the cytostatic therapy) could result in a persistent bacteremia. The treatment with cefazolin allows the infection to be cured.

[The isolation of Arcanobacterium haemolyticum from the pharyngeal exudate of children]. / Izolarea Arcanobacterium haemolyticum din exsudatul faringian la copii.

A. haemolyticum is involved in acute pharingotonsillitis in present, reaching a maximal incidence between 10 and 30 years of age. The authors examined 7402 throats swabs obtained from children between March 1995 and February 1996. The swabs were plated on a selective culture medium: 5% sheep blood agar added with 3.5% NaCl; the plates were incubated for 48 h in aerobic conditions. The colonies of A. haemolyticum have been suspected on the basis of a) the growing time interval (48 h); reduced size (diameter less than 1 mm); c) the presence of a narrow zone of incomplete beta-haemolysis and d) the typical pitting of the culture medium beneath the colony. The definitive identification was realised on the basis of the microscopical appearance (diphtheroid gram-positive bacilli), negative catalase test and inverse CAMP test (narrowing of the haemolytic zone produced by staphylococcal beta-lysine). The frequency of A. haemolyticum in the throat swabs investigated was 0.07% (5 cases), comparing with S. pyogenes which was found in 8.21% of cases.

[HIV infection in a seronegative child diagnosed by isolation of the virus. The significant immunological and epidemiological signs]. / Infectie cu HIV la un copil seronegativ diagnosticata prin izolarea virusului. Semnificatii imunologice si epidemiologice.

HIV-1, subtype F was isolated from a seronegative child aged 2.5 yr. ELISA tests (Behring HIV-1 + 2, Abbott HIV-1 + 2, Wellcozyme HIV-1 Recombinant, Clonatec HIV-1 + 2, Genelavia Mixt), and also rapid tests (Abbott Pack, Serodia) were all negative, although some of them presented borderline reactivities. Western Blot (Cambridge Biotech) revealed an undetermined profile (traces of anti-gp160 plus anti-p24). A new WB test (Sanofi Dg. Pasteur) performed at a higher serum concentration (1/25) revealed a complete antibody profile, despite the very low intensity of bands. A new serum sample prelevated 6 month later was completely negative on all tests used. Both samples, were negatives in WB for HIV2 and HTLVs. A heparinised blood sample was used for the co-cultivation of PBMC and was proven to be positive in the 14th day of culture. The isolated DNA from end-culture cells was subjected to PCR amplifications for Heteroduplex Mobility Assay direct subtyping (primers ES7 and ES8) and for the investigation of genotypic sensitivity to AZT (primers A/NE1). Lymphocyte populations phenotyping revealed leukocytosis (> 15,000/mL) with a predominance of the CD8+ subset CD4/CD8 ratio was < 1. Plasmatic HIV-1 load (measured by bDNA--Chiron) did not reached detectable levels of HIV-1 RNA. p24 Ag assay (EIA-Coulter) revealed a detectable p24 antigenemia only in the first serum sample and only after acid dissociation. So, this patient may present an integrated HIV-1 infection until now "silent".

[Pyogenic infections with different locations caused by Streptococcus anginosus alone or in association with anaerobic bacteria]. / Infectii piogene cu localizari diferite cauzate de Streptoccus anginosus, singur sau în asociatie cu bacterii anaerobe.

Isolation and identification of S. anginosus from pathologic products are possible to be realised in informed clinical laboratory, allowing so a better knowledge of these infections' incidences and on adequate treatment. The authors' report 11 cases of pyogenic infection caused by S. anginosus. Five out of these 11 cases evaluated as mixed infections, S. anginosus being associated with anaerobic bacteria. 10 children hospitalised in surgery Department of Children Hospital had infections with different localisations; necrotizing fasciitis, preknee cap abscess, generalised peritonitis, abscess postappendectomy, pleurisy and acute mediastinitis, knee arthritis, acute osteomyelitis of mandible and an infection of the fracture's focus in upper 1/3 of the thigh bone. For all these patients the favoring factor was represented by a traumatic or surgical lesion of the skin or diverse mucosa; oral, oesophageal, intestinal, allowing the access of the normal flora of these covers to normally sterile sites. The eleventh case was an adult with a lung abscess and pleurisy, as a complication of an aspiration pneumonia. The treatment of S. anginosus infections consisted especially in penicillin or ampicillin, associated with metronidazol when anaerobic bacteria were present.

[The frequency of Streptococcus anginosus in the pharyngeal exudate from children and its differentiation from other beta-hemolytic streptococci]. / Frecventa Streptococcus anginosus în exsudatul faringian la copii si diferentierea de alti streptococi beta-hemolitici.

UNLABELLED: S. anginosus is a commensal of the oro-pharyngeal mucous membrane without any signification for the local pathology. Ignoring the existence of beta-haemolytic colonies of this species, the risk to report the presence of some beta-haemolytic streptococci that actually belong to the normal flora exists. The antigenic identifications of beta-haemolytic streptococci maintain the confusion either, S. anginosus being able to react with specific sera anti group G, C or A. In our study, two identification criteria out of those available demonstrated a high value: the small or very small colonies' size, especially in secondary cultures and the production of acetoin (Voges-Proskauer test). S. anginosus was isolated with a quite great frequency in pharyngeal exudate from children: 41 strains out of 90 strains of beta-haemolytic non-group A streptococci were S. anginosus. Antigenically they belonged, in numerical order to groups C, G, F or they were ungroupable. IN CONCLUSION: The microbiologist has to identify, but not to report the presence of S. anginosus in pharyngeal exudate, it being a normal component of the oro-pharyngeal flora. Doing so, a better evaluation of the clinical signification of the other beta haemolytic streptococci's non group A will be possible.

[The isolation and subtyping of the human immunodeficiency virus (HIV) from children in Moldova. The evidence for subtype F]. / Izolarea si subtiparea virusului imunodeficientei umane (HIV) la copii din Moldova. Evidentierea subtipului F.

HIV epidemic related to nosocomial transmission in Romanian nursed children represents up to now more than 50% of paediatric AIDS cases in Europe. Although the sources of this epidemic are obscure, HIV-1 subtype F, a minor form in Brasil and Africa, realised a founder effect in this risk group, thus becoming the major form in Romanian epidemic. This study presents the results of the virus isolation from HIV-infected children in Northeast Romania. Heteroduplex mobility assay (HMA) was performed in order to establish HIV-1 viral subtype for 6 isolates. All tested HIV-1 strains were proved to belong to F subtype. So, our study confirm that HIV-1 subtype F is responsible for the epidemic in the risk group of Romanian nosocomially infected children.

[Seroepidemiological data on the circulation of influenza virus in Moldova in 1991-1992]. / Date seroepidemiologice privind circulatia virusurilor gripale în Moldova în anii 1991-1992.

OBJECTIVES: 1. To establish the predominant circulating antigenic subtypes of influenza viruses in the epidemic season (19911992). 2. To evaluate the efficiency of seroepidemiological method in determining the circulating antigenic subtypes and its practical consequences. METHODS: Our study consist of 1082 patients with acute respiratory disease or their contacts. Antigens prepared at "Cantacuzino Institute", C.D.C. Atlanta and from viral strains isolated in our laboratory were used. Hemagglutination-inhibiting Test was preceded by the elimination of the unspecific inhibitors with IO4K M/90. Significant titers were considered those > 1/10. RESULTS: Were assessed by determining the number of antibody carriers, their ratio and geometrical mean of the reciprocal value of H.I. antibody titers. CONCLUSIONS: 1. In the winter of 1991 and 1992 A/H3N2 infections and in the spring 1991 and 1992 A/H1N1 virus prevailed, while B virus circulated by the end of spring 1992 epidemic season. 2. The decrease in 1992 of A/Iasi/1/69 (H3N2) activity at the same time with high titers against A/Iasi/1/76 (H3N2) and A/Iasi/1/80 (H3N2) suggests a marked antigenic drift occurring in this interval 3. Serological method for determining the presence of hemagglutination inhibiting antibodies seemed enough and compulsory for detecting the etiological agent of acute respiratory disease, and an epidemic outbreak. 4. The circulation of three distinct antigenic subtypes determines the options for composition of anti-influenza vaccine.