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.

Epidemiological and laboratory features of chronic hepatitis B cases in the interval 2010-2013.

UNLABELLED: HBV virus infection is an important public health problem because of its huge transmission potential, and severe evolution to cirrhosis or liver cancer. AIM: Analysis of the epidemiological and laboratory features of chronic hepatitis B virus infection. MATERIAL AND METHODS: The patients with chronic hepatitis B admitted to the "Sf. Parascheva" University Hospital for Infectious Diseases in the interval: January 1st, 2010 - December 31st were analyzed. RESULTS: Patients age was 18 to 66 years with a prevalence of middle-aged males. Most patients came from urban areas. Alanine aminotransferase (ALAT) levels were elevated, without significant differences between HBeAg-positive and HBeAg-negative patients, the elevated ALAT levels being associated with the increased prevalence of fibrosis. HBeAg-positive patients had viral loads above the threshold of 2,000/l in 34 cases (89.5%), and below 2,000 IU/l in only 10.5% of cases, and the majority (88%) of HBeAg-negative patients presented high viral load levels. The prevalence of stage F2-F4 liver fibrosis was 63.4% in the HBeAg-negative patients with viremia > 25,000 IU/l compared to 55.2% in the HBeAg-positive patients. The correlation between the level of viral load and fibrosis shows that there are significant differences between viremia and the status of HBeAg-positive or negative patients. Increased viral load was correlated with increasing prevalence of fibrosis, significant in HBeAg-negative patients, and the increasing fibrosis prevalence was correlated with low viral load. CONCLUSIONS: The correlation between viral load and fibrosis shows that there are significant differences between viral load and the status of HBAg-positive or negative patients.

Viral meningitis admitted to an infectious diseases hospital: a retrospective case series.

UNLABELLED: Given its epidemic potential and development of severe forms of disease, viral meningitis (VM) is a serious public health problem. AIM: to characterize the main clinical, epidemiologic features, the etiology and treatment of VM cases admitted to the Iasi Infectious Diseases Hospital, in 2012. MATERIAL AND METHODS: We retrospectively analyzed the medical records of the patients admitted for viral meningitis at the Iasi "St. Parascheva" Infectious Diseases Hospital in the interval January 1- December 31, 2012 (98 cases). The etiologic diagnosis was made by determining the IgM/IgG antibodies against Coxsackie virus and/or West Nile virus in blood/CSF. RESULTS: There was a fourfold increase in the number of cases as compared to the average for the years 2009-2011. Most cases (73.5%) were children aged 1 to 14 years. 61.8% of patients were males, 51.7% from urban areas. The most common symptom was headache (85.7%), followed by fever (77.6%), and vomiting (66.3%). Neck stiffness was absent in 28.6% cases. In43.5% of the 39 patients serologically investigated a Coxsackie virus infection was confirmed and 1/20 was positive for West Nile virus; three varicella-zoster virus infections and one mumps infection were diagnosed clinically. 68.3% of the patients received first-line antibiotic treatment. CONCLUSIONS: The illness mainly affected children, fever and neck stiffness being sometimes absent. The etiology was known in 22.4% of cases; enter viruses being the most frequent causative agent. Most patients received antibiotic therapy. The course was favorable in all cases.

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.

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.

[Beta-lactamases...until when?]. / Despre beta-lactamaze...pâna când?

Due to environmental factors and wide use of antimicrobials, only those species that developed their own defense mechanisms shall survive. Enzymatic inactivation is the most common cause of antibiotic resistance. Beta-lactamase production has been described early after the discovery of penicillin and it continues to diversify being now able to inactivate even the most advanced antibiotic. The association with other resistance determinants makes the infection with this kind of bacteria a major therapeutic problem.

[Demographic, clinical and laboratory characteristics of erisypelas in the period 2001-2010]. / Erizipelul--caracteristici demografice, clinice si paraclinice în perioada 2001-2010.

AIM: to describe demographic and clinical characteristics of erysipelas and to compare the sensitivity of two laboratory tests. MATERIAL AND METHODS: we studied patients with erysipelas hospitalized in the Dermatological Clinic between 2001 and 2010. RESULTS: the investigated 140 cases represented 8% of all skin infections hospitalized. Distribution of annual admissions has shown a gradual reduction in the number of admissions in the second half of the decade. A higher frequency was found in the second half of the year. Most patients were from rural areas (55%). The female gender predominated (69.3%). With few exceptions, the patients were adults averaging 59 years. The most common location was the lower leg (91.4%). Most clinical forms were mild and medium. Septic complications were absent. Recurrent erysipelas occurred in 5% of cases. Comorbidity included: chronic venous insufficiency (14.2%), hypertension (10%), obesity (8%), diabetes mellitus (5.7%) or chronic hepatitis (3.5%). CONCLUSIONS: the "benign" appearance of our cases is contrary to the trend rate of severe cases of cutaneous streptococcal infections in some western areas. From comparing laboratory tests results we observed their frequent mismatch. The ESR and the increase in percentage of polymorphonuclear neutrophils were more significant than the total number of leukocytes. Etiological therapy with penicillin G at a dose of 4 million UI/day was effective. The analysis allows the establishment of demographic and clinical features of erysipelas during the period and given territory.

[The quality of life if HIV/AIDS patients in Iasi Romania]. / Calitatea vietii la pacientii Centrului Regional HIV/SIDA din Iasi.

UNLABELLED: Quality of life in relation to health is a consequence of disease and treatment on the patient's perception of his ability to have a full and useful life. Due to its nature, the quality of life is a multidimensional and subjective construct, based on the patient's experience. We operationalized the quality of life using the following parameters: CD4 count and HIV viral levels in the patient's blood, the number of days of hospitalization, number of antiretroviral plans, types of side effects and their frequency, psychological issues (anxiety, depression, and neurotic tendencies). METHODS: We centralized data from a total of 600 patients from the Regional Center in Iasi in 2010-2011. Side effects accused by the patients emerged from discussions with the infectious disease doctor and psychologist, and psychological aspects were measured by specific instruments (PA Inventory, Beck Depression Scale). RESULTS: Most patients enrolled in the study were male (59%) with mean age of 21.1 years. 34% of them came from rural areas. Average schooling level was 6 primary classes, with extremes between the two classes of primary and higher education. Only 14% of patients had a job, while the rest did not have a stable job or were not employed. 38% came from broken homes or foster care. 85% of patients were in therapy at the time of data centralization. 55% were in the second, third or fourth regimen. 25% were at their first scheme, while 10% in the seventh - eighth scheme. The mean CD4 count ranged between 13 and 269/mmc, while the average viral load varied between 1730 and 3.180.000/mmc. The average number of days of hospitalization was 4. Among the antiretroviral side effects patients complained nausea and vomiting in 85% of cases, lipodystrophy symptoms in 25% of cases, diarrhea 15%. With regard to psychological aspects, 65% of patients showed an above average level of anxiety, 40% showed depressive symptoms, while 10% had specific obsessions-compulsions, and 10% neurotic and hysterical tendencies. CONCLUSIONS: By measuring the quality of life through the above parameters, we obtained a clear and comprehensive picture of the situation facing the HIV patient. We believe that close cooperation between the team of doctors and psychologists assisting the infectious patient, on the one hand, and specialists in other medical fields that interact with the patient, on the other hand, can enhance the quality of life of the HIV patient and maintain it at a comfortable level.

[Adverse reactions of different treatments in chronic hepatitis C]. / Consideratii privind reactiile adverse ale terapiei specifice in hepatita cronica cu virus C.

Hepatitis C virus infection is estimated to affect over 170 million people worldwide. Standard treatment for chronic HCV involves an interferon-based preparation and ribavirin for 24 to 48 weeks. These therapeutic regimens are associated with numerous adverse events, among which constitutional and neuropsychiatric symptoms, as well as hematological abnormalities, stand out. Adverse events resulting from the treatment of hepatitis C can jeopardize the quality of life of patients and their response to treatment. The control of those events involves medicinal and non-medicinal interventions. The latter include a reduction in the dosage of IFN or RBV and discontinuation of the treatment.

[Community acquired acute bacterial meningitis--a 10 year review]. / Meningite bacteriene comunitare: analiza pe 10 ani.

UNLABELLED: Bacterial meningitis is still an important topic for the infectious diseases specialist, due to it's high incidence, severity and it's high mortality rate. MATERIAL AND METHOD: We retrospectively studied 679 patients diagnosed with community acquired bacterial meningitis in the Infectious Diseases Hospital Iasi, Romania between 1998 and 2007. RESULTS: The annual number of admissions slightly decreased in the last years. Most patients were males (62.1%). Predisposing factors were present in 34.9% of cases. Seizures were described in 19.6% of cases, more frequent in children. The CSF was purulent only in 69.4% of patients, 29.6% of them receiving antibiotics prior to admission; the albumin level in the CSF of pneumococcal meningitis was higher than in other meningitis. The etiology was established in 51.6% of cases, more frequent in sucklings (68.1%). N. meningitidis was the most common cause of community acquired acute bacterial meningitis (CABM) (28.5%) followed by S. pneumoniae (14%). S. pneumoniae was susceptible to penicillin in 79% of cases. The mean mortality rate was 13.1%. CONCLUSION: Factors associated with a poor prognosis were: pneumococcal etiology, age over 60, and the presence of seizures or coma at admission.

[Sepsis with Staphylococcus aureus in immunocompromised patients]. / Sepsis-ul cu Staphylococcus aureus la imunodeprimati.

UNLABELLED: The aim of our study was to analyze clinical and biological characteristics of immunocompromised patients with staphylococcal sepsis and to compare with the same data in non-immunocompromised patients. MATERIAL AND METHOD: The diagnosis of sepsis was made based on Bone criteria. MiniAPI system ID 32 STAPH was used for identification and antibiotic susceptibility was assessed by ATB STAPH method and by E-test for oxacillin and vancomycin. RESULTS: Among the 147 patients with Staphylococcus aureus sepsis--66.67% had concomitant immunosuppressive conditions (diabetes mellitus, liver diseases, renal failure, corticotherapy, etc). We have found a significant correlation between the immunosuppressed status and MRSA (methicillin-resistant Staphylococcus aureus) involvement (p = 0.0018) and also, between this group of patients and treatment failure (p = 0.0012). CONCLUSION: Because of the high rate of MRSA involvement in systemic infections in the Eastern region of Romania first intention treatment of patients with staphylococcal infections and conditions of immunosuppression must include antibiotics effective against methicillin-resistant strains.

[Gamma interferon testing in blood and cerebrospinal fluid--rapid method for the diagnosis of tuberculous meningitis]. / Dozarea gama-interferonului în sânge si în lichid cefalorahidian--metoda rapida de diagnostic a meningitei tuberculoase.

AIM: To evaluate the benefit of this early method of diagnosis of tuberculous meningitis, gamma-interferon levels comparatively in blood and cerebrospinal fluid (CSF). MATERIAL AND METHOD: We have studied 50 patients with tuberculous meningitis admitted in the Clinic of Infectious Diseases Iasi between 2006-2007, from the epidemiological, clinical, diagnosis and therapeutical points of view. RESULTS: Tuberculous meningitis was more frequent in males, with a mean ration of 2.5. The age of patients varied between 2 and 78 years of age, with a mean value of 30.5 years. 35.6% of patients were children. In 32 cases the meningeal infection was secondary, disseminated from a primary site, most frequently from the lungs (68,7%). The bacteriologic confirmation was through culture in 13.3%, with an average of 23.4 days of incubation. In whole blood the sensitivity Quantiferon TB Gold assay (QTF) was 78.57%. In CSF the specificity was higher than in blood (96.1 vs. 88.4%), having a positive prediction value over 90%. Antituberculous therapy prior to QTF testing had a negative impact, 50 to 6 cases having negative QTF results. CONCLUSION: The performance indicators of TB Gold Quantiferon Test in serum or CSF are high, being more sensitive and rapid than the direct exam of CSF or BK culture.

[The co-infection with hepatitis virus B and D--cases admitted in the infectious diseases hospital from Iasi, Romania (2003-2005)]. / Co-infectia cu virusurile hepatitice B si D--cazuri internate în clinica de boli infectioase Iasi (2003-2005).

Despite the major medical advance, over 350 million people worldwide still have chronic infection with hepatitis B virus and HBV-associated liver disease remains a major cause of morbidity and mortality. 15-50% of patient VHB infected have serological markers for VHD co-infection. We retrospectively studied 252 cases of acute hepatitis B (AHB) admitted in our hospital between 2003-2005; 12 of them (4.76%) had a co-infection with hepatitis D virus. Most of the patients were young males with an urban origin. The route of transmission was unknown in 8/12 cases. Abdominal pain was more frequent during the onset of the disease than in AHB (p < 0.05). A cholestatic pattern was noted in 9 cases. The frequency of severe/ fulminant cases was greater then in AHB. The HBsAg was absent in 3 patients, and the HBV-DNA was present at low levels in 3/12 patients tested. Two patients had HBsAg present 6 month later.

[Lamivudine and alpha-IFN treatment of a severe case of acute hepatitis B]. / Lamivudina si alpha-interferonul în tratamentul unei forme severe de hepatita acuta cu virus B. Caz clinic.

In order to enhance the viral clearance we used a combined antiviral therapy in an 18 year old patient, hospitalized in the Infectious Diseases Hospital-Iasi, in June 2002. The evolution under standard therapy was unsatisfactory, with the aggravation of the icteric syndrome and a constant cytolytic syndrome. At this point we used the combination of Lamivudine (Zeffix) 100 mg/24 h + alpha-IFN 3 milUI x 3/week for the duration of 8 weeks. The improvement in both clinical and biochemical condition of the patient was obvious. At the end of the treatment (8 weeks) none of the signs or symptoms were present, the patient became AgHBs negative, AgHBe negative and anti-HBe positive. The combined antiviral therapy was useful (with the clearance of the HBs antigen) in a severe case of acute hepatitis B.

[Tetanus in childhood--experience at the Infectious Disease Hospital Iasi, January 1980-October 2003]. / Tetanosul la copil. Experienta Clinicii de Boli Infectioase Iasi în perioada 1980-2003.

The aim of our study is to present the tetanus pediatric cases for almost 24 year period. We analyzed epidemiologically, clinico-biologically and the treatment from the patients' files. In above mentioned period were admitted 8 children with tetanus, 4 cases in 1980-1990; 5 patients were female, mainly came from suburban area; 12-15 year old group of age was mainly involved-3 cases. A point of entry was certified in 7 cases, the mean incubation period was 9.2 days, all the cases had a typical form of the disease. The complications were: bronchopneumonia, ileus (1 case). The performed treatment--antitetanic serum, antibiotics, sedatives, curare for 3 patients; no patient died. A rare disease for the pediatric age, tetanus could be a severe disease, with severe complications.

[Postoperative and posttraumatic meningitis. Comments on 87 cases]. / Meningita postoperatorie si posttraumatica. Consideratii pe 87 cazuri.

Iatrogenic and traumatic cerebromeningitis infections are increasing in frequency in the last two decades. Retrospective analysis of 87 patients iatrogenic and traumatic bacterial meningitis were admitted in the Clinic of Infectious Diseases from Iasi between 1, 01, 1990-31, 12, 1994. Head trauma, lumbar punctures and iatrogenic meningitis infections were the causes cerebromeningitis infections. The diagnosis is usually difficult because of the poor specificity of the clinical signs. Predominant pathogens were gram-negative bacteria and Staphylococcus in iatrogenic meningitis and gram-positive bacteria (S. pneumoniae) in traumatic meningitis. The treatment was based on the use penicillin G + chloramphenicol, 3rd generation cephalosporins and sometimes 2nd generation quinolones. Ten of the 87 patients with iatrogenic and traumatic cerebromeningitis infections died (10.3%).