Screening for latent BK virus infection in a renal transplant population for the first time in Romania: a single-center experience.

INTRODUCTION: The BK virus nephropathy (BKVN) is one of the most important infectious complications in renal transplant recipients. As BKVN lacks any effective antiviral treatment, early diagnosis is required in order to try to limit viral replication and subsequent damage to the renal allograft, by reducing the immunosuppressive therapy. Our study, the first of its kind in Romania, aimed to assess the prevalence of BKVN among renal transplant patients in our center. MATERIALS AND METHODS: In this cross-sectional study, we included 143 renal transplant patients from our center who had received their renal allograft between 2005 and 2010. We searched for latent BK virus infection by detection of serum anti-BK virus antibodies, using an in-house developed enzyme-linked immunosorbent assay (ELISA) technique. Serology was considered positive if results were >0.33 optical density units. In patients with positive serology, we searched for BKVN with qualitative (polymerase chain reaction, PCR) and quantitative (TaqMan real-time PCR) molecular techniques. Additionally, we searched for other viral infections, including hepatitis B (with HBsAg test), hepatitis C (with anti-HCV Abs test), and cytomegalovirus (CMV, with pp65Ag test). RESULTS: All patients screened with ELISA were found to have positive BK virus serology and two of these were diagnosed with BKVN. Both patients with BKVN presented with acute impairment of the renal graft function, and one of them also developed a ureteral graft stenosis. In both cases, BKVN resolved after reduction of immunosuppressive doses. We also diagnosed hepatitis B in 18.18%, hepatitis C in 7.0%, and CMV in 27.97% of patients. CONCLUSIONS: Our study demonstrates for the first time the existence of BK virus in Romania, and we believe it opens the prospective of diagnosing BKVN in high-risk patients in our country in the future. In renal transplant patients from our center, we found the prevalence of BK virus infection to be as high as 100%. The prevalence of hepatitis B and CMV was also remarkably high. In patients with BKVN, the reduction of immunosuppression enables the spontaneous resolution of the disease.

[Monitoring of Mycobacterium tuberculosis infections in Iasi County in 2009]. / Monitorizarea infectiei cu Mycobacterium tuberculosis în judetul Iasi, în anul 2009.

UNLABELLED: Tuberculosis is a major public health problem worldwide. Our study aimed to investigate epidemiological and demographic characteristics of tuberculosis infection and resistance to antituberculous drugs in Iasi County in 2009. MATERIAL AND METHOD: We have analysed the epidemiological parameters for 687 patients with pulmonary tuberculosis, new cases confirmed by microscopy and cultivation on Lowenstein Jensen. First and second-line antituberculous susceptibility testing was done for 130 strains, using agar proportion method and absolute-concentration method. RESULTS: The number of new cases of tuberculosis was higher in rural areas and in males 41-50 years old (sex ratio=2.22). The proportion of positive cases in microscopy was 81.51%. Drug resistance was as follows: 16 isolates (12.3%) to isoniazid, 5 (3.84%) to rifampin, 2 (1.53%) to ethambutol, 2 (1.53%) to streptomycin and 4 (3.07%) were multidrug-resistant. CONCLUSIONS: In this study we found high resistance rates to isoniazid, streptomycin and ethambutol. This requires increasing efficiency of tuberculosis diagnosis and susceptibility testing.

[Use of real time PCR for testing Staphylococcus aureus isolates from the Iasi Infectious Diseases Hospital]. / Utilizarea real time PCR pentru testarea izolatelor clinice de Staphylococcus aureus din Spitalul Clinic de Boli Infectioase Iasi.

UNLABELLED: S. aureus is capable of producing a wide spectrum of diseases and can quickly develop resistance to antibiotics. These features require a careful monitoring of these organisms, by detection of resistance genes and virulence factors, such as Panton-Valentine leukocidin (PVL). AIM: To determine the presence of mecA and pvl genes in S. aureus isolates by a Real Time-PCR technique (RT-PCR) in order to shorten the detection time. MATERIALS AND METHODS: We tested 119 strains isolated from pus, using phenotypic methods for methicillin resistance characterization, according to CLSI 2008-2010 guidelines. Detection of mecA and pvl genes was done with hydrolysis probes. RESULTS: The prevalence rate of methicilin resistant S. aureus (MRSA) was 40,33%, and pvl was detected in 52,08% of those strains. The results of the conventional methods for methicillin resistance detection were validated by those obtained by RT-PCR CONCLUSIONS: RT-PCR is useful in epidemiological surveillance of MRSA and PVL-producing strains and validation of test results for phenotypic resistance to oxacillin.

[Carbapenem resistance in Klebsiella pneumoniae clinical isolates from urinary tract infections]. / Emergenta rezistentei la carbapeneme la tulpini de Klebsiella pneumoniae izolate din infectii ale tractusului urinar.

UNLABELLED: Resistance to carbapenems by KPC (Klebsiella pneumoniae carbapenemase) production in Klebsiella pneumoniae clinical isolates was first described ten years ago in the U.S.A. and recently reported in other countries. This enzyme inactivates all beta-lactam antibiotics and is associated with fluoroquinolone and aminoglycoside resistance. MATERIAL AND METHODS: We investigated the carbapenem resistance in 498 Escherichia coli and Klebsiella pneumoniae strains isolated from urinary tract infections during 2009 in the lasi "Dr. C. I. Parhon" Clinical Hospital. Antimicrobial susceptibility testing was performed according to CLSI guidelines. To detect ESBL (extended spectrum beta-lactamase) and KPC production we used phenotypic tests and molecular biology methods (PCR). RESULTS: From all tested strains, only two K. pneumoniae strains showed modified susceptibility to carbapenems. The modified Hodge test was positive for the strain resistant to ertapenem, meropenem, imipenem (KA) and negative for the strain resistant only to ertapenem (K(B)). Both KA and K(B) isolates were negative for blaKPC and blaTEM genes, but harbored blaSHV and bla(CTX-M) genes, respectively. CONCLUSIONS: We report the first carbapenem resistant K. pneumoniae strains from Northeast Romania. The resistance is not mediated by KPC-carbapenemase; the possibility of dual mechanisms through cefalosporinases production and porins loss is suggested.

[Polyomavirus BK and its role in associated kidney transplantation pathology]. / Virusul polyoma bk s implicatiile acestuia în patologia asociata transplantului renal.

In the last three decades kidney transplantation became a therapeutic approach in Romania but, unfortunately, the increasing of kidney transplantation procedures is related to an increasing rate of associated pathology such as Polyomavirus BK Associated Nephropathy (BKVAN). Studies published recently emphasize that BKVAN is a consequence of different risks factors, particular viral pathogenesis, humoral and cellular immunity and high doses of immunosuppressive drugs used for a long time are the main conditions that influence the BKVAN's evolution. Since there is no specific and effective treatment, optimal medical management is to diagnose nephropathy in early stages, to stop viral replication, limiting tubular lesions and prevent progress toward destruction by decreasing doses of immunosuppressive agents.