Incidence and etiological agents of bacterial meningitis among children <5 years of age in two districts of Romania.

To expand upon the limited comprehensive population-based data for childhood bacterial meningitis in Eastern Europe, the present study was conducted in the Iasi and Constanta districts of Romania. From March 2000 through March 2002, children <5 years of age hospitalized for bacterial meningitis were enrolled in a prospective surveillance study. A total of 56 cases of bacterial meningitis were identified, including 37 due to Neisseria meningitidis (22 per 100,000 per year), 13 due to Haemophilus influenzae type b (7.6 per 100,000 per year), and six due to Streptococcus pneumoniae (3.5 per 100,000 per year). Of the 31 meningococcal isolates that were serotyped, 12 were serogroup A, eight were serogroup B, and 11 were serogroup C. Among all cases of bacterial meningitis, 25 occurred in children <1 year of age, including those due to meningococci (n=14), H. influenzae type b (n=7), pneumococci (n=3), and Klebsiella pneumoniae (n=1). In Romania the incidence of H. influenzae type b meningitis is similar to that found in other areas of Southern and Eastern Europe during the pre-vaccination era, and the incidence of meningococcal meningitis is one of the highest yet found in Europe. An unexpectedly high proportion of these meningococcal meningitis cases is due to serogroup A. Disease burden could be substantially reduced through the introduction of H. influenzae type b conjugate vaccine and, when available, meningococcal conjugate vaccine protective against serogroups A, B and C.

[Clinical and biological study of acute diarrhea with mixed etiology in 48 patients]. / Studiu clinico-biologic al diareei acute cu etiologie mixta pe un lot de 48 pacienti.

OBJECTIVES: The study of incidence, clinical manifestation and treatment of acute diarrhea with mixed etiology. MATERIAL AND METHOD: Study of 48 patients with acute diarrhea with mixed etiology admitted in the Hospital of Infectious Diseases of Iasi during 1995-1998. RESULTS: 12 cases (24%) were mixed bacterial infections with the following microorganisms associations: Salmonella + Shigella (10 cazuri); Salmonella + Yersinia enterocolitica (1 case); Salmonella + Rotavirus (1 case). 16 cases (44%) had mixed digestive infections with parasites, in double or triple associations: Giardia intestinalis + Ascaris lumbricoides (10 cases); Giardia intestinalis + Ascaris lumbricoides + Entamoeba coli (1 case); Giardia intestinalis + Enterobius vermicularis (3 cases); Ascaris lumbricoides + Trichiuris trichiura (2 cases). The rest of 20 cases presented mixed infections with bacteria and parasites: Salmonella + Rotavirus + Giardia (2 cases), Salmonella + Shigella + Giardia intestinalis or Ascaris lumbricoides (6 cases), Salmonella + Giardia intestinalis (8 cases); Salmonella + Entamoeba coli (3 cases); Shigella + Trichiura trichiuris + Entamoeba coli (1 case). The majority was male patients from rural areas with age between 5 month and 56 years, the majority being children, 4 cases were found in immunosupressed patients. The clinical symptomatology was dominated by diarrheal syndrome (100%) and the diagnosis was established by clinical characters and confirmed by coproculture and parasitologic exam. The ethiological therapy was guided by antibiogram, in the majority of cases we used fluorochinolones (associated with ceftriaxone in severe cases), together with antiparasitic medications. CONCLUSIONS: In this study predominated the bacterial and parasitic infections, most frequently being isolated Salmonella, Shigella and Giardia intestinalis; the therapy associated fluorochinolones with antiparasitic medication.

Sensitivity and resistance to antibiotics of Streptococcus pneumoniae involved in severe infections (1990-2000).

S. pneumoniae implicated in severe infections presents now a high frequency of the resistant strains to Penicillin G or multiresistance in the whole world. Our study on 136 strains of invasive pneumococcus isolated in the last 10 years showed a medium resistance to penicillin of 22.8% with yearly variations. The resistance to Rifampin, Cloramphenicol and Eritromycin was of 4.4%, 7.8% and 8.0%. The treatment of pneumococcal infections must be adapted to actual antibiotypes. These results present therapeutic implications.

[The clinical picture, treatment and prognosis of meningitis due to anaerobic and nonfermentative bacteria]. / Clinica, tratamentul si prognosticul meningitelor determinate de bacterii anaerobe si nonfermentative.

OBJECTIVES: The study of incidence, clinical manifestations and prognosis of meningitis with anaerobic and non-fermentative bacteria. MATERIAL AND METHOD: Retrospective study of 10 patients with severe forms of purulent meningitis admitted in the Hospital of Infectious Diseases of Iasi, during 1.01.1990-31.12.1998. RESULTS: 3 of them were diagnosed with etiology with polymicrobial flora and the rest had etiology with: Peptostreptococcus (2 cases), Acinetobacter calcoaceticus (4 cases), Eikenella corrodens (1 case). The majority were male sex (8 cases), and from rural area (9 cases). The age of patients ranged from 2.5 to 59 years (the majority being adults of group of age 50-60 years). The gate of entrance was: iatrogenic in the majority of cases (6 cases), posttraumatic (2 cases) and othogen (2 cases); 3 cases being with cerebrospinal fluid fistula and 8 patients being in coma. The factors associated with poor prognosis were: the immunosuppression (chronic etilism--4 cases; bronchopneumonia--2 cases, pulmonary cancer--1 case) and the presence of the focal neurological findings on the noser of illness. The diagnosis was established by clinical characters and confirmed by isolating germs from cerebrospinal fluid. The treatment was done at the beginning with first intervention antibiotic association with a high spectrum and then according to the antibiogramme. The evolution was severe even under treatment with 3 deaths, the mortality being of 30.0%. CONCLUSIONS: We wished to present these cases as a general remark on the severity of illness, generally appeared on a suppressed ground, together with the rarity of those germs implicated in the etiology of purulent meningitis.

[Nosocomial staphylococcal meningitis]. / Meningita stafilococica nosocomiala.

OBJECTIVE: Clinical, bacteriological and therapeutically study on iatrogenic staphylococcal meningitis. METHOD: Retrospective analysis of 33 cases of iatrogenic staphylococcal meningitis admitted to the Hospital of Infectious Diseases of Iasi in the interval 1988-1997. RESULTS: In the interval under study the recorded incidence was 1-5 cases per year. The predisposing factors were neurosurgical procedures for endocranial processes (12 cases), operated chronic otomastoiditis (11 cases), ventriculoatrial or peritoneal shunt (5 cases) and neurosurgical assessment (5 cases). The onset was slow, with persisting and mild headache persistence recurrence of fever, vomiting and convulsions followed by meningeal contracture and encephalitic phenomena. In 24 patients cerebrospinal fluid was typical for purulent meningitis. The causal agents were isolated in 25 cases being Staphylococcus aureus (20 cases) and Staphylococcus epidermidis sensitive to usual antistaphylococcal agents. Three therapeutically schemes were used the association cefotaxim î gentamycin proving to be the most effective vancomycin was required in but 2 cases. Three deaths were recorded. CONCLUSIONS: The symptoms of iatrogenic staphylococcal meningitis are mild marked by the underlying disease the most effective treatment being the association of cefotaxim with an aminoglycoside.

[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%).

[The streptococcal and staphylococcal toxic shock syndrome. Comments on 4 cases]. / Sindromul socului toxic streptococic si stafilococic. Consideratii asupra a 4 cazuri.

Between 1989 and 1995 in the Hospital of Infectious Diseases from Iasi have been diagnoses 4 cases of streptococcal/staphylococcal toxic syndrome. Three patients have been grown up and one child. Two of them were immunocompromised hosts (cirrhosis, lung tuberculosis, alcoholism). The gate of entry was cutaneous in 3 cases and probably mucous in the 4th case. The clinical symptoms were fever, generalized erythematous rush followed by desquamation, low arterial pressure with oliguria, tachycardia, jaundice moderate, elevated ALAT. The bacteriological diagnosis was confirmed by isolating the pathogen agent from the erysipelatous placard and from blood culture. The evolution of the illness was nefavourable in 2 cases. The cause of the death was the MSOF (multiple systemic organic failure).

[The value of C-reactive protein for the differentiation of bacterial meningitis from viral meningitis]. / Valoarea proteinei C-reactive pentru diferentierea meningitelor bacteriene de meningitele virale.

In order to differentiate bacterial meningitis versus viral meningitis, we have comparatively tested the efficacy of the following tests: C-reactive protein (CRP), erythrocytes sedimentation rate (ESR), fever, level of glucose in cerebro-spinal fluid (CSF), glucose in CSF/glycemia ratio, number of white blood cells in peripheric blood, percentage of neutrophils in peripheric blood, level of proteins in CSF and number of nucleated cells in CSF for a group of 49 patients, both children and adults with central nervous system infection (37 patients with bacterial meningitis and 12 with viral meningitis) hospitalised between May 1993 and July 1994 in Clinical Hospital for Infectious Diseases in Iasi. The mean value of CRP in bacterial meningitis patients was 8.78 mg%, contrasting with the mean value of CRP = 1.92 mg% recorded in patients with viral meningitis. Ten out of 37 bacterial meningitis patients presented a CRP concentration < 1.85 mg%. All these 10 patients have already had an antibiotic treatment at the moment of the assay. One out of 12 cases of viral meningitis had a value of CRP = 3.3 mg%, all the remainder cases having values under 1.85 mg%. We recorded highly significant differences between the two patient groups for CRP (p < 0.001), ESR (p < 0.01), protein concentration in CSF (p < 0.001) and number of nucleated cells in CSF (p < 0.001). Differences recorded for fever, concentration of glucose in CSF, glucose in CSF/glycemia ratio, number of leucocytes in peripheric blood and percentage of neutrophils in peripheric blood, were not significant (p > 0.5). Data were analysed also by box-plot method which facilitates the visual appraisal of the differences recorded between the two aetiological groups. In conclusion, assays of CRP and ESR may be used as differentiation tests for bacterial meningitis versus viral meningitis, when assay is done before the antibiotic treatment, being sufficient sensitive, and easy to perform.

[Scleromyxedema with laryngeal changes. Beneficial results of the treatment with mucopolysaccharidases]. / Scléromyxoedème avec modifications laryngées. Résultats bénéfiques du traitement par mucopolysaccharidases.

We observed a case of scleromyxoedema with specific cutaneous lesions in a 62-year-old man. These lesions were associated with modifications of the central nervous system, latent thyroid failure, cardiovascular changes and myopathy, usual manifestations of this disease, but without paraproteinaemia. Unusual laryngeal manifestations were a dysphonia with chronic pseudomyxomatosis of the larynx. Urinary mucopolysaccharide excretion was increased. It is important to underscore the favourable response to Thiomucase when more toxic drugs had become ineffective.

Bioactive polymers: in vitro and in vivo study of controlled release neomycin.

Neomycin is coupled on xanthan-a polysaccharide of microbial biosynthesis produced by Xanthomonas campestris-through ionic complexation. The kinetics of neomycin release, in vitro, at pH = 8.2 is studied. A controlled release of neomycin, following a zero order kinetics is observed, regardless of the eluent flow. Neomycin complexed on xanthan, administered in a unique daily dose to patients suffering from dysentery in the 100 cases taken in study, has shown a high clinical efficiency as compared with the treatments with ampicillin or furazolidone, administered for 5-10 days or longer.

[Acute nosocomial bacterial meningitis. Apropos 27 cases]. / Meningite bacteriene acute nosocomiale. Consideratii asupra 27 cazuri.

Our series includes 27 patients with nosocomial meningitis (22 post neurosurgery and 5 post spinal puncture) of whom 15 with stated etiology (gram-negative bacilli and staphylococcus aureus in equal shares). Under the treatment with chloramphenicol + rifampicin + gentamicin a cure was obtained in 22 cases, improvement in 3 cases and 2 patients died.

[Bacterial liver abscess cured by nonsurgical treatment. Comments on 8 cases]. / Abcesul hepatic bacterian vindecat sub tratament nechirurgical. Consideratii asupra opt cazuri.

Eight cases (3 children aged 7-15 years and 5 adults aged 16-46 years) of hepatic abscess in whom a cure was obtained by medical therapy are presented. The abscess occurred during septicemia (2 cases), cutaneous staphylococcosis (2 cases) and pyocholecystitis (1 case). In 3 patients the abscess remained cryptogenic. The clinical diagnosis was confirmed by scintigraphy, ultrasonography and in one case by radiography with contrast substance in the abscess. The microorganisms, isolated in 3 patients from the abscess and in one patient from hemoculture, were S. aureus (3 cases) and gram negative bacilli (1 case). The systemic antibiotic therapy consisted in the administration of gentamicin and oxacillin or rifampicin in 4 cases and gentamicin and chloramphenicol or ampicillin and metronidazole in other 4 cases for an average interval of 39 days. The associated local therapy (3 cases) consisted in one or more punctures, followed by the injection of gentamicin.