Costin Cernescu

West Nile encephalitis epidemic in southeastern Romania

BACKGROUND West Nile fever (WNF) is a mosquito-borne flavivirus infection endemic in Africa and Asia. In 1996, the first major WNF epidemic in Europe occurred in Romania, with a high rate of neurological infections. We investigated the epidemic to characterise transmission patterns in this novel setting and to determine its origin. METHODS Hospital-based surveillance identified patients admitted with acute aseptic meningitis and encephalitis in 40 Romanian districts, including Bucharest. Infection was confirmed with IgM capture and indirect IgG ELISAs. In October, 1996, we surveyed outpatients in Bucharest and seven other districts to estimate seroprevalence and to detect infected patients not admitted to hospital. We also measured the rates of infection and seropositivity in mosquitoes and birds, respectively. RESULTS Between July 15 and Oct 12, we identified 393 patients with serologically confirmed or probable WNF infection, of whom 352 had acute central-nervous-system infections. 17 patients older than 50 years died. Fatality/case ratio and disease incidence increased with age. The outbreak was confined to 14 districts in the lower Danube valley and Bucharest (attack rate 12.4/100000 people) with a seroprevalence of 4.1%. The number of mild cases could not be estimated. WN virus was recovered from Culex pipiens mosquitoes, the most likely vector, and antibodies to WN virus were found in 41% of domestic fowl. INTERPRETATION The epidemic in Bucharest reflected increased regional WNF transmission in 1996. Epidemics of Cx pipiens-borne WNF could occur in other European cities with conditions conducive to transmission.

Risk Factors for West Nile Virus Infection and Meningoencephalitis, Romania, 1996

In 1996, an epidemic of 393 cases of laboratory-confirmed West Nile meningoencephalitis occurred in southeast Romania, with widespread subclinical human infection. Two case-control studies were performed to identify risk factors for acquiring infection and for developing clinical meningoencephalitis after infection. Mosquitoes in the home were associated with infection (reported by 37 [97%] of 38 asymptomatically seropositive persons compared with 36 [72%] of 50 seronegative controls, P<.01) and, among apartment dwellers, flooded basements were a risk factor (reported by 15 [63%] of 24 seropositive persons vs. 11 [30%] of 37 seronegative controls, P=.01). Meningoencephalitis was not associated with hypertension or other underlying medical conditions but was associated with spending more time outdoors (meningoencephalitis patients and asymptomatically seropositive persons spent 8.0 and 3.5 h [medians] outdoors daily, respectively, P<.01). Disease prevention efforts should focus on eliminating peridomestic mosquito breeding sites and reducing peridomestic mosquito exposure.

Evaluation of TV cell line viral susceptibility using conventional cell culture techniques

Despite the fact that a lot of methods have been developed for rapid virus detection, classic cell culture is still “the golden standard”. The range of viruses that can be isolated and cultured in cell line systems is often limited by the susceptibility of cells to support viral replication. Since the primary cell culture, the best cellular system available to support replication of a large number of viruses, is very expensive and diffcult to obtain, cell lines, which are easier to manipulate, are commonly used for virus growth and isolation.In two previous papers we described the TV cell line initiated by our team from a laryngeal tumor, which harbors human papillomavirus (HPV) gene sequences. In this paper we analyze its capacity to support virus replication. Depending on the virus, different cytopathic effects were produced. Comparison of viral effect observed on this cell line with the effect obtained on other cell lines has been performed. This cell line might be used in the clinical virology laboratory for virus isolation.

HCV non-1b genotypes in injecting drug users from Romania

INTRODUCTION Chronic hepatitis C cases diagnosed in Romania were mostly related to unsafe parenteral treatments and blood transfusions; HCV genotype 1b was prevalent. During the last decade, an increasing number of HCV infections was reported among people who inject drugs (PWID). The aim of the current study was to test if this epidemiological shift triggered a diversification of the circulating viral strains. METHODOLOGY HCV genotypes were determined by reverse hybridization in 130 HCV-infected PWID (87.7% males; mean age 27.9 ± 6.7 years, injecting drugs for 8.1 ± 4.8 years). RESULTS HIV-HCV co-infection was diagnosed in 80.8% of the subjects and 26.9% were HIV-HCV-HBV triple infected. Active HCV viral replication was present in 104 PWID (80%), more frequently in those HIV-co-infected (91.4% vs. 52% in HCV mono-infected, and 77.148.5% in HIV-HCV-HBV triple-infected, p = 0.0001). Non-1b genotypes were prevalent (54.8%), with subtype 1a the most commonly detected (24%), followed by genotypes 3a (14.4%) and 4 (7.7%). Mixed infections with genotypes 1a and 1b were found in nine subjects (8.7%). There was no difference in the genotypes frequencies based on HIV or HBV co-infection status, length of drug usage, or associated risk factors (tattoos, piercing, detention). CONCLUSION The continuous surveillance of HCV genotypes in PWID from Romania will add valuable information to the overall European epidemiological picture, with important therapeutic implications.

Influence of social changes on the evolution of HIV infection in Romania

The Romanian HIV epidemic started and evolved as a paediatric one, accounting for more than a quarter of the total European juvenile AIDS cases. In response to this major AIDS outbreak, emphasis was placed on the patient’s treatment, by implementation of a free, universal access program of Highly Active AntiRetroviral Therapy. This approach has been highly successful, and has greatly increased the rate of survival in infected children. Nevertheless, these children are now teenagers or young adults, representing a large cohort of ‘long‐term survivors’ – a unique population that represent a great challenge for the public health system and for their integration in the civil society. As the number of HIV infected adults is increasing, new high‐risk behaviour groups, as well as vulnerable populations (young people, people living in poverty, Rroma community) need to be reached in prevention programs. This article explores the impact of the socio‐economic changes on the evolution of the HIV epidemic in Romania and speculates about the factors that might drive future increases in the incidence of HIV infections.

Romanian experience in post‐event environment surveillance for West Nile virus infections

In the summer of 1996 Romania experienced a large outbreak of West Nile virus (WNV) meningoencephalitis with more than 500 clinical cases and high rates of death (up to 10%). It was the first epidemic recorded in Europe associated with urban/suburban infrastructural conditions that favoured an increase in the distribution and abundance of mosquito vectors. Careful monitoring of acute neurological human cases reported in previously affected districts, during a 10‐year period following the epidemic, revealed a gradual decrease of viral transmission and the absence of recurrent outbreaks. An additional benefit of WNV surveillance system has been the ability to pick up summer meningoencephalitis outbreaks or other causes of neurologic morbidity, like heatstroke, occurring in epidemic form during heat waves. This article provides a critical analysis of the post‐epidemic surveillance system together with a review of the intermediate‐term changes in ecological factors favouring viral transmission, by increasing interaction between mosquito vectors, avian hosts and susceptible human population.

Phagocytic function of monocytes in children with human immunodeficiency virus type 1 infection.

ABSTRACT We investigated the phagocytic function of monocytes in 7- to 10-year-old children horizontally infected with human immunodeficiency virus type 1 (HIV-1) in comparison to that in healthy sex- and age-matched controls. CR3-mediated phagocytosis was increased in patients with HIV-associated pulmonary tuberculosis, independently of CD4 counts and p24 antigenemia.