Emanoil Ceausu

Ongoing outbreak of multiple blood-borne infections in injecting drug users in Romania.

In the recently published 2012 annual report on the state of the drugs problem in Europe, the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) underlined the continuous increase in the drug-related infectious diseases, with a special mention for human immunodeficiency virus (HIV) infection and hepatitis C virus (HCV). According to the last data released from the EMCDDA, Romania has experienced an increase in the lifetime use for all types of illicit drugs among subjects aged 15e64 years old, from 1.7% in 2007 to 4.3% in 2010. Central estimates for the capital city, Bucharest, show an increase with 5.37% in the number of problem drug users, in the 18e49-year old age group only: from 17 387 in 2008 to 18 316 in 2010, with a low number of treatment demands (between 10 and 15%); at the country level, these data are largely unknown. There are few published data on the prevalence of drug-related infectious diseases. Surveys using respondent-driven sampling or testing among those looking for medical assistance (both consisting on rather small samples of 200e500 drug users) reported high, although slightly decreasing levels, of HCV infection (from 72.6% in 2008 to 68.5% in 2011, with higher levels among those >34 years old); increasing rates of hepatitis B virus (HBV)

Rickettsia massiliae infection and SENLAT syndrome in Romania.

The purpose of this prospective study is to describe the clinical and epidemiological characteristics of rickettsioses in Romania, where only Rickettsia conorii is known by clinicians but new Rickettsia species have been identified recently in ticks. A total of eight patients, including a nine-year-old child, were included between June 2011 and June 2012, in the Hospital for Infectious and Tropical Diseases, Bucharest, Romania. Seven cases presented during summer months and one in spring. Six patients presented a generalized rash with fever, myalgia and skin eschar. The last two patients presented a typical SENLAT syndrome, characterized by scalp eschar and neck lymphadenopathy. Using serological tools, we confirmed for the first time two cases of Rickettsia massiliae, the agent of spotted fever disease, and one case of Rickettsia slovaca, and one case of R. slovacaRickettsia raoultii the agents of SENLAT syndrome.

Neurologic Complications of Influenza B Virus Infection in Adults, Romania

Infection with this virus should be considered as an etiologic factor for encephalitis.

Complications of Varicella in Unvaccinated Children From Romania, 2002-2013: A Retrospective Study.

The epidemiologic and clinical pattern of varicella-related hospitalizations recorded during 2002–2013 in Romania showed the highest hospitalization rate in the 0–1 year age group. Younger age and diagnosis after 2007 were independent predictors of varicella-related complications, recorded in half of the hospitalized cases.

Antiretroviral treatment in adult ethnobotanical intravenous drug users recently infected with HIV

During the last few years in Romania, increased numbers of new HIV infections among ethnobotanicals intravenous drug users (eIVDU) were observed. Although most cases have relatively good immunological status, some patients reclaim antiretroviral (ARV) treatment because of very low CD4 count, severe comorbidities and/or pregnancies despite difficulties related to their adherence. Retrospective analysis of 32 patients, eIVDU, treated with ARV in our hospital between 1st January 2010 and 31st January 2014. From all 32 patients, 27 are males (84.4%). The main reason for starting ARV treatment was represented by severe AIDS-defining illness (71.4%) related to immunodepression with CD4 count below 100 cells/cmm 11 cases (34.3%) and one pregnancy. In our study group the mean CD4 count at baseline was of 110.1 cells/cmm (median CD4 102.5 cells/cmm). 24 patients (75%) received at first triple therapy including NNRTI (10 cases with nevirapine, 14 cases with efavirenz), the other 8 patients (25%) received from the beginning regimens with protease inhibitors. 7 patients from the first group were then switched to protease inhibitors, mostly after completing tuberculostatic treatment, while 2 patients from the second group were switched to integrase inhibitors because of potential drug-drug interactions involving rifampin. All patients in our study were coinfected with HCV, 9 patients (28.9%) had also HBV, and 15 patients (46.8%) had active tuberculosis. Only 15 patients were truly adherent to ARV (43.7%); we registered 5 cases of abandon and one death. From all 5 patients who discontinued treatment 3 were social cases; from all 28 patients who are currently treated 20 have good family support (71.4%) and 6 (21.4%) receive psychological counseling and methadone substitution therapy. Mean value of CD4 count at 1 month of HAART therapy was of 225.8 cells/cmm, probably related to ARV treatment received correctly during admission in our clinic, but this value decreased to 213.3 cells/cmm at 3 months, probably related to poor compliance at home. Despite the fact that they are recently infected with HIV, increasingly more eIVDU patients are in need of ARV treatment, because mainly of rapid immunodepression and comorbidities associated with AIDS. Family support as well as psychological counseling and substitution therapy with methadone are mandatory for achieving clinical success with HAART, while lack of adherence is the principal cause for immunological and virological failure. Tuberculosis with both pulmonary and extrapulmonary involvement is the principal complication associated with AIDS, involving almost half of the eIVDU in our country.

Predictors of Chronic Hepatitis C Evolution in HIV Co-Infected Patients From Romania

Background Due to a recent alarming increase in the number of HIV-HCV co-infected patients in Romania. Objectives A cross sectional study was conducted to assess the baseline predictors of liver disease evolution. Patients and Methods 83 HIV-HCV co-infected patients, untreated for HCV infection, were evaluated for viral replication, liver fibrosis (estimated by a noninvasive marker - FIB4), and plasma levels of IP-10 (interferon-gamma inducible protein 10) - a cytokine associated with an unfavorable outcome of HCV infection. Results The median value for HCV viral load was high (6.3 log10 IU/mL), 98.8% of the patients were infected with HCV genotype 1. Although 53% of the patients received antiretroviral therapy (cART), only 31.8% of these achieved undetectable HIV levels. HCV viral load was significantly higher in patients with AIDS (6.4 vs. 6.1 log10IU/mL; P = 0.04), and in those naïve for cART (6.5 vs. 5.9 log10 IU/mL; P = 0.04). Severe fibrosis was directly correlated with immunosupression (56% vs. 17.4%, P = 0.03), HCV replication (6.1 vs. 4.9 log10IU/mL P = 0.008), and IP-10 median values (312 vs. 139 pg/ml, P=0.008). A serum IP-10 level higher than 400 pg/mL was significantly associated with FIB-4 median values (4.09 vs. 1.7, P = 0.004), HCV viral load (6.4 vs. 6.1 log10 IU/mL, P = 0.02) and ALT level (206.8 vs. 112.4 IU/L, P = 0.05). Conclusions An important part of the HIV-HCV co-infected patients had negative baseline predictors for the evolution of HCV infection; their therapeutical management must be conducted with special attention towards adherence and potential overlapping drug toxicities. High concentrations of plasma IP-10 are reliable markers for the severity of liver disease.

Mycobacterium tuberculosis infection in intravenous drug users recently diagnosed with HIV/AIDS

Methods We performed a retrospective study on 45 patients, intravenous drug users (IVDU), diagnosed with HIV infection between 01 December 2010 – 01 August 2013 (30 months), in our department for HIV/AIDS infection in the Clinical Hospital of Infectious and Tropical Diseases “Dr. Victor Babeş” in Bucharest. All of these patients were also diagnosed and treated for Mycobacterium tuberculosis (TB) infection with different localizations and severity forms.

Re-emergence of severe West Nile virus neuroinvasive disease in humans in Romania, 2012 to 2017–implications for travel medicine

BACKGROUND In Romania, after a major outbreak in 1996, West Nile neuroinvasive disease (WNND) was reported only in a limited number of cases annually. During 2016-2017, a significant increase in the number of WNND cases was reported at the national level, associated with high mortality rates. METHODS A retrospective analysis of all cases confirmed with WNND, hospitalized during 2012-2017 in a single tertiary facility from Bucharest was performed in order to determine the annual prevalence and mortality rate and the risk factors associated with a severe outcome. RESULTS 47 cases were confirmed as WNND. The mortality rate was 25.5%, all death occurred during 2016-2017. Coma, confusion, obtundation, sleepiness and depressed deep tendon reflexes were symptoms predicting a severe outcome. In a univariate analysis age (p < 0.001), associated cancers (p = 0.012) and low levels of chloride in the CSF (p = 0.008) were risk factors for mortality. In a multinomial logistic analysis, age older than 75 years remained the only independent predictor of death in WNND. CONCLUSIONS The increase in both the number and the mortality rate of WNND cases suggest a changing pattern of WNV infection in Romania. Public health authorities and clinicians should be aware of the risk of severe WNV infection in travelers returning from Romania.

Real-world efficacy and safety of ombitasvir, paritaprevir/r+dasabuvir+ribavirin in genotype 1b patients with hepatitis C virus cirrhosis†

Direct antiviral agents (DAA) showed very good results in terms of efficacy and safety in clinical trials, but real‐life data are still needed in order to confirm this profile.

Influence of hepatitis C virus on serum glutathione-S-transferase

Methods Serum level of GSTpi was quantified by immunoenzymatic method in 42 patients with active systemic lupus erythematous (based on SLEDAI score), without any treatment divided in two groups: Group A – 30 cases with active SLE (SLEDAI = 11.2 ± 3.2), with chronic C hepatitis; Group B – 12 cases with active SLE (SLEDAI = 12.1 ± 4.5) without hepatitis C. The results were compared to those obtained in the control group, which included 42 healthy subjects.