Eugen Dumitru

Clostridium difficile colitis – a serious current problem

Background Clostridium difficile is currently considered a significant cause of nosocomial infection and is associated with increasing morbidity and mortality. The probability of colonization of hospitalized patients increases with the length of their hospital stay and depends on the local epidemiologic situation. The study aimed to evaluate the epidemiological, clinical and treatment features of Clostridium difficile colitis (CDC), and the relapse associated risk factors in the Infectious Diseases Clinic and Gastroenterology Clinic.

Toxic Megacolon – A Three Case Presentation

Abstract Introduction: Toxic megacolon is a life-threatening disease and is one of the most serious complications of Clostridium difficile infection (CDI), usually needing prompt surgical intervention. Early diagnosis and adequate medical treatment are mandatory. Cases presentation: In the last two years, three Caucasian female patients have been diagnosed with toxic megacolon and treated in the Clinical Infectious Diseases Hospital, Constanta. All patients had been hospitalized for non-related conditions. The first patient was in chemotherapy for non-Hodgkin’s lymphoma, the second patient had undergone surgery for colon cancer, and the third patient had surgery for disc herniation. In all cases the toxin test (A+B) was positive and ribotype 027 was present. Abdominal CT examination, both native and after intravenous contrast, showed significant colon dilation, with marked thickening of the wall. Resolution of the condition did not occur using the standard treatment of metronidazole and oral vancomycin, therefore the therapy was altered in two cases using intracolonic administration of vancomycin and intravenous tigecycline. Conclusions: In these three cases of CDI, the risk factors for severe evolution were: concurrent malignancy, renal failure, obesity, and immune deficiencies. Ribotype 027, a marker for a virulent strain of CD, was found in all three cases complicated by toxic megacolon. The intracolonic administration of vancomycin, and intravenous tigecycline was successful when prior standard therapy had failed, and surgery was avoided.

Immunological diagnosis of CMV infection in HIV-infected patients

7‐11 November 2010, Tenth International Congress on Drug Therapy in HIV Infection, Glasgow, UK

Inflammatory Bowel Diseases: focus on epidemiology

Abstract The worldwide incidence and prevalence of Inflammatory Bowel Diseases (IBD) continues to increase, recent studies showing a future global spread of Inflammatory Bowel Diseases. Epidemiological data coming for Romania are scarce. The aim is to describe epidemiological features of Inflammatory Bowel Diseases in an adult population in the South-East side of Romania. The retrospective and descriptive study included 128 patients: group 1=Crohn’s Disease (CD) (79), group 2=Ulcerative Colitis (UC) (46) and group 3=Unclassified Colitis (Unclassified C) (3). We calculated the prevalence of Inflammatory Bowel Diseases in Constanţa in 2016. The phenotypic distribution was: 62% with Crohn’s Disease, 36% with Ulcerative Colitis and 3 patients with Unclassified Colitis. Crohn’s Disease: The prevalence was 0.11/100000 inhabitants. 51% were female and 49% were male. The age distribution showed a uniform model of the frequency of Crohn’s Disease in patients aged between 21 and 50 years. According to Montreal Classification, ileo-colonic involvement L3 was the most frequent in 47% and 60% patients presented inflammatory phenotype B1. 44% had intestinal complications. 9% had extraintestinal complications. 16.4% required surgical interventions. Ulcerative Colitis: The prevalence was 0.06/100000 inhabitants. We noticed a slight male predominance: 57% were male and 43% female. The age distribution showed a bimodal peak of incidence in patients aged between 21-30 years and 41-50 years. The most common disease extension was left colitis E2 in 47% cases. One patient had an enterovesical fistula. Extraintestinal complications were not reported in this group. No patient required surgical intervention. Unclassified Colitis: 3 male patients with ages between 31-50 years were diagnosed with Unclassified Colitis. Complications or need for surgery were not reported in this group. We noticed the predominance of Crohn’s Disease in our region while in other parts of Romania Ulcerative Colitis is predominant. We suppose that the predominance of Crohn’s Disease in Dobrogea can be due to environmental factors, diet or ethnics, but additional epidemiological studies to define better the association with environmental factors and risk factors for Crohn Disease or Ulcerative Colitis in our region are needed.

Efficacy Of Pegylated Interferon And Ribavirin Treatment In Coinfected HIV HCV Patients

Abstract The objectives of the study were to determine the efficacy of pegylated interferon alfa 2 b (PegINF) and ribavirin (RBV) treatment in co-infected HIV / HCV patients, to identify predictive factors associated with sustained viral response (SVR) in these patients. Out of the 956 HIV infected patients, 38 were HCVAb (4%) positive, 14 of which had undetectable HCV RNA, only 6 patients met the inclusion criteria. Screening failure was due to: liver cirrhosis Child Pugh B / C, hepatocellular carcinoma, pulmonary TB, thyroid dysfunction, CD4 <200 cells3, detectable HIV RNA and depressive syndrome. We initiated PegINF and RBV therapy for 48 weeks. SVR was achieved in 16.6% of cases (only one patient) and correlated with HCV RNA level, CD4 count, duration of HIV infection, CDC classification and liver fibrosis. In conclusion, our study group has a low prevalence of HIV / HCV co-infection (2.6%) with a large number of patients HCVAb positive but undetectable HCV RNA. Positive predictive factors for SVR were: low levels of HCV RNA, small duration of HIV infection, high levels of CD4, B1/B2 (CDC classification) and low degree of fibrosis.

Toxoplasmosis in immunocompetent and immunocompromised population of Constanţa, Romania

Abstract We analyzed a total of 412 adult patients diagnosed with toxoplasmosis in the Clinical Infectious Diseases Hospital Constanta between 01Jan 2010 - 01 Jan 2015. Of these patients, 82.03% were from urban area, 74% female, majority aged 30-48 years. 3.15% were diagnosed with HIV infection (13 patients), in four of these patients, toxoplasmosis was the primary clinical manifestation. The most common clinical manifestation in nonHIV infected patients was painless cervical adenopathy (106 patients), 49 patients had associated infection with Toxocara and in HIV infected patients prevailed cerebral toxoplasmosis (toxoplasmic encephalitis, with or without focal CNS lesions). 59 pregnant women (6 with acute infection and 53 with chronic infection) were followed during pregnancy. Reporting the number of cases of toxoplasma infection in Constanta population (254.693 inhabitants), we obtain a prevalence of 161.76 cases/100.000 inhabitants. Most of the patients were female and their supervision is required for possible implications in pregnancy. We believe that Toxoplasma infection is underdiagnosed in our county.

The association between metabolic syndrome and the occurrence of nephrolithiasis in HIV-infected patients

7‐11 November 2010, Tenth International Congress on Drug Therapy in HIV Infection, Glasgow, UK