Simona Claudia Cambrea

Can HIV infection during pregnancy cause an intrauterine growth restriction

Background Intrauterine growth restriction (IUGR) indicates the presence of a pathophysiological process occurring in utero that inhibits fetal growth. IUGR has been associated with increased perinatal and infant mortality. There are many maternal factors responsible for IUGR. Some studies have suggested that HIV infection could increase the risk of IUGR. Specifically, in IUGR, the baby’s estimated weight is below the 10th percentile. The objective of this study was to evaluate the proportion of children born to HIV positive women who presented IUGR.

Disseminated toxoplasmosis in an HIV positive patient in cART era

Toxoplasmosis is a disease caused by the intracellular parasite Toxoplasma gondii. Toxoplasmosis is considered one of the most common cerebral opportunistic infections in HIV-AIDS patients. It develops when CD4 count falls below 100 cells/cmm, either from acute exposure to the parasite or from reactivation of latent infection. These patients may also develop extra-cerebral toxoplasmosis such as ocular toxoplasmosis and pulmonary diseases. Another clinical manifestation described in HIV-infected patients is disseminated toxoplasmosis which consists of fever, pulmonary infiltrates and sepsis-like syndrome. We present a case of a 22 years old female patient diagnosed with HIV since her childhood. Over the years she was uncompliant to combined antiretroviral therapy (cART). After 16 years from her HIV diagnosis she presented an acute hepatitis type C with severe prolonged evolution, from which she slowly recover after a period of 3 months. After discharge she was well for about one month but came back with left hemiparesis difficulties in speech and visual disturbances. Also during this last hospitalization she presented a severe bronchopneumonia. After 20 days of hospitalization she died. Postmortem histopathological examinations revealed a disseminated toxoplasmosis involving multiple organ systems: central nervous system, lung, liver, spleen and lymph nodes. Lung examinations revealed bronchopneumonia due to multiple opportunistic coinfections with T. gondii, CMV and fungal infection. We noticed also an extensive ulcerated esophagitis of HSV and fungal etiology. In immunosuppressed patients disseminated toxoplasmosis has a polymorphic clinical presentation requiring a more attentive investigation because it may hide also an involvement with other opportunistic infections. The syndrome of disseminated toxoplasmosis is affecting more than two organs and it is highly lethal in HIV positive patients.

Liver damage in HIV+HBV co-infected patients determined by transient elastography

In our country the prevalence of HIV-HBV co-infection in young infected patients, between 1985-1990, transmitted through nosocomial or vertical path is approximately 40%. We followed the prevalence and risk factors associated with liver damage in HIV+HBV infected patients. Longitudinal evaluation of liver fibrosis was carried out in the patients included in the study group, by transient elastography (TE). Several studies using non-invasive methods for the assessment of fibrosis have been performed in HIV infected patients, and in patients co-infected with hepatitis virus B, although up to now these methods have not been validated for this segment of the population. For statistical analysis, the TE results were designated to different stages of fibrosis in accordance with the previous recommendations. The predefined cut-off values were: F0-F1≤7.1 kPa, F2-F3>7.1 and ≤12.5 kPa and for cirrhosis (corresponding to F4) >12.5kPa. We included in the study 71 patients co-infected with HIV and hepatitis B. 71.85% of patients had minimal liver damage, 18.30% of them had moderate to severe fibrosis, 9.85% were F4. Patients were divided according to CD4 count into three groups: CD4 (0-200)/cmm, [200-500)/cmm, and >500 cells/cmm. By applying the ANOVA test we found significant differences between the 3 groups (p=0.037 500) [cells/cmm], p=0.033 400 copies/mL. For assessing the role of hepatitis virus B in liver disease severity in co-infected patients, patients were divided into two groups: HBV-DNA level≤ 2,000 IU/mL and >2,000 IU/mL. Since p=0.006 2,000 IU/mL), 95%CI (-4.642,-0.788). We confirm the role of HIV-induced immunosuppression in liver disease progression. As well we confirm the presence of more severe liver disease linked to hepatitis virus B replication.

Evaluation of anthropometric and virologic data in newborn from HIV positive mothers

Constanța used to be one of the most affected counties of Romania by HIV in children. Nowadays in Constanța there are an increasing number of HIV positive young women at fertile age who have babies. Even though there were implemented active measures for prevention of mother to child HIV transmission we still diagnose mothers with HIV after delivery. On the other hand HIV infection increases the risk of intrauterine growth restriction (IUGR) of newborn. The objectives of this study were to evaluate the proportion of children born from HIV positive women who presented IUGR; and to evaluate materno-fetal transmission rate of HIV in Constanța County. We performed a retrospective study on the relevant parameters in newborns and mothers: demographic data; CD4 count and HIV viral load in last trimester of pregnancy of mothers; HIV viral load in newborn. We analyzed anthropometric data of the newborn: weight, length, cranial circumference, and Apgar score. Statistical analysis was performed using SPSS version 19. Over a period of 6 years and 2 months, 135 newborn from 117 HIV+ mothers have been monitored. From all 135 children born from HIV positive mothers 5 were HIV positive. The median age in mothers was 23 and mean 23.08 (range: 17 to 39, SD=3.58). The mean Apgar score in newborns was 8.47 (range: 2 to 10, SD=1.202), and median 9. The mean birth weight in newborns was 2692 g (range: 1000 to 3900, SD=516.389), and median 2700 g. The proportion of children with birth weight less than 10th percentile was 58.05%. The mean length was 47.66 cm (range: 39 to 52, SD = 2.75), with a proportion of children below the 10th percentile of 27.4%. Infants who presented below the 10th percentile for weight and length were 23%. About 21.48% of infants were below the 10th percentile for weight, length and cranial circumference. Mean CD4 count in mothers in third trimester of pregnancy was 415.14 (range 27-1156), and median 397. 53.3% of mothers were with HIV viral load undetectable in the last trimester of pregnancy. In the studied period the mortality rate was 6.7% in children and 5.9% in mothers. The materno-fetal rate of HIV transmission was 3.7%. More than half (58.05%) of the infants born to HIV positive mothers were small for gestational age. 23% of infants were with IUGR and 23% of them presented symmetrical IUGR.

Micronodular lung lesions in an HIV positive patient - dilemmas in differential diagnosis

Background In HIV positive patients from countries with a high burden of tuberculosis (TB), patients with lung cancer are often misdiagnosed as pulmonary tuberculosis, leading to delay in the correct diagnosis as well as exposure to inappropriate medication. Even though there are many similarities between the two diseases (involvement of the lung parenchyma and similar symptoms), there are also many differences between them like different etiologies, different consequences, and altogether different management.

Enterovirus Meningitis in Children from Constanta

Abstract Introduction: Many different viruses can cause meningitis. Most children are exposed to some of them during their life without developing meningitis. Of all the viruses, enteroviruses are the most frequent involved in etiology of meningitis. Material and Method: The evaluated group consisted of 73 patients, boys and girls aged 1 to 12 years, hospitalized at Constanta Clinical Infectious Diseases Hospital during the period May 2016 - October 2017. Results: Over the studied period, 243 patients were admitted with suspicion of meningitis, but just 73 of them were confirmed (30.04%). The average age of children with Viral Meningitis was 5 years and 8 months old, with a gender distribution that revealed a 2:1 balance in boy’s favor. The most affected age groups were 1-3 years and 4-6 years with 27 cases each. Fever, headaches and vomiting were the most common symptoms, occurring in majority of the patienst (53/73). Cerebrospinal fluid was clear in 58 cases, meanwhile in 15 cases the fluid was opalescent. Polymerase chain reaction on cerebrospinal fluid revealed Enterovirus in 27 out of the 73 cases. Conclusions: Viral meningitis with enteroviruses should be considered in any paediatric patients admitted with fever, headaches and vomiting, boys and girls, due to the potential outbreaks that can appear during the summer or autumn.

Urinary tract infection in Children Hospitalized at Constanta Clinical Infectious Diseases Hospital

Abstract Introduction: In pediatrics, the urinary tract infection is one of the most frequent bacterial infection, representing an important health problem due to its high incidence, wide etiology, asymptomatic evolution, and multiple and sever complications, relapses and sequelae.” Material and Method: We evaluated 45 children, aged between 6 months and 16 years, diagnosed and treated for urinary tract infection at the Clinical Infectious Diseases Hospital, of Constanta County, in a period of 3 years and 6 months. Results: During studied period, between January 2014 and June 2017 from a total of 9343 patients admitted to the Constanta Clinical Infectious Diseases Hospital, we selected 45 children (4.81‰) diagnosed with urinary tract infection. The average age of children with urinary tract infections was 5 years and 5 months. The gender distribution revealed a 2:1 balance in girl’s favor. The most affected group of age was 1-3 years. Fever was the dominating symptom. Urine cultures were positive for 37 cases, meanwhile for eight cases had been negative. The predominant germs are E. coli for female and for male Proteus. We noticed that for E. coli the highest sensitivity is preserved to Ertapenem -15 cases, followed by Ceftriaxone and Ciprofloxacin -10 cases each, and Gentamycin -9 cases. Conclusions: Pediatric urinary tract infection should be considered in every patient under 3 years with unexplained fever.

Medical Informatics applied in psoriasis diagnosis and management

Abstract Psoriasis represents a chronic disease, with a prevalence of 0.91% to 8.5% worldwide. The clinical manifestations of the disease vary a lot from patient to patient and the response to treatment also varies a lot. Today, in spite of the drawbacks it has, PASI (Psoriasis Area Severity Index) represents one of the best tools used to evaluate the extent of the disease and the response to medication. One of the drawbacks of using this scoring system is considered to be the way a doctor has to calculate the result. In this study we offer, step by step, a possible solution to create an informatics tool that can offer the result of the score based on the inputs made by the doctor.

Invasive Lung Adenocarcinoma Mimicking Nodular Tuberculosis in a HIV Positive Patient (Case report)

Abstract Even though there are many similarities in symptoms and radiological aspect between pulmonary tuberculosis (TB) and lung neoplasia, there are many differences between them like different etiologies, different consequences, and altogether different management. We present a case of a 59 years old male, heterosexual, who was HIV diagnosed in the last 16 years. He had a good immunological and virusological evolution over the time. In the last 5 months of his life he was diagnosed with pulmonary TB and he received specific treatment. After 4 months of antituberculous treatment patient became asthenic, febrile, with productive cough, and weight loss. Imagistic evolution was unfavorable. The suspicion of pulmonary neoplasm raises in the last 3 weeks of his life. Macroscopic lung examination during autopsy was suggestive rather to a pulmonary TB than a lung neoplasm, with a nodular pattern very similar with nodular TB. Histopathological examination evidenced a lung adenocarcinoma. In HIV patients a delayed or missed diagnosis of lung cancer, can lead to late treatment or wrong treatments, and finally death of patient.

Etiology of acute diarrhea in patients requiring hospitalization in Clinical Infectious Diseases Hospital - Constanța

Results In the study period 3,929 patients with AD (with 353 positive cases) presented to the Infectious Diseases Hospital out of which 2,550 children (with 301 positive cases) and 1,371 adults (with 52 positive cases). In children rotavirus enteritis ranked first in the etiology of infectious enteritis with a confirmed etiology of 62% over the entire period (186 cases) with a peak incidence in January-March – 78% of enteritis with infectious etiology confirmed (92 cases). Of bacterial causes of enteritis in children under 2 years, Klebsiella ranked first with 60% (32 cases), followed by enteropathogenic E. coli, with 25.9% (14 cases). The isolated strains of Klebsiella were 100% sensitive to imipenem, 92% sensitive to quinolones, 80% sensitive to ceftriaxone but only 33.3% sensitive to amoxicillin/clavulanic acid. In children over 2 years, the most frequently encountered bacteria was Salmonella spp. – 47.5% of bacterial enteritis (29 cases), followed by Shigella spp. – 26.2% (16 cases) and Campylobacter – 11.47% (7 cases). The most common cause of enteritis with confirmed infectious etiology in adults was Salmonella spp., with a percentage of 47.9% (23 cases), followed by Clostridium spp. with 29.1% (14 cases) and Shigella spp. with 16.6% (8 cases). The strains of Salmonella spp. that had been isolated from adults were 100% sensitive to: quinolones, cephalosporins, imipenem, gentamicin, but 26% (6 cases) were resistant to tetracycline.