Stela Halichidis

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.

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.

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.

Etiology of UTI – pathogens involved and their sensitivity to antibiotics

Methods At the Infectious Disease Hospital in Constanța, between January 2014 and June 2014, urine cultures were performed in patients presenting urinary tract infections. Urine was seeded by loops calibrated technique on Columbia agar with 5% sheep blood and Drigalski agar. To identify the germs we used latex agglutination kits for Gram-positive germs and API galleries (BioMerieux) for Gram-negative bacilli. Antibiotics susceptibility testing was performed with the help of Kirby-Bauer disc diffusion method.

Opportunistic infections and immune reconstitution inflammatory syndrome (IRIS) in HIV infected patient – late presenter in cART era: case report

HIV-infected individuals are at high risk of developing numerous opportunistic infections. The severity of these infections may increase proportional to the immunosuppression degree. We must pay special attention to immune reconstitution inflammatory syndrome (IRIS) in order to prevent worsening symptoms and death. HIV coinfection is associated with high mortality rate despite effective antiretroviral therapy. We present the case of a 42 male patient who was diagnosed with AIDS and pulmonary tuberculosis in 2011 in our clinic. Our theme includes clinical, biological, immunological, virological evolution and therapeutics of this patient. He was a late-presenter patient with advanced immunodepression at baseline: low CD4 count, increased viral load in blood and cerebrospinal fluid. After a month of tuberculosis treatment, antiretroviral therapy was instituted according to guidelines. During one year the patient subsequently developed IRIS and, one by one, several opportunistic infections, including CNS involvement. Thus he presented: Cryptococcus neoformans meningoencephalitis resistant to fluconazole with multiple relapses, TB meningoencephalitis, severe form of CMV disease with encephalitis, demyelinating lesions, necrotic ulcerative stomatitis and esophagitis with HSV, systemic candidiasis, severe bacterial infections with multidrug-resistant germs. Diagnoses were based on the usual investigations, including molecular biology techniques (RT-PCR: Mycobacterium tuberculosis, JC virus, Cryptococcus neoformans), viral resistance testing, PLEX-ID, MRI. Viral PLEX-ID identified the presence of Epstein Barr virus in CSF at a high level. Opportunistic infections occurred imposed specific therapy and reconsideration of antiretroviral therapy with CNS penetration ARV (score Letendre). The patient was adherent to ARV therapy. The evolution was initially favorable under specific therapy with clinical, immunological and virological improvement. Unfortunately, about 10 months after diagnosis, the patient developed CNS lymphoma possibly in relationship with increased levels of Epstein Barr virus in CSF, having fatal outcome. The evolution of this case pointed out once again that in a patient with AIDS at the time of initiating ART, it should be considered the possibility of IRIS and future opportunistic infections, associated with a poor prognosis. Therefore it is important to detect persons with HIV infection in the early stages of the disease in order to obtain a favorable evolution.

Evolution of parasitic diseases in a collectivity of HIV positive children

Abstract Introduction: Intestinal parasitism represents an important problem of children health. Infestations with protozoa and helmints even have an increased incidence in children they weren’t observed because they were asymptomatic and atypical but with negative influence on their health regardless their immune status. Objective: To evaluate parasitic infections in a collectivity of 38 children HIV+ from Cernavoda city (Hospis “St. Laurence”) over a period of 10 years (2002 - 2012). Material and method: We performed two coproparasitologic examinations (in year 2002 - before antiretroviral treatment and in year 2012 - after 10 years of antiretroviral treatment) by concentration and staining methods and ELISA for Cryptosporidium parvum antigen. Results: In our group of study the median age was 11.65 yrs. in 2002 and 20.6 yrs. in 2012. Sex ratio was M: F = 1:1.2. In year 2002 we found an incidence of parasitic disease of 94.9%, and in year 2012 we found an incidence of 26.31%. In year 2002 we found 6 cases of Giardia intestinalis, 5 cases of Blastocystis hominis, 15 cases of Chilomastix mesnili, 2 cases of Entamoeba coli, 1 case of Ascaris lumbricoides, 2 cases of Hymenolepis nana and 5 cases of poliparasitic disease. In year 2012 we found 4 cases of Giardia intestinalis, 2 cases of Entamoeba coli, 2 cases of Blastocystis hominis and one case of Isospora belli and another one case of Ascaris lumbricoides. Conclusions: After ten years of HAART the incidence of parasitic diseases registered an important decrease from 94.9% to 26.31%.

Pulmonary silicotuberculosis in an electrician male - Case report and literature review

Abstract This is a case report of a pulmonary silicotuberculosis in a former smoker, male, 43 years old, having 21 years of occupational exposure to particulate coniotic-free crystalline-silicon dioxide as an electrician, developing symptoms as fever higher than 38°C, dry cough and diffuse chest pain, being diagnosed with miliary of the lung in 2002. Silicosis was confirmed later by histological exam obtained through an exploratory thoracotomy and it was included in the transient first to second stage of pneumoconiosis. Three years later, in July 2005, Pulmonary Tuberculosis was diagnosed by acid-fast stains positive smears. The evolution of the case was to a progressive deterioration till 2008, leading to silicosis stage III. Silicosis is a pulmonary fibrosis which must be always suspected in persons working in conditions of occupational exposure to dust of silicon dioxide, having suggestive radiological changes including micronodular radiological pattern or pseudotumoral one. Once the diagnosis of silicosis is confirmed, tuberculosis may be frequently associated. The more advanced silicosis is, the more the combination of the two diseases is commonly revealing and, often, the TB morbidity among workers in the silica industry exceeds that of general population. A hint orientation for the silicotuberculosis’ diagnosis, in this reported case, was represented by the radiological dynamic of the lesions. Tuberculosis lesions are less dense and imprecisely defined, located in upper lobes and develop necrotic centers.