Irina Duport-Dodot, C. Tilișcan, M. Rădulescu, Anca Saran, Laurențiu Stratan, A. Negru, Nicoleta Mihai, M. Dodot, A. Croitoru, V. Aramă, Ș. Aramă
Although Hepatitis C virus (HCV) infection has become a curable disease, the aftermath of the infection remains an important aspect to be evaluated. HCV infection is well known for its extrahepatic manifestations, mostly the tight relationship between HCV, type 2 diabetes mellitus (T2DM) and dyslipidemia. Not only HCV increases the risk of T2DM, but it also affects its control in diabetic patients, increasing the risk of diabetes related complications. Furthermore, HCV hijacks the lipid metabolism resulting in abnormalities in circulating lipids which can lead to multiple complications, such as increased atherosclerotic risk and hepatic steatosis. Objectives. The aim of this study was to evaluate the dynamics of the parameters of carbohydrate and lipid metabolism in HCV-infected diabetic patients compared to non-diabetic patients after viral eradication. Material and methods. This is a prospective study conducted on 100 patients with chronic HVC infection who obtained viral clearance after interferon-free treatment. 58 patients had type 2 diabetes mellitus and 42 were non-diabetic. We evaluated serum total cholesterol, triglycerides, blood glucose and glycosylated hemoglobin in both groups at treatment initiation and 1 year after. Continuous variables were expressed as mean values ± standard deviation or median, categorical variables were represented as relative or absolute frequencies. Characteristics were compared using the Mann-Whitney method or the two-sample Student's T-test method for continuous variables, Chi-square and Fischer's test for categorical variables. A p value < 0.05 was considered statistically significant. Outcomes. The study analyzed and compared lipid and glycemic profiles of diabetic and non-diabetic HVC patients before and after viral cure. Conclusions. 1 year after treatment initiation the changes in lipid metabolism seem to persist, carbohydrate metabolism seems to remain unchanged, with no differences between diabetic and non-diabetic patients.
{"title":"Evaluation of carbohydrate and lipid metabolism dynamics in chronic HCV diabetic patients treated with direct antiviral agents","authors":"Irina Duport-Dodot, C. Tilișcan, M. Rădulescu, Anca Saran, Laurențiu Stratan, A. Negru, Nicoleta Mihai, M. Dodot, A. Croitoru, V. Aramă, Ș. Aramă","doi":"10.37897/rjid.2023.2.3","DOIUrl":"https://doi.org/10.37897/rjid.2023.2.3","url":null,"abstract":"Although Hepatitis C virus (HCV) infection has become a curable disease, the aftermath of the infection remains an important aspect to be evaluated. HCV infection is well known for its extrahepatic manifestations, mostly the tight relationship between HCV, type 2 diabetes mellitus (T2DM) and dyslipidemia. Not only HCV increases the risk of T2DM, but it also affects its control in diabetic patients, increasing the risk of diabetes related complications. Furthermore, HCV hijacks the lipid metabolism resulting in abnormalities in circulating lipids which can lead to multiple complications, such as increased atherosclerotic risk and hepatic steatosis. Objectives. The aim of this study was to evaluate the dynamics of the parameters of carbohydrate and lipid metabolism in HCV-infected diabetic patients compared to non-diabetic patients after viral eradication. Material and methods. This is a prospective study conducted on 100 patients with chronic HVC infection who obtained viral clearance after interferon-free treatment. 58 patients had type 2 diabetes mellitus and 42 were non-diabetic. We evaluated serum total cholesterol, triglycerides, blood glucose and glycosylated hemoglobin in both groups at treatment initiation and 1 year after. Continuous variables were expressed as mean values ± standard deviation or median, categorical variables were represented as relative or absolute frequencies. Characteristics were compared using the Mann-Whitney method or the two-sample Student's T-test method for continuous variables, Chi-square and Fischer's test for categorical variables. A p value < 0.05 was considered statistically significant. Outcomes. The study analyzed and compared lipid and glycemic profiles of diabetic and non-diabetic HVC patients before and after viral cure. Conclusions. 1 year after treatment initiation the changes in lipid metabolism seem to persist, carbohydrate metabolism seems to remain unchanged, with no differences between diabetic and non-diabetic patients.","PeriodicalId":53394,"journal":{"name":"Revista Romana de Boli Infectioase","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43651456","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
G. Jugulete, A. Panciu, Mihaela Safta, Bianca Borcoș, Luminita Marin, Elena Gheorghe, Luciana Zah, Delia Negrea, M. Merișescu
SARS-CoV-2 infection is usually a self-limiting viral infection in healthy children. Still, it’s effects on the neonatal population remain largely unknown. There has been evidence of adverse events on neonates, mostly consisting in case reports of patients with severe forms of COVID-19 and also recent cohort studied of the pediatric population including the neonatal subgroup. The clinical presentation appears different in the neonatal patients in contrast with older children, and may manifest also as a life-threatening respiratory infection with systemic complications. In this paper we present a clinical case of a premature boy with a corrected age of 40 weeks at admission to the Pediatric Infectious Diseases Clinical Department IX of the National Institute of Infectious Diseases “Prof. Dr. Matei Bals” with the diagnosis of SARS-CoV-2 infection. The positive diagnosis was established on suggestive clinical picture (fever, dry couch, rhinorrhea, loose stools and inappetence) and confirmed by SARS-CoV-2 rapid antigen test. Laboratory investigations at admission showed only moderate to severe anemia, mild inflammatory syndrome and a mild neonatal hyperbilirubinemia, with normal leukocyte count, normal glycaemia, ionograme and blood gases. Chest x-ray showed moderate interstitial pneumonia. In the second day of admission, after 24h of favorable evolution, with no fever and present appetite, he suddenly presented during defecation a presumptive vasovagal syndrome, with general hypotonia and a short period of desaturation. Laboratory investigations made during the episode showed normal glycaemia, normal ionograme, normal blood gases, moderate-severe anemia and important metabolic acidosis. A new chest x-ray showed evolution of the interstitial pneumonia. We did a blood transfusion and continued antiviral treatment, antibiotic treatment and perfusions. He maintained normal pulmonary and cardiac function for another 6 hours, after which he presented a tonic-clonic seizure and after administration of intrarectal benzodiazepines he presented cardio-pulmonary arrest. He was resuscitated, intubated and sedated and transfer to a children ICU. 2 weeks later after admission in the ICU he was discharged with favorable outcome. The case presented shows that although SARS-CoV-2 infection is often a mild condition in children, COVID-19 in neonates can have an unpredicted course. Rapid evolution to sever forms can be a possible disease outcome. Preterm birth with associated complications like bronchodysplasia or anemia, can predispose to sever evolution of the disease, and this child must be kept safe. There is also a neurotropic potential of the SARS-CoV-2 virus that has to be followed.
{"title":"Severe form of COVID-19 in a neonate with resuscitated cardio-respiratory arrest - Case presentation","authors":"G. Jugulete, A. Panciu, Mihaela Safta, Bianca Borcoș, Luminita Marin, Elena Gheorghe, Luciana Zah, Delia Negrea, M. Merișescu","doi":"10.37897/rjid.2023.2.4","DOIUrl":"https://doi.org/10.37897/rjid.2023.2.4","url":null,"abstract":"SARS-CoV-2 infection is usually a self-limiting viral infection in healthy children. Still, it’s effects on the neonatal population remain largely unknown. There has been evidence of adverse events on neonates, mostly consisting in case reports of patients with severe forms of COVID-19 and also recent cohort studied of the pediatric population including the neonatal subgroup. The clinical presentation appears different in the neonatal patients in contrast with older children, and may manifest also as a life-threatening respiratory infection with systemic complications. In this paper we present a clinical case of a premature boy with a corrected age of 40 weeks at admission to the Pediatric Infectious Diseases Clinical Department IX of the National Institute of Infectious Diseases “Prof. Dr. Matei Bals” with the diagnosis of SARS-CoV-2 infection. The positive diagnosis was established on suggestive clinical picture (fever, dry couch, rhinorrhea, loose stools and inappetence) and confirmed by SARS-CoV-2 rapid antigen test. Laboratory investigations at admission showed only moderate to severe anemia, mild inflammatory syndrome and a mild neonatal hyperbilirubinemia, with normal leukocyte count, normal glycaemia, ionograme and blood gases. Chest x-ray showed moderate interstitial pneumonia. In the second day of admission, after 24h of favorable evolution, with no fever and present appetite, he suddenly presented during defecation a presumptive vasovagal syndrome, with general hypotonia and a short period of desaturation. Laboratory investigations made during the episode showed normal glycaemia, normal ionograme, normal blood gases, moderate-severe anemia and important metabolic acidosis. A new chest x-ray showed evolution of the interstitial pneumonia. We did a blood transfusion and continued antiviral treatment, antibiotic treatment and perfusions. He maintained normal pulmonary and cardiac function for another 6 hours, after which he presented a tonic-clonic seizure and after administration of intrarectal benzodiazepines he presented cardio-pulmonary arrest. He was resuscitated, intubated and sedated and transfer to a children ICU. 2 weeks later after admission in the ICU he was discharged with favorable outcome. The case presented shows that although SARS-CoV-2 infection is often a mild condition in children, COVID-19 in neonates can have an unpredicted course. Rapid evolution to sever forms can be a possible disease outcome. Preterm birth with associated complications like bronchodysplasia or anemia, can predispose to sever evolution of the disease, and this child must be kept safe. There is also a neurotropic potential of the SARS-CoV-2 virus that has to be followed.","PeriodicalId":53394,"journal":{"name":"Revista Romana de Boli Infectioase","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49497595","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Endocrine damage in infectious diseases (bacterial, viral) has been proven for a long time, confirming the disruption of the functions of most endocrine glands via the hypothalamic-pituitary-glandular axis. Endocrine activity takes place in tandem with the activity of the immune system. They intercondition and influence each other, any change in one sector influencing the other (positively or negatively). Severe (critical), bacterial or viral infections go through the stage of SEPSIS, the background of which is the disruption (disorganization) of the host’s response to the infection. The mechanisms by which the endocrine glands are affected are multiple (direct, immunologically mediated, thrombotic) leading to multiple, morphological and functional lesions. The recovery of these injuries takes place over time, and permanent sequelae are possible. The recent pandemic caused by SARS-CoV-2, through the ways of manifestation and evolution of the diseases, justifies the interest regarding the endocrine damage in the SARS-CoV-2 infection, both in the acute and post-acute phase (long COVID evolves with symptoms, some newly appeared, which are also present in non-COVID endocrinopathies). Material. The arguments regarding the endocrine damage were extracted from the publications mentioned at the end of the work as bibliographic titles. The results highlight the endocrine damage in infections, especially in severe ones - and the impact on the immediate and late evolution of the illnesses. Conclusions. In order to understand the pathogenic, physio-pathological and clinical aspects of an infection, attention must be paid to the state of the endocrine system in correlation with the immune system, especially in patients receiving shorter or longer corticosteroid therapy.
{"title":"Endocrine impact in infections including COVID-19","authors":"D. Cârstina","doi":"10.37897/rjid.2023.2.1","DOIUrl":"https://doi.org/10.37897/rjid.2023.2.1","url":null,"abstract":"Endocrine damage in infectious diseases (bacterial, viral) has been proven for a long time, confirming the disruption of the functions of most endocrine glands via the hypothalamic-pituitary-glandular axis. Endocrine activity takes place in tandem with the activity of the immune system. They intercondition and influence each other, any change in one sector influencing the other (positively or negatively). Severe (critical), bacterial or viral infections go through the stage of SEPSIS, the background of which is the disruption (disorganization) of the host’s response to the infection. The mechanisms by which the endocrine glands are affected are multiple (direct, immunologically mediated, thrombotic) leading to multiple, morphological and functional lesions. The recovery of these injuries takes place over time, and permanent sequelae are possible. The recent pandemic caused by SARS-CoV-2, through the ways of manifestation and evolution of the diseases, justifies the interest regarding the endocrine damage in the SARS-CoV-2 infection, both in the acute and post-acute phase (long COVID evolves with symptoms, some newly appeared, which are also present in non-COVID endocrinopathies). Material. The arguments regarding the endocrine damage were extracted from the publications mentioned at the end of the work as bibliographic titles. The results highlight the endocrine damage in infections, especially in severe ones - and the impact on the immediate and late evolution of the illnesses. Conclusions. In order to understand the pathogenic, physio-pathological and clinical aspects of an infection, attention must be paid to the state of the endocrine system in correlation with the immune system, especially in patients receiving shorter or longer corticosteroid therapy.","PeriodicalId":53394,"journal":{"name":"Revista Romana de Boli Infectioase","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44788917","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Tuberculosis remains as a major global public health threat and infected more than >10 million cases worldwide. Nowadays, public have witnessed epidemiological shift between chronic and infectious disease globally. Diabetes mellitus as a non-communicable disease and on the other side, Tuberculosis as an infectious disease coexist in the same individual may became health challenge in the near future. DM’s impact on clinical presentation and treatment outcome of TB remains poorly. Detecting and managing TB patients with DM comorbidity by routine laboratory screening provides an opportunity for monitoring patients' prognosis and decreasing disease severity to better outcomes. But in facts, not all laboratory services can provide complex yet expensive assays. Studies has shown Neutrophil to Lymphocyte Ratio (NLR) and Immature Granulocyte Percent (IG%) may be an option as an easy, quick, simple, low-cost, repeatable and reliable assays to monitor TB-DM patient’s prognosis.
{"title":"Neutrophil to lymphocyte ratio and immature granulocyte: assessing for promising parameters to monitor tuberculosis-diabetes mellitus patients","authors":"Widaninggar Rahma Putri, Y. Hernaningsih","doi":"10.37897/rjid.2023.2.6","DOIUrl":"https://doi.org/10.37897/rjid.2023.2.6","url":null,"abstract":"Tuberculosis remains as a major global public health threat and infected more than >10 million cases worldwide. Nowadays, public have witnessed epidemiological shift between chronic and infectious disease globally. Diabetes mellitus as a non-communicable disease and on the other side, Tuberculosis as an infectious disease coexist in the same individual may became health challenge in the near future. DM’s impact on clinical presentation and treatment outcome of TB remains poorly. Detecting and managing TB patients with DM comorbidity by routine laboratory screening provides an opportunity for monitoring patients' prognosis and decreasing disease severity to better outcomes. But in facts, not all laboratory services can provide complex yet expensive assays. Studies has shown Neutrophil to Lymphocyte Ratio (NLR) and Immature Granulocyte Percent (IG%) may be an option as an easy, quick, simple, low-cost, repeatable and reliable assays to monitor TB-DM patient’s prognosis.","PeriodicalId":53394,"journal":{"name":"Revista Romana de Boli Infectioase","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47346989","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Bogdan-Alexandru Georgescu, Bianca Neagu, Andrei Osman, Carmen Liana Mocanu, Sorin Rugina
The pandemic with the new coronavirus – SARS-CoV-2 – has caused extraordinary changes in our way of life. Infection with this virus has caused a huge number of diseases worldwide. After healing from this infection, many patients continued to show symptoms at a distance after the infection itself. SARS-CoV-2 virus infection is mainly manifested by symptoms related to the lower respiratory tract, such as fever, cough, dyspnea and chest pressure, which could rapidly evolve to acute respiratory distress syndrome (SARS). However, COVID-19 also causes various symptoms related to the upper respiratory tract, including nasal congestion, neck pain and olfactory dysfunction. We aim to review, analyze and compare small-looking research studies. Studies show what are the changes in ENT in COVID-19 pandemic disease, how these symptoms influence the course of the disease and how much immunodepressed the patient this virus.it is found that this virus leaves a very precarious immune system and leaves serious consequences in terms of activating some pathologies and symptoms. We also intend to present an atypical case of a patient infected with the SARS-CoV-2 virus that showed a multitude of ENT manifestations both during the acute state and after healing.
{"title":"The impact of ENT manifestation in COVID-19 patients","authors":"Bogdan-Alexandru Georgescu, Bianca Neagu, Andrei Osman, Carmen Liana Mocanu, Sorin Rugina","doi":"10.37897/rjid.2023.2.2","DOIUrl":"https://doi.org/10.37897/rjid.2023.2.2","url":null,"abstract":"The pandemic with the new coronavirus – SARS-CoV-2 – has caused extraordinary changes in our way of life. Infection with this virus has caused a huge number of diseases worldwide. After healing from this infection, many patients continued to show symptoms at a distance after the infection itself. SARS-CoV-2 virus infection is mainly manifested by symptoms related to the lower respiratory tract, such as fever, cough, dyspnea and chest pressure, which could rapidly evolve to acute respiratory distress syndrome (SARS). However, COVID-19 also causes various symptoms related to the upper respiratory tract, including nasal congestion, neck pain and olfactory dysfunction. We aim to review, analyze and compare small-looking research studies. Studies show what are the changes in ENT in COVID-19 pandemic disease, how these symptoms influence the course of the disease and how much immunodepressed the patient this virus.it is found that this virus leaves a very precarious immune system and leaves serious consequences in terms of activating some pathologies and symptoms. We also intend to present an atypical case of a patient infected with the SARS-CoV-2 virus that showed a multitude of ENT manifestations both during the acute state and after healing.","PeriodicalId":53394,"journal":{"name":"Revista Romana de Boli Infectioase","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136255137","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
E. O. Irokanulo, Eugene Ayeni, Charles Nwonuma, Dolapo Orotayo, Benita Agbaso
The persistence and frequency of prevalent infectious diseases continue to be a major problem on the African continent. Malaria, TB, and HIV/AIDS are the most common infectious diseases in Sub-Saharan Africa. Malaria and tuberculosis have had a considerable negative impact on poor nations’ health, resulting in high mortality and morbidity. Fortunately, the World Health Organization’s introduction of the RTS, S/AS01 malaria vaccine may soon put an end to the lingering difficulties in malaria eradication, barring new contagious disease outbreaks like COVID-19. The literature reviewed looked at the current condition of endemic infectious illnesses in low-income countries from 2018 to 2022. Improvements in disease management and other mitigating strategies were evaluated alongside the resurgence of malaria, and particularly tuberculosis, the deadliest infectious disease of considerable global health concern in recent decades. The study’s focus was the destructive effects of COVID-19 on the treatment and prevention of infectious illnesses. PubMed, Web of Science, and Google Scholar were used as relevant databases. The COVID-19 pandemic had a significant global impact on Africa, but not because the continent was directly impacted by the scourge and its fatal effects; rather, it did so by successfully forcing resource reallocation and diverting medical personnel to COVID-19 treatment, which in turn made TB, malaria, and HIV/AIDS-related problems worse. To halt the endemicity of these diseases and their potential intensification if a new pandemic like COVID-19 emerges in the future, enhanced efforts from all stakeholders, particularly in poorer climes, are required to be more inward looking and less reliant on foreign support.
流行传染病的持续和频繁仍然是非洲大陆的一个主要问题。疟疾、结核病和艾滋病毒/艾滋病是撒哈拉以南非洲最常见的传染病。疟疾和结核病对贫穷国家的健康产生了相当大的负面影响，造成了高死亡率和发病率。幸运的是，世界卫生组织推出的RTS, S/AS01疟疾疫苗可能很快就会结束消灭疟疾的长期困难，除非出现新的传染病，如COVID-19。文献综述研究了2018年至2022年低收入国家地方性传染病的现状。在对疾病管理和其他缓解战略的改进进行评估的同时，疟疾，特别是最近几十年来引起全球相当大的健康关切的最致命传染病结核病又死灰复燃。该研究的重点是COVID-19对传染病治疗和预防的破坏性影响。相关数据库采用PubMed、Web of Science和谷歌Scholar。2019冠状病毒病大流行对非洲产生了重大的全球影响，但这并不是因为非洲大陆直接受到这一祸害及其致命影响的影响;相反，它成功地迫使资源重新分配并将医务人员转移到COVID-19治疗中，这反过来又加剧了结核病、疟疾和艾滋病毒/艾滋病相关问题。为了遏制这些疾病的流行，以及在未来出现COVID-19这样的新大流行时，这些疾病可能会加剧，所有利益攸关方，特别是在较贫穷的地区，都需要加强努力，更加内向，减少对外国支持的依赖。
{"title":"COVID-19 pandemic complexities on endemic infectious disease management and diagnosis in poor countries","authors":"E. O. Irokanulo, Eugene Ayeni, Charles Nwonuma, Dolapo Orotayo, Benita Agbaso","doi":"10.37897/rjid.2023.2.5","DOIUrl":"https://doi.org/10.37897/rjid.2023.2.5","url":null,"abstract":"The persistence and frequency of prevalent infectious diseases continue to be a major problem on the African continent. Malaria, TB, and HIV/AIDS are the most common infectious diseases in Sub-Saharan Africa. Malaria and tuberculosis have had a considerable negative impact on poor nations’ health, resulting in high mortality and morbidity. Fortunately, the World Health Organization’s introduction of the RTS, S/AS01 malaria vaccine may soon put an end to the lingering difficulties in malaria eradication, barring new contagious disease outbreaks like COVID-19. The literature reviewed looked at the current condition of endemic infectious illnesses in low-income countries from 2018 to 2022. Improvements in disease management and other mitigating strategies were evaluated alongside the resurgence of malaria, and particularly tuberculosis, the deadliest infectious disease of considerable global health concern in recent decades. The study’s focus was the destructive effects of COVID-19 on the treatment and prevention of infectious illnesses. PubMed, Web of Science, and Google Scholar were used as relevant databases. The COVID-19 pandemic had a significant global impact on Africa, but not because the continent was directly impacted by the scourge and its fatal effects; rather, it did so by successfully forcing resource reallocation and diverting medical personnel to COVID-19 treatment, which in turn made TB, malaria, and HIV/AIDS-related problems worse. To halt the endemicity of these diseases and their potential intensification if a new pandemic like COVID-19 emerges in the future, enhanced efforts from all stakeholders, particularly in poorer climes, are required to be more inward looking and less reliant on foreign support.","PeriodicalId":53394,"journal":{"name":"Revista Romana de Boli Infectioase","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42826256","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Introduction. Coxiella burnetii is the causative agent of Q fever, a zoonosis that is usually associated with cattle, sheep, goats and their bodily fluids, mainly milk or amniotic fluid. The disease manifests most commonly as an upper respiratory tract infection or pneumonia, but, in less common cases can lead to endocarditis, hepatitis, meningo-encephalitis and osteomyelitis. In the acute stage, patients usually have a self-limited febrile illness, which can progress to the chronic form of Q fever, most commonly with endocarditis. Endocarditis is the main manifestation of chronic Q fever and it usually affects patients with risk factors, such as prosthetic valves, abnormal native valves or other cardiac disease history, but it can also be seen in patients with no prior medical history, like the one we describe. The diagnosis is confirmed using the same Duke Criteria used in infectious endocarditis, with one major criterion being either a positive blood culture or PCR for C. burnetii, or a positive IgG phase I serological test [>1:6400). The preferred treatment regimen is doxycycline plus hydroxychloroquine, maintained for a minimum of 18 months, along with regular follow-ups for serology testing and side-effects evaluation. Case presentation. We describe the case of a 53-year old male with no medical history who presented in our clinic for a 2-week evolution of fever, chills and weight loss. The physical examination revealed no pathological findings. The trans-esophageal cardiac echography showed small vegetations on the mitral valve and the serological test for Coxiella burnetii was positive, thus allowing us to confirm the diagnosis of Coxiella burnetii endocarditis and start treatment with Doxycycline and Hydroxychloroquine. Conclusions. Coxiella burnetii must be taken into account as a possible diagnosis for culture-negative endocarditis, even in patients with no cardiological medical history and no environmental risk factors.
{"title":"An unexpected case of Coxiella burnetii endocarditis","authors":"Stefan Malciolu, A. Veja, G. Gherlan","doi":"10.37897/rjid.2023.1.5","DOIUrl":"https://doi.org/10.37897/rjid.2023.1.5","url":null,"abstract":"Introduction. Coxiella burnetii is the causative agent of Q fever, a zoonosis that is usually associated with cattle, sheep, goats and their bodily fluids, mainly milk or amniotic fluid. The disease manifests most commonly as an upper respiratory tract infection or pneumonia, but, in less common cases can lead to endocarditis, hepatitis, meningo-encephalitis and osteomyelitis. In the acute stage, patients usually have a self-limited febrile illness, which can progress to the chronic form of Q fever, most commonly with endocarditis. Endocarditis is the main manifestation of chronic Q fever and it usually affects patients with risk factors, such as prosthetic valves, abnormal native valves or other cardiac disease history, but it can also be seen in patients with no prior medical history, like the one we describe. The diagnosis is confirmed using the same Duke Criteria used in infectious endocarditis, with one major criterion being either a positive blood culture or PCR for C. burnetii, or a positive IgG phase I serological test [>1:6400). The preferred treatment regimen is doxycycline plus hydroxychloroquine, maintained for a minimum of 18 months, along with regular follow-ups for serology testing and side-effects evaluation. Case presentation. We describe the case of a 53-year old male with no medical history who presented in our clinic for a 2-week evolution of fever, chills and weight loss. The physical examination revealed no pathological findings. The trans-esophageal cardiac echography showed small vegetations on the mitral valve and the serological test for Coxiella burnetii was positive, thus allowing us to confirm the diagnosis of Coxiella burnetii endocarditis and start treatment with Doxycycline and Hydroxychloroquine. Conclusions. Coxiella burnetii must be taken into account as a possible diagnosis for culture-negative endocarditis, even in patients with no cardiological medical history and no environmental risk factors.","PeriodicalId":53394,"journal":{"name":"Revista Romana de Boli Infectioase","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49272766","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Oana Ganea, Aida Adamescu, C. Tilișcan, V. Molagic, A. Negru, Anca Saran, Laurențiu Stratan, D. Mangaloiu, Nicoleta Mihai, Ș. Aramă, V. Aramă
An increase in the number and the complexity of cardiac surgery has brought on a rise in the proportion of healthcare-associated Infectious Endocarditis (IE), and as a result, today S. aureus is the most common causative pathogen for this condition. Clinical suspicion for IE should be raised in front of a patient with predisposing risk factors, a new heart murmur and/or vasculitic/embolic events. The Duke Criteria have been long used to diagnose IE. However, they underwent several changes in order to improve their sensitivity in the diagnosis of Q-fever IE and to decrease the size of the possible IE group. Our primary goal is to enhance the knowledge regarding the diagnosis and treatment of infective endocarditis. In acute IE, prior to beginning antibiotic therapy, at least three sets of blood cultures must be taken, ideally from three distinct sites, as determining the etiologic agent is of highest importance. The diagnosis of IE cannot be made based just on a single positive blood culture. To diagnose subacute IE, three to five sets of blood cultures must be drawn over the course of 24 hours. Transthoracic echocardiography (TTE) remains the preferred investigation when the diagnosis of IE is suspected. Transesophageal echocardiography (TOE) is recommended when TTE is unremarkable but the suspicion is still high. A whole-body CT scan, an MRI, a cardiac CT, PET-CT, or radiolabeled leucocyte single-photon emission computed tomography may be helpful when TTE and TOE are inconclusive. Recommended empirical therapy for Native Valve Endocarditis (NVE) and late Prosthetic Valve Endocarditis (PVE) consists of IV Amoxicillin, Oxacillin and Gentamicin administered until blood culture results are available. If a patient is allergic to penicillin, IV Vancomycin and Gentamicin should be given. The recommended empirical antibiotic regimen for early PVE includes IV Vancomycin, Gentamicin, and Rifampin. Once the results of blood cultures are available, the treatment will depend on the isolated organism, its sensitivity to antibiotics, and whether it is an NVE or a PVE.
{"title":"Management of infectious endocarditis from the perspective of the Infectious Diseases specialist – a 2023 update","authors":"Oana Ganea, Aida Adamescu, C. Tilișcan, V. Molagic, A. Negru, Anca Saran, Laurențiu Stratan, D. Mangaloiu, Nicoleta Mihai, Ș. Aramă, V. Aramă","doi":"10.37897/rjid.2023.1.4","DOIUrl":"https://doi.org/10.37897/rjid.2023.1.4","url":null,"abstract":"An increase in the number and the complexity of cardiac surgery has brought on a rise in the proportion of healthcare-associated Infectious Endocarditis (IE), and as a result, today S. aureus is the most common causative pathogen for this condition. Clinical suspicion for IE should be raised in front of a patient with predisposing risk factors, a new heart murmur and/or vasculitic/embolic events. The Duke Criteria have been long used to diagnose IE. However, they underwent several changes in order to improve their sensitivity in the diagnosis of Q-fever IE and to decrease the size of the possible IE group. Our primary goal is to enhance the knowledge regarding the diagnosis and treatment of infective endocarditis. In acute IE, prior to beginning antibiotic therapy, at least three sets of blood cultures must be taken, ideally from three distinct sites, as determining the etiologic agent is of highest importance. The diagnosis of IE cannot be made based just on a single positive blood culture. To diagnose subacute IE, three to five sets of blood cultures must be drawn over the course of 24 hours. Transthoracic echocardiography (TTE) remains the preferred investigation when the diagnosis of IE is suspected. Transesophageal echocardiography (TOE) is recommended when TTE is unremarkable but the suspicion is still high. A whole-body CT scan, an MRI, a cardiac CT, PET-CT, or radiolabeled leucocyte single-photon emission computed tomography may be helpful when TTE and TOE are inconclusive. Recommended empirical therapy for Native Valve Endocarditis (NVE) and late Prosthetic Valve Endocarditis (PVE) consists of IV Amoxicillin, Oxacillin and Gentamicin administered until blood culture results are available. If a patient is allergic to penicillin, IV Vancomycin and Gentamicin should be given. The recommended empirical antibiotic regimen for early PVE includes IV Vancomycin, Gentamicin, and Rifampin. Once the results of blood cultures are available, the treatment will depend on the isolated organism, its sensitivity to antibiotics, and whether it is an NVE or a PVE.","PeriodicalId":53394,"journal":{"name":"Revista Romana de Boli Infectioase","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44329801","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
G. Jugulete, Mihaela Safta, Elena Gheorghe, Bianca Borcoș, M. Luminos, M. Merișescu
Sepsis is one of the most severe pediatric infectious diseases that can progress to serious complications or even death without specialized treatment. It often evolves as a complication of a viral illness or against the background of a depressed host immune terrain. SARS-CoV-2 infection is a self-limiting viral infection in children, which is rarely complicated, especially in immunocompromised or co-morbid individuals. In this paper we present a clinical case of a 1 year and 2 months old child admitted to the Pediatric Infectious Diseases Clinical Department IX of the National Institute of Infectious Diseases “Prof. Dr. Matei Bals” with the diagnosis of SARS-CoV-2 infection. The positive diagnosis was established on epidemiological data (parents with SARS-CoV-2 infection), suggestive clinical picture (fever, inappetence, vomiting) and confirmed by RT-PCR. 72 hours after admission, with favorable clinical evolution, the child presented again fever and chills. Laboratory investigations show leukocytosis with neutrophilia, inflammatory syndrome present and, in nasal exudate and blood culture, staphylococcus aureus MSSA is isolated. Also, immunogram shows low IgA level, the rest of the laboratory tests are within normal limits. Antibiotic treatment was instituted, symptomatic hydroelectrolytic and acid-base rebalancing infusions with favorable evolution. The case presented shows that although SARS-CoV-2 infection is often a mild condition in children, it can evolve severely, especially in immunosuppressed individuals with comorbidities. The presented child was not known to have selective IgA immunodeficiency, which probably in combination with COVID-19 induced immunosuppression, favored the development of sepsis.
{"title":"Sepsis with Staphylococcus aureus in child with selective IgA deficiency and SARS-CoV-2 infection - case presentation","authors":"G. Jugulete, Mihaela Safta, Elena Gheorghe, Bianca Borcoș, M. Luminos, M. Merișescu","doi":"10.37897/rjid.2023.1.6","DOIUrl":"https://doi.org/10.37897/rjid.2023.1.6","url":null,"abstract":"Sepsis is one of the most severe pediatric infectious diseases that can progress to serious complications or even death without specialized treatment. It often evolves as a complication of a viral illness or against the background of a depressed host immune terrain. SARS-CoV-2 infection is a self-limiting viral infection in children, which is rarely complicated, especially in immunocompromised or co-morbid individuals. In this paper we present a clinical case of a 1 year and 2 months old child admitted to the Pediatric Infectious Diseases Clinical Department IX of the National Institute of Infectious Diseases “Prof. Dr. Matei Bals” with the diagnosis of SARS-CoV-2 infection. The positive diagnosis was established on epidemiological data (parents with SARS-CoV-2 infection), suggestive clinical picture (fever, inappetence, vomiting) and confirmed by RT-PCR. 72 hours after admission, with favorable clinical evolution, the child presented again fever and chills. Laboratory investigations show leukocytosis with neutrophilia, inflammatory syndrome present and, in nasal exudate and blood culture, staphylococcus aureus MSSA is isolated. Also, immunogram shows low IgA level, the rest of the laboratory tests are within normal limits. Antibiotic treatment was instituted, symptomatic hydroelectrolytic and acid-base rebalancing infusions with favorable evolution. The case presented shows that although SARS-CoV-2 infection is often a mild condition in children, it can evolve severely, especially in immunosuppressed individuals with comorbidities. The presented child was not known to have selective IgA immunodeficiency, which probably in combination with COVID-19 induced immunosuppression, favored the development of sepsis.","PeriodicalId":53394,"journal":{"name":"Revista Romana de Boli Infectioase","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45163056","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
D. Mangaloiu, Isabela-Daniela Staicu, A. Negru, V. Molagic, C. Tilișcan, Aida Adamescu, Oana Ganea, Laurențiu Stratan, Nicoleta Mihai, Ș. Aramă, V. Aramă
Febrile neutropenia (FN) is a well-known complication of chemotherapy (CHT) regimens, which appears more frequently in patients receiving CHT for hematologic malignancies, than those with solid tumors. Given the fact that this condition is life threatening, as well as multiple complications that may happen, rapid intervention is required, administration of empirical antibiotic therapy being necessary in the first hour of admission. Due to the high mortality rate associated with Pseudomonas aeruginosa infections, patients at risk should be given an antipseudomonal antibiotic agent, such as cefepime, carbapenem or piperacillin-tazobactam. Regarding empirical antibiotic coverage for gram-positive microorganisms, this is preserved for hypotensive patients, with skin/soft infections or suspected catheters infection or those taking fluoroquinolone. Considering the fact that a variety of bacterial, viral and fungal pathogens are responsible for high morbidity and mortality among patients with FN, preventable measures like antibiotic, antifungal and antiviral, as well as vaccination and prophylaxis with G-CSF, are crucial components in providing medical treatment for onco-hematological patients.
{"title":"Management of the febrile neutropenic patient in 2023","authors":"D. Mangaloiu, Isabela-Daniela Staicu, A. Negru, V. Molagic, C. Tilișcan, Aida Adamescu, Oana Ganea, Laurențiu Stratan, Nicoleta Mihai, Ș. Aramă, V. Aramă","doi":"10.37897/rjid.2023.1.1","DOIUrl":"https://doi.org/10.37897/rjid.2023.1.1","url":null,"abstract":"Febrile neutropenia (FN) is a well-known complication of chemotherapy (CHT) regimens, which appears more frequently in patients receiving CHT for hematologic malignancies, than those with solid tumors. Given the fact that this condition is life threatening, as well as multiple complications that may happen, rapid intervention is required, administration of empirical antibiotic therapy being necessary in the first hour of admission. Due to the high mortality rate associated with Pseudomonas aeruginosa infections, patients at risk should be given an antipseudomonal antibiotic agent, such as cefepime, carbapenem or piperacillin-tazobactam. Regarding empirical antibiotic coverage for gram-positive microorganisms, this is preserved for hypotensive patients, with skin/soft infections or suspected catheters infection or those taking fluoroquinolone. Considering the fact that a variety of bacterial, viral and fungal pathogens are responsible for high morbidity and mortality among patients with FN, preventable measures like antibiotic, antifungal and antiviral, as well as vaccination and prophylaxis with G-CSF, are crucial components in providing medical treatment for onco-hematological patients.","PeriodicalId":53394,"journal":{"name":"Revista Romana de Boli Infectioase","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47177025","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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