Candida auris Outbreak in a Multidisciplinary Hospital in Romania during the Post-Pandemic Era: Potential Solutions and Challenges in Surveillance and Epidemiological Control.

Candida auris is a newly emerging yeast, which is raising public health concerns due to its outbreak potential, lack of protocols for decontamination and isolation of patients or contacts, increased resistance to common antifungals, and associated high mortality. This research aimed to describe the challenges related to identifying the outbreak, limiting further contamination, and treating affected individuals. We retrospectively analyzed all cases of C. auris detected between October 2022 and August 2023, but our investigation focused on a three-month-long outbreak in the department of cardio-vascular surgery and the related intensive care unit. Along with isolated cases in different wards, we identified 13 patients who became infected or colonized in the same area and time, even though the epidemiological link could only be traced in 10 patients, according to the epidemiologic investigation. In conclusion, our study emphasizes the substantial challenge encountered in clinical practice when attempting to diagnose and limit the spread of an outbreak. Therefore, it is crucial to promptly apply contact precaution measures and appropriate environmental cleaning, from the first positive case detected.

Increasing the Awareness of Under-Diagnosed Tropical Cases of Dengue in Romania.

Global travelling increases every year and according to a report released during the COVID-19 pandemic by the UN World Tourism Organization, international travel doubled in 2022, compared to levels in 2021. his fact led also to travel-imported cases of arboviral infections and physicians are often confronted with tropical diseases, such as dengue or chikungunya. Since there is are no pathognomonic cues for these tropical illnesses, early diagnosis is still a big challenge and it depends on many factors, such as exposure risk factors, the epidemiological context, the incubation period, and the wide spectrum of differential diagnoses, including cosmopolitan or exotic infections. Since the clinical presentation of dengue is not typical and there are other febrile illnesses similar to arboviral diseases, misdiagnosis is common even among experienced doctors. Differential diagnosis needs up to date knowledge considering the short viraemic period, the antibody cross-reactivity, and the traps in recognising the nonspecific symptom picture. We present two cases of Dengue diagnosed in Romania which were initially clinically misconstrued, despite the characteristic symptom picture. The main purpose is to increase the level of awareness and to underline the difficulties that clinicians face in recognizing travel-related imported dengue virus disease.