[Prognostic score in infective endocarditis--innovative and useful predictibility factor for disease's evolution]. / Scorul prognostic în endocarditele infectioase--nou factor de predictibilitate în evolutia bolii.

AIM: Evaluate the potential of evolution in infective endocarditis (IE) according to patient's personal parameters (biological, clinical and paraclinical), and Carmeli score, as purpose in establishing an appropiate antibiotherapy. MATERIAL AND METHODS: Clinico-therapeutic observations concerning a cohort of 868 patients admitted between 1995 and 2008 in three hospital services of Iasi. The following guide marks were included in the study: age, sex, previous state of heart, left/right sided IE, number of valves implicated, presence of major complications, health care associated IE/nosocomial IE, major associated diseases, type of microorganism implicated/negative blood cultures. According to their importance, the score varied for each between 0 and 2, resulting a global minimum of 1 and a maximum of 10. All scores obtained were correlated with mortality and Carmeli score. RESULTS: Patients with score 1-4 had a mild evolution, > 4 - < 7 usual trends of evolution with mortality close to medium rate, and 7-10 severe, mortality growing at every point with 15-18%. Carmeli score 1 was associated with 1-4 new score, 2 with > 4 - < 7, and 3 with 7-10 score. Antibiotic regimens changed usually during therapy, higher succes rates being obtained in IE with isolated pathogen. CONCLUSIONS: As new score may vary during patient's evolution, there is an important connection (especially at the time of admission)--but not similarity--between this new factor and Carmeli score, therapy being highly related to guide proposed regimens. However, antibiotherapy in IE should be applied using a mix of these scores, as there are important interferences due to major prognostic factors proposed in the new score, often needing next level's Carmeli score related antibiotherapy.

Tuberculosis meningo-encephalitis with positive csf for KB and slowly favourable evolution. Case report.

BACKGROUND: Meningoencephalitis produce by Koch bacillus is a disease including various symptoms, with often atypical onset and evolution, and with an etiological diagnosis being rarely established. It therefore remains a disease with severe prognosis, despite adequate treatment. CASE REPORT: a 47 years old male from Neamt County, with chronic otitis in his recent medical history, comes to the emergency room for fever, severe headache, confusion, equilibrium disorders, influenced health status, and meningeal irritation signs. Given his otitis and antibiotic therapy received in recent medical history, the patient was initially diagnosed and treated for beheaded bacterial meningitis (348 elements/mm3, 89% lymphocytes, 5% granulocytes, proteinorrhachia 1.54 g/l). Clinical and paraclinical evolution was poor with persistent fever and headache, impaired mental state, and the spinal puncture showed increased pleocytosis (725 elements/mm3), lymphocytosis (78%), increased proteinorrhachia (2.12 g/l), and low levels of glycorrhachia and chlorurorrhachia. Tuberculosis meningoencephalytis was suspected (confirmed after 3 weeks through cultures on Lowenstein-Jensen medium: positive for Mycobacterium tuberculosis), and a tuberculostatic treatment associating four drugs and intravenous Ciprofloxacin was started. Although the treatment included substances against cerebral edema and neurotrophic agent, his evolution showed persistent headache syndrome. We noticed very slow decrease in CSF pleocytosis (after a month) of treatment the patient still had 240 elements/mm3, 85% lymphocytesand 15% granulocytes. Moreover, due to hepatic toxicity a reduction of the tuberculostatic doses was needed. CONCLUSIONS: The beginning of the tuberculosis infection symptoms is often surprising, with clinical signs regarding secondary determinations (meningoencephalitis) association with another infection (otitis--wrong diagnosis). as well as persistent yet slowly favorably evolving symptoms, both clinically and paraclinically (CSF parameters). The etiological agent is extremely rarely isolated, due to a very slow growth of the Koch bacillus on special culture mediums and also because such diagnosis is not often considered before starting the treatment.

Tuberculous meningitis--clinical and epidemiological considerations (a retrospective study 2008-2011).

UNLABELLED: Tuberculous meningitis represents one of the most severe forms of tuberculosis and is often a difficult diagnostic and therapeutic problem. The objective of this study is to analyze the cases of tuberculous meningitis in our region. MATERIAL AND METHODS: We retrospectively analyzed 76 observation sheets of patients aged 4 months to 84 years, diagnosed with tuberculous meningitis, admitted to Infectious Diseases Hospital Iasi during 2008 to 2011. RESULTS: Tuberculous meningitis has affected mostly males (65.7%). Only a small proportion of patients (23.68%) had tuberculosis in their personal history. 26.2% were diagnosed also with other localization of tuberculosis (mostly pulmonary). Fever was identified in only 43.4% of cases; 40% of patients had an altered conscience at admission. The outcome was favorable in all cases. CONCLUSIONS: Tuberculous meningitis predominantly affects males, almost equally affects patients with other focuses of TB and those with a history of tuberculosis disease.

[Community acquired acute bacterial meningitis--a 10 year review]. / Meningite bacteriene comunitare: analiza pe 10 ani.

UNLABELLED: Bacterial meningitis is still an important topic for the infectious diseases specialist, due to it's high incidence, severity and it's high mortality rate. MATERIAL AND METHOD: We retrospectively studied 679 patients diagnosed with community acquired bacterial meningitis in the Infectious Diseases Hospital Iasi, Romania between 1998 and 2007. RESULTS: The annual number of admissions slightly decreased in the last years. Most patients were males (62.1%). Predisposing factors were present in 34.9% of cases. Seizures were described in 19.6% of cases, more frequent in children. The CSF was purulent only in 69.4% of patients, 29.6% of them receiving antibiotics prior to admission; the albumin level in the CSF of pneumococcal meningitis was higher than in other meningitis. The etiology was established in 51.6% of cases, more frequent in sucklings (68.1%). N. meningitidis was the most common cause of community acquired acute bacterial meningitis (CABM) (28.5%) followed by S. pneumoniae (14%). S. pneumoniae was susceptible to penicillin in 79% of cases. The mean mortality rate was 13.1%. CONCLUSION: Factors associated with a poor prognosis were: pneumococcal etiology, age over 60, and the presence of seizures or coma at admission.

[Leptospirosis in children. Clinico-biological and therapeutic aspects for the cases hospitalised between 1992-2005]. / Leptospiroza la copil. Aspecte clinico-biologice si terapeutice pentru cazurile internate in perioada 1992-2005.

UNLABELLED: The aim of the study is that of showing the prevalence of the disease in childhood in our county. MATERIAL AND METHOD: We studied the observation files of the patients admitted in our unit in between 1992 and 2005 comprised in the 0-15 year old age bracket, noticing all the epidemiological, clinical and therapeutic aspects. RESULTS: In the above mentioned period, 16 patients from the 0-15 year old group (3.12% of all the patients suffering from leptospirosis) were admitted in our clinic. Male (93.75%) and suburban area (60%) were dominant; 11-15 year old group was represented in 87.5% cases; the prevalence was observed during the summer (11 cases) and during 1999 (6 cases); the meningeal signs were noticed in 5 cases and jaundice for 3 children; the most frequent agent was L. icterohaemorrhagiae--7 cases. The etiological treatment was performed for 14 cases with betalactamines for 7.4 days in average; no lethal cases were noticed. CONCLUSIONS: In the case of Iasi County, leptospirosis is a clinico-biological entity considered in the diagnosis of the jaundice, meningeal and febrile syndromes in children.

[Varicella-zoster infection--extreme clinical aspects]. / Infectia cu virusul varicelo-zosterian aspecte clinice extreme.

UNLABELLED: Infections with the varicella-zoster (VZ) virus are a constant of our everyday practice. The aim of the present study is that of underlining unusual aspects of the infection with the VZ virus--primary infection in adults and herpes zoster in children. If varicella, or chickenpox, has been traditionally considered a childhood disease, nowadays, an increased number of adults are affected by primary infections. On the contrary, more and more children present the secondary form of the infection, which appears as herpes zoster, a disease usually diagnosed in adults. MATERIAL AND METHODS: We studied the observation papers of adult patients with varicella, hospitalized in our clinic during 2004-2005 and we analyzed the herpes zoster manifestations in non-HIV children, diagnosed with the disease during the same period of time. RESULTS: During 2004-2005, 34 adult patients were diagnosed with varicella, while 10 children presented herpes zoster. 16 of the adults with varicella were 25-34 years old. One of the children with herpes zoster was less than one year old. All the adults with varicella were treated with acyclovir; in 14 cases, the therapy was supplemented with rifampicin. All the children with herpes zoster came from rural areas. The pathology that determined the decrease of general immunity was represented by neoplasia (3 cases), malnutrition and rickets (2 cases), associated infectious pathologies--bronchopneumonia (3 cases). CONCLUSIONS: Varicella in adults has an increased incidence, which is underestimated, in our opinion. Its loud clinical manifestations impose the therapy with acyclovir. Herpes zoster in children reveals significant subsidiary pathologies and a depressed immune system that impose special medical care and many days of hospitalization.

[Epidemiology of viral hepatitis B in the Iasi County in the interval 1990-2005]. / Aspecte din epidemiologia hepatitei virale B, în judetul Iasi, în perioada 1990-2005.

Viral hepatitis and especially hepatitis B (HVB) continue to represent major health problems. In Romania, the morbidity from HVB is still 3 to 5 times higher than in Western Europe and North America. In the Iasi County, the effectiveness of the preventive measures is proven by a curve of morbidity values close to or even below those recorded at national level. As a result of the preventive interventions, in the interval 1996-2005, the morbidity from HVB was lower in all age groups as compared to the interval 1990-1995. The significant decrease in morbidity following the introduction of a vaccination program and the preservation of a constantly descending trend reflect the favourable change in the epidemiological process of HVB.

[The co-infection with hepatitis virus B and D--cases admitted in the infectious diseases hospital from Iasi, Romania (2003-2005)]. / Co-infectia cu virusurile hepatitice B si D--cazuri internate în clinica de boli infectioase Iasi (2003-2005).

Despite the major medical advance, over 350 million people worldwide still have chronic infection with hepatitis B virus and HBV-associated liver disease remains a major cause of morbidity and mortality. 15-50% of patient VHB infected have serological markers for VHD co-infection. We retrospectively studied 252 cases of acute hepatitis B (AHB) admitted in our hospital between 2003-2005; 12 of them (4.76%) had a co-infection with hepatitis D virus. Most of the patients were young males with an urban origin. The route of transmission was unknown in 8/12 cases. Abdominal pain was more frequent during the onset of the disease than in AHB (p < 0.05). A cholestatic pattern was noted in 9 cases. The frequency of severe/ fulminant cases was greater then in AHB. The HBsAg was absent in 3 patients, and the HBV-DNA was present at low levels in 3/12 patients tested. Two patients had HBsAg present 6 month later.

[The streptococcal and staphylococcal toxic shock syndrome. Comments on 4 cases]. / Sindromul socului toxic streptococic si stafilococic. Consideratii asupra a 4 cazuri.

Between 1989 and 1995 in the Hospital of Infectious Diseases from Iasi have been diagnoses 4 cases of streptococcal/staphylococcal toxic syndrome. Three patients have been grown up and one child. Two of them were immunocompromised hosts (cirrhosis, lung tuberculosis, alcoholism). The gate of entry was cutaneous in 3 cases and probably mucous in the 4th case. The clinical symptoms were fever, generalized erythematous rush followed by desquamation, low arterial pressure with oliguria, tachycardia, jaundice moderate, elevated ALAT. The bacteriological diagnosis was confirmed by isolating the pathogen agent from the erysipelatous placard and from blood culture. The evolution of the illness was nefavourable in 2 cases. The cause of the death was the MSOF (multiple systemic organic failure).

[The effect of cardioversion in sinus rhythm on the systolic dynamics in atrial fibrillation and flutter]. / Influenta cardioversiei în ritm sinusal asupra dinamicii sistolice în fibrilatia si flutterul atrial.

In 60 cases of atrial fibrillation and flutter the systolic time intervals, haemodynamic ratios (PEj/PPE, PPE/PEj and PEj/TCIV) and ejection fraction before and after cardioversion in sinus rhythm were determined. The cardiac performance was markedly improved in all cases regardless the etiology and the degree of ventricular efficiency, pleading for the use of cardioversion anytime there is a chance to restore and maintain the sinus rhythm. The persistence of anticreased venous pressure, as well as the absence or late resumption of atrial mechanic activity usually indicate that arrhythmia soon recurs. In atrial fibrillation and atrial flutter, the inclusion in calculation only of those systoles preceded by R-R higher than 800 ms permits a better estimation of the degree of cardiac performance deterioration consecutive to the existing cardiopathy, the obtained data being very close to the postconversion values.

[Epidemiologic and clinical aspects of acute hepatitis B in the past decade]. / Aspecte epidemiologice si clinice ale hepatitei acute B în ultimul deceniu.

To study the clinical and epidemiological aspects of acute B hepatitis during the last 11 years. We retrospectively studied 1712 patient files, admitted in the Department of Infectious Diseases Iasi, with acute B hepatitis between 1992-2002. The majority of the patients (69%) had an urban origin. Teenagers and young adults were predominantly affected (59% had between 15 and 34 years). A point of entry of the pathogen was identified only in 20% of the patients. The mean incubation period was 4 month. 24% of the patients had a prolonged form of the disease (over 30 days of jaundice). A fulminant evolution was noted in 1.2% of cases. Extrahepatic involvement was described in 25% of the patients. The global mortality was 1.15%. The number of patients with acute B hepatitis decreased by half during the last 11 years.

[Clinical and biological study of acute diarrhea with mixed etiology in 48 patients]. / Studiu clinico-biologic al diareei acute cu etiologie mixta pe un lot de 48 pacienti.

OBJECTIVES: The study of incidence, clinical manifestation and treatment of acute diarrhea with mixed etiology. MATERIAL AND METHOD: Study of 48 patients with acute diarrhea with mixed etiology admitted in the Hospital of Infectious Diseases of Iasi during 1995-1998. RESULTS: 12 cases (24%) were mixed bacterial infections with the following microorganisms associations: Salmonella + Shigella (10 cazuri); Salmonella + Yersinia enterocolitica (1 case); Salmonella + Rotavirus (1 case). 16 cases (44%) had mixed digestive infections with parasites, in double or triple associations: Giardia intestinalis + Ascaris lumbricoides (10 cases); Giardia intestinalis + Ascaris lumbricoides + Entamoeba coli (1 case); Giardia intestinalis + Enterobius vermicularis (3 cases); Ascaris lumbricoides + Trichiuris trichiura (2 cases). The rest of 20 cases presented mixed infections with bacteria and parasites: Salmonella + Rotavirus + Giardia (2 cases), Salmonella + Shigella + Giardia intestinalis or Ascaris lumbricoides (6 cases), Salmonella + Giardia intestinalis (8 cases); Salmonella + Entamoeba coli (3 cases); Shigella + Trichiura trichiuris + Entamoeba coli (1 case). The majority was male patients from rural areas with age between 5 month and 56 years, the majority being children, 4 cases were found in immunosupressed patients. The clinical symptomatology was dominated by diarrheal syndrome (100%) and the diagnosis was established by clinical characters and confirmed by coproculture and parasitologic exam. The ethiological therapy was guided by antibiogram, in the majority of cases we used fluorochinolones (associated with ceftriaxone in severe cases), together with antiparasitic medications. CONCLUSIONS: In this study predominated the bacterial and parasitic infections, most frequently being isolated Salmonella, Shigella and Giardia intestinalis; the therapy associated fluorochinolones with antiparasitic medication.

[Postoperative and posttraumatic meningitis. Comments on 87 cases]. / Meningita postoperatorie si posttraumatica. Consideratii pe 87 cazuri.

Iatrogenic and traumatic cerebromeningitis infections are increasing in frequency in the last two decades. Retrospective analysis of 87 patients iatrogenic and traumatic bacterial meningitis were admitted in the Clinic of Infectious Diseases from Iasi between 1, 01, 1990-31, 12, 1994. Head trauma, lumbar punctures and iatrogenic meningitis infections were the causes cerebromeningitis infections. The diagnosis is usually difficult because of the poor specificity of the clinical signs. Predominant pathogens were gram-negative bacteria and Staphylococcus in iatrogenic meningitis and gram-positive bacteria (S. pneumoniae) in traumatic meningitis. The treatment was based on the use penicillin G + chloramphenicol, 3rd generation cephalosporins and sometimes 2nd generation quinolones. Ten of the 87 patients with iatrogenic and traumatic cerebromeningitis infections died (10.3%).