Risk factors for poor outcome of patients with Coronavirus disease 2019 (COVID-19) in Albania.

INTRODUCTION: The study aims to identify potential risk factors for the poor outcome of hospitalized patients with SARS-CoV-2 infection in Albania. METHODOLOGY: A retrospective observational study on 133 consecutive hospitalized patients at "COVID 1" Hospital, University Hospital Center of Tirana. The study analyzed the correlation between potential risk factors and in-hospital mortality. RESULTS: The study included 133 patients, 65.4% of the patients were male, age 60.46 ± 13.53 years. The mortality rate resulted in 22.6%. Univariate analysis revealed that early risk factors for mortality included: laboratory alterations on admission, such as lymphocytes count < 1.000/mm3 (OR = 3.30, 95% CI = 1.17-9.33), lactate dehydrogenase > 250 U/L (OR = 12.48, 95% CI = 1.62-95.78) and D dimer > 2 mg/L (OR = 4.72, 95% CI = 1.96-11.36); lung parenchymal involvement > 75% on chest computed tomography on admission (OR = 54.00, 95% CI = 11.89 - 245.11). Cox proportional hazard regression showed that independent risk factors for mortality were lung parenchymal involvement > 75% on chest computed tomography (HR = 8.31, 95%CI: 1.62-42.45) and occurrence of complications during hospital stay (OR = 10.28, 95% CI = 2.02-52.33). CONCLUSIONS: The risk of poor outcome can be predicted from the early stage of COVID 19 disease, using laboratory data and chest computed tomography. Among patients with COVID 19, lung parenchymal involvement and alterations > 75% on chest computed tomography on admission and laboratory findings, such as lymphocytopenia, and elevated lactate dehydrogenase and D dimer levels, turned out to be early risk factors for in-hospital mortality.

Posterior Reversible Encephalopathy Syndrome in a Patient with Hemorrhagic Fever with Renal Syndrome.

We presently report the case of hantavirus infection in a 45-year-old male who was hospitalized to our clinic of infectious diseases, with fever, myalgia, vomiting, nausea, headache, and abdominal pain. The physical findings included hepatomegaly, splenomegaly, rash, and conjunctival injection. Eight days before the start of complaints, the patient has cut trees in the mountain. An acute renal failure was observed with an oliguria and an increase of serum creatinine and blood urea nitrogen. Urinalysis shows albuminuria and hematuria. Elevations of amylase, lipase, and liver enzymes levels, low serum albumin level, and thrombocytopenia were observed. A positive ELISA test for hantavirus IgM/IgG antibodies confirmed hemorrhagic fever with renal syndrome. On the third day of hospitalization, the patient had seizures. The unenhanced head computed tomography (CT) performed after seizures showed subcortical bilateral hypodensities within frontal, parietal, and occipital regions corresponding to areas of increased signal intensity in magnetic resonance imaging (MRI) associated with cerebral edema in posterior reversible encephalopathy syndrome (PRES). The treatment consisted of supportive therapy. The patient underwent another head MRI with contrast enhancement after 2 months, which resulted normal.

Two cases of imported hemorrhagic fever with renal syndrome and systematic review of literature.

Many factors are involved in the epidemiology of hemorrhagic fever with renal syndrome (HFRS). Imported cases, as well as those by emigrants, have been reported in literature worldwide. Our goal is to document two cases of HFRS, imported by two immigrants from two countries, and to make a review of the imported HFRS literature data. We performed a systematic literature review (PRISMA guidelines) of imported cases of HFRS and herein describe our two clinical cases. We found 20 published papers, with 16 of them in English and 4 in other languages. Twenty-three patients with travel- or immigration-associated HFRS, including our two cases, were identified. We included only papers that were in English. The average age of the patients was 35.9 ±â€¯15.13 years, and the ratio of male to female was 8:1. Imported disease from Europe to Europe occurred in seven cases, America to Europe occurred in four cases, Europe to America occurred in two cases, America to America occurred in two cases, Asia to Asia in one case, Asia to Europe in one case, and Europe to Asia in one case. The results of the two cited cases are based on the clinical-laboratory, anamnestic, and serologic data for both the patients who tested positive for HFRS. Our systematic analysis shows that international travelers are important sources of infectious diseases. HFRS related to travel and immigration is a rare event. Principal risk factors for travelers and immigrants are camping outside recommended areas or under unsuitable conditions. In recent years, various publications have shown that international travelers and immigrants have expanded the spectrum of imported infectious diseases. The literature data show that the actual reported numbers of imported case of HFRS are limited.

Crimean-Congo hemorrhagic fever with hepatic impairment and vaginal hemorrhage: a case report.

BACKGROUND: Crimean-Congo hemorrhagic fever is a tick-borne disease described in more than 30 countries in Europe, Asia, and Africa. Albania is located in the southwestern part of the Balkan Peninsula. In 1986, the first case of Crimean-Congo hemorrhagic fever was registered, and cases of patients with hemorrhagic fever are rising, and most of them present in a serious condition, when the mortality rate is very high. In districts like Mirdite, Lezhe, Gjirokaster, Skrapar, Erseke, and Kukes, there is delineated human-to-human transmission. CASE PRESENTATION: We report the case of a 32 year-old Albanian woman from a rural area of Albania. She was hospitalized at the Infectious Diseases Service, for a severe influenza-like illness of 4 days duration. Our patient had been bitten by a tick while working in her garden. She presented with nausea, vomiting, headache and muscle pain. A physical examination found a high fever of 40 °C, an enlarged liver, petechia, and vaginal bleeding; flapping tremor and fetor hepaticus were found as a sign for hepatic encephalopathy; and confusion and disorientation were observed in her neurological examination. Her platelet and white blood cell counts were very low, while her aspartate aminotransferase and alanine aminotransferase levels were very high. She was transferred to the intensive care unit because of her worsening condition. Serological and C-reactive protein test results for Crimean-Congo hemorrhagic fever were positive. She was treated with oral ribavirin and discharged with normal parameters. CONCLUSIONS: People in high-risk professions in the endemic areas should be informed and trained on the risk of Crimean-Congo hemorrhagic fever as a matter of urgency. Vaginal bleeding is not always a gynecological problem. In Albania, these places are the mountainous areas, so people who have traveled to these areas and who have symptoms after a tick bite are advised to contact their doctors.

Epidemiological, clinical and therapeutic aspects of cerebral malaria imported in Albania.

This is a case-report of two patients with cerebral malaria (CM) imported from West-African countries. Notably, this form of malaria was developed as a second disease episode, while the first episode was experienced in West Africa. These findings suggest that the second episode of malaria was caused by a different strain of Plasmodium falciparum as compared to the first one. They are the first cerebral malaria cases imported in Albania after the eradication and absence of Plasmodium for five decades. Early treatment of cerebral malaria is decisive on the duration of coma and disease's outcome.

Ocular and cutaneous manifestation of leptospirosis acquired in Albania: A retrospective analysis with implications for travel medicine.

UNLABELLED: Albania is an attractive tourism destination with an increasing volume of travel. As a Mediterranean country some tropical infectious diseases are present in certain areas of Albania, including leptospirosis, which is a zoonotic infectious disease prevalent around the world. The goal of this retrospective study is to describe the ocular and cutaneous manifestations of leptospirosis in Albanian patients and raise awareness to travelers travelling in and out of the country. METHODS: We retrospectively studied 107 cases of leptospirosis, treated at "Mother Teresa" University Hospital Center, in Tirana, Albania between January 2009 and December 2014. All cases included in the analysis had a clinical and epidemiological presentation suggestive of leptospirosis, confirmed with ELISA (enzyme linked immunoassay) positive for IgM antibodies against Leptospira. RESULTS: There were 89.7% males (n = 96) and 10.2% females (n = 11). Mean age at the time of diagnoses was 43.7 ± 17.8 years old (range 17-78). All patients were native and residents of Albania. Conjunctival suffusion was present in 81.3% of the cases, whereas subconjunctival hemorrhage was seen in 12 patients (11.2%). Uveitis was seen in 38.3% of the cases and all patients with uveitis presented a severe systemic disease. A cutaneous rash was present in 58.8% of patients. Other cutaneous manifestations include jaundice in 62.6% and intense pruritus in 5.6% of cases. CONCLUSIONS: Ocular and cutaneous involvement happens more frequently in patients with Leptospirosis, than it was thought to be. Therefore the clinician should be more careful in his systemic evaluation of the disease.

A Neglected Zoonosis in Albania: why Echinococcosis is Becoming a Surgeon's Exclusivity?

Echinococcosis is an endemic zoonosis in the Mediterranean area, with Albania interested actually to a level that is becoming a public health concern. Authors describe preliminary data from the only tertiary (university) medical facility of Albania, positioned in the capital of the country (Tirana), with 333 new cases diagnosed and treated during the period 2005 - 2011. Out of all these 333 new cases an impressive majority of 91% had a surgical treatment right from the first admission, rendering the disease almost a surgical exclusivity. Even more, 80% of all patients from the study group were hospitalized straightforwardly in surgical wards, with options of surgical intervention's percentages outrunning figures from other sources and authors of the same geographical area. Such a situation, together with a very important level of patients' origin from highly urbanized areas such as those of the capital, suggest the necessity of well-organized interventions, among which might be the mandatory notification of all human cases with Echinococcus infection.

A study on the epidemiology and aetiology of acute gastroenteritis in adult patients presenting at the infectious diseases hospital in tirana, Albania.

BACKGROUND: Acute gastroenteritis remains a common cause of hospital emergency room visits in Albania. However, the aetiology of severe gastroenteritis leading to hospitalization in adults frequently remains unclear. AIMS: Our objective was to study the epidemiology and causes of community-acquired, acute gastroenteritis in adult patients presenting to hospital. STUDY DESIGN: Cross sectional study. METHODS: A prospective study was conducted from January 2010 to January 2012, among patients ≥15 years old with community-acquired gastroenteritis presenting to the emergency room of the University Hospital "Mother Theresa" in Tirana, Albania. Stool samples and rectal swabs were collected from the patients for microbiological testing. RESULTS: The median age of the study patients was 33 (15-88) years and 577 (58%) were females. The median age of males was 35 (15-87) years. The vast majority of cases occurred in urban area (849, 85%), p<0.01. Patients were admitted throughout the year with peak admissions for patients infected by bacterial pathogens in summer and those affected by viral pathogens in autumn. A total of 917 (91.7%) patients underwent a laboratory examination. The overall isolation rate was 51%. Bacterial pathogens were found in 29%, viral pathogens in 19% and protozoal pathogens in 2.5% of patients. No aetiological agent or other cause of acute diarrhoea was found in 449 (49%) patients. Twenty-nine (3.2%) patients were hospitalized. CONCLUSION: Despite extensive laboratory investigations, enteropathogens were detected in only 51% of adult patients who presented to the hospital ER with acute gastroenteritis. Viral infections ranked as the second most common cause of gastroenteritis in adults.

Imported malaria in Albania and the risk factors that could allow its reappearance.

Malaria is an infectious disease gradually becoming a serious concern for public health institutions, even in European countries where the eradication of the disease was previously taken for granted. Albania was listed as an endemic area from the beginning of the 20th Century, but the disease was gradually under control and some decades after the World War II it was merely considered a historical curiosity. Nevertheless, for many reasons, since 1994 and in increasing trend, Albanian health facilities have registered several cases of malaria. Tracing the remnants of the autochthonous disease and finding links with the actual situation seems difficult, due to the relatively long period separating the proclaimed eradication of malaria with the re-appearance of the infection. Among major factors leading to such re-appearance might be massive migratory movements, and environmental changes such as the flooding of areas close to river deltas that flow into the Adriatic and Ionian Seas. These factors, combined with the constant presence of several Anopheles species, have led to newly-diagnosed imported malaria cases in Albania. Although all reported cases are considered imported, measures have to be put in place, in order to prevent reappearance of autochthonous malaria cases, and to control disease spread.

Hemorrhagic fever with renal syndrome associated with acute pancreatitis.

Hemorrhagic fever with renal syndrome (HFRS) is a systemic infectious disease caused by Hantaviruses and characterized by fevers, bleeding tendencies, gastrointestinal symptoms and renal failure. It encompasses a broad spectrum of clinical presentations, ranging from unapparent or mild illnesses to fulminant hemorrhagic processes. Among the various complications of HFRS, acute pancreatitis is a rare find. In this report, based on clinical data, laboratory and radiologic examination findings, we describe a clinical case, with HFRS from Dobrava virus, associated with acute pancreatitis. The patient was successfully treated by supportive management. Clinicians should be alert to the possibility of HFRS when examining patients with epidemiological data and symptoms of acute pancreatitis.

Reconstruction of the epidemic history of hepatitis B virus genotype D in Albania.

Despite a recent decrease in the prevalence of HBsAg in the general population, Albania is still highly endemic for HBV infection. Genotype D is the most prevalent HBV strain in the Mediterranean area. We studied the prevalence and distribution of HBV genotypes and subgenotypes in a total of 73 HBsAg-positive patients living in Albania, and reconstructed the epidemiological history of the most prevalent HBV D subgenotype using a "phylodynamic" framework. A time-scaled genealogy of the Albanian patients' and reference P gene sequences with known sampling dates was reconstructed using an MCMC Bayesian approach that allows population growth to be estimated on the basis of coalescent theory. All of the Albanian subjects were infected with the HBV D genotype, and a percentage varying from 44.4% to 100% (depending on the ethnic or risk group) were infected with subgenotype D2, the most prevalent in the study population (72.4%). The other subgenotypes present in a minority of subjects were D1 (13.8%) and D3 (13.8%). The Bayesian skyline plot population dynamics analysis showed that genotype D2 entered the Albanian population in the late 1960s, and that the effective number of infections grew gradually until the second half of the 1980s and more rapidly until the mid-1990s, when it reached a plateau that still persists today. Our data suggest that political and socio-economic factors played an important role in determining the rapid spread of HBV infection in Albania.

Spondylodiscitis due to Sallmonela in an immunocompetent patient.

Salmonella is a gram-negative bacillus that penetrates in human from contaminated food or water. Sallmonela spondylodiscitis is a rare condition occur secondary to hematogenous spread after bacteremia episode. We presented a successful treatment with Levofloxacin in a 26 years old immunocompetent male with a septic form of sallmonelosis complicated with lumbar spondylodiscitis without surgery. He was treated with intravenous Levofloxacin for three weeks and was discharged from the hospital with oral Levofloxacin for more than two months. Clinical and laboratory evaluation two months after oral treatment resulted normal.

Hemorrhagic fever with renal syndrome complicated by orchitis.

Hemorrhagic fever with renal syndrome (HFRS) is a disease caused by viruses of the family Bunyaviridae, genus Hantavirus. HFRS from Dobrava virus (DOBV) is a seldom reported disease in Albania. Clinically HFRS is manifested as mild, moderate, or severe. Therefore, the number of cases of Hantavirus' infection may be underestimated, and should be included in the differential diagnosis of many acute infections, hematologic diseases, acute abdominal diseases and renal diseases complicated by acute renal failure. We report here an atypical presentation of HFRS from Dobrava virus complicated by orchitis with a positive outcome.

Streptococcus bovis isolated in haemoculture a signal of malignant lesion of the colon.

S. bovis is known for causing bacteremia and endocarditis as well as accompanying malignant diseases of the gastrointestinal tract. Hence, identification of this species and recognition of the clinical characteristics of infections caused are essential for both therapy and prognosis. S. bovis isolated from haemoculture requires an immediate search for gastrointestinal tract lesions.

Dexamethasone efficacy on bacterial meningitis--a retrospective analysis of Albanian adult patients.

BACKGROUND: Research on the effects of corticosteroids in bacterial meningitis (BM) yielded conflicting results. While some studies reveal that corticosteroids improve the outcomes in BM treatments, others provide strong evidence that patients do not profit from this treatment. We investigated the factors that may impact the dexamethasone efficacy in patients with BM. METHODOLOGY: In this retrospective study, we analyzed the medical records of patients with probable acute bacterial meningitis hospitalized between 2002 and 2008 at the Infectious Diseases Department, University Hospital Centre "Mother Theresa" of Tirana, Albania. They were all treated with dexamethasone. For study purposes, patients were divided into two subgroups: 1) Severely ill patients (Glasgow Coma Scale [GCS] or= 13. RESULTS: Sixty-seven patients analyzed had a mean age of 43.8 +/- 17.0 years old, forty-five (67.2%) of whom were males. The mean recovery time (RT) was 3.5 +/- 1.3 days, and four (6%) died. In the severely ill subgroup (GCS