Molecular characterization of Echinococcus granulosus in south-eastern Romania: evidence of G1-G3 and G6-G10 complexes in humans.

Clin Microbiol Infect ABSTRACT: Echinococcus granulosus is the aetiological agent of cystic echinococcosis (CE), which is a public health problem in many eastern European countries, particularly in Romania, where the infection causes a high number of human and animal cases. To shed light on the transmission patterns of the parasite, we performed a genotyping analysis on 60 cyst samples obtained from patients who live in south-eastern Romania and who underwent surgery for liver or lung CE. DNA was extracted from the endocysts or the cyst fluids, and fragments of cytochrome c oxidase subunit 1 and NADH dehydrogenase subunit 1 mitochondrial genes (cox1 and nd1, respectively) were amplified by PCR and sequenced. We found that most of the samples analysed (59/60) belonged to the G1-G3 complex (E. granulosus sensu stricto), which contains the most widespread and infective strains of the parasite. We also identified the first human patient infected by a non-G1-G3 genotype of E. granulosus in this country. As the DNA sequence of this cyst sample showed maximum homology with the G6-G10 complex (Echinococcus canadensis), this is, in all likelihood, a G7 genotype, which is often found in pigs and dogs in most countries of eastern and south-eastern Europe.

[Disability in pulmonary tuberculosis in the city of Bucharest]. / Consideratii privind invaliditatea prin tuberculoza pulmonara în municipiul Bucuresti.

The authors analyse the invalidity (new retreated cases) for pulmonary tuberculosis, in a period of 9 years (1986-1994), comparing the time before and after the December 1989 Revolution, by making a screening in 2 districts of Bucharest which, by number of population and incidence of tuberculosis, are representative for Bucharest. In the analyzed time, in Romania was noticed a three times increase of tuberculosis invalidity, especially due to pulmonary tuberculosis. In the two districts of Bucharest, in the 1991-1994 period compared to the 1986-1990 period, an increase in tuberculosis invalidity was noticed in men and women, the most affected age group being the one with the greatest work involvement (age 41 to 50). A great percentage of cavitary tuberculosis was registered (89%), with an increase of bilateral cavitary lesions frequency from 28% to 36% in the last 4 years. In the same time, the amount of deaths among the retreated patients increased, with a reduction of number of patients returning to work. All the data show a worsening in the last period (1991-1994) of the tuberculosis endemic and invalidity by this disease, probably due to the social and economical factors.

[The results of the chemotherapy of a patient cohort with pulmonary tuberculosis followed-up for a 3-year period]. / Rezultatele obtinute prin chimioterapie la o cohorta de bolnavi cu tuberculoza pulmonara, urmariti timp de 3 ani.

In 1992, in the fourth district of Bucharest 184 news adult patients with pulmonary tuberculosis were registered, and they received specific chemotherapy. The initial sputum bacteriological examination was M+C+ in 63.1% of these patients, M-C+ in 21.7% and M-C- in 15.2%. After three years of surveillance the results of the treatment were evaluated. 27 patients were excluded from the initial group, because they failed to be controlled. The final results were influenced by the sex and the initial bacteriological examination of sputum: the persistent negativation of sputum was obtained in 96.2% of the women, and only in 89.5% of men; depending on the initial bacteriological sputum examination, 100% of the M-C+ cases were negated, but only 86.4% of the M+C+ group.

[The role of the epidemiological survey in childhood tuberculosis]. / Rolul anchetei epidemiologice în tuberculoza infantila.

All epidemiological inquiries in tuberculous children are centralized and processed in the Institute of Pneumophtisiology. The analysis of 4,171 inquiries processed during 1985-1992 shows: after 1985 an increase of diseased children is noted. This increase is higher in gipsy children, whose weight reached 38.7% out of the total in 1992; the tb. children were found out mainly by symptoms and in 20-25% by ascendent epidemiological inquiry; the bacillary sources which infected the children have been found out by ascendent epidemiological inquiry in 70% of cases; the infection sources consisted mainly in new lung tb. cases in adults (78-82%), relapses (6-8%) and chronic cases (12-14%). In certain areas, the weight of chronic cases as infection sources exceded 20%.

[The prevalence of tuberculous infection in 6- and 14-year-olds in 1990-1991]. / Studiu privind prevalenta infectiei tuberculoase la 6 si 14 ani în anii 1990-1991.

Tb infection prevalence and incidence are considered as the most relevant epidemiological indices which characterizes the endemic disease in a population. The study tried to establish the level of Tb infection prevalence in the age groups "6-7" and "14-15", based on the information included in the card-index for BCG pre- vaccination in the above groups, in 11 districts of Romania and the city of Bucharest. To calculate the Tb prevalence results from the BCG tests in 24,175 pupils aged 6 and 14, the persons with reactions of 10-19 mm Palmer type I-II, and reactions > or = 20 mm regardless the Palmer type were considered as infected. In 1990, infection prevalence was of 2.13% and 6.73% in pupils aged 6 and 14, respectively. The study was not intended to establish the average level of Tb infection prevalence for the whole country since it would have required adequate samples of population and working teams of the same technical level as regards skin testing and its interpretation. The obtained data allowed the calculation of the average annual rate of infection for "age-group 0-6" within the study group (0.36%). It is estimated that infection prevalence evolution can be followed up at district level, by processing the data of the card-index for pre-vaccinal tests in the pupils of the I-st and VIII-th forms.

[Tuberculosis in the elderly: sociomedical aspects]. / Tuberculoza la varstnici; aspecte medico-sociale.

A study on a group of 100 tb patients aged over 60 years registered between 1987-1991 in the district 4 of Bucharest has been carried out aiming at the evaluation of medical and social aspects. In order to increase the relevance of the obtained data, these were compared with a group of young tb patients aged 20-39 years, in the same territory and period of time. The results show: the case-finding predominantly passive, extrarespiratory forms in 25%, high contamination risk (63% acid fast bacilli eliminators on microscopy) non-compliance to treatment in 1/5 of cases. These aspects could be explained by psychic particular features in aged persons, associated diseases a.s.o., leading to treatment failures. The analysis of social and epidemiological aspects of tb in aged subjects evidences some lack of good results in this important public health problem of people.

[The association of tuberculosis with HIV/AIDS infection in children in Romania]. / Asocierea tuberculozei cu infectia HIV/SIDA la copii, în România.

The great number of AIDS cases in children in Romania, together with the high annual risk of Tb infection, created the premises for the occurrence of a relatively great number of disease cases through HIV infection/AIDS + tuberculosis, particularly in the age-group "0-5 years". Serum positive HIV children were considered as AIDS cases when tuberculosis was also associated. Twelve cases in which the infections were concomitant, transmitted through injections, constituted an exception to the point. The 12 children serum positive for HIV showed a primary musculo-cutaneous complex on their thighs, at the very place of injections. A proportion of 50% of them showed a favourable evolution under anti-Tb treatment. Most children developed primary tuberculosis aerogenically acquired, associated with AIDS. A proportion of 59.5% of them evoluted towards severe disseminated forms (milliaria, meningitis), with many deaths, and 37.8% only showed a favorable evolution under anti-tuberculosis treatment. HIV infection in children took place predominantly between 1987-1989. Tuberculosis was associated 1-2 years later, when the switching from bacillary infection into active tuberculosis was facilitated by the progressive immunodepression which is specific for AIDS. The tuberculin test with 2 IU-PPD was positive in less advanced AIDS cases but faded in children in the final stage of the syndrome or in those with severe forms of tuberculosis. Tuberculosis finding out in children with HIV infection/AIDS is however possible; therefore, skin test reaction is compulsory in all children in this category. In children with a tuberculosis cured through specific treatment in their histories, the association of HIV infection reaching AIDS stage can lead to a Tb relapse.(ABSTRACT TRUNCATED AT 250 WORDS)

[The exclusively outpatient treatment of pulmonary tuberculosis under the conditions in Romania]. / Tratamentul exclusiv ambulator al tuberculozei pulmonare în conditiile tarii noastre.

In order to demonstrate the possibility of an exclusively outpatient treatment of pulmonary tuberculosis in the present conditions in our country, a study was performed on 140 cases in Bucharest. The admission criteria were as follows: sputum negative patients (M-C-); paubacillary cases, sputum positive only in culture (M-C+); Tb pleuritis; patients refusing hospitalization, regardless their bacteriological status, and sputum positive cases also at smear examination (M+C+), if they had no household contacts under 20 years of age or with a good social economic standard of life. The patients were given the intensive chemotherapy regimen HSRZ 2/7 for 6 months, that was prolonged to 9 months in specified cases. A number of 31 patients were non-bacillary (M-C-) out of which 14 cases with pleuritis; 70 were paucibacillary (M-C+), and 39 were smear positive (M+C+). Out of 109 patients which were bacteriologically confirmed, sputum reversion in culture was obtained in 71.6% of cases at 2 months and in 89.0% at 3 months. At treatment end, sputum negativation was not obtained in a single patient (0.9%). Case follow-up for 6-41 months after treatment end led to the registration of 8 therapeutical failures and bacteriological relapses (5.7%). Five cases recovered through re-treatment, 1 patient (0.7%) died through tuberculosis, and 2 (1.4%) became chronic case. Periodical control of the 95 contact children in the respective households revealed a single conversion of the tuberculin reaction and no Tb case after treatment start in index cases, which proves the epidemiological reliability of the method.

[The risk of tuberculosis infection and disease among children in contact with tuberculous foci]. / Riscul de infectie si îmbolnavire prin tuberculoza al copiilor contacti în focarele tuberculoase.

Three groups of children aged 0-14 years, in the 4-th district of Bucharest, have been followed up during 1988-89, as follows: a retrospective group--331 contact children in new tb foci registered in 1986-87; a prospective group--213 contact children in newly registered foci in 1988 and a group of 49 contact children in chronic foci. The children have been controlled clinically and X-ray and tuberculin tested on case-finding of the index-case and 3, 6 and 12 months thereafter; those from the retrospective group even after 2-3 years. The non-infected children were BCG vaccinated; in those infected chemoprophylaxis was administrated. The most dangerous infection sources for children were the tb bacilli eliminators on microscopy. The tuberculin conversions were noted during the first 3-6 months after contact; the children from chronic foci can converse even after 1-3 years. The active tuberculosis in children were noted on the initial check-up and were missing during the follow-up period, even in chronic foci. These observations could be accounted to the prophylactic measures applied in contact children, corroborated with intensive treatment of infection sources. Since most of disease cases in children were under 2-3 years of age, we consider necessary to continue the BCG vaccination at birth.

[The recovery of work capacity within the framework of short-term antitubercular chemotherapy]. / Recuperarea capacitatii de munca în cadrul chimioterapiei antituberculoase de scurta durata.

The authors compare the results of chemotherapy reflected in the proportion of recoveries of work capacity and the number of retired persons in two groups of patients--one including 102 cases treated between 1970 and 1971 by a 3/6 regimen, and another one including 91 patients treated in 1986 by a modern intensive 3 + 3 regimen. The data indicate better results with the 1986 lot as compared with the 1970-1971 lot. In the 1986 group there were no fatalities and the persons that recovered their work capacity represented 90.1% of the total. By contrast, in the group treated between 1970 and 1971 there were two fatalities and only 84.3% of all the patients did recover the work capacity. The number of retired persons decrease from 11.7% in the first group to 7.7% in the second. Temporary incapacity decreased from an average of 321 days to an average of 267 days in the second group. All these results were obtained by shortening the treatment from an average of 9 months to an average of 6 months.