A case of Covid-19-associated invasive pulmonary mucormycosis in a pediatric patient with a newly diagnosed diabetes.

Mucormycosis is a rare, potentially life-threatening disease that is growing during the Covid-19 pandemic. This study reports a case of an 11-year-old patient with fatal Covid-19-related pulmonary mucormicosis and diabetes mellitus with ketoacidosis. The diagnosis was set post mortem. It was based on histochemical detection of the causative agent. Massive hemoptysis due to erosion of a large pulmonary vessel caused mechanical asphyxia and lethal outcome. Pulmonary mucormycosis may be highly suspected in patients with long-term Covid-19, poorly controlled diabetes mellitus with ketoacidosis, and corticosteroid therapy. Early diagnosis and treatment with Amphotericin B are potentially curative options for this invasive fungal infection and can led to better outcome.

A rare case of an HIV-seronegative patient with Toxoplasma gondii meningoencephalitis.

Cerebral toxoplasmosis is a common opportunistic infection that causes expansive brain lesions in people living with HIV/AIDS. But it is extremely rarely associated with HIV negative patients. This study presents a case of a 23-year-old male with non HIV-relative cerebral toxoplasmosis. There was an acute onset of the disease. The first symptoms included fever and signs of meningoradicular irritation. Neurological abnormalities progressed in cranial nerves disorders and pyramidal syndrome. The cerebrospinal fluid (CSF) changes were consistent with those of viral meningoencephalitis. CT and MRI showed multiple ring-enhancing lesions with high-intensity signals in cerebrum brain stem and cerebellum. The tests for HIV (ELISA and Western blot) were negative. Serological detection of Toxoplasma gondii (T. gondii) IgM and IgG antibodies in the CSF confirmed the diagnosis. Parasitic, bacterial, viral encephalitis and meningoencephalitis, as well as neoplastic metastatic process and other neurological diseases were discussed in the differential diagnosis. The intensity of the disease activity fluctuated during the hospital stay regardless of the adequate therapy.

Aseptic meningitis outbreak caused by echovirus 30 in two regions in Bulgaria, May-August 2012.

An aseptic meningitis outbreak emerged in two regions in Bulgaria in 2012 and echovirus 30 (E30) was established as the aetiological agent by cell culture isolation, serological test, and molecular-based techniques. A total of 157 patients with aseptic meningitis were investigated, of which 117 were confirmed as having E30-associated disease. Molecular analysis of 12 E30 isolates revealed 99-100% nucleotide and amino-acid identity between them and a close correlation with a Greek strain involved in an E30 outbreak in 2012. Children aged 5-14 years were mainly affected, which could reflect the absence of E30 epidemics in Bulgaria for a period of 11 years. The first case with E30 isolation (a 2-year-old patient from Plovdiv) was notified at the end of April 2012. This was most likely the index case, from which the spread of the virus started, causing sporadic cases first, which later led to an aseptic meningitis outbreak facilitated by person-to-person viral transmission.

[Rare case of Crimean haemorrhagic fever in a pregnant woman].

A rare case of Crimean haemorrhagic fever in a pregnant woman during the sixth month of gestation is described. The typical clinical course of the disease is present with positive anamnesis and visible locus from tick bite. After several days, fever and local lymphadenitis appear, followed by severe toxicoinfectious and haemorrhagic syndromes. The disease is proved virologically and serologically. The outcome is favourable for the pregnant woman. She is discharged home after 16-day hospital treatment. During the illness no complications of the fetus are documented. The pregnancy terminates with a normal-term delivery of a healthy newborn baby with birthweight of 3350g. The clinical and laboratory follow up of the baby showed no abnormalities. The case is of interest because of the rarely and often severe course of the disease during pregnancy. In this case the outcome is favourable for both the mother and the newborn child.

[The assisted reproduction and the newborn child].

A review of the literature was made concerning the perinatal complications of children conceived through assisted reproduction technology. The main complications were due to the high frequency of multiple gestation and prematurity. There is convicting data for a twofold increase of the frequency of congenital malformations: neural tube defects, intestinal atresia and hypospadias. Chromosomal disorders are more frequent when Intracytoplasmic spermal injection is used. There is no evidence of increased risk of tumors. The psychomotor and intellectual development of the children conceived by assisted reproduction is normal. Nowadays, in order to decrease the incidence of multiple pregnancy, elective single embryo transfer if the preferable technology of assisted reproduction.

Clostridium difficile-associated disease with lethal outcome in a 77-year-old woman. A case report.

Clostridium difficile-associated disease (CDAD) ranges in severity from mild diarrhoea to fulminant colitis and death. Antimicrobial use is the primary risk factor for development of CDAD. C. difficile typically affects older or severely ill patients, hospitalized or residents in long-term-care facilities. We report a case of CDAD in a 77-year-old woman operated on for cholecystitis calculosa and treated with cephalosporins and aminoglycosides. Symptoms and signs of CDAD were watery diarrhoea, mucus stool, high fever and, weakness. Sigmoidoscopy was provided on the second day after hospitalization. It revealed diffuse pseudomembranes throughout the distal colon, confirming C. difficile infection. Antimicrobial agents administered at the admission were stopped and treatment with oral vancomycin, metronidazole and famotidine was initiated. Despite this the patient's status worsened and she died because of cardiogenic shock.

Clinical course and outcome of a nosocomial outbreak of hepatitis C in a urology ward.

This paper describes a prospective study of the clinical course and outcome of a nosocomial outbreak of hepatitis C virus (HCV) infection in six male urology patients at a hospital in Stara Zagora, Bulgaria. These patients had been previously hospitalised in the urology ward, during which all had received intravenous therapy. Approximately three weeks later, all six were admitted to the infectious diseases unit with acute hepatitis, shown to be caused by HCV genotype 1b. The diagnosis was confirmed by polymerase chain reaction during the first week of their hospital stay. Infected patients were followed up for 30 months following diagnosis and 54 potential contacts for 6 months post-exposure. Four patients recovered completely; one developed chronic HCV infection and one died. The latter already had cirrhosis due to co-infection with hepatitis B virus. The investigation established the index case as a patient with chronic hepatitis C, who had been an in-patient on the same ward at the same time. The most likely route of transmission was intravenous heparin flushes administered with a common syringe. Contrary to the common assumption that acute HCV infection often leads to chronic disease, only one chronic case was observed during the 30-month period of investigation.