Clinical manifestations in the West Nile virus outbreak.

During the summer of 1996 an unusual clustering of meningoencephalitis cases was recorded in the Capital City, Bucharest, and in some areas from South-East Romania. After an initial suspicion of an enteroviral etiology was discarded, the West Nile etiology was confirmed by specific antibodies demonstration through hemagglutination-inhibition and ELISA tests. This study included 251 patients with the diagnoses of West Nile acute encephalitis (166 cases), acute meningitis (57 cases) and acute febrile disease (33 cases). The patients' age ranged from 1 to 89 years (mean 51.1 years). The most frequent clinical manifestations were: fever (95.7% of cases), cephalalgia (92.6%), stiffness of the neck (89.1%), vomiting (62.5%), marked asthenia (46.5%), myalgia (28.9%). In addition, patients with encephalitis exhibited: alteration of consciousness (89.2% of cases), tremor of extremities (40.4%), ataxia (44%), paralysis (15.1%). The fatality rate was 15.1% in acute encephalitis, 1.8% in acute meningitis and 0% in the acute febrile disease.

[Rapid diagnosis in tuberculosis by using the MB/BacT system]. / Diagnostic rapid în tuberculoza prin folosirea sistemului MB/BacT.

428 clinical samples were examined by the MB/Bact system and by inoculation on "Tebeglut" medium. 43.9% of the samples were positive for Mycobacterium sp. when examined by MB/BacT system and 29.6% when cultivated on Tebeglut. The reported percent of positivity (43.9%) is highly superior if compared with those reported in other countries: Great Britain (9.1%), France, (7.0%). The MB/BacT system is much more effective in detecting mycobacteria if compared with Tebeglut cultivation, mainly in two categories of samples: those with no evidence of AARB and those with fewer than 10% AARB. From 156 Mycobacterium sp. isolated in MB/BacT system, 88.5% were M. tuberculosis, the others being atypical mycobacteria.

[Pharyngitis produced by Arcanobacterium haemolyticum]. / Faringite produse de Arcanobacterium haemolyticum.

Arcanobacterium haemolyticum (A.h.) was recovered from 0.43% of throat cultures of 3715 patients with sore throat, scarlatina and various skin rash. In a 57.90% patients A.h. was the only bacterial pathogen isolated, while in the remainder beta-haemolytic streptococci, Haemophilus and S. aureus were also detected. beta-haemolytic streptococci were much more frequent than A.h. in the throat cultures (26.83%). All A.h. strains were of the smooth type based on colony morphology and the ability to ferment sucrose. The strains were susceptible to penicillins, cephalosporins, erytromycin and resistant to trimethoprim-sulphamethoxazole. Pharyngeal injection in 89.47% and exanthem in 78.90% were the most common signs present to the patients.

Serodiagnosis of tuberculous meningitis by enzyme-linked immunosorbent assay (ELISA).

IgG antibodies against glycolipids and proteins isolated from M. tuberculosis and BCG suspension were determined by ELISA in sera, in CSFs and in serum and CSF paired samples, from patients with tuberculous meningitis and from healthy control subjects. With specificities between 90 and 94% for the antigens used, we obtained senitivities of 75% for Pr-ELISA, 60% for G1-ELISA and 35% for BCG-ELISA. As specific antibodies were detected in serum and CSFs, only one sample is enough to perform the test. We concluded that Pr-ELISA and G1-ELISA could be used as a supporting test in TBM diagnosis, especially when repeated bacteriological methods failed to prove the presence of tubercle bacilli and in cases without evidence of pulmonary tuberculosis.

Study of the sensitivity to antimicrobial drugs of some S. pneumoniae strains isolated from different pathological states.

76 Str.pneumoniae strains isolated from different clinical disease forms were studied for the sensitivity to antimicrobial drugs using the diffusimetric method and the dilution in agar method (MIC to penicillin). The results revealed that 44.74% of pneumococci were sensitive to penicillin, the remaining pneumococci being resistant; 18.42% showed a high resistance (MIC > or = 2 micrograms/ml). A close relationship was seen between sensitivity to penicillin on the one hand and the Pneumococcus origin and serotype on the other. As concerning the multiresistance to antimicrobial drugs, 47.4% of the strains presented resistance to > or = antibiotics belonging to different classes, the most frequent resistance pattern being P, E, Te, SxT. The most active antimicrobial drugs were vancomycin, amoxiclave, rifampicin, followed by ceftriaxone and amoxicillin.

[Staphylococcus saprophyticus isolated in blood cultures from normal-weight newborn infants with septic arthritis]. / Staphylococcus saprophyticus izolat din hemoculturi provenind de la nou-nascuti normoponderali cu artrite septice.

The paper deals with the identification of some Staphylococcus saprophyticus strains received by the Staphylococcus National Reference Centre, in the Cantacuzino Institute, Bucharest, Romania. The strains were isolated from blood cultures pre-elevated in a maternity in Bucharest from normoponderal newborns with septic arthritis. Recent data from literature concerning the infections caused by coagulase negative staphylococci in general, with special reference to those cause by S. saprophyticus are presented. The identification scheme used in the Cantacuzino Institute and the minimal microbiological diagnosis tests of S. saprophyticus recommended to the clinical laboratories by the International Society for the Taxonomy of Staphylococci and Micrococci are also described.

Characteristics of Enterococcus strains isolated in 1991-1992.

The paper presents the identification and resistance to antibiotics as well as the high-level resistance of 96 strains of enterococci isolated in 1991-1992 from patients admitted in the "Victor Babes" Hospital of Infectious Diseases. The identification of Enterococcus species using the Facklam-Collins schedule and several additional tests reveal 86.4% E. faecalis, 7.2% E. faecium, 4.1% E. gallinarum and 1.0% E. durans and 1% E. hirae. The high-level resistance to aminoglycosides was 69.8% for Streptomycin, 50%--Kanamycin and 21.8%--Gentamicin. The phenotype of resistance to Streptomycin, Kanamycin and Gentamicin was found in 19.8% of strains. 7.4% of enterococci had MIC values higher or equal to 32 mcg/ml to Penicillin and MIC > or = to 16 mcg/ml to Ampicillin. Six E. faecalis strains and two E. gallinarum strains were resistant to Vancomycin.

Bacteriological study of Neisseria strains isolated in Romania 1971-1992.

1496 Neisseria strains isolated from patients and carriers from 24 counties in Romania and Bucharest in 1971-1992 were studied. Serogroup A identified in 84.5% in 1987 shows a remarkable decrease in pre- and post-epidemic periods when serogroups B and C reach rates varying from 0 to 66.6% in 1975 for B and 38.8% in 1974 for C. Non-groupable strains were more frequently isolated in inter-epidemic periods, especially in carriers. Sensitivity to antibiotics of the meningococcal strains revealed a law rate of resistant strains, the most active antibiotics in decreasing order being: penicillin, chloramphenicol, tetracycline, ampicillin, rifampicin and erythromycin. Serogroup A was the most resistant to sulfamides as compared to the other serogroups, its resistance rate rising from 18.1% strains resistant to sulfathiazole in 1980-1985 to 60.7% in 1987 and to 83.3% in 1988.

Evaluating the minimum active concentrations of penicillin G and V and of retard forms in clinical conditions.

Following several signals indicating the inefficiency of the clinical treatment with various penicillin preparations in some cases, we decided to study the seric penicillin concentrations in the patients hospitalized in the "V. Babes" Hospital of Infectious Diseases, after administration of the various Romanian made forms of penicillin currently used in the therapy of streptococcal infections and in the prophylaxis of the sequelae of these infections. The data obtained on groups exceeding 30 persons by using two methods of determining the penicillin concentrations the dilutions and the diffusimetric methods revealed protective penicillin seric levels satisfactory for penicillin G and Efitard, according to the present treatment schemes. After 5 days from Moldamin administration only 45.4% of children and 43.3% of adults were found to have satisfactory penicillin concentrations. The administration of penicillin V reaches active penicillin concentrations in terms of the dose administered. The paper points out only one of the causes which together with others (such as beta-lactamase production and tolerance), contribute to the unsuccessful treatment with various forms of penicillin.

Characteristics of Neisseria meningitidis strains isolated in Romania between 1986 and 1989.

499 N. meningitidis strains were studied, 454 being isolated from CSF and blood and 45 from nasopharynx. Meningococcal serogroup A was prevalent in 1986-1988, having a decreasing tendency from 84.90% in 1987 to 45.0% in 1989. Serogroup C increased from 0.86% in 1986 to 15% in 1989. All strains, examined by diffusiometric method, were sensitive to ampicillin, cephalotin, chloramphenicol and rifampin. For tetracycline, resistance ranged from 2.28 to 6.0% in 1987-1989. The frequency of 52.0-72.14% resistant to sulphamides strains seems to be due to serogroup A prevalence. Six N. meningitidis strains, isolated in 1989, proved to be moderately resistant to penicillin with MIC greater than or equal to 0.1 mcg/ml. The results indicate the necessity of a continuous surveillance of meningococcal infection, both from the point of view of serogroup circulation and also of antibiotics sensitivity.

Diagnosis of pneumococcal meningitis by coagglutination method.

It was tested the possibility to evidence the pneumococcal capsular antigen, by coagglutination, directly in CSF, using a specific coagglutinating reagent for all the 10 serological types of S. pneumoniae more frequently encountered in our country. Were investigated 134 CSF from purulent meningitis, out of which 37 were of probable pneumococcal etiology, on the basis of bacterioscopic examination, 26 of other etiology and 71 of unknown etiology. The results obtained showed 28 (75.7%) positive reactions in the fluids from probably pneumococcal meningitides on the basis of the positive bacterioscopic examination. The specificity of the reactions is demonstrated by the negative reactions with the fluids from meningitides of other etiology, as well as by the concordance between the antigen serotype from the liquid and that of the isolated S. pneumoniae strain. For a good test sensitivity could argue the positive reactions obtained with 6 CSF from meningitides of unknown etiology.