Toxoplasma gondii Seroprevalence and Trends in Women Presenting for Toxoplasma Screening in South-West Romania.

Toxoplasmosis, caused by the obligate intracellular protozoan parasite Toxoplasma gondii (T. gondii), is a globally prevalent zoonotic disease with potentially severe implications for immunocompromised individuals, pregnant women, and their fetuses/children. This study examined the prevalence of anti-T. gondii IgM and IgG antibodies in two groups of childbearing age women, including 653 participants in Group 1 (2013-2016) and 3221 participants in Group 2 (2019-2022). Our results revealed a decrease in the overall positivity rate of anti-T. gondii IgM antibodies from 2.32% to 1.06%, suggesting improved public health interventions over time. However, there were variations among different age groups and between rural and urban environments, with a significant decrease in urban areas across all age groups from Group 1 to Group 2. Regarding anti-T. gondii IgG antibodies, we did not observe a significant change in the seropositivity rate between the two groups. In the rural population with an age group over 35 years, we observed the highest positivity rate in Group 2. This study provided information on the risk factors and burden of toxoplasmosis in women of childbearing age with data that can be valuable to public health policies and the planning of healthcare measures for effective toxoplasmosis management.

Seroprevalence of Infections with TORCH Agents in Romania: A Systematic Review.

Maternal-fetal infectious pathology-notably the TORCH panel (Toxoplasma gondii, rubella, Cytomegalovirus, and herpes simplex viruses)-critically impacts maternal and neonatal health. This review collates data on the seroprevalence of IgG and IgM antibodies against TORCH agents in Romanian women, aiming to discern regional and population differences and identify risk factors. Twenty studies were included in the review, revealing variable seroprevalence rates across the country. Regions such as Moldavia and Banat showed higher anti-T. gondii IgG seroprevalence rates than Bihor, with notable declines in Banat. Rural, older, and multiparous women showed elevated T. gondii IgG rates. Anti-rubella vaccine introduction significantly reduced the prevalence of anti-rubella IgG antibodies, but recent vaccination coverage decreases raise concerns. CMV and HSV seroprevalence varied geographically, with rural areas generally showing higher CMV rates and HSV influenced by factors like education level and number of sexual partners. Concurrent seroprevalence of multiple TORCH components in some cases underscores potential common risk factors. This study highlights the importance of continuous monitoring and preventive measures such as vaccinations and awareness campaigns to mitigate the health impact on the pregnant population.

In-stent restenosis in acute coronary syndrome-a classic and a machine learning approach.

Background: In acute coronary syndrome (ACS), a number of previous studies tried to identify the risk factors that are most likely to influence the rate of in-stent restenosis (ISR), but the contribution of these factors to ISR is not clearly defined. Thus, the need for a better way of identifying the independent predictors of ISR, which comes in the form of Machine Learning (ML). Objectives: The aim of this study is to evaluate the relationship between ISR and risk factors associated with ACS and to develop and validate a nomogram to predict the probability of ISR through the use of ML in patients undergoing percutaneous coronary intervention (PCI). Methods: Consecutive patients presenting with ACS who were successfully treated with PCI and who had an angiographic follow-up after at least 3 months were included in the study. ISR risk factors considered into the study were demographic, clinical and peri-procedural angiographic lesion risk factors. We explored four ML techniques (Random Forest (RF), support vector machines (SVM), simple linear logistic regression (LLR) and deep neural network (DNN)) to predict the risk of ISR. Overall, 21 features were selected as input variables for the ML algorithms, including continuous, categorical and binary variables. Results: The total cohort of subjects included 340 subjects, in which the incidence of ISR observed was 17.68% (n = 87). The most performant model in terms of ISR prediction out of the four explored was RF, with an area under the receiver operating characteristic (ROC) curve of 0.726. Across the predictors herein considered, only three predictors were statistically significant, precisely, the number of affected arteries (≥2), stent generation and diameter. Conclusion: ML models applied in patients after PCI can contribute to a better differentiation of the future risk of ISR.

Aspects of Humoral Immunity after Vaccination with Bnt162b2: A Small Study.

Starting from December 2020, vaccination against COVID-19 became available in Romania. There are a lot of uncertainties regarding the kinetics of immunity and its persistance over time. This is a small prospective study developed between January-September 2021 in the Infectious Diseases Clinic from Craiova and comprising 61 subjects immunised with BNT162b2 (Comirnaty). We have found that after two doses of vaccine there is a strong humoral response, but the immunity lowers six months later. Subjects with a diagnosis of COVID-19, previously or in between the two doses, have had the most significant immunological response, but, also, the sharpest decline in antibody titer. The immune response seems to be the same, regardless the gender of the subjects. There are a variety of responses at the individual level, but overall vaccine effectiveness is 96.72% two weeks following immunisation and 88.52% after six months; however for those who have been in contact with the virus, they all had an antibody titer well above the laboratory limit.

The Role of QuantiFERON-TB Gold Plus in Mycobacterium Tuberculosis Detection in a Severe HIV Immunocompromised Patient-Case Report.

Tuberculosis (TB) is an important opportunistic infection in HIV-positive people. We are reporting a case of a 31-year-old HIV-infected patient who was hospitalized in July 2021 for dyspnea, cough with mucopurulent sputum and asthenia. He was confirmed to have Serratia liquefaciens pneumonia and acute respiratory failure. The evolution was unfavorable despite the antibiotic, pathogenic and symptomatic treatment. Because the patient had severe immunosuppression (CD4 count = 37 cell/mm3), we used QuantiFERON-TB Gold Plus for the detection of the Mycobacterium tuberculosis infection. The antituberculosis therapy was initiated, which resulted in a significant improvement of the general condition and the patient was discharged with the recommendation to continue antiretroviral therapy, antituberculosis treatment and Trimethoprim/Sulfamethoxazole-single tablet daily for the prophylaxis of Pneumocystis pneumonia.

Lemierre's Syndrome: Case Presentation of a Rare and Possibly Life-Threatening Condition.

Lemierre's syndrome is, presently, a very rare condition, but a life-threatening one. The syndrome was first described in 1936 by Andre Lemierre and comprises an oropharyngeal infection (most commonly associated with anaerobic bacteria Fusobacterium necrophorum), internal jugular vein thrombophlebitis and, possibly, secondary septic metastasis (common sites are lungs or brain). We describe such a rare case diagnosed at our Infectious Diseases Department in September 2019.

Analysis of the First 300 Cases of SARS CoV2 Infection from the Infection Disease Clinic of Craiova, Romania.

COVID-19 is an ongoing pandemic and an intermediate analysis of the first 300 cases treated in the Infectious Diseases Clinic from Craiova has been performed. We have found that most of the cases were asymptomatic or mild, but the severity of the symptomatic cases increases with age. The main comorbidities associated mainly with the severe cases were high blood pressure, obesity, other cardiac conditions, diabetes mellitus and malignancies. Inflammation, coagulation and metabolic disorders are significantly more expressed in critically ill patients. Fatality rate is relatively low, death seems to be associated with old age.

Human Anthrax in Dolj County, Romania-A Series of Three Cases.

Bacillus anthracis is the causative agent of anthrax, primarily a disease of herbivorous animals, which can be accidentally transmitted to humans. Three cases of cutaneous human anthrax were recorded in August 2020 in Dolj county, Romania. These cases included livestock farmers (husband and wife, as well as a man from their entourage). The women presented malignant edema, which required surgery for compartment syndrome; and the men presented the common form of cutaneous anthrax. According to the laboratory investigation, two cases complied with the criteria in the case definition. All cases were successfully treated with antibiotics and the women received reconstructive plastic surgery of the skin defects, restoring normal hand function. The contact with sick animals was ruled out by the health authorities concluding that it was the contamination of pre-existing skin lesions with B. anthracis spores from the soil, the anthracogenic area.

Considerations About Risk Factors for Peripheral Neuropathies in Romanian HIV-Infected Patients.

PURPOSE: The study aims at detecting risk factors for developing peripheral neuropathy in Romanian HIV infected subjects. MATERIAL/METHODS: retrospective study (january 1990-january 2009) who analyzed data from patients hospitalized in the Regional Center Craiova. We have compared 26 patients (group N) diagnosed with peripheral neuropathy  with 40 patients (group C) without neuropsychological sufferings, randomly selected. We have analysed: age, height, HIV mode of transmission, AIDS status, the average and nadir of CD4 lymphocytes, the mean viral load, the average duration of antiretroviral treatment (ART), use and duration of use of d-drugs, the presence of certain coinfection, diabetes or ethanol abuse. RESULTS: the following differences were statistically significant: age (31,54±14,64 vs 23,9±12,03 years, p=0.024), HIV mode of transmission  (parenteral/sexual: 13/13 vs 28/8, p = 0.044), the monitoring time duration (5,31±3,77 vs 7,75±5,4 years, p=0.043), median ART duration (37,2±9,66 vs 45,12±8,75 months, p=0.001). Close to the threshold of statistical significance are the CD4 nadir (97,33±65,6 vs 123,15±43,35 cells/mm3, p=0.058) and duration of use of d-drugs (22,5±31,94 vs 12,24±8,6 months, p=0.057). Odds ratio (OR) and relative risk (RR) increase with age. ROC analysis for the study group establishes a threshold difference of 29 years (sensitivity 50%, specificity 80%). CONCLUSIONS: higher age and advanced immunosupression are the most important risk factors for developing symptomatic peripheral neuropathy in Romanian HIV infected patients; taking into account the small number of cases studied, although not statistically significant, it should be noted the CD4 nadir and the length of d-drug use.

HBV influence on Response to Antiretroviral Therapy in Horizontally HIV-HBV Coinfected Patient during Early Childhood.

BACKGROUND: There are few studies on pediatric HIV-HBV coinfection, so evidences about relationships between the two viruses are scarce. OBJECTIVES: influence of HBV infection on virological and immunological response to antiretroviral therapy (ART) in antiretroviral-naïve horizontally HIV-HBV coinfected subjects during early childhood. MATERIAL AND METHODS: observational study on 826 HIV+ subjects in evidence of Craiova Regional Centre (CRC); we analyzed the immunological and virological response at 6-12 months after starting first antiretroviral regimens compared in 2 groups: horizontally HIV-HBV coinfected subjects during early childhood (CoS) versus horizontally HIV infected subjects during early childhood without HBV infection (non-CoS). RESULTS: Number of subjects: CoS-66 subjects, non-CoS-132 subjects. Demographic data: CoS-gender ratio F:M=0.886, the majority lived in rural area (57.58%), mean age on diagnosis-9.288±4.607 years, non-CoS-gender ratio F:M=0.859, the majority lived in urban area (53.79%), mean age on diagnosis-10.742±5.107 years. At baseline, HIV category was: CoS-A-1.52%, B-80.30%, C-18.18%, non-CoS-A-2.27%, B-70.45%, C-27.27% (p Chi(2)=0.332), the mean CD4+ cell count was: CoS-148.33±148.10 cells/ml, non-CoS-163.17±155.39 cells/ml (p Student=0.521) and the mean HIV viral load (HIV VL) was: CoS-5.06±0.80 lgcopies/ml (for 29 subjects), non-CoS-5.04±0.84 lgcopies/ml (for 61 subjects) (p Student=0.978). At the end of the studied period, the mean increase in CD4+ cell count was: CoS-177.068±141.676 cells/ml, non-CoS-176.015±191.751 cells/ml (p Student=0.969) and the mean decrease in HIV VL was: CoS-5.04±0.79 lgcopies/ml, non-COS-4.69±2.04 lgcopies/ml (p Student=0.911). CONCLUSIONS: The presence of HBV coinfection does not influence immunological or virological response to ART.