Revista Romana de Boli Infectioase

Dear colleagues, The Romanian Journal of Infectious Diseases (Ro. J. Infect. Dis.) was the official journal of the Romanian National Infectious Diseases Society and has evolved since the fi rst number in 1997 with a trimestrial publication frequence, into a local medical speciality. Ro. J. Infect. Dis. is already indexed in the international databases EBSCO, Scirius, getCITED and WAME.

Currently the journal is nationaly ranked CNCSIS, in B+ category and is applying for international indexing (Medline, Scopus, MedSci Communications, Medical-Journal, etc.).

The journal presents papers that are adressed mainly to infectious diseases specialists, but also to those interested in the field.

The journal has the following structure: editorial, reviews, original papers, case reports, special sections. The topics are mainly in the infectious diseases fi elds also covering bacteriology, virusology, parasitology domains.

We aim to do some changes in order to extend fi rst of all the adresability of this journal.

We intend to establish a high-quality, refereed journal of infectious diseases that can be accessed by infectious diseases specialists worldwide. It will give Romanian but also Eastern European Countries Infectious Diseases Specialists the opportunity to publish their studies, and also to get access to reviews, updates and international research papers. Burning issues, HIV and hepatitis viruses will have special alocated spaces in each number. Specialists from limited resources countries have often dificulties to get papers published in well-known international journals, due to constrains regarding the resources and language. Therefore we intend to give free access to scientifi c articles for individuals. At least for the first year, the electronic version of the journal will be distributed at no cost over the internet. (In the future, we may have to charge a minimal subscription fee.)

The noncommercial reproduction of articles for educational and research purposes will be explicitly permitted.

The journal already has close partnerships with other journals (Journal of Family Practice, The Canadian Family Physician) and information sources (eg. Reuters/Health) in order to be constantly upto-date.

Prof. Dr. Ludovic Paun, President of Romanian Society of Infectious Diseases

M. Nica 1, P.A. Fonteyne 2, A. Dascalu1, T. Biolan 1, E. Mozes 1, J.L. Gala 2, D. Duiculescu 1, L. Ene 1, S. Erscoiu 1, E. Ceautu 1, P. Calistru 1
1) Clinical Hospital of Infectious and Tropical Diseases "Dr. V. Babes" /SVB, Bucharest, Romania
2) Laboratory of Applied Molecular Technology, Université Catholique de Louvain, Brussels, Belgium (CTMA-UCL) Correspondence address: D Duiculescu, Clinical Hospital of Infectious and Tropical Diseases "Dr. Victor Babes", 281 Mihai Bravu Str., Bucharest, 030303

ABSTRACT

Objective: To compare the conventional identifi cation with the molecular methods, based on fungal DNA markers.
Methods: 95 strains were isolated at SVB between Jan-Apr 2009. Their isolation was made on BHI sheep blood/agar, Sabouraud agar, ChromID Candida agar. Yeasts were identifi ed according to Germ tube test, India ink examination, rapid urease test, detection of soluble Cryptococcus neoformans antigens, API ID 32 C and VITEK 2C. At the CTMA-UCL 30 DNA extractions were made with NucliSENS® lysis magnetic extraction reagents and NucliSENS® miniMAG. A real time PCR amplifi cation was performed using the ITS3 and ITS4 primers. Data were recorded on a Roche LightCycler® 480 System. Aspergillus fumigatus strain DSM 63359 was used as a positive control. The amplicons were sequenced on an automated 3130 Genetic Analyser.
Results: The strains identifi ed by conventional methods in SVB were: C. albicans, C. glabrata, C. krusei, Sacharomices cerevisiae, C. kefyr, C. tropicalis, C. guillermondii, C. holmii, Aspergillus fumigatus, Aspergillus fl avus, Aspergillus niger, Aspergillus spp, Cryptococcus neoformans. Correlation between the melting genotype and the phenotypic identifi cation was perfect for C. albicans, C. glabrata, C. krusei, C. guillermondii and C. neoformans. Conclusions: SVB place a high priority on maximizing their capabilities for the early diagnosis of opportunistic fungal infections.

Keywords: molecular diagnosis, pathogenic fungi, quantitative detection, Real-Time PCR.

Asist. Univ. Dr. Simin Florescu, Prof. Dr. Emanoil Ceausu, Prof. Dr. Petre Calistru, Dr. Cristina Voinea, Dr. Elena Turcu (Mozes), Dr. Maria Nica, Dr. Corneliu Popescu, Prof. Dr. Ludovic Paun
Spitalul Clinic de Boli Infectioase si Tropicale "Prof. Dr. Victor Babes", Bucuresti

REZUMAT

Afectiunile tropicale de import sunt prezente constant in Romania, ca si in alte tari europene nonendemice. Raritatea acestor boli in tara noastra fac uneori diagnosticul dificil, dar prezenta unui context epidemiologic de risc determina orientarea diagnostica. Malaria si leishmaniaza viscerala sunt cele mai frecvente afectiuni de import. La acestea se adauga cazuri mai putin frecvente de holera, schistosomiaza digestiva, filariaza limfatica, amibiaza.

Cuvinte cheie: malarie, leishmaniaza, diagnostic, epidemiologie

ABSTRACT

Imported tropical diseases are constantly present in Romania, as well as in all nonendemic European countries. The diagnosis is sometimes diffi cult due to the rarity of these diseases in our country; the epidemiological risk factors are important for approaching the diagnosis.

Keywords: malaria, leishmaniasis, diagnosis, epidemiology

Conf. Dr. Dan Duiculescu 1, 2, Dr. Luminita Ene 1, Dr. Roxana Radoi 1, Dr. Gratiela Tardei 1, Dr. Maria Nica 1
1) Spitalul Clinic de Boli Infectioase si Tropicale "Dr. Victor Babes", Bucuresti
2) Facultatea de Medicina, Universitatea "Titu Maiorescu", Bucuresti

REZUMAT

Ne-am propus sa evaluam retrospectiv toti copiii cu infectie HIV-1 si PML diagnosticati in perioada 1997 - 2009 la Spitalul Clinic de Boli Infectioase si Tropicale "Dr. Victor Babes". Diagnosticul de PML a fost stabilit conform definitiei de consens. A fost analizata atat probabilitatea de supravietuire, cat si factorii de prognostic asociati cu supravietuirea indelungata. Au fost evaluati 26 de pacienti, 15 baieti cu media de varsta de 14,1 ± 4,1 ani, toti cu transmitere parenterala a infectiei HIV si imunodepresie severa, majoritatea naivi la tratamentul antiretroviral combinat (cART). Au fost inregistrate 15 decese (57,7 %), toate in perioada august 1997 – septembrie 2004. Durata mediana de supravietuire a fost de 3,6 luni pentru intregul lot, cu o probabilitate de supravietuire la 4 luni de 41,9% si la 12 luni de 37,3 %. Singurul factor asociat cu supravietuirea indelungata in cadrul analizei de regresie univariata, Cox a fost tratamentul antiretroviral (p = 0,05). In analiza univariata supravietuirea la copiii care au primit cART s-a asociat cu scorul mai mare de penetrabilitate al medicatiei antiretrovirale in LCR si cu varsta mai mare a pacientilor la momentul diagnosticului. Lucrarea descrie, din cunostintele noastre, factorii asociati cu supravietuirea din cadrul celei mai mari cohorte pediatrice cu PML si infectie HIV.

Cuvinte cheie : leucoencefalopatie multifocala progresiva, PML, HIV, copii, cART

ABSTRACT

We aimed to evalute restrospectivey all the children with HIV-1 infection and PML diagnosed between 1997 - 2009 at "Dr. Victor Babes" Hospital for Infectious and Tropical Diseases, Bucharest. PML diagnosis was estabilished based on consensus case defi nition. We analyzed the probability of survival and the prognostic factors asociated to long-term survival. Twenty-six pacients have been evaluated, 15 boys, with average age of 14.1 ± 4.1 years, all of them with parenterally acquired HIV infection, severe immune suppression, most of them naive to combined antiretroviral treatment (cART). We have encountered 15 deaths (57,7 %), all of them between August 1997 and September 2004. The median survival period was 3,6 months for the whole group, with a survival probability at 4 months of 41.9 %, and at 12 months of 37.3 %. The only factor associated with long-term survival by univariate Cox regression was cART (p = 0,05). In univariate analyze survival among children who have received cART was associated with higher cerebrospinal fluid antiretroviral penetrability score and with higher age of pacients at the PML diagnosis. The paper describes, after our knowledge, the factors associated with survival among the largest pediatric cohort with PML and HIV-1 infection.

Keywords: Progressive Multifocal Leucoencephalopathy, PML, HIV, children, cART

Emmanuel A. Mpolya, Yuki Furuse, Nao Nukiwa, Akira Suzuki, Taro Kamigaki, Hitoshi Oshitani
Department of Virology, Graduate School of Medicine, Tohoky University

ABSTRACT

The cause of atypical respiratory illness in several Mexican states in mid-March 2009 was determined to be a novel pandemic (H1N1) 2009 virus. It has since then spread to six continents, causing illness and death. We review this virus against an epidemiological triangle model for understanding and visualizing communicable diseases that describes the interaction of an agent, host, and environment. We review the agent, i.e., pandemic (H1N1) 2009 virus, hosts focusing on human beings, and the environment, suggesting from this agent-host-environment interactionmeasures for controlling and preventing infection spread due to pandemic (H1N1) 2009 virus and the related issues.

Keywords: pandemic (H1N1) 2009 virus, epidemiological triangle.

Alessandra Zappa, Antonella Amendola, Luisa Romanò, Alessandro Zanetti
Dipartimento di Sanità Pubblica-Microbiologia-Virologia, Università degli Studi di Milano, Italy

Dr. Luminita Ene 1, Dr. Sorin Ene 2, Conf. Dr. Dan Duiculescu 1, 3
1) Spitalul Clinic de Boli Infectioase si Tropicale "Dr. Victor Babes", Bucuresti
2) Spitalul Clinic de Urgenta "Bagdasar-Arseni", Bucuresti
3) Faculatatea de Medicina "Titu Maiorescu", Bucuresti

REZUMAT

Afectarea neurocognitiva a pacientilor cu infectie HIV reprezinta o problema de actualitate, desi in contextul actual al terapiei antiretrovirale s-a inregistrat un declin de la formele severe la forme clinice moderate sau usoare. Ca urmare, au fost necesare remanieri nosologice, definitiile acceptate actual fiind incadrate in conceptul de HAND (HIV associated neurocognitive disorders – tulburari neurocognitive asociate HIV).

Articolul isi propune o trecere in revista a definitiilor dementei si ale altor deficite cognitive aparute in cursul unor boli infectioase. Sunt abordate in special clasificarile deficitelor cognitive la pacientii cu infectie HIV. Este subliniat rolul evaluarii neuropsihologice ca o parte esentiala a unei evaluari comprehensive a persoanei cu HIV ca si implicatiile practice ale diagnosticului unei afectari neurocognitive secundare HIV.

Cuvinte cheie: HIV, afectare neurocognitiva, HAND

ABSTRACT

The neurocognitive impairment of HIV-infected patients is currently still a problem, even if the severity of the impairment declined in the antiretroviral therapy era, from severe to milder or moderate forms. Thus nosological changes became necessary, and nowadays the accepted definitions are included in the concept of HAND (HIV associated neurocognitive disorders). The review is focused on the definition of dementia and other cognitive disorders associated with several infectious diseases and especially on clasification of neurocognitive deficits in HIV-infected patients. The role of neurocognitive evaluation, as essential part of a comprehensive evaluation of a HIV-infected person and the practical implications of a neurocognitive impairment are discussed.

Keywords: HIV, neurocognitive impairment, HAND

Asist. Univ. Dr. Corneliu Petru Popescu, Asist. Univ. Dr. Simin Aysel Florescu, Prof. Dr. Emanoil Ceausu
Universitatea de Medicina si Farmacie "Carol Davila", Bucuresti

REZUMAT

Hepatita acuta cu VHC este o afectiune insuficient studiata din cauza manifestarilor clinice nespecifice, a dificultatilor de diagnostic si a datelor epidemiologice limitate. Rata crescuta de cronicizare a hepatitei acute C si evolutia rapida spre ciroza si carcinom hepatocelular, sunt argumente suficiente pentru o interventie terapeutica timpurie, fapt demonstrat de RVS (raspuns virusologic sustinut) de pana la 94 % - 98 % in studiile ce au tratat pacientii cu interferon standard sau peginterferoni. Lipsa unui regim de tratament universal acceptat conduce la necesitatea unei analize atente a acestor studii si la elaborarea unor recomandari de tratament. Se desprinde astfel un regim de tratament cu peginterferon alfa-2a sau alfa-2b de 12 - 24 saptamani, initiat in primele 12 saptamani de la debutul bolii.

Cuvinte cheie: VHC, hepatita acuta, RVS, peginterferon

ABSTRACT

Acute hepatitis C is an insuffi cient studied disease because unspecific clinical manifestations, diagnostic difficulties and limited epidemiological data. High rate of development of chronic C hepatitis, rapid progression to cirrhosis and hepatocellular carcinoma are sufficient arguments for an early treatment of acute hepatitis C. Interferon treatment of acute hepatitis C is highly efficient, fact proved by the SVR (sustained virological response) up to 94 - 98 % in the studies of patients treated with conventional interferon or pegylated interferons. The absence of a standard therapy lead to necessity to analyse all this studies and to elaborate several treatment recommendations. The available data at this moment points to a therapy with pegylated interferon alpha-2a or alpha-2b, with 12-24 weeks duration, initiated in the first 12 weeks after acute onset of hepatitis.

Keywords: HCV, acute hepatitis, SVR, pegylated interferon

REZUMAT

Hepatita B este o problema importanta din domeniul public, din cauza dificultatilor bolii. Managementul corespunzator al bolii se bazeaza pe diagnostic (screening), supravegherea infectiei si a bolii hepatice si daca este necesar, tratament antiviral. Managementul hepatitei B se bazeaza pe istoria naturala a infectiei. Inaintea tratamentului si pentru toti pacientii care nu au nevoie de tratament, consilierea si monitorizarea sunt vitale.

Cuvinte cheie: HVBm screening, tratament antiviral

ABSTRACT

Hepatitis B is a significant problem of public health, because of the burden of the illness. Appropriate management of the disease is based on diagnosis (screening), surveillance of the infection and the hepatic disease and, if necessary, antiviral treatment. The management of hepatitis B is based on the natural history of the infection. Before the treatment and in all the patients which do not need treatment, counseling and monitoring are crucial.

Keywords: HVB, screening, antiviral treatment