Revista Romana de Boli Infectioase

Prof. Dr. Ludovic Paun

REZUMAT

Se prezinta :

1. Conceptul si perspectivele evolutive in bolile infectioase acute transmisibile in conditiile "Globalizarii patologiei infectioase"*
2. Definitia specialitatii "Boli infectioase" elaborata de Societatea Nationala Romana de Boli Infectioase "in acord" cu societatile de microbologie si epidemiologie "in dezacord" cu considerarea specialitatii "boli infectioase" o subspecialitate a medicinei interne sau pediatriei
3. Geneza, dezvoltarea si perspectivele Spitalului Clinic de Boli Infecþioase si Tropicale "Dr. Victor Babes" Bucuresti, dupã 55 de ani de la infiintare (1955 - 2010) o concretizare a punctului de vedere exprimat in definirea specialitatii de boli infectioase**
4. Perspective in activitatea Spitalului Clinic de Boli Infectioase si Tropicale "Dr. Victor Babes", Bucuresti

Cuvinte cheie : boli infecþioase acute, transmisibil

* Globalizare : concept universal, ce doreste sa surprinda evolutiile mondiale naturale, social economice si politice, dupa cel de-al Doilea Razboi Mondial si a razboiului rece in incercarea de a codifica si clarifica reactia persoanelor, grupurilor de persoane, organizatiilor etc., ce recurg inclusiv la violenta, in lupta pentru putere, favoruri - M. Lutz si Blenda Lutz in Global Terrorism, Routledge First Published, 2004 "Causes of Terrorism", pag.17.
** Specialitate clinica independenta, se preocupa de manifestarile clinice ale bolilor emergente si reemergente, diagnosticul si tratamentul bolilor infectioase (asistenta medicala) produse de agenti etiologici cunoscuti sau in curs de identifi care (microbiologie) si de limitarea morbiditatii si a mortalitatii prin boli infectioase (vaccinuri, chimioprofi laxie) (Sanatate Publica).

ABSTRACT

The paper presents :

1. The concept and evolutive perspectives in transmissible infectious acute diseases in the context of "infectious pathology globalization"*
2. The definition of the speciality of "infectious diseases" elaborated by Infectious Diseases Romanian National Society "in agreement" with microbiology and epidemiology societies "in disagreement" with considering the speciality of "infectious diseases" a subspeciality of internel or pediatric medicine
3. Genesis, development and perspectives of "Dr. Victor Babes" Clinical Hospital of Infectious and Tropical Diseases, Bucharest, after 55 years since its construction (1955 - 2010), a concretization of the point of view expressed in the defi nition of infectious diseases speciality**
4. Perspectives in the activity of "Dr. Victor Babes” Clinical Hospital of Infectious and Tropical Diseases, Bucharest.

Keywords : acute infectious diseases, transmissible

* Globalization : universal concept, aiming to capture the natural world developments, economic and social policy after the Second World War and the Cold War in an attempt to decode and clarify the response of individuals, groups of people, organizations, etc. who use all means, violence included, in the struggle for power, Favors - M. Lutz and Lutz Blenda in Global Terrorism
** Independent clinical speciality, concerned with the clinical manifestations of new and re-emerging diseases, diagnosis and treatment of infectious diseases (health care) determined by known or not identified etiologic agents (microbiology) and limiting morbidity and mortality caused by infectious diseases (vaccines , chimioprophylaxis) (Public Health).

Dr. Violeta Melinte, Dr. Maria Nica, Dr. Tatiana Biolan, Dr. Amalia Dascalu
Spitalul Clinic de Boli Infectioase si Tropicale "Dr. Victor Babes"

REZUMAT

Introducere : Antibiograma pentru Mycobacterium tuberculosis este solicitata in special in caz de recadere sau rezistenta multidrog (MDR). Metodele de cultivare in vitro si testare a sensibilitatii la agentii antituberculosi sunt laborioase si nu sunt disponibile in orice laborator de bacteriologie. Metoda nitrat-reductazei (NRA) - simpla si ieftina - a fost comparata cu metoda standard a proportiilor in determinarea antibiogramei M. tuberculosis, in scopul evaluarii eficientei si utilitatii acesteia ca metoda de screening, in laboratoarele spitalelor de pneumoftiziologie.
Materiale si metoda : Antibiogramele au fost efectuate pentru 105 probe de sputa prin NRA directa si pentru 34 culturi proaspete de Mycobacterium tuberculosis prin NRA indirecta si metoda proportiilor, utilizand o concentratie de 0,2 µg izoniazida (HIN), respectiv 40 µg rifampicina (RPM).
Rezultate : Sensibilitatea si specificitatea inregistrate prin NRA directa au fost de 75 % si 100 % pentru rifampicina, respectiv 75 % si 98,4 % pentru izoniazida. Sensibilitatea si specificitatea metodei indirecte au fost de 77,7 % si 92 % pentru rifampicina, respectiv 85,7 % si 85,2 % pentru izoniazida.
Concluzii : Testarea sensibilitatii M. tuberculosis prin metoda NRA este simpla, cu rezultate rapide in 10 - 14 zile, fata de 42 zile prin metoda proportiilor. Utilizarea directa a sputelor bacili acid-alcoolo-rezistenti (BAAR) pozitive este reproductibila si mai rapida cu 3 - 8 saptamani necesare pentru izolarea M. tuberculosis.

Cuvinte cheie : Mycobactrerium tuberculosis, antibiograma, metoda nitrat-reductazei

ABSTRACT

Background : Drug susceptibility testing for Mycobacterium tuberculosis is especially required in difficult cases of tuberculosis chemotherapy and in cases of multidrug resistance (MDR). The methods for in vitro cultivation and drug susceptibility testing (DST) of M. tuberculosis are cumbersome and not readily adaptable in most routine laboratories. A simple and cost effective method, the nitrate reductase assay (NRA), was compared with the gold standard proportion method for DST of M. tuberculosis in order to substantiate its suitability as screening method in tuberculosis hospitals.
Method : Drug susceptibility test was performed for 105 sputum specimens (direct DST) and 34 pulmonary isolates of M tuberculosis (Indirect DST) by the NRA and the proportion method using 0.2 µg isoniazid (HIN), 40 µg rifampicin (RPM).
Results: The sensitivity and specificity of direct NRA for RMP was 75 % and 100 %, but for HIN was 75 %, and 98,4 % respectively. The indirect NRA showed sensitivity and specificity for HIN : 85,7 % and 85,2 %, and for RMP: 77,7 % and 92 % respectively.
Conclusion : Drug susceptibility test of M. tuberculosis by the NRA is simple and sensitive with shorter turn around time of 10 to 14 days compared to 42 days by the proportion method. The direct use of acid fast bacilli (AFB) positive sputum specimens is likewise reproducible and excludes about 3 – 8 weeks period required for isolation of M. tuberculosis.

Keywords : Mycobacterium tuberculosis, drug susceptibility test, nitratereductase assay

Dr. Adriana Motoc, Dr. Augustina Culinescu, Dr. Cristina Calomfirescu, Dr. Emanoil Ceausu, Prof. Dr. Ludovic Paun
Spitalul Clinic de Boli Infectioase si Tropicale "Dr. Victor Babes"

REZUMAT

Numeroase studii au aratat o prevalenta crescuta a diabetului zaharat in infectia cu virus C, mai ales in stadii mai avansate de boala. Pacientul cu hepatita C si diabet zaharat face parte din categoria celor "dificil de tratat", cu sanse mai mici de raspuns virusologic sustinut. Astfel, o cercetare pe doua loturi de pacienti (109 cu hepatita C si diabet zaharat si 94 de pacienti fara diabet) a evidentiat un raspuns virusologic sustinut in proportie semnificativ mai mica la diabetici, mai ales datorita opririi terapiei antivirale (prin lipsa de raspuns sau reactii secundare). Viremia pozitiva la 3 luni ar putea fi considerata un motiv de intrerupere a terapiei deoarece se asociaza cu lipsa de raspuns la tratament. De aceea, la persoanele cu diabet zaharat trebuie depistata cat mai devreme infectia cu virus C. Terapia antivirala trebuie aplicata cat mai precoce, pentru a creste sansele de raspuns virusologic sustinut.

Cuvinte cheie: hepatita C, diabetul zaharat, pacienti difi cil de tratat, lipsa raspunsului virusologic sustinut, viremia la 3 luni-factor predictiv negativ

ABSTRACT

Several studies have showed a high prevalence of diabetes mellitus in hepatitis C infection, mostly in patients with advanced liver disease. Patient with hepatitis C and diabetes mellitus is "difficult to treat", with lower chances of sustained response to antiviral therapy. A study in 109 patients with hepatitis C and diabetes and 94 patients without diabetes has shown a lower chance (statistically signifi cant) to achieve a sustained response after the antiviral therapy. Incomplete early virological response is a very strong negative predictor. Positive viremia at week 12 may be a reason to discontinue the treatment. That’s why in diabetes is important to diagnose early the hepatitis C infection. In order to get a sustained virological response, the hepatitis C infection must be treated as early as possible (before diabetes occurs).

Keywords : Hepatitis C, Diabetes mellitus, patients diffi cult to treat, sustained virological response, early virological response - negative predictive factor

Dr. Doinita Ispas, Dr. Mihaela Comanici
Facultatea de Medicina si Medicina Dentara, Universitatea "Titu Maiorescu", Bucuresti

ABSTRACT

In resource-constraint settings, aggravated by the actual global recession, but where the overwhelming majority of HIV/AIDS infections worldwide occur, the viral load (HIV-1 RNA) testing is limited. To date, in specialized and well founded centers, the treated or naive patients are monitored by testing the HIV-1 RNA using PCR and real-time PCR amplifi cation kits. A potential alternative is HIV-1 p24 boosted ELISA assay (p24), a technology accessible for every hospital laboratory, which costs ten times less, at least, as compared to molecular assays.
P24 is a diagnostically important HIV-1 protein that is used in fourth generation HIV-1/2 (combo) screening assays. The production and release of p24 and of particle-associated HIV-1 RNA from infected cells are tightly linked. They are both derived from unspliced HIV-1 mRNA, and p24 is a component of the HIV-1 precursor proteins p160 (gag-pol) and p55 (gag), thus being stoechiometrically linked with p9, another component of the precursor, which is directly involved in the encapsidation of HIV-1 RNA.
In the last decade, p24 testing was successively signifi cantly improved, by thermal and chemical denaturation for interference antibody elimination, as well as subsequent enzyme signal boosting with tyramide. Although p24 is of demonstrated predictive value for the CD4 decline and disease progression, it was not immediately accepted as appropriate alternative to the viral load, for mainly two reasons: (1) the p24 changes after HAART initiation, treatment stop or viral failure, are far less pronounced when compared to the fl uctuations of HIV-1 RNA, and (2) in spite of meanwhile improvements, p24 assay had not proven yet enough sensitivity, equivalent to the molecular kit performances, suitable for the detection of less than 50 copies/ml or below.
At present, p24 is used and recognized as diagnostic test in children born to positive mothers, having chance to become alternate monitoring test in chronic HIV/AIDS patients. The new dissociation protocol using SNCR buffer proven its effi cacy in samples with not detectable viral load (fewer than 5 copies/ml) from adult patients under long-term HAART, in which the lack of detection specifi city was excluded.
In conclusion, the long-term surveillance of the chronic diseases prompts both reconsideration and implementation of a reliable and accessible technique with respect of settings and costs, far away from being abandoned, but well supported by impressive increasing number of publications.

Keywords : viral load testing, molecular assaz

Dr. Mihnea Hurmuzache 1, Dr. Andrei Vata 1, Dr. Elena Duca 2, Dr. Carmen Dorobat 1
1) "Gr. T. Popa" University of Medicine and Pharmacy of Iasi, Infectious Disease Hospital of Iasi 2) Public Health Authority of Iasi

ABSTRACT

The purpose of this paper was to analyze the activity of the AH1N1 influenza virus and the specific prophylactic measures taken in Iasi County, at the end of the 2009 - 2010 flu season. An accurate estimate of the number of affected persons was difficult to achieve; 352 cases were etiologically confirmed, most of whom were adults (73.5 %). The vaccination campaign had not a linear evolution, as it started slowly, among healthcare workers, and it peaked during the first weeks of January, when the vaccination centers in hospitals were under siege. A total of 75.959 people were inoculated, that is 9.2 % of the population (11.4 % of those over 16 years of age). The development of this vaccination campaign and people’s reaction to it confirm the presence and importance of an epidemiology of collective emotions linked to the disease, which is different from that of the disease itself.

Keywords: AH1N1 influenza virus, propylactic measures

Chairul A. Nidom, Ryo Takano, Shinya Yamada, Yuko Sakai-Tagawa, Syafril Daulay, Didi Aswadi, Takashi Suzuki, Yasuo Suzuki, Kyoko Shinya, Kiyoko Iwatsuki-Horimoto, Yukiko Muramoto, and Yoshihiro Kawaoka
Author affiliations: Airlangga University, Surabaya, East Java, Indonesia (C.A. Nidom); University of Tokyo, Tokyo, Japan (R. Takano, S. Yamada, Y. Sakai-Tagawa, K. Iwatsuki-Horimoto, Y. Muramoto, Y. Kawaoka); Ministry of Agriculture, Jakarta, Indonesia (S. Daulay); Agriculture and Livestock Agency, Tangerang, Indonesia (D. Aswadi); University of Shizuoka, Shizuoka City, Japan (T. Suzuki, Y. Suzuki); Chubu University, Kasugai City, Japan (Y. Suzuki); Kobe University, Kobe, Japan (K. Shinya, Y. Kawaoka); and University of Wisconsin, Madison, Wisconsin, USA (Y. Kawaoka)

ABSTRACT

Pigs have long been considered potential intermediate hosts in which avian infl uenza viruses can adapt to humans. To determine whether this potential exists for pigs in Indonesia, we conducted surveillance during 2005 – 2009. We found that 52 pigs in 4 provinces were infected during 2005 – 2007 but not 2008 – 2009.
Phylogenetic analysis showed that the viruses had been introduced into the pig population in Indonesia on at least 3 occasions. One isolate had acquired the ability to recognize a human-type receptor. No infected pig had influenza-like symptoms, indicating that influenza A (H5N1) viruses can replicate undetected for prolonged periods, facilitating avian virus adaptation to mammalian hosts. Our data suggest that pigs are at risk for infection during outbreaks of influenza virus A (H5N1) and can serve as intermediate hosts in which this avian virus can adapt to mammals.

Keywords : avian influenza viruses, host

Prof. Dr. Ludovic Paun, Dr. Dan Duiculescu
Spitalul Clinic de Boli Infectioase si Tropicale "Dr. Victor Babes", Bucuresti

REZUMAT

Prezentam primul pacient din Romania diagnosticat in anul 1985 cu infectie HIV/SIDA. Diagnosticul a fost stabilit pe date epidemiologice (relatii homosexuale cu persoane atat din tara, cat si din strainatate), clinic (Sarcom Kaposi), precum si prin laborator (anticorpi anti HIV pozitivi prin ELISA si confirmare prin Western Blot). Cazul este important in special pentru analiza epidemiologica retrospectiva a infectiei HIV/SIDA la adulti in Romania.

Cuvinte cheie : HIV, primul pacient, SK

ABSTRACT

We present the first patient diagnosed in Romania with HIV/AIDS in 1985. The diagnosis was established on epidemiological data (men having sex with men from Romania and abroad), clinical data (Kapos Sarcoma) and on laboratory tests (HIV antibodies tested by ELISA and confi rmed by Western Blot). This first case is important for the epidemiological retrospective analyze of HIV/AIDS infection in Romania.

Keywords : HIV, fi rst patient, KS