Fifth European Dirofilaria and Angiostrongylus Days (FiEDAD) 2016

Peer reviewe

A Challenge of COVID—19: Associated Infective Endocarditis with Streptococcus gordonii in a Young Immunocompetent Patient

The COVID-19 pandemic is a new challenge for the diagnosis and treatment of infective endocarditis (IE). Fever and other unspecific symptoms of coronaviral infection could be misleading or masking its manifestations. We present the case of a young patient admitted for persistent fever, profuse sweating, headache, articular pain, myalgias, and weight loss. She reported regression taste and smell disorders compared to a month earlier when diagnosed with moderate COVID-19 pneumonia. While the RT-PCR SARS-COV-2 test was positive, she was admitted to a COVID-19 ward. Investigations of febrile syndrome revealed two positive blood cultures with Streptococcus gordonii and the presence of vegetations on the aortic valve, supporting a certain diagnosis of IE. After six weeks of antibiotic treatment, the patient had clinical and biologic favorable outcomes. Streptococcus gordonii is a common commensal related to the dental biofilm, although there were no caries in our patient. The influence of COVID-19 infection on the human microbiome by modifying the virulence of some commensal germs may be a risk factor for IE pathogenesis on native valves and requires the vigilance of clinicians for suspicion of this disease

Diagnostic and Treatment Challenges of Emergent COVID-Associated-Mucormycosis: A Case Report and Review of the Literature

Mucormycosis is a rare fungal infection, with high mortality, commonly associated with diabetes, malignancies, immunosuppressive therapy, and other immunodeficiency conditions. The emergence of mucormycosis cases has been advanced by the COVID-19 pandemic. Clinical presentation is variable, from asymptomatic to persistent fever or localized infections. We present a case of a Romanian old man, without diabetes or other immunodepression, with COVID-19 who developed severe rhino-orbital mucormycosis and bacterial superinfections, with Pseudomonas aeruginosa and Klebsiella pneumoniae. The late diagnostic and antifungal treatment was related to extensive lesions, bone and tissue loss, and required complex reconstruction procedures. We review the relationships between mucormycosis, COVID-19, and bacterial associated infections. The suspicion index of mucormycosis should be increased in medical practice. The diagnostic and treatment of COVID-19-Associated-Mucormycosis is currently challenging, calling for multidisciplinary collaboration

CURRENT ISSUES ON HIV ADULTS IN SOUTH EAST OF ROMANIA

Objective. To identify the current priorities of the fight against HIV/AIDS in the South-East region of Romania. Methods. The profile of HIV adult confirmed with HIV, the mortality rate and the risk factors related to death were analyzed in a retrospective study. Data were collected from the medical files of Galati HIV/AIDS Clinic. New diagnosed HIV infected patients, over age 15 were followed-up from January 2005 to December 2016. Results. During the 12 years study period, 225 new HIV adult cases were confirmed. The characteristics of the new diagnosed cases were: young age (average 25.17±11.94), predominant heterosexual transmission mode (73%) and high percentage of late presentation (67.6%). The retention in care rate was 91% and 95% of patients received ART. The mean annual mortality rate was 14.6‰, one third of deaths occurring during the first year after diagnosis. In the last 6 years, there was an increase trend in mortality rates, compared to the period 2005-2011, as HIV people are aging and more non-AIDS deaths are registered. The survival rates were not influenced by the first line ART, containing protease inhibitors, non-nucleoside reverse transcriptase or integrase inhibitors. However, all ART regimen significantly improved the survival rate. Conclusions. Even if ART improved HIV survival rates, the mortality rate among persons diagnosed with HIV was still higher than in the general population. As HIV patients are aging, continuing increase in non-AIDS comorbidities are expected in the next years. The local present priorities in the fight against HIV are to enhance the efficiency of ART, early HIV diagnosis and retention in care

Parkinsonian Syndrome and Toxoplasmic Encephalitis

Toxoplasmosis encephalitis in patients with human immunodeficiency virus may progress rapidly with a potentially fatal outcome. Less common neurological symptoms associated with this are Parkinsonism, focal dystonia, rubral tremor and hemichorea–hemiballismus syndrome

ACTUALITĂŢI PRIVIND EPIDEMIA HIV LA ADULŢII DIN SUD-ESTUL ROMÂNIEI

Obiective. Identificarea priorităţilor actuale de intervenţie pentru combaterea epidemiei HIV/SIDA în regiunea de Sud-Est a României. Metode. Am evaluat retrospectiv profilul pacienţilor adulţi confirmaţi cu infecţie HIV în perioada 2005-2016, rata mortalităţii şi factorii de risc pentru deces. Datele demografice, epidemiologice şi clinice au fost colectate din dosarele medicale din Clinica HIV/SIDA Galaţi. Rezultate. În ultimii 12 ani, au fost confirmate 225 de noi cazuri de infecţie HIV la adulţii din Spitalul de Boli Infecţioase din Galaţi. Caracteristicile cazurilor nou diagnosticate cu HIV au fost: vârsta medie 25,17 ± 11,94 ani la iniţierea studiului, transmiterea predominant heterosexuală (73%) şi diagnosticul în stadii avansate de imunodepresie (67,6%). După diagnostic, 95% dintre pacienţi au primit tratament antiretroviral (TARV) şi 91% au rămas in evidenţă pentru HIV. Rata medie anuală a mortalităţii a fost de 14,6‰. O treime dintre decese au avut loc în primul an după diagnostic. Rata mortalităţii a avut o tendinţă de creştere în ultimii 6 ani, comparativ cu perioada 2005-2011, din cauza fenomenului de îmbătrânire asociat supravieţuirii mai îndelungate a pacienţilor cu HIV şi creşterii morbidităţii prin afecţiuni non definitorii-SIDA. Prima linie de TARV s-a bazat pe combinaţii cu inhibitori de protează, inhibitori non-nucleozidici de reverstranscriptază şi inhibitori de integrază. Ratele de supravieţuire nu au fost influenţate de tipul combinaţiilor TARV, dar supravieţuirea a fost semnificativ mai scăzută la pacienţii fără TARV, faţă de orice combinaţie antiretrovirală. Concluzii. Tratamentul antiretroviral a îmbunătăţit speranţa de viaţă a persoanelor cu infecţie HIV, dar mortalitatea s-a menţinut mai crescută faţă de cea din populaţia generală. Comorbidităţile nondefinitorii de SIDA tind să crească în următorii ani, pe măsura îmbătrânirii pacienţilor diagnosticaţi cu infecţie HIV. Priorităţile locale actuale de combatere a HIV sunt: creşterea eficienţei TARV, diagnosticarea precoce a infecţiei şi menţinerea pacienţilor în sistemul de îngrijire şi tratament

Nosocomial Staphylococcal Toxic Shock. Case Report

Staphylococcal toxic shock syndrome (STSS) is a rare, potentially lethal infection, with a clinical picture of multiple organ dysfunction and shock. The etiology is Staphylococcus aureus exotoxin, while enterotoxins act as superantigens. Most cases are identified in women using a vaginal tampon. A 51-year-old female, with a past medical history of biliary dyskinesia, presented in the emergency room complaining of sudden onset of abdominal pain, vomiting, headache, myalgia, and chills. The initial diagnosis was biliary colic and was treated parenterally with Amoxi-clavulanate and fluid replacement. Initially, progress was unsatisfactory. Four days after admission she developed a systemic inflammatory syndrome, diffuse rash, jaundice, oliguria, confusion, persistent hypotension and biological evidence of thrombocytopenia, nitrogen retention, and cholestasis. She was admitted to the intensive care unit. A gluteal phlegmon induced after intramuscular injections was identified and surgically treated. Blood bacteriological cultures were negative, though MRSA was isolated in phlegmon pus. A diagnosis of STSS was based on CDC criteria

Characteristics of Hepatitis B Co-infection and Disease Evolution in HIV-Positive Paediatric Patients in Romania

Background: Infection with hepatitis B virus (HBV) contributes to morbidity and mortality in people living with human immunodeficiency virus (HIV). Aims: The aim of the present study is to assess the influence of HBV co-infection in clinical characteristics and disease evolution among nosocomial HIV infected youth in Romania. Study Design: Retrospective study. Methods: We assessed HBsAg in 179 young people with nosocomial paediatric HIV infection. Demographic data, ALAT level, CD4-count, HIV-RNA, antiretroviral therapy and clinical behaviour were all statistically compared in patients who were HIV mono-infected and HBV-co-infected. Results: The characteristics of patients are as follows: sex ratio M/F: 55.3%, AIDS category 88%, median nadir CD4-count 126/mm3. The prevalence of persistent HBsAg was 44.6%. The mortality rate was 11.1%, but no correlation with HBsAg was found. An average of three antiretroviral combinations is experienced by 97.7% of patients, including Lamivudine for over 5 years in 76% of cases and Tenofovir/Emtricitabine in 16.75% of patients. Patients under antiretroviral therapy achieved 53.07% sustained undetectable HIV-RNA and 40.78% restored immunity CD4-count >500/mm3. ALAT enzyme was found to be high in 54.75% of patients. Conclusion: During our research, we noticed that HBsAg was elevated in young people with HIV in Romania. Mortality rate was not statistically correlated to HBsAg. High ALAT levels are related with HBV, HDV co-infections, virological failure to antiretroviral treatment and the risk of death

Diagnostic and Treatment Challenges of Emergent COVID-Associated-Mucormycosis: A Case Report and Review of the Literature

Mucormycosis is a rare fungal infection, with high mortality, commonly associated with diabetes, malignancies, immunosuppressive therapy, and other immunodeficiency conditions. The emergence of mucormycosis cases has been advanced by the COVID-19 pandemic. Clinical presentation is variable, from asymptomatic to persistent fever or localized infections. We present a case of a Romanian old man, without diabetes or other immunodepression, with COVID-19 who developed severe rhino-orbital mucormycosis and bacterial superinfections, with Pseudomonas aeruginosa and Klebsiella pneumoniae. The late diagnostic and antifungal treatment was related to extensive lesions, bone and tissue loss, and required complex reconstruction procedures. We review the relationships between mucormycosis, COVID-19, and bacterial associated infections. The suspicion index of mucormycosis should be increased in medical practice. The diagnostic and treatment of COVID-19-Associated-Mucormycosis is currently challenging, calling for multidisciplinary collaboration