VARICELLA-ZOSTER VIRUS INFECTION IN PREGNANCY

Varicella-zoster virus infection (VVZ) is an important cause of morbidity, with global spread, which causes two distinct clinical forms of disease: varicella and shingles. Primary infection with VVZ during pregnancy can have important consequences for both maternal and fetal health. Epidemiological data shows that vaccination significantly reduced the number of VVZ infections in both mothers and fetuses. Vaccination strategies vary according to the individual at risk (maternal, fetal, newborn, child), the moment with the highest infection risk (first-trimester of pregnancy, last trimester of pregnancy or postnatal) and the duration of the protective immunity after vaccination. The most common complication of chickenpox during pregnancy is varicella pneumonia that is manifested through cough, dyspnea, fever and tachypnoea. The effects of VVZ on the fetus can be: congenital varicella syndrome, premature or spontaneous abortion, neonatal varicella. Congenital varicella was first described in 1947. Spontaneous abortion rates, premature births and intrauterine death are not higher in pregnant mothers with chickenpox compared to those not infected. Neonatal infection results from the transmission of VVZ from mother to fetus during the perinatal period

INFECŢIA CU VIRUSUL VARICELO-ZOSTERIAN ÎN SARCINĂ

Infecţia cu virusul varicelo-zosterian (VVZ) este o cauză importantă de morbiditate, cu răspândire la nivel global, ce determină două forme clinice distincte de boală: varicela şi herpesul zoster. Infecţia primară cu VVZ în timpul sarcinii poate avea consecinţe importante atât asupra sănătăţii materne, cât şi fetale. Datele epidemiologice arată că vaccinarea a redus semnificativ numărul infecţiilor cu VVZ atât la mame cât şi la nounăscuţi. Strategiile de vaccinare diferă în funcţie de individul la risc (mamă, nou-născut, copil), de momentul cu riscul cel mai mare de infectare (primul trimestru de sarcină, ultimul trimestru de sarcină sau postnatal) şi de durata imunităţii protectoare după vaccinare. Cea mai frecventă complicaţie a varicelei la mamă în timpul sarcinii este pneumonia variceloasă, care se manifestă cu tuse, dispnee, febră şi tahipnee. Efectele infecţiei VVZ asupra fătului pot fi: sindromul de varicelă congenitală, prematuritate sau avort spontan, varicela neonatală. Varicela congenitală a fost descrisă pentru prima dată în 1947. Ratele de avort spontan, naşterile premature şi decesul intrauterin nu sunt mai mari la mamele cu varicelă în sarcină comparativ cu cele fără varicelă. Infecţia neonatală rezultă din transmisia VVZ de la mamă la făt în perioada perinatală

INFECTIOUS ENDOCARDITIS TO AN INJECTABLE DRUG USER

Background. Injecting drug users are a particular category of patients, where infectious pathology, including infectious endocarditis, is much more common. In Romania, in 2016 there were about 21,000 opioid users (www.ana.gov.ro). Besides opioid drugs, there are also ethnobotanics and a growing trend of injecting amphetamines. Material and methods. We present the case of a young drug user diagnosed in our hospital with infected mitral valve infectious endocarditis. Particularities consist of the type of affected valve and the involvement of a strain of methicillin-sensitive aureus staphylococcus (in a patient with multiple risk factors for infection with multi-resistant strains). Results. Clinical evolution is with many ups and downs because different complications occur, but after 54 days of hospitasization he is out, then valvular surgery takes place and he returns to our clinic for the antibiotic consolidation treatment. Conclusions. This is a case of severe infection in an IDU, with many features indicating a posible negative evolution. Proper antibiotic treatment, associated with other complementary medical interventions, conducted to the favorable uotcome of this young patient

ENDOCARDITA INFECŢIOASĂ LA UN UTILIZATOR DE DROGURI INJECTABILE

Introducere. Utilizatorii de droguri injectabile reprezintă o categorie aparte de pacienţi, la care patologia infecţioasă, inclusiv endocardita infecţioasă, este mult mai frecventă. În România, în 2016 existau aproximativ 21.000 de utilizatori de opiacee (www.ana.gov.ro). În afară de opioide, există şi etnobotanicele şi, de asemenea, o tendinţă în creştere de administrare a amfetaminelor pe cale injectabilă. Material şi metode. Vom prezenta cazul unui tânăr consumator de droguri diagnosticat în clinica noastră cu endocardită infecţioasă de valvă mitrală nativă. Particularităţile constau în tipul de valvă afectată şi implicarea unei tulpini de stafilococ auriu meticilino-sensibil (la un pacient cu multipli factori de risc pentru infecţie cu tulpini multirezistente). Rezultate. Evoluţia clinică este ondulantă, deoarece apar diferite complicaţii, dar, după 54 de zile de spitalizare, este externat, ulterior beneficiază de intervenţie chirurgicală valvulară şi se întoarce în clinica noastră pentru tratament antibiotic de consolidare. Concluzii. Acesta este un caz de infecţie severă la un utilizator de droguri injectabile, cu numeroase caracteristici care indică o potenţială evoluţie nefavorabilă. Tratamentul antibiotic adecvat, asociat cu alte măsuri medicale complementare, a condus la rezultatul favorabil în cazul acestui pacient tânăr

PROFILUL ETIOLOGIC ŞI CLINIC AL MENINGITELOR INFECŢIOASE INTERNATE ÎN SPITALUL CLINIC DE BOLI INFECŢIOASE ŞI TROPICALE „DR. VICTOR BABEŞ“, BUCUREŞTI

Meningitele infecţioase sunt afecţiuni severe cu evoluţie rapid nefavorabilă în cazul întârzierii aplicării tratamentului corect. Obiective. Prezentarea aspectelor clinice şi paraclinice (laborator) ale pacienţilor suspectaţi de meningită, internaţi în perioada 2014-2017 la Spitalul Clinic de Boli Infecţioase şi Tropicale „Dr. V. Babeş“. Metode. Au fos incluşi în studiu pacienţii care prezentau semne şi simptome de meningită acută conform definiţiei de caz. Valorile clinice şi paraclinice au fost înregistrate într-o bază de date care ulterior a fost prelucrată statistic pentru identificarea diferenţelor semnificative statistic între grupul infirmat şi grupul celor confirmaţi de meningită şi între diferitele subgrupuri din cadrul celor confirmaţi de meningită. Rezultate. Dintre cele 96 de cazuri de meningite infecţioase confirmate, 53 (54%) de cazuri au fost virale, 31 (32%) bacteriene, 12 cazuri de meningită tuberculoasă, 1 caz de meningită fungică. Au fost identificate diferenţe semnificative statistic între variabilele clinice şi paraclinice şi etiologia meningitei

ETIOLOGICAL PROFILE OF INFECTIOUS MENINGITIS AT “DR V. BABES” CLINICAL HOSPITAL OF INFECTIOUS AND TROPICAL DISEASES, BUCHAREST

Infectious meningitis is a serious medical problem that can be fatal if treatment is delayed. Objectives. There are presented clinical and laboratory aspects of patients with suspected meningitis, presented and hospitalized during 2014-2017 at Hospital for Infectious and Tropical Diseases Dr V. Babes Bucharest. Clinical and paraclinical variables that show statistically significant differences depending on the etiology of meningitis have been identified. Methods. Patients who showed signs and symptoms according to the case definition would be included in the study. Clinical and laboratory values were recorded in a database which was then processed to identify statistically significant differences between the group of patients with suspicion only but subsequently not ill against the group of confirmed, and also among different subgroups within the confirmed. Results. Of the 97 cases of infectious meningitis included within 3 years, 53 cases (55%) were viral, 31 (32%) bacterial, one case of fungal meningitis and 12 cases of tuberculous meningitis

Efficacy and safety of tigecycline versus levofloxacin for community-acquired pneumonia.

Abstract Background: Tigecycline, an expanded broad-spectrum glycylcycline, exhibits in vitro activity against many common pathogens associated with community-acqui red pneumonia (CAP), as well as penetration into lung tissues that suggests effectiveness in ho spitalized CAP patients. The aim of the present study was to compare the efficacy and safety of intravenous (IV) tigecycline with IV levofloxacin in hospitalized adults with CAP. Methods: In this prospective, double-blin d, non-inferiority phase 3 trial, eligible patients with a clinical diagnosis of CAP supported by radiographic evidence were stratified by Fine Pneumonia Severity Index and randomized to tigecycline or levofloxacin for 7-14 days of therapy. Co-primary efficacy endpoints were clinical response in the clinically evaluable (CE) and clinical modified intent- to-treat (c-mITT) populations at te st-of-cure (Day 10-21 post-therapy). Results: Of the 428 patients who received at least on e dose of study drug, 79% had CAP of mild-moderate severity according to their Fine score. Clinical cure rates for the CE population were 88.9% for tigecycline and 85.3% for levofloxac in. Corresponding c-mITT population rates were 83.7% and 81.5%, respectively. Eradication rates for Streptococcus pneumoniae were 92% for tigecycline and 89% for levofloxac in. Nausea, vomiting, and diarrhoea were the most frequently reported adverse events. Rates of premature disc continuation of study drug or study withdrawal because of any adverse event were similar for both study drugs. Conclusion: These findings suggest that IV tigecycline is non-inferior to IV levofloxacin and is generally well-tolerated in the treatment of hospitalized adults with CAP