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Open access

Roxana I. Serban, Iuliana Radu and Irina Codita

Abstract

Introduction. Boutonneuse fever (BF) is an emerging infectious disease in Romania evolving in the southern part of the country, as revealed by the incidence rates registered in our previous epidemiological descriptive studies performed during last years. We aimed to evaluate the presence of Rickettsia conorii specific IgG antibodies in a population sample from the affected area. Methods. An ELISA serological survey was performed on 301 serum samples collected from the general population, living in an area most affected by BF, in southern Romania. One of the selection criteria was the absence of signs and symptoms of the disease during the seasonal development of BF. Data were processed in SPSS V.19 (indicators of central tendency, dispersion, frequency and benchmarking). Results. Serological results showed a general positivity rate of 25.2%, with the highest rate in the population group aged over 60 years, this age group accounting for 34.21 % of the whole sample (55.6% for Bucharest area and 63.16% for Tulcea district). Conclusions. By confirming the hypothesis based on our previous descriptive epidemiological studies that BF is fitting an endemic pattern in southern Romania, our study results strongly support the need to set up a national surveillance program, aiming at improving BF prevention, management and control in our country. To our knowledge, this is the first study on Rickettsia conorii specific IgG antibodies seroprevalence in Romania.

Open access

Rudzik Roxana, Şuş Ioana, Hadadi László, Şerban Răzvan Constantin and Dobreanu Dan

Abstract

Introduction: Coronary vasospasm is a possible cause of ventricular tachyarrhythmias and is frequently associated with atherosclerotic lesions. The revascularization of mild to moderate coronary artery stenosis which causes symptoms only due to associated vasospasm is still a matter of debate, as the standard treatment of Prinzmetal angina is represented by the long term administration of calcium-channel blockers.

Case presentation: We present the case of a 46 year old woman with an intermediate severity coronary artery stenosis complicated by vasospastic angina and subsequent polymorphic ventricular tachycardia. Although the functional significance of the fixed coronary artery lesion was equivocal at invasive fractional flow reserve measurement, a combined pharmacologic and interventional treatment strategy was chosen with stent implantation and long acting calcium channel blocker administration with a symptom-free, good clinical outcome.

Conclusion: Patients with vasospastic angina and intermediate severity atherosclerotic coronary artery stenoses are at risk of malignant ventricular arrhythmias, therefore myocardial revascularization should be considered in addition to the standard medical treatment.

Open access

Elena-Carmina Drăgulescu, Mihaela Oprea, Cătălina Zorescu, Roxana Şerban and Irina Codiţă

Abstract

A prolonged outbreak of Healthcare-Associated Infections (HCAIs) evolved since December 2013, in a Newborns Unit from Hospital A, sited in the North-Eastern development region, Romania. A first cluster consisted of 19 cases, of which 18 infections in newborns and 1 labour infectious complication in a mother. Except for five cases declared and treated in the Neonatology Unit as hospital-acquired infections, the other cases were discharged and further required rehospitalisation and treatment.

Eight of these innitialy discharged cases were readmitted to the Pediatric Surgery Unit and two others to the Pediatrics Unit of Hospital B, while three others were readmitted to three hospitals: one to the Pediatrics Unit of Hospital C, and other two to Hospital A and Hospital D, respectively. The mother with the labour infectious complication was readmitted to the Gynecology Unit of the Hospital A.

A number of fifteen Staphylococcus aureus (S. aureus) strains isolated from the HCAI first episode and 8 strains from 7 HCWs were received by „Cantacuzino” Institute, Nosocomial Infections and Antibiotic Resistance Laboratory from the County Public Health Directorate, for confirmation and molecular typing.

After a first round of interventions for infection control, a second episode bursted in Hospital A and our laboratory received six other S. aureus isolates from newborns, hospital environment, and HCWs.

Public Health interventions based on epidemiologic data and molecular microbiology results were finally successful. The evolution of all cases was favorable.

An important factor favoring the outbreak was the moving of the Birth Unit of Hospital A to an innapropriate location for an 18-month interval, more than innitially estimated, in relation to rehabilitation of the ward.

We considered to report this episode taking into account the unusual evolution, the risk of multiresistant bacterial strains spreading, and multiple unwanted consequences caused by shortcomings in providing appropriate hygiene conditions.

Open access

Ioana Macovei, Daniela Lemeni, Roxana Șerban, Andreea Niculcea, Gabriel A. Popescu, Maria Nica, Anca Petrini and Grigore Mihăescu

Abstract

This study investigated the antibiotic susceptibility patterns and genetic resistance markers of 35 C. difficile strains isolated from patients with C. difficile infection. Vancomycin, metronidazole, tigecycline, teicoplanin, rifampicin, moxifloxacin, cefotaxime, tetracycline, erythromycin, clindamycin, chloramphenicol, linezolid and imipenem MICs were determined for toxigenic strains belonging to PCR ribotypes (PR) 012 (2), 014 (4), 017 (3), 018 (2), 027 (17), 046 (2), 087 (3) and 115 (2). Results showed vancomycin, metronidazole, tigecycline and teicoplanin to be active against all isolates. High resistance rates were noticed against cefotaxime (n = 35), clindamycin (n = 33), imipenem (n = 31), moxifloxacin (n = 25), erythromycin (n = 25) and rifampicin (n = 22). Linezolid-resistance was found in three isolates (PR 017/2, PR 012/1), showing complex resistance (7-9 antibiotics). PR 012, 017, 018, 027 and 046 isolates (n = 26) were resistant to 5-9 antibiotics. Twelve resistance profiles (2-9 antibiotics) were detected. Rifampicin-moxifloxacin-cefotaxime-erythromycin-clindamycin-imipenem-resistance was predominant, being expressed by 18 strains (PR 027/17, PR 018/1). PCR results suggested tetracycline-resistance to be induced by the gene tetM. Three tetM-positive isolates (PRs 012, 046), were also tndX-positive, suggesting the presence of a Tn5397-like element. Only two MLSB-resistant strains (PR 012) had the ermB gene and chloramphenicol-resistance determinant catD was not detected, leaving room for further investigating resistance mechanisms. Multidrug resistance could be attributed to most analysed strains, underlining, once more, the impact of wide-spectrum antimicrobial over prescription, still a tendency in our country, on transmission of antimicrobial resistance and emergence of epidemic C. difficile strains generating outbreaks.

Open access

Ovidiu Alexinschi, Roxana Chirita, Alin Ciobica, Padurariu Manuela, Romeo Dobrin, Raluca Prepelita, Ionela Lacramioara Serban and Vasile Chirita

Abstract

Background: Although it is generally accepted that there is an increased oxidative stress status in alcoholics, the separate relevance of oxidative stress following alcohol withdrawal is still not understood to this date. There are reports stating that the increased oxidative stress status in alcoholics may persist independently of the constant presence of alcohol intake, while on the other side, it was demonstrated that the antioxidant defense mechanism could significantly increase after alcohol withdrawal.

Methods: In the present work, we were interested in studying the relevance of oxidative stress status in the alcohol withdrawal processes, by determining some oxidative stress markers (two antioxidant enzymes: superoxide dismutase - SOD and glutathione peroxidase - GPX and a lipid peroxidation maker - MDA) after one week and one month of abstinence, as compared to the baseline and a control group of subjects.

Results: Our data confirmed the increased oxidative stress status in alcoholic patients and, more importantly, we de m - onstrated here a significant decrease of the oxidative stress status one week and one month following the withdrawal, as showed by a significant increase in the specific activity of SOD (p<0.003), as well as by a decrease in MDA levels (p<0.019). Still, in the case of all three markers of oxidative stress status which we determined, the levels after one week or one month of abstinence were significantly altered when compared to controls.

Conclusions: This suggests that severe and prolonged deficiency in the oxidative stress marker levels needs longer than one month of abstinence to normalize.