An Assessment of West Nile and Usutu Viruses' Seroprevalence in Hospitalized Patients: A Preliminary Study on Flavivirus Exposure in Eastern Romania

WNV and USUV are closely related epornitic flaviviruses transmitted by Culex mosquitoes which can cause febrile and neurodegenerative disease in humans. The impact of both viruses on public health has increased in the recent decades.

AIM

The aim of the study was to evaluate the seroprevalence of WNV and USUV in hospitalized patients from eastern Romania who did not show symptoms corresponding to the case definition.

METHODS

Human blood samples from the hospitalized patients were collected in 2015 and from April to September 2019 in Iasi County, Romania. The samples were screened by ELISA for anti-WNV IgG, IgM, and anti-USUV IgG antibodies.

RESULTS

A cumulative seroprevalence of 3.4% was recorded for anti-WNV IgG antibodies and 9.1% for anti-WNV IgM. No sample was positive for anti-USUV antibodies.

CONCLUSION

The cumulative seroprevalence observed provides support for the consideration of WNV as being endemic in the east of Romania. The absence of anti-USUV antibodies may be related to cross-reactivity and cohort size, thus, USUV should be considered in clinical practice and become an objective for active surveillance in Romania.

Common European Origin of Hepatitis E Virus in Human Population From Eastern Romania

The purpose of this research was to improve the epidemiological data on HEV infection in the human population in Romania. The analysis targeted hospitalized subjects with acute hepatitis (n = 94) of unknown etiology from the Infectious Diseases Regional Hospital in Iasi. Moreover, patients without liver disease (n = 40) from a different county hospital located in Eastern Romania were included. The presence of HEV infection and first characterization of human HEV strains was determined using serological and molecular assays. The apparent HEV seroprevalence varied between 29.16% (95% CI, 16.31–42.03) and 32.5% (95% CI, 17.98–47.02) according to patient grouping. Molecular analysis enhanced the detection of two HEV isolates, that clustered in subtype HEV-3c, the most commonly identified subtype in Europe. Identification of acute hepatitis E cases, together with the first detection and molecular characterization of human HEV in Romania represent the originality attributes of the present study.

Characteristics of co infection with hepatitis B virus among Romanian patients infected with human immunodeficiency virus

AIM

To determine the epidemiological and viroimmunological features and outcome of HIV/HBV-co infected patients cared in the lasi HIV/AIDS Regional Center.

MATERIAL AND METHODS

This retrospective study included 252 patients diagnosed with HIV infection and associated hepatitis B virus (HBV) infection assessed at the Hospital of Infectious Diseases in the interval 2000-2013 and treated with antiretroviral drugs active against both HIV and HBV.

RESULTS

The prevalence of HIV/HBV co infection was 19.9%. A slightly higher frequency of this co infection was found among males (53.2%); most patients belonged to age group 20-29 years (86.5%), mean age was 25.56 years. The predominant route of transmission was parenteral (58.5%), followed by heterosexual transmission (40.1%). The mean CD4 cell count was 246.20 cells/mm3, in over 41% of cases CD4 count ranging from 200 to 499 cells/mm3. The mean HIV plasma viral load was 142,906 copies/ml. ALT levels varied between 10-323 IU/l, average 49.90 IU/l, over 65% of subjects having pathological levels. In 21.8% of the cases, total cholesterol was very high, and in 16.8% of the patients the serum triglyceride levels were below the reference range (160 mg %).

CONCLUSIONS

Our results suggest that HIV-positive patients, chronic hepatitis B infection has a high incidence, especially in younger age groups and is correlated with significant degrees of immunosuppression.

Side effects of antiviral therapy in hepatitis C virus infection-sarcoidosis - case report

Standard therapy in chronic hepatitis C virus infection is still a combination of peginterferon alfa2a/2b and ribavirin for 48 weeks. As of side effects, there are organic side effects, such as hematologic disorders, and functional side effects, reflected in the quality of life of hepatitis C patients. Up to 30% of the patients develop specific side effects such as headache, fever, fatigue. Sarcoidosis, known as a granulomatous disease of uncertain cause, is an uncommon finding in this category of patients. This cause-effect relation is accounted for by the convergent action of peginterferon and ribavirin of stimulating type 1 T helper cells and reducing type 2 helper T cells activation. We present the case of male patient known with chronic hepatitis C who developed pulmonary sarcoidosis following antiviral therapy. The first manifestation of the disease was unexplained fever accompanied by pulmonary tract disease. The diagnosis was established by immunophenotyping in bronchial aspirate

Severe invasive listeriosis--case report

Listeriosis is a rare food borne infection which, in the invasive form, presents as bloodstream infection, central nervous system infection, materno-fetal infection, or focal infection. Certain immunosuppressive conditions have been identified as risk factors for severe invasive disease. The invasive forms of listeriosis are associated with a high case fatality rate. We present the case of a 62-year-old male with an unremarkable medical history admitted to the Iasi Infectious Diseases Hospital for fever. headache, ataxia, and diplopia. Physical examination revealed high temperature, confusion, relative bradycardia, and signs of meningeal irritation. Laboratory test showed leukocyt osis with neutrophilia. pathological CSF findings (high WBC count with predominance of neutrophils, low glucose and high protein levels), increased liver enzymes (ALAT, ASAT, AP, gammaGT), and important renal impairment (normal levels at presentation). No abnormalities at chest x-ray, cranial CT and abdominal ultrasound. CSF and blood cultures were positive for Listeria monocytogenes. Under antibiotics (ampicillin and ciprofloxacin), the course was marked by respiratory failure requiring mechanical ventilation, coma, hypotension, tachycardia. and death 12 days after admission. The particularity of this case consists in the association of the two classical forms of invasive listeriosis, meningitis and bacteriemia, with a focal infection. acute hepatitis, and a course marked by multiple organ dysfunction syndromes and exitus in a previously apparently healthy individual.

[Side effects of antiretroviral therapy]

Highly active antiretroviral therapy (HAART) has changed the natural history of HIV infection, but the presence of adverse events may limit its efficacy. Nucleoside reverse transcriptase inhibitors can cause mitochondrial toxicity and anemia, non-nucleoside reverse transcriptase inhibitors are associated with rash and central nervous system disturbance; protease inhibitors elicit gastrointestinal adverse effects and metabolic abnormalities including lipodystrophy syndrome, hyperlipidemia and insulin resistance. These complications have the potential to increase morbidity and mortality significantly in those requiring long-term treatment of HIV-infection. The presence of such abnormalities also has an impact on adherence to treatment. Besides providing health benefits, HAART may have a negative impact on patients' quality of life. Identifying and treating these complications has important implications for patient survival.

[Possibilities and limits of antiretroviral actual therapy]

The therapies now approved for HIV-infection inhibit one of two viral-specific enzymes, reversetranscriptase or protease. Combining this drugs into regimes based on at least three individual drugs--so-called HAART--has resulted in a remarkable reduction in HIV-associated morbidity and mortality. Despite these therapeutic advances, many patients are either intolerant of available agents or develop virologic failure. Problems of adherence, drug-resistance, latent reservoirs and drug-induced toxic effects that compromise effective viral control point to need for new strategies (e.g. structured treatment interruptions--STIs) and new classes of anti-HIV drugs with different modes of action (e.g. blocking HIV entry into human cells or fusion process). The use of adjunctive immune-based therapy such as IL-2 may permit more extensive immune restoration.