Biomedical subjects
E Miftode
Publications and source records attributed to E Miftode.
[The clinico-evolutionary considerations of 492 cases of measles hospitalized in the Infectious Disease Clinic Iaşi in 1997].
Between 01.01.1997-31.12.1997 in the Infections Diseases Clinical Hospital of Iaşi were admitted 492 patients suffering from measles. The above mentioned number of patients represents 4.92% of all the patients (10097) who were admitted during this period of time. More than half of the patients (56.9%) are residents in suburban arias. Teen-agers and young adults (15-24 years) were involved in most of the cases, followed by new born babies (0-11 months). The clinical signs were prevalent minor and the atypical exanthema was found in 1/4 of all cases. The most frequent complications were pneumonia, bronchopneumonia and otitis media. Of all the patients, two children (average age 1-4 years) died.
[Nosocomial staphylococcal meningitis].
OBJECTIVE: Clinical, bacteriological and therapeutically study on iatrogenic staphylococcal meningitis. METHOD: Retrospective analysis of 33 cases of iatrogenic staphylococcal meningitis admitted to the Hospital of Infectious Diseases of Iaşi in the interval 1988-1997. RESULTS: In the interval under study the recorded incidence was 1-5 cases per year. The predisposing factors were neurosurgical procedures for endocranial processes (12 cases), operated chronic otomastoiditis (11 cases), ventriculoatrial or peritoneal shunt (5 cases) and neurosurgical assessment (5 cases). The onset was slow, with persisting and mild headache persistence recurrence of fever, vomiting and convulsions followed by meningeal contracture and encephalitic phenomena. In 24 patients cerebrospinal fluid was typical for purulent meningitis. The causal agents were isolated in 25 cases being Staphylococcus aureus (20 cases) and Staphylococcus epidermidis sensitive to usual antistaphylococcal agents. Three therapeutically schemes were used the association cefotaxim î gentamycin proving to be the most effective vancomycin was required in but 2 cases. Three deaths were recorded. CONCLUSIONS: The symptoms of iatrogenic staphylococcal meningitis are mild marked by the underlying disease the most effective treatment being the association of cefotaxim with an aminoglycoside.
[Difficulties in the diagnosis of prolonged fever in infants].
We report the case of an infant with cytomegalovirus (CMV) infection who developed a nosocomial sepsis of mixed etiology. Fever failed to decrease despite long-time and sustained antibiotic therapy. Treatment with an antiviral agent following the detection of CMV antibody of the IgM class resulted in clinical improvement and subsequent full recovery. We suggest that the diagnosis of CMV infection should be considered even in immunocompetent patients in whom antibiotic therapy fails.
[Bartonella infection].
Bartonella species have been recently recognized as an important human pathogen associated with a wide spectrum of diseases. Four members of the genus are known to cause human infection: Bartonella baciliformis, B. henselae, B. quintana and B. elizabethae. B. baciliformis, the first identified Bartonella species, is the agent of two disease entities, Oroya fever and verruga peruana., B. henselae and B. quintana are two species involved in producing bacteremic syndromes (relapsing fever, trench fever, endocarditis), chronic lymphadenopathy in immunocompetent patients (cat-scrath disease) and chronic vascular lesions in immunocompromised hosts (bacillary angiomatosis and bacillary peliosis hepatis-recognized as new opportunistic infections in HIV-infected patients).
[Clinical and biological study of acute diarrhea with mixed etiology in 48 patients].
OBJECTIVES: The study of incidence, clinical manifestation and treatment of acute diarrhea with mixed etiology. MATERIAL AND METHOD: Study of 48 patients with acute diarrhea with mixed etiology admitted in the Hospital of Infectious Diseases of Iaşi during 1995-1998. RESULTS: 12 cases (24%) were mixed bacterial infections with the following microorganisms associations: Salmonella + Shigella (10 cazuri); Salmonella + Yersinia enterocolitica (1 case); Salmonella + Rotavirus (1 case). 16 cases (44%) had mixed digestive infections with parasites, in double or triple associations: Giardia intestinalis + Ascaris lumbricoides (10 cases); Giardia intestinalis + Ascaris lumbricoides + Entamoeba coli (1 case); Giardia intestinalis + Enterobius vermicularis (3 cases); Ascaris lumbricoides + Trichiuris trichiura (2 cases). The rest of 20 cases presented mixed infections with bacteria and parasites: Salmonella + Rotavirus + Giardia (2 cases), Salmonella + Shigella + Giardia intestinalis or Ascaris lumbricoides (6 cases), Salmonella + Giardia intestinalis (8 cases); Salmonella + Entamoeba coli (3 cases); Shigella + Trichiura trichiuris + Entamoeba coli (1 case). The majority was male patients from rural areas with age between 5 month and 56 years, the majority being children, 4 cases were found in immunosupressed patients. The clinical symptomatology was dominated by diarrheal syndrome (100%) and the diagnosis was established by clinical characters and confirmed by coproculture and parasitologic exam. The ethiological therapy was guided by antibiogram, in the majority of cases we used fluorochinolones (associated with ceftriaxone in severe cases), together with antiparasitic medications. CONCLUSIONS: In this study predominated the bacterial and parasitic infections, most frequently being isolated Salmonella, Shigella and Giardia intestinalis; the therapy associated fluorochinolones with antiparasitic medication.
Spinal epidural abscess.
In a retrospective study, 68 patients with Spinal Epidural Abscess (SEA) were reviewed. Of these, 66% had different predisposing factors such as staphylococcal skin infections, surgical procedures, rachicentesis, trauma, spondilodiscitis. Abscess had a lumbar region location in 53% of cases. Staphylococcus aureus was the most frequent etiological agent (81%). The overall rate of mortality in SEA patients was 13.2%.
[The value of C-reactive protein for the differentiation of bacterial meningitis from viral meningitis].
In order to differentiate bacterial meningitis versus viral meningitis, we have comparatively tested the efficacy of the following tests: C-reactive protein (CRP), erythrocytes sedimentation rate (ESR), fever, level of glucose in cerebro-spinal fluid (CSF), glucose in CSF/glycemia ratio, number of white blood cells in peripheric blood, percentage of neutrophils in peripheric blood, level of proteins in CSF and number of nucleated cells in CSF for a group of 49 patients, both children and adults with central nervous system infection (37 patients with bacterial meningitis and 12 with viral meningitis) hospitalised between May 1993 and July 1994 in Clinical Hospital for Infectious Diseases in Iaşi. The mean value of CRP in bacterial meningitis patients was 8.78 mg%, contrasting with the mean value of CRP = 1.92 mg% recorded in patients with viral meningitis. Ten out of 37 bacterial meningitis patients presented a CRP concentration < 1.85 mg%. All these 10 patients have already had an antibiotic treatment at the moment of the assay. One out of 12 cases of viral meningitis had a value of CRP = 3.3 mg%, all the remainder cases having values under 1.85 mg%. We recorded highly significant differences between the two patient groups for CRP (p < 0.001), ESR (p < 0.01), protein concentration in CSF (p < 0.001) and number of nucleated cells in CSF (p < 0.001). Differences recorded for fever, concentration of glucose in CSF, glucose in CSF/glycemia ratio, number of leucocytes in peripheric blood and percentage of neutrophils in peripheric blood, were not significant (p > 0.5). Data were analysed also by box-plot method which facilitates the visual appraisal of the differences recorded between the two aetiological groups. In conclusion, assays of CRP and ESR may be used as differentiation tests for bacterial meningitis versus viral meningitis, when assay is done before the antibiotic treatment, being sufficient sensitive, and easy to perform.