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A special issue of Microorganisms (ISSN 2076-2607). This special issue belongs to the section "Public Health Microbiology".

Deadline for manuscript submissions: 15 July 2025 | Viewed by 5685

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Special Issue Editor

Dr. Daniela Piţigoi

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Guest Editor

1. Department of Epidemiology, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
2. National Institute for Infectious Diseases “Prof. Dr. Matei Balș”, 021105 Bucharest, Romania
Interests: vaccine preventable diseases; surveillance; vaccination; infection control; influenza; West Nile

Special Issue Information

Dear Colleagues,

Communicable diseases continue to pose a challenge to public health systems, both globally and in Romania. Diseases can spread rapidly from one country to another, with new pathogens being identified frequently. Antibiotic resistance, a lack of information, misinformation, vaccine hesitancy, migration, economic and social crises are the risk factors associated with outbreaks, so it is necessary to implement robust, functional surveillance systems that provide timely information regarding the monitoring of communicable disease trends; this is in order to identify risk factors and areas for intervention. Epidemiological surveillance systems must be capable of collecting and analyzing data, disseminating information to public health authorities and regularly assessing the effectiveness of the disseminated data.

This Special Issue aims to present recent findings related to the surveillance and control of communicable diseases in Romania. We welcome both original research and review articles whose scope includes, but is not limited to, the following topics:

The surveillance, epidemiology, clinical and microbial features of communicable diseases in Romania;
The surveillance of vaccine-preventable diseases and vaccinations in special population groups;
The molecular epidemiology of specific infections;
Challenges and advances in the surveillance and control of outbreaks, and in alert management;
The surveillance of influenza, COVID-19 and severe acute respiratory infections;
The surveillance of healthcare-associated infections, antimicrobial resistance and antibiotic consumption;
The technologies and tools used for the surveillance and control of communicable diseases, including vaccination monitoring;

We look forward to receiving your contributions.

Dr. Daniela Piţigoi
Guest Editor

Manuscript Submission Information

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Keywords

surveillance
vaccine preventable diseases
antimicrobial resistance
health care associated infection
influenza
COVID-19
Romania

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Published Papers (7 papers)

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16 pages, 1173 KiB

Open AccessArticle

Cytomegalovirus Infection Screening in Pregnant Women from Northwest Romania: Results of a 15-Year Follow-Up Program

by Monica Muntean, Violeta Tincuța Briciu, Angela Monica Ionică, Melinda Horvat, Mihaela Lupse and Amanda Radulescu

Microorganisms 2025, 13(7), 1513; https://doi.org/10.3390/microorganisms13071513 - 28 Jun 2025

Viewed by 133

Abstract

Pregnancy-related cytomegalovirus (CMV) infection may have negative consequences on the developing fetus and child. In Romania, screening for CMV infection is included in the first prenatal evaluation. We aimed to evaluate the seroprevalence rates in pregnant women who underwent screening over 15 years (May 2008–February 2023). We evaluated 28,012 pregnant women, from whom 23,970 (85.57%) had an index CMV screening, and 4082 had at least two presentations during the same or consecutive pregnancies. A total of 32,290 paired anti-CMV IgM/IgG serological tests were performed. Passed infection with IgG positivity represented 90.15% (29,110) of all tests, corresponding to 28,649 women (88.72%). The seroprevalence increased with women’s age, was more frequently associated with rural residence, and decreased in time intervals. A total of 2322 women (9.69%) displaying an IgM/IgG negative pattern were at risk of acquiring the infection during pregnancy. Only 144 out of 2342 (6.14%) women at risk presented twice during the same pregnancy, of which 12 women (0.51%) displayed a pattern of primary infection. Our population from Northwest Romania shows a high rate of immunization against CMV infection and a low risk of primary infection. We found a low adherence to retesting in cases of probable primary CMV infections, which highlights the need for infection mitigation by hygiene measures and improvement of the existing protocols. Full article

(This article belongs to the Special Issue Infectious Disease Surveillance in Romania)

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15 pages, 1043 KiB

Open AccessArticle

Clinical Characteristics and Outcomes in Multisystemic Inflammatory Syndrome in Children (MIS-C) Associated with COVID-19: A 12-Month Prospective Study

by Viorela Gabriela Nitescu, Diana-Andreea Usurelu, Teodora Olsavszky, Ana-Maria Mihalcea, Andra Postelnicu, Ruxandra Florea, Simona Stanca, Iolanda Cristina Vivisenco, Madalina Elena Petran, Maria-Dorina Craciun, Carmen-Daniela Chivu, Alexandru Ulici and Coriolan Emil Ulmeanu

Microorganisms 2025, 13(6), 1405; https://doi.org/10.3390/microorganisms13061405 - 16 Jun 2025

Viewed by 341

Abstract

Multisystemic inflammatory syndrome in children (MIS-C) is a rare but potentially severe condition that affects multiple organ systems. This study aimed to assess the clinical characteristics and outcomes of patients diagnosed with multisystemic inflammatory syndrome in children (MIS-C) associated with COVID-19. A 12-month prospective study was conducted at the “Grigore Alexandrescu” Clinical Emergency Hospital for Children, Bucharest. This study included children aged 0–18 years who were diagnosed with MIS-C, as defined by the World Health Organization (WHO), the Royal College of Paediatrics and Child Health (RCPCH), and the Centers for Disease Control and Prevention (CDC) criteria. Data on age, gender, clinical and laboratory findings, treatment, and outcomes were analyzed. Follow-up evaluations occurred at one, three, six, nine, and twelve months post-discharge. Among 36 patients (47.3% female, 52.7% male; mean age, 9.9 years), fever and inflammatory syndrome were present in all patients. Other common symptoms included mucocutaneous (63.8%), gastrointestinal (52.7%), cardiac (47.2%), pulmonary (38.8%), and neurological (11.1%) manifestations. At admission, 14/36 were IgM-positive, while 34/36 were IgG-positive. Follow-up revealed sequelae in two patients, including coronary aneurysms and ground-glass pulmonary opacities. Although MIS-C can be severe, most patients had favorable outcomes with proper treatment. Few long-term, organ-specific complications were observed, highlighting the importance of systematic monitoring to ensure full recovery. Full article

(This article belongs to the Special Issue Infectious Disease Surveillance in Romania)

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30 pages, 3390 KiB

Open AccessArticle

Microbiological Profiles, Antibiotic Susceptibility Patterns and the Role of Multidrug-Resistant Organisms in Patients Diagnosed with Periprosthetic Joint Infection over 8 Years: Results from a Single-Center Observational Cohort Study from Romania

by Serban Dragosloveanu, Rares-Mircea Birlutiu, Bogdan Neamtu and Victoria Birlutiu

Microorganisms 2025, 13(5), 1168; https://doi.org/10.3390/microorganisms13051168 - 21 May 2025

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Abstract

This study examines temporal patterns in pathogens isolated from prosthetic joint infection (PJI) cases and antimicrobial resistance patterns at a Romanian orthopedic center. We have conducted a retrospective cohort study that included 674 patients undergoing hip or knee replacement revision surgery between January 2016 and December 2023. From these, 102 confirmed PJI cases requiring surgical intervention were selected for analysis. We isolated 27 microorganisms from acute PJI cultures and 82 from chronic PJIs. Staphylococcus epidermidis (33 cases, 30.3%; 95% CI 22.0–40.3) was the predominant pathogen, with coagulase-negative Staphylococci (22 cases, 20.18%; 95% CI 0.9–41.3) and Enterobacteriaceae (13 cases, 11.9%; 95% CI 6.4–18.3) also prevalent. Methicillin resistance was identified in 43.6% of coagulase-negative staphylococci and 45.5% of Staphylococcus aureus isolates. All Gram-positive isolates remained susceptible to vancomycin, linezolid, and tigecycline. Among Gram-negative bacilli, Klebsiella oxytoca and Proteus mirabilis showed resistance to third-generation cephalosporins, with phenotypic profiles suggestive of extended-spectrum β-lactamase (ESBL) production. All Escherichia coli, Enterobacter spp., and Citrobacter freundii strains were fully susceptible to tested agents, while Pseudomonas aeruginosa exhibited reduced susceptibility to ciprofloxacin, aztreonam, and imipenem. Among the isolated strains, 47 were multidrug-resistant (MDR), with Staphylococcus aureus accounting for the highest MDR count, including methicillin resistance. The distribution of microorganism types and MDR strains remained consistent throughout the study period, with no significant association between infection type and MDR strain presence or between infection site and microorganism presence except for a strong association between MDR strains and the type of microorganism (p < 0.05). The microbial profile and resistance patterns in PJIs have remained stable over eight years. Our observations do not suggest that MDR PJIs are more commonly acute cases, contrary to what has been highlighted in previous reports. The ongoing prevalence of MDR strains underscores the importance of targeted antimicrobial treatments based on local susceptibility profiles. Full article

(This article belongs to the Special Issue Infectious Disease Surveillance in Romania)

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16 pages, 602 KiB

Open AccessArticle

Comorbidities and Severe COVID-19 Outcomes: A Retrospective Analysis of Hospitalized Patients in Three Counties in Romania

by Réka Bodea, Toader Septimiu Voidăzan, Lorand Iozsef Ferencz and Zoltán Ábrám

Microorganisms 2025, 13(4), 787; https://doi.org/10.3390/microorganisms13040787 - 29 Mar 2025

Viewed by 556

Abstract

The COVID-19 pandemic represents a major global health crisis, with clinical manifestations ranging from asymptomatic infection to fatal outcomes. While all individuals are susceptible, specific populations, particularly those with pre-existing medical conditions, face a heightened risk of severe disease. This study aimed to assess the prevalence of severe COVID-19 among hospitalized patients with comorbidities in the Central Region of Romania, and to analyze the association between these conditions and mortality. We conducted a retrospective cohort study using data from the Corona Forms platform (2020–2022), encompassing hospitalized cases across three Romanian counties. A total of 1458 patients with confirmed SARS-CoV-2 infection and documented comorbidities were included. Demographic characteristics, comorbid conditions, and hospitalization outcomes were analyzed. The overall mortality rate among comorbid patients was 89.3%. Renal, neurologic, hepatic disease, cardiovascular conditions, obesity, type 2 diabetes mellitus, and cerebrovascular accidents are significant risk factors for death outcomes in the SARS-CoV-2-infected study population. The strength of their association varies, with odds ratios ranging from 25.32 to 1. The findings underscore the critical impact of comorbidities on COVID-19 severity and mortality among the Central Romanian population, emphasizing the necessity of targeted clinical interventions and public health strategies to protect high-risk populations. Full article

(This article belongs to the Special Issue Infectious Disease Surveillance in Romania)

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18 pages, 1819 KiB

Open AccessArticle

Bacterial Diversity in Pet Rabbits: Implications for Public Health, Zoonotic Risks, and Antimicrobial Resistance

by Smaranda Crăciun, Cristiana Ştefania Novac, Nicodim Iosif Fiţ, Cosmina Maria Bouari, Lucia Victoria Bel and George Cosmin Nadăş

Microorganisms 2025, 13(3), 653; https://doi.org/10.3390/microorganisms13030653 - 13 Mar 2025

Cited by 2 | Viewed by 1098

Abstract

This study examined epidemiological aspects of rabbit pathologies, identified bacterial strains, and assessed their antimicrobial resistance, emphasizing rabbits as potential reservoirs for zoonotic multidrug resistant (MDR) bacteria and the need for continuous monitoring and antimicrobial stewardship. Samples from rabbits were cultivated and then identified using Vitek^® 2 and MALDI-TOF. Antimicrobial susceptibility was assessed by disk diffusion testing. This study analyzed 170 individuals with various pathologies, with males (58.24%) outnumbering females (41.76%). Dental abscesses (35.29%) and respiratory infections (28.24%) were most common. Antibiotic exposure was noted in 47.06% of cases, primarily involving trimethoprim (35.56%). Of the total samples, 91.18% tested positive, revealing 200 isolates from 23 bacterial genera, with Staphylococcus spp. (31%) and Escherichia coli (12%) being most frequently identified as well as species with zoonotic potential, such as Pseudomonas aeruginosa, Staphylococcus aureus, Klebsiella pneumoniae, Proteus mirabilis, and Enterococcus faecium. Antimicrobial susceptibility testing showed high efficacy for florfenicol (75%), ciprofloxacin (74.12%), and amikacin (68.65%), while significant resistance was found for kanamycin, neomycin, and trimethoprim. Nearly 49% of strains were MDR, with Gram-positive cocci, Enterobacteriaceae, and non-Enterobacteriaceae showing varying resistance, across 18 MDR genera. In conclusion, pet rabbits are potential reservoirs of zoonotic and MDR bacterial species, posing a risk for their owners. Full article

(This article belongs to the Special Issue Infectious Disease Surveillance in Romania)

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20 pages, 1231 KiB

Open AccessArticle

Cryptococcus neoformans: Brain Preference, Gender Bias, and Interactions with Mycobacterium tuberculosis and Toxoplasma gondii in HIV-Positive Patients

by Ruxandra Moroti, Adriana Hristea, Georgiana Neagu, Irina Penescu, Dragos Florea, Catalin Tiliscan and Serban Nicolae Benea

Microorganisms 2025, 13(3), 481; https://doi.org/10.3390/microorganisms13030481 - 21 Feb 2025

Cited by 1 | Viewed by 1259

Abstract

Cryptococcus neoformans, a high-priority pathogen (WHO, 2022) and ubiquitous fungus, is responsible for hundreds of thousands of meningoencephalitis cases annually, with a high fatality rate. Its distribution is uneven: it primarily affects immunocompromised individuals (especially HIV-positive patients). Our study aims to explore the Cryptococcus’ brain tropism in immunosuppressed patients, its gender preference and the possible interactions with other opportunistic neurotropic microorganisms, such as Mycobacterium tuberculosis (MTB) and the brain microbiota, with a particular focus on Toxoplasma gondii (T. gondii). Methods: We conducted a retrospective descriptive analysis of all cases diagnosed with central nervous system cryptococcosis (Crypto-CNS) in HIV-positive patients admitted over 10 years (2010–2019) in a tertiary Romanian hospital. We examined their demographic, clinical, immunobiological, and imaging data, as well as their medical history, comorbidities, and coinfections. Results: Forty-two cases were admitted, with a male predominance (3.6:1) and a mean age of 33.3 years; 24% were diagnosed concomitantly with HIV infection and Crypto-CNS. All patients were severely immunosuppressed, with CD4 counts <200 cells/mm³ (median = 20.5 [1–163], mean = 31.6). Recent/concomitant tuberculosis was found in 10 (27.7%). T. gondii-seropositive patients developed Crypto-CNS at a lower immunological state than seronegative ones (27.1 CD4 cells/mm³ vs. 46.7 cells/mm³, means). Of 25 cases with available brain imagery, 28% had high intracranial pressure. Twelve patients (28.5%) died during the hospitalization within 26.3 days (mean, SD = 21.4); 1-year mortality increased to 50%. In-hospital mortality was associated with lower CD4 counts, increased intracranial pressure, and T. gondii-seropositivity. Conclusions: Crypto-CNS in HIV-positive patients mainly affects men and may be promoted by concomitant or recent tuberculosis. T. gondii may confer some protection even at low immune levels but increases mortality when immunity is critically low. Full article

(This article belongs to the Special Issue Infectious Disease Surveillance in Romania)

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10 pages, 2226 KiB

Open AccessCase Report

How Common Is Imported Cutaneous Leishmaniasis in Romania? Two Case Reports

by Victoria Birlutiu, Gabriela Iancu, Rares-Mircea Birlutiu and Simin Aysel Florescu

Microorganisms 2025, 13(6), 1207; https://doi.org/10.3390/microorganisms13061207 - 25 May 2025

Viewed by 445

Abstract

Background: Leishmaniasis is a vector-borne zoonotic disease caused by protozoa of the genus Leishmania. While it is endemic in the Mediterranean Basin and the Balkans, Romania remains a non-endemic country. However, climate change, increased international travel, and the documented presence of competent vectors (Phlebotomus spp.) have raised concerns about the potential emergence of autochthonous cases. Case Presentation: We report two cases of imported cutaneous leishmaniasis (CL) diagnosed in central Romania, a region without previously confirmed human or animal cases. The first case involved a 31-year-old male with a recent travel history to Spain, presenting with erythematous papules and plaques that evolved into ulcerated lesions. The diagnosis was confirmed histopathologically and by a PCR. Treatment with miltefosine was effective, with minimal hepatic toxicity and a sustained response at a six-month follow-up. The second case concerned an 11-year-old boy who had traveled to Elba, Italy. He developed ulcerative lesions that progressed rapidly and were complicated by Pseudomonas aeruginosa superinfection. Despite an initially negative smear, PCR testing of the skin lesion confirmed the presence of CL. Antifungal therapy with fluconazole led to clinical improvement; treatment was ongoing at the time of publication. Discussion: These cases highlight the diagnostic and therapeutic challenges associated with CL in non-endemic settings. The varied clinical evolution underscores the importance of considering leishmaniasis in the differential diagnosis of chronic, non-healing cutaneous lesions, particularly in patients with a travel history to endemic regions. Conclusions: Increased awareness among clinicians, supported by accurate diagnostic tools and public health surveillance, is essential to identify and manage imported leishmaniasis. Given the absence of a licensed vaccine and the growing risk of vector expansion in Eastern Europe, these cases support the WHO’s inclusion of leishmaniasis among the priority neglected tropical diseases targeted for intensified global control efforts by 2030. Full article

(This article belongs to the Special Issue Infectious Disease Surveillance in Romania)

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