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15 pages, 280 KiB

Open AccessArticle

Evaluation of Bone Mineral Density and Related Factors in Romanian HIV-Positive Patients Undergoing Antiretroviral Therapy

by Ioana-Melinda Luput-Andrica, Adelina-Raluca Marinescu, Talida Georgiana Cut, Alexandra Herlo, Lucian-Flavius Herlo, Andra-Elena Saizu, Ruxandra Laza, Anca Lustrea, Andreea-Cristina Floruncut, Adina Chisalita, Narcisa Nicolescu, Cristian Iulian Oancea, Diana Manolescu, Romanita Jumanca, Daniela-Ica Rosoha and Voichita Elena Lazureanu

Microorganisms 2025, 13(8), 1768; https://doi.org/10.3390/microorganisms13081768 - 29 Jul 2025

Abstract

Human Immunodeficiency Virus (HIV) infection remains a major global health issue, with effective antiretroviral therapy (ART) extending life expectancy but also increasing age-related issues like osteopenia and osteoporosis. This cross-sectional study examines bone mineral density (BMD) and related risk factors in Romanian HIV-positive [...] Read more.

Human Immunodeficiency Virus (HIV) infection remains a major global health issue, with effective antiretroviral therapy (ART) extending life expectancy but also increasing age-related issues like osteopenia and osteoporosis. This cross-sectional study examines bone mineral density (BMD) and related risk factors in Romanian HIV-positive patients, emphasizing regional and therapy influences. The patients varying in HIV infection duration underwent DXA scanning to measure BMD in the lumbar spine, femoral neck, and total femur. A high prevalence of low BMD, especially in the lumbar spine, was identified along with significant associations between reduced BMD and factors such as smoking, alcohol use, vitamin D deficiency and serum phosphorus levels. ART like Protease Inhibitors and Nucleoside Reverse Transcriptase Inhibitors were linked to increased bone loss, emphasizing the multifactorial nature of osteoporosis in HIV-infected individuals and underscore the importance of regular BMD assessments, lifestyle adjustments, and careful management of antiretroviral therapy to minimize fracture risk and enhance overall health and quality of life. Full article

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

11 pages, 490 KiB

Open AccessArticle

Seroprevalence of Anaplasma phagocytophilum Antibodies Following Tick Bites: A Serosurvey in a Tertiary Care Hospital in Romania

by Cristina Alexandra Cheran, Diana Gabriela Iacob, Georgiana Neagu, Andreea Madalina Panciu and Adriana Hristea

Microorganisms 2025, 13(8), 1758; https://doi.org/10.3390/microorganisms13081758 - 28 Jul 2025

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Abstract

Human granulocytic anaplasmosis is an emerging tick-borne disease. Although Anaplasma phagocytophilum has been identified in vectors and animal reservoirs in Romania, evidence of human exposure has not yet been reported. This study aimed to generate initial evidence of human infection by evaluating A. [...] Read more.

Human granulocytic anaplasmosis is an emerging tick-borne disease. Although Anaplasma phagocytophilum has been identified in vectors and animal reservoirs in Romania, evidence of human exposure has not yet been reported. This study aimed to generate initial evidence of human infection by evaluating A. phagocytophilum antibodies in individuals with recent tick exposure. We conducted a cross-sectional serosurvey between 2023 and 2024 at a tertiary care hospital in Bucharest, enrolling 80 participants 4 to 12 weeks following a tick bite. Serum IgG antibodies against A. phagocytophilum were detected using an indirect immunofluorescence assay, with a titer of ≥1:64 considered indicative of seropositivity. Eight (10%) participants tested positive for A. phagocytophilum IgG antibodies. Seropositivity was not significantly associated with demographics, geographical region, or clinical symptoms. However, fatigue and myalgia were more frequently seen in A. phagocytophilum IgG seropositive individuals. Notably, 43.8% of all participants reported erythema migrans, including five of the eight individuals with positive A. phagocytophilum IgG serology. This study provides the first serological evidence of human exposure to A. phagocytophilum in Romania. A 10% seroprevalence in this high-risk group suggests that anaplasmosis may be underrecognized. Clinicians should consider it in patients with tick exposure and compatible symptoms. Full article

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

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14 pages, 267 KiB

Open AccessArticle

Acute Viral Meningitis of Unidentified Etiology: Insights from a Mixed-Methods Study

by Andreea-Mădălina Panciu, Laura-Elena Marin, Ruxandra Moroti and Adriana Hristea

Microorganisms 2025, 13(8), 1747; https://doi.org/10.3390/microorganisms13081747 - 26 Jul 2025

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Abstract

Background: Etiologic diagnosis in suspected viral meningitis is not always achievable, yet it can play a significant role in patient management. Our study aimed to do a comprehensive analysis of current practices regarding etiologic diagnosis in these cases and compare patients with and [...] Read more.

Background: Etiologic diagnosis in suspected viral meningitis is not always achievable, yet it can play a significant role in patient management. Our study aimed to do a comprehensive analysis of current practices regarding etiologic diagnosis in these cases and compare patients with and without known etiologic diagnosis in order to visualize if and how having an etiological diagnosis can impact patient management and/or outcome. Methods and results: We conducted a convergent mixed-methods study. Quantitative data was obtained from 118 patients hospitalized during a one-year period. There were 40.7% (n = 48) cases with unknown etiology. The length of hospitalization was longer in the group with unknown etiology vs. known etiology (12.6 days vs. 9.8 days p = 0.01). Thematic analysis was used for the qualitative approach in order to evaluate physicians’ overall perceptions regarding this subject. Conclusions: Our mixed-methods study shows that while clinicians consider etiologic diagnosis very important, it remains a diagnostic challenge even in modern times. Continued efforts are needed to optimize diagnostic strategies and address existing gaps in the etiologic workup of viral meningitis. There may be overlooked pathogens that have cost-efficient testing methods, like TBEV, that can be introduced in a testing protocol and may enhance patient management and reduce unnecessary hospital stays. Full article

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

14 pages, 1496 KiB

Open AccessArticle

Tetanus in Romania—Trends and Challenges

by Andreea Marilena Păuna, Ștefan Eduard Mîinea, Bianca Georgiana Enciu, Daniela Pițigoi, Anca Mirela Sîrbu, Rodica Popescu, Carmen Daniela Chivu, Carmen-Cristina Vasile and Maria Dorina Crăciun

Microorganisms 2025, 13(7), 1654; https://doi.org/10.3390/microorganisms13071654 - 12 Jul 2025

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Abstract

Tetanus is a life-threatening, vaccine-preventable disease caused by tetanospasmin and tetanolysin, which are potent neurotoxins produced by Clostridium tetani, an anaerobic, spore-forming bacterium. Due to the widespread presence of spores in the environment, the disease cannot be eradicated. However, global tetanus prevention [...] Read more.

Tetanus is a life-threatening, vaccine-preventable disease caused by tetanospasmin and tetanolysin, which are potent neurotoxins produced by Clostridium tetani, an anaerobic, spore-forming bacterium. Due to the widespread presence of spores in the environment, the disease cannot be eradicated. However, global tetanus prevention initiatives have contributed to a significant decline in tetanus incidence worldwide. Aiming to present the tetanus trends in Romania, we conducted a retrospective analysis of the tetanus surveillance data. During the study period (2010–2023), 97 cases of tetanus were reported in Romania (median: 6.5; IQR: 5–7) with an average incidence rate of 0.03 per 100,000 inhabitants (95% CI: 0.02–0.04; range: 0.01–0.09). The highest incidence rates were recorded among people aged 1 to 14 years old (0.09 per 100,000 inhabitants, 95% CI: 0.06–0.13; range: 0.00–0.20), male (0.05 per 100,000 inhabitants; 95% CI: 0.03–0.06; range: 0.03–0.12), and from rural areas (0.05 per 100,000 inhabitants; 95% CI: 0.03–0.08; range: 0.01–0.17). A decline in the number of tetanus cases of 7% by year was observed, which is supported by the statistical analysis showing a p-value of 0.005 (IRR: 0.93; 95% CI: 0.88–0.98). However, the same decline in tetanus incidence was not supported by the statistical analysis (IRR: 0.93; 95% CI: 0.44–1.98; p = 0.9). Forty-seven tetanus deaths were recorded, with an average case fatality ratio of 42% (95% CI: 25.62–57.92; range: 0–100), showing a decreasing trend of 9% by year (IRR: 0.91; 95% CI: 0.89–0.93). Although the annual number of tetanus cases in Romania has shown a slight downwards trend, its situation has remained relatively stable, as shown by the tetanus incidence. Moreover, the case fatality rate continues to be high. Therefore, our study emphasizes the importance of achieving high vaccination uptake among children and adolescents, raising awareness of the importance of booster doses in adults, and improving the management of tetanus-prone wounds. Full article

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

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25 pages, 2374 KiB

Open AccessArticle

Pulmonary Embolism in COVID-19: Trends from a Single-Center Study Across Ten Pandemic Waves in Romania

by Alexandra Herlo, Adelina Raluca Marinescu, Talida Georgiana Cut, Ruxandra Laza, Adina Maria Marza, Claudia Raluca Balasa Virzob, Cristian Iulian Oancea, Lucian-Flavius Herlo, Ioana-Melinda Luput-Andrica and Voichita Elena Lazureanu

Microorganisms 2025, 13(7), 1634; https://doi.org/10.3390/microorganisms13071634 - 10 Jul 2025

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Abstract

The COVID-19 pandemic has significantly impacted global health, with pulmonary embolism (PE) emerging as a critical complication due to the hypercoagulable state induced by SARS-CoV-2 infection. Despite advancements in prevention and treatment, PE remains a major cause of morbidity and mortality in COVID-19 [...] Read more.

The COVID-19 pandemic has significantly impacted global health, with pulmonary embolism (PE) emerging as a critical complication due to the hypercoagulable state induced by SARS-CoV-2 infection. Despite advancements in prevention and treatment, PE remains a major cause of morbidity and mortality in COVID-19 patients. This study analyzes the trends, outcomes, and contributing factors of PE across ten pandemic waves in Romania, highlighting the evolving clinical burden and management approaches. This retrospective observational study was conducted on confirmed COVID-19 patients that also developed PE, who were admitted to “Victor Babeș” Hospital and Municipal Emergency Hospital in Timișoara, Romania. Data on demographics, clinical features, inflammatory markers, comorbidities, and treatment were collected from medical records. Statistical analyses, including ANOVA and Kaplan–Meier survival analysis, were conducted to evaluate trends and survival outcomes over time. The study included 166 patients, with a mean age of 67.26 ± 13.57 years. Mortality peaked at 50% in Wave 1, declined to 12% in Wave 7, and increased again to 28% in Wave 10. Intubation rates varied, with a high of 29% in Wave 6 and a low of 12% in Wave 8. Lung involvement was the most severe in Wave 4 (mean 0.54 ± 0.18) but improved in later waves, reaching a mean of 0.24 ± 0.12 in Wave 8. This study highlights the dynamic trends in PE during the COVID-19 pandemic in Romania. Improved clinical management, vaccination, and adaptive healthcare strategies contributed to better outcomes in later waves. Full article

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

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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

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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 [...] Read more.

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

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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 [...] Read more.

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

Cited by 1 | Viewed by 607

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 [...] Read more.

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

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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 [...] Read more.

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 4 | Viewed by 1280

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 [...] Read more.

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 1469

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 [...] Read more.

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

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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 [...] Read more.

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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