Search Results (129)

Mpox has become a significant health concern since the global outbreak that began in 2022. The aim of this study is to present the epidemiological situation of Mpox in Romania during 2022–2023 and to describe a severe case of Mpox in a patient who survived despite multiple co-pathologies. Forty-seven confirmed cases were reported at the national level, all in men, in 2022. The median age was 33 years. Twenty-six cases involved men who have sex with men (MSM), and twenty-three tested positive for HIV. We also describe a severe case involving a 34-year-old bisexual male with newly diagnosed AIDS who developed severe Mpox with persistent necrotic skin lesions, respiratory involvement, and multiple opportunistic infections: tuberculosis, pneumocystis pneumonia, syphilis, and oral candidiasis. The patient presented with fever, night sweats, weight loss, and dyspnea, with a single ulcerative facial lesion that later disseminated. Mpox infection was confirmed through PCR from skin lesion, serum, saliva, urine, rectal, nasal, and pharyngeal swab samples, with high viral loads persisting despite prolonged Tecovirimat therapy. The patient developed immune reconstitution inflammatory syndrome following the initiation of antiretroviral therapy. This case emphasizes the challenges of treating Mpox in immunocompromised patients. Full article

An increase in invasive group A streptococcal (iGAS) infections among children under 15 years of age was reported in several countries between late 2022 and early 2023. This retrospective study aims to describe the epidemiology and clinical features of iGAS infections in children in Cyprus during the same period. Medical records of patients under 16 years old admitted with iGAS infection to the Archbishop Makarios Hospital, the only tertiary paediatric referral centre in Cyprus, between 1 January 2021 and 30 June 2024, were reviewed. Twenty-two cases were identified, of which twenty were classified as confirmed and two as probable. Half of the cases occurred in children aged 0–4 years, and 59% were recorded between December 2022 and April 2023. Scarlet fever was diagnosed in six children, five of whom developed pneumonia and empyema. Streptococcal toxic shock syndrome (STSS) was observed in five patients, resulting in two deaths and one case requiring prolonged extracorporeal membrane oxygenation (ECMO). The overall case fatality rate was 9.1%. Emm 1, belonging to the M1UK clone, was the predominant strain (66.6%). The findings underscore the severity of iGAS infections, particularly in younger children, and highlight the importance of timely diagnosis, appropriate management and continued epidemiological surveillance. Full article

Background: Infectious complications are common after percutaneous nephrolithotomy (PCNL). Clinical guidelines recommend, previous to surgery, prolonged antibiotic regimens in patients with preoperative positive urine cultures to reduce infectious risk. However, such strategies may increase selective pressure and promote antimicrobial resistance. Evidence supporting the use of a single antibiotic dose tailored to culture sensitivity in these cases is limited but emerging. Methods: We conducted a retrospective observational study including 187 PCNL procedures performed between 2021 and 2023 under an individualized antibiotic prophylaxis protocol. Patients with negative or contaminated urine cultures received a single empirical dose, while those with recent positive cultures received a single dose based on antimicrobial susceptibility testing. Postoperative complications—including fever, sepsis, and a composite outcome—were analyzed through multivariable logistic regression, comparing high- and low-risk patients. Results: A total of 67.9% of procedures were performed in patients meeting at least one high-risk criterion, including a positive preoperative urine culture in 32.1%. The overall incidence of infectious complications was 11.9% (fever 8.7%, sepsis 3.2%), with no significant differences between risk groups. A low concordance was observed between preoperative and intraoperative urine cultures (Spearman = 0.3954). Conclusions: A single preoperative antibiotic dose adjusted to the antibiogram, even in patients with a positive urine culture, was not associated with increased infectious complications. This approach is an initial step that supports a rational and individualized prophylactic strategy aligned with the goals of antimicrobial stewardship programs (ASPs). Full article

Background: Histologic chorioamnionitis (HCA) is a placental inflammatory condition characterized by neutrophilic infiltration of the fetal membranes, often occurring without overt clinical signs or symptoms. Risk factors include prolonged labor, premature rupture of membranes (PROM) exceeding 12 h, nulliparity, labor dystocia, and lower socioeconomic status. Although HCA frequently presents as a subclinical condition, its early diagnosis remains challenging. Nevertheless, HCA is associated with an increased risk of maternal and neonatal morbidity, including early-onset neonatal sepsis, cerebral palsy, and long-term neurodevelopmental impairment. We report the case of a 29-year-old primigravida at 40 + 0 weeks of gestation, admitted for decreased fetal movements. Discussion: Cardiotocographic (CTG) monitoring revealed a “zigzag pattern” in the absence of maternal fever, leukocytosis, or tachycardia. Due to the CTG findings suggestive of possible fetal compromise, in addition to reduced fetal movements, an emergency cesarean section was performed. Intraoperative findings included heavily meconium-stained amniotic fluid, then the examination of the placenta confirmed acute HCA with a maternal inflammatory response, without evidence of fetal inflammatory response. Conclusion: This case highlights the crucial role of CTG abnormalities, particularly the “zigzag pattern,” as an early marker of subclinical intrauterine inflammation. Early recognition of such patterns may facilitate timely intervention and improve perinatal outcomes in cases of histologic chorioamnionitis. Full article

Objectives: Our objective was to investigate the clinical characteristics, complications, and treatment outcomes of Epstein–Barr virus (EBV)-related infectious mononucleosis (IM) in children and to identify risk factors associated with prolonged fever and abnormal liver function. Methods: This retrospective study included 3006 children admitted to Shenzhen Children’s Hospital from May 2009 to April 2024 with suspected EBV-related IM. After excluding cases without etiological evidence and those with underlying diseases, 2660 cases were analyzed. Data on demographics, clinical manifestations, laboratory findings, complications, and treatment outcomes were collected. Logistic regression was used to identify risk factors for prolonged fever and abnormal liver function. Results: Among the 2660 confirmed cases, patients ranged from 8 months to 17 years of age, with a median age of 4 years and a male-to-female ratio of 1.46:1. Co-infections were identified in 369 (13.9%) patients, predominantly with Group A Streptococcus. Complications occurred in 560 (24.46%) of the 2289 patients without co-infections, with bronchitis being the most common (42.68%). Elevated ferritin and atypical lymphocyte percentage were associated with prolonged fever (p < 0.001), while elevated lactate dehydrogenase (LDH) and a lower CD4% predicted abnormal liver function (p < 0.001). Antiviral therapy did not shorten fever duration or hospital stay but prolonged both when combined with corticosteroids or intravenous immunoglobulin (IVIG) (p < 0.001). Conclusions: Specific laboratory markers such as ferritin, atypical lymphocyte percentage, LDH, and CD4% are important predictors of prolonged fever or liver dysfunction in EBV-IM. Our findings suggest that antiviral therapy may not be beneficial in uncomplicated cases and highlight the need for tailored treatment strategies to optimize patient outcomes. Full article

Background: Myelotoxicity, usually manifested by moderate leukopenia (particularly neutropenia), is a well-known adverse drug reaction to azathioprine (AZA) therapy. Thiopurine methyltransferase (TMPT) and nucleoside diphosphate-linked moiety X-type motif 15 (NUDT15) genotyping are not routinely performed in patients starting AZA therapy due to their low cost-effectiveness. Additionally, the concomitant use of xanthine oxidase inhibitors and 5-aminosalicylates may slow the metabolism of 6-mercaptopurine. Case Description: We describe a case of a 26-year-old Caucasian man with Crohn’s disease and psoriatic arthritis treated with mesalazine and AZA (100 mg daily) who developed prolonged bone marrow aplasia and neutropenic fever after increasing the daily dose of AZA from 100 to 150 mg (from 44 to 66 mg/m²), without frequent total blood count monitoring. Discontinuation of AZA, multiple transfusions of red blood cells and platelet concentrate, filgrastim, empirical antibiotic therapy, and antiviral and antifungal prophylaxis were obtained after 11 days complete recovery of bone marrow aplasia. Methods: Genomic DNA genotyping of coding regions of TPMT (exons 2–9) and NUDT15 (exons 1–3). Results: Heterozygous alleles in the untranslated region (c.460G>A and c.719A>G) associated with TPMT deficiency and a benign variant (c.*7G>A) in the 3′-UTR of NUDT15 with no effect on enzyme activity were found. Conclusions: This case highlights the importance of monitoring the total blood count frequently during the first weeks of treatment with moderate-to-high doses of AZA. Furthermore, the interaction between AZA and mesalazine may play a significant role in the development of prolonged bone marrow aplasia. Full article

Clostridioides difficile infection (CDI), the most common cause of nosocomial diarrhea, presents with a wide spectrum of clinical manifestations, ranging from mild diarrhea to severe, life-threatening conditions such as pseudomembranous colitis and toxic megacolon. In recent years, both the incidence and severity of CDI have increased, leading to a significant burden in terms of morbidity, mortality, and healthcare costs. We conducted a single-center, retrospective cohort study for 30 months at “Sf. Parascheva” Infectious Diseases Clinical Hospital Iași, in North Eastern Romania, aiming to assess the clinical and laboratory characteristics of CDI, as well as treatment approaches and their association with patient outcomes. A total of 534 patients were included during the study period, of whom 484 had favorable outcomes, while 50 have died of the disease. Fever (p = 0.007) and age over 65 (p = 0.001) were associated with prolonged hospitalization. Patients positive for both A and B toxins and GDH had the highest risk of recurrence (p = 0.020). Among comorbidities, obesity was the only condition significantly linked to recurrence (p = 0.001). In female patients over 65 years old, the probability of survival drops below 60% after 21 days of hospitalization, highlighting a critical risk factor in this population. These results underscore the importance of comprehensive risk assessment in CDI, particularly focusing on advanced age and comorbidities, to guide early therapeutic interventions, optimize patient management, and improve clinical outcomes among high-risk populations. Full article

Background: Prevention of an irreversible sequalae in neurosyphilis patients requires immediate high-dose intravenous benzylpenicillin administered for a prolonged period of time. However, life-threatening neutropenia has been reported as one of the complications following extended usage of benzylpenicillin. Case presentation: We report a 54-year-old male patient with HIV who developed high-dose benzylpenicillin-induced febrile neutropenia during neurosyphilis treatment. The patient developed a fever of up to 39.8 °C, severe leukopenia (<1 × 10⁹/L), and neutropenia (0.2 × 10⁹/L). He also presented with slightly elevated C-reactive protein and procalcitonin levels but had no clear symptoms of other infections. The diagnosis was confirmed by excluding other possible causes of neutropenia: flu, measles, sepsis, and HIV-related neutropenia. Third-generation antipseudomonal cephalosporin in combination with vancomycin and granulocyte colony-stimulating factor were administered, and the patient saw a rapid improvement in clinical symptoms and laboratory findings. Conclusions: High-dose benzylpenicillin-induced neutropenia should be considered a complication after prolonged periods of neurosyphilis treatment with high-dose benzylpenicillin when there is no evidence of other potential causes of neutropenia. Early diagnosis and proper treatment are critical in order to prevent this dangerous condition from deteriorating further. Full article

Background/Objectives: This overview provides a comprehensive safety evaluation of the approved live-attenuated vaccine VLA1553 (IXCHIQ^®) for active immunization for the prevention of disease caused by chikungunya virus (CHIKV) in clinical trials. Methods: Protocol-defined solicited systemic events (i.e., fever, arthralgia, myalgia, fatigue, and headache) and other unsolicited arthralgia-related events were evaluated. Additionally, during a regulatory review, a broader definition of adverse events of special interest (broad-definition AESIs) (fever and ≥1 AESI symptom within 30 days post-vaccination) was evaluated post hoc. Results: The most frequently reported solicited systemic events post-VLA1553 included fever (13.5%), arthralgia (17.2%), myalgia (23.9%), fatigue (28.5%), and headache (31.6%), with very few prolonged symptoms. The incidence of unsolicited arthralgia-related events (arthritis, osteoarthritis, musculoskeletal stiffness, joint stiffness, and joint swelling) was comparable between VLA1553 and placebo groups. Broad-definition AESIs were observed in 11.7% (361/3082) participants (VLA1553) and 0.6% (6/1033) participants (placebo), with a duration of 1–182 days (median: 4 days; prolonged broad-definition AESI [≥1 symptom lasting ≥ 30 days] occurred in 0.5% of participants) (VLA1553) and 4–27 days (median: 8 days) (placebo). Most symptoms contributing to broad-definition AESIs were solicited. In the VLA1553 group, the most common of these symptoms, in addition to fever, were headache (9.1% of participants), fatigue (8.6%), myalgia (7.0%), and arthralgia (5.2%). There were few severe cases (1.6% of participants in the VLA1553 group). Conclusions: In clinical trials, VLA1553 showed an acceptable safety profile that was consistent with other live-attenuated vaccines. The incidence of broad-definition AESIs was mainly limited to the immediate post-vaccination period, and broad-definition AESI symptoms were mostly solicited systemic adverse events. Full article

Visceral leishmaniasis (VL) is a severe parasitic disease caused by Leishmania spp., with a significant impact on pediatric populations, particularly in endemic regions. The diagnosis of VL in children requires a high index of suspicion, as clinical manifestations—such as prolonged fever, hepatosplenomegaly, and pancytopenia—overlap with other infectious and hematologic diseases. While serological and molecular tests aid in detection, bone marrow aspiration remains the gold standard for definitive diagnosis. In this case series, we describe five pediatric patients diagnosed with VL in Italy, emphasizing the importance of a timely and accurate diagnostic approach. Liposomal amphotericin B (LAmB) is the first-line treatment in Southern Europe due to its high efficacy and reduced toxicity. Our patients received a standard regimen of 3 mg/kg daily for five days, plus an additional dose on day 10, leading to rapid clinical improvement. However, some cases required supportive care, such as red blood cell transfusions, particularly in patients with co-infections. Despite being a neglected disease, VL is re-emerging in Europe, influenced by climate change, increased pet ownership, and migration from endemic regions. Prevention strategies focus on vector control, canine vaccination, and public health awareness. The global rise in pediatric VL highlights the need for improved surveillance, access to affordable treatments, and the development of effective vaccines to mitigate the disease burden in both endemic and non-endemic areas. Full article

Dengue virus is the most prevalent arthropod-borne viral disease in humans. Severe dengue, defined by hemorrhagic fever and dengue shock syndrome, can develop quickly in people who have warning indications such as abdominal pain, mucosal bleeding, and a significant decrease in platelet count. Laboratory markers such as hematocrit, platelet count, liver enzymes, and coagulation tests are critical for early diagnosis and prognosis. This retrospective study was carried out from January 2023 to December 2024 at a super-specialty tertiary care hospital. There were 283 adult patients with dengue with warning signs, who were categorized into 102 with platelet transfusion and 181 with no platelet transfusion. Data on patient demographics, clinical history, laboratory values, and radiological findings were systematically obtained from hospital records at the time of admission. Laboratory parameters such as white blood cell (OR = 2.137), hemoglobin (OR = 2.15), aPTT (OR = 5.815), AST²/ALT (OR = 2.431), platelet count (OR = 26.261) and NS1 (OR = 4.279) were found to be significantly associated (p < 0.01) with platelet transfusion. Similarly, an increased prothrombin time (OR = 2.432) contributed to prolonged hospital stays and the presence of ascites (OR = 5.059), gallbladder wall thickening (OR = 4.212), and pleural effusion (OR = 2.917), contributing to the severity of the dengue infection. These significant laboratory markers help with identifying patients with dengue who may develop severe dengue, requiring platelet transfusion, thereby prioritizing patient care and enabling the implementation of targeted interventions. Full article

Background/Objectives: Deep neck space infections (DNSIs) in children, particularly parapharyngeal and retropharyngeal abscesses, pose a significant risk due to their ability to cause airway obstruction. The management of these infections in children differs from that in adults, requiring a multidisciplinary approach. This study aimed to evaluate the clinical presentation, diagnostic imaging, and surgical management of pediatric DNSIs. Methods: A retrospective review was conducted on pediatric patients (≤16 years) diagnosed with deep neck space infections between 2002 and 2022. A total of 266 cases were identified using ICD-10 codes, of which eight patients (3%) had para- or retropharyngeal abscesses. The clinical presentation, imaging modalities, airway management, and surgical approaches were analyzed. Results: Children with parapharyngeal or retropharyngeal abscesses had a mean age of 5.2 years, being significantly younger than those with peritonsillar abscesses (mean age: 13.5 years). The most common symptoms were a high fever (100%) and torticollis (63%). All patients underwent initial ultrasound (US), but a definitive diagnosis required contrast-enhanced CT or MRI. Seven patients (87.5%) underwent surgical drainage, with the decision to perform an incision dictated by the location of the abscess relative to vascular structures. Image-guided navigation facilitated minimally invasive transpharyngeal drainage in four cases. Postoperatively, six patients required prolonged intubation due to airway edema or surgical site management. One patient was successfully managed conservatively with antibiotics. Conclusions: DNSIs in children require prompt diagnosis and a tailored surgical approach. Imaging plays a crucial role in the localization of the abscess, with MRI preferred for detailed soft tissue assessment. Airway management is critical, and minimally invasive, image-guided techniques improve the precision of surgery. Multidisciplinary care optimizes patient outcomes. Full article

A 5-year-old boy affected by chronic granulomatous disease (CGD) underwent two allogeneic hematopoietic cell transplants (HCT) from the same unrelated donor. The first HCT was complicated by prolonged fever and primary graft failure. While fully aplastic, the patient developed a disseminated infection by Scedosporium apiospermum involving the knee and parasternal skin (day +34 and +40 post-HCT). The patient was treated with voriconazole and granulocyte transfusions followed by a second HCT 80 days after the first HCT. At day +105, the patient developed fever, headache, and altered level of consciousness associated with multiple bilateral cerebral abscesses at magnetic resonance imaging. The serum B-D-glucan test was positive. Micafungin was added to voriconazole. Despite an initial clinical improvement, the patient developed hydrocephalus. Scedosporium apiospermum was cultured from cerebrospinal fluid. Liposomal amphotericin B, instead of micafungin, was combined with voriconazole as salvage therapy. Unfortunately, the patient developed uncal herniation and died at day +193 from HCT. This case shows that the prognosis of scedosporiosis remains poor despite adequate antifungal treatment. Noteworthy, the B-D-Glucan test is confirmed useful as a non-invasive marker for early diagnosis and may help the differential diagnosis of mycoses. Full article

Background and Objectives: Eosinophilic lung diseases (ELD) encompass disorders with an abnormally high number of polymorphonuclear eosinophils in the lungs. Presentation severity can range from low-grade fever and cough to life-threatening acute respiratory distress syndrome (ARDS). Due to the rarity of these conditions, no large sample studies have been performed to assess the characteristics of patients with pulmonary eosinophilia. Materials and Methods: Patients admitted with a diagnosis of pulmonary eosinophilia between the years 2016 and 2020 were extracted from the largest inpatient US database, the Nationwide Inpatient Sample (NIS). Patients under the age of eighteen and those with diabetic ketoacidosis were excluded. Baseline demographic characteristics and medical comorbidities were evaluated for individuals admitted with pulmonary eosinophilia depending on intubation requirement. The primary outcomes included in-hospital mortality, intubation, and length of stay (LOS). Results: 3784 records were extracted, among which 384 patients required intubation. Patients who required intubation had higher rates of in-hospital mortality (23.9% vs. 1.2% p < 0.0001%) and a significantly more prolonged hospital stay (19 days vs. 6 days p < 0.001) compared to patients who did not need intubation. Factors associated with mortality in the intubated group included increasing age (OR: 1.022, 95% CI 1.002–1.042), duration of intubation superior to 96 h (OR: 2.705, 95% CI 1.235–5.927), and AKI (OR: 2.964, 95% CI 1.637–5.366). Conclusions: Our findings suggest that ELD patients requiring intubation experience significantly higher rates of in-hospital mortality, acute kidney injury, deep venous thrombosis, and ARDS. Full article

Background: Kawasaki disease (KD) is an acute inflammatory vasculitis with a particularly high incidence of coronary artery complications and constitutes a significant cause of acquired heart disease in children and young adults. Methods: We conducted a retrospective analysis of consecutive patients aged 0–18 years hospitalized at the “Prof. Dr. Matei Balş” National Institute of Infectious Diseases in Bucharest with Kawasaki disease over a period of 6 years (2018–2023). Results: A total of 25 children were discharged from hospital with this diagnosis during the analyzed period. The mean age was 2.9 years, and 56% were boys. Fever ≥5 days was present in all cases, and the most frequent additional sign was the presence of oral changes. Patients were treated according to in-effect guidelines with intravenous immunoglobulin (IVIG) (100%) and acetylsalicylic acid (68%). Only two cases were considered IVIG resistant and received a second IVIG infusion. Only mild cardiovascular changes were noted in echocardiography: mild coronary artery dilatation (21.7% of cases), mild valvular regurgitation, and small pericardial effusion. Infants displayed less inflammation and higher percentages of leukocytosis, developed an increase in platelet count sooner, received IVIG faster, and had longer hospital stays. Outcomes were generally favorable, and 92% of children were discharged, while the two remaining patients were transferred to other centers. No deaths were recorded. Conclusions: To our knowledge, this is the largest contemporary Romanian cohort of Kawasaki disease published to date, outlining the local diagnostic process, therapeutic strategies, and early outcomes of Kawasaki disease. Full article