Epidemiology of human giardiasis in Romania: A 14 years survey

Prevalence and Genotyping of Water- and Food-Borne Parasitic Protozoans (Giardia duodenalis and Cryptosporidium spp.) in Hospitalized Patients from Northwestern Romania

Giardia duodenalis and Cryptosporidium spp. are important zoonotic protozoan pathogens that infect the gastro-intestinal tract of numerous vertebrates, including humans, and both parasites are responsible for water- or food-borne outbreaks of disease worldwide. Although, globally, both parasites are highly prevalent, particularly in developing countries, epidemiological data from Romania are scarce, and genotyping has rarely been performed. The aims of the present study were to investigate the occurrence and genetic diversity of G. duodenalis and Cryptosporidium spp. in patients hospitalized in Northwestern Romania in relation to clinical and paraclinical presentation and to identify the relative frequency of non-specific symptoms and potential risk factors. Between June 2022 and January 2024, 426 fecal samples were screened for gastro-intestinal parasites by rapid tests and microscopical examination, further confirmed by PCR and sequencing. Giardia duodenalis was detected and characterized in 12 samples (2.82%), while Cryptosporidium parvum was confirmed in four samples (0.94%). A majority of positive patients were symptomatic and reported nausea and vomiting with a significantly higher frequency compared to negative ones. This study provides new insights into the epidemiological status and clinical implications of gastro-intestinal parasite species and genospecies in Romania that are necessary for an in-depth understanding of the potential zoonotic transmission and improvement of patient care.

Change in the incidence of intestinal diseases caused by parasitic protozoa in the Mexican population during the period (2015-2019) and its association with environmental and socioeconomic risk factors

Diarrheal diseases are one of the main health problems worldwide, especially in developing countries with poor health systems, high rates of poverty, and poor nutrition. The main causative agents of diarrheal disease are bacteria, viruses, and parasites; among the latter, the intestinal protozoa Giardia and Entamoeba stand out. In the present work, a observational analysis of the national surveillance data of amebiasis, giardiasis, and other protozoan intestinal infections was carried out. The data issued by the Directorate General of Epidemiology was analyzed to establish its relationship with geography, socioeconomic, and environmental conditions in Mexico during the 2015-2019 period. New cases of amebiasis decreased by 25.03% between 2015 and 2019, while giardiasis and other protozoan intestinal infections remained constant; in all cases, incidence was higher in females than in males, and children under 5 years of age were the most affected. The contribution of environmental conditions (seasonality, temperature, and humidity) and socioeconomic factors in the number of protozoan intestinal infection cases was assessed by a multivariable regression model using a backward selection procedure. Peaks in cases were observed in spring and summer, which are characterized by warm and humid climates. Additionally, states with high humidity and annual average temperature contribute to a notably higher incidence of these parasites, especially annual average temperature, as demonstrated through multivariable linear regression models. Moreover, the majority of these states have the largest population living in poverty with inadequate measures for the distribution, dispensing, and sanitation of water. These data are essential to incidence rate monitoring and focus efforts on eliminating risk factors and improving health programs in Mexico.

Epidemiology of botulism in the north-western Romania-a 7-year survey

Botulism is a rare, acute, life-threatening neuro-paralysis. The digestive onset may raise diagnostic issues. The objective of our study was to analyze the clinical and epidemiological data of patients diagnosed with botulism and hospitalized in "Gavril Curteanu" Municipal Clinical Hospital (Oradea, Romania). Detection of the Clostridium botulinum neurotoxin (type B) in the laboratories of the National Institute of Medical-Military Research Development "Cantacuzino", Bucharest, Romania (using the mouse bioassays method) confirmed the diagnostics. The statistical analysis was performed using the IBM SPSS software. Forty-eight patients with the diagnosis of foodborne botulism were hospitalized between 2012 and 2018 (36.92% of the total number of cases of botulism reported in Romania). The winter-spring period was the period when most cases were registered (36 patients, p=0.020). Women from rural areas were predominant (but not statistically significant), and the patients' mean age was 39.93±12.59 years. The most common source/cause of botulism was the consumption of homemade ham. The incubation period was 26.68±22.94 h, and 2.25±1.68 days passed from the clinical onset to diagnosis. The results prove that botulism is still a public health issue, especially in areas where homemade products are prepared using inappropriate/unsafe recipes/procedures.

Retrospective analysis and time series forecasting with automated machine learning of ascariasis, enterobiasis and cystic echinococcosis in Romania

The epidemiology of neglected tropical diseases (NTD) is persistently underprioritized, despite NTD being widespread among the poorest populations and in the least developed countries on earth. This situation necessitates thorough and efficient public health intervention. Romania is at the brink of becoming a developed country. However, this South-Eastern European country appears to be a region that is susceptible to an underestimated burden of parasitic diseases despite recent public health reforms. Moreover, there is an evident lack of new epidemiologic data on NTD after Romania's accession to the European Union (EU) in 2007. Using the national ICD-10 dataset for hospitalized patients in Romania, we generated time series datasets for 2008-2018. The objective was to gain deep understanding of the epidemiological distribution of three selected and highly endemic parasitic diseases, namely, ascariasis, enterobiasis and cystic echinococcosis (CE), during this period and forecast their courses for the ensuing two years. Through descriptive and inferential analysis, we observed a decline in case numbers for all three NTD. Several distributional particularities at regional level emerged. Furthermore, we performed predictions using a novel automated time series (AutoTS) machine learning tool and could interestingly show a stable course for these parasitic NTD. Such predictions can help public health officials and medical organizations to implement targeted disease prevention and control. To our knowledge, this is the first study involving a retrospective analysis of ascariasis, enterobiasis and CE on a nationwide scale in Romania. It is also the first to use AutoTS technology for parasitic NTD.

Efficiency of antiviral treatment in COVID-19

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic is responsible for generating a global effort to discover urgent therapeutic solutions to limit the human damage caused by COVID-19. In the period of April to June 2020, 105 patients diagnosed with COVID-19 met the conditions for inclusion in the present study. They were treated with antiviral therapy according to local guidelines: D group (53 cases), treated with darunavir/ritonavir (DRV/r); and K group (52 cases), treated with lopinavir/ritonavir (LPV/r). Patients from the K group required 7.5 days of hospitalization less compared to those from the D group (P<0.001). The blood oxygen saturation values recorded in the groups were statistically different [K group (94.02±3.12%) vs. D group (92.13±4.24%), P=0.010]. The percentage of patients with unsatisfactory clinical evolution were non-significantly higher in the D group compared with the K group [20 (37.74%) vs. 12 (23.08%), P=0.157]. We did not note statistically significant differences between the two groups tracked considering the values for the Brescia-COVID Respiratory Severity Scale (BCRSS) of the patients with unsatisfactory clinical evolution, nor of the chest CT' evolution after 10 days of therapy. We did not register significant adverse effects after antiviral therapy in the two groups. Antiviral therapy with LPV/r had some favorable results compared to DRV/r in patients with COVID-19. Both therapies were well tolerated.

Distribution of hepatitis C virus genotypes in Punjab region, Pakistan, based on a study of 4177 specimens

Hepatitis C virus (HCV) is a heterogenetic infectious agent that affects a huge proportion of population around the globe. Diverse distribution of multiple subtypes of HCV makes it mandatory and remarkably imperative to understand the genotypic distribution in target population. It could serve as an indictive guideline for the improvement of diagnostic methodologies, and development of effective therapies against this viral infection, in order to improve the infected patients' quality of life. This study included HCV infected patients presented to the diagnostic facility of the Centre for Applied Molecular Biology, University of Punjab, Lahore, between 2016 and 2019. During the 4 years of study, samples were collected from 4177 subjects. Our data revealed no significant differences regarding the prevalence of various genotypes between genders in the adult population. Genotyping was carried out by following the Ohno protocol. The obtained results shown that genotype 3a is the most frequent genotype and accounts for 66.29% of cases. Among other genotypes, 1a is 2.11%, 1b is 0.07%, 3b is 1.89%, 5a is 0.02%, while genome of 28.23% patients was untypable; 1.22% of the samples were non-detectable as viremic. An important concern is that this untypable genome in HCV infected patients may indicate possible mutation of HCV.

Risk Factors Associated with Recurrent Clostridioides difficile Infection

Clostridioides difficile (CD) is responsible for nosocomial diarrhea syndrome with possible severe progression. Recurrence of the disease induces higher health system costs, as well as exposes patients to additional health risks. Patients with recurrence of this disease are difficult to identify, so the purpose of this study is to quantify various demographic, clinical, and treatment factors that could prevent further progression to recurrence of the disease. In the period 2018–2019, about 195 patients were diagnosed with more than one episode of CDI in the three months following the first episode. The recurrence rate for CDI was 53.84% (60.95% for one episode and 39.05% for multiple episodes). Most commonly afflicted were 60–69-year-old patients, or those with higher Charlson Comorbidity Index (CCI). Multiple analyses associated cardiovascular (odds ratios (OR) = 3.02, 95% confidence intervals (CI) = 1.23–7.39, p = 0.015), digestive (OR = 3.58, 95% CI = 1.01–12.63, p = 0.047), dementia (OR = 3.26, 95% CI = 1.26–8.41, p = 0.014), immunosuppressive (OR = 3.88, 95% CI = 1.34–11.21, p = 0.012) comorbidities with recurrences. Risk factor identification in the first episode of CDI could lead to the implementation of treatment strategies to improve the patients’ quality of life affected by this disease.

Risk Factors Associated with Recurrent Clostridioides difficile Infection

Clostridioides difficile (CD) is responsible for nosocomial diarrhea syndrome with possible severe progression. Recurrence of the disease induces higher health system costs, as well as exposes patients to additional health risks. Patients with recurrence of this disease are difficult to identify, so the purpose of this study is to quantify various demographic, clinical, and treatment factors that could prevent further progression to recurrence of the disease. In the period 2018-2019, about 195 patients were diagnosed with more than one episode of CDI in the three months following the first episode. The recurrence rate for CDI was 53.84% (60.95% for one episode and 39.05% for multiple episodes). Most commonly afflicted were 60-69-year-old patients, or those with higher Charlson Comorbidity Index (CCI). Multiple analyses associated cardiovascular (odds ratios (OR) = 3.02, 95% confidence intervals (CI) = 1.23-7.39, p = 0.015), digestive (OR = 3.58, 95% CI = 1.01-12.63, p = 0.047), dementia (OR = 3.26, 95% CI = 1.26-8.41, p = 0.014), immunosuppressive (OR = 3.88, 95% CI = 1.34-11.21, p = 0.012) comorbidities with recurrences. Risk factor identification in the first episode of CDI could lead to the implementation of treatment strategies to improve the patients' quality of life affected by this disease.