Papers by Victoria Birlutiu
Bulletin of the Transilvania University of Braşov, Jul 6, 2023
Subacute thyroiditis (SAT) is an inflammatory condition affecting the thyroid gland, usually trig... more Subacute thyroiditis (SAT) is an inflammatory condition affecting the thyroid gland, usually triggered by a viral infection or occurring after a viral illness. It is characterized by neck tenderness, along with the typical symptoms of thyrotoxicosis and an elevated erythrocyte sedimentation rate. SAT has been identified as a potential complication associated with SARS-CoV-2 infection. The aim of this study is to present and discuss two cases of subacute thyroiditis that occurred following a viral infection, potentially linked to SARS-CoV-2 infection. We describe the clinical, biochemical, and imaging features of two cases of SAT that manifested six weeks after the onset of COVID-19-associated symptoms. Both cases involved female patients, aged 58 and 39, who developed subacute thyroiditis, characterized by neck pain, fever, and fatigue. These symptoms emerged three weeks after recovering from a viral episode marked by acute coryza, cough, and anosmia. Due to a persistent fever lasting three weeks, one of the patients required hospitalization to rule out other infectious causes of prolonged febrile syndrome. Laboratory analyses revealed elevated inflammatory markers, positive serology for SARS-CoV-2 infection, thyroid function tests showed thyroid over-activity and thyroid ultrasound confirmed the diagnosis of SAT. The patients received corticosteroid treatments and beta-blockers, resulting in the complete resolution of symptoms and normalization of inflammatory markers, within three weeks after the SAT diagnosis. Post-COVID-19 thyroiditis can emerge as a potential complication of SARS-CoV-2 infection. It is crucial for clinicians to be aware of this possibility, highlighting the importance of considering post-COVID-19 thyroiditis in patients presenting with relevant symptoms.
Experimental and Therapeutic Medicine, Sep 28, 2022
COVID-19 pandemic is a continuing ongoing emergency of public concern. Early identification of ma... more COVID-19 pandemic is a continuing ongoing emergency of public concern. Early identification of markers associated with disease severity and mortality can lead to a prompter therapeutic approach. The present study conducted a multivariate analysis of different markers associated with mortality in order to establish their predictive role. Confirmed cases of 697 patients were examined. Demographic data, clinical symptoms and comorbidities were evaluated. Laboratory and imaging severity scores were reviewed. A total of 133 (19.1%) out of 697 patients succumbed during hospitalization. Obesity was the most common comorbidity, followed by hypertension, diabetes, coronary heart disease and chronic kidney disease. Compared with the survivor patients, non-survivors had a higher prevalence of diabetes, chronic kidney disease and coronary heart disease, as well as higher values of laboratory markers such as neutrophil-lymphocyte ratio (NLR), D-dimer, procalcitonin, IL-6 and C Reactive protein (CRP) and respectively high values of imaging severity scores. Multivariate regression analysis showed that high values of the proposed markers and chest computerized tomography (CT) severity imaging score were predictive for in hospital death: NLR [
Germs, Mar 1, 2022
IntroductionAmong the less common symptoms associated with the SARS-CoV-2 infection the attention... more IntroductionAmong the less common symptoms associated with the SARS-CoV-2 infection the attention is drawn by a persistent hiccup that was recently quoted in the literature.Case reportWe present the case of a 46-year-old Caucasian male patient hospitalized in the Infectious Diseases Clinic of the Academic Emergency Hospital Sibiu, Romania with laboratory confirmation of SARS-CoV-2 infection with a positive result of real-time reverse transcriptase–polymerase chain reaction (RT-PCR) assay from nasopharyngeal swabs, that during the disease course developed persistent hiccup associated with the administration of cortisone therapy, dexamethasone. A decision to stop the treatment with cortisone preparations was made, with the disappearance of the hiccup after 36 hours.ConclusionsFrom our experience, other cases of SARS-CoV-2 infection that we managed during these months of the pandemic, with mild or severe forms of the disease, showed hiccup under treatment with dexamethasone, an event also described in other medical conditions under the same treatment and improved at its cessation or when replaced by methylprednisolone.
Biomedicines, Mar 27, 2023
This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY
Romanian Biotechnological Letters, 2020
Not much time has passed since it was established that the coagulation balance is changed towards... more Not much time has passed since it was established that the coagulation balance is changed towards hypercoagulability in patients with chronic liver disease. The relationship between hypercoagulability and fibrogenesis in these patients can also be surprising, but it is a clinical reality. Microthrombi produced into intrahepatic vascular tree lead to ischemic lesions, followed by parenchymal extinction or hepatocytes collapse and hepatic stellate cells activation through a direct thrombin-mediated pathway or preceded by an inflammatory response. Hepatic stellate cells are the main effector cells involved in liver fibrogenesis, although they are also central regulators of liver immunology. Subsequently, a fibrous tissue remodeling occurs. Hepatitis C virus can produce direct endothelial lesions involved in tissue factor activation, alteration of fibrinolysis and augmented platelet activity and aggregability. The patients with chronic hepatitis C and detectable tissue factor microparticles activity had a higher mean liver stiffness score measured by transient elastography. Liver fibrosis progresses more rapidly in patients with chronic liver diseases who are carriers of some thrombophilic markers. Some of cryptogenic cirrhosis may be due to the presence of thrombophilic factors or their association with the blood group type non-O. The relationship between hypercoagulability and fibrogenesis provide new potential therapeutic targets.
Biomarkers, 2019
Background: There is only limited data in the literature on the thrombotic risk of patients with ... more Background: There is only limited data in the literature on the thrombotic risk of patients with Clostridium difficile colitis, although this disease is widespread throughout the world. Objective: The aim of this study was to explore thrombin generation in these patients-the best way to evaluate their coagulation. Methods: A prospective observational study was conducted during 15 months on hospitalized patients with Clostridium difficile colitis. Thrombin generation was performed in platelet-poor plasma using a Ceveron® alpha analyzer and was compared with a group of volunteer control subjects. Results: Thirty-three patients and 51 control subjects were enrolled in the study. Two biomarkers-mean velocity index and peak thrombin-were significantly higher in patient group, compared to the control subjects (p=0.010, respectively p=0.0395). This pattern of thrombin generation suggests that patients with Clostridium difficile colitis without septic shock have a potential thrombotic risk. The mean velocity index significantly correlated with the estimated related risk of death according to Charlson age-comorbidity index. Conclusions: The higher values of thrombin generation suggest that Clostridium difficile colitis increases the thromboembolic risk. The pattern of thrombin generation could identify patients with particularly higher thromboembolic risk. They are potential candidates for thromboprophylaxis strategies and monitorization.
Is an isolated positive sonication fluid culture in revision arthroplasties clinically relevant?
Clinical Microbiology and Infection, Jul 1, 2023
Open Forum Infectious Diseases
Background Previous studies demonstrated the efficacy of a rifampicin-based regimen in the treatm... more Background Previous studies demonstrated the efficacy of a rifampicin-based regimen in the treatment of acute staphylococcal periprosthetic joint infections (PJIs) treated with surgical debridement. However, evidence is lacking to support the use of rifampicin in cases where the implant is exchanged during revision. Methods We included all consecutive cases of staphylococcal PJIs treated from January 2013 to December 2018 with revision surgery in this international, retrospective, multicenter observational cohort study. PJI was defined according to the European Bone and Joint Infection Society diagnostic criteria. A relapse or reinfection during follow-up, the need for antibiotic suppressive therapy, the need for implant removal, and PJI-related death were defined as clinical failure. Cases without reimplantation or with follow-up <12 months were excluded. Results A total of 375 cases were included in the final analysis, including 124 1-stage exchanges (33.1%) and 251 2-stage exc...
Microorganisms
Background: PJIs following total hip and knee arthroplasty represent severe complications with br... more Background: PJIs following total hip and knee arthroplasty represent severe complications with broad implications, and with significant disability, morbidity, and mortality. To be able to provide correct and effective management of these cases, an accurate diagnosis is needed. Classically, acute PJIs are characterized by a preponderance of virulent microorganisms, and chronic PJIs are characterized by a preponderance of less-virulent pathogens like coagulase-negative staphylococci or Cutibacterium species. This paper aims to analyze if there are any changes in the causative microorganisms isolated in the last years, as well as to provide a subanalysis of the types of PJIs. Methods: In this single-center study, we prospectively included all retrospectively consecutive collected data from patients aged over 18 years that were hospitalized from 2016 through 2022, and patients that underwent a joint arthroplasty revision surgery. A standardized diagnostic protocol was used in all cases,...
Pharmaceuticals
The Gram-positive anaerobic bacterium Clostridioides difficile (CD) can produce intense exotoxins... more The Gram-positive anaerobic bacterium Clostridioides difficile (CD) can produce intense exotoxins, contributing to nosocomial infections, and it is the most common cause of health-care-associated infectious diarrhea. Based on spontaneous Individual Case Safety Reports from EudraVigilance (EV), we conducted a descriptive analysis of Clostridioides difficile infection (CDI) cases that reported a spontaneous adverse reaction related to using ceftriaxone, colistimethate, ciprofloxacin, gentamicin, linezolid, meropenem, and piperacillin/tazobactam. Most ADR reports registered in EV that were related to CDI were associated with ceftriaxone (33%), ciprofloxacin (28%), and piperacillin/tazobactam (21%). Additionally, the disproportionality analysis performed showed that all studied antibiotics had a lower reporting probability when compared to clindamycin. A causal relationship between a drug and the occurrence of an adverse reaction cannot be established from EV data alone because the phen...
Correlations between serum leptin levels and classical biomarkers in SARS-CoV-2 infection, in critically ill patients
Microbial Pathogenesis
Healthcare
Human hepatic fasciolosis has been reported in 81 countries, some of which are endemic areas. In ... more Human hepatic fasciolosis has been reported in 81 countries, some of which are endemic areas. In Europe, case reports from humans were published in Portugal, Spain, France, and Italy. Regarding Romania, we do not have any data on the prevalence of this parasitosis, with the exception of two cases of twins that were born in Romania and diagnosed in the last 37 years in Italy after joining their mother that lived there. We report the case of a patient diagnosed in Romania with chronic fasciolosis, presented as a hepatic pseudotumor that was diagnosed during the histopathological examination of the hepatic lesion. The patient received oral treatment with triclabendazole, two doses of 10 milligrams (mg) per kilogram (kg) of body weight, given 12 h apart, with no side effects during or after the treatment. The evolution of the patient was favorable. In conclusion, even in areas free of human fasciolosis, the presence of an anemic syndrome especially in children, abdominal pain in the upp...
Antibiotics
Antimicrobial resistance is considered one of the major threats to public health and is an import... more Antimicrobial resistance is considered one of the major threats to public health and is an important factor that influences the patient’s outcome in the intensive care unit. Pharmacovigilance can help raise awareness of potential drug resistance (DR) or ineffectiveness (DI) through adverse drug reaction reports that are submitted to different spontaneous reporting systems. Based on spontaneous Individual Case Safety Reports from EudraVigilance, we conducted a descriptive analysis of adverse drug reactions associated with meropenem, colistin, and linezolid, with a focus on DR and DI. Of the total adverse drug reactions (ADRs) reported for each analyzed antibiotic by 31 December 2022, between 2.38–8.42% and 4.15–10.14% of the reports were related to DR and DI, respectively. A disproportionality analysis was conducted to evaluate the frequency of reporting adverse drug reactions relevant to the DR and DI of the analyzed antibiotics compared to other antimicrobials. Based on the analysi...
Tropical Medicine and Infectious Disease
Streptococcus pseudoporcinus is a nonmotile Gram-positive, catalase, and benzidine negative, arra... more Streptococcus pseudoporcinus is a nonmotile Gram-positive, catalase, and benzidine negative, arranged in short chains, isolated from the genitourinary tract group B Streptococcus. S. pseudoporcinus was also identified from blood, urine, skin, cervical area, wounds, rectum, and placenta samples. Two cases of infective endocarditis have been reported in the literature. Based on these data, the identification of a case of S. pseudoporcinus infective endocarditis associated with spondylodiscitis in a patient with undiagnosed systemic mastocytosis until the age of 63 years is unusual. Two sets of blood specimens were collected, and both sets were positive for S. pseudoporcinus. Transesophageal echocardiography revealed, multiple vegetations on the mitral valve. A lumbar spine MRI revealed L5-S1 spondylodiscitis that associates prevertebral and right paramedian epidural abscesses with compressive stenosis. The performed bone marrow biopsy, and cellularity examination revealed 5–10% mast c...
Ventilator-associated pneumonia is one of the most severe complications of critically ill patient... more Ventilator-associated pneumonia is one of the most severe complications of critically ill patients that need mechanical respiratory support, as it poses a significant risk of prolonging hospitalization, disability, and even death. This is why physicians worldwide target newer methods for prevention, early diagnosis, and early target treatment for this condition. There are few methods for a quick etiological diagnosis of pneumonia, especially point of care, and most are only readily available in some intensive care units. This is why a new, simple, and cheap method is needed for determining the bacteria that might be infectious in a particular patient. The method in question is sonication. Method: In this prospective, observational, single-center study, endotracheal cannula specimens will be collected from a minimum of 100 patients in our intensive care unit. This specimen will be submitted to a specific sonication protocol for bacteria to dislodge the biofilm inside the cannula. The...
The Parvovirus B19 infection is responsible in children for the fifth disease, also called erythe... more The Parvovirus B19 infection is responsible in children for the fifth disease, also called erythema infectiosum or the slapped-cheek disease. In patients with chronic hemolytic anemia such as sickle-cell disease, spherocytosis, pyruvate kinase deficiency or beta-thalassemia, the parvovirus B19 infection may induce transient aplastic crisis diagnosed by the decreasing of hemoglobin with more than 2g/dL or reticulocytes under 0.2%. The infection in immunocompetent adults is rarely associated with rash, 80% of women present pain in the inter-phalangeal joint of the hands, fist, elbow, knee, occasionally in the cervical and lumbar region and hips, pain that lasts for 2-4 weeks. The Parvovirus B19 infection associated with the first semester of pregnancy may induce miscarriage in 5-10% of cases and hydrops fetalis in the second and third trimester In immunocompromised patients, the parvovirus B19 causes a persistent infection. We report a case of a female patient with aplastic anemia associated with iron-deficiency anemia in the context of parvovirus B19 infection.
Rezumat: Prezentăm cazul unui bărbat de 34 ani, la risc de muşcături de căpuşă profesional, inter... more Rezumat: Prezentăm cazul unui bărbat de 34 ani, la risc de muşcături de căpuşă profesional, internat în secţia Boli Infecţioase a Spitalului Clinic Judeţean Sibiu cu meningoencefalită acută, cu evoluţie bifazică, cu serologie IgM pozitivă pentru encefalita de c ă puşă şi boala Lyme, complicată cu bronhopneumonie.
Cuvinte cheie: infecţii, tablou clinic, tratament Rezumat: Infecţiile la vârstnici, se diferenţia... more Cuvinte cheie: infecţii, tablou clinic, tratament Rezumat: Infecţiile la vârstnici, se diferenţiază de cele ale adultului imunocompetent prin aspectele etiologice, tablouri clinice atipice, discordante cu severitatea bolii, dar şi prin atitudinea terapeutică la un pacient cu comorbidităţi, insuficienţe de organ asociate senescenţei, aflat în tratamentul cronic al acestora (polipragmazie). Susceptibilitatea crescută la infecţii a vârstnicului este favorizată de scăderea imunităţii umorale şi celulare, a funcţiilor fiziologice, medicaţie imunosupresivă, imobilizare etc. În acest articol vom prezenta particularităţile etiologice, clinice şi terapeutice ale infecţiilor urinare, pulmonare, articulare, digestive, meningocerebrale şi sistemice la vârstnici. Abstract: Infections in the elderly are different from those of the immunocompetent adult through etiological aspects, atypical clinical presentations, discordant with the disease severity, but also in terms of the therapeutic approach ...
Cuvinte cheie: boala Lyme, Borrelia Rezumat: Modificările climaterice din ultimii 3 ani, au antre... more Cuvinte cheie: boala Lyme, Borrelia Rezumat: Modificările climaterice din ultimii 3 ani, au antrenat importante modificări în circulaţia vectorilor şi implicit, în incidenţa antropozoonozelor. Este şi cazul bolii Lyme, transmisă în zonă predominant prin Ixodes ricinus, a cărei incidenţă a crescut în România, de la 0.5% 000 locuitori în 2009 la 1.5% 000 locuitori în 2010, respectiv 2.2% 000 locuitori în 2011. În centrul ţării, se constată cea mai mare incidenţă, în judeţul Sibiu, de peste două deviaţii faţă de media naţională. Material şi metodă: Ne-am propus un studiu observaţional, în perioada 2009-2011, al cazurilor confirmate cu infecţie cu Borrelia spp, analizând lotul din punct de vedere demografic, aspecte clinice şi de stadializare, probleme de diagnostic, terapia şi evoluţia cazurilor. Rezultate: Dacă în 2009, am confirmat clinic şi serologic prin ELISA şi Western Blot 15 cazuri de boală Lyme, în 2010, 71 cazuri, în 2011 numărul a crescut la 128. Au fost înregistrate mai mul...
The biofilm is a structure consisting of bacterial cells (one or more microorganism species), an ... more The biofilm is a structure consisting of bacterial cells (one or more microorganism species), an aggregate of microorganisms, in which cells are surrounded by a matrix produced by the bacteria, a structure in which the cell that are adherent to each other and/or to a surface.
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Papers by Victoria Birlutiu