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.

The aim of this study was to evaluate differences in the clinical manifestations and outcomes in hospitalized patients with COVID-19 in a single Romanian center during four pandemic waves determined by different SARS-CoV-2 variants of concern (VOCs). A retrospective study on 9049 consecutive hospitalized adult patients was performed between 27 February 2020 and 31 March 2023. The study interval was divided into waves based on national data on SARS-CoV-2 VOCs’ circulation. Multivariate logistic regression models were built, predicting death and complications as functions of comorbidities, therapy, wave, severity form, and vaccination status, and adjusted for ages ≥65 years. Pulmonary (pneumothorax/pneumomediastinum, pulmonary embolism) and extrapulmonary complications (liver injury, acute kidney injury, ischemic/hemorrhagic stroke, myocardial infarction, and gastrointestinal bleeding) were present, more frequently in ICU hospitalized patients and with differences between waves. The highest in-hospital mortality was found in patients presenting pneumothorax/pneumomediastinum. All of the evaluated risk factors were significantly associated with death, except for obesity and the Omicron wave. Our study highlights the changing nature of COVID-19 and acknowledges the impacts of viral mutations on disease outcomes. For all four waves, COVID-19 was a severe disease with a high risk of poor outcomes.

Visceral leishmaniasis is a rare parasitic infection in non-endemic regions such as Romania. We report the case of a 25-year-old female kidney transplant recipient from Cluj County, Romania, who developed persistent bicytopenia with anemia and thrombocytopenia. Despite no history of travel outside Cluj County and being the only organ recipient from the same donor to experience signs and symptoms, she was diagnosed with visceral leishmaniasis. The second bone marrow aspirate performed revealed Leishmania amastigotes. She was quickly sent to Victor Babes Infectious Disease Hospital in Bucharest for additional tests and treatment. The kidney function of the patient was maintained. This case highlights the importance of considering leishmaniasis in immunosuppressed patients presenting with unexplained cytopenia, even in non-endemic regions. This is the first documented case of visceral leishmaniasis in a kidney transplant recipient in Romania. The present report could serve as a foundation for future educational programs targeted toward informing both healthcare providers and patients about the risks, diagnosis, and management of leishmaniasis in immunosuppressed individuals in non-endemic regions.

Lyme neuroborreliosis (LNB) may mimic other neurological diseases, while neurological diseases may be misdiagnosed as LNB. The aims of the study were to contribute to the knowledge regarding the epidemiology and clinical manifestations of LNB, discuss differential diagnosis, and compare characteristics in patients with and without LNB. We present patients evaluated for suspected LNB by the multidisciplinary team of a “Lyme Borreliosis Centre” in a highly endemic area in Romania. A retrospective study was performed between January 2011 and October 2023 on patients referred for suspected LNB based on neurological manifestations and positive serology for Borrelia burgdorferi antibodies using two-tier testing. A lumbar puncture was performed for diagnosis, and the European LNB definition was used for classification. Of three hundred and three LNB suspected patients, five (1.65%) were classified as definite LNB, eighty-three (27.39%) as possible LNB, and in two hundred and fifteen patients (70.95%), LNB was excluded. Comparing the definite/possible to excluded LNB patients, there was no significant difference in neurological symptoms/manifestations. The patients presented fifty-one neurological, twelve rheumatological, and seven psychiatric diagnoses, with significantly more meningitis/encephalitis/myelitis diagnoses in the definite/possible LNB group, and more demyelinating disease and discopathy in the LNB-excluded group. Considering the complex differential diagnoses, access to laboratory diagnostics and multidisciplinary management should be available in centres that evaluate suspected LNB patients. Comparing results with data from the national surveillance system, we conclude that LNB is underdiagnosed/underreported in Romania.