Introduction: Despite the advances in its prevention, invasive meningococcal disease (IMD) remains a serious health problem worldwide due to its high morbidity and mortality, including in Romania, with 22% mortality rate. The objectives were to describe the trends of IMD cases admitted to a tertiary care hospital in Romania, over 24 years, and the case fatality rate (CFR) by age, year of admission, and Neisseria meningitidis serogroups. Materials and Methods: A retrospective study was conducted in IMD patients admitted to the National Institute for Infectious Diseases “Prof. Dr. Matei Bals”, Bucharest, Romania, between 2001 and 2024. Results: A total of 256 IMD patients were admitted, 171 under fourteen years, out of which 75 were infants. Most cases were reported before 2008. The case distribution showed 90 patients (35%) with meningitis, 84 (32%) with meningococcaemia, and 82 (32%) with an association of both. Serogroup B was the most frequently and steadily found (58 cases). The overall CFR was 12%. CFR was highest in infants younger than 6 months (19%) and meningococcaemia cases (29%). Conclusions: In our study, IDM had the highest frequency and CFR in infants and meningococcaemia cases. The trends showed a decline in cases after 2008. Serogroup B was the most prevalent and stable strain over 24 years.

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.

The accurate differentiation between asymptomatic carriage with group A streptococcus (GAS) and active streptococcal pharyngitis is a complex task with important clinical and public health implications. This work aims to highlight the key strategies necessary for optimizing the diagnostic and therapeutic management of pediatric pharyngitis. Clinical scores are essential tools for improving diagnostic accuracy. When combined with laboratory tests such as throat cultures and rapid antigen detection tests, these systems enable effective risk stratification of patients, supporting more precise treatment decisions. In addition to diagnostic strategies, the article underscores the importance of patient-centered communication, particularly with the families of pediatric patients. Clear, empathetic discussions about the condition, diagnostic rationale, and treatment plan help foster trust, enhance adherence to medical recommendations, and reduce anxiety related to potential complications. A critical outcome of these combined strategies is the reduction of unnecessary antibiotic use, which plays a pivotal role in preventing both overdiagnosis and overprescription. This, in turn, mitigates the growing threat of antimicrobial resistance, one of the most significant global health challenges. By integrating clinical expertise, standardized protocols, and effective communication, healthcare providers can promote judicious and effective management of streptococcal pharyngitis or asymptomatic carriage, contributing to improved individual and population health outcomes.

Background: Herpes zoster (HZ) is uncommon in children and is typically considered a mild disease. However, hospitalized cases may be associated with complications. Data on herpes zoster in children in Eastern Europe are limited. This study aimed to describe the clinical features, complications, and factors associated with severity in hospitalized pediatric HZ. Methods: We conducted a retrospective cohort study including children (<18 years) hospitalized with HZ between January 2015 and December 2025, at a tertiary infectious diseases center in Bucharest, Romania. Demographic, clinical, laboratory, and outcome data were extracted from medical records. Univariable and multivariable analyses were performed to identify factors associated with complications and prolonged hospital stay. Results: Among 612 pediatric HZ cases, 92 (15.0%) required hospitalization. The median age was 8.8 years (IQR 4.8–13.2), and 52.2% were male. Overall, 43.5% developed complications, most commonly bacterial superinfection (30.4%), followed by neurological and ophthalmological involvement. Herpes zoster sine herpete was identified in 4.3% of cases and was associated with central nervous system involvement. Headache (OR = 4.34, p = 0.025) and lymphopenia (OR = 3.01, p = 0.020) were independently associated with complications. Patients with complications had longer hospital stays (median of 6 vs. 4 days, p = 0.002). In multivariable analysis, complications, immunocompromised status, and chronic conditions were associated with prolonged hospitalization. Conclusions: Herpes zoster in children is generally mild and has a favorable prognosis; however, hospitalized cases are often associated with complications, especially bacterial superinfections and neurological involvement. These findings derive from a selected population and highlight the role of clinical and host-related factors in shaping outcomes in hospitalized pediatric herpes zoster.