Infections with cestodes from genus Echinococcus are usually acquired by oral ingestion of eggs, direct contact with carriers, and contaminated food (especially vegetables) or water. Echinococcosis, previously characterized as a malady of medical importance only, depends upon veterinary solutions and faces political obstacles; it is considered the most important zoonotic disease in Romania. As a result of the increased number of human and animal cases, Romania was framed in the forefront of the European countries and among the first countries worldwide in 1995. The present paper is the first international systematized review concerning echinococcosis in Romania. It covers a period of 146 years, beginning in 1862, when the first case of human hydatid disease was mentioned in medical annals, until 2007 and aims at overviewing and analyzing data provided by major studies from different fields of human and veterinary medicine. Authors also present unpublished data of a 37-year surveillance performed in a reference infectious disease hospital. During the period 1979-1988, 8557 patients were hospitalized for hydatid disease requiring 210,057 days of health care, and 516 fatalities (6.03%) were registered. The prevalence of the disease in livestock during the period 1983-1994 varied between 24.3% and 92.9% in sheep, 31.2% and 43.6% in cattle, and 20.4% and 73.8% in swine. The economic losses in animals are very high due not only to increased mortality rates but also to weight loss and decreased productivity. Epidemiological data available showed that at least one person from 45.5% of Romanian localities underwent surgery for cystic echinococcosis. The information presented outlines the severity of the situation from human- and livestock-associated cystic echinococcosis in Romania. Control programs based on combinations of animal vaccination, dehelmintization of dogs, and education programs should be implemented to achieve effective prevention of disease transmission.

Neurological involvement may occur in 0.2%-52% of cases with trichinellosis, generally in the most severely affected patients. This review focuses on neurotrichinellosis and includes a brief overview of selected cases reported in the literature. Our primary goal was to increase the awareness of infectious diseases specialists, neurologists, and general practitioners about these major complications with possible fatal outcome. Seventy seven of the cases, for which enough details were available, have been pooled for statistical analysis. The mean age of the investigated group was 34.6 ± 16.8 years. Patients with both focal and diffuse manifestations predominated (55.8%), and they were significantly older (40 ± 15.5 years old) than those who presented solely focal (28.9 ± 17.8 years old; p = 0.03) or diffuse lesions (27.9 ± 15.3 years old; p = 0.007). In most of the cases (59.7%), complete recovery was reported, whereas 23.4% of cases had sequelae and 16.9% of the patients died. Patients who died had significantly lower eosinophil counts (13.8% ± 14%) when compared with those who made complete recovery (28.7% ± 18%; p = 0.015) and the cases with sequelae (35% ± 17.9%; p = 0.006). To sum up, trichinellosis must be considered in the differential diagnosis of any patient with encephalitis or other central nervous system malady of ambiguous etiology.

For a long period of time, trichinellosis represented a serious public health and ecological concern because of the favorable social, economic, cultural, and geographic conditions of this territory. Despite rich history, an overall decrease in the number of human trichinellosis cases over the 10-year study period was revealed and the decline might have been favored by the following positive aspects: improvement of sanitary conditions, implementation of a more reliable collaboration between veterinarians and pig breeders/consumers, education of the population, and a more careful supervision of the public health services.

Intestinal parasitic diseases such as enterobiasis, giardiasis, and ascariasis are detected most frequently in Romania, but their importance is definitely surpassed by trichinellosis, cystic echinococcosis, and toxoplasmosis. Malaria was common until its eradication in 1963, and only imported cases are reported nowadays. The aim of this review was to bring together essential data on the epidemiology and history of human parasitoses in Romania. Information on 43 parasitic diseases was collected from numerous sources, most of them unavailable abroad or inaccessible to the international scientific community. Over time, Romanian people of all ages have paid a significant tribute to the pathogenic influences exerted by the parasites. Sanitary and socio-economical consequences of the parasites diseases have great negative impact on the quality of life of affected individuals and the overall well-being of the population. Implementation of efficient public health measures and informative campaigns for the masses as well as changing the inadequate habits that are deeply rooted in the population are mandatory for cutting successfully this Gordian knot.

According to the International Commission on Trichinellosis, Romania accounted for the most cases of trichinellosis reported worldwide in 2004. The following report summarizes the evolution of trichinellosis in Romania over a 140-year period (1868-2007). The sylvatic cycle, such as the consumption of meat from wild boar and bear, has been implicated in human cases. However, 95% of human trichinellosis cases originate from specific cultural food practices involving pork consumption. The first report of human and pig trichinellosis in Romania dates back to 1868. After the political changes of 1989, the annual incidence increased from between 0.1 and 4.1 cases per 100,000 inhabitants during the communist period (1963-1989) to 6.2 cases per 100,000 inhabitants, with a range of 2-15.9 per 100,000 between 1990 and 2007. Trichinellosis is a major public health issue in Romania that requires that policies be put forth to advance efficient prevention and control strategies.

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Although the botulism cases decreased over the study period in southwest Romania, this life-threatening disease continues to be an important concern. A strategy addressing individual behaviors in the home is needed to improve food safety.

Trichinellosis still remains a concern and a major issue of public health in Arad County. Implementation of strict hygienic measures, especially in the rural areas, must be a priority.