Immunological and Clinical Responses to Vaccinations among Adults Living with HIV.

People living with human immunodeficiency virus (HIV) are at higher risk of morbidity and mortality due to vaccine-preventable diseases. At the same time, they are less likely to respond to vaccinations, and might have a higher rate of vaccine adverse event and faster waning of protective effect. International and national guidelines emphasize the importance of vaccinating people living with HIV against respiratory system disease pathogens including seasonal influenza, Streptococcus pneumoniae, and COVID-19, as well as against sexually transmitted infections, i.e., Hepatitis A and B (HAV, HBV) and human papillomavirus (HPV). This narrative review aims to provide a comprehensive examination of the current knowledge regarding the immune and clinical responses elicited by vaccinations in the older adult population living with HIV.

Prevention strategies for sexually transmitted infections, HIV, and viral hepatitis in Europe.

The current prevention efforts for STIs, HIV and viral hepatitis in the WHO European Region, especially in the Central and Eastern subregions, are hindered by healthcare disparities, data gaps, and limited resources. In this comprehensive narrative review, we aim to highlight both achievements and persisting challenges while also exploring new developments that could significantly impact the prevention of these infections in the near future. While pre-exposure prophylaxis (PrEP) for HIV has been broadly approved and implemented in 38 out of 53 countries in the region, challenges remain, including cost, limited licensing, and incomplete adherence. We explore innovative approaches like on-demand PrEP, long-acting injectable cabotegravir, and intravaginal rings that have shown promising results, alongside the use of six-monthly lenacapavir, the outcomes of which are pending. Additionally, the potential of doxycycline post-exposure prophylaxis has been discussed, revealing efficacy in reducing chlamydia and syphilis risk, but effectiveness against gonorrhoea being contingent on tetracycline resistance rates, and the need of further data to determine potential resistance development in other bacteria and its impact on the gut microbiome. We examine successful vaccination campaigns against HBV and HPV, the ongoing development of vaccines for chlamydia, syphilis, herpesvirus, and gonorrhoea, and challenges in HIV vaccine research, including lines of research with significant potential like sequential immunization, T-cell responses, and mRNA technology. This review underscores the research endeavors that pave the way for a more resilient and robust approach to combating STIs, HIV, and viral hepatitis in the region.

Hospital Admission Factors Independently Affecting the Risk of Mortality of COVID-19 Patients.

INTRODUCTION: COVID-19 is a disease characterized by high in-hospital mortality, which seems to be dependent on many predisposing factors. OBJECTIVES: The aim of this study was to analyze the clinical symptoms, abnormalities in the results of laboratory tests, and coexisting chronic diseases that independently affected the risk of in-hospital mortality in patients with COVID-19. PATIENTS AND METHODS: We analyzed the records of patients with COVID-19 who were hospitalized from 6 March 2020 to 30 November 2021. RESULTS: Out of the entire group of 2138 patients who were analyzed, 12.82% died during hospitalization. In-hospital mortality was independently associated with older age (OR 1.53, 95% CI 1.20-1.97); lower arterial blood oxygen saturation (OR 0.95, 95% CI 0.92-0.99); the presence of a neoplasm (OR 4.45, 95% CI 2.01-9.62), a stomach ulcer (OR 3.35, 95% CI 0.94-11.31), and dementia (OR 3.40, 95% CI 1.36-8.26); a higher score on the SOFA scale (OR 1.73, 95% CI 1.52-1.99); higher lactate dehydrogenase (LDH) (OR 1.08, 95% CI 1.05-1.12); higher N-terminal pro-brain natriuretic peptide (NT pro BNP) (OR 1.06, 95% CI 1.01-1.11); and lower total bilirubin in blood concentration (OR 0.94, 95% CI 0.90-0.99). CONCLUSIONS: We found that low oxygen saturation, old age, and the coexistence of cancer, gastric ulcers, and dementia syndrome were variables that independently increased mortality during hospitalization due to COVID-19. Moreover, we found that decreased platelet count and bilirubin concentration and increased levels of LDH and NT-proBNP were laboratory test results that independently indicated a higher risk of mortality. We also confirmed the usefulness of the SOFA scale in predicting treatment results. The ability to identify mortality risk factors on admission to hospital will facilitate both adjusting the intensity of treatment and the monitoring of patients infected with SARS-CoV-2.

Parents' Attitudes towards Vaccinations Regarding the Ukrainian Migration to Poland in 2022.

Background: Russia's aggression against Ukraine in early 2022 resulted in a large migration of refugees to many countries, including Poland. Vaccination coverage for some infectious diseases in Ukraine is lower than in Poland; consequently, the incidence of infectious diseases-including measles, poliomyelitis, tuberculosis, and COVID-19-is higher. We aimed to investigate whether the migration of Ukrainians had influenced decisions of Polish parents on having their children vaccinated and to examine their attitudes towards vaccinations. Material and methods: A cross-sectional online survey study was designed. Data on parents' demographics, attitudes toward vaccination, and knowledge of the current epidemiological situation in Poland were collected. Parents participating in the study were divided into two subgroups for further analysis according to their decisions to have their children vaccinated. Results: A total of 568 questionnaires were collected, of which 21 did not meet the inclusion criteria for the analysis (respondents were not parents). The Ukrainian immigrants' influx affected 54 (9.87%) participants in their decision of having their children vaccinated. Respondents in this group were more likely to have a positive attitude toward recommended vaccinations (p = 0.0428); in addition, they more often had their children vaccinated with recommended vaccinations (p = 0.0063), believed the vaccination coverage with mandatory vaccinations was higher in Poland than in Ukraine (p = 0.0014), and believed the incidence of diseases covered by mandatory (p = 0.0472) and recommended (p = 0.0097) vaccinations was higher in Ukraine. In addition, parents who declared that the migration had affected their decision regarding their children's vaccinations had more often been vaccinated due to the influx of Ukrainian immigrants (p < 0.00001) and were more likely to be aware of how migration had impacted the current epidemiological situation in Poland (p = 0.0021). Moreover, the survey more often made these participants think about getting additional vaccinations for themselves (p < 0.0001) and their children (p < 0.0001). Conclusions: The Ukrainian immigrants' influx affected nearly one tenth of surveyed parents in their decision of having their children vaccinated. This group was more aware of the differences between infectious diseases' epidemiology in Poland and Ukraine. In addition, they also had a more positive attitude toward vaccinations.

The clinical course of herpes zoster is similar in immunocompetent and immunocompromised paediatric patients.

AIM: We aimed to compare the clinical manifestation of HZ in immunocompetent and immunocompromised children. METHODS: Medical charts of all consecutive children hospitalized and/or consulted in the Regional Hospital for Infectious Diseases in Warsaw due to HZ were retrospectively analysed. Age, history of varicella, time interval between varicella and HZ, underlying diseases, immunosuppresive therapy, dermatome involvement and HZ complications were analyzed in both groups. RESULTS: In total 152 children were included in the analysis, 56 (36.84%) of them were hospitalsed, whereas 96 (63.16%) were consulted and discharged home due to good general condition. The median age was 10 years (IQR 5.75-12), there were 73 (48.03%) boys and 79 (51.97%) girls. In 16/152 (10.5%) one or more complications occurred, including: skin bacterial superinfection (16/17, 94.2%), sepsis (1/17, 5.9%), meningitis (1/17, 5.9%). Thoracic dermatomes were the most commonly affected (81/152, 53.29%). Most of the children didn't have any immunodeficiencies 118/152 (77.6%), and 34/152 (22.4%) of them were immunocompromised (and had been treated with intravenous acyclovir). The clinical picture of the disease was similar in both groups (Table 1). However, immunocompromised children more often had sacral dermatomes affected (5/35, 14.3% vs. 1/117, 0.9%, p < 0.001), and less often thoracic dermatomes were involved in this group (12/35, 34.3% vs. 69/117, 59%, p = 0.0102). CONCLUSIONS: To conclude, herpes zoster occurs in both immunocompetent and immunocompromised children. Clinical manifestations are similar. Serious complications, although uncommon, affect not only immunocompromised patients but also otherwise healthy children.

The Clinical Effectiveness and Safety of Vaccinations against COVID-19 in HIV-Positive Patients: Data from Observational Study in Poland.

People living with HIV (PLWH) are a heterogeneous group of immunocompromised persons, yet underrepresented in randomized clinical trials leading to vaccination registration. Detectable HIV viral load and having chronic comorbidities may increase the risk of severe COVID-19 outcomes in this group of patients. We aimed to assess the efficacy and safety of vaccinations against COVID-19 in PLWH. MATERIALS AND METHODS: We performed a retrospective analysis of medical records of HIV-positive individuals routinely followed up between 1 January 2021 and 30 April 2022 that were at the HIV Outpatient Clinic in Warsaw. The analysis included data on the type and date of administration of subsequent doses of COVID-19 vaccination, adverse vaccine reactions, and the history of SARS-CoV-2 infection. RESULTS: In total, 217 patients were included in the analysis, with a median age of 43 years (IQR: 35.5-51.5 years) and median CD4+ count of 591 cells/uL (IQR: 459.5-745.0 cells/uL). Most of the patients were male (191/217, 88.0%) and were vaccinated with the BNT162b2 vaccine (143/217, 65.9%). None of the patients diagnosed with COVID-19 required hospitalization. Vaccine adverse events (VAE) mostly occurred after the 1st dose (in 33/217 (15.2%)), and none of them were severe or required medical care. CONCLUSIONS: In our cohort of patients, vaccination against COVID-19 proved to be safe and effective against a severe course of the disease among people living with HIV. However, vaccination, to a lesser degree, protects against mild SARS-CoV-2 infection. Longer observations are required in order to assess the sustainability of protection against severe COVID-19 in this group of patients.

Comparison of the prevalence of risk factors for Toxoplasma Gondii infection among pregnant women in rural and urban areas in Poland.

Introduction: Toxoplasma gondii is a protozoan parasite. While this infection typically exhibits no symptoms in humans, it poses a potential threat to the developing fetus in pregnant women. Several risk factors contribute to toxoplasmosis infection. Adherence to hygiene protocols and avoiding the consumption of raw meat, unwashed vegetables, and fruits may mitigate the risk of this disease. Objective: This study aimed to compare the prevalence of toxoplasmosis risk factors among pregnant women suspected of toxoplasmosis living in rural areas with those residing in urban areas. Materials and methods: A retrospective observational study was conducted by analyzing data from the medical records of pregnant women suspected of toxoplasmosis. These women were consulted at the Provincial Infectious Diseases Hospital between September 2019 and March 2020. The analysis encompassed patients' demographic data and information concerning toxoplasmosis risk factors. A total of 273 women's data were included in the analysis. Diagnosis relied on serological verification using the VIDAS® analyzer (bioMérieux, Lyon, France). Results: Women residing in rural areas were less likely to report a good socio-economic status (p=0.0064), and toxoplasmosis infection was less frequently ruled out (p=0.0023). In comparison to women living in urban areas, pregnant women from rural regions were more likely to have confirmed primary toxoplasmosis (p=0.0164). Additionally, they were more prone to working in gardens without gloves (p<0.0001), consuming unwashed vegetables (p=0.0025), eating raw meat during pregnancy (p=0.0008), and cats caregiving during pregnancy (p=0.0002). This exposure included both care for domestic cats before and during pregnancy (p=0.0069) and interactions with wild cats (p<0.0001). Conclusions: Pregnant women living in rural areas exhibited significantly higher exposure to toxoplasmosis risk factors. They also displayed a higher incidence of primary infections during pregnancy and a lower rate of excluded infections.

Higher Immunological Response after BNT162b2 Vaccination among COVID-19 Convalescents-The Data from the Study among Healthcare Workers in an Infectious Diseases Center.

Introduction: The BNT162b2 vaccination studies did not specifically focus on groups that were heavily exposed to SARS-CoV-2 infection. Therefore, we aimed to assess the safety and efficacy of the BNT162b2 vaccine among healthcare workers (HCWs). Methods: Study participants were recruited from hospital employees who received BNT162b2 vaccination at the Hospital for Infectious Diseases in Warsaw. Blood samples were collected before and after each vaccination dose. At each timepoint, the levels of anti-SARS CoV-2 IgM, anti-n SARS-CoV-2 IgG, and S-RBD antibodies were measured. Data on concomitant diseases and the vaccine's adverse events (VAE) were collected after each vaccination dose. In the statistical analyses, non-parametric tests were used. Results: In total, 170 healthcare workers were included in the analysis. Their median age was 51 years (interquartile range (IQR): 41−60 years); most of them were women (n = 137, 80.6%) working in direct contact with patients (n = 137, 73.2%); and 46 (27.0%) had concomitant diseases. More than one fifth of subjects had COVID-19 before their first dose of vaccination (n = 38, 22.6%). In terms of immunological responses, our investigations showed a high level of efficacy for the BNT162b2 mRNA vaccination as measured by S-RBD antibody concentrations: these were positive in 100% of participants 14 days after the second dose of the vaccine. It was also observed that employees with high S-RBD antibodies (>=433 BAU/mL) were more likely to be COVID-19 convalescents before receiving the first vaccine dose (p < 0.001). Conclusion: The BNT162b2 vaccine is safe and effective among HCWs. Vaccine adverse events occurred, but serious events were not observed. Moreover, the BNT162b2 vaccine is effective against symptomatic and severe COVID-19­none of the workers that acquired a SARS-CoV-2 infection after vaccination required hospitalization or medical care. We also observed higher immunological responses among COVID-19 convalescents.

The Clinical Course and Outcomes of Patients Hospitalized Due to COVID-19 during Three Pandemic Waves in Poland: A Single Center Observational Study.

Background: The first case of coronavirus disease 2019 (COVID-19) in Poland was reported on 4 March 2020. We aim to compare the clinical course and outcomes of patients hospitalized in the Hospital for Infectious Diseases in Warsaw due to COVID-19 during three pandemic waves. Materials and methods: The medical data were collected for all patients diagnosed with COVID-19 hospitalized in our hospital from 6 March 2020 till 30 November 2021. COVID-19 diagnosis was confirmed by nasopharyngeal swabs using real-time polymerase chain reaction assay (RT-PCR) or SARS-CoV-2 antigen test. COVID-19 waves were defined based on the number and dynamics of cases. Results: Altogether, 2138 patient medical records were analyzed. The majority of the cohort was male (1235/2138, 57.8%), and the median age was 65 years [IQR: 50−74 years]. Patients hospitalized during the third wave had lower oxygen saturation on admission (p < 0.001) and were more likely to receive oxygen supplementation (p < 0.001). Serious complications, including pneumothorax (p < 0.001) and thromboembolic complications (p < 0.001), intensive care unit admission (p = 0.034), and death (p = 0.003), occurred more often in patients of the third wave. Conclusions: During the third wave, patients in our cohort experienced a more severe course of the disease and poorer outcomes.

Complementary dose of COVID-19 vaccination may prevent SARS-CoV-2 breakthrough infection among previously vaccinated HIV positive persons.

People living with HIV (PLWH) are a heterogeneous group of immunocompromised persons. Detectable HIV viral load and chronic comorbidities are independently increasing the risk of severe outcomes from COVID-19 among PLWH. We aimed to assess the efficacy and safety of the COVID-19 vaccines in PLWH. A significant increase in S-RBD antibody titers >100 AU/mL was observed when compared the titers measured one week after the 1st dose to titers performed after the 2nd vaccine dose.

Study of the first clinical cases on monkeypox in Poland.

Monkeypox is a viral, zoonotic, emerging infectious disease that has become the most significant orthopoxviral infection among humans since the eradication of smallpox. It is endemic in Central and West Africa, and since May 2022 it has caused a multi-country outbreak in six continents. So far, no clinical cases of this disease have been observed in Poland. Monkeypox can be transmitted by any person, regardless of gender identity or sexual preferences, through direct contact with the secretion from skin lesions or through fomites contaminated with infectious material. Therefore, people infected with the monkeypox virus require isolation until the skin lesions heal completely and the scabs fall off, which is equivalent to the end of their infectivity. The paper presents a study of the first nine clinical cases of monkeypox in Poland, along with photographic documentation. All patients were young men, the vast majority of whom had contact with multiple sexual partners, and presented a higher prevalence of human immunodeficiency virus (HIV) infection than in the general population. The course of the disease was self-limited and no specific antiviral treatment was required by any of the patients. Nonetheless, there was a change in the route of transmission of the infection to sexual contact and an atypical clinical course of the disease, which resulted both in skin lesions initially appearing in the anogenital area, skin lesions occurring at various stages of development, and the appearance of skin lesions before the onset of general symptoms. In one of the patients, skin changes were not observed at all.

Testing for HIV Increases the Odds of Correct Fetal Ultrasound Result.

Introduction: Infectious diseases during pregnancy may pose a threat to both mother and the developing fetus. It also creates an opportunity to screen for diseases being widely underdiagnosed among women in Poland, such as human immunodeficiency virus (HIV) or sexually transmitted infections (STI). Therefore, we aimed to assess the number of pregnant women that had not been tested for HIV despite the recommendations. In addition, a comparison of clinical evaluation between HIV-tested and non-tested pregnant women was also performed. Material and methods: Medical records of all consecutive pregnant women, referred to our Infectious Diseases Hospital between September 2019 and March 2020 were retrospectively analyzed. Implementation of recommended screening testing towards infectious diseases during pregnancy including human immunodeficiency virus (HIV), hepatitis B virus (HBV), hepatitis C virus (HCV), cytomegalovirus (CMV), syphilis, and rubella, were also analyzed. Results: Medical records of 273 women were included in the analysis. The median age was 32 years (interquartile range: 26−33 years). In total 243/273 (89.0%) had been tested for HIV as recommended, and the remaining 30/273 (11.0%) had not been tested. HIV infection was not confirmed in any of the participants. Only one woman within the HIV non-tested group had been correctly tested towards other infections during her pregnancy. The recommended full testing was more likely to be correctly implemented in women who had also been tested for HIV (171/243, 70.4% vs. 1/30, 3.3%, OR 68.9; 95% CI 9.2−515.3, p < 0.00001). Moreover, the correct fetal ultrasound result was more likely to be obtained in women who had been tested for HIV as recommended (234/243, 96.3% vs. 11/30, 36.7%, OR 44.9; 95% CI 16.6−121.8, p < 0.00001). Conclusions: Despite the law regulations, 11% of pregnant women referred to consultations to the infectious diseases center had not been tested for HIV. At the same time, correct fetal ultrasound results are more likely to occur in women tested for HIV according to recommendations. This suggests that a holistic approach to screening, both for communicable and non-communicable diseases, among pregnant women may translate to better pregnancy outcomes.

The attitude of Polish women planning pregnancy and/or having children towards vaccinations: a cross-sectional survey study.

OBJECTIVES: Infectious diseases in pregnant women can cause birth defects. Implementing appropriate prevention methods while planning pregnancy can help avoid some of them. MATERIAL AND METHODS: A cross-sectional survey study was performed. The questionnaire investigated attitudes towards vaccinations, as well as opinions on anti-vaccine movements and the so-called "chickenpox parties". The questionnaire was developed for the purpose of this study and the survey was conducted using the google form, which was posted on social media groups for women planning pregnancy, being pregnant or for mothers' groups from Poland. RESULTS: The study group consisted of 2402 women; their median age was 31 years (range 16-54 years). Most women were from cities > 100,000 inhabitants (49.7%, 1194/2402) and had higher education (71.9%, 1726/2402). A positive attitude towards vaccinations was more common among younger, nulliparous women from big cities (p = 0.02, p = 0.04 and p = 0.01, respectively). 2068/2402 (86.1%) of respondents were not vaccinated before pregnancy and 1931/2402 (80.4%) of women were not vaccinated during pregnancy. While most women (1545/2402, 64.3%) considered vaccination safe, and effective (1904/2402, 79.3%) against infectious diseases, many (n = 296/2402 12.3%) have no opinion on the so-called chickenpox party. CONCLUSIONS: Most surveyed women had a positive attitude towards vaccinations and consider vaccines a safe and effective method of protection against infectious diseases. Since a significant proportion of women were not vaccinated before or during pregnancy and about 12% of women are undecided, the physician's role is crucial in educating and persuading the patient to be vaccinated.

The Presence of Either Typical or Atypical Radiological Changes Predicts Poor COVID-19 Outcomes in HIV-Positive Patients from a Multinational Observational Study: Data from Euroguidelines in Central and Eastern Europe Network Group.

HIV-positive patients may present lungs with multiple infections, which may hinder differential diagnoses and the choice of treatment in the course of COVID-19, especially in countries with limited access to high-standard healthcare. Here, we aim to investigate the association between radiological changes and poor COVID-19 outcomes among HIV-positive patients from Central and Eastern Europe. Between November 2020 and May 2021, the Euroguidelines in Central and Eastern Europe Network Group started collecting observational data on HIV and COVID-19 co-infections. In total, 16 countries from Central and Eastern European submitted data (eCRF) on 557 HIV-positive patients. The current analyses included patients who had a radiological examination performed. Logistic regression models were used to identify the factors associated with death, ICU admission, and partial recovery (poor COVID-19 outcomes). Factors that were significant in the univariate models (p < 0.1) were included in the multivariate model. Radiological data were available for 224 (40.2%) patients, 108 (48.2%) had computed tomography, and 116 (51.8%) had a chest X-ray. Of these, 211 (94.2%) were diagnosed using RT-PCR tests, 212 (94.6%) were symptomatic, 123 (55.6%) were hospitalized, 37 (16.6%) required oxygen therapy, and 28 (13.1%) either died, were admitted to ICU, or only partially recovered. From the radiologist's description, 138 (61.6%) patients had typical radiological changes, 18 (8.0%) atypical changes, and 68 (30.4%) no changes. In the univariate models, CD4 count (OR = 0.86 [95% CI: 0.76−0.98]), having a comorbidity (2.33 [1.43−3.80]), HCV and/or HBV co-infection (3.17 [1.32−7.60]), being currently employed (0.31 [0.13−0.70]), being on antiretroviral therapy (0.22 [0.08−0.63]), and having typical (3.90 [1.12−13.65]) or atypical (10.8 [2.23−52.5]) radiological changes were all significantly associated with poor COVID-19 outcomes. In the multivariate model, being on antiretroviral therapy (OR = 0.20 [95% CI:0.05−0.80]) decreased the odds of poor COVID-19 outcomes, while having a comorbidity (2.12 [1.20−3.72]) or either typical (4.23 [1.05−17.0]) or atypical (6.39 [1.03−39.7]) radiological changes (vs. no changes) increased the odds of poor COVID-19 outcomes. Among HIV patients diagnosed with symptomatic SARS-CoV-2 infection, the presence of either typical or atypical radiological COVID-19 changes independently predicted poorer outcomes.

The Beneficial Effect of the COVID-19 Vaccine Booster Dose among Healthcare Workers in an Infectious Diseases Center.

Introduction: Healthcare workers in Poland received a booster dose of the BNT162b2 mRNA vaccine (Pfizer-BioNTech, Manufacturer: Pfizer, Inc., and BioNTech; Moguncja, Germany) at the beginning of October 2021. Here, we report on the preliminary results of an ongoing clinical study into the antibody response to SARS-CoV-2 of healthcare workers previously exposed to the virus, with or without evidence of past infection, in the Hospital for Infectious Diseases in Warsaw before and after the vaccine booster dose. Methods: Blood samples were collected on the day the vaccine booster dose was administered and again 14 days later. The levels of SARS-CoV-2 IgG antibodies (against the n-protein, indicative of disease) and S-RBD (indicative of a response to vaccination) were measured. Results: One hundred and ten health care workers from the Hospital for Infectious Diseases were included in the study. The percentage of subjects with a positive test for anti-n-protein IgG antibodies at both time points remained unchanged (16, 14%), while a statistically significant increase in the percentage of subjects producing high levels of S-RBD antibodies (i.e., >433 BAU/mL) was observed (from 23, 21% to 109, 99%; p = 0.00001). Conclusions: The results of the study indicate that the booster dose of the vaccine significantly increases the percentage of people with high levels of S-RBD antibodies, regardless of previous contact with the virus, which may indicate greater protection against both the disease and a severe course of COVID-19.

Analysis of Preventable Risk Factors for Toxoplasma gondii Infection in Pregnant Women: Case-Control Study.

BACKGROUND: Toxoplasma gondii (TG) is a parasitic protozoon that may cause miscarriages or birth defects if the infection occurs during pregnancy. The study's aim was to evaluate the risk factors associated with TG infection in pregnant women. MATERIALS: Medical charts for all 273 pregnant women with suspected TG infection consecutively admitted to the Hospital of Warsaw between 2019 and 2020 were retrospectively analyzed. The presumptive TG diagnosis was verified by a serologic assessment of IgM and IgG titers, and IgG affinity tests. RESULTS: The median age was 32 years (range: 19-42 years). The diagnosis of primary TG infection was confirmed in 74/273 (27.1%) women. In 114/273 (41.8%) there was evidence of past infection. In 71/273 (26%) women, an infection was excluded. In 172/273 (62%) women the recommended testing for other infectious diseases putting fetus development at risk was performed correctly. Logistic regression model analysis revealed that living in rural areas and eating raw meat were independent factors associated with increased risk of TG infection during pregnancy (OR 2.89, 95% CI: 1.42-5.9, p = 0.004; and OR 2.07, 95% CI: 1.03-4.18, p = 0.04, respectively). CONCLUSIONS: The independent risk factors for TG infection during pregnancy include living in rural areas and eating raw meat. The physician's educational role here is crucial for the efficient prevention of congenital toxoplasmosis.

A challenge in diagnosing rash in HIV-positive MSM patient during overlapping epidemics in Central and Eastern Europe: Case report.

In 2018-19, in Poland, there was a significant increase in the incidence of both measles and syphilis. In 2019, a 38-year-old HIV-positive MSM patient was admitted to a Department of Hospital for Infectious Diseases in Warsaw due to a rash on his trunk and palms. The patient had a past medical history notable for several syphilis episodes and hepatitis C twice. The patient was under care of the HIV Outpatient Clinic in the Hospital for Infectious Diseases in Warsaw since 2015, on fully effective antiretroviral therapy. Due to new syphilis onset with high titers and concomitant acute hepatitis C, he was hospitalized and treated with crystalline penicillin in a dose of 4x5 million units intravenously for 2 weeks along with benzathine penicillin 2.4 million units intramuscularly before being discharged. Ten days after being discharged home, the patient presented at the HIV clinic with fever and a non-itchy maculopapular rash that first appeared on the face and then also on the trunk and limbs. In presumptive diagnosis, three main conditions were taken into account: new onset of sexually transmitted disease, delayed allergic reaction to benzathine penicillin, and-in relation to a recent epidemical outbreak-measles. On physical examination, small white spots on the inner lining of the cheek were found (Koplik's spots). Swabs taken for measles RNA testing confirmed the diagnosis. Regarding the fact that both diseases may occur with a rash, they may pose a diagnostic challenge. Physicians should always include local epidemiological situation, including the possibility of overlapping outbreaks in differential diagnosis of nonspecific symptoms.