Clostridium difficile infection in young people - 2 case reports.

Clostridium difficile infection (CDI) remains one of the most important healthcare-associated infections of the last two decades. The pathogen is a Gram-positive, toxin-producing, anaerobic, rod-shaped and sporeforming bacterium; it is ubiquitous in the human environment. Transmission occurs by the fecal-oral route. The consequence of the action of bacterial toxins is initially a local inflammatory reaction, which then goes into systemic inflammation. Clinical presentation is varied; some patients are asymptomatic, in symptomatic form the main symptom is diarrhea of varying severity, which is sometimes accompanied by acute abdominal pain, nausea, vomiting and high fever. Risk factors of CDI include prior antibiotic use, increasing age and recent hospitalisation. Extremely rarely does CDI occur in immunocompetent patients under 30 years of age, even if previously treated with an antibiotic. Here presented are two untypical cases of CDI development in the lower age group, in the presence of additional risk factors of comorbid gastrointestinal tract infections. Both developed infections are following recent infection - Salmonella enterididis in the first case and Salmonella typhi in the second case. Therefore, the article also contains basic principles for the diagnosis and treatment of Salmonella spp.

[Diagnostic difficulties in amebic liver abscess].

Amebiasis is a widespread parasitic infection caused by the human-specific protozoan Entamoeba histolytica (E.- histolytica). Tropical and subtropical regions with poor socioeconomic and sanitary conditions belong to endemic areas. The highest rates of E. histolytica infection are observed in India, Mexico, Africa, some parts ofCentral and South America. Up to 90% of infections remain asymptomatic, about 10% of patients develop amebic colitis. About 10% of symptomatic individuals may present with an extraintestinal manifestation, mostly amebic liver abscess (ALA). Clinical symptoms of ALA appear within 5 months after an exposition to E. histolytica cysts. Anamnesis revealing a travel to endemic area plays a crucial role in a diagnostic process, which is further supported by an physical examination, radiological findings, serology and parasitology test. The following article presents the difficulties which may occur when the ALA is suspected in a patient traveling from endemic areas.

Rheological properties of erythrocytes in patients infected with Clostridium difficile.

INTRODUCTION: Clostridium difficile infection (CDI) is a bacterial infection of the digestive tract. Acute infections are accompanied by increased risk for venous thromboembolism (VTE). To date, there have been no studies of the rheological properties of blood during the course of digestive tract infections. The aim of our study was to examine the effects of CDI on red blood cell (RBC) rheology, specifically RBC deformability, RBC aggregation, and plasma viscosity. In addition, the activity of glucose 6 phosphate dehydrogenase (G6PD) and acetylcholinesterase (AChE) in RBC was studied. MATERIALS AND METHODS: Our study group included 20 patients with CDI, 20 healthy persons comprised the control group. We examined the effects of CDI on the rheology of RBCs, their deformability and aggregation, using a Laser-assisted Optical Rotational Cell Analyzer (LORCA). Plasma viscosity was determined using a capillary tube plasma viscosymeter. Moreover, we estimated the activity of AChE and G6PD in RBC using spectrophotometric method. RESULTS: A statistically significant increase was found in the aggregation index, viscosity and activity of G6PD whereas the amount of time to reach half of maximum aggregation (t½) and the amplitude of aggregation (AMP) both showed statistically significantly decreases among patients with CDI compared to the control group. We also observed that the Elongation Index (EI) was decreased when shear stress values were low, between 0.3 Pa and 0.58 Pa, whereas EI was increased for shear stress in the range of 1.13-59.97 Pa. These observations were statistically significant. CONCLUSIONS: We report for the first time that acute infection of the gastrointestinal tract with Clostridium difficile is associated with abnormalities in rheological properties of blood, increased serum viscosity as well as increased aggregation of RBCs, which correlated with severity of inflammation. These abnormalities may be an additional mechanism causing increased incidence of VTE in CDI.

The Involvement of Prolactin in Stress-Related Disorders.

The most important and widely studied role of prolactin (PRL) is its modulation of stress responses during pregnancy and lactation. PRL acts as a neuropeptide to support physiological reproductive responses. The effects of PRL on the nervous system contribute to a wide range of changes in the female brain during pregnancy and the inhibition of the hypothalamic-pituitary axis. All these changes contribute to the behavioral and physiological adaptations of a young mother to enable reproductive success. PRL-driven brain adaptations are also crucial for regulating maternal emotionality and well-being. Hyperprolactinemia (elevated PRL levels) is a natural and beneficial phenomenon during pregnancy and lactation. However, in other situations, it is often associated with serious endocrine disorders, such as ovulation suppression, which results in a lack of offspring. This introductory example shows how complex this hormone is. In this review, we focus on the different roles of PRL in the body and emphasize the results obtained from animal models of neuropsychiatric disorders.

[Interleukin 8 and interferon gamma in ocular toxoplasmosis]. / Interleukina 8 oraz interferon gamma w ocznej postaci toksoplazmozy.

UNLABELLED: Toxoplasmosis is one of the most common parasitic infections in the world, it is caused by Toxoplasma gondii. The infection is typically asymptomatic or the symptoms are very mild. Approximately 10% patients have limphadenopathy, involvement of the others organs, like eyes, nervous system, liver, heart, are observed more rarely. PURPOSE: The aim of our study was to assess the level of selected cytokines in blood among patients with ocular toxoplasmosis. MATERIAL AND METHODS: We have enrolled in the study 30 patients, 19-42 years old, treated for ocular toxoplasmosis, and 20 healthy volunteers, 20-48 years old, to the control group. Tests for blood morphology, C-reactive protein, the level of IL-8 and IFN-gamma were performed in all patients. The blood parameters in toxoplasmosis group were performed before antiparasitic treatment was given. RESULTS: The level of IFN-gamma in blood was lower among patients with ocular toxoplasmosis comparing with control group (1.52 vs. 4.18 pg/ml; p = 0.002). The level of IL-8 in blood was lower among patients with ocular toxoplasmosis comparing with control group (22.96 vs. 94.3 pg/ml; p = 0,007). There were no correlations between analyzed cytokines and blood morphology or CRP. CONCLUSIONS: The low level of IFN-gamma and IL-8 in blood is important factor leading to reactivation of the ocular toxoplasmosis.

[Neurological complications among patients with zoster hospitalized in Department of Infectious Diseases in Cracow in 2001-2006]. / Powiklania neurologiczne w przebiegu pólpasca w materiale Kliniki Chorób Zakaznych w Krakowie w latach 2001-2006.

BACKGROUND: Herpes zoster is an infectious disease caused by varicella zoster virus (VZV). After replication at the place of entry, VZV spreads via the blood into the skin and mucosa, causing the varicella. From these regions VZV migrates into the sensory ganglia where it establishes a latent infection. The aim of our study was to analyze the localization of the skin changes and correlations of neurological complications among patient with zoster. MATERIAL AND METHODS: We have reviewed medical documentation of the 67 patients with herpes zoster, hospitalized in our Department during the years 2001-2006. We have studied localization of the herpes zoster changes and frequency of neurological complications among these patients. RESULTS: Neuralgia was less intensive and last shorter time, when antiviral treatment had been started earlier. Neuralgia, meningitis, encephalitis and complications of the eye zoster were present more often among patients over 65 years old.

[A case of Salmonella paratyphi A infection in Poland]. / Przypadek zawleczenia paraduru typu A do Polski.

Paratyphoid fever is an acute infection caused by Salmonella paratyphi A, B or C. The disease is transmitted from person to person by fecal-oral way. Typical for typhoid fever are splenomegaly, bradycardia, fever, constipation or mild diarrhoea oftten associated with abdominal tenderness. We present the case of patient who was infected by Salmonella paratyphi C while his travelling in Asia.

[Outbreak of Lyme borreliosis with joint manifestation--case report]. / Borelioza z Lyme z zajeciem stawów--opis przypadku.

Lyme borreliosis is caused by the spirochete Borrelia burgdorferi, which is transmitted into the human body by ticks. The clinical symptoms are associated with skin, joints, heart and nervous system. Four groups of antibiotics are used in Lyme borreliosis treatment: penicillins, cephalosporins, tetracyclines and macrolides. We present the case of Lyme borreliosis with outbreak joint manifestation.

[Studies on relationship between immunodeficiency in HIV-infected people and condition of upper gastrointestinal tract mucosa, prevalence of mycosis and Helicobacter pylori infection]. / Badania nad zaleznoscia uposledzenia odpornosci u osób zakazonych HIV a stanem blony sluzowej górnego odcinka przewodu pokarmowego, wystepowaniem grzybicy i infekcji Helicobacter pylori.

HIV infection leads to progressive deterioration of immunity. Upper gastrointestinal symptoms are often reported in patients with this infection. The aim of the study was to evaluate morphological changes in upper gastrointestinal tract mucosa and prevalence of opportunistic infections and Helicobacter pylori in HIV-infected people in relationship to the degree of immunosupression. We studied 94 HIV-infected patients with dyspeptic symptoms, 47 suffered from severe immunodeficiency expressed by low CD4+ lymphocyte count below 200/ mm3. Control group consisted of 52 non HIV-infected patients. During endoscopy, gastrointestinal tract mucosa was evaluated and biopsy samples were taken from gastric body and antrum for histopathological analysis and rapid urease test. In patients with CD4+ lymphocyte count below 200/mm3, endoscopic examination revealed significantly more frequent esophageal candidiasis (36%); whereas reflux esophagitis (13%) was significantly less often diagnosed in comparison to the rest of the patients. Duodenitis and duodenal erosions were also less frequent in them. Prevalence of Helicobacter pylori infection in gastric antrum was significantly lower in HIV-infected patients with severe immunodeficiency (40%) in comparison to the rest of the patients (72%) and control group (69%). Chronic active gastritis of the antral mucosa was less frequent in HIV-infected patients with CD4+ lymphocyte count below 200/mm3.

[Whooping cough in a previously vaccinated patient--case report]. / Zachorowanie na krztusiec u osoby uprzednio szczepionej--opis przypadku.

Pertussis is an acute contagious human disease caused by gram-negative Coccobacilli Bordetella pertussis. Numerous factors and toxins produced by Bordetella pertussis play important role in pathogenicity of the disease. Typical illness has three clinical stages: catarrhal, paroxysmal and convalescent. In therapy erythromycin is the antibiotic of choice. We present a case of pertussis in a seventeen year old, previously vaccinated patient.

[Tuberculous meningoencephalitis--own observations]. / Gruzlicze zapalenie opon mózgowo-rdzeniowych i mózgu--obserwacje wlasne.

Nine cases of the tuberculous meningoencephalitis in adult men and women treated in years 1993-2000 have been presented. The diagnosis was established on the basis of clinical picture and examination of the cerebrospinal fluid (CSF). Routine analysis of CSF was done, as well as the microscopic examination, biological assay, and culture on the Lowenstein-Jensena medium and using Bactec 460 TB system. Only in one case Mycobacterium tuberculosis was found in the smear of CSF stained by Ziehl-Nielsen method. In one case the biologic assay was positive and Mycobacterium tuberculosis was cultured on Lowenstein-Jensen medium. In another 4 cases the pathogen was detected by Bactec 460 TB technique. In 4 cases Mycobacterium tuberculosis was also cultured from the secretion of the respiratory tract, and in one patient urine. On chest X-ray characteristic changes for pulmonary tuberculosis were observed in 5 cases (56%). Seven patients (78%) had hydrocephalus detected on CT scan of the head. One patient died, one (11%) developed persistent complication in form of spastic paralysis of lower extremities and sphincters dysfunction. Seven patients (78%) recovered completely after the 12 months therapy with standard chemotherapeutic regimen for tuberculosis.

[Calcifications of basal ganglia and cerebellum in patient with pseudohypoparathyroidism--case report]. / Zwapnienia jader podstawy mózgu i mózdzku u chorego z rzekoma niedoczynnoscia przytarczyc--opis przypadku.

Presented is the case report of symmetrical calcifications of basal ganglia, cerebellum and subcortical white matter of cerebral hemispheres (Fahr's syndrome) in a 34 year old man with pseudohypoparathyroidism. Attention has been put on characteristic features of Fahr's syndrome and differential diagnosis of this rare disease.

IL28B polymorphism as a predictor of antiviral response in chronic hepatitis C.

AIM: To evaluate the effect of single nucleotide polymorphisms of interleukin (IL)-28B, rs12979860 on progression and treatment response in chronic hepatitis C. METHODS: Patients (n = 64; 37 men, 27 women; mean age, 44 ± 12 years) with chronic hepatitis C, genotype 1, received treatment with peg-interferon plus ribavirin. Genotyping of rs12979860 was performed on peripheral blood DNA. Histopathological assessment of necroinflammatory grade and fibrosis stage were scored using the METAVIR system on a liver biopsy sample before treatment. Serum viral load, aminotransferase activity, and insulin level were measured. Insulin resistance index, body mass index, waist/hip ratio, percentage of body fat and fibrosis progression rate were calculated. Applied dose of interferon and ribavirin, platelet and neutrophil count and hemoglobin level were measured. RESULTS: A sustained virological response (SVR) was significantly associated with IL28B polymorphism (CC vs TT allele: odds ratio (OR), 25; CC vs CT allele: OR, 5.4), inflammation activity (G < 1 vs G > 1: OR, 3.9), fibrosis (F < 1 vs F > 1: OR, 5.9), platelet count (> 200 × 10(9)/L vs < 200 × 10(9)/L: OR, 4.7; OR in patients with genotype CT: 12.8), fatty liver (absence vs presence of steatosis: OR, 4.8), insulin resistance index (< 2.5 vs > 2.5: OR, 3.9), and baseline HCV viral load (< 10(6) IU/mL vs > 10(6) IU/mL: OR, 3.0). There was no association with age, sex, aminotransferases activity, body mass index, waist/hip ratio, or percentage body fat. There was borderline significance (P = 0.064) of increased fibrosis in patients with the TT allele, and no differences in the insulin resistance index between groups of patients with CC, CT and TT alleles (P = 0.12). Spearman's rank correlation coefficient between insulin resistance and stage of fibrosis and body mass index was r = 0.618 and r = 0.605, respectively (P < 0.001). Significant differences were found in the insulin resistance index (P = 0.01) between patients with and without steatosis. Patients with the CT allele and absence of a SVR had a higher incidence of requiring threshold dose reduction of interferon (P = 0.07). CONCLUSION: IL28B variation is the strongest host factor not related to insulin resistance that determines outcome of antiviral therapy. Baseline platelet count predicts the outcome of antiviral therapy in CT allele patients.

Levels of sVCAM-1 and sICAM-1 in patients with lyme disease.

INTRODUCTION: Lyme disease is a multi-organ animal-borne disease caused by the spirochete Borrelia burgdorferi (Bb). OBJECTIVES: As the pathogenesis of Lyme borreliosis is not fully understood, the study has been designed to examine levels of soluble vascular cell adhesion molecule-1 (sVCAM-1) and soluble intercellular adhesion molecule-1 (sICAM-1) in serum and the cerebrospinal fluid (CSF) of patients with Lyme borreliosis and their associations with clinical signs and symptoms and anti-Borrelia burgdorferi (anti-Bb) antibody titers. PATIENTS AND METHODS: Sixty-four patients were enrolled in the study, including 39 patients treated for Lyme borreliosis and 25 without the disease (control group). In both groups sVCAM-1 and sICAM-1 levels were determined in serum and the CSF. RESULTS: Mean serum sICAM-1 and sVCAM-1 levels were higher in patients with Lyme borreliosis than in the control group. Serum sICAM-1 levels were significantly lower among patients with results positive for immunoglobulin M seroreactivity with Bb than among those with negative antibody responses. In patients with Bb-specific serum immunoglobulin G (IgG) antibodies, significantly higher serum sICAM-1 levels were found. Higher sVCAM-1 and sICAM-1 levels in the CSF were observed in patients positive for anti-Bb IgG antibody titers in the CSF. CONCLUSIONS: In patients with Lyme borreliosis, endothelial cell activation results in elevated levels of sICAM-1 and sVCAM-1 in serum and the CSF.

Neuroborreliosis with extrapyramidal symptoms: a case report.

The disease of Lyme is a tick-borne infection. It involves skin, the nervous system, joints and the heart. Spirochaeta Borrelia burgdorferi is the etiologic agent of the disease. In the majority of cases, clinical symptoms, like migrating erythema, occur from 3 to 30 days, sometimes to 3 months after a bite from a tick. The early disseminated infection involves multiple migrating erythema, neuroborreliosis, arthritis, myocarditis and other organ-related symptoms. The late stage of chronic infection involves chronic atrophic leg dermatitis, neurological and rheumatological symptoms, and other organ-related symptoms which persist for above 12 months. The diagnosis of the disease of Lyme is based upon specific clinical symptoms confirmed by serologic tests. The two-step diagnostic protocol including the ELISA method, confirmed by the Western-blot test, is optimal. The present article describes a case of a 59-year-old man, a computer specialist, who often spends his free time walking in woods for recreation, and who was bitten by a tick 3 years before hospitalization. The bite resulted in migrating erythema that subsided without antimicrobial treatment. In spite of this, the man had not changed his hobby exposing himself to bites from ticks. One year later, multiple migrating erythema and extrapyramidalis symptoms appeared without any other organ malfunctions. In the current year, the patient was admitted to the Infectious Diseases Hospital, and received antibiotics (ceftriaxon) with following neurological improvement. Several months later, extrapyramidal symptoms increased. On the day of admission to the hospital, the neurologic examination showed abnormalities of upper and lower limbs movements (propulsive walking and the right lower leg traction), the right hand tremor, pouts of the face, and sleepiness.