Reinfections from SARS-CoV-2: A Retrospective Study from the Gyncentrum Genetic Laboratory in Sosnowiec, Poland, April 2020 to July 2022.

BACKGROUND The increasing number of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) reinfections has opened a new research direction related to analyzing long-term immune response and accurately characterizing individual cases of reinfection to understand its mechanism and estimate the risk of widespread reinfection both locally and globally. This retrospective study from the Gyncentrum Genetic Laboratory in Sosnowiec, Poland aimed to evaluate reinfections from SARS-CoV-2 between April 2020 and July 2022. MATERIAL AND METHODS The study extended the previously published report on SARS-CoV-2 infection cases in Poland by analyzing 8041 reinfections diagnosed with real-time reverse transcription-polymerase chain reaction (RT-PCR) assay. Data were collected on the amount of time elapsed from the first infection to the next and, based on these data, all results were divided into several groups for statistical analysis: 0-44, 45-90, 91-200, 201-310, 311-420, and >420 (days). RESULTS The study showed that of the 8041 patients who experienced reinfection, the vast majority (5505) became reinfected more than 310 days after the original infection, even though the average time between infections was 354.3 days. Statistical analysis revealed that the risk of SARS-CoV-2 reinfection increases with time and that this relationship becomes statistically significant after the 200th day following the initial infection (p<0.01). CONCLUSIONS We have shown that acquired immunity to SARS-CoV-2 infection is relatively short-lived - it starts diminishing about 6 months after the initial positive test. Moreover, the risk of reinfection is very high more than 1 year after the initial infection.

Clinical significance of asymptomatic [i]Clostridium difficile[/i] colonisation in patients undergoing antibiotic treatment.

BACKGROUND: [i]Clostridium difficile[/i] infections become a serious problem in terms of nosocomial infections, as well as a consequence of common use of antibiotics. AIM: The aim of the study was to evaluate [i]Clostridium difficile[/i] carriage in patients admitted to the Clinical Department of Infectious Diseases and Hepatology without acute or chronic diarrhea and to assess the impact of antibiotic treatment on the development of enteritis in hospital. Other factors that may affect the risk of infection were also analyzed. RESULTS: Fourteen patients (14%) were carriers of [i]Clostridium difficile[/i] at admission. Second assessment taken after fourteen days of antibiotic treatment showed decrease in GDH antigen prevalence to eight subjects (12.1%). Three patients (3%) had diarrhea during hospitalization, and the toxins A and/or B were found in them. CONCLUSIONS: The frequency of [i]Clostridium difficile[/i] carriage among adults in Poland may be underestimated. Screening for Clostridium difficile GDH antigen may be useful although do not provide definite prognosis of symptomatic disease during ceftriaxone treatment. The risk of Clostridium difficile infection may be reduced mainly by rationalizing antibiotic therapy and following appropriate procedures.

Cerebrospinal fluid ferritin concentration in patients with purulent, bacterial meningitis ­ own observations / Stezenie ferrytyny w plynie mózgowo-rdzeniowym chorych z ropnymi, bakteryjnymi zapaleniami opon i mózgu - obserwacje wlasne

THE AIM: The aim of the study was to evaluate the usefulness of cerebrospinal fluid (CSF) ferritin concentration assessment in adults with purulent, bacterial meningoencephalitis. MATERIAL AND METHODS: The investigation was performed in 18 subjects hospitalized at the Clinical Ward of Infectious Diseases, Medical University of Silesia in Bytom from 2008 through 2012, for purulent, bacterial meningoencephalitis. The patients were divided into two groups, according to severity of their clinical condition: Group I ­ very severe course of the disease, group II ­ moderate and mild course of the disease. In all the individuals, CSF interleukin-6 concentration was evaluated during the first 24 hours of hospitalization. RESULTS: Mean CSF ferritin concentration in patients in very severe clinical condition (group I) was 314.71 ng/mL as compared to 162.13 ng/mL in subjects of group II with moderate and mild course of the disease. The difference between CSF mean concentration of this cytokine was statistically significant (p<0.01). Correlations between CSF ferritin and CSF protein and lactate were determined. The control assays performed in 6 patients from group I revealed only slightly decrease of CSF ferritin level in the fatal course of the disease. In survivals with recovery CSF concentration of this protein was decreased markedly as compared to the initial level. CONCLUSIONS: The obtained results indicate the usefulness of CSF ferritin concentration assessment in estimation of intensity of inflammation in the subarachnoid space, and indirectly, of severity of the patient's clinical condition. The level of this protein concentration also seems to be helpful as a prognostic marker in purulent, bacterial meningoencephalitis.

Acute liver failure during treatment of interferon alpha 2a chronic hepatitis B and coinfection of parvovirus B19

Parvovirus B19 infection is associated with a broad spectrum of clinical manifestations among which some are well known but others remain controversial. The role of this infection as a cause of acute hepatitis or exacerbation of chronic liver disease requires discussion regarding its significance in a strategy of prevention and treatment of patients with chronic hepatitis. Clinical importance of this infection in patients with chronic hepatitis B treated with pegylated interferon alpha 2a is still unclear but exactly in this population significant complications during treatment may arise. Parvovirus B19 infection is not rare among persons with chronic hepatitis B, therefore searching for co-infection should be placed in standard diagnostic procedures especially in case of exacerbation of chronic hepatitis, pancytopaenia or anaemia of unknown origin. Pegylated interferon alpha 2a still remains a gold standard of therapy of patients with chronic hepatitis B according to European (EASL) and Polish guidelines. We present a case of 35 years old woman treated with pegylated interferon alpha 2a who developed acute liver failure in 23rd week of chronic hepatitis B therapy. An exacerbation of hepatitis with encephalopathy and pancytopaenia have been observed. Parvovirus B19 and HBV co-infection does not increase the frequency of liver function abnormalities in patients with chronic hepatitis B. Further investigations should be done to describe the natural course of co-infection with parvovirus B19 and HBV and to establish possible association between parvovirus B19 infection and chronic hepatitis B and also the influence of interferon alpha 2a on the infections course.

Increased concentration of interferon lambda-3, interferon beta and interleukin-10 in the cerebrospinal fluid of patients with tick-borne encephalitis.

Tick-borne encephalitis (TBE) has a wide clinical spectrum, from asymptomatic to severe encephalitis, and host-dependent factors determining the outcome remain elusive. We have measured concentrations of pro-inflammatory/Th1 interferon-γ (IFNγ), immunomodulatory/Th2 interleukin-10 (IL-10), anti-viral type I (IFNß) and type III (IFNλ3) interferons in cerebrospinal fluid (csf) and serum of 18 TBE patients, simultaneously genotyped for polymorphisms associated with the expression of genes IFNL3 (coding IFNλ3), IL10, CD209 and CCR5. IL-10, IFNß and IFNλ3 were up-regulated in csf, with IFNλ3 level higher in patients with the milder clinical presentation (meningitis) than in meningoencephalitis. There was an increased serum IFNß and a tendency for increased serum IL-10 in meningitis patients. Genotype in rs12979860 locus upstream of IFNL3 was associated with IFNλ3 expression and in rs287886 (CD209) - IL-10 expression. IL-10, IFNß and IFNλ3 are expressed and play a protective role in TBE and their expression in TBE patients is associated with genetic polymorphisms.

Chemokine CXCL13 concentration in cerebrospinal fluid in patients with neuroborreliosis--own observations.

THE AIM: of the study was to evaluate the usefulness of cerebrospinal fluid chemokine CXCL13 concentration assay in diagnostics of neuroborreliosis in adults. MATERIAL AND METHODS: Investigations were carried out in 22 patients treated for neuroborreliosis , manifested as lymphocytic meningitis, at the Department of Infectious Diseases, Medical University of Silesia, in Bytom between 2011-2013. Based on the presence or absence of anti-borrelial antibodies in the cerebrospinal fluid, the examined individuals were divided into two groups on the day of admission: group I--patients with antiborrelial antibodies in the cerebrospinal fluid (confirmed diagnosis of neuroborreliosis), group II--patients without antiborrelial antibodies in the cerebrospinal fluid (possible diagnosis of neuroborreliosis). In all patients the cerebrospinal fluid CXCL13 level was assessed on the first day of hospitalization. Control tests were performed in both groups after 14 days of therapy with antibiotics. RESULTS: Mean cerebrospinal fluid CXCL13 concentration in group I on the 1st day was 4123 pg/mL, and in group II--3422 pg/mL. Differences in mean concentrations of this chemokine were statistically insignificant. No correlations between examined mean CXCL13 concentrations and other cerebrospinal fluid inflammatory parameters were revealed. The control tests showed the evident decrease of CXCL13 level in cerebrospinal fluid in both groups. Besides, in individuals of group II anti-Borrelia burgdorferi antibodies appeared in cerebrospinal fluid, whereas in group I, the control results of this parameter were similar to preliminary values. CONCLUSION: The obtained results indicate a kind of usefulness of estimation of cerebrospinal fluid chemokine CXCL13 concentration in diagnostics of early, acute neuroborreliosis, manifested as lymphocytic meningitis, especially in case of anti-borrelia antibodies absence in cerebrospinal fluid. Changes in this chemokine concentrations, opposite to cerebrospinal fluid levels of anti-borrelia antibodies, may be prognostic in acute, early neuroborreliosis.

The epidemiological and clinical analysis of Clostridium difficile infections in patients hospitalized due to the infection at the Department of Infectious Diseases in Bytom.

UNLABELLED: Clostridium difficile infections are becoming a more serious problem as hospital-acquired infections and the consequence of common antibiotic therapy, also on an out-patient basis. AIM OF THE STUDY: The aim of the study was the epidemiological and clinical analysis of patients with Clostridium difficile-associated disease (CDAD) at the Clinical Department of Infectious Diseases and Hepatology, Bytom in 2014. MATERIAL AND METHODS: A retrospective analysis of the medical documentation of patients with the diagnosis of CDAD was performed. The study group was comprised of 24 patients. The following factors were analysed: gender, age, recent hospitalization, use of proton-pump inhibitors, H2-receptor inhibitors, use of antibiotics, co-morbidities, and the clinical course with consideration given to additional laboratory tests (CRP, creatinine, WBC count). RESULTS: All patients with diagnosed CDAD had been previously hospitalized and 75% of subjects were treated with antibiotics in the period preceding the onset of the disease. Recurrence of the disease was observed in 29% of cases, on average, 12.5 days after hospital discharge. In 16.7% of patients, CDAD resulted in death. Higher CRP concentrations on admission were observed in patients who died compared to the survivors (91.1 mg/l vs. 33.6 mg/l, p=0.015). Additionally, higher concentrations of CRP and leukocytosis were observed in patients with an unfavourable outcome of the disease. Respiratory insufficiency and hypotension were connected with a higher risk of death. CONCLUSION: Hospitalization, antibiotic therapy, advanced age and co-morbidities may contribute to the occurrence of CDAD. In our study, initially high concentrations of CRP, respiratory insufficiency and hypotension were the predictive factors of a fatal outcome of the disease. The dynamics of changes in the leukocyte value and CRP concentration were of lesser importance.

Cerebrospinal fluid interleukin-6 concentration in patients with purulent, bacterial meningitis - own observations.

AIM: This study aimed at evaluating the usefulness of determining cerebrospinal fluid (CSF) interleukin-6 (IL-6) concentration in adults with purulent, bacterial meningoencephalitis. MATERIALAND METHODS: A study group consisted of 16 patients hospitalized in the Department of Infectious Diseases of the Medical University of Silesia in Bytom in 2008 - 2012 due to purulent, bacterial meningoencephalitis. All of them were classified into two groups based on clinical severity, assessed on admission: group I - severe condition, group II - moderately severe or mild condition. CSF IL-6 concentration was measured in all patients on the first day of hospitalization. RESULTS: Mean concentrations of IL-6 in CSF were assessed at 391.54 pg/mL and 110.51 pg/mL in patients in severe (group I) and moderately severe or mild condition (group II), respectively. Differences between CSF mean concentrations of this cytokine in both groups were statistically significant (p<0.01). No correlations between CSF IL-6 concentrations and other CSF inflammatory parameters were determined. Control testing performed in 5 patients of group I revealed only slight decrease of CSF IL-6 concentration in fatal cases. In case of patients who recovered from disease, IL-6 concentration in CSF was evidently decreased compared to its initial value. CONCLUSIONS: Results suggest the usefulness of determining CSF interleukin-6 concentration to estimate inflammation intensity in the subarachnoid space, and indirectly, patient's clinical severity. IL-6 concentration may be also of prognostic importance in purulent, bacterial meningoencephalitis.

Distribution of HCV genotypes in Poland.

UNLABELLED: Available data on prevalence of HCV genotypes in Poland are insufficient. The aim of the study was the analysis of distribution of HCV genotypes in Poland over the period of recent 10 years regarding the age of patients and the regions of the country. MATERIAL AND METHODS: Analysis of HCV genotypes in Poland was carried out between 2003 and 2012, and included 14 651 patients from 22 centers where patients with chronic viral hepatitis C are diagnosed and treated. Genotypes were analyzed in age groups (< 20 years of age, 20-40 years of age, > 40 years of age) as well as in populations of HBV and HIV co-infections. RESULTS: Genotype (G) 1 infection was demonstrated in 79.4%, G2 -0.1%, G3- 13.8%, G4- 4.9%, G6-0.09% and mixed infections in 1.6%. There was no infection with genotype 5. The highest prevalence of G1 was observed in the Lódzkie voivodship (89.2%) and the Slaskie voivodship (86.7%) while the lowest one in the Warminsko-mazurskie (62.0%) and the Podlaskie voivodships (68.2%). Genotype 3 most commonly occurs in the Warminsko-mazurskie (28.1%), and the Podlaskie voivodships (23.0%) and is least common in the Malopolskie (7.9%) and the Lódzkie voivodships (9.0%). Genotype 4 is more common in the Kujawsko-pomorskie (11.7%) and the Podlaskie voivodships (8.6%) and relatively less common in the Lubelskie (1.1%) and the Lódzkie voivodships (1.8%). Prevalence of G1 infection in 2003-2004 was 72% and increased up to 85.6% in 2011-2012, that was accompanied by decrease of G3 prevalence from 17% to 8% in this period. In HBV co-infected (n = 83), G1 infection was demonstrated in 85.5%, G3 - in 7.2%, G4 -4.8%, and mixed genotypes in 6%. Among HIV co-infected (n = 391), a much lower prevalence of G1 (33.0%) and a high of G3 (40.4%) as well as G4 (24.0%) were observed. CONCLUSIONS: There is a geographic variability of HCV genotypes prevalence in Poland. Increase of HCV G1 infections and decrease of G3 and G4 were observed in the last 10 years. Genotypes G3 and G4 occur more often in HCV/HIV co-infected than in HCV mono-infected patients.

HIV-1 integrase resistance among antiretroviral treatment naive and experienced patients from Northwestern Poland.

BACKGROUND: HIV integrase inhibitor use is limited by low genetic barrier to resistance and possible cross-resistance among representatives of this class of antiretrovirals. The aim of this study was to analyse integrase sequence variability among antiretroviral treatment naive and experienced patients with no prior integrase inhibitor (InI) exposure and investigate development of the InI drug resistance mutations following the virologic failure of the raltegravir containing regimen. METHODS: Sequencing of HIV-1 integrase region from plasma samples of 80 integrase treatment naive patients and serial samples from 12 patients with observed virologic failure on raltegravir containing treatment whenever plasma vireamia exceeded >50 copies/ml was performed. Drug resistance mutations were called with Stanford DB database and grouped into major and minor variants. For subtyping bootstrapped phylogenetic analysis was used; Bayesian Monte Carlo Marcov Chain (MCMC) model was implemented to infer on the phylogenetic relationships between the serial sequences from patients failing on raltegravir. RESULTS: Majority of the integrase region sequences were classified as subtype B; the remaining ones being subtype D, C, G, as well as CRF01_AE , CRF02_AG and CRF13_cpx recombinants. No major integrase drug resistance mutations have been observed in InI-treatment naive patients. In 30 (38.5%) cases polymorphic variation with predominance of the E157Q mutation was observed. This mutation was more common among subtype B (26 cases, 54.2%) than non-B sequences (5 cases, 16.7%), p=0.00099, OR: 5.91 (95% CI:1.77-22.63)]. Other variants included L68V, L74IL, T97A, E138D, V151I, R263K. Among 12 (26.1%) raltegravir treated patients treatment failure was observed; major InI drug resistance mutations (G140S, Q148H and N155H, V151I, E92EQ, V151I, G163R) were noted in four of these cases (8.3% of the total InI-treated patients). Time to the development of drug resistance ranged from 2.6 to 16.3 months with mean increase of HIV viral load of 4.34 (95% CI:1.86-6.84) log HIV-RNA copies/ml at the time of emergence of the major mutations. Baseline polymorphisms, including E157Q were not associated with the virologic failure on raltegravir. CONCLUSIONS: In InI treatment naive patients polymorphic integrase sequence variation was common, with no major resistance mutants. In the treatment failing patients selection of drug resistance occurred rapidly and followed the typical drug resistance pathways. Preexisting integrase polymorphisms were not associated with the treatment failure.

Genotypic tropism of antiretroviral-treated patients with drug resistant HIV-1.

CCR5 inhibitors remain an attractive antiretroviral treatment option for HIV-infected patients; however, tropism testing should be utilized prior their introduction. This study analyzed genotypic HIV-1 tropisms in patients with evidence of genotypic drug resistance to antiretroviral therapies in Northwest Poland. V3 loop sequences were analyzed from plasma samples obtained from patients presenting with virologic treatment failure while on combined antiretroviral treatment and with evidence of genotypic drug resistance. Genotypic X4 and R5 tropisms were identified using the geno2pheno algorithm with a false positive rate threshold set at 10%. Clinical data for all patients examined was collected, in addition to determining the CCR5 Δ32 genotype and calculating the genotypic susceptibility score (GSS). Virologic treatment failure and the presence of drug resistant mutations were observed in 37/450 (8.4%) patients on cART (combination antiretroviral therapy) with successful tropism analysis carried out on 35 (95%) cases. In 22 (62.9%) and 13 (37.1%) cases the R5 and X4 tropisms were predicted, respectively. An association between viral X4 tropism and the M41L (P = 0.04) resistance mutation and R5 tropism and the K103N (P = 0.07) resistance mutation were observed. GSS values were lower in the group with NRTI (P = 0.01) and NNRTI resistance (P = 0.048). In the majority of the drug resistant patients, R5 tropic viruses were found. As genotypic tropism testing is easy to carry out and interpret, its use in clinical practice would be highly useful in determining the use of appropriate drug therapies.

[Polish multicenter study on safety and efficacy of adefovir dipivoxil in the treatment of lamivudine resistant chronic hepatitis B in adults (HEP 2008)]. / Wieloosrodkowe badanie bezpieczenstwa i skutecznosci preparatu dipiwoksyl adefowiru w leczeniu przewleklego wirusowego zapalenia watroby typu B u doroslych z opornoscia na lamiwudyne (HEP 2008).

Initiated in April 2008 Polish multicenter study HEP2008 aimed clinical data concerning safety and efficacy of adefovir dipivoxil (ADV, Hepsera, Gilead Sciences) in adult chronically infected HBV with lamivudine (LAM) resistance after earliest treatment. We examined 38 men (70.4%) and 16 women (29.6%) with chronic hepatitis B in age 23-81 (average 53) mostly HBeAg positive (70.4%). Majority of patients received earlier LAM (72%), but others additional entekawir and\ or pegylated interferon. Average time from discovering infection HBV was 95 +/- 77 (10-307) months. Majority of patients received monotherapy ADV, but physicians decided at 12 (22%) persons about continuation of LAM therapy. Median HBV DNA level decreased from a baseline value 6.73 +/- 1.71 (1.8-9.0) to 3.25 log10 copies/mL. At least HBV DNA drop 1 log10 and 2 log10 get 78.8 and 60.6% in 24 week, 84.8 and 69.7% in 48 week. HBV DNA reduction below level 300 and 50 copies/mL it observed in 15.2 and 6.1% in 24 week, 39.4 and 30.3% in 48 week. Patients with undetectable Mean ALT activity dropped significantly and were below limit norm at 24 week in 40%, and at 48 week in 58% of patients. Patients treated ADV and LAM reached great reduction of ALT activity but was no influence on HBV DNA reduction. Results of research have confirmed efficiency and safety 48-week's therapy ADV in patients with LAM resistance.

Characteristics of HIV-1 non-B subtype infections in Northwest Poland.

The number of non-B subtype HIV-1 infections in Europe has been increasing even though major regional differences have been observed. This trend was investigated in northwestern Poland using sequence and epidemiological data from a cohort of 102 HIV-1-infected patients from Szczecin, Poland. HIV-1 subtypes were defined by phylogenetic analysis of viral reverse transcriptase- and protease-partial coding regions, and results were compared with online subtyping by Standford and REGA tools. Subtype analysis using on-line subtyping methods produced varying results if compared to phylogenesis, with concordant variant assignment obtained for 98% (100/102) of sequences by Stanford and 85% (87/102) by REGA. In the population studied, non-B subtype infections comprised 21% of the infections and consisted of subtype D (57%, n = 12), CRF01_AE (19%, n = 4), A and C clades (9.5%, n = 2), and the CRF13_cpx recombinant isolate (4.8%, n = 1). Patients carrying non-B subtypes were predominantly heterosexuals with high percentage (57%) of women observed in the group. All HIV-1 non-B women were Caucasian with majority (83%) of infections acquired in Poland; however, among 12 travelers included in the study a higher proportion of non-B infections was noted (50%, P = 0.01). Moreover, lower baseline lymphocyte CD4 counts (P = 0.01), higher baseline HIV-1 viremia (P = 0.08), and a more advanced stage of the disease (P = 0.03) were observed among individuals infected with non-B subtypes. The data indicated that the proportion of HIV-1 non-B subtype infections was higher than previously reported in Poland consisting of a high subtype D prevalence. Furthermore, subtype D transmission occurred primarily between heterosexual Caucasian individuals from this region.

[Evaluation of quality of HIV diagnostic procedures in Poland]. / Ocena jakosci procedur diagnostycznych zwiazanych z zakazeniem HIV w Polsce.

UNLABELLED: The aim of this work was quality assessment of HIV diagnostic procedures in Poland, including human and technical resources as well as laboratory practice. Sixty questionnaires were distributed among diagnostic centers to obtain qualitative data. Basing on the survey data serological control using coded panels of HIV-1/2 samples was performed. Thirty-one filled questionnaires were received (50.8%). Surveyed laboratories perform from 350 to 5500 serological screening tests per year. In most of laboratories fourth generation assays are available, while Blood Donation Centers screen the blood both with serological assays and by HIV-RNA detection. Sanitary and Epidemiological Stations and academic laboratories hold the ISO/IEC 17025 or IS0 9001:2001 accreditation, five of the surveyed centers participate in Labquality assurance and two in Quality Control in Molecular Diagnostics programs. Data of control serological testing were received from 21 centers. In the quality control assessment 194 analyses were performed with 91 true negative, 2 false negative, 96 true positive and 5 false positive results. False negative rate of % and false positive rate of 5.2% was noted for this study. CONCLUSIONS: Currently, virtually no guidelines related to the HIV-diagnostics quality assurance and control in Poland are in delineated. Development of the national unified quality control system, basing on the central institution is highly desirable. National certification within the frames of the quality control and assurance program should be mandatory for all the diagnostic labs, and aim at improvement of reliability of the result distributed among clinicians and patients.

[Antiviral treatment of chronic B hepatitis; 2010 - therapeutic recommendations]. / Leczenie przeciwwirusowe przewleklego zapalenia watroby typu B--zalecenia terapeutyczne 2010.

The drugs currently approved for treatment of HBV infections are: interferon alpha2a and alpha2b, pegylated interferon (PeglFN-al-pha2a) natural interferons and nucleos(t)ide analogues (NA): adefovir, entecavir, lamivudine, telbivudine (currently not available in Poland) and tenofovir. The following questions are described: the primary goal of antiviral treatment, criteria in therapeutic decision-making (including extrahepatic manifestations, compensated and decompensated cirrhosis of the liver), treatment failure (including: drug resistance), management of patients with HBV-positive markers, in whom chemotherapy or other immunosuppressive therapy is planned. In treatment-naive patients with chronic hepatitis B the first line therapy should be PeglFN-alpha2a monotherapy, and the first-line should be entecavir or tenofovir (highest potential for HBV replication suppression and high genetic barrier to resistance). In drug resistance the patient should be switched to another, preferably high-potency NA (entecavir or tenofovir) or start PeglFN-alpha2a therapy.

Lymphocyte-To-Monocyte Ratio as the Best Simple Predictor of Bacterial Infection in Patients with Liver Cirrhosis.

Background and aim: The aim of this study was to assess the diagnostic performance of new morphology-related indices and Child-Turcotte-Pugh (CTP) and Model for End-Stage Liver Disease (MELD) scores during hospitalization in predicting the onset of bacterial infection in patients with liver cirrhosis. Material and methods: A total of 171 patients (56.9% males; median age 59 years; total number of hospitalizations 209) with liver cirrhosis were included in this observational study. The diagnosis of cirrhosis was made on the basis of clinical, biochemical, ultrasonic, histological, and endoscopic findings. The neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), modified aspartate aminotransferase-to-platelet ratio index (APRI), aspartate aminotransferase-to-alanine aminotransferase ratio (AAR), Fibrosis-4 index (FIB-4), platelet-to-lymphocyte ratio (PLR), neutrophil-to-monocyte ratio (NMR), and CTP and MELD scores were calculated for the cases of patients with cirrhosis. Results: Bacterial infection was diagnosed in 60 of the 209 (28.7%) hospitalizations of patients with cirrhosis. The most common infections were urinary tract infection (UTI), followed by pneumonia and sepsis. The more severe the liver failure, the greater the bacterial infection prevalence and mortality. Patients with decompensated liver cirrhosis were infected more often than subjects with compensated cirrhosis (50.0% vs. 12.9%, p = 0.003). The calculated MELD score, CTP, NLR, LMR, AAR, monocyte count, and C-reactive protein (CRP) concentration were also related to the bacterial infection prevalence, and mortality areas under the curve (AUC) were 0.629, 0.687, 0.606, 0.715, 0.610, 0.648, and 0.685, respectively. The combined model with two variables (LMR and CTP) had the best AUC of 0.757. The most common bacteria isolated from patients with UTI were Escherichia coli, Enterococcus faecalis, and Klebsiella pneumonia. Gram-negative bacteria were also responsible for spontaneous bacterial peritonitis (SBP), and together with gram-positive streptococci and staphylococci, these microorganisms were isolated from blood cultures of patients with sepsis. Significant differences were found between CTP classification, MELD score, NLR, LMR, AAR, CRP, and PLR in patients with cirrhosis with, or without, bacterial infection. Conclusions: Bacterial infection prevalence is relatively high in patients with liver cirrhosis. Although all analyzed scores, including the LMR, NLR, aspartate aminotransferase (AST)/alanine aminotransferase (ALT), CRP, CTP, and MELD, allowed the prediction of bacterial occurrence, the LMR had the highest clinical utility, according to the area under the curve (AUC) and odds ratio (OR).

[Late AIDS diagnosis in patients hospitalized in Clinic of Infectious Diseases and Hepatology PAM in years 2003-2007]. / Pózne wykrywanie AIDS u osób hospitalizowanych w Klinice Chorób Zakaznych i Hepatologii PAM w latach 2003-2007.

AIM OF THE STUDY: Assessment of the phenomenon of the late HIV diagnosis, as defined by the disease diagnosis alongside with the AIDS defining illness (late HIV testing). METHODS: Retrospective epidemiological and clinical data analysis of patients with confirmed HIV infection, treated in the Chair and Department of Infectious Diseases and Hepatology Pomeranian Medical University, Szczecin from 2003 to 2007 in comparison to data from 1989-2002. RESULTS: Data of 275 patients aged 1-71 years (mean 35+/-10) who attended the clinic for the first time in period 2003-2007 were collected. Individuals of male gender were prevailing in the analyzed group (78%), the percentage of women have been changing over the years with 32% in 2003, through 9% in 2005 to 30% in 2007. More than half of the patients presented clinical symptoms of immune deficiency: without AIDS--36% and with AIDS--22%. Lymphocyte T CD4+ count < 200 cells/microl among 118 of 275 new patients (43%) was noted. In the period 2003-2007, 59% of new patients were started on cART treatment. Late AIDS diagnosis was confirmed among 61% patients, with considerably higher frequency among men--84%. Late testers were three years older if compared to the whole of the newly diagnosed patients. The most common AIDS defining illness was the pulmonary and extrapulmonary tuberculosis, diagnosed in 13/51(25%) patients. CONCLUSIONS: In most of cases HIV-infected patients are referred to the infectious diseases specialist when the clinical symptoms of immune deficiency occur, often being deeply immunocompromised. It is truly terrifying, that this situation has not truly changed since 1989. This notion creates the field for discussion on the universality and accessibility of HIV screening among Poles, in order to introduce a more common diagnostics.

State of the iron metabolism in patients with chronic hepatitis C type C does not influence antiviral treatment with interferon and ribavirin.

BACKGROUND/AIMS: Comparison of the iron status in patients who responded and did not respond to combination treatment with interferon alpha and ribavirin in chronic hepatitis C. METHODOLOGY: The study group comprised of 61 patients with chronic hepatitis C (genotype 1) treated with alpha 2b interferon and ribavirin. The iron metabolism was evaluated based on serum iron level, total iron binding capacity, transferrin saturation, serum ferritin concentration and hepatic iron concentration. In the evaluation of antiviral treatment efficacy biochemical and virological responses were taken into account. RESULTS: End of treatment response was observed in 38 patients (62%). Significant differences in iron parameters were not observed between responders and non-responders. Also, sustained viral response, 6 months after treatment completion, was reached in 32 patients (52.5%). Iron metabolism parameters did not differ significantly in the group of sustained responders versus non- responders. Finally, ALT normalization was observed in 42 patients (68.9%). Again, no significant differences in iron status were observed between patients with and without biochemical response excluding significantly higher serum ferritin concentration in non-responders. CONCLUSIONS: Results of this study show that iron status does not significantly influence the efficacy of treatment with interferon and ribavirin in patients with chronic hepatitis C.