The Consumption of Raw Goat Milk Resulted in TBE in Patients in Poland, 2022 "Case Report".

The alimentary route is the second most important route of tick-borne encephalitis infection. In Poland, the last TBE case due to the consumption of unpasteurized milk or dairy products of infected animals was recorded in 2017 as the fourth documented outbreak of TBEV infection in the country. In this study, two patients infected with TBEV through consumption of unpasteurized goat's milk from one source are described from a cluster of eight cases. In August and September 2022, a 63- and 67-year-old woman were hospitalized at the Infectious Diseases Clinic of the Institute of Rural Health (Lublin, Poland). The patients denied been recently bitten by a tick, and neither had been vaccinated against TBEV. The disease had a biphasic course. In the first case, the patient suffered from a fever, spine pain, and muscle weakness and paresis of the lower left limb. The second patient suffered from fever, vertigo, headaches, abdominal pain, and diarrhoea. The results of IgM and IgG antibodies were positive in both cases. After three weeks hospitalization, the patients were discharged in good condition. In one case, slight hearing impairment was observed. Vaccination and avoiding the consumption of unpasteurized milk remain the most effective ways to prevent tick-borne encephalitis.

Concentration of LDLR, degree of hepatic fibrosis and hepatic steatosis in patients with chronic hepatitis B infection treated with tenofovir disoproxil fumarate.

INTRODUCTION: Epidemiological data indicate that one-third of the world's population have serological markers of hepatitis B virus infection. Hepatic steatosis is often observed in patients with chronic liver diseases. The exact mechanisms of hepatic steatosis progression and the efficacy of antiviral therapy in patients with CHB and hepatic steatosis are not yet fully understood. OBJECTIVE: The aim of the study was to investigate the LDLR concentration and degree of hepatic fibrosis and hepatic steatosis in patients with chronic hepatitis B infection during tenofovir disoproxil fumarate therapy. MATERIAL AND METHODS: The study group consisted of 54 patients with CHB. The LDLR concentration, assessment of the degree of hepatic fibrosis, hepatic steatosis, total cholesterol, low density lipoprotein, high density lipoprotein and triglyceride concentrations, were assessed at the beginning of therapy, 6 months later, and 12 months after commencement of therapy. The control group consisted of 18 healthy individuals. RESULTS: The mean LDLR concentration in the studied groups was statistically significantly lower (p<0.05) than in the controls. The antiviral therapy based on TDF had no influence on the LDLR concentration and HBsAg level. CONCLUSIONS: The results indicate a statistically significant lower(p<0.05) concentration of LDLR in patients with chronic hepatitis B infection. Negative correlations between HBsAg level and LDLR concentration in patients with chronic HBV, at all stages of the study may indicate, that HBsAg protects hepatocytes from LDL accumulation.

[Natural interferon alpha (Le-IFNalpha) treatment in patients with thrombocytopenia during chronic HCV infection--our observations]. / Interferon naturalny (Le-IFNalpha) w leczeniu chorych z maloplytkowoscia w przebiegu zakazenia HCV--obserwacje wlasne.

The aim of our study was to assess efficacy and safety of antiviral treatment with natural interferon alpha in patients with thrombocytopenia during chronic HCV infection. The study group consisted of 14 patients infected with HCV genotype lb. There were 8 women and 6 men (mean age 50). 11 of these had compensated liver cirrhosis. Three patients had previous reIFN or PegIFN alpha therapy with severe adverse events and lack of sustained viral response (SVR). Sustained viral response was achieved in 4 patients. Only in one case therapy was discontinued due to symptomatic hemorrhagic purpura.

An overview of Human Papillomavirus (HPV) as an etiological factor of the anal cancer.

Human papillomavirus (HPV) is a DNA tumour virus that is the primary cause of sexually transmitted infections (STIs). The direct connection between HPV and cervical cancer was discovered in 1980, however, many physicians and the general public are still oblivious to the association of HPV and anal cancer; most individuals find out about this relationship after a confirmed diagnosis, and therefore, it is important to raise awareness about HPV as an etiological agent in anal cancer. There is a quadrivalent vaccine available, which prevents an individual from being infected with HPV, thus anal cancer is mainly a preventable cancer when caused by HPV, and ultimately, preventing cancer is better than curing cancer, especially when there is no definite cure.This article aims to review the microbiology, pathophysiology, epidemiology, clinical presentation, diagnostic evaluation, prophylaxis and treatment options for HPV as an etiology agent in anal cancers in light of recent literature.

The first report evaluating the post-exposure rabies prophylaxis in children exposed to animals in the Lublin Province (Eastern Poland) in 2010-2016 - a retrospective study.

INTRODUCTION: Rabies continues to be one of the most important viral diseases and remains a significant threat to public health across the globe. The World Health Organization (WHO) has determined that most rabies cases occur in children. Dog bites on humans are a major public-health problem. Poland has not achieved rabies free status yet. Post-exposure prophylaxis (PEP) in humans can effectively prevent death after exposure to a potentially infected animal. THE AIM: The main objective of this study was to estimate the frequency of PEP among children exposed to animals, who had attended consultations at the Department of Infectious Diseases for Children in the Jan Bozy Hospital in Lublin. PATIENTS AND METHODS: We retrospectively analyzed the medical records from the period of 2010-2016 of all pediatric patients (0-17 years of age) who had been exposed to animals and attended consultations at the Department of Infectious Diseases for Children in the Jan Bozy Hospital in Lublin. RESULTS: During the studied period, 519 children who had been exposed to animals attended consultations, and a prophylactic procedure consisting of active immunization was applied to 32.8%. The male children accounted for 55.3%. The mean age was 9.2 years. The biggest group of children (406) had been exposed to dogs, 62 children to cats, and 15 to rats. Most children had upper-limbs injuries. During the studied period, i.e. 2010-2016, there were 1713 confirmed cases of rabid animals in Poland, and 60 cases were recorded in the Lublin Province. We did not observe any cases of rabies in our exposed and vaccinated patients. CONCLUSIONS: The number of rabid animals in the Lublin Province had decreased to low levels, but the expected decrease in the number of PEP's administered did not occur. Since all children were vaccinated in accordance with the recommendations, the possible reason for vaccination's being administered in the quantities greater than the number of rabid animals recorded in the Lublin Province are bites by animals unavailable for veterinary observations and also the lack of more frequent reports regarding the current epizootic situation of rabies. The use of rabies immunoglobulin (RIG) in children in the Lublin Province is at a very low level, i.e. at 0.58%. The yearly numbers of exposed pediatric patients were at similar levels, which indicates that education programs should be introduce to reduce the number of animal bites in children.

Hepatitis E - A new era in understanding.

Hepatitis E virus [HEV], the last of the five hepatotropic viruses to be discovered, was originally considered to cause an acute, travel-associated self-limiting illness restricted to humans; however, new research shows that there are animal reservoirs and zoonotic transmission. Additionally, HEV is now considered as a major health burden worldwide, leading to significant morbidity and mortality; therefore, the topic of hepatitis E is of re-emerging importance, having brought to light important questions such as the transmission of HEV, especially in developed countries, as well as treatment and vaccination options. HEV belongs to the genus Hepevirus in the Hepeviridae family. The HEV genome sequence is relatively stable; however, there is a diversity of genotypes which are helpful in comprehending the epidemiological phenomena. HEV is classified based on the nucleotide sequences of the genome and is now characterised as a single serotype with four major genotypes [HEV 1-4]. Hepatitis E cases are not clinically distinguishable from other types of acute viral hepatitis, although diagnosis can be strongly suspected in certain epidemiological settings. It is imperative to raise awareness among physicians about the importance of HEV, with the aim of helping recognise, prevent and treat HEV infections. This review article highlights the current developments of HEV in microbiology, epidemiology, clinical features, treatment and prophylaxis.

A systematic review of the present and future of non-alcoholic fatty liver disease.

Non-alcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease in the Western world. Ongoing research has furthered our understanding of NAFLD, the nature of progression of this disease, and its impact on morbidity and mortality. An active form of NAFLD is non-alcoholic steatohepatitis (NASH); it is the most severe subtype, without any current recommended therapies, according to the European Medicines Agency. The development of new therapies presents challenges, notably due to the slow progression of NASH and the clinically relevant endpoints. Correlating new data with effective treatment regimens is an emerging challenge, which will increase our understanding of the factors affecting the NAFLD course. This can enable more appropriate non-invasive prognostic assessments, which can focus on specifically at-risk NAFLD populations for tailored individual treatment. This review article aims to highlight the current developments in the field of NAFLD: pathogenesis, epidemiology, diagnosis, clinical features, and available treatment, including novel targets and therapies.

Acute hepatitis A virus infection in patients hospitalized at the Department of Infectious Diseases, Medical University of Lublin (Eastern Poland) in 2017 - a hospital-based retrospective study.

The aim of our study was to analyze medical records of all adult patients with acute hepatitis A virus (HAV) infection who were hospitalized at the Department of Infectious Diseases, Medical University of Lublin, Poland in 2017. During the studied period acute HAV infection was confirmed in 33 patients. In the study group there were 30 men and 3 women. The mean time of hospitalization was 12 days. All patients recovered with no clinical sequelae.

[Thrombocytopenia in HCV infection. Natural interferon as an alternative therapy]. / Maloplytkowosc w zakazeniu HCV. Interferon naturalny jako terapia alternatywna.

The current standard of care for the treatment of hepatitis C virus (HCV) infection is the combination of pegylated interferon and ribavirin. The interferon-based therapy is contraindicated in patients with HCV-associated thrombocytopenia. The pathogenesis of HCV-associated thrombocytopenia is still unclear. In this paper the main aspects of HCV-associated thrombocytopenia and alternative therapy with natural interferon (Alfaferone) are presented.

Post-exposure rabies prophylaxis in humans exposed to animals in Lublin province (Eastern Poland) in 2012-2015 - A retrospective study.

Rabies continues to be one of the most important viral diseases and remains a significant threat to public health across the globe. The post-exposure prophylaxis in humans can effectively prevent death after exposure to a potentially infected animal. In Poland, recommendations for rabies PEP followed the national guidelines which recommend that people should receive PEP when bitten by an animal suspected to be infected by rabies. PEP in humans includes cleansing and disinfecting the wound or point of contact, and administering anti-rabies immunization. Rabies vaccine should be given for contacts of category II and category III exposures. RIG should be given for category III contact. The vaccination schedule includes 5 doses given within a 30 day period (the Essen regimen). THE AIM: The aim of our study was to determine the frequency of post-exposure prophylaxis among patients exposed to animals and also to assess the animal species suspected as a source of rabies exposure. METHODS: We have retrospectively analyzed medical records from the years 2012-2015 of all adult patients who were exposed to animals and consulted at the Dispensary of Rabies Prophylaxis in the Department of Infectious Diseases at the Medical University in Lublin, Poland. All consulted patients were asked to give an informed consent in case of decision to use collected data for future research work. Ethical approval was obtained from the Ethics Committee of the Medical University of Lublin, Poland, and all patients included in this study gave an informed consent during consultation after the exposure to animals. RESULTS: During the studied 4-year period, 511 persons exposed to animals were consulted and prophylactic procedure consisting of active immunization were applied in 54.2% of the total consulted. Dogs and cats were the most common animal species suspected as the source of the rabies exposure. Anti-rabies prophylaxis was applied in 45.8% of all vaccinated patients exposed to dogs, and in 24.2% exposed to cats. All patients with bite wounds were consulted at the Department of Surgery and wound care followed surgical recommendations. In the study group, 45 patients had category III contact. There were 38 patients exposed to dogs, and 7 exposed to cats. There were no people exposed to wildlife in this group. All animals were available for veterinary observation. During and after exposure, none of the animals that serve as a potential source of infection presented with symptoms of rabies. The local epidemiological data indicated that during exposures of our patients, there were no confirmed cases of rabies among animals in Lublin province. Based on the data mentioned above, RIG was not applied. During the studied period in Lublin province, rabies was confirmed mainly in wildlife, and only in 2 dogs. CONCLUSIONS: In Lublin province, people are still at risk of exposure to rabid animals. The majority of our patients were vaccinated after domestic animals exposure, but rabies was confirmed mainly in wildlife, and since 2013, there were no cases of rabies among domestic animals.

Post-exposure anti-rabies prophylaxis in Lublin province (Eastern Poland) in 2004-2005.

Rabies is considered a disease of the highest mortality rate and all humans are vulnerable to infection. Specific anti-rabies immunoprophylaxis is the only efficient method of protection. The analysis of indications for active alone and active and passive immunization among patients reported to the dispensary of rabies prophylaxis in the Department of Infectious Diseases of Medical University of Lublin (eastern Poland) in 2004-2005 is presented. Prophylactic procedures were applied in 120 persons (14.98 % of overall number consulted). Passive immunization, i.e. rabies immune globulin, was administered in 1 person (0.12 %). In 2004, 64 persons (7.99 %) received active vaccination, and 56 patients (6.99 %) were vaccinated in 2005. Most of vaccinated patients lived in an urban area where the risk of rabies should be lower; however, in cities like Lublin there is a higher risk of being bitten by homeless animals. The most common species with rabies suspicion were dogs and cats. The decrease in the number of patients bitten by animals with confirmed rabies in Lublin province, and of the number of cases of animal rabies may indicate that oral vaccination of red foxes, representing a main reservoir of rabies virus in Poland, has been shown to be effective.

Acute hepatitis A virus infection in patients hospitalised at the Department of Infectious Diseases, Medical University of Lublin (Eastern Poland) in the years 2009-2015.

The aim of our study was to analyse all medical records from the years 2009-2015 for adult patients with acute hepatitis A virus (HAV) infection who were hospitalised at the Department of Infectious Diseases, Medical University of Lublin (Eastern Poland). During this 7-year study, there were only 5 hospitalised patients with confirmed HAV infection. In the study group 4 out of 5 patients had travelled to HAV-endemic areas (Egypt, Ukraine), and 3 of the hepatitis A cases were imported from Egypt. Our data indicate that during the past 7-year period most HAV patients hospitalised at the Department of Infectious Diseases in Lublin were due to travel.

Efficacy of HCV treatment in Poland at the turn of the interferon era - the EpiTer study.

THE AIM OF THE STUDY: Was to analyze the efficacy achieved with regimens available for chronic hepatitis C (CHC) in Poland between 2013 and 2016. MATERIAL AND METHODS: Data were collected from 29 centers and included 6786 patients with available sustained virologic response (SVR) data between 1 January 2013 and 31 March 2016. RESULTS: The sustained virologic response rate for genotypes (G) 1a, 1b, 2, 3 and 4 was 62%, 56%, 92%, 67% and 56% respectively; 71% patients (n = 4832) were treated with pegylated interferon α (Peg-IFNα) and ribavirin (RBV), with SVR rates of 58%, 49%, 92%, 67% and 55% respectively. The sustained virologic response among 5646 G1 infected patients was the lowest with natural interferon α (7%, n = 70) or PegIFN (50%, n = 3779) with RBV, and improved in those receiving triple regimens of Peg-IFN + RBV combined with boceprevir (47%, n = 485), telaprevir (64%, n = 805), simeprevir (73%, n = 132) or sofosbuvir (70%, n = 23). The sustained virologic response with interferon-free regimens of sofosbuvir and RBV (n = 7), sofosbuvir and simeprevir (n = 53), and ledipasvir and sofosbuvir (n = 64) achieved 86%, 89% and 94% respectively. The highest SVR of 98% was observed with ombitasvir/paritaprevir combined with dasabuvir (n = 227). Patients infected with G3 (n = 896) and G4 (n = 220) received mostly Peg-IFN + RBV with SVR of 67% and 56% respectively. Interferon-free regimens were administered in 18 G3/G4 patients and all achieved an SVR. Sofosbuvir combined with Peg-IFN and RBV was administered to 33 patients with an SVR rate of 94%, and a similar rate was achieved among 13 G2 patients treated with interferon and RBV. CONCLUSIONS: We observed significant differences in efficacy of HCV regimens available in Poland at the turn of the interferon era. The data will be useful as a comparison for therapeutic options expected in the next few years.

Prevalence of HCV genotypes in Poland - the EpiTer study.

THE AIM OF THE STUDY: Was to assess current prevalence of hepatitis C virus (HCV) genotypes in Poland, including their geographic distribution and changes in a given period of time. MATERIAL AND METHODS: Data were collected with questionnaires from 29 Polish centers and included data of patients diagnosed with HCV infection between 1 January 2013 and 31 March 2016. RESULTS: In total, data of 9800 patients were reported. The highest prevalence was estimated for genotype 1b (81.7%), followed by 3 (11.3%), 4 (3.5%), 1a (3.2%) and 2 (0.2%). Genotype 5 or 6 was reported in 6 patients only (0.1%). The highest prevalence of genotype 1 was observed in central (lódzkie, mazowieckie, swietokrzyskie), eastern (lubelskie) and southern (malopolskie, slaskie) Poland. The highest rate for genotype 3 was observed in south-western (dolnoslaskie, lubuskie) and eastern (podlaskie, warminsko-mazurskie and podkarpackie) Poland. Compared to historical data, we observed an increasing tendency of G1 prevalence from 72.0% in 2003 to 87.5% in 2016, which was accompanied by a decrease of G3 (17.9% vs. 9.1%) and G4 (9.0% vs. 3.1%). CONCLUSIONS: Almost 85% of patients with HCV in Poland are infected with genotype 1 (almost exclusively subgenotype 1b), and its prevalence shows an increasing tendency, accompanied by a decrease of genotypes 3 and 4.

First case of imported African tick-bite fever in Poland - Case report.

This is the first report of a case of African tick bite fever (ATBF) imported to Poland from South-Africa. The patient presented with fever of 38.4(o)C, generalized maculopapular rash and single eschar. Diagnosis was confirmed by polymerase chain reaction (PCR) from eschar biopsies. The patient recovered without any sequelae after 7 days treatment with doxycycline.

Post-exposure anti-rabies prophylaxis in humans exposed to animals in Lublin province (Eastern Poland) in 2006-2011.

The aim of our study was to analyze medical records from years 2006-2011 of all patients exposed to animals and consulted at the Dispensary of Rabies Prophylaxis in the Department of Infectious Diseases at the Medical University of Lublin in Eastern Poland. During the studied 6-year period, 1,504 persons exposed to animals were consulted, and prophylactic procedure consisted of active immunization applied in 19.21% of the total consulted. Dogs and cats were the most common animal species suspected as the source of rabies exposure. Anti-rabies prophylaxis was applied to 51.56% of all vaccinated patients exposed to dogs and to 20.06% exposed to cats. Rabies was confirmed mainly in domestic animals (2 cats, 1 dog). Among wild animals, only 1 case of rabies was confirmed in a single bat.

Dehydroepiandrosterone sulphate and androstenedione concentration in the serum of male patients with chronic hepatitis C.

In this study the dynamics of DHEAS and androstenedione serum concentration in male patients with CHC infection were analyzed. The study group consisted of 52 men, 26 of them being the control group of healthy men. The DHEAS and androstenedione serum concentration was determined twice with radioimmunological method (RIA). 1. Mean values of suprarenal androgens serum concentration in male patients with CHC infection were lower than in healthy men and the observed differences were incidental, 2. There was no correlation between dehydroepiandrosterone and androstenedione serum concentration in male patients with CHC infection.

Dynamics of proinflammatory cytokines serum levels during viral hepatitis type A.

In this study we assessed the dynamics concerning IL-2, sLL-2R and IL-4 serum levels in the course of an acute viral hepatitis A infection. The study group consisted of 48 persons. The serum concentrations of IL-2, sIL-2R and IL-4 were assessed with the use of ELISA methods. In patients the assessments were done twice--in the first and third week of the hospitalisation. In the control group, which consisted of 24 healthy persons the assessments were done once. The obtained data were analysed with the use of c-Cochran and Cox statistical test. We observed a statistically important decrease in IL-2 and IL-4 serum levels in patients with acute viral hepatitis A infection in the first week of the hospitalisation compared to values observed in the control group. We also observed an increase in sIL-2R levels in the course of the disease. The dynamics of IL-2, sIL-2R and IL-4 serum levels in patients with acute hepatitis A infection was of a random type. The assessment of IL-2, sIL-2R and IL-4 serum levels can be helpful in examining the cellular response in viral hepatitis A infection.

Concentration of prothrombin fragment 1 + 2 (f1 + 2) in patients with liver cirrhosis and chronic hepatitis C infection.

The aim of this study was to assess the serum concentration of F1 + 2 in patients with liver cirrhosis developed during HCV infection and in patients with chronic hepatitis C infection. The study group consisted of 52 patients hospitalised at the Department of Infectious Diseases of Medical University of Lublin, Poland. Among them, 18 patients (8 men and 10 women), aged 19-59 years, had a stable liver cirrhosis and 34 patients (21 men and 13 women), aged 20-41 years, were diagnosed with chronic hepatitis C infection. The control group consisted of 25 healthy individuals (13 men and 12 women), aged 19-60 years. The serum concentration of F1 + 2 was determined by the immunoenzymatic assay Enzygnost F1 + 2 micro. There were no statistically significant differences observed in serum concentration of F1 + 2, both in patients with stable cirrhosis and with CHC, compared to controls. However, in 16.7% of patients with cirrhosis and in 35.3% of patients with CHC elevated serum levels of F1 + 2 were observed.