Clinico-laboratory profile of dengue patients returning from tropical areas to Poland during 2010-15.

BACKGROUND & OBJECTIVES: Dengue is a mosquito-borne viral disease, incidences of which have increased rapidly in the past decade. About 400 million new infections are recorded annually worldwide, and 40% of the human population lives in the areas at risk of dengue transmission. In this study, the clinical and laboratory profile of dengue diagnosed patients returning to Poland from tropical areas has been analyzed. METHODS: This is a retrospective study of 65 patients based on clinical symptoms and serological tests conducted in the Department of Tropical Parasitology of Institute of Maritime and Tropical Medicine (IMTM) in Gdynia, Poland during 2010-15. The diagnosis of dengue virus (DENV) infection was based on the detection of specific immunoglobulin M (IgM) and IgA antibodies performed by specific ELISA assays. The samples were considered as positive, if the absorbance was >10% above the cut-off value. RESULTS: Among 65 persons with dengue selected for the analysis, 59 patients were admitted to the hospital because of clinical symptoms of the disease; the six persons initially asymptomatic were hospitalized due to routine control treatment returning from tropical regions. Patients reported various destinations, purpose and duration of their travels. All of them had returned from dengue endemic regions and were positive for IgM antibodies against DENV. Common clinical symptoms observed were fever (ranging from 38 to 40°C in 43% of patients), weakness, headache and rash. Laboratory tests revealed elevated levels of transaminase activity, leukopenia and thrombocytopenia in 35.3, 24.6 and 20% of patients, respectively. INTERPRETATION & CONCLUSION: The number of Polish travelers to subtropics and tropics increases every year. As cases of fever and other symptoms appear to be increasingly in Polish people returning from tropical regions of Asia, America and Africa, their screening and management should be taken seriously. The study also suggests that the disease might be more widespread than it was known previously.

Liver Transplantation for Incurable Alveolar Echinococcosis: An Analysis of Patients Hospitalized in Department of Tropical and Parasitic Diseases in Gdynia.

INTRODUCTION: Alveolar echinococcosis is a parasitic disease caused by the larval stage of tapeworm Echinococcus multilocularis. It usually involves the liver, but can spread to other organs. The treatment of choice is a surgical resection supported by antiparasitic drugs. In the advanced stages of the disease a liver transplantation is the only option. AIM: This article presents the problems related to care of patients after liver transplantation for advanced alveolar echinococcosis. MATERIAL: Sixty-seven patients with alveolar echinococcosis were hospitalized in our clinic in the years 2000-2015. Liver transplantation has been a therapeutic option for 9 patients. We retrospectively analyzed data of qualification for the liver transplantation and the postoperative treatment. RESULTS: Follow-up time after liver transplantation ranged from 7 months to 155 months (average, 6.4 years). One patient, with a history of advanced disease (P4N1M0), died due to liver failure. One patient was lost to follow-up. After liver transplantation all patients were receiving albendazole treatment. Two patients did not follow the medical recommendations. In 1 patient, who decided to stop therapy after 1 year, the relapse of alveolar echinococcosis in the left lobe of the transplanted liver passing through the diaphragm to the pericardium was detected. In another case we suspected a relapse of alveolar echinococcosis in transplanted liver due to positive serological tests. CONCLUSION: The prognosis of patient after liver transplantation for alveolar echinococcosis is good. The main problem caused by immunosuppressive therapy is a recurrence of disease in the transplanted liver.

Usefulness of PCR for diagnosis of imported malaria in Poland.

The aim of the present study was to use the polymerase chain reaction (PCR) to detect and identify Plasmodium spp. in diagnostic specimens, especially in those from patients diagnosed by microscopy as having possible mixed infections, and in those demonstrating low parasitemia or those that were parasite-negative. For most of the specimens, the PCR results were in accordance with microscopic findings, and in 16.2% of the cases with low parasitemia PCR enhanced the results by identifying the parasite species. This method detected one additional case of Plasmodium falciparum malaria among the patients with fever of unknown origin. The sensitivity of PCR for detecting Plasmodium DNA was found to correspond to 1.35-0.38 and 0.12 for Plasmodium falciparum and Plasmodium vivax parasites per microliter of blood, respectively. Follow-up examinations demonstrated that most of the patients became negative for Plasmodium DNA from 1 to 4 days after the disappearance of parasitemia, as determined by examination of blood films. In conclusion, PCR performed by the reference laboratory significantly enhanced the microscopic diagnosis of malaria and proved very helpful in cases of low parasitemia and in cases of mixed infection.

Liver injury in the course of malaria.

121 malaria cases treated in the Ward of Tropical Diseases of the Clinic of the Institute of Maritime and Tropical Medicine in Gdynia in the years 1993-1999 were analysed. About 37% of the patients showed symptoms of parenchymal liver injury manifested by increased bilirubin concentration, elevated transaminase, alkaline phosphatase and GGTP levels. Histopathological examination of the liver revealed the activation of cells of mononuclear phagocyte system, Kupffer's cells in particular, with the presence of granules of browny-black ,,malarial" pigment and iron deposits. In one fatal tropical malaria case, symptoms of disseminated intravascular coagulation were found along with a few lymphocytic infiltrations in portal spaces, and focal necrosis of hepatocytes. In some patients with the so-called ,,untypical" secondary liver lesions present in the histopathological examination, the toxic effect of antimalarial drugs should be taken into account. A liver biopsy is justified in patients manifesting multiple courses of malaria. It is indispensable in cases of suspected polyetiological changes in the liver and in cases of recompensation payment claims.

Diagnosing and treatment of skin filariases based on own observations.

7 cases of Mansonella perstans filariasis and 9 of Loa loa invasion were diagnosed and treated in the clinic of the Institute of Maritime and Tropical Medicine in Gdynia in the years 1993-1999. The study group comprised 7 women aged 15-45 and 19 men aged 32-49. The most frequently occurring symptoms and signs of the disease, results of laboratory tests, diagnostic methods, ways of treatment and their efficacy were discussed. The diagnosis was made on the basis of the presence of filaria larvae in peripheral blood and, in part, on positive serological reactions. The most frequently reported and observed in our patients were Calabar swellings, allergic lesions of the skin and general symptoms. In the laboratory tests the most characteristic were elevated white blood cells counts with marked eosinophilia and a rise in immunoglobulin E during the active phase of the disease. In doubtful cases, Mazzotti's test was applied. In spite of the treatment with DEC lasting for 3-4 weeks and a combined therapy with levamisole and albendazole, relapses occurred in 5 cases in the period from 2 months to 2 years after the completion of the therapy. In 3 patients treated with ivermectin the period of observation was still too short (2 and 5 months) to draw conclusions as to the efficacy of such treatment.

Plasmapheresis in the treatment of tropical malaria.

A case of tropical malaria imported from Kenya was described. Plasmodium falciparum (an etiological agent of this disease) is often drug resistant, therefore pharmacological treatment of the patients was supplemented with plasmapheresis. Full recovery has been achieved. It is suggested that plasmapheresis may be recommended for a complex therapy of severe forms of tropical malaria.

Malaria as an Occupational Disease in Polish Citizens.

Background: Since 1963, malaria has been exclusively recognized in Poland as an imported disease, which has become increasingly frequent in recent years. When associated with performing duties in malaria-endemic areas, malaria is acknowledged as an occupational disease. Methods: Ninety five cases of malaria recognized as an occupational disease in Polish citizens in the years 1984-1993 were studied retrospectively in terms of working conditions, epidemiologic and clinical features, and permanent disability sequelae. Results: Among patients examined, young and professionally active persons who called at tropical ports or who worked in rural areas or in the regions of military conflict were predominant. Most infections were contracted in Africa during the first few months of the stay. The observed morbidity and recrudescence rates were mainly attributable to Plasmodium falciparum. Disregard of prevention and chemoprophylaxis of malaria were key risk factors. In 33% of the patients, severe symptoms and complications occurred and these required long-term therapy. In seven cases, disturbances of the central nervous system, hepatic, renal, or cardiac system occurred 6 months after termination of treatment, and these occurrences resulted in permanent disability and an inability to work. Conclusions: The disability and inability to work and its legal consequences, such as indemnity, demonstrate that malaria may present a serious socioeconomic problem, even in the country where it is an imported disease.

[Endocarditis lenta--a problematic disease]. / Endocarditis lenta--choroba problematyczna.

4 endocarditis lenta cases with negative blood cultures are reported: 3 patients with risk heart lesions and 1 subject with no predisposing cardiac condition. The mean age of the patients was 53.7 years. Based on the cases reported the following items are discussed: evolution of the clinical syndrome, diagnostic difficulties, problem of negative blood cultures, therapeutic procedure.

[Anemia and thrombocytopenia in malaria. I. Mechanisms]. / Niedokrwistosc i maloplytkowosc w malarii. Czesc I. Mechanizmy.

Pathomechanism of thrombocytopenia and anaemia which frequently occur in patients with malaria is of a complex origin. Anaemia occurs due to sequestrating, destruction and hemolysis of damaged, parasite infected erythrocytes, as well as of the impaired and ineffective erythropoiesis in the marrow. Thrombocytopenia in these patients may also result from both increased destruction of blood platelets and decreased thrombocytopoiesis. Similar natures of the processes cause that anaemia and thrombocytopenia frequently co-exist in patients with malaria.

[Anemia and thrombocytopenia in malaria. II. Mean erythrocyte and thrombocyte count in 45 patients with malaria observed in the Clinic of the Institute of Maritime and Tropical Medicine in Gdynia]. / Niedokrwistosc i maloplytkowosc w malarii. II. Srednia liczba erytrocytów i plytek krwi u 45 chorych z malaria obserwowanych w Klinice Instytutu Medycyny Morskiej i Tropikalnej w Gdyni.

In the years 1987-92, 45 patients with malaria were hospitalized in our clinic. All the patients were before staying in tropical countries. 30 patients were infected with PI. falciparum while the rest - with other species of this parasite. From among numerous different symptoms of malaria, in the majority of the patients profound anaemia and thrombocytopenia occurred. The simultaneously observed drop in the erythrocyte and blood platelet levels confirms that the destruction pathways of them in patients with malaria may be similar, as are the reasons for ineffective erythro- and thrombocytopoiesis. Anaemia and thrombocytopenia gradually subsided in the course of the therapy, as the parasitemia decreased and the state of the patients improved.

[Disturbances of hemostasis in malaria]. / Zaburzenia hemostazy w malarii.

Clinically significant bleeding is relatively uncommon in malaria and occurs in approximately 5% of patients. Severe haemostatic abnormalities are of complex origin and are manifested in thrombocytopenia, decreased activity of coagulation factors and symptoms of vascular diathesis. In 10% of patients with cerebral malaria disseminated intravascular coagulation (DIC) has been demonstrated. DIC is relatively common in patients from western countries with "imported malaria". In our article the aspect of haemostatic disorders in malaria has been discussed.

Malaria as an occupational disease.

In Poland, cases of imported malaria are noted at present. In Polish citizens who work abroad, malaria is considered as an occupational disease. 95 cases of malaria in Polish citizens treated at the Clinic of the Institute of Maritime and Tropical Medicine in 1984-1993 were subjected to retrospective analysis, considering their occupational, epidemiological and clinical aspects as well as permanent sequelae of the disease. The most numerous groups among the patients examined were seafarers, fishermen, priests and missionaries. They were infected mostly in West Africa, during the first year of work. The majority of patients neglected chemoprophylaxis of malaria. In about 1/3 of patients, the resulting incapacity for work exceeded 1 month and more. In 7% of patients, 6 months after the treatment, permanent sequelae of the disease were observed: damage to the central nervous system, liver, kidneys and heart. The social and material costs of this invasive occupational disease were high. Malaria is an important health problem in Poles who work in endemic areas. Malaria prevention should be intensified.

Selected epidemiological and clinical aspects of malaria in the material of the Institute of Maritime and Tropical Medicine in Gdynia.

Despite numerous endeavours to eradicate malaria remains a problem to be solved. This is reflected in high morbidity and mortality rates in endemic zones of this disease, and in the continually growing parasites resistance to the drugs applied within chemoprophylaxis and the treatment employed. In the compass of 1976-1987 a group of 20 thousand people, back from the tropics, was examined. In that number 415 having suffered from malaria while stay in the endemic zone of the disease, in 64 patients malaria was diagnosed in the course of the examinations. They were all subjected to the therapy in the IMTM. In several cases serious complications occurred. In the conclusions the authors point at the insufficient and inaccurate use of chemoprophylaxis the necessity of adopting individual procedure towards each patient and of considering the possibility of Plasmodium sp. infection in the people with the fever of the aetiology unknown, referring their stay in malarial regions.