Imported Malaria in Countries where Malaria Is Not Endemic: a Comparison of Semi-immune and Nonimmune Travelers.

The continuous increase in long-distance travel and recent large migratory movements have changed the epidemiological characteristics of imported malaria in countries where malaria is not endemic (here termed non-malaria-endemic countries). While malaria was primarily imported to nonendemic countries by returning travelers, the proportion of immigrants from malaria-endemic regions and travelers visiting friends and relatives (VFRs) in malaria-endemic countries has continued to increase. VFRs and immigrants from malaria-endemic countries now make up the majority of malaria patients in many nonendemic countries. Importantly, this group is characterized by various degrees of semi-immunity to malaria, resulting from repeated exposure to infection and a gradual decline of protection as a result of prolonged residence in non-malaria-endemic regions. Most studies indicate an effect of naturally acquired immunity in VFRs, leading to differences in the parasitological features, clinical manifestation, and odds for severe malaria and clinical complications between immune VFRs and nonimmune returning travelers. There are no valid data indicating evidence for differing algorithms for chemoprophylaxis or antimalarial treatment in semi-immune versus nonimmune malaria patients. So far, no robust biomarkers exist that properly reflect anti-parasite or clinical immunity. Until they are found, researchers should rigorously stratify their study results using surrogate markers, such as duration of time spent outside a malaria-endemic country.

Case of Plasmodium knowlesi Malaria in Poland Linked to Travel in Southeast Asia.

We report a case of Plasmodium knowlesi malaria imported to central Europe from Southeast Asia. Laboratory suspicion of P. knowlesi infection was based on the presence of atypical developmental forms of the parasite in Giemsa-stained microscopic smears. We confirmed and documented the clinical diagnosis by molecular biology techniques.

Dirofilaria repens infection as a cause of intensive peripheral microfilariemia in a Polish patient: process description and cases review.

Dirofilariasis is a parasitic disease of dogs and other carnivores transmitted mainly by the mosquitoes of the genera Culex, Aedes, Anopheles. Full life cycle of the Dirofilaria nematodes in humans is extremely rarely observed, usually lacking species determination at the molecular level. We report fully documented unusual clinical manifestation of subcutaneous dirofilariasis with intensive microfilariemia in peripheral blood revealed by the Knott's concentration technique. The identification of the Dirofilaria repens nematode was based on typical morphological findings for adult gravid female nematode found in the histopathological preparations. The morphology of microfilariae obtained from patient's peripheral blood was also typical for D. repens. The final identification was confirmed by the molecular analysis of microfilariae collected from the blood.

Schistosomiasis in European Travelers and Migrants: Analysis of 14 Years TropNet Surveillance Data.

Schistosomiasis remains one of the most prevalent parasitic diseases worldwide and the infection is frequently found in travelers and migrants. The European Network for Tropical Medicine and Travel Health conducted a sentinel surveillance study on imported schistosomiasis between 1997 and 2010. This report summarizes epidemiological and clinical data from 1,465 cases of imported schistosomiasis. Direct pathogen detection and serology were the main diagnostic tools applied. Of these, 486 (33%) cases were identified among European travelers, 231 (16%) among long-term expatriates, and 748 (51%) among non-European immigrants. Overall, only 18.6% of travelers had received pretravel advice; 95% of infections were acquired in the African region. On species level, Schistosoma mansoni was identified in 570 (39%) and Schistosoma haematobium in 318 (22%) cases; 57.5% of patients were symptomatic. Acute symptoms were reported in 27% of patients leading to earlier presentation within 3 months. Praziquantel was used in all patients to treat schistosomiasis. Many infections were detected in asymptomatic patients. In 47.4% of asymptomatic patients infection was detected by microscopy and in 39% by serology or antigen testing. Schistosomiasis remains a frequent infection in travelers and migrants to Europe. Travelers should be made aware of the risk of schistosomiasis infection when traveling to sub-Saharan Africa. Posttravel consultations particularly for returning expatriates are useful given the high potential for detecting asymptomatic infections.

Intestinal coccidian parasites as an underestimated cause of travellers' diarrhoea in Polish immunocompetent patients.

Intestinal coccidian parasites are intracellular protozoa most frequently transmitted during food-borne and water-borne infections. This group of parasites is responsible for acute diarrhoeal illnesses especially among immunocompromised patients. However, they are more frequently detected in immunocompetent individuals including travellers, and they should also be considered as important etiologic factors of travellers' diarrhoea. We examined 221 immunocompetent patients hospitalized due to acute or chronic diarrhoea and other gastrointestinal symptoms after returning from international journeys to hot climates. A basic microscopical examination and acid - fast staining of stool samples was performed. Each patient was also a part of the epidemiological investigation to define potential risk factors of tropical gastrointestinal infections. Intestinal coccidiosis was confirmed in 12 out of 221 successively hospitalized patients (5.4%). The most common coccidian parasite was Cryptosporidium spp., detected in nine Polish travellers (4.1%). Cyclospora spp. was diagnosed in three cases (1.4%), including two mixed infections with Cryptosporidium spp., and Cystoisospora spp. in two other cases (0.9%). The study has revealed that intestinal coccidian parasites are a significant threat to immunocompetent travellers and should be always considered in the differential diagnosis of gastrointestinal disorders. Therefore, it is necessary to perform specialized diagnostic methods for the detection of Cryptosporidium spp., Cystoisospora spp., and Cyclospora spp. oocysts in reference parasitology laboratories. Clinical observations demonstrated simultaneously an insufficient level of knowledge in Polish tourists concerning the main risk factors of intestinal parasitic diseases during international travels, particularly to developing countries with lower economic and sanitary conditions.

Recommended management of Toxoplasma gondii infection in pregnant women and their children.

Aforesaid recommendations for the management of T.gondii infection, elaborated by the group of experts, are intended for physicians of various specialties in order to standardize and facilitate diagnostic and therapeutic management. Early diagnosis of congenital toxoplasmosis, both symptomatic and asymptomatic, in neonatal period, initiation of adequate treatment and long-term, multispecialist monitoring, including multi-organ rehabilitation of children may prevent or reduce the complications of congenital toxoplasmosis. Health education, whose role is often underestimated, should be targeted mainly on girls and women at reproductive age as to prevent from infection during pregnancy.

Outcome of acute East African trypanosomiasis in a Polish traveller treated with pentamidine.

BACKGROUND: African trypanosomiasis is a parasitic infection sporadically imported to Europe by tourists or immigrants returning from endemic areas. We present the first and an unusual case of East African trypanosomiasis imported to Poland by a patient returning from a tourist trip to Uganda and Rwanda, which was successfully treated with pentamidine. CASE PRESENTATION: A 61-year-old Polish man was admitted to the Department because of high-grade fever and multi-organ dysfunction after a tourist trip to East Africa. He experienced a single tsetse fly bite during a safari trip to the Queen Elizabeth National Park in Uganda. On admission, his clinical status was severe, with high fever of 41ºC, preceded by chills, bleeding from the gums and oral mucosa, haemorrhages at the sites of venipuncture, numerous ecchymoses, fine-spotted skin rash, tachycardia, hepatosplenomegaly, dehydration, jaundice, dyspnoea, hypoxaemia, generalised oedema and oliguria. There was a typical non-painful trypanosomal chancre with central necrosis and peripheral erythema on his left arm. Laboratory investigations showed leucopenia, thrombocytopenia, haemolytic anaemia, hyperbilirubinaemia, hypoglycaemia, elevated creatinine and urea, high activity of aminotransferases, elevated levels of inflammatory markers, hypoproteinaemia, proteinuria, abnormal clotting and bleeding times, low fibrinogen level, metabolic acidosis, and electrolyte disturbances. A peripheral blood smear showed numerous Trypanosoma brucei trypomastigotes with a massive parasitaemia of 100,000/µl. T. brucei rhodesiense subspecies was finally identified on the basis of the characteristic serum resistance-associated gene using a polymerase chain reaction, and a seroconversion of specific immunoglobulin M and G antibodies in the peripheral blood by enzyme-linked immunosorbent assay. Serological tests for T. brucei gambiense subspecies were negative. A severe clinical course of acute rhodesiense trypanosomiasis with renal failure, respiratory distress, disseminated intravascular coagulation syndrome, haemolysis, liver insufficiency and myocarditis was confirmed. Intensive anti-parasitic and symptomatic treatment was immediately instituted, including intravenous pentamidine, plasmaphereses, oxygen therapy, blood transfusion, catecholamine administration, and fluid infusions, as well as haemostatic, hepatoprotective, anti-inflammatory, antipyretic and diuretic drugs. The final outcome was a full recovery with no late sequelae. CONCLUSION: Sleeping sickness should always be considered in the differential diagnosis of fever in people returning from safari trips to the national parks or nature reserves of sub-Saharan Africa.

Human alveolar echinococcosis in Poland: 1990-2011.

BACKGROUND: Alveolar echinococcosis (AE) caused by Echinococcus multilocularis infections is a dangerous old disease in the Northern Hemisphere. The aim of the paper was to collect and analyze data on human AE in Poland in the last two decades. METHODOLOGY/PRINCIPAL FINDINGS: The sources of data were both the cases officially registered and detected by an active field and laboratory surveillance. The cases were verified by clinical, epidemiological, and laboratory criteria. Altogether 121 human cases of AE were detected. Among these 83 (68,6%) cases were classified as confirmed, 16 as probable and 22 as possible. During the two decades a continuous increase in detection rate was noticed. The cases were 6-82 years old at the time of diagnosis (mean - 47.7 years). Sex ratio M/F was 0.86/1.0. The AE was fatal in 23 (19%) patients (mean age at death - 54.1 years). Family agglomeration of AE was found in 4 foci, involving 9 patients. Seventy six of the cases were diagnosed in an advanced stage of disease. In all cases the liver was the primary location of AE. In 30 (24.8%) patients a spread to other organs was observed. Ninety four of the patients were treated with albendazole. In 73 (60%) patients a surgical operation was performed, including 15 liver transplantations. CONCLUSIONS/SIGNIFICANCE: The studies confirmed that AE is an emerging disease in Poland, which is the fourth country in Europe with over 120 cases detected. The results also indicate the need of a wider national programme for implementation of screening in the highest AE risk areas (north-eastern Poland) with an effort to increase the public awareness of the possibility of contracting E. multilocularis, and above all, training of the primary care physicians in the recognition of the risk of AE to allow for an early detection of this dangerous disease.

Prenatal treatment for serious neurological sequelae of congenital toxoplasmosis: an observational prospective cohort study.

BACKGROUND: The effectiveness of prenatal treatment to prevent serious neurological sequelae (SNSD) of congenital toxoplasmosis is not known. METHODS AND FINDINGS: Congenital toxoplasmosis was prospectively identified by universal prenatal or neonatal screening in 14 European centres and children were followed for a median of 4 years. We evaluated determinants of postnatal death or SNSD defined by one or more of functional neurological abnormalities, severe bilateral visual impairment, or pregnancy termination for confirmed congenital toxoplasmosis. Two-thirds of the cohort received prenatal treatment (189/293; 65%). 23/293 (8%) fetuses developed SNSD of which nine were pregnancy terminations. Prenatal treatment reduced the risk of SNSD. The odds ratio for prenatal treatment, adjusted for gestational age at maternal seroconversion, was 0.24 (95% Bayesian credible intervals 0.07-0.71). This effect was robust to most sensitivity analyses. The number of infected fetuses needed to be treated to prevent one case of SNSD was three (95% Bayesian credible intervals 2-15) after maternal seroconversion at 10 weeks, and 18 (9-75) at 30 weeks of gestation. Pyrimethamine-sulphonamide treatment did not reduce SNSD compared with spiramycin alone (adjusted odds ratio 0.78, 0.21-2.95). The proportion of live-born infants with intracranial lesions detected postnatally who developed SNSD was 31.0% (17.0%-38.1%). CONCLUSION: The finding that prenatal treatment reduced the risk of SNSD in infected fetuses should be interpreted with caution because of the low number of SNSD cases and uncertainty about the timing of maternal seroconversion. As these are observational data, policy decisions about screening require further evidence from a randomized trial of prenatal screening and from cost-effectiveness analyses that take into account the incidence and prevalence of maternal infection. Please see later in the article for the Editors' Summary.

The co-occurrence of Toxocara ocular and visceral larva migrans syndrome: a case series.

INTRODUCTION: Ocular toxocarosis associated with high peripheral eosinophilia and together with systemic signs of visceral damage has been reported sporadically. Eye infections caused by numerous migrating larvae of Toxocara parasites, probably due to re-invasion or delayed reactivation, and leading to a progressive loss of vision is relatively rare. We report three atypical cases of toxocarosis with the co-existence of ocular larva migrans syndrome and generalized signs of Toxocara infection in schoolboys. CASE PRESENTATION: Two children aged 8 and 14 years respectively, with symptomatic ocular and visceral larva migrans syndromes, and one 16-year-old adolescent with chronic multifocal eye invasion, characterized by severe granulomatous retinochoroiditis with unilateral blindness, chronic abdominal pain and generalized synthesis of total immunoglobulin E antibody are described. The three patients, heavily infected with Toxocara species were boys of Polish origin. Ocular location of the parasite was confirmed by the detection of intraocular synthesis of specific anti-Toxocara immunoglobulin G antibody in aqueous humour samples from the affected eyes. Immunological parameters of tissue eosinophilia, allergy or hypersensitivity reactions to the presence of the migrating Toxocara parasites were analysed. Irreversible eye complications were observed in the patients with high level of exposure to Toxocara species in a contaminated environment, with a suggestion of possible re-activation or re-infection by different species or strains of the parasite. CONCLUSIONS: Wide promotion of sanitary education is strongly justified in children and adolescents in Toxocara endemic areas in order to reduce the potential risk of primary invasion or re-infection with the parasites, which can lead to a severe course or progression of the disease. A long-term clinical follow-up and more intensive anti-parasitic treatment is recommended in patients with subclinical and overt forms of toxocarosis to prevent later reactivation of the migrating larvae in tissues.

Genetic and epigenetic factors at COL2A1 and ABCA4 influence clinical outcome in congenital toxoplasmosis.

BACKGROUND: Primary Toxoplasma gondii infection during pregnancy can be transmitted to the fetus. At birth, infected infants may have intracranial calcification, hydrocephalus, and retinochoroiditis, and new ocular lesions can occur at any age after birth. Not all children who acquire infection in utero develop these clinical signs of disease. Whilst severity of disease is influenced by trimester in which infection is acquired by the mother, other factors including genetic predisposition may contribute. METHODS AND FINDINGS: In 457 mother-child pairs from Europe, and 149 child/parent trios from North America, we show that ocular and brain disease in congenital toxoplasmosis associate with polymorphisms in ABCA4 encoding ATP-binding cassette transporter, subfamily A, member 4. Polymorphisms at COL2A1 encoding type II collagen associate only with ocular disease. Both loci showed unusual inheritance patterns for the disease allele when comparing outcomes in heterozygous affected children with outcomes in affected children of heterozygous mothers. Modeling suggested either an effect of mother's genotype, or parent-of-origin effects. Experimental studies showed that both ABCA4 and COL2A1 show isoform-specific epigenetic modifications consistent with imprinting. CONCLUSIONS: These associations between clinical outcomes of congenital toxoplasmosis and polymorphisms at ABCA4 and COL2A1 provide novel insight into the molecular pathways that can be affected by congenital infection with this parasite.

Neonatal Screening Programme for Increasing Early Postnatal Diagnosis of Congenital Cytomegalovirus Infection in the West Poland Province.

Congenital infection with cytomegalovirus (CMV) is the main cause of sensorineural hearing loss and psychomotor impairment which can develop at birth or later in infant's life. Because of a lack of nation-wide serological screening for pregnant women and accepted antiviral therapy during pregnancy in a high seroprevalence rate population of Poland, we introduced the regional screening programme for CMV infection in neonates from the Poznan Province to diminish a risk of the symptomatic disease. The aims of the study were: (i) to determine the prevalence of specific anti-CMV antibodies in populations of pregnant women and newborns from the Poznan area, (ii) to increase the early postnatal detection of congenital CMV infections, and (iii) to evaluate a risk of perinatal or early postnatal infections with CMV in newborns or infants born to seropositive mothers. Serological testing was performed in 4.192 live born neonates, using dried blood filter-paper specimens. The seropositivity rate in the studied population of neonates and pregnant women was 78.6%. The incidence of perinatal and early postnatal CMV infections was evaluated to be 3.1% or 1 per 25 neonates born to seropositive mothers. Congenital CMV infections confirmed by a presence of specific IgM antibodies were diagnosed in 5 newborns, which represent 1 case per 838 successive deliveries. In a clinical pattern of cytomegalovirus disease respiratory disorders and low birth weight were most frequently observed, and neurological signs, hepatitis, haemorrhagies or jaundice were sporadically diagnosed. Implementation of mass immunodiagnostic screening for congenital CMV infection, combined with other obligatory neonatal tests for metabolic errors, congenital malformations and endocrine disorders seems to be a valuable third line prophylactic strategy to prevent a late development of clinically overt cytomegalovirus disease.

Serological Screening of Newborns for Toxoplasma Gondii-Specific IgA and IgM Antibodies in Peripheral Blood Collected on Filter-Papers.

The strategic approach for preventing congenital toxoplasmosis is strictly related to the incidence of primary T. gondii infection during pregnancy in a studied population. Early postnatal diagnosis by mass testing of newborns is an option in areas where obligatory serological screening in pregnant women has not been implemented but it requires sensitive immunodiagnostic methods followed by a good confirmatory analysis. The aims of the regional neonatal screening programme were (i) analysis of the prevalence of congenital T. gondii infection at birth in the West Poland Province, (ii) determination of the value of the serological examination of filter-paper blood specimens collected at birth for the diagnosis of congenital toxoplasmosis, and (iii) evaluation of the duration of T. gondii-specific immunoglobulin A and immunoglobulin M antibodies in infants' sera. The neonates born in the obstetric clinics of the University Gynaecology-Obstetrics Hospital in Poznan (Poland) and in the maternity wards of the 10 main district hospitals from the West Poland region were systematically screened for congenital T. gondii infection. Peripheral blood from newborns was collected by a non-invasive heel-stick puncture during the first 3 days of life, absorbed onto Guthrie cards and analysed for anti-T. gondii specific IgM (1996-1998) or both IgA and IgM antibodies (1998-2000) by non-commercial immunocapture ELISAs. When the screening result was positive, the diagnosis of congenital infection was confirmed by testing serum samples from the suspected neonate and the mother using a Western blot IgM-IgG comparative immunological profile analysis and traditional serological techniques (ELISA, ISAGA) for anti-Toxoplasma IgA, IgM and IgG specific antibodies. From June 1996 to April 2000, 45,169 filter-paper specimens from liveborn neonates were screened: 27,516 samples were tested for specific IgM and the next 17,653 Guthrie cards were analysed by the combined IgA/IgM assay. The prevalence of anti-Toxoplasma IgM in filter-paper eluates at birth was 1 per 2,117 liveborn neonates (0.47/1000) or 1 per 1,185 infants (0.84/1000) born to seronegative women with a potential risk of primary T. gondii infection during pregnancy. For the joint detection of IgA and IgM, these values significantly increased to 1 per 929 neonates (1.08/1000) or 1 per 520 pregnancies at risk (1.92/1000) respectively, comparing to the seropositivity rate of 43.7% in a pregnant women population in the studied area. In newborns untreated prenatally, the diagnostic sensitivity of the IgM ELISA using neonatal Guthrie cards was not more than 86.7% and that of the combined IgA/IgM ELISA was 95%; the diagnostic specificity of the both methods was calculated to be 99.9%. Congenital T. gondii infection was finally diagnosed in 35 neonates, mostly asymptomatic at birth. CONCLUSIONS: (i) The neonatal screening for anti-Toxoplasma IgA and/or IgM antibodies is a good sensitivity method for an early postnatal diagnosis of congenital toxoplasmosis in newborns untreated prenatally. (ii) In the absence of obligatory nation-wide screening during pregnancy followed by an early prenatal treatment, this valuable technique may be considered a preventive option in areas of a high annual number of births associated with a high seroprevalence of T. gondii infection.

[Analysis of comparative immunological profiles of intraocular fluid and serum samples in patients suspected of ocular toxoplasmosis or toxocarosis]. / Ocena porównawczego profilu immunologicznego swoistych przeciwcial w plynie sródocznym i krwi obwodowej pacjentów podejrzanych o toksoplazmoze lub toksokaroze oczna.

High seroprevalence of Toxoplasma and Toxocara spp. in populations of children and adults in Poland constitutes a significant risk of supradiagnosed parasitic eye infections. We described the clinical characteristics in relation to the analysis of comparative immunological profiles of T. gondii-specific antibodies in aqueous humour and serum samples in patients with reactivated retinochoroiditis, and of Toxocara spp. ones in cases with posterior granuloma, fibrotic and calcified tumor-like masses simulating retinoblastoma, detected by ophthalmoscopy and echography. Intraocular synthesis of specific IgG antibodies was detected in anterior eye chamber fluid in 1/2 and 2/3 of patients respectively, strongly suspected of ocular toxoplasmosis or toxocarosis. The evidence of a local production of specific antibodies in intraocular fluid shown by the Western blot seems to be a valuable immunodiagnostic method for a final confirmation of eye lesions of parasitic origin and crucial in the choice of an appropriate treatment regimen.

[Evaluation of a risk of a cross-reactivity with Echinococcus multilocularis-specific Em2plus antigen in patients with liver cancer]. / Ocena ryzyka wystepowania niespecyficznych reakcji krzyzowych z antygenem Em2plus Echinococcus multilocularis u pacjentów z nowotworami watroby.

The incidence of non-specific reactions with E. multilocularis antigen in patients with liver malignancies, and the risk of a supradiagnosis of alveolar echinococcosis (AE) in space-occupying lesions in the liver due to neoplastic proliferative diseases were studied. Analysis of specific IgG serum antibody against Em2plus antigenic complex was performed in 11 AE patients in comparison to 76 individuals with malignant neoplasms of abdominal or extra-hepatic location, including some patients with primary hepatocellular cancer or distant metastases to liver, and 42 patients with benign hepatic lesions. Only one false borderline result was reported in a case with colorectal cancer, and dissemination to liver. Low risk of false positive results with E. multilocularis-specific Em2plus antigen in patients with liver malignancies makes the test valuable for practical reasons in a differential diagnosis of irregular tumor masses visualized by imaging techniques.

[Case definitions and clinical evaluation of patients infected with Echinococcus multilocularis treated in the Poznan centre]. / Kryteria rozpoznawania oraz oceny klinicznej pacjentów zarazonych Echinococcus multilocularis leczonych w osrodku poznanskim.

Recent epidemiological reports have shown an increasing risk of E. multilocularis infection among red foxes and humans in Poland. The aims of the study were: (i) to improve the early detection of alveolar echinococcosis (AE) in humans by implementation of clinical, imaging, immunodiagnostic, ultrastructural and molecular methods, (ii) to realize the parasitological verification of registered cases suspected of alveococcosis by the specialized, parasitological centres, and (iii) to standardize diagnostic and therapeutic procedures for this severe parasitic disease. Since 1993, eight cases of AE were registered in the Poznan centre. The final diagnosis was based on PAS-positive staining of lesions by histopathology or a detection of the parasite's DNA in liver sections. Collaboration with physicians of various medical specialities is crucial for an early and more effective recognition of AE. Alveococcosis should always be considered in the differential diagnosis of space-occupying lesions in the liver suggesting slow-growing cancer.

[Role of adhesion molecules in a determination of progression stages and clinical prognosis of patients with Echinococcus multilocularis]. / Rola czasteczek adhezyjnych w ocenie stopnia zaawansowania i prognozowania klinicznego przypadków Echinococcus multilocularis.

Alveococcosis in humans is characterized by a tumor-like growth with a tendency to infiltration of neighbouring organs or metastases formation in the lungs and brain. The study aimed to improve on the clinical evaluation of patients with alveolar echinococcosis (AE) and to determine the risk of metacestode spreading to adjacent tissues or distant organs by a detection of adhesion molecules involved in the tumorigenesis process. Serum concentrations of sPECAM-1, sVCAM-1 and sE-selectin adhesion molecules were studied in 8 AE patients in comparison to 75 cases with malignant neoplasms, including cases with tumors of hepatic and extra-hepatic location. The adhesion molecules were found to be early predictive markers of the active, tissue infiltrated alveococcosis with the risk of parasite spreading through the circulation. High serum levels of soluble PECAM-1 molecule were strongly related to the advanced, progressive disease and the fatality of patients' clinical prognosis.

[Risk of alveococcosis for humans in Poland]. / Zagrozenie bablowica wielojamowa (alweokokoza) dla ludzi w Polsce.

The paper presents data on occurrence, diagnosis and treatment of alveolar echinococcosis in humans as well as possible methods of its prevention. Studies done in 2001-2003 in Poland have shown the high prevalence of the tapeworm in red foxes in the north-east (34.5%) and south-east (39.3%) of Poland with foci of infection in some counties (up to 70% foxes infected). It makes the high potential risk for human infection in these areas.

[Visceral leishmaniasis]. / Leiszmanioza trzewna.

Leishmanioses are widespread in 88 countries of the tropical and subtropical zone, including regions of the Mediterranean Sea basin of Southern Europe. Actually, approximately 350 million of people live in Leishmania endemic areas and about 12 million of individuals are infected. Visceral leishmaniosis (kala-azar disease, tropical splenomegaly) is caused by at least 3 species of Leishmania protozoa: L. donovani, L. infantum and L. chagasi. The incidence of the disease is estimated at 500,000 new cases annually. The infection is transmitted by Phlebotomus or Lutzomyia mosquitos bites, in which intestines forms invasive to humans are developed. Leishmania spp. have a predilection to the reticulo-histiocytary system cells, leading to their proliferation and disruption, and after spreading to the circulation they invade spleen, liver and bone marrow. Visceral leishmaniosis should be suspected in travelers returning from tropical and subtropical areas with signs of splenomegaly and twice temperature spikes in a day. We reported a case of the kala-azar disease in the 22 year-old Polish patient seasonally working in Italy. The clinical picture was expressed by two daily pikes of fever proceeded by chills, excessive sweat, hepatosplenomegaly, lymphadenopathy, general weakness, abdominal pain and nausea. The Leishmania infection was complicated by candidiosis. Laboratory tests showed anaemia, thrombocytopenia, leucopenia, hypergammaglobulinaemia and a suppression of immunological cellular response. The diagnosis was confirmed by a presence of amastigota forms in macrophages of the bone marrow aspirate and a detection of specific antibodies to L. infantum by Westernblotting. The patient was successfully treated with Glucantime.

[Bacterial flora from bronchoalveolar lavage and occurrence of class IgG and IgA antibodies to Chlamydia pneumoniae in patients with chronic obstructive pulmonary disease (COPD)]. / Flora bakteryjna popluczyn oskrzelowo-pecherzykowych oraz wystepowanie przeciwcial klasy IgG i IgA dla Chlamydia pneumoniae u chorych na przewlekla obturacyjna chorobe pluc (POCHP).

Bronchoalveolar lavage taken from 46 patients (ranging in age from 21 to 71 years, mean 50.6 +/- 13.9) was examined for aerobic and anaerobic bacterial flora. Sera taken from 39 of patients as well as sera taken from 25 healthy blood donors of similar age (P = 0.99) were examined to determine IgG and IgA antibodies to C. pneumoniae. Bacterial flora was routinely cultured and determined using ATB computer system (bioMérieux,). IgG and IgA antibodies were tested by the enzyme immunoassays (Labsystems, Finland, Helsinki). Sera containing anti -C. pneumoniae IgG antibodies with titers of 45 EIU or higher and IgA with titers of 12 EIU or higher were considered positive. 143 of aerobic and 74 of anaerobic bacterial strains were cultured. Streptococci group viridans, pneumococci, enteric bacilli, Haemophilus spp., Prevotella spp., Actinomyces spp., Bifidobacterium spp. and Veilonella spp. were most often cultured. 66.6% of patients had IgG or IgA antibodies, in contrast, to the control group in which 60.0% and 44.0% of examined blood donors had IgG and IgA antibodies respectively. COPD patients were more frequently positive for specific anti-C. pneumoniae antibodies than the healthy donors (p = 0.003). The difference in a seropositivity rate of specific IgA and IgG antibodies was significant (p = 0.00002 and p = 0.003 respectively). Bronchoalveolar lavage of patients suffering from COPD can be contaminated with high number of aerobic and anaerobic bacterial species, and immunological status of the patients indicated persistent infection caused by C. pneumoniae more often than in controls.