Increased levels of sphingosine-1-phosphate in cerebrospinal fluid of patients diagnosed with tick-borne encephalitis.

BACKGROUND: Tick-borne encephalitis (TBE) is a serious acute central nervous system infection that can result in death or long-term neurological dysfunctions. We hypothesize that changes in sphingosine-1-phosphate (S1P) concentration occur during TBE development. METHODS: S1P and interleukin-6 (IL-6) concentrations in blood plasma and cerebrospinal fluid (CSF) were measured using HPLC and ELISA, respectively. The effects of S1P on cytoskeletal structure and IL-6 production were assessed using rat astrocyte primary cultures with and without addition of plasma gelsolin and the S1P receptor antagonist fingolimod phosphate (FTY720P). RESULTS: We report that acute inflammation due to TBE virus infection is associated with elevated levels of S1P and IL-6 in the CSF of infected patients. This elevated concentration is observed even at the earliest neurologic stage of disease, and may be controlled by glucocorticosteroid anti-inflammatory treatment, administered to patients unresponsive to antipyretic drugs and who suffer from a fever above 39°C. In vitro, treatment of confluent rat astrocyte monolayers with a high concentration of S1P (5 µM) results in cytoskeletal actin remodeling that can be prevented by the addition of recombinant plasma gelsolin, FTY720P, or their combination. Additionally, gelsolin and FTY720P significantly decreased S1P-induced release of IL-6. CONCLUSIONS: TBE is associated with increased concentration of S1P and IL-6 in CSF, and this increase might promote development of inflammation. The consequences of increased extracellular S1P can be modulated by gelsolin and FTY720P. Therefore, blocking the inflammatory response at sites of infection by agents modulating S1P pathways might aid in developing new strategies for TBE treatment.

Depletion of plasma gelsolin in patients with tick-borne encephalitis and Lyme neuroborreliosis.

BACKGROUND/AIMS: Cell damage during the course of inflammation results in cytoplasmic actin release, which if not eliminated by the extracellular actin scavenger system, composed of gelsolin and vitamin D binding protein, can cause dysfunction of hemostasis and toxicity towards surrounding cells. In this study, we test the hypothesis that an inflammatory reaction induced by central nervous system infections such as tick-borne encephalitis (TBE) or Lyme neuroborreliosis (LNB) will result in plasma gelsolin concentration changes in the blood and cerebrospinal fluid (CSF). METHODS: Quantitative Western blot was used to determine gelsolin levels in 58 samples, which include: 29 patients without infection (diagnosed with conditions such as idiopathic cephalalgia, idiopathic Bell's facial nerve palsy and ischialgia due to discopathy in which standard CSF diagnostic tests show no abnormalities), 12 patients diagnosed with TBE, and 17 patients diagnosed with LNB sub forma meningitis. RESULTS AND CONCLUSION: The gelsolin concentration in the blood of patients with TBE (163.2 ± 80.8 µg/ml) and LNB (113.6 ± 56.8 µg/ml) was significantly lower (p < 0.05 and p < 0.001, respectively) compared to the control group (226.3 ± 100.7 µg/ml). Furthermore, there was no statistically significant difference between the CSF gelsolin concentration in patients with TBE (3.9 ± 3.3 µg/ml), LNB (2.9 ± 1.2 µg/ml) and the control group (3.7 ± 3.3 µg/ml). An observed decrease in gelsolin concentration in the blood of TBE and LNB patients supports previous findings indicating the involvement of gelsolin in the pathophysiology of an inflammatory response. Therefore, evaluation of blood gelsolin concentration and administration of recombinant plasma gelsolin might provide a new tool to develop diagnostic and therapeutic strategies for TBE and LNB.

[Transmission and circulation of tick borne pathogens (TBE and Lyme borreliosis) and the role of changing environment]. / Transmisja i krazenie patogenów odkleszczowych (kzm i boreliozy) i rola zmieniajacego sie srodowiska.

Ixodes ricinus is regarded as a species with great medical and veterinary meaning. Transmission of tick borne pathogens in mammals depends not only on systemic infection. Transmission of B. burgdorferi and tick-borne encephalitis virus in an infected organism differs, because of different location in tick, the differences in dissemination of the virus and bacteria (own motility) as well as mechanisms supporting bacterial infection. The mechanisms governing the transmission of these pathogens in nature have epidemiological importance and are essential in understanding the pathogenesis of diseases. The increase in the incidence of tick-borne encephalitis in recent years, is a marker of tick borne diseases. In the 90s, the number of cases among humans in many European countries remains at a higher level compared to the eighties. Similar observations consider to Lyme borreliosis. Natural environmental changes, mainly related to climate, as well as regional and local changes in distribution of the small rodents species, wild animals, anthropogenic factors (reforestation, drainage of swamps, increasing the reservoir of animals), and social change (increased human activities in forests, vaccinations) may have a significant impact on rates of tick-borne diseases.

[Peripheral neuropathies in Lyme borreliosis]. / Neuropatie obwodowe w przebiegu boreliozy z lyme.

UNLABELLED: Lyme borreliosis is a multisystem disease and when involves the nervous system it is termed neuroborreliosis. The symptomatology of peripheral neuroborreliosis is rich and varied. The early symptoms are asymmetric polyradiculopathies and paralysis of the cranial nerves (most commonly facial nerve). Thereafter, there are multifocal mononeuropathies and sensory-motorpolyneuropathies. Difficulties in making a correct diagnosis can result from the long time lag between tick bite and the occurrence of neurological symptoms. In the treatment the most important role play antibiotics. CASE REPORTS: We report the cases of three patients with symptoms of damage to various structures of the peripheral nervous system in the course of Borrelia burgdorferi infection. In all cases, clinical improvement was obtained after treatment with antibiotics, which further confirms the diagnosis of neuroborreliosis. CONCLUSIONS: About neuroborreliosis as a cause of peripheral neuropathy we should always think in the case of vague symptoms of peripheral nervous system lesions in patients with potential exposure to tick bites. Peripheral neuropathies may occur a long interval from the tick bite and are not always preceded by other forms of the disease.

[Presence of antibodies against gangliosides among patients with Lyme borreliosis--preliminary study]. / Wystepowanie przeciwcial przeciw gangliozydom w surowicy chorych na borelioze z Lyme--badania wstepne.

UNLABELLED: THE AIM of the study was the evaluation of autoantibody reaction against endogenous gangliosides in the course of Lyme borreliosis. MATERIAL AND METHODS: Antibodies against profile of gangliosides composed of GM1, GM2, GM3, GD1a,GD1b,GT1b, GQ1b were evaluated in serum patients with early disseminated (neuroborreliosis) Lyme disease (n = 16), patients with long lasting serologic response against Borrelia burgdorferi (n = 32) and in healthy subjects (n = 16). Immunoblot test for IgG was used. RESULTS: Antibodies were detected in all evaluated groups. In group of neuroborreliosis (lymphocytic meningitis with cranial nerve invoIvement) there was no essential difference with control group. It was stated in group of forestry workers with serological features of infection B. burgdorferi lasting for years. CONCLUSIONS: Results of the study do not support the thesis of participation of IgG autoantibodies against gangliosides in pathogenesis early disseminated Lyme borreliosis in form of lymphocytic meningitis with cranial nerves paresis. Antibodies against endogenous glicosfingolipides in Lyme borreliosis probably can lead to affecting nervous system (demielinisation and polineuropathy) but probably require long-term immunization, what is suggested by results of examined group of patients with the multi-annual serological features of infection.

[Fractalkine--structure, functions and biological activity]. / Fraktalkina--budowa, wlasnosci i biologiczna rola.

Although chemokines, as chemotactic factors, were already known in 70's of the past century, it was only the progress in molecular biology, genetics and immunology which occurred in the past few years that opened the way to discover new molecules, their chemical structure and biological functions. Fkn (fractalkine, CX3CL1) is a unique chemokine and the only representative of CX3C group. It exists as a membrane-bound and soluble form. It interacts with cells expressing CX3CR1, a G-coupled protein receptor. The polymorphism of CX3CR1 gene modulates Fkn affinity to its receptror, which influences the risk of development and progression of various diseases. Its unique character is determined by its functions. Fkn is not only a chemotactic factor, but it also participates in leukocyte trafficking, adhesion and cytotoxic activities, modulates expression of cytokines, adhesion molecules, free oxygen radicals, iNOS and influences apoptosis. Its elucidation should not only help understanding of molecular events occurring in many autoimmune inflammatory, neoplasmatic diseases, but would allow to use Fkn, its receptor, or anti-Fkn antibodies in treatment of those diseases.

[Neuroradiologic imaging results suggestive of parasitic cysts in central nervous system in course of neoplastic disorders--cases report]. / Obraz neuroradiologiczny imitujacy torbiele pasozytnicze osrodkowego ukladu nerwowego w przebiegu chorób nowotworowych--opisy przypadków.

Cystic changes within CNS, revealed by computed tomography or magnetic resonance imaging, pose difficult diagnostic and therapeutic problem. We present two patients with primary diagnosis of parasitic cysts of CNS, in whom neoplastic etiology was finally confirmed. Differential diagnosis of cystic foci should from the beginning include not only parasitic infections, but also neoplastic diseases, which are much more frequent in Poland at present and in which prolonged diagnostic process and delayed treatment is highly unfavorable.

[Long-term fever as a first symptom of neoplasmatic process in young patients--case reports]. / Dlugotrwala goraczka, jako pierwszy objaw choroby nowotworowej u osób mlodych--opis przypadków.

UNLABELLED: Fever is a thermoregulation disorder with body temperature increased (above 38 degrees C). The most often accompanies infections, but it may also be a symptom of neoplasmatic disease. CASE REPORTS: In our paper we described 2 patients, who were admitted to the Department of Infectious Diseases and Neuroinfections with fever as a main symptom. Laboratory tests excluded the infection as causative agents of a long term fever. Wide spectrum diagnosis in both cases led to diagnosis of neoplasmatic disease. Presented cases indicate that in patents with long term fever, even in young age, neoplasmatic process should be taken into consideration.

[Neuroborreliosis--some aspects of pathogenesis, diagnosis and treatment]. / Neuroborelioza--wybrane aspekty patogenezy, diagnostyki i leczenia.

Chosen pathophysiological aspects of Lyme borreliosis influencing on neurological symptoms, difficulties in diagnosis of neuroborreliosis and current opinions about effectivness of treatment. European recomendations--results of EUCALB expert group, AAN-American Academy Neurology supported some important studies connected with duration of therapy are described.

[Transforming growth factor beta, metalloproteinase 2 and its tissue inhibitor 2 in the serum from patients with early and late boreliosis]. / Transformujacy czynnik wzrostu beta oraz metaloproteinaza 2 i jej tkankowy inhibitor 2 w surowicy chorych na wczesnq i pózna borelioze z Lyme.

UNLABELLED: Boreliosis is an arthropod transmitted, bacterial infection, known for its complicated pathogenesis and prolonged course. Boreliosis can be divided into early, localized type, early generalized type as well as late type. Cytokines control homeostasis of the organism by transmitting signals between cells. TGF (transforming growth factor) beta is one of the cytokines that modulates cell differentiation, proliferation and angiogenesis. In larger concentrations it blocks the expression of IL-1 and TNF-alfa. TGF-beta stimulates production of selectin, collagen, fibrinoectin and integrin. It inhibits metalloproteinase that causes degradation of the above mentioned proteins. THE AIM OF THE STUDY: We assessed a concentration of TGF-beta in the blood of patients presented with an early form of boreliosis Erythema Migrans (EM) as well as in patients with an advanced form of this disease Lyme arthritis (LA) In addition, levels of metalloproteinase (MMP-2), its tissue inhibitor (TIMP) was assessed. We attempted to analyze the effects of treatment by measuring specific markers of inflammation. MATERIAL AND METHODS: We tested a group of 40 patients with Lyme disease. The first group included 20 patients with an early form--(EM), while the second group of 20 patients, had a chronic form of the disease--(LA). The control group consisted of 8 healthy blood donors. The serum levels of TGF beta, metalloproteinase (MMP-2) and its tissue inhibitor (TIMP-2) were obtained using ELISA. Levels were obtained prior to treatment and after 4 weeks of treatment with Doxycyclin or Rocephin (Ceftriaxon). RESULTS: The results indicated that levels of TGF-beta were lower in the Lyme patients than in the healthy control. In the patients group, the early form of disease had higher levels of TGF-beta than in the chronic. Acute, early phase group had also higher serum levels of MMP-2 and TIMP-2 in comparison to the chronic stage group. LA group showed correlation between TGF-beta concentration and levels of MMP-2. It has not been the case in the acute stage of the disease. Both groups of patients had higher levels of IL-1-aRII and selectin E in comparison with control. CONCLUSIONS: As suggested by the results, decreased levels of TGF-beta in patients with boreliosis can be due to increased levels of MMP-2 and TIMP. The above markers and their concentration can be useful in the monitoring of the effectiveness of provided therapy and suggest that inflammation can persist in spite of the normalization of the clinical picture. The results suggest extremely complicated pathophysiology of Lyme disease where pro and antiinflammatory cytokines are as important as the pathogen itself.

[Immunopathology of Lyme arthritis]. / Zaburzenia immunologiczne w zapaleniu stawów w boreliozie z lyme.

Lyme borreliosis (Lyme disease) is the most prevalent tick-borne disease caused by spirochaetes of the Borrelia species complex. Arthritis is one of the common manifestations of B. burgdorferi infection. The pathomechanism of articular changes in Lyme arthritis has not yet been elucidated. Histopathological studies of synovia and immunological changes are similar to rheumatoid arthritis. In the early stage of inflammation B. burgdorferi interact with polynuclear granulocytes and epithelial cells, triggering production of reactive oxygen species, lipid peroxidation products and other inflammatory mediators. The imbalance between anabolic and catabolic processes in inflamed joints results in the progressive destruction of articular cartilage and disintegration of extracellular matrix. Molecular mimicry between OspA (outer surface protein A) and adhesion molecule LFA-1alpha seems to be responsible for chronic arthritis.

[Comparison of test with antigen VlsE (C6) with tests with recombinant antigens in patients with Lyme borreliosis]. / Porównanie wyników testu z antygenem VIsE (C6) oraz testów z zastosowaniem antygenów rekombinowanych u chorych na borelioze z Lyme.

UNLABELLED: In diagnosis of Lyme borreliosis classic, recombinant antigens are used. Introduced recombinant antigen VlsE increases hope to improve sensibility of the tests. AIM OF THE STUDY: Serological results detecting antibodies against Borrelia burgdorferi, recombinant antigens in both classes and test with VlsE were compared. MATERIAL AND METHODS: Quick ELISA C6 Borrelia Assay Kit (U.S.A.) for both classes simultaneusly were compared with two tests composed of recombinant antigens Borrelia IgG recombinant, Borrelia IgM recombinant (Biomedica, Austria)separate for IgM i IgG antibodies. Patients with borreliosis as eryhtema migrans were evaluated (n=36) and group with chronic Lyme arthritis (n=68). RESULTS: Statistical coincidence between results of test ELISA C6 and presence of antibodies IgM (p < 0.0001) and IgG (p < 0.0001) obtained in tests based on recombinant antigens in group erytema migrans. In group Lyme arthritis coincidence (p < 0.0002), with IgM antibodies was stated. CONCLUSIONS: Test ELISA C6 (with protein VlsE-C6) in group of patients with Lyme borreliosis had statistically essential predictive values of presence antibodies in IgM i IgG class, stated in tests performed separately for IgM and IgG classes with recombinant antigens. Tests based on conservative part of protein VlsE (C6), detecting antibodies in both classes are very promising in diagnosis of early stages Lyme borreliosis.

[Cilliary neurotrophic factor in tick-borne encephalitis]. / Rzeskowy czynnik neurotrtropowy w kleszczowym zapaleniu mózgu.

THE PURPOSE OF THIS STUDY: To evaluate concentrations of cilliary neutrophic factor (CNTF) in serum and cerebrospinal fluid of patients with tick-borne encephalitis (TBE) and bacterial meningitis. MATERIAL AND METHODS: 49 patients (14 females and 35 males), aged 19 to 62 were examined. Patients were divided into three groups: group I--23 patients (47%) with diagnosed TBE, group II--16 patients (33%) with bacterial meningitis and 10 (20%) healthy individuals as control group. The examination was performed twice before and after 4-weeks treatment. In achieved results CNTF concentration in serum from group I and II in both examinations was significantly higher compared to control group. RESULTS: Patients with TBE showed higher serum CNTF concentration compared to group with bacterial meningitis in both examinations as well. In examination 1 cerebrospinal fluid CNTF concentration of both groups was significantly higher in comparison to control group. Examined cytokine CSF concentration was higher in group with bacterial meningitis. After treatment CNTF concentration decreased significantly in group I and II. In group I CNTF concentration was comparable to control group. CONCLUSION: Concentration of CNTF in csf could be used as a marker of the inflammatory process in the central nervous system.

[Clinical forms of neuroborreliosis among hospitalized patients in the years 2000-2005]. / Kliniczne postacie neuroboreliozy u chorych hospitalizowanych w latach 2000-2005.

THE AIM OF THE STUDY: To evaluate the frequency of clinical forms as well as laboratory and neuroimaging results of patients with diagnosed neuroborreliosis in the years 2000-2005 due to neuroborreliosis. MATERIAL AND METHODS: The records of 125 patients at the age of 21-83 (mean 49 years) treated in the years 2000-2005 in the Department of Infectious Diseases and Neuroinfections, Medical University, Bialystok were subject to retrospective analysis. Diagnosis was based on case history along with a clinical picture and presence of antibodies against Borrelia burgdorferi, using ELISA test (Borrelia IgM and Borrelia IgG recombinant Biomedica). The subject of the detailed analysis was demographic data, clinical symptoms as well as subjective complaints, results of neurological examinations, the results of cerebrospinal fluid (CSF) parameters and results of serologic tests. RESULTS: The most frequent clinical symptoms observed were: headaches 71%, vertigo 44%, meningeal symptoms 22% and neurological paresis 27% (including facial palsy--23%). Inflammatory changes in CSF in the form of increased proteins concentration and pleocytosis were present among 34% of patients. In all cases the antibodies against B. burgdorferi were present in CSF in diagnostically significant titer. Serum presence of antibodies antiborrelia IgM was found with 55% of patients and anibodies antiborrelia IgG with 76% of patients. 17% of patients suffering from neuroborreliosis were also coinfected with tick-borne encephalitis virus. Along with the neurological symptoms, which were crucial to diagnosis, general symptoms coexisted, such as: weakness 35%, arthralgia 54% and nausea 17%. In the analyzed period of time neuroborreliosis was diagnosed in a 13% of hospitalized patient suffering from borreliosis. CONCLUSIONS: Absence of erythema migrans does not exclude existence of neuroborreliosis. Symptoms that may suggest presence of neuroborreliosis are not only neurological symptoms such as facial palsy, but also memory and concentration disorders and general symptoms.

[Soluble CD40 and soluble CD40L concentrations in the serum and the cerebrospinal fluid of patients with tick borne encephalitis and neuroborreliosis]. / Ocena stezenia sCD40 i sCD40L w plynie mózgowo-rdzeniowym i surowicy chorych na kleszczowe zapalenie mózgu i neuroborelioze

BACKGROUND AND PURPOSE: The interaction between CD40 and CD40L is essential in generating of an immunological response also intrathecally. The aim of the study was estimation of a concentration soluble form of CD40, CD40L (CD154) in the bacterial and viral inflammation of the central nervous system in two compartments - blood circulation and intrathecally, before and after the treatment. MATERIAL AND METHODS: sCD40 and sCD40L were tested twice before and after treatment in pairs serum and CSF of 40 patients treated in the Dept. of Infectious Diseases and Neuroinfections. Patients were divided in two groups: (n=20) patients with tick borne encephalitis (TBE) (group I, n=20) and patients with neuroborreliosis in the form of lymphocytic meningitis (group II, n=20). ELISA assays were performed. RESULTS: Significantly increased concentrations of sCD40, sCD40L in CSF (higher in neuroborreliosis) were measured. We found also an increased concentration of sCD40L in inflammatory CSF in both tested groups (in neuroboreliosis lasting also after 4 weeks of treatment), compared with the control group (below the detection limit in normal CSF). CONCLUSIONS: Results of estimation of the sCD40 and sCD40L concentrations indicate their role in the intrathecal inflammation process of bacterial and viral etiology. The increased serum concentration of sCD40L in TBE and CD40 in neuroborreliosis indicate that peripheral activation of the immunological system persists after cessation of treatment and after the clinical recovery. The defense mechanisms are more pronounced in neuroborreliosis than in tick borne encephalitis.

[Difficulties in early diagnosis of Herpes simplex encephalitis]. / Trudnosci wczesnej diagnostyki opryszczkowego zapalenia mózgu.

Herpes simplex virus infection of the central nervous system is still a significant cause of morbidity and often mortality at relatively young people. Changes of central nervous system are results of primary infection or activation of latent HSV-1, HSV-2. Neurological deficits often follow encephalitis herpetica. CT, MRI and SPECT are usefull tools in early recognition of herpes encephalitis. The aplication of PCR is prompt and specific diagnosis of herpes simplex virus infections of the brain. Advances in treatment Herpes simplex encephalitis with acyclovir have improved outcome.

[Serum and cerebrospinal concentrations of sICAM-1 sICAM-2, sICAM-3 in neuroborrellosis and tick borne encephalitis--preliminary report]. / Stezenie sICAM-1, sICAM-2, sICAM-3 w surowicy i plynie mózgowo-rdzeniowym u chorych na neuroborelioze i kleszczowe zapalenie mózgu--doniesienie wstepne.

OBJECTIVE: The aim was to evaluate the concentrations of the soluble forms of ICAM-1, ICAM-2, ICAM-3 in the serum and cerebrospinal fluid (CSF) of patients with neuroborreliosis and thick borne encephalitis before and after therapy in comparison with the control group. MATERIAL AND METHODS: We examined 30 patients, 10 in each group: neuroborreliosis-group I (NB), tick borne encephalitis--group II (TBE) and in the control group (group K). The diagnosis of neuroborreliosis and TBE based on the clinical features was confirmed by ELISA assays: FSME Virus/TBE Virus test (VIRION, Germany) for TBE and Borrelia IgM and IgG Recombinant (Biomedica Austria) for NB. The assays of sICAM-1, sICAM-2, sICAM-3 (ELISA, Bender Med System, USA) were performed twice in group I and II: before and after 3-4 weeks long treatment and once in control group. RESULTS AND CONCLUSIONS: Increased concentration of soluble forms of ICAM-1, ICAM-2, ICAM-3 in CSF suggest their important role in inflammatory process of viral and bacterial origin. In NB group, the serum concentrations of sICAM-1, sICAM-2 were significantly increased before and after treatment in comparison with control as well as with the analogous test results in TBE group. It may suggest NB as the part of systemic inflammation. The CSF concentration of sICAM-2 decreases after treatment in NB group in comparison with the analogous test results of TBE group. The increased CSF concentration of sICAM-2 in TBE group when compared to the CSF concentration in NB group suggest slow recovery and still persisting immunological activation in this group, even when the neurological symptoms disappeared. Increased concentrations in CSF in both diseases indicate intrameningeal activity of lymphocytes and may be a useful marker of inflammation.

[Pathogenetic-clinical problems of Lyme borreliosis]. / Problemy patogenetyczno--kliniczne boreliozy z Lyme.

In this article a short review of pathogenesis and clinical manifestations of Lyme disease is presented. As regards pathogenesis, attention was paid to the mosaic protein structure of the B. burgdorfieri spirochete, particularly of outer surface proteins (Osp) that influence the clinical course and diagnosis of the disease. The presence of various atypical spirochete forms: spheroplastic L (without cell walls), cystic, and granular "blebs" may lead to a chronic form of the disease and to a low efficacy of antibiotic therapy. An important part of the pathogenesis is epithelial damage, stimulating the production of inflammatory cytokines (mainly IL-1, TNF-alpha, IFN-gamma), adhesive molecules and acute-phase proteins. Moreover, in the course of the disease not only an impairment of phagocytosis and chemotaxis was found, but also B. burgdorfieri spirochete binding by antibodies into immunological complexes that may maintain chronic inflammation. In terms of the Asbrink classification, complaints predominating in the clinical picture of an early and late stage of the disease were presented, with an emphasis on neuroborreliosis.

[Should ticks be regarded as a tularemia vector in habitants of North-Eastern Poland?]. / Czy kleszcze sa wektorem tularemi u mieszkanców pólnocno-wschodniej Polski?

BACKGROUND: A growing incidence of tick borne encephalitis and Lyme borreliosis in north-eastern Poland as well as an increasing number of Ixodes ricinus ticks in wooded areas and meadows have prompted the authors to evaluate the presence of antibodies against Francisella tularensis in serum of forest workers. MATERIALS AND METHODS: Sera of 820 persons, including 765 healthy forest workers (group I) and 55 patients with lymphadenopathy (group II) admitted to the Department of Infectious and Neuroinfectious Diseases, Medical Academy, Bialystok, were diagnosed for antibodies against F. tularensis. Agglutination test at 37 degrees C, with suspensed F. tularensis (Biomed, Kraków, Poland) were used. Simultaneously all sera were tested for the presence of antibodies against B. burgdorferi, using ELISA test, Borrelia IgM and Borrelia IgG recombinant (Biomedica, Austria). RESULTS: Of the 765 forest workers (group I), 20 (2.06%), persons showed positive (1:20) result of agglutination test, including 8 persons with antibodies against B. burgdorferi in IgG, of these 1 in IgM and IgG. Twenty persons with positive agglutination test had no signs of present or past tularemia in physical examination. Nine persons with prior diagnosis of arthritic form of Lyme boreliosis had undergone repeated antibiotic therapy (two 30-days therapy courses with cefotaksym or doxycycline). In group II, sera of 55 patients were negative in the agglutination test with F. tularensis. CONCLUSIONS: The results of our study show that in North-Eastern Poland, Ixodes ricinus is not essential in Francisella tularensis transmission in this region.

[Viral nosocomial infections: the problem of contemporary hospital management]. / Wirusowe zakazenia szpitalne--problemem wspólczesnego szpitalnictwa.

The most frequent viral pathogens which are the cause of nosocomial infections were presented. Influenza and parainfluenza viruses as well as RS virus affect frequently respiratory tract. So called enteric viruses which are rotaviruses, adenoviruses, small round viruses, astroviruses, caliciviruses, corona viruses, Coxackie, ECHO may be the agents of disorders in digestive tract in the form of intoxications. Viruses of viral hepatitis B, C, D and HIV, CMV, EBV may be the source of nosocomial viral infections transmitted by blood (transfusions).