[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.

[Impact of pegylated interferon alpha and ribavirin therapy of chronic hepatitis C on peripheral blood and intrahepatic lymphocytes]. / Wplyw leczenia skojarzonego interferonem pegylowanym alpha i rybawiryna przewleklego zapalenia watroby typu C na zmiany subpopulacji limfocytów krwi obwodowej i wewnatrzwatrobowych.

UNLABELLED: The role of cellular immune response in pathogenesis of liver cell injury and course of chronic hepatitis C have been previously confirmed. The aim of this study was to determine the modification of T-lymphocyte subsets during pegylated interferon alpha (PegIFN) and ribavirin treatment and its correlation with response to the treatment. MATERIAL AND METHODS: The assessment of subsets of intrahepatic lymphocytes and peripheral blood lymphocytes was done in 62 patients with chronic hepatitis C using flow cytometry and immunohistochemical method. RESULTS: Significant increase in peripheral blood CD4+ cells, was observed in week 12 of treatment in patients with both complete and partial response to therapy. There were no significant modifications in nonspecific CD8+ subsets, but after 12 week of treatment in patients with response to therapy, decrease or lack of HCV-specific CD8+ cells were observed. The assessment of subsets of intrahepatic lymphocytes revealed a significantly higher percentage of CD8+ cells in pretreatment liver biopsies from patients with sustained viral response. CONCLUSIONS: The results confirmed the impact of interferon alpha and ribavirin treatment on cellular response. Some immunological host factors should be considered in the early prognosis of successful treatment.

[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.

[Intrahepatic and peripheral blood lymphocytes during hepatitis C]. / Limfocyty wewnatrzwatrobowe i krwi obwodowej w przebiegu wirusowego zapalenia watroby typu C.

OBJECTIVE: The pathogenesis of liver cell injury during chronic hepatitis C is poorly understood and cellular immune response is thought to play a key role in both inhibition of viral replication and liver pathology. We investigated a panel of markers of intrahepatic T-lymphocyte subsets in 44 hepatitis C virus (HCV)-infected patients. METHODS: The assessment of subsets of intrahepatic lymphocytes and peripheral blood lymphocytes was done using flow cytometry and immunohistochemical study. RESULTS: The proportion of CD4 and CD8 cells were similar in both compartments. A significantly larger percentage of NK cells was observed in intrahepatic infiltrates compared to peripheral blood lymphocytes (14,5+/-8,1 vs 10,5+/-7,1; p<0,01). No statistical correlation was found between lymphocytes parentage and age, sex, transaminase activities and viremia. Linear regression indicated the positive correlation between the percentage of CD8 and histological activity (r= 0.46, p=0,00 ) and NK cells and histological activity (r-0.44, p=0,003). There was not such a correlation between subsets of peripheral blood lymphocytes and histological activities.

TT virus infection and pancreatic cancer: relationship or accidental coexistence.

TT virus (TTV) was first isolated in 1997 from the patient with acute post-transfusion hepatitis. This fact led to the conclusion that the virus was hepatotropic and could be one of the causative agents of acute hepatitis. Afterwards, however, the virus was found in other human tissues and serological studies revealed that it was widespread. Multiple tropisms of TTV and the fact of its high incidence in general population are considered to indicate no medical significance of TTV in human pathology. Here we present a report of two cases of TTV infection in patients who developed pancreas cancer. The patients were hospitalized at the Department of Infectious Diseases due to hepatitis of unknown origin. Since serological and virological markers of common primary and secondary hepatotropic viruses were negative, TTV-DNA was found in serum and was believed to be the only causative agent with probable hepatotropic action. The patients later developed pancreas cancer and they underwent operation. The relationship is difficult to confirm, however the cases we present should be treated as a preliminary report and a comment on the real role of TTV in human pathology.

[Pegylated interferon-alfa 2a with ribavirin in chronic viral hepatitis C (final report)]. / Pegylowany interferon alpha-2a z rybawiryna w leczeniu przewleklego wirusowego zapalenia watroby typu C (raport koncowy z badan).

UNLABELLED: We evaluated the efficacy and safety of peginterferon alfa-2a [40KD] (Peg-IFNalpha-2a) plus ribavirin in patients with chronic hepatitis C in an open-label programme in a routine clinical setting in Poland. Patients received Peg-IFNalpha-2a 180mg/week plus ribavirin 800-1200 mg/d for 48 weeks. Sustained virological response (SVR) was defined as undetectable HCV RNA (<50IU/mL) at the end of follow-up (week 72). 466 adults were enrolled. Most patients (87.3%) had genotype 1 infection. 440 subjects (94,4%) completed treatment. The overall SVR rate was 55.7%. A higher SVR rate was obtained in treatment-naïve patients (58.7%) than in relapsers (47.8%; p=0,048). SVR rates in genotype 1 and non-1 patients were 51.1% and 88.5%, respectively (p<0.001). There were significant higher SVR rates in patients with lower baseline fibrosis (p=0,01). There were no differences in SVRs by gender or viral load. Hemoglobin, leukocyte and neutrophil levels decreased significantly during treatment, but returned to baseline after the end of treatment. ALT levels decreased significantly during treatment in patients with and without an SVR. 38.4% of patients experienced adverse events like neutropenia, anemia, thrombocytopenia, and other. There was one death (severe thrombocytopenia). CONCLUSIONS: The overall SVR achieved in this predominantly genotype 1 population was 55.7%. SVR rates were significantly higher in treatment-naïve patients, those with non-1 genotypes, and in patients with lower baseline fibrosis scores.

The risk of exposure to Anaplasma phagocytophilum infection in Mid-Eastern Poland.

Both the presence of Anaplasma phagocytophilum in ticks and the seroprevalence of human granulocytic anaplasmosis have been reported in different parts of Europe. There are few reports concerning this problem in Poland. The aim of the study was to assess the prevalence of Anaplasma phagocytophilum in ticks, and to detect antibodies against the HGE agent in serum of forest workers in the region of Mid-Eastern Poland. In our opinion, this should reflect the real probability of infection of people exposed to Ixodes tick bites. Seroactivity against Anaplasma phagocytophilum was detected in 20.6% of persons in the study group. Coexistence of anti-Borrelia burgdorferi was present in 84.6 % of individuals seropositive to A. phagocytophilum. The PCR test identifying Anaplasma phagocytophilum was positive in 13.1% of overall tick samples. The highest prevalence of infection (45.7%) was found in female ticks. Anaplasmal DNA was detected in 4.5% of male ticks and only in 0.9% of nymphs. The results of our study confirmed the existence of A. phagocytophilum in the natural environment of Mid-Eastern Poland. As the risk for infection exists, it should call the attention of public health services to the possibility of an increasing number of patients with this disease.

[Concentration of sVAP in serum of patients with different forms of Lyme borreliosis]. / Stezenie sVAP-1 w surowicy krwi w wybranych postaciach klinicznych boreliozy z Lyme.

OBJECTIVES: The aim of our work was to assess the serum concentration of soluble VAP-1 (sVAP-1) in patients with arthral type of borreliosis and erythema migrans. METHODS: We included in our study 30 patients in the age of 17-53 years who were treated for erythema migrans and 30 patients in the age of 25-63 years who were diagnosed with arthral type of borreliosis. The control group consisted of 30 healthy blood donors. The diagnosis of borreliosis was made on the basis of anamnesis, physical examination and additional tests, one of which proved the existence of IgM and IgG antibodies against Borrelia burgdorferi antigen present in the serum of patients. All samples for investigations were taken in a single collection manner. The serum concentration of sVAP-1 protein was assessed with ELISA method. All data were analysed statistically. We assumed 5% risk of conclusion error. CONCLUSIONS: 1. We did not observe an increase in serum sVAP-1 concentration in patients with erythema migrans compared to the control group. All observed differences in the serum level of this protein seemed to be random ones. 2. We showed a statistically important increase in soluble sVAP-1 serum concentration in patients with arthral type of borreliosis compared to the control group.

[Serum copper and zinc level in patients suffering from infectious mononucleosis and after the regression of clinical symptoms]. / Stezenie miedzi i cynku w surowicy oraz wartosc wskaznika miedziowo-cynkowego w przebiegu mononukleozy zakaznej i po ustapieniu objawów klinicznych.

UNLABELLED: The aim of this work was to assess the serum copper (Cu) and zinc (Zn) level and ratio Cu/Zn in the acute, symptomatic period of infectious mononucleosis and during the convalescence period, when no clinical symptoms were present. MATERIAL AND METHODS: We examined 50 persons, including 26 patients (14 women and 12 men) in the age of 16 to 27 years, examined in the acute, symptomatic period of the disease. The diagnosis of infectious mononucleosis was based on the clinical, haematological, biochemical and serologic criteria. Cu and Zn concentration was measured 3 times: on the 1st day and the 2nd week of hospitalisation, and also after the regression of clinical symptoms. The control group consisted of 24 healthy individuals (13 men and 11 women) in the age of 17 to 26 years. Cu and Zn concentration was measured once in this group. All measurements of Cu and Zn serum concentration were done using the method of atomic absorption spectrophotometry (AAS) with AAS-3 spectrophotometer of Carl Zeiss-Jena production, at the wavelength for Cu--324.8, Zn--213.9 nm. We observed the Cu and Zn serum concentration and ratio Cu/Zn in patients with acute, symptomatic infectious mononucleosis and also after the regression of clinical symptoms to be statistically higher that the results from the healthy individuals. CONCLUSION: The statistical significant elevated serum Cu and Zn concentration observed during the course of infectious mononucleosis and after clinical symptoms regression in comparison to healthy persons expressed the perturbation of trace elements homeostasis. If copper to zinc ratio reflects myeloproliferative diseases activity, the practical value for infectious mononucleosis monitoring is the same as copper and zinc serum level measurement.

[Peginterferon alpha-2b in patients with chronic hepatitis C]. / Pegylowany intefeon alpha-62b i rybawiyna w leczen przewlekllego wirusoweg zapalenia watroby typu C.

150 adult patients were assigned pegylated interferon alpha-2b (once weekly 1.5 microg/kg) plus ribavirin (800-1200 mg depending on bodyweight). The treatment lasted 52 weeks and was completed by 139 persons (92.7%). Because of adverse events the treatment was interrupted in 7 persons, 4 other persons resigned. Periodical reduction of pegylated interferon doses was necessary in 19% and the reduction of ribavirin in 21% of patients. Six months after the completion of treatment HCV-RNA was negative in 82 (59%) patients. Neither hepatitis C virus genotype, nor viremia was marked in the study. The negative correlation between the degree of fibrosis in the liver tissue and the results of sustained virological response was stated. Degree of inflammation at liver tissue, sex, age over and less than 40 years did not correlate with the final virological results. The recurrence of infection happened at 7% of the treated persons (negative HCV-RNA directly after the treatment--positive 6 months after the completion). During the treatment period, and comparison with the results obtained before its implementation, statistically significantly decreased: hemoglobin concentration, the number of leukocytes, granulocytes and thrombocytes. They returned to the referential values half a year after the completion of treatment. The activity of enzymes (AIAT, AspAT, GGTP) was decreasing statistically significantly since the first weeks of the treatment till the end and remained significantly lower after 6 months. In both sexes statistically significant reduction of bodyweight was stated, while it increased during the six months after the completion of treatment. Adverse events, which mostly were mild and were not the cause of interruption of treatment, were numerous and occurred at different frequency, in the range from over 50% (flu-like) to 0.7%.

[Dynamics of changes in magnesium (Mg) serum levels in patients suffering from infectious mononucleosis]. / Ocena dynamiki zmian poziomu magnezu (Mg) w surowicy krwi chorych na mononukleoze zakazna.

The aim of the study was to assess the dynamics of changes in magnesium (Mg) serum levels in the acute, symptomatic period of infectious mononucleosis and during the convalescence period, when clinical symptoms were no longer present. 50 subjects were included, among them 26 patients (14 women and 12 men) at the age of 16 to 27 years in the acute, symptomatic stage of the disease. The diagnosis of infectious mononucleosis was based on the clinical, hematological, biochemical and serologic criteria. Mg concentration was measured 3 times: on the 1st day and in the 2nd week of hospitalization, and also in the convalescence period--3 weeks after the regression of clinical symptoms. The control group consisted of 24 healthy individuals (5 men and 5 women) at the age of 17 to 26 years. Mg concentration was measured once in this group. All measurements of Mg serum concentration were performed using the method of atomic absorption spectrophotometry (AAS) at the wavelength of 285.2 nm. We observed significantly higher Mg serum concentrations in patients with acute, symptomatic infectious mononucleosis than in healthy individuals. During the convalescence period Mg serum concentrations were lower but still statistically higher than in the control group.

[Profile of microorganisms isolated in nasopharyngeal swabs from the patients with acute infectious mononucleosis]. / Charakterystyka drobnoustrojów izolowanych z blon sluzowych jamy nosowo-gardlowej u chorych z mononukleoza zakazna.

Infectious mononucleosis is a self-limiting lymphoproliferative disorder, which contribute to the development of the various clinical symptoms. Exudative tonsillitis was found to be caused by Epstein-Barr virus in 19% of all viral infections and may imitate a bacterial etiology. The aim of this study was to identify the microbes from the nasopharyngeal swabs obtained from the patients with exudative tonsillitis and to assess their susceptibility to antibiotics. The patients were hospitalized as an infectious mononucleosis after unsuccessful antibiotic therapy. 84 patients were investigated: group I--patients with serological positive infectious mononucleosis tests and group II--patients with acute exudative tonsillitis and with serologically excluded infectious mononucleosis. The diagnosis was confirmed clinically, haematologically, biochemically and serologically. Nasopharyngeal specimens were taken, once, at the first day of hospitalization. Then, routine microbiological assays were performed. Isolated strains were identified biochemically: API Strep, API Staph, API E, API Ne, APINH (bioMerieux). The susceptibility to antibiotics with an agar diffusion assay was performed according to Kirby-Bauer. We concluded that various, potentially pathogenic bacterial flora was found in throat during infectious mononucleosis. Haemophilus spp. and Staphylococcus aureus MSSA were isolated more frequently. Haemophilus influence was susceptible to cefotaxime and azytromycine. Candida albicans was isolated in every fourth patient. Streptococcus pyogenes as an etiological agent of exudative tonsillitis was confirmed in the group II. The pharyngeal candidiosis was also observed more frequently in the group II.

[Ramsay Hunt syndrome--a case study]. / Zespól Ramsaya Hunta--opis przypadku.

In this work we present a patient, aged 40 with Ramsay Hunt syndrome, who was treated at the Department of Infectious Disease, Medical Academy in Lublin (Poland). The diagnosis of the disease was based on the anamnesis concerning epidemiology of the disease, the course and three major symptoms: facial paralysis, neuralgia, herpetic eruption in the mouth and on the ear. The combined treatment with antiviral drugs and corticosteroids was partially successful and did not resolve the seventh nerve palsy.

Serum zinc (Zn) level dynamics in blood serum of patients with acute viral hepatitis B and early recovery period.

The aim of the present study was an analysis of serum zinc level dynamics in patients with acute hepatitis B and early recovery period compared with control group. The investigation included 39 patients aged 18-76 hospitalised in the Department of Infectious Diseases of the Medical University of Lublin, because of acute hepatitis B. Determinations of zinc (Zn) level in blood serum were made four times during hospitalisation and once, four weeks after discharging from the clinic in the early recovery period using atomic absorption spectrometry (AAS). The control group included 24 persons aged 22-69. Zinc (Zn) levels of those people were determined once. The obtained numerical data were subjected to statistical analysis. Lack of significant differences between men and women allowed to calculate the range of our norm, which was assumed at the level of M +/- 2SD, that is between 12.948-19.036 mumol/l. The significantly decreased serum zinc level was observed during hospitalisation while the differences stated in the serum level of this element in initial and early recovery determination compared with control group results are markedly at random.

Pregnancy during lamivudine therapy in chronic hepatitis B--case report.

In case of a pregnancy in a patient infected with hepatitis B virus there is a risk of intrauterine fetus infection, which rises significantly with the serological profile of positive hepatitis B surface antigen, hepatitis Be antigen and in the presence of HBV DNA in serum. Therefore, in clinical practice the monitoring of antiviral therapy in chronic hepatitis B in women of reproductive age is becoming especially important. The safety of lamivudine use in pregnant women infected with hepatitis B virus has not yet been proven. In this case, the patient became pregnant during the treatment with lamivudine and when hepatitis B virus replication markers were present in the serum (hepatitis B surface antigen, hepatitis Be antigen, hepatitis B virus DNA). Treatment with lamivudine lasted through the first 6 weeks of pregnancy, which was complicated by a possibility of intrauterine hepatitis B virus infection, did not cause any fetus injury.

Prolactin concentration in the serum of male patients with chronic hepatitis C.

In this work we analysed the dynamics of prolactin serum concentration in male patients with chronic hepatitis C. A group of 52 men were included in the study, 26 of them constituted the control group. The diagnosis of the disease was confirmed by the presence of HCV-RNA in the serum and by the histological examination of the liver. None of the examined men was diagnosed with any co-existing disease nor any infection markers of HAV and HBV were found. The prolactin concentration was determined in the serum of patients twice: on the 2nd day of hospitalisation and after 4 weeks of hospitalisation by the use of radioimmunological method (RIA) applying a prepared set of reagents RIA-PROL-CTK-4 (Sorin Biomedica, Italy). The results were statistically analysed. An analysis of the dynamics of prolactin serum concentration in male patients with chronic hepatitis C shows a statistically important increase in this hormone serum concentration.

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.

TT virus (TTV)--etiologic agent of acute hepatitis?

TT virus (TTV) was first isolated in 1997 from the patient with acute posttransfusion hepatitis. This fact led to the conclusion the virus was hepatotropic and could be considered as one of causative agents of acute hepatitis. However, later it was found in other human tissues and serological studies have revealed it is widespread. Multiple tropisms of TTV and the fact the virus is found in high rate of general population, are considered arguments for lack of medical significance of TTV in human pathology. Here we present a report of two cases of acute viral hepatitis in patients hospitalized at the Department of Infectious Diseases, Medical University of Lublin, in whom TTV-DNA was found in serum and serological and virological markers of common primary and secondary hepatotropic viruses were negative. The cases of acute hepatitis we present here should be treated as a preliminary report and the comment in the discussion about the real role of TTV in human pathology.

Copper/zinc ratio in measles patients.

UNLABELLED: The aim of this study was to evaluate the serum copper (Cu), zinc (Zn) levels and Cu/Zn ratio in measles patients in comparison to the control group. The study was conducted on 26 patients. The serum Cu and Zn levels were determined three times using atomic absorbtion spectrometry. The control group included 24 healthy persons. The serum Cu and Zn levels in those persons were determined once. CONCLUSION: in the acute period of the disease, a significant and highly significant increase in Cu/Zn ratio takes place.