The use of CytoSorb in acute oral mercuric chloride poisoning at a potentially lethal dose.

INTRODUCTION: The study aims to present a case of acute mercuric chloride poisoning treated successfully with continuous renal replacement therapy using the CytoSorb filter. CASE DESCRIPTION: A 21-year-old female patient after a suicide attempt by intentional ingestion of mercuric chloride, was admitted to the hospital with features of multiple organ damage for specific treatment. The performed laboratory tests confirmed high levels of mercury in the blood (1051 µg/L) and urine (22,960 µg/L). Due to acute renal failure, continuous renal replacement therapy (CRRT) CVVHD Ci-Ca was initiated; the procedure was then converted to CVVHDF Ci-Ca with ultrafiltration to optimise therapy, and CytoSorb was added to the artificial kidney system on day 3. Specific antidote therapy (DMPS) was administered concurrently. The ongoing treatment resulted in a reduction in subjective complaints, a decrease in blood mercury levels to 580 µg/L, and an improvement in parenchymal organ function. CONCLUSION: In the event of poisoning with inorganic mercury compounds (mercuric chloride), continuous renal replacement therapy using the CytoSorb filter as an extracorporeal blood purification method may be considered.

Acute mercuric chloride poisoning at a potentially lethal dose ended with survival: symptoms, concentration in cerebrospinal fluid, treatment.

This study aims to present a case of acute mercuric chloride poisoning at a potentially lethal dose treated with the antidote - 2,3-dimercapto- 1-propanesulfonic acid (DMPS) and continuous renal replacement therapy (CRRT) combined with CytoSorb. A 21-year-old woman was admitted to a hospital with abdominal pain, vomiting, and suspected gastrointestinal bleeding after taking 5000 mg of mercuric chloride for suicidal purposes. Due to the patient deteriorating general condition and multiple organ damage, on the third day she was transported to the Clinic of Anaesthesiology and Intensive Care (CAaIC), Lódz, Poland. Laboratory tests confirmed features of acute kidney injury and high mercury levels in the blood (1051 µg/l) and urine (22 960 µg/l) - DMPS therapy and CRRT combined with CytoSorb were instituted. Due to nervous system complaints (headache, dizziness), a lumbosacral puncture was performed - the mercury concentration in the cerebrospinal fluid (CSF) was 5.45 µg/l. During a colonoscopy, significant diagnostic abnormalities revealed features of colonic mucosal necrosis. The treatment resulted in a decrease in subjective complaints, decreased mercury levels in biological material, and improved parenchymal organ function. On the 15th day of therapy, the patient was transferred to the primary care center for further treatment. The case confirms the possibility of improvement of patient condition following ingestion of a potentially lethal dose (5 g) as a result of the initiation of appropriate therapy even on the third day. The presence of mercury in CSF confirms that inorganic mercury compounds (mercuric chloride) can pass through the blood-brain barrier after oral ingestion. Int J Occup Med Environ Health. 2023;36(5):685-92.

Prevalence of Lyme Carditis in Patients with Atrioventricular Blocks.

Infections with Borrelia may cause cardiac conduction system abnormalities, including atrioventricular blocks (AVBs). Therefore, we aimed to identify patients in whom Lyme carditis (LC) could be considered as the initial diagnosis among consecutive subjects who were referred for implantation of a permanent pacemaker due to symptomatic AVBs. To date, such a systematic evaluation has not been reported yet. Validation of the Suspicious Index for Lyme Carditis (SILC) in our study population was considered as an additional goal. We investigated consecutive patients with AVB admitted to our department for a pacemaker implantation. Serological diagnostic tests against Borrelia burgdorferi sensu lato (Bbsl) were performed in those with no obvious cardiac causes of AVB. The final study population consisted of 130 patients (80 M, mean age 67.4 ± 17.6). Lyme carditis was assumed as the initial diagnosis in 16 patients (12%) based on ABV and IgM Bbsl seropositivity. The patients with LC were younger and more frequently manifested constitutional symptoms of infection and fluctuating AVB. The highest prognostic value for identification of LC patients was obtained for the modified SILC, which included the following parameters: (1) age lower than 75 years; (2) risky outdoor activity and living in the countryside; (3) tick bite; (4) constitutional symptoms of Lyme disease; (5) erythema migrans; (6) male sex and (7) fluctuating atrioventricular block. We concluded that diagnostics for LC should be routinely considered in patients with advanced AVB. Modified SILC may identify the patients at risk of LC.

Soluble urokinase plasminogen activator receptor level in individuals of advanced age.

Soluble urokinase plasminogen activator receptor (suPAR) is a biomarker whose clinical value has been tested in various groups of patients. The aim of the present study was to determine the suPAR level in a previously uninvestigated population of 182, generally healthy, community-dwelling seniors aged 74-89 years. In addition to suPAR level, selected laboratory parameters of heart and kidney function, lipid and C-reactive protein levels were determined. A group of 45 younger individuals aged 24-66 years was used for comparison. The seniors had higher suPAR levels than younger controls: 3.79 ng/mL (95% CI 3.64-3.96 ng/mL) vs. 3.16 ng/mL (95% CI 2.86-3.45 ng/mL). These levels increased further with advancing age, and were similar in women and men. A multiple regression model confirmed that biomarker level was related to cardiac function, renal function and inflammation, and this remained after adjusting for age. These correlation patterns were similar in older women and men.

Stray dogs and cats as potential sources of soil contamination with zoonotic parasites.

INTRODUCTION AND OBJECTIVE: The main source of many zoonoses is soil contaminated with feline and canine faeces. Thus, the aim of this study was to estimate the prevalence of intestinal parasites in stray dogs and cats adopted in Lodz shelter (Poland). MATERIALS AND METHODS: In total, 163 faecal samples were collected from 95 dogs and 68 cats from 2011 to 2012. The samples were processed by sedimentation techniques using Mini Parasep®SF. RESULTS: Six parasite genera belonging to protozoa, cestoda, and nematoda, were found in dogs, while eight were found in cats. Out of the 163 fecal samples, 37.4% were positive for the presence at least one species of intestinal parasites. The majority of positive dog samples contained eggs from Toxocara and Trichuris genera, and the family Ancylostomatidae, while Toxocara and Taenia eggs, as well as Cystoisospora oocysts, predominated in cat faeces. A significantly higher prevalence of parasites was noted in cats (48.5%) than in dogs (29.5%) (χ2=6.15, P=0.013). The Toxocara genus was the most prevalent parasite in both populations; eggs were found in 27.9% and 16.8% of cats and dogs, respectively. Animals younger than 12 months of age showed higher infection rates with Toxocara, but differences were not statistically significant. The average numbers of Toxocara eggs/gram of faeces in positive puppy and kitten samples were over 5 and 7 times higher than in older dogs and cats, respectively. Mixed infection were found in dogs (5.3%) and cats (8.8%). CONCLUSIONS: Cat faeces represent a more important potential source of environmental contamination with zoonotic parasites than dog faeces. Among the detected parasites of stray dogs and cats, Toxocara present an important zoonotic risk for the local human population, especially children.

Presence of Toxocara spp. eggs in children's recreation areas with varying degrees of access for animals.

INTRODUCTION AND OBJECTIVE: The contamination, seasonal and vertical distributions of Toxocara eggs in children's recreation areas were estimated with respect to their accessibility to domestic and stray animals. MATERIALS AND METHODS: During autumn 2011 and spring 2012, a total 88 composite samples of soil/sand (300g each) were taken twice, from 2 depths, from 11 sandpits and 11 play areas situated in the city of Lódz, Poland. From the collected material, 528 samples (20g) were tested using the flotation method. Half the sample sites were secured from access to dogs and cats, while the other half were not. RESULTS: The difference in the numbers of positive samples from sandpits and playing areas was significant (c 2 = 13.72, p = 0.0002). The highest rate of contamination was observed in poorly-secured play areas (15.8% of positive samples and 1.2 eggs/100 g of soil/sand). The average density of Toxocara eggs in secured play areas was 6 times less than that found in unsecured areas, while secured sandpits were 3 times less contaminated than those unsecured. The contamination rate was similar in autumn 2011 and spring 2012 (6.4% and 6.8%, respectively). An inverse relationship between the sand/soil depth and number of recovered Toxocara eggs was observed. Additionally, other intestinal helminth eggs (Ancylostomidae, Ascaris spp., and Trichuris spp.) and oocysts of Isospora spp. were also detected from soil samples collected from playing fields. CONCLUSIONS: The number of Toxocara eggs recovered decreased following fence construction around the examined children's play areas, but it did not sufficiently prevent the contamination by eggs. These data indicate the necessity for educational programmes which should be implemented for the protection of the local child population from zoonotic infection.

In vitro evaluation of the ovistatic and ovicidal effect of the cosmopolitan filamentous fungi isolated from soil on Ascaris suum eggs.

The ovicidal activity of seven fungal strains: Acremonium alabamense, Alternaria chlamydospora, Cladosporium herbarum, Fusarium solani, Paecilomyces variotii, Paecilomyces viridis and Penicillium verruculosum isolated from urban soil samples from Poland was determined in vitro. The fungal mycelium was co-cultured with Ascaris suum eggs on plates with 2% water-agar for 28 days. Eggs exposed and unexposed (control) to fungal mycelium were observed weekly by light microscopy and the percentage of malformed eggs were determined. The eggs were classified according to following parameters: type 1 - biochemical and physiological effect without morphological damage to the eggshell; type 2 - lytic effect with morphological alteration of the eggshell and embryo; type 3 - lytic effect with morphological alteration of eggshell and embryo with hyphal penetration and internal egg colonization. All examined species of fungi extended embryogenesis, but the retardation of embryonic development was varied and depended on the species. A. alabamense, A. chlamydospora and P. verruculosum exhibited very high inhibitory activity on A. suum egg development. The fungus-exposed eggs revealed morphological alternations in all stages of embryogenesis. Isolates of F. solani, P. variotii and P. viridis showed hyphal penetration and internal colonization of A. suum eggs (type 3 effect). No appressoria were produced and simple hyphal penetrations were most commonly observed. A. alabamense and P. verruculosum demonstrated morphological destruction, with eggshell destruction. The remaining fungi showed type 1 effect. The results demonstrated that examined strains of F. solani, P. variotii and P. viridis may be considered to be potential limiting factors of parasitic geohelminth populations.

Biological interactions between soil saprotrophic fungi and Ascaris suum eggs.

The in vitro effect of saprotrophic soil fungi on the embryonic development of Ascaris suum was evaluated. The fungi tested were Aspergillus fumigatus, Aspergillus terreus, Penicillium citrinum, Penicillium expansum, Fusarium oxysporum and Trichothecium roseum, isolated from children's recreation areas in the city of Lodz (Poland). Each species was co-cultured with A. suum egg suspension (6 × 10(3)eggs/ml) at 25 ± 2°C for 60 days. Each day, 100 eggs were randomly collected and their developmental stage was classified macroscopically. Additionally, at days 4, 7, 14, 28, 42 and 60 of incubation, the viability and the percentage of eggs with morphological altered embryo/larva were determined in each sample. Microscopic examination revealed that exposure of eggs to the mycelium of examined fungi inhibited embryogenesis of A. suum. All control culture eggs reached L2 larval stage after 26 days of incubation, while the experimental cultures did so after 32-51 days, depending on the fungal species. Three species were found to exhibit very high inhibitory activity on A. suum egg development: A. terreus, P. expansum and F. oxysporum. Embryopathies and non-viable embryos/larvae were observed significantly more frequently in the eggs co-cultured with fungal species than in control cultures. The fungus-exposed eggs revealed morphological alternations in the early zygotic cleavage, blastula, gastrula and larval stages. After 60 days of incubation with mycelia of P. expansum, A. terreus and F. oxysporum, the mortality of the larvae reached 55.3-60.3%. P. expansum and F. oxysporum showed hyphal penetration and internal egg colonization of A. suum eggs.

Geohelminth egg contamination of children's play areas in the city of Lodz (Poland).

The contamination of soil and sand with helminth eggs in children's play areas in Lodz (Poland) was assessed over two seasons using the flotation method with saturated sodium nitrate solution. A total of 88 samples were examined from 7 children's playgrounds from various public parks, 6 sandpits situated in school or kindergarten areas and 9 school sports fields. The differences in the number of positive samples from these sites were significant (χ(2)=21.83, d.f.=2 and p<0.0001). The highest rate of contamination was found in the area around sports fields. (15.7%). There was a significant difference between the frequencies of positive samples from the surface and from the deeper layers of the examined sites (χ(2)=11.41, d.f.=1, and p=0.0007). The average density of geohelminth eggs in 100g of soil or sand was 1.1 from sports fields, 0.4 from playgrounds and 0.07 from fenced sandpits. Throughout the study, 4 genera of nematode eggs (Toxocara, Uncinaria/Ancylostoma, Ascaris, Trichuris) and 1 genus (Cystoisospora spp.) of oocysts were detected. A total of 62 eggs were recovered, and 43.5% were fully developed to embryonated egg stages. The contamination rate was different in autumn 2010 and spring 2011, but there was no significant difference in the number of positive findings between these seasons. The helminth eggs were found in 10.9% and 7.6% of samples collected in the spring and in the autumn, respectively. The most frequently seen eggs were from Toxocara sp., which were the most prevalent in both seasons.

Comparative analysis of morphometric features of the eggs of selected alimentary tract parasites and of the plant pollens.

The aims of the study were: 1. to compare morphometric features of eggs of selected alimentary tract parasites and common garden plants pollen, which may accidentally contaminate a feces undergoing parasitological examination; 2. to make laboratory diagnosticians aware of a possibility of an error at coproscopic examination as well as in helminthologic evaluation of the environmental samples (soil, water). Eggs of 7 species of alimentary tract parasites and 52 common garden plants pollens were examined and compared; using of MultiScanBase v.8.08 computer program the perimeter, length and width of the given objects/images were measured and statistical calculations were made in Statistica 9.1 program. The following conclusions can be drawn: 1. The computer image comparative analysis of parasite eggs and plant pollen proved the existence of statistically significant differences between the particular morphometric features; 2. A routine direct microscopic observation of feces is performed with the naked eye which is not able to notice slight differences (up to a few µm in size), and therefore, despite lack of statistically significant differences, it is easy to make an error; 3. During a routine microscopic observation it should be remembered that the structure, shape or exine of many commonly occurring pollen grains are extremely similar to eggs of some parasites; 4. Both in the analysis of feces specimens and the evaluation of environmental samplings characteristic morphological features of eggs should be considered to facilitate differentiation between eggs and pollen grains; 5. Following the precautionary measures to avoid contamination of feces simples with plants pollens, quality control as well as reliability and awareness of risk eliminates danger of obtaining false positive results.