Liver injury in the course of malaria.

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

Diagnosing and treatment of skin filariases based on own observations.

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

[Lung manifestation of visceral larva migration syndrome due to Toxocara canis infection]. / Plucna postac zespolu wedrujacej larwy trzewnej wywolana przez Toxocara canis.

32 year-old patient was hospitalized because of disseminated lung lesions. 2 years earlier he manifested chorioditis. Exact disease history suggested suspicion of toxocare infection. The diagnosis was confirmed by serological tests with anti-Toxocara canis antibodies, bronchial lavage and chest CT scan. Administration of 450 mg of dietylokarbamasin (Hetrazan) resulted in complete resolution of pulmonary lesions.

Malaria as an Occupational Disease in Polish Citizens.

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

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

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

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

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

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

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

Malaria as an occupational disease.

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

Studies on the risk of ischaemic heart disease in fishermen, seafarers and dockers.

To assess the risk of ischaemic heart disease, the following examinations were conducted in 350 seafarers, 480 deep-sea fishermen and 500 dockers: physical examination, chest X-ray, standard 12-lead electrocardiogram, exercise stress test, echocardiography, laboratory tests. A complete medical history aimed at detection the coronary risk factors was collected from each man. The mean age of persons examined was as follows: 47.6 years - fishermen, 44.8 - seamen, and 42.9 - dockers. It was estimated that the main risk factors found both in fishermen and seamen were cigarette smoking, hypercholesterolemia and overweight. The incidence rates of high serum cholesterol level and overweight in the above occupational groups were higher as compared with the prevalence of these factors in the general male population in Poland. The study data argue for the need for adequate dietary change, habit modification and promotion of recreational physical activities among seafarers.