Chronic intestinal schistosomiasis caused by co-infection with Schistosoma intercalatum and Schistosoma mansoni.

The Grand Round concerns a 24-year-old man from Zimbabwe who was studying and living in Poland. The patient had been complaining of abdominal pain, fatigue, alternating diarrhoea and constipation, and presence of blood in his stool for 3 years. The patient had the following diagnostic tests: colonoscopy, CT scan, histopathology, and parasitological and molecular tests. Results of the examinations showed that the cause of the patient's complaints was chronic intestinal schistosomiasis due to the co-infection with Schistosoma intercalatum and Schistosoma mansoni. The patient had two cycles of praziquantel therapy (Biltricide) and responded well to the treatment. In the Grand Round, we describe full diagnostics as well as clinical and therapeutic management in the patient with S intercalatum and S mansoni co-infection. This case allows us to draw attention to cases of forgotten chronic tropical diseases (including rare ones) in patients from regions with a high endemic index staying in non-endemic regions of the world for a long time. Co-infection with S intercalatum and S mansoni should be considered as a very rare clinical case.

Analysis of the concentration of selected serological parameters in patients undergoing antibiotic treatment of Lyme disease and assessment of their potential application in the control of the therapy effectiveness - pilot study.

OBJECTIVE: The aim of the study was to analyze the concentrations of some serological parameters in patients undergoing antibiotic therapy for LD, and to assess the potential use of IgG anti-C6VlsE in the assessment of treatment effectiveness. MATERIAL AND METHODS: The study involved 21 patients diagnosed with LD. To determine the levels of anti-C6VlsE IgG, metalloproteinases and cytokines, blood was collected three times: before treatment, immediately after treatment, and 3-4 months after treatment. RESULTS: Immediately after the antibiotic therapy, all the patients in the study group declared improvement in their health. At 3-4 months post-treatment, 50% of patients reported recurrence of the disease symptoms. The anti-C6VlsE IgG concentrations at the analyzed time points exhibited varied dynamics: in 15% of patients, a decrease in the concentration of anti-C6VlsE was observed in the three consecutive serum samples; an increase of anti-C6VlsE IgG was detected in 35% of cases; in 15% of the subjects, the concentration of anti-C6VlsE IgG increased immediately after the antibiotic therapy and declined after 3-4 months, whereas a reverse situation was noted in 10% of the patients. CONCLUSIONS: The presence of high concentrations of anti-C6VlsE IgG is associated with appearance of response to Borreliella spp. infection, which suggests that the parameter can be used in the diagnosis of the active form of borreliosis. However, from a practical point of view, a marker of successful elimination of infection should indicate the effectiveness or failure of antibiotic therapy within a relatively short post-treatment period. The anti-C6VlsE IgG antibodies do not seem to satisfy this provision.

Analysis of selected serological parameters in patients with diagnosed Lyme borreliosis and in seropositive patients with no clinical symptoms.

OBJECTIVES: The aim of the study was to analyze some metalloproteinases, cytokines, and chemokines in LB patients and healthy seropositive subjects. The presence of IgM/IgG antibodies against specific Borreliella antigens was analyzed in the presence or absence of clinical manifestations of LB. MATERIAL AND METHODS: The study involved 38 patients diagnosed with LB and arthralgia and/or arthritis symptoms, and 57 foresters presenting no clinical symptoms of LB. The ELISA test was applied for general screening of anti-Borreliella IgM/IgG. Western blot was used for confirmatory diagnosis of LB for the positive and borderline results. Serum IL-2, IL-4, IL-6, IL-10, IL-17A, IFN-γ, TNF, IL-8, CCL5, CXCL9/MIG, CCL2/MCP-1, CXCL10/IP-10 concentrations were measured with the use of the Human Cytometric CBA test. The concentration of MMP-2 and MMP-9 in the serum was determined with the use of ELISA tests. RESULTS: Analysis of the cytokines and chemokines revealed that only the concentration of IL-2 was significantly higher (2.4 pg/m; p=0.00641) in patients with LB symptoms than in the seropositive individuals (0.4 pg/ml). The MMP2 concentration was significantly higher (233.3 ng/ml; p=0.00294) in patients with clinical manifestations of LB than in those occupationally exposed to tick bites, but did not have anti-Borreliella antibodies (192.0 ng/ml). CONCLUSIONS: The presence of IgG antibodies against a number of Borreliella antigens and the differences in the IL-2 and MMP2 levels in seropositive or seronegative individuals and symptomatic LB patients, may indicate differences in the intensity of the immune response to the infection and, consequently, may induce development of clinical manifestations of the disease in seropositive and seronegative individuals.

Borrelia burgdorferi sensu lato as activators of the complement system in in vitro model.

INTRODUCTION: The following parameters were analyzed: C5a, which is significant in classical and alternative pathways of the complement system activation, and factor H, the major function of which is to regulate the alternative pathway. Factor H, in the case of Borrelia infection, is combined by CRASPs proteins of spirochetes, and thus prevents C3b molecules from contact with the pathogen, opsonisation and lysis of bacteria. MATERIAL AND METHODS: The experimental material in the model for the presented work consisted of whole blood of healthy persons (without the presence of antibodies anti-Borrelia) and persons with clinical symptoms of Lyme disease, which was stimulated with three genospecies of spirochetes recognized as pathogenic in Poland and Europe: B. afzelii, B. burgdorferi s.s. and B. garinii. RESULTS: The increase in the level of C5a in the experimental model after in vitro stimulation of whole blood with three genospecies Borrelia can be treated as an indicator of an effective activation of the complement's cascade. The increase in level C5a in the plasma relies on the genospecies and the strongest is for B. garinii. The decrease in the level of factor H, observed after the incubation of whole blood with three genospecies Borrelia, shows that this parameter was included in the spirochetes' mechanisms acting against factors of the innate immunity system of a host, which prevents lysis of bacteria via the alternative pathway. CONCLUSIONS: The results obtained on the basis of the in vitro model can be analysed from the aspect of spirochetes' real contact with a host's organism during the bite of infected ticks. Despite blocking of the alternative pathway, Borrelia initiate the activation cascade regardless of antibodies via the first contact of a host's organism with spirochetes, or in accordance with antibodies during the infection or subsequent contact with bacteria.

Post-exposure anti-rabies prophylaxis in Lublin province (Eastern Poland) in 2004-2005.

Rabies is considered a disease of the highest mortality rate and all humans are vulnerable to infection. Specific anti-rabies immunoprophylaxis is the only efficient method of protection. The analysis of indications for active alone and active and passive immunization among patients reported to the dispensary of rabies prophylaxis in the Department of Infectious Diseases of Medical University of Lublin (eastern Poland) in 2004-2005 is presented. Prophylactic procedures were applied in 120 persons (14.98 % of overall number consulted). Passive immunization, i.e. rabies immune globulin, was administered in 1 person (0.12 %). In 2004, 64 persons (7.99 %) received active vaccination, and 56 patients (6.99 %) were vaccinated in 2005. Most of vaccinated patients lived in an urban area where the risk of rabies should be lower; however, in cities like Lublin there is a higher risk of being bitten by homeless animals. The most common species with rabies suspicion were dogs and cats. The decrease in the number of patients bitten by animals with confirmed rabies in Lublin province, and of the number of cases of animal rabies may indicate that oral vaccination of red foxes, representing a main reservoir of rabies virus in Poland, has been shown to be effective.

[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.

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.

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.

[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.

Candidosis of the pharyngeal mucosa in patients with infectious mononucleosis.

The aim of our study was to assess the frequency rate of Candida yeast-like fungi in isolations from nasal and pharyngeal mucosa in patients diagnosed with IM who had undergone an antibiotic therapy. The study was performed in 51 patients aged 17-33. The diagnosis of IM was made on the basis of clinical symptoms, haematological, biochemical and serologic examination results. The material constituted of nasal and pharyngeal swabs. The identification of Candida species was done according to the routine microbiological diagnostics. Our results show that among the Candida genus, C. albicans was the only pathogenic species isolated from patients with IM. It was observed only in pharyngeal swabs in 27.4% of the patients.

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.

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.

Dehydroepiandrosterone sulphate and androstenedione concentration in the serum of male patients with chronic hepatitis C.

In this study the dynamics of DHEAS and androstenedione serum concentration in male patients with CHC infection were analyzed. The study group consisted of 52 men, 26 of them being the control group of healthy men. The DHEAS and androstenedione serum concentration was determined twice with radioimmunological method (RIA). 1. Mean values of suprarenal androgens serum concentration in male patients with CHC infection were lower than in healthy men and the observed differences were incidental, 2. There was no correlation between dehydroepiandrosterone and androstenedione serum concentration in male patients with CHC infection.

[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.

[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.

[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.

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.

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.