Analysis of Clinical Course and Vaccination Influence on Serological Response in COVID-19 Convalescents.

Our goal was to assess the anti-SARS-CoV-2 antibodies presence in COVID-19 convalescents and assess the differences in anti-SARS-CoV-2 antibodies production regarding the disease severity, sex, vaccination, and assess the correlation between anti-SARS-CoV-2 antibodies production and inflammatory parameters. Three hundred twenty-two COVID-19 patients (282 hospitalized and 40 patients with oligosymptomatic COVID-19 isolated at homes) were included in the study. Blood was taken at 4 time points: during hospitalization, 1 month, 3 months, and 6 months. Detection of SARS-CoV-2 antibodies was performed with LIAISON SARS-CoV-2 S1/S2 IgG tests (DiaSorin, Italy). Clinical and laboratory parameters were compared. Significant differences between higher anti-SARS-CoV-2 antibodies titer in symptomatic patients 3 months after infection (III sample) and significantly higher ratio II/I in symptomatic patients were observed. Subgroup analysis based on sex showed differences only in laboratory tests, not in serological. Analysis of the results of serological tests showed significant differences in ratio IV/I and a significant increase in antibodies level after vaccination. The most significant rise was observed between the 3rd and 6th month when the patients received a vaccination. Immunological response after COVID-19 infection lasted over 6 months in all patients, although antibodies titers were significantly higher in patients with a history of severe COVID-19 and vaccinated patients. Immunological response after COVID-19 infection did not depend on sex. There was a significant correlation between anti-SARS-CoV-2 antibodies production and the degree of inflammation in the acute phase of the disease (inflammatory parameters in blood and severity of lung affection in CT). IMPORTANCE The results of our study confirm the knowledge on immune response in the Polish population and add new information regarding correlations with the severity of the disease. The data in the literature concerning the correlation between antibodies response and sex are ambiguous, and we did not observe differences between antibodies production and gender, which also adds new information.

Assessment of the YKL-40 concentration in patients with tick-borne encephalitis.

Tick-borne encephalitis (TBE) is a viral infection of the central nervous system (CNS) caused by tick-borne encephalitis virus (TBEV). It might take several clinical courses such as: meningitis, meningoencephalitis or meningoencephalomyelitis. The aim this study was to compare the YKL-40 concentration in cerebrospinal fluid (CSF) of patients with different clinical presentations of TBE and patients with excluded meningitis (control group). The concentration of YKL-40 in CSF was determined using Fujirebio tests (Ghent, Belgium) in 32 patients with TBE: Group I-patients with meningoencephalitis (n = 16); Group II-patients with meningitis (n = 16). The control group (CG) consisted of 17 patients in whom any inflammatory process in central nervous system was excluded. The concentration of YKL-40 was significantly higher in encephalitis group than in the CG after 7 days from the last dose of treatment. The concentration in patients with neuroinflammation had a significantly different concentration of YKL-40 compared to patients from the neuroinflammation control group. The ROC curve analysis indicates that CSF YKL-40 concentration at cut-off 783.87 differentiated TBE patients from CG with 100% specificity and 70% sensitivity and CSF YKL-40 concentration at cut-off 980.11 differentiated meningitis from meningoencephalitis with 87.5% specificity and 62.5% sensitivity. YKL-40 takes part in TBE pathogenesis, its concentration is the highest at the early stage of CNS involvement and decreases in the convalescent period. As YKL-40 was significantly higher in the meningitis than in the meningoencephalitis group, it might be used as biomarker in differentiation of these clinical forms of TBE.

A 63-Year-Old Woman with SARS-CoV-2 Infection, Who Developed Severe COVID-19 Pneumonia and Was Supported with Convalescent Plasma Therapy.

BACKGROUND There is no evidence-based treatment for coronavirus disease 2019 (COVID-19). We report the case of a 63-year-old woman with SARS-CoV-2 infection who developed severe COVID-19 pneumonia and was treated with convalescent plasma. CASE REPORT A 63-year-old woman who presented with severe and prolonged course of COVID-19 disease (fever up to 39.4°C, persistent cough, and dyspnea) received a convalescent plasma transfusion, which led to complete recovery. The diagnosis was confirmed by RT-PCR testing using the CFX96 Real-Time System (Bio-Rad, USA) from nasopharyngeal swabs. In laboratory tests, an increase in acute-phase parameters was observed. Chest computed tomography (CT) showed abnormalities typical for COVID-19. On days 9 and 11 of the disease, she received the convalescent plasma prepared from a single plasmapheresis donation from a male donor. This male donor was qualified as a convalescent plasma donor according to Polish guidelines, which are compliant with European guidelines. He donated plasma at the Regional Centre for Transfusion Medicine in Bialystok, Poland. The therapy with convalescent plasma led to clinical improvement and normalization of inflammatory parameters. CONCLUSIONS This report presents a case of severe COVID-19 pneumonia in a 63-year-old woman who was given supportive treatment with convalescent plasma. Ongoing clinical trials will determine whether convalescent plasma therapy is an effective treatment for SARS-CoV-2 infection.

Coxiella burnetii and Q fever - a review.

Q fever is an emerging infectious disease in Europe. Q fever is a zoonosis and infected animals are the main source of infection. Ticks may act as a vector and transmit the pathogen to animals and humans. Q fever has non-specific symptoms and is difficult to diagnose. Results of serological tests are positive many days after manifestation of symptoms. PCR method might be useful in the diagnostic process.

Assessment of Coxiella burnetii presence after tick bite in north-eastern Poland.

PURPOSE: The aim of the study is to assess anti-Coxiella burnetii antibodies presence in inhabitants of north-eastern Poland, to assess the risk of Q fever after tick bite and to assess the percentage of co-infection with other pathogens. METHODS: The serological study included 164 foresters and farmers with a history of tick bite. The molecular study included 540 patients, hospitalized because of various symptoms after tick bite. The control group consisted of 20 honorary blood donors. Anti-Coxiella burnetii antibodies titers were determined by Coxiella burnetii (Q fever) Phase 1 IgG ELISA (DRG International Inc. USA). PCR was performed to detect DNA of C. burnetii, Borrelia burgdorferi and Anaplasma phagocytophilum. RESULTS: Anti-C. burnetii IgG was detected in six foresters (7.3%). All foresters with the anti-C. burnetii IgG presence were positive toward anti-B. burgdorferi IgG and anti-TBE (tick-borne encephalitis). Anti-C. burnetii IgG was detected in five farmers (6%). Four farmers with anti-C. burnetii IgG presence were positive toward anti-B. burgdorferi IgG and two with anti-TBE. Among them one was co-infected with B. burgdorferi and TBEV. Correlations between anti-C. burnetii IgG and anti-B. burgdorferi IgG presence and between anti-C. burnetii IgG presence and symptoms of Lyme disease were observed. C. burnetii DNA was not detected in any of the 540 (0%) patients. CONCLUSIONS: C. burnetii is rarely transmitted by ticks, but we proved that it is present in the environment, so it may be a danger to humans. The most common co-occurrence after tick bite concerns C. burnetii and B. burgdorferi.

Pathogens carried by Ixodes ricinus and Dermacentor reticulatus ticks including coinfections.

Ticks and tick-borne pathogens are becoming an emerging threat to the health of both humans and animals. The number of cases of tick-borne diseases, especially Lyme disease, is constantly growing. Over the last several years, coinfections, which could be explained as presence of two of more pathogens in one organism are being observed with growing interest. Their occurrence may lead to severe or unusual symptoms, prolonged disease duration, diagnostic and therapeutic difficulties. Research on this subject concerns mainly ticks of the species Ixodes ricinus, however, literature data suggest that also the species Dermacentor reticulatus plays an important role as a vector of tick-borne pathogens.

Prevalence of Spotted Fever Group Rickettsia in North-Eastern Poland.

Purpose: The north-eastern Poland is an endemic region of tick-borne diseases. The aim of the study is to assess the prevalence of anti-Rickettsia antibodies in the inhabitants of the north-eastern Poland and to assess the risk of acute infection (rickettsiosis) after a tick bite. Other aim was to assess the risk of co-infection with other pathogens after a tick bite. Methods: Two types of examinations were performed: serological and molecular. Serological analysis was performed in 82 foresters and 82 farmers with a history of tick bite. The molecular study was performed in 540 patients with various symptoms after a tick bite. The control group consisted of 20 honorary blood donors with no tick bites in anamnesis. Anti-Rickettsia spp. antibodies titres were determined by ELISA: Rickettsia SFG IgG ELISA (DRG International Inc. USA). PCR tests were performed towards Rickettsia spp. Borrelia burgdorferi, Anaplasma phagocytophilum.Results: In 64 (39.02%) farmers and foresters, anti-Rickettsia IgG antibodies were detected. The presence of anti-Rickettsia IgG antibodies was confirmed in 42 foresters (51.22%) and in 22 farmers (26.83%). In control group, results of all tests were negative. Rickettsia spp. DNA has not been confirmed in any out of 540 (0%) symptomatic patients. Conclusions: Seroprevalence of Rickettsia spp. infection in north-eastern Poland is high, especially in people often bitten by ticks, which makes this pathogen potentially dangerous for humans. Prevalence of anti-Rickettsia IgG antibodies in foresters is higher than in farmers. Symptomatic infection with Rickettsia spp. in humans in north-eastern Poland is uncommon.

Assessment of the tau protein concentration in patients with tick-borne encephalitis.

There have been suggestions that tick-borne encephalitis (TBE) may cause neurodenenerative changes in the brain. The aim of this study was the assessment of the tau protein concentration in cerebrospinal fluid (CSF) of patients with different clinical forms of TBE. The concentration of tau protein in CSF was determined using Fujirebio tests (Ghent, Belgium) in 35 patients with TBE: group I-patients with meningitis (n = 16); group II-patients with meningoencephalitis (n = 19). None of the patients reported any neurodegenerative disorder that could affect the results of the study. The control group (CG) consisted of 10 patients in whom inflammatory process in central nervous system was excluded. Tau protein concentration in CSF before treatment did not differ significantly between the examined groups, while its concentration was significantly higher in encephalitis group than in CG after 14 days of treatment. Significant increase in tau protein concentration after treatment was observed in both examined groups. The comparison between the group of patients who fully recovered and patients who presented with persistent symptoms on discharge showed significant differences in tau protein concentration before and after treatment. ROC curve analysis indicates that CSF tau protein concentration before treatment may predict complicated course of the disease with 90.9% specificity and 80% sensitivity, while after treatment, specificity became 72.7% and 71.4% for sensitivity. Correlation analysis showed that in TBE patients (both meningoencephalitis and meningitis groups), CSF pleocytosis before treatment correlated negatively with tau protein concentration in CSF. (1) Neurodegeneration process is present in TBE encephalitis. (2) Tau protein concentration may be used as a predictor of complicated course of TBE.

Tick-borne rickettsioses in Europe ­ a review

Tick-borne rickettsioses are emerging diseases in Europe. The Mediterranean region is endemic for rickettsioses, but the disease can also occur in other European countries. Ticks can be a vector of these bacteria. Spotted fevers caused by rickettsiae have nonspecific symptoms and are difficult to diagnose. The results of serological tests are positive many days after the onset of symptoms. PCR method can be useful in the diagnostic process. In the article we discuss the problem of rickettsia in Europe.

Evaluation of NSE and S100B in patients with tick-borne encephalitis.

INTRODUCTION: The aim of this study was the assessment of neuron-specific enolase (NSE) and S-100 concentration in serum and cerebrospinal fluid (CSF) in patients with different clinical forms of tick-borne encephalitis (TBE). MATERIAL AND METHODS: The serum and CFS concentrations of S100B and NSE of 43 patients with TBE were measured with ELISA method using commercial kits: NSE and S100B Elisa Kit (DRG, Germany). Subjects were divided into: Group I-patients with meningoencephalitis (n = 17) and Group II-patients with meningitis (n = 26). None of the patients reported any neurodegenerative disorder that could affect the results of the study. The control group (CG) consisted of 13 patients. These patients were admitted to the hospital because of headache, and the CSF examination excluded inflammatory process. Samples were collected on admission (sample 1) and after treatment (sample 2). RESULTS: Neuron-specific enolase concentration in CSF was higher in group I than in group II (p = 0.0002) and controls (p = 0.04). NSE concentration was higher in the second serum and CSF sample in both groups. S100B concentration did not differ between TBE patients and controls. NSE concentration in serum after 14 days was higher in the sequelae group (34.3 ± 9.7 vs. 16.7 ± 15, p = 0.04). Also, NSE serum sample 2/serum sample 1 ratio was significantly higher in the sequelae group (3.57 ± 0.92 vs. 1.53 ± 1.99, p = 0.04). Receiver Operating Characteristic curve analysis indicated that NSE concentration in serum II differentiates sequelae group from other meningoencephalitis patients (p = 0.0001). S100B serum sample 2/CSF sample 2 ratio was lower in the sequelae group (0.05 ± 0.1 vs. 0.37 ± 0.28, p = 0.02). CONCLUSIONS: (a) Neurodegeneration process is present in TBE encephalitis. (b) NSE concentration correlates with inflammatory parameters in CSF in TBE. (c) Neurodegeneration is present even after clinical recovery of TBE. (d) NSE could be used in the prediction of TBE course. (e) S-100 did not differ between TBE patients and controls.

Effect of a single dose of mannitol on hydration status and electrolyte concentrations in patients with tick-borne encephalitis.

OBJECTIVE: This study was performed to assess the effect of a single dose of 15% mannitol on the hydration status and electrolyte balance in patients with tick-borne encephalitis (TBE). METHODS: Forty-one patients with TBE were treated with 0.25 g/kg of 15% mannitol. The electrolyte concentrations (Na, K, and Cl), creatinine concentration, and hydration status were measured before and after mannitol infusion. RESULTS: After mannitol administration, 7 patients had hyponatremia, 3 had hypokalemia, 1 had hyperkalemia, and 17 had hypochloremia. The total body water volume (TBW) changed by 0.44% ± 0.55%, the external body water volume (EBW) changed by 0.12% ± 0.15%, and the internal body water volume (IBW) changed by 0.19% ± 0.40%. The mean ECW/ICW ratio was 0.7694 ± 0.07 before treatment and 0.7699 ± 0.07 after treatment. Age was correlated with the TBW change in men (R = 0.42, p < 0.05) and with the potassium change in women (R = 0.66, p < 0.05). CONCLUSIONS: Patients with TBE should receive mannitol two to four times daily depending on the clinical manifestation. Administration of a single dose of mannitol (0.25 g/kg) requires at least 300 mL of fluid supplementation. Bioimpedance might be useful for individual evaluation of dehydration. Additionally, patients require monitoring for potential hyponatremia. Older men may be more prone to dehydration after receiving mannitol.

Tick paralysis

Tick paralysis is caused by neurotoxins secreted by adult female ticks, primarily in North America and on the east coast of Australia. Sporadic illness is also recorded in Europe and Africa. In the European countries, including Poland, there are 6 species of ticks capable of causing tick paralysis. The disease occurs in people of all ages, but is most commonly diagnosed in children under 8 years of age. Paralysis can take different forms - from rare isolated cranial nerve infections to quadriplegia and respiratory muscles paralysis. After the tick remove, the symptoms resolve spontaneously. In severe cases with paralysis of respiratory muscles, when there is no possibility of mechanical ventilation, the disease may lead to death.