[Tuberculosis and mycobacteriosis important opportunistic disease in AIDS patients]. / Gruzlica i mykobakteriozy, wazne choroby oportunistyczne u chorych na AIDS.

OBJECTIVE: The aim of the search was investigation of tuberculosis in AIDS patients. Each year 8-9 mln people fall ill of tuberculosis and one third of them die. To the infection of tuberculosis and fast development into active state are especially exposed people with AIDS. MATERIAL AND METHODS: 696 people were examined on tuberculosis most of which were AIDS patients hospitalized and cured in Hospital of Infection Diseases and Prison Hospital. 159 patients were women and 537 were men. The average age was between 25 and 45 (70%). The investigated population was characterized according to age, social and living conditions, using drugs and former contact with tuberculosis. All patients suspected of tuberculosis had chest X-rayed, sputum, BAL and pleural liquor were taken to bacteriological examination when extrapulmonary tuberculosis was suspected. The material was taken adequately to the disease process: CSF, urine, lymph nodes, peritoneal fluids, blood, stool, swabs and other. Bacteriological investigations have been carried out by fast cultivating method since 1998 and rapid genetic method since 1999. Apart from modern, fast diagnostic methods, routine bacteriological procedures were applied in tuberculosis diagnosis. RESULTS: More than 30% of the examined population were from bad social-living conditions, 78% had risk factors, 65% were drug users. The analysis of the tuberculosis illness from 1997 to July 2001 shows growing tendency. Nowadays it is 20% cases proved by bacteriological diagnosis. The structure of falling ill with tuberculosis has changed. Considerable increase of extrapulmonary tuberculosis was observed, 20 patients died due to tuberculosis and 8 patients due to mycobacteriosis. Resistance of M.tub.complex occurred within the range of 10% cases.

[Pneumocystis carinii infections in patients with neoplasms and AIDS--clinical-pathologic changes in the lungs]. / Zakazenia pneumocystis carinii u chorych na nowotwory i AIDS--obraz kliniczno-patologiczny zmian w plucach.

Pneumocystis carinii (PC) has been documented as a cause of pneumonia in a broad range of immunocompromised patients. The presentation of disease will very based on the underlying predisposing condition but a confirmation depends upon the identification of organisms in a bronchial aspiration or lung biopsy specimen. This retrospective study based on autopsies of 15 patients (pts) with AIDS and 12 non AIDS pts with neoplastic diseases. Pneumocystis carinii pneumonia (PCP) was confirmed by histologic examination. The clinico-pathological analysis emphasizes a spectrum of morphologic variation of the disease in relation to the clinical course of a principal disease. A distinction was made between the microscopical diagnosis of PC infection in AIDS and non AIDS pts; the burden of organisms in infected AIDS pts appeared greater than that of neoplastic diseases (mostly with small cell lung carcinoma). Nonspecific features of diffuse alveolar damage associated with PC organisms were identified in 67% of non AIDS pts and 13% of AIDS pts. Various degree of interstitial fibrosis was more prominent in AIDS pts (67%) than in non AIDS pts. The high frequency of atypical changes in lung might be the result of various chemotherapeutic agents used in managing these pts or repeated pulmonary infections.

[Humoral response to HBV antigens in acute and chronic hepatitis B]. / Odpowiedz humoralna na antygeny HBV w ostrym i przewleklym wir usowym zapaleniu watroby typu B.

Sera of patients with acute and chronic hepatitis B and antigenemia were tested for the presence of anti-HBe and anti-HBs antibodies, free or bound in immune complexes. The possible occurrence of immune complexes of HBcAg in these sera was also investigated. Immune complexes were identified by antigen specific enzyme immunoassay, in which polyclonal antibodies against synthetic fragments of proteins S and C of HBV and mono- and polyclonal anti-HBc antibodies were used as a solid phase. Free and/or antigen bound anti-HBe antibodies were detected in 100% of patients with acute (81% HBeAg positive) and in 37% of patients with chronic hepatitis, all HBeAg positive. Anti-HBs antibodies or their immune complexes were found in 83% and 37% of patients, respectively. In not any patient circulating complexes of HBcAg could be identified. The results obtained support the observations that humoral immune response to HBeAg and HBsAg can be detected earlier than generally accepted; they also suggest that the detection of anti-HBs in a single sample of serum should not be considered as the evidence of elimination of infection.

[Antibody avidity in diagnosis of toxoplasmosis]. / Oznaczanie widnosci przeciwcial w diagnostyce toksoplazmozy.

The sequential changes in avidity of antibodies to Toxoplasmosis gondii were investigated. The values of avidity were observed to be significantly lower in serum samples drawn in early stages of infection than 3-4 months later and increasing with time of duration of the infection. A correlation was found between antibody avidity and antibody level measured in international units (IU/l), whereas, no correlation was observed between avidity, IU/l and antibody titers.

[Initial evaluation of the diagnostic usefulness of tuberculin tests among the patients of the Center of Diagnosis and Treatment of AIDS]. / Wstepna ocena przydatnosci diagnostycznej próby tuberkulinowej w populacji pacjentów Centrum Diagnostyki i Terapii AIDS.

Tuberculin and Candida skin tests were done on 98 HIV(+) and 42 control HIV(-) patients of AIDS Diagnosis and Therapy Center in Warsaw. Prevalence of the positive Tuberculin tests in the control group was 29% and it was not significantly different from those groups of patients HIV(+) whose CD4 cell count was higher than 350. For those with CD4 cell count 350 or below, tests were positive only in two cases both of the patients with active tuberculosis. The prevalence of positive Candida tests was in the control group only 12% and such result did not differ significantly from any other group of HIV positive patients with different CD4 cell counts. It is concluded that routine Tuberculin skin tests might be of value due to low initial prevalence among patients of the AIDS Center and that those persons who undergo conversion into positive tests will be under high suspicion of TB asymptomatic infection. Low prevalence and rather random distribution of positive Candida skin tests shows their insufficiency as single reference tests in anergy panel.

[Initial assessment of the use of polymerase chain reaction (PCR) in diagnosis of tuberculosis among patients of the Center for Diagnosis and Treatment of AIDS]. / Wstepne badania zastosowania techniki reakcji lancuchowej polimerazy (PCR) w diagnostyce gruzlicy w populacji pacjentów Centrum Diagnostyki i Terapii AIDS.

This initial report on the use of PCR in diagnosis of TB was based on a group of 180 patients observed in the AIDS Diagnosis and Therapy Center in Warsaw. Out of 6 patients with positive results of PCR assay for MTB, five had positive AFB smears in induced sputum or BAL, two had positive MTB cultures. Five of them were treated with tuberculostatic drugs with clinical improvement and had negative sputum PCR MTB results after several weeks. Additional 11 patients with AFB positive sputum or BAL smears and negative PCR MTB were observed. None of them developed pulmonary tuberculosis, and none of them was confirmed by culture as MTB infection. The results presented in this paper confirm high specificity and sensitivity of polymerase chain reaction (PCR) as an fast diagnostic test very useful in the clinical settings of AIDS. With the increase of collected material further evaluation will be continued.