Occurrence of alert pathogens in patients hospitalised in the department of lung diseases.

INTRODUCTION: Infections caused by multiple drug-resistant pathogens represent an increasingly often encountered challenge in clinical practice. The problem particularly applies to patients with chronic lung diseases resulting in multiple hospitalisations. The aim of this paper was to analyse the incidence of alert pathogens isolated from patients hospitalised in the department of lung diseases, who were divided into three groups: patients qualified for lung transplantation, patients treated for neoplastic diseases and patients with chronic lung diseases. MATERIALS AND METHODS: Analysis involved microbiological test results of 3950 samples obtained from 3521 patients divided into: 200 patients being qualified for lung transplantation, 1292 patients treated for neoplastic diseases and 2029 patients with chronic lung diseases. RESULTS: Infection with alert pathogen was found in 155 of 3521 patients (4.4%). Most often isolated infectious agent was P. aeruginosa, which accounted for 27% of infections. Other pathogens were as follows A. baumanii ESBL(-) (13%), S. pneumoniae (12%), E. cloacae ESBL(+) (10%), K. pneumoniae ESBL(+) (10%), S. aureus MRSA (8%), E. faecalis (7%), E. coli ESBL(+) (6%), S. maltophilia ESBL(+) (5%) and E. kobei ESBL(+) (2%). Alert pathogens were found in 31 (15%) of 200 patients being qualified for lung transplantation, 89 (4.4%) of 2029 patients with chronic lung diseases and 35 (2.7%) of 1292 patients treated for neoplastic diseases. Difference between infection frequency in patients being qualified for lung transplantation and the remaining groups was statistically significant (p < 0.01). P. aeruginosa infection was the most frequent in all groups. It constituted 35% in patients being qualified for lung transplantation, 29% in patients treated for neoplastic diseases and 22% in patients with chronic lung diseases. CONCLUSIONS: Infections caused by alert pathogens were found in more than 4% of patients hospitalised in the department of lung diseases between 2007 and 2011. Their frequency was significantly higher in patients being qualified for lung transplantation than in other analysed groups. In all examined groups the most frequently isolated bacteria was P. aeruginosa (27% of all isolates).

[The diagnostic value of virus serology in patients with non-ischemic systolic heart failure and parvovirus B19 infection]. / Wartosc diagnostyczna testów serologicznych u chorych ze skurczowa nie-niedokrwienna niewydolnoscia serca i zakazeniem parwowirusem B19.

INTRODUCTION: We determined retrospective analysis of the diagnostic value of virus serology in patients with non-ischemic systolic heart failure and parvovirus B19 infection. MATERIAL AND METHODS: Virus serology and endomyocardial biopsy were performed in 31 patients with non-ischemic systolic heart failure hospitalized from 2001 to 2006 in our clinic. RESULTS: The serum specimens from 31 patients were tested for IgM and IgG antibody against parvovirus B19. IgM antibodies were identified in 3 patients and IgG antibodies were identified in 23 patients. All of the patients underwent endomyocardial biopsy which revealed chronic active myocarditis in 10 patients (32.4%), chronic persistent myocarditis in 14 patients (45.1%) and no myocarditis in 7 patients (22.5%). CONCLUSIONS: Virus serology has no relevance for the diagnosis of non-ischemic systolic heart failure caused by parvovirus B19 infection. The result of serological tests are positive more frequently than the biopsy specimens results.

Citric acid cough threshold in patients with gastroesophageal reflux disease rises after laparoscopic fundoplication.

BACKGROUND: It has been reported that antireflux surgery can diminish chronic cough due to gastroesophageal reflux disease (GERD) that is resistant to pharmacologic therapy. The aim of this study was the assessment of citric acid cough threshold (CACT) in patients with chronic cough due to GERD before and 3 months after laparoscopic Toupet fundoplication. METHODS: Thirty subjects (20 women and 10 men; median age, 45.3 years) with chronic cough due to GERD and 15 healthy volunteers underwent cough challenge with doubling concentrations of citric acid. Twenty subjects with GERD, a group of 14 women and 6 men (mean age, 45.5 years), underwent the same protocol 3 months after laparoscopic fundoplication. Daytime and nighttime cough score questionnaires (verbal category descriptive score) were completed in all groups. RESULTS: The geometric mean of CACT was significantly lower in GERD patients (9.62 mg/mL) than in healthy volunteers (50.8 mg/mL, p < 0.001). The results of cough score measurement significantly improved within 2 weeks after laparoscopic surgery. In 13 weeks of postoperative follow-up, cough disappeared or was greatly improved in 14 of the 20 patients (70%); in 3 other patients, cough resolved partially. In three patients. there was no improvement in cough. Cough challenge after surgery revealed a significant increase in mean cough threshold, from 8.28 to 19.03 mg/mL (p < 0.05). CONCLUSIONS: The results suggest that GERD influences CACT, which was significantly lower in GERD patients compared to healthy subjects. A significant correlation was found between subjective and objective measurements of cough in GERD patients. We found laparoscopic fundoplication to be objectively beneficial in GERD-induced chronic cough, as it reduced the CACT.

[Microbiological and molecular analysis of mycobacterium tuberculosis complex strains isolated from patients with pulmonary tuberculosis]. / Mikrobiologiczna i molekularna analiza szczepów Mycobacterium tuberculosis complex izolowanych od chorych na gruzlice ukladu oddechowego.

The aim of the study was to perform microbiological and molecular analysis of Mycobacterium tuberculosis complex strains isolated from patients with pulmonary tuberculosis originating from two different regions of Silesia voivodship in 2000 year. One of 135 strains subjected to the study lacked IS6110 insertion sequence. Its belonging to Mycobacterium tuberculosis complex was confirmed by positive test for specific gyrB gene sequence. Strain resistance analysis revealed that in previously diagnosed patients resistance to streptomycin (16,2%) was more frequent than other. In contrast to never treated patients group where the prevalence of resistance to isoniazid was the most frequent (4,5%). In both group of patients resistance to rifampin or ethambutol was not detected. The multidrug resistance strains (4,6%) were detected only in the previously diagnosed group. Combined analysis of microbiological, epidemiological and molecular data are essential for creation of functional registry of patients infected with resistant Mycobacteria, giving the possibility of surveillance of drug resistant tuberculosis in populations.

[Quantitative analysis of sigma genes expression in Mycobacterium tuberculosis cultures exposed to rifampicin and isoniazid]. / Analiza profilu ekspresji genów kodujacych czynniki sigma w hodowlach Mycobacterium tuberculosis eksponowanych na ryfampicyne oraz izoniazyd.

The aim of the study was quantitative analysis of five genes encoding Mycobacterium tuberculosis sigma factors sigA, sigE, sigF, sigH, and sigI as well as the 85B reference gene known as the mycobacterial viability marker, in cultures exposed to rifampicin and isoniazid. The mRN levels were assessed using QRT-PCR technique, in the automated system of real time quantification with the ABI PRISM 7700 Sequence Detector System (TaqMan). The number of each analyzed gene transcript copies was expressed as a number of mRNA per 1 eg of isolated total RNA. In cultures exposed to the tested chemicals the number of 85B mRNA copies declined as compared to the controls (without tested chemicals). There was no detectable expression of sigA and sigI in the control cultures. Both, rifampicin and isoniazid induced expression of sigA and sigI genes. The sigE gene expression increased during exposure to isoniazid and decreased under rifampicin exposure conditions. The sigF mRNA was detected neither in the control culture, nor in cultures exposed to rifampicin or isoniazid. Both tested chemicals caused decrease of sigH expression.

PCR-RFLP analysis of a point mutation in codons 315 and 463 of the katG gene of Mycobacterium tuberculosis isolated from patients in Silesia, Poland.

Resistance to antituberculous agents is an important cause of ineffectiveness of antimicrobial therapy. The resistance of M. tuberculosis to antituberculous agents is a result of mutations in genes participating in those agent's action. The antituberculous drug--isoniazid can be activated by Mycobacterium tuberculosis either through a hydroperoxidase I/II or a superoxide-dependent oxyferrous pathway. The present study analyzed the frequency of the mutations occurring in codons 315 and 463 in katG gene of Mycobacterium tuberculosis strains, isolated from patients with pulmonary tuberculosis from Silesia, Poland. In this study 23 isoniazid-resistant Mycobacterium tuberculosis strains were analyzed. For RFLP analysis, a 620 bp amplified fragment of katG gene was digested with restriction endonuclease MspI. Among 24 isoniazid-resistant strains, isolated from patients between 2000-2001, point mutations were found in 30% of analyzed isoniazid-resistant strains in codons 315 or 463 (7 strains). In contrast, no mutations in codons 315 and/or 463 katG gene were found in 16 strains (70%). Obtained results suggests that point mutations S315T (AGC-->ACC) and R463L in katG gene are infrequent in the analyzed population.

Human cytomegalovirus serological status in patients with interstitial lung diseases.

Recent data, especially from immunocompromised patients, suggest that human cytomegalovirus (HCMV) plays an important role in lung pathology. In this study the serological status of HCMV infection and characteristic of the HCMV infected patients with interstitial lung diseases were determined. The subjects were enrolled prior to immunosuppression therapy introduction.

Lower respiratory tract infections in patients during hospital stay after heart transplantation.

A retrospective analysis was performed on the records of 95 pts who underwent heart transplantation at Dept. Of Cardiac Surgery & Transplantation in 1999 and 2000 y. In 34 pts lower respiratory tract infections were observed. In all cases bacterial factor was detected in sputum or bronchoalveolar lavage. In study population we analysed influence of such factors as age of the patients, the intensity and duration of immunosuppression, pre-existing diseases and timing after transplantation on the incidence of infection. Most often, in 43 pts gram negative stains bacteria was detected. Pseudomonas aeruginosa (15 pts), Acinetobacter baumanii (7 pts) and Enterobacter cloacae (6 pts) were predominant. Gram positive stains bacteria was detected only in two cases (Streptococcus pneumoniae and Staphylococcus aureus). In 1 pt we observed lung tuberculosis and in 2 pts Pneumocystis carinii pneumonia. Older recipient age was the only risk factor leading to occurrence of respiratory tract infections in patients after heart transplantation.

Possibility to treat lung tuberculosis without use of rifampicin in heart transplant recipients--two cases report.

Pulmonary infections remain the leading cause of death in patients after heart transplantation. Lung tuberculosis is more common in transplant recipients than in general population. Two cases of tuberculosis are presented in patients after heart transplantation. Regarding to influence of rifampicin on immunosuppressive therapy, those patients were treated with antimycobacterial drugs except rifampicin. A cure without recurrence can be achieved with a scheme of treatment regimes without rifampicin.

[Broncho-alveolar lavage cells are the most significant reservoir of human cytomegalovirus genome]. / Komórki z popluczyn oskrzelowo-pecherzykowych (BAL) istotnym rezerwuarem genomu ludzkiego wirusa cytomegalii.

The aim of the study is to estimate human cytomegalovirus DNA copy number in different compartments (BAL cells, blood leukocytes, serum) in patients with idiopathic pulmonary fibrosis (IPF). There were 16 patients (mean age 40.87 +/-10.97; 9 males, 7 females) with newly diagnosed and so far not treated IPF included in the study. The diagnosis of IPF was confirmed by typical HRCT findings and/or lung biopsy histopathological examination (result of the biopsy: "usual interstitial pneumonia"). There were also 16 adult volunteers (mean age 36.75 +/- 6.43; 12 males, 4 females) included in the study as a control group. Using the real-time quantitative polymerase chain reaction the HCMV DNA copy number was estimated. The prevalence of HCMV DNA positive subjects in the IPF group (75%) was higher, but did not differ significantly from the control group (69%). The HCMV DNA copy number in 1 million BAL cells was significantly higher comparing to blood leukocytes, both in IPF and control group (log10 = 2.7 vs. 1.2 for IPF and 2.8 vs. 0.9 for control, respectively). Higher mean HCMV DNA copy number was observed in IPF patients comparing to control group (log10 = 3.2 for IPF and 2.0 for control) in 1 mL of blood serum. We concluded that the lungs play an important role in human cytomegalovirus latency and infection reactivation and thus could be a cofactor modulating the course of IPF in humans. The contribution of HCMV infection in IPF patients should be taken into account during immunosuppression therapy planning.

[Two cases of bronchial tuberculosis--diagnostic difficulties]. / Dwa przypadki gruzlicy oskrzeli--trudnosci rozpoznawcze.

We present two cases of bronchial tuberculosis. The first one, man aged 45, showed diffuse necrotic changes in bronchoscopic picture described histologically as coagulative necrosis. AFB were not found in sputum smear but only in the cultures. The second patient--19-year old female presented the features of right lung bronchopneumonia. Bronchoscopic examinations showed diffused necrotic infiltration. Tuberculosis etiology was confirmed by positive results of examined brosage, concomitantly with negative Mantoux reaction.

[Detection of 85B mRNA in Mycobacterium tuberculosis cultures using the quantitative QRT-PCR (TaqMan) method]. / Wykrywanie mRNA genu 85B (fbpB) w hodowlach Mycobacterium tuberculosis technika QRT-PCR.

The paper presents the in-house method of quantitative analysis of 85 B mRNA in Mycobacterium tuberculosis cultures coming from seeded biological material taken from tuberculosis patients. After the proper culture time, the total RNA was isolated. Than, a one-step QRT-PCR was performed. High specificity and sensitivity of the method was confirmed e.g. by participation in the Mycobacterium tuberculosis QC Proficiency Panel Programme (European Quality Control for Molecular Diagnostics, Glasgow, Scotland, UK).

Synthesis and tumoricidal activity evaluation of new morin and quercetin sulfonic derivatives.

Flavonoids are a group of naturally occurring compounds with interesting medical properties, such as antiinflammatory, antiallergic, antiviral, antibacterial and antitumor activities. In our experiments we were trying to examine the tumoricidal activity of newly synthesized derivatives of two flavonoids: 3,5,7,2',4'-pentahydroxyflavone (morin) and 3,5,7,3',4'-pentahydroxyflavone (quercetin). These derivatives were: natrium salt of morin-5'-sulfonic acid (NaMSA), natrium salt of quercetin-5'-sulfonic acid (NaQSA), complex of Mg2+ with quercetin-5'-sulfonic acid (QSA), complex of iron(II) with QSA. The antitumor activity of these agents was tested in vitro on two cell lines: L1210--murine lymphocytic leukaemia and P-815--murine mastocytoma. Our experiments showed that sulfonic derivatives of these two flavonoids were less potent than the original agents in their cytostatic and cytotoxic activities. However, their solubility in water was greater than that of the original agents and higher culture medium concentration of these derivatives was obtained. The results indicate that the ability of flavonoids to act tumoricidally is reciprocally correlated with their lipophilicity.

[VEGF (vascular endothelial growth factor) concentration in serum and pleural fluid of patients with pleural malignancy and pleural tuberculosis]. / Stezgnie VEGF (Vascular Endothelial Growth Factor) w surowicy oraz w plynach oplucnowych u chorych z nowotworowa lub gruzlicza patologia oplucnej.

The purpose of this study was comparison of VEGF (vascular endothelial growth factor) levels in serum and pleural fluid and estimation of this test usefulness in diagnosis of pleural effusions. VEGF levels were measured by ELISA method in 68 patients (45 males and 23 females) aged 19-81 years. By Light's criteria in 16 cases transudate and in 52 cases exudate was recognized. By means of fluid cytology, pleural biopsy, microbiology or thoracoscopy in 10 cases pleural metastases from distant organs, in 15 cases coexisting pulmonary neoplasm, in 11 cases mesothelioma and in 16 cases tuberculosis were determined as a cause of fluid accumulation in pleural space. The mean VEGF levels were significantly higher (p < 0.001) in patients with exudates than in patients with transudates (3833 pg/ml and 325 pg/ml respectively). Based on likelihood ratios analysis, as a cut off value in differentiation of exudates and transudates a value 700 pg/ml was accepted. The sensitivity of this test was 75% and the specificity 93% and likelihood ratio (LR) 12.5. The mean VEGF level in exudates was seven times higher than mean VEGF level in serum (3833 pg/ml and 573 pg/ml respectively). Mean VEGF levels in malignant exudates (4615 pg/ml) were significantly higher than in tuberculous exudates (2073 pg/ml). As a cut off value in differentiation between malignant and tuberculous exudates a value of 4500 pg/ml was accepted. We conclude that our results suggests the local VEGF production in pleural cavity and the significant role of this cytokine in pleural exudates accumulations and also suggests the usefulness of VEGF estimation in pleural fluid in differentiation transudates from exudates and malignant from tuberculous pleural fluids.

[Chronic obstructive pulmonary disease in inhabitants of Zabrze]. / Przewlekla obturacyjna choroba pluc u mieszkanców miasta Zabrza.

In 2001 a modified MRC questionnaire and spirometry were performed in the inhabitants of Zabrze (Poland). Two hundred and thirty-nine men and 320 women aged 19-69 years were studied. Forty percent of men and 23% of women were smokers. In men but not in women a decline in smoking habit was observed as compared with previous studies in Zabrze carried out in the eighties. More men (32%) than women (19%) gave up smoking. The prevalence of chronic productive cough was closely related to smoking habit. Dyspnea and wheezing were also related to smoking but less strongly than productive cough. The prevalence of COPD (diagnosed according to GOLD criteria) was 10.2%. COPD was more common in smokers than in non-smokers, especially among men (19% and 2% respectively). Persistent productive cough, wheezing and advanced dyspnoea as well as intensive smoking (more than 40 pack years) were strongly connected with the prevalence of COPD. COPD was previously diagnosed in more than 50% of subjects identified as having COPD in this study. Almost 80% of subjects with COPD were not given any treatment in the past year.