Adverse Reactions in Antifolate-Treated Toxoplasmic Retinochoroiditis.

This study seeks to define factors affecting the development of adverse reactions to intensive therapy of toxoplasmic retinochoroiditis with antifolate agents (pyrimethamine/sulfadoxine) and antibiotics followed by secondary antifolate prophylaxis. The study was of retrospective and observational nature. Medical files were reviewed of 551 patients suffering from ocular toxoplasmosis during 1994-2013. All patients were treated with the same protocol: 3-week intensive pyrimethamine/sulfadoxine plus antibiotic/steroid therapy. Three hundred and fourteen out of the 551 patients qualified for the subsequent 6-month long secondary antifolate prophylaxis. The type and occurrence rate of adverse reactions were taken into account. The probability of an adverse reaction during the intensive therapy phase was 33.4%. Hypertransaminasemia was the most common event observed in 24.6% of the patients, but it assumed a severe character in just 0.9%, with male gender and age over 25 years being the predisposing factors. Less common adverse effects included thrombocytopenia (8.3%), hypersensitivity skin reactions (3.0%), and abdominal pain (1.4%). The adverse effects of secondary antifolate prophylaxis, most commonly hypersensitivity skin reactions and hypertransaminasemia, followed by thrombocytopenia and abdominal pain, were observed in 4.9% of the patients. Ten of them (2.7%) had to discontinue the treatment while eight others continued with pyrimethamine alone without further adverse effects, which suggests that discontinuation of the sulfonamide decreased the propensity for adverse reactions. The treatment strategy in these patients differed from previous reports in that it used lower doses of pyrimethamine/sulfonamide, with no folinic acid supplementation. Nonetheless, the rate and severity of adverse events were no greater than those noticed with traditional regimens, with higher antifolate doses and folinic acid supplementation. We conclude that the dose and drug-mitigated treatment strategy we employed deserves consideration as a promising alternative to traditional treatments for ocular toxoplasmosis.

The Impact of Short-Term, Intensive Antifolate Treatment (with Pyrimethamine and Sulfadoxine) and Antibiotics Followed by Long-Term, Secondary Antifolate Prophylaxis on the Rate of Toxoplasmic Retinochoroiditis Recurrence.

PURPOSE: To assess the impact of intensive antifolate treatment, followed by secondary antifolate prophylaxis (A-SP) on the recurrence rate of toxoplasmic retinochoroiditis (TRC). To investigate whether there are any other factors potentially predisposing for recurrence. MATERIAL AND METHODS: A total of 637 medical records of TRC patients, who had been treated in the years 1994-2013 were reviewed. All patients were treated with pyrimethamine /sulfadoxine one 25mg/500mg tablet daily (P/S 25/500mg) for 21 days with a double loading dose for the first two days. From Day 2 the patients also received prednisone at a starting dose of 40mg and spiramycine 3 million IU three times daily, given for 10 days followed by azithromycin 500mg once daily for another 6 days. The analysis of the recurrence rate involved 352 patients who had completed 6-month secondary prophylaxis (P/S one 25 mg/500mg tablet twice a week). RESULTS: When secondary antifolate prophylaxis (A-SP) was instituted immediately after the treatment for TRC, the probability of 3-year recurrence-free survival after the first course of A-SP was 90.9%. A recurrence was most likely approximately 3.5 years after the first treatment. A univariate Cox regression model demonstrated that a risk for recurrence was 2.82 times higher (p = 0.02) in patients with retinal scars. In the multivariate analysis, the risk for recurrence was 2.41 higher (p = 0.06). In patients with haemorrhagic lesions the risk for recurrence was lower, aRR = 0.17 (approaching borderline statistical significance p = 0.08). CONCLUSIONS: With the institution of A-SP of immediately after the intensive treatment for TRC, i.e. when a reactivation was most likely, there was no recurrence during A-SP. Following A-SP the recurrence rates were low and recurrence-free periods tended to be longer. The treatment regimen employed had a beneficial effect on the recurrence interval as it reduced and delayed the highest probability of recurrence.

Spotted fever rickettsiosis caused by Rickettsia raoultii--case report.

We report the case of rickettsial eschar-associated spotted fever, most probable due to Rickettsia raoultii, an emerging pathogen, which was previously described in patients with tick-borne lymphadenopathy (TIBOLA), also called Dermacentor-borne necrosis erythema and lymphadenopathy (DEBONEL). The pathogenicity of R. raoultii is not well established. The survey of ticks from Poland (Ixodes ricinus and Dermacentor reticulatus) revealed that R. raoultii occur in all regions of Poland and predominate over other rickettsiae of spotted fever group--R. slovaca and R. helvetica. A 17-year-old otherwise healthy girl was admitted to Department of Zoonotic and Tropical Diseases because of fever, eschar and rash. Multiple disseminated small lesions were present on the skin of her head, trunk and limbs, also palms and soles, and mucosa of her lips. The majority of them had necrotic center slightly elevated with redness around, single ones had vesicular appearance. The lymph nodes on the right side of her neck were enlarged. Laboratory investigations revealed: leukopenia (with 22% of bands in differential), thromocytopenia, slightly elevated C-Reactive Protein, as well as procalcytonin. The quick improvement was observed with a treatment with ceftriaxone and doxycycline. Two weeks after the onset of disease, IgG serum antibodies titer of 128 reacting with R. rickettsii antigen only was detected. IFA tests with six SFG rickettsial species demonstrated the strongest reaction with R. raoultii group antigens in a titer of 64. The case we report, resembling boutonneuse fever, with leukopenia, thrombocytopenia and septic parameters indicates possible higher virulence of R. raoultii than it was previously observed.

[Dengue as haemorrhagic fever]. / Denga jako goraczka krwotoczna.

Dengue virus is distributed in tropical and subtropical regions and transmitted by mosquitoes of the genus Aedes. In September 2010 two cases of indigenous dengue fever were diagnosed in metropolitan France for the first time and next DENV infection was diagnosed in a German traveler returning from a trip to Croatia. The Aedes albopictus mosquitoes were found in several European countries (for example in greenhouses in Netherlands). The indigenous DENV infections in Europe are rare diseases, probably acquired after bites of infected mosquitoes imported by airplanes from endemic areas. Nonspecific symptoms including: fever (up to 39 degrees C), chills, arthralagia, headache, myalgia and abnormalities in laboratory tests such as: thrombocytopaenia, leukopaenia and liver tests cause problems with differential diagnosis ofhematologic and hepatologic syndromes. The most serious complications are associated with dengue shock syndrome with mortality rate of 50%.

[Dengue in patients hospitalized in the hospital ward of zoonoses and tropical diseases in Warsaw in years 2002-2011]. / Denga u pacjentów hospitalizowanych w klinice chorób odzwierzecych i tropikalnych w warszawie w ostatnim dziesiecioleciu (2002-2011).

The article presents the clinical course of Dengue in 22 patients hospitalized in the Ward of Tropical Diseases and Zoonoses in Warsaw in 2002-2011. Dengue belong to hemorrhagic fevers.The virus which causes dengue (DENV) belonging to the Flaviviridae family of RNA viruses. It is transmitted by arthropods (mosquitoes Aedes). Among the hospitalized patients most aged 20-30 years (10 people), there were more women than men. There were two foreigners from Asia and Central America. The majority of patients visited regions of South East Asia (Thailand, Laos, Vietnam) then India, Brazil and Mexico. Most of hospitalized people had light and average course. Symptoms of the disease usually occurred shortly after returning from the visited region and were not specific (flulike). In of one of the patients the course was very heavy. The average hospital stay was 9 days, the longest, in one person was 27 days. All patients were treated symptomatically, one person received a platelet transfusion twice without complications. Two people were treated with steroid drugs. All patients were discharged without serious consequences for health and life.

[Clinical manifestations, diagnosis and treatment of swine flu (A/H1N1) infection among patients hospitalized in the Hospital of Infectious Diseases in Warsaw in 2009]. / Objawy kliniczne, rozpoznanie i leczenie grypy wywolanej wirusem A/H1N1 u osób hospitalizowanych w Szpitalu Zakaznym w Warszawie w 2009 r.

UNLABELLED: The aim of this paper was the evaluation of clinical characteristics, demographics and therapeutic response for oseltamivir, among patients with swine flu confirmed, hospitalized in the Hospital For Infectious Diseases in Warsaw, Poland. MATERIAL: We have observed infection A/H1N1 occurrence in 109 patients (Female-64, Male-45, aged 17-71 y), hospitalized between August and December 2009. The influenza specific test PCR (TaqMan A/H1N1) were used to pandemic flu confirmation. RESULTS: Out of 109 analyzed patients, 67% were young, before 40 y. old. The largest infected group were patients between 20 and 29 years. Among multiple acute symptoms we observed high temperature, cough, myalgia and neurological manifestations, very frequent. In 42 patients (38%) the interstitial pneumonia were observed. Eight patients developed severe respiratory insufficiencies -ARDS (7%) and one died. We observed also 10 infections A/H1N1 influenza during pregnancy, with good oseltamivir tolerance and without recent perinathal complications. CONCLUSIONS: Among 109 individuals with swine flu influenza, 67% have not complicated clinical manifestation and they recovered during 3-4 days. Eight patients developed ARDS and one of them died. Test PCR for influenza A/H1N1 was the basis in diagnostics procedures of the new pandemic influenza confirmation. Oseltamivir safety and tolerability were verified in patients with new variant infection A/H1N1.

[Influence of concomitant illness on clinical manifestations and severity of A/H1N1 influenza infection among patients hospitalized in the Hospital of Infectious Diseases in Warsaw--clinical cases]. / Wplyw chorób towarzyszacych na przebieg kliniczny grypy wywolanej przez wirus A/H1N1 u osób hospitalizowanych w Szpitalu Zakaznym w Warszawie--opis przypadków.

UNLABELLED: Many cases of swine flu is mild or even asymptomatic. The recent cases have been much more severe, and many patients have presented pneumonia, respiratory failure and acute respiratory distress syndrome (ARDS). Illness-related fatalities have been recorded among individuals hospitalized in The Hospital For Infectious Diseases in Warsaw, Poland. There were 109 patients (age: 17-71y), with A/H1N1 infection confirmed by PCR. In this article have shown cases of H1N1 influenza - related complications. We observed bacterial superinfections associated with swine flu, ARDS and shock syndrome, secondary bacterial pneumonia and neurological complications. Severe hypoxemia, multilobar pneumonia, and dramatic signs and symptoms progression, were reported in 8 individuals. All patients required admission to intensive care unit and the mechanical ventilation. One patient died due to ARDS and encephalitis. Many people have experienced risk factors, e.g.: asthma, sarcoidosis, or chronic bronchitis and other pulmonary illness. One patient after renal transplant with immunosuppressive therapy recovered, as well as two patients with chronic lymphatic leucaemia in remission. Two woman with clinically-relevant obesity have developed rapid progression of respiratory insufficiency and were still on mechanical ventilation. Influenza A/H1N1 were observed in 10 pregnant women, without co-morbidities. Three of them developed interstitial pneumonia. Consequently pregnant women with confirmed pandemic A/H1N1 infection received treatment with oseltamivir. IN CONCLUSION: Among 109 hospitalized individuals with A/H1N1 infection, eight (7%) developed severe pulmonary complications, and one of this patient died. The risk factors of progression to acute respiratory distress syndrome (ARDS) have all of this group patients.

Tularaemia after tick exposure - typical presentation of rare disease misdiagnosed as atypical presentation of common diseases: a case report.

A 44-year-old female was admitted because of tender, enlarged inguinal lymph nodes with a history of tick bite five weeks earlier. In the place of a tick bite on the skin a small ulcer was present. The primary symptoms before admission suggested typical diseases related to tick bite such as Lyme borreliosis and tick-borne encephalitis, what corresponded with positive IgM ELISA test for Lyme borreliosis. The course of disease however clarified the diagnosis of tularaemia, which is a relatively rare disease in Poland (6 cases per 40 million population are reported annually). The ultimate diagnosis was confirmed by serological tests.