Risk of human toxocarosis in Poland due to Toxocara infection of dogs and cats.

The purpose of this paper was to present the current data on the risk of toxocarosis in humans in Poland and to give an overview of the clinical and diagnostic aspects of the disease. The number of reported clinical cases of Toxocara infection in children in Poland in medical literature has increased recently. The results of field surveys aimed to evaluate the soil contamination with geohelminth eggs conducted during the last few years showed that Toxocara is the most common zoonotic agent in urban public sites and in rural settlements. The questionnaire revealed rural inhabitants' low awareness of zoonotic parasite threats to humans. In particular parents should be advised as to what proper preventive measures to undertake to eliminate the toxocarosis risk factors for children in rural environment. Prevention of initial environment contamination with Toxocara canis and T. cati eggs, which includes proper treatment regimes to eliminate patent infections in dogs and cats and preventing pets from defecating in public areas and private households is vital. To provide the public with suitably presented information as well as pet owners with uniform recommendations, a close collaboration between veterinary and public health professionals is crucial.

[Precocious puberty in a vertically HIV-infected girl]. / Przedwczesne dojrzewanie pliowe u dziewczynki wertykalnie zakazonej HIV.

The authors present the case of a vertically HIV infected, six-year-old girl, with precocious puberty. The late diagnosis of HIV both in the mother and in the child is of significance. Different causes of adrenarche precox are also discussed. In pediatric practice vertical HIV infection should be taken into consideration in differential diagnosis. In routine care of HIV-infected children, monitoring of development including sexual development is indicated. The presence of symptoms of adrenarche precox, as in noninfected children needs in depth diagnostic investigations. The role of HIV infection and of antiretrovirus treatment in the pathogenesis of adrenarche precox remains unclear and needs further investigation.

Cystic echinococcosis in a child infected with HIV.

Echinococcosis is a parasitic disease caused by the tapeworm Echinococcus granulosus. Echinococcus infection is possible at any age, including childhood. Most of the cases are recognized accidentally. HIV infection in children is rarely diagnosed in Poland. A currently 16-year-old girl was diagnosed with HIV vertical infection at the age of 13. Antiretroviral therapy was started after 6 months of observation. Routine ultrasound examination of her abdomen revealed a cystic lesion in the liver. The IgG ELISA test for E. granulosus infection was negative. However, she was treated with albendazole due to clinical suspicion of echinococcosis. After anti-parasitic treatment, an abdominal ultrasonography (US) and computed tomography (CT) scans were performed and revealed progression of the lesion (one year of observation). As an additional imaging study, biliary tract scintigraphy was done. Localization of the cyst allowed its surgical removal. The surgery was performed under pharmacological protection with albendazole. Histopathology examination confirmed the diagnosis of echinococcosis.Currently, the clinical condition of the patient is good, antiretroviral treatment is effective and repeated abdominal ultrasound is unremarkable. E. granulosus infection in children is rare and may be accompanied by other diseases and infections. Diagnosis is difficult and it is often based on the clinical picture without serological confirmation. Surgical treatment should be supplemented with pharmacological treatment.

[Evaluation of antibody response to HPV vaccination in HIV infected girls]. / Ocena skutecznosci szczepienia przeciwko HPV dziewczat zakazonych HIV na podstawie badania obecnosci przeciwcial poszczepiennych.

BACKGROUND: HIV-infected women have an increased prevalence of HPV infections and high risk of cervical cancer. HPV vaccines seem to be a successive method of prevention in immunocompetent women. AIM: To evaluate HPV vaccination effectiveness based on the presence of HPV antibodies in HIV infected girls and to establish factors, which influence vaccination effectiveness. PATIENTS AND METHODS: Post vaccination antibodies were evaluated in 17 HIV -infected girls who received 3 doses of quadrivalent (types 6/11/16/18) HPV vaccine at the mean age of 11,5 years (range 9-17 yr). HPV antibodies were checked 1 month to 2 years (mean 18 months) after the third vaccine dose by ELISA HPV IgG assay (Dia.Pro Diagnostic Bioprobes). All patients have been receiving combined antiretroviral treatment (cART). Analyzed factors included: age at HIV diagnosis, age at the first vaccine dose, Centers for Disease Control and Prevention (CDC) classification at diagnosis, at vaccination and at evaluation. RESULTS: HPV antibodies were present in all 17 (100%) patients. HIV-infection was diagnosed at the mean age of 3,5 years (range 1 month--10.5 years). Nadir clinical CDC category: 7/17 patients (41%)--A, 5/17 (29,5%)--B, 5/29 (29.5%)--C. Nadir CDC count pointed moderate immunosuppression in 8/17 (47%) children and severe in 9/17 (53%). At vaccination 15/17 girls had CDC classification N1/A1, 2/17 (11.7%) were classified N2. At evaluation all girls had CDC classification N1 or A1. CONCLUSIONS. HPV vaccination in HIV infected girls resulted in successful antibody response. Immune recovery due to cART resulted in a good vaccine response, even in children with prior severe immunodeficiency.

[Toxocariasis in children--difficult clinical problem]. / Toksokaroza u dzieci--trudny problem kliniczny.

Toxocariasis in humans is a zoonosis due to the migration of Toxocara canis or T. cati larvae in human body. This review provides basic information on pathology of infection and clinical signs and symptoms of toxocariasis in children. The cases diagnosed in the recent years in central Poland are presented. The disease was recognised accidentally based on the results of laboratory analysis performed for other reasons, when abnormalities suggesting an active helminthiasis were found (eosinophilia, elevated IgE level and/or anemia). The high rate of soil contamination in households of the patients demonstrated elevated risk of infection and reinfection in both, rural and urban areas. Presented data show the need for educational programs which should be implemented for prevention of Toxocara infection in children.

Environmental and personal risk factors for toxocariasis in children with diagnosed disease in urban and rural areas of central Poland.

To investigate the epidemiology of human toxocariasis a field survey was carried out at homes of 194 children (80 of rural and 114 of urban origin) with diagnosed disease from central Poland. A questionnaire referring to the possible risk factors was directed to their parents. Overall contamination rate of soil by Toxocara eggs was 27.5% in rural and 21.1% in urban environment in the households examined, with difference not significant (chi2=1.08, p=0.2986). In rural settlements 29.3% of yards surrounding houses were found contaminated, whereas in urban 25.0% of family gardens, 26.4% of private yards and 10.7% of public sandpits were positive. Frequency of positive samples differs only for rural yards and urban sandpits (chi2=3.85, p=0.0499). The study showed a high risk of reinfection for the ill children in sites of their residence. Despite diagnosed toxocariasis kids were not adequately supervised by their parents with no measures undertaken to avoid further infection. These data present strong need for educational programs which should be implemented for prevention of Toxocara infections in children.

A serological and epidemiological evaluation of risk factors for toxocariasis in children in central Poland.

The level of specific anti-Toxocara IgG was examined in 343 children from central Poland with suspected Toxocara infection. Based on the presence of specific IgG antibodies and clinical signs and symptoms, toxocariasis was confirmed in 249 patients. The serological results of diagnosed cases were analysed in connection with epidemiological data (contamination of soil around the children's homes and presence of a dog or a cat). A higher prevalence of soil contamination with Toxocara eggs was found in suburban and rural areas (30.9% and 24.6%, respectively) whereas it was lower in urban areas (10.3%). In about 40% of the children whose households were not contaminated, a decrease in the antibody level was observed 2 years after treatment for toxocariasis, while there was no such decline in those living in contaminated places. The logistic regression model employed to determine the correlation between seropositivity in the children and selected epidemiological risk factors showed a statistically significant relationship in connection only with dog ownership (P = 0.0238). The present results have demonstrated the high risk of toxocariasis for children from rural and suburban areas in Poland. The sero-epidemiological investigations indicated that re-infection might be the reason for persistence of seropositivity after treatment.

[The risk of vertical HCV transmission in children born to HIV infected mothers]. / Ocena ryzyka zakazenia wertykalnego wirusem C zapalenia watroby u dzieci matek zakazonych HIV.

OBJECTIVE: The aim of the study was to evaluate the incidence of mother-to-infant HCV transmission in children born to HIV positive mothers, to qualify the risk factors of the mother-to-child HCV transmission, to settle of conduct diagnostic principles in a child after exposition on HIV and HCV. METHODS: 52 children, born to 52 HIV-infected mothers were studied between June 2001 and September 2005. The full regimen of investigations was executed in 44 children, 7 fell out from the observation, 1 child was below 12th month of life. The course of gestation, mode and duration of delivery were examined. The following laboratory tests were done: alanine aminotrnsferase (ALT) activity, AbHCV assay in 1s and 13th month of life (EIA--third generation) and genetic material HCV (Amplicor HCV assay v. 2.0--Roche). At the same time the diagnostics of HIV vertical infection was made. HCV/HIV coinfections was diagnosed in 43/52 mothers. HCV vertical transmission was diagnosed based on at least twice tested existence of HCV-RNA in serum in the first year of life and/or HCV-Ab presence in a child >12th month of life. RESULTS: HCV-antibodies in the first month of life were present in 40/52 children (76.9%). HCV-RNA diagnosed by RT-PCR was detected in 7/43 children (16.2%): in 1 child transient viremia was observed, 6 children had chronic HCV infection. Symptoms of hepatitis infection were observed in 5 among 7 children with HCV transmission. HCV vertical transmission appeared in children of mothers with HCV viremia above 10(5) copies/ml. Vaginal delivery lasting over 4 hours after membrane rupture and emergency cesarean section were statistic significant risk of HCV transmission (significant data--chi2(1) = 5.01, p < 0.05). HIV infection was diagnosed in 4 children, there was no case with coinfection HIV/HCV. CONCLUSIONS: . All children born to HIV positive mothers need diagnostics of HCV vertical infection, the risk of vertical HCV transmission is high (16.2%). The risk factors of HCV vertical transmission included: high level of HCV viremia in the mother (>10(5) copies/ml), prolonged vaginal delivery (>4 hrs after membrane rupture) and emergency cesarean section. Children from vertical HCV exposition should be followed up at least for 24 months.

[20-years experiences of HIV infected children's care]. / 20-letnie doswiadczenie w opiece nad dziecmi zakazonymi HIV.

OBJECTIVE: The aim was to present the 20-years experiences of medical care of children borne to HIV(+) mothers and HIV infected children. METHODS: Between 1987 and 2006 year 305 children borne to HIV(+) mother were investigated. The risk of vertical transmission was estimated. We analyzed routs of HIV transmission, the reasons of HIV diagnosis, HIV staging at diagnosis, HBV and HCV coinfection, ART treatment and its efficacy. MAIN OBSERVATIONS AND RESULTS: HIV infection was confirmed: 75 cases of vertical HIV infection and 8 children infected in other ways. 260 children were borne after 1994 year (the date of introducing recommendation of the use of ART to reduce perinatal transmission of HIV). 158 of them received prophylaxis of vertical HIV infection. The risk of HIV vertical in children receiving prophylaxis was 5% comparing to 45.6% risk in children without prophylaxis regimens. 66 children receive ART regimen. The efficacy of treatment was: viral 85%, immunological: 89% and clinical: 85% improvement. CONCLUSIONS: HIV testing should be offered to every women in the child-bearing age. Current prophylaxis, which suppress maternal VL HIV below detection level, decrease the risk of vertical HIV transmission to 0-1%. The child born to HIV(+) mother requires early diagnostics of HIV, HBV, HCV infections. Because of rapid progression of the disease, the HIV infected child should be diagnosed and treated since the first year of life. Properly treated children reach to mature age.

[HIV infection in children in Poland - clinical advancement at time of diagnosis]. / Zakazenie HIV u dzieci w polsce - zaawansowanie kliniczne choroby w momencie rozpoznania.

UNLABELLED: At the end of 2006, there were about 130 children with confirmed HIV infection in Poland, 90% of them being infected vertically. AIM: to present the causes, the diagnostic procedure of HIV infection and the assessment of clinical staging at diagnosis of vertical infection in a child. MATERIALS AND METHODS: between 1987-2006 there were 86 HIV infected children (45 male, 41 female) treated in our Department. 78 children had been infected vertically, 8 by other route. Reasons for HIV testing in children and clinical staging at diagnosis were analysed in vertically infected children. The patients were divided into two groups: I - diagnosed because of clinical signs and symptoms, II - because of knowledge of HIV positive status in family members. RESULTS: there were 22/79 children in group I and 56/79 in group II. Vertical HIV infection diagnosis was confirmed at the age from 1 month to 11 years, the mean age was: 26 months - in group I, 25 months - in group II. During the first year of life HIV infection was diagnosed in 36 children (33% of them having AIDS, 36% severe immunodeficiency), at the age of 12-35 months in 22 children (23% of them having AIDS, 32% severe immunodeficiency) and above 35 months in 20 children (15% of them having AIDS, 35% severe immunodeficiency), respectively. Children diagnosed because of clinical manifestations were more likely to have AIDS (p<0.01) and severe immunodeficiency (p<0.07). CONCLUSIONS: early diagnosis in children relies on the knowledge on the mother's HIV infection positive status. In Poland vertical HIV infection diagnosis is established late (mean: above 2 years), often at the advanced stage of the disease.

[Tuberculosis in HIV infected children]. / Gruzlica u dzieci zakazonych HIV.

UNLABELLED: Tuberculosis (TB) is important threat in HIV-infected people. Although there is slow but constant decline TB-infections among adults and children in Poland, about 30% HIV-(+) adults is coinfected with TB. There were 12 cases of TB in HIV(+) children diagnosed in Department of Pediatric Infectious Diseases in 1994-2005. The aim was analysis of reasons for TB diagnostic tests in HIV (+) children, coinfection HIV and TB and efficacy of anti TB treatment. TB diagnostics was performed in 23 children because of clinical indications (15/23) and conversion or excessive skin tests (8/23). There were bacteriological and radiological exams done in all cases of TB suspicion. When active TB was diagnosed there were 4 tuberculostatic drugs used (6-12 months). In latent or unlocalized TB-INH was used for 12 months. RESULTS: 12 cases of TB infection were diagnosed: active TB--4, BCG-itis--1, latent--1 and unlocalized TB--6. In 10 cases TB infection was excluded. All cases of tuberculostatic treatment was successful. 5/12 cases are presently treated. CONCLUSIONS: Skin test is lonely, generally used method of TB control in HIV (+) children without clinical manifestations of TB. There is a necessity of diagnosis and chemoprophylaxis in all cases of conversion or enlarged (above 10 mm, vesicularis) skin test. TB diagnosis is an indication for HIV diagnostics.