Comparison of tick-borne encephalitis between children and adults-analysis of 669 patients.

The aim of our study was to compare the course of TBE in children and adults. A retrospective analysis of the medical records of 669 patients was performed. The patients were categorized into 2 groups: Group I with 68 children and group II with 601 adults. TBE symptoms in children were milder compared with adults, with meningitis in 97% of cases. In adults, meningoencephalitis and meningoencephalomyelitis made up 49.26% of cases. Nausea and vomiting are more frequent in children, while neurological manifestations are more frequent in adults. There were no differences in CSF pleocytosis at the onset of disease in both groups, while CSF protein concentration was higher in adults. Children treated with corticosteroids over 7 days had higher checkup pleocytosis than pleocytosis at the onset of disease compared with adults. Corticosteroid use prolongs the disease duration but does not influence the development of TBE sequelae. Children had more favourable outcomes than adult patients.

Comparison of Neuroborreliosis Between Children and Adults.

BACKGROUND: Lyme neuroborreliosis (NB) is a tick-borne infectious disorder of the nervous system caused by Borrelia burgdorferi spirochetes. There are not many data available regarding the differences in the course of NB in children and adults. The aim of our study was to compare the clinical course of NB between children and adults. METHODS: Retrospective analysis of medical documentation of 181 patients with NB was performed. The patients were divided into 2 groups: Group I: 57 children with NB; Group II: 124 adults with NB. Medical data, such as patients' age, sex, place of living (residence), time from a tick bite, subjective complaints, general examination results, laboratory parameters and treatment were analyzed. RESULTS: In children, the most common symptoms were headache (89.5%), neck stiffness (64.9%) and nausea and vomiting (56.1%). In adults, the most common symptoms were headache (77.4%), facial nerve palsy (59.7%), neck stiffness (59.7%), vertigo (41.9%) and lumbosacral region pain (37.1%). Bannwarth's syndrome was observed in 10.5% of children and 36.3% of adults. In cerebrospinal fluid (CSF) in children, the pleocytosis at admission was higher than in adults, but protein concentration was significantly lower. There were no differences in percentage of mononuclear cells in CSF smear between the groups. In CSF examination after treatment, a decrease in pleocytosis and protein concentration was observed in both groups. Analysis of effectiveness of treatment mostly with third generation cephalosporins (defined as complete recovery) between the groups, calculated by the Kaplan-Meier method and compared with the use of the log-rank test, showed no significant differences between children and adults (log-rank P = 0.619). CONCLUSIONS: In children, NB more frequently presented as meningitis, and in adults in the form of Bannwarth's syndrome. CSF pleocytosis in children with NB was higher than in adults, while the protein concentration in children was lower. Outcomes in children and adults were favorable and did not differ after standard NB treatment.

Neuroborreliosis ­ clinical presentation ­ Current state of knowledge

Neuroborreliosis is one of the manifestations of Lyme disease involving central and peripheral nervous system. It is caused by infection with Borrelia burgdorferi spirochete which is transmitted by tick bites. Neuroborreliosis can affect both adults and children. The clinical course in children is often different than in adults. The article discusses the most common clinical symptoms, complications, diagnostics and treatment of neuroborreliosis in children.

Whole-genome comparative analysis of Campylobacter jejuni strains isolated from patients with diarrhea in northeastern Poland.

BACKGROUND: Campylobacter jejuni is the leading cause of bacterial gastroenteritis (campylobacteriosis) in humans worldwide, and the most frequent pathogen associated with Guillain-Barré syndrome (GBS) and Miller-Fisher syndrome (MFS). The study was designed in order to assess similarities between genomes of Campylobacter jejuni strains, isolated from children suffering from acute diarrhea in northeastern Poland, in comparison to C. jejuni genomes stored in public databases. The analysis involved phylogeny, resistome and virulome. In addition, the Campylobacter PubMLST database was used to estimate the prevalence of the analyzed C. jejuni sequence type (STs) in other countries. RESULTS: Campylobacter jejuni ST50, ST257 and ST51 represented 5.3%, 4.5% and 2.2% of the PubMLST records, respectively. Overall, strains representing the STs showed common resistance to tetracyclines (51.3%) and fluoroquinolones (31.8%), mediated through the tetO gene (98.2%) and point mutation (T86I) in the gyrA gene (100%). However, the latter was present in all our isolates. The major differences in virulence patterns concerned serotypes, lipooligosaccharide (LOS) classes and certain clinically relevant genes. CONCLUSIONS: Campylobacter jejuni ST50, ST51 and ST257 are among the top ten of STs isolated in Europe. WGS revealed diversity of serotypes and LOS classes in ST50 strains, that deserves further clinical and epidemiological investigations as it might be related to a risk of post-infectious neurological sequels such as Guillain-Barré syndrome. Additionally, the results implicate lower pathogenic potential and distinct transmission chains or reservoirs for C. jejuni ST51 isolates responsible for campylobacteriosis in northeastern Poland.

[Selected viral neuroinfections in children]. / Wybrane wirusowe neuroinfekcje u dzieci.

Viral meningitis may be present not only in adults but also in children. It constitutes a significant public health problem in child population. The clinical manifestation of the disease in children varies depending on the age of the child, the causative agent or the way of acquiring the infection. Thanks to the widespread availability of vaccinations, the epidemiology of central nervous system infections is changing. The methods of diagnosing and determining the causative factor have also changed. Sensitive and rapid molecular methods such as PCR tests are being used more frequently. The article contains an overview of the most common causes, clinical signs and symptoms, complications and principles of diagnosing and treating viral meningitis in children. Currently, Enteroviruses are at the top positions among the causes of sporadic and epidemic meningitis in children living in various geographic regions of the world. In European countries, the common cause of viral meningitis and/or encephalitis is tick-borne encephalitis virus. The severity of the clinical course of TBE is inversely proportional to the age of the affected children. In USA, sub-Saharan Africa and recently in southern Europe epidemic West Nile Virus (Flaviviridae family) central system infections were reported. Herpes simplex encephalitis is uncommon in children and has a severe course (especially in vertically infected infants). The mortality rate in Herpes simplex encephalitis is 20- 25% despite acyclovir treatment.

Toxocarosis in children: poor hygiene habits and contact with dogs is related to longer treatment.

The objective of this study was to investigate the main clinical signs and symptoms of toxocarosis in children and the treatment results. The study group consisted of 66 seropositive children aged 2 to 16 years, evaluated in an outpatient clinic in north-eastern Poland for 24 months. Male gender and living in urban areas predominated in the study population. Children presented with non-specific symptoms, of which the most common was abdominal pain or tenderness, which was reported by 39 (59%) patients. Absolute eosinophil counts were increased in 32 (48%) children. Total IgE concentrations were increased in 31 of 55 (56%) tested children. All evaluated children received albendazole as a first-line treatment. In 19 cases, additional treatment with albendazole and/or diethylcarbamazine was provided. The analysis of possible causes of prolonged treatment revealed that significant risk factors were geophagia [odds ratio (OR), 6.3; 95% confidence interval (95% CI), 1.8-21.8; p < 0.01] and daily contact with a dog [OR, 5.9; 95% CI, 1.3-27.3, p < 0.05]. We hypothesise that poor hygiene habits and daily contact with a dog pose a risk of reinfection and limits treatment efficiency. Because of non-specific signs and frequent lack of eosinophilia, physicians should maintain high levels of suspicion for toxocarosis, particularly in patients who live in regions heavily contaminated with Toxocara eggs.

Polish consensus guidelines on the use of acyclovir in the treatment and prevention of VZV and HSV infections.

A physician has to perform a benefit-risk assessment each time acyclovir is prescribed "off label" for children. A group of Polish infectious disease experts was created to develop evidence-based guidelines on the use of acyclovir in the treatment and prevention of varicella zoster and herpes simplex infections. In primary varicella zoster virus infections, oral acyclovir treatment is recommended in children over 12 years of age and should be considered in younger children who fall into one of the groups at risk of severe varicella. Intravenous acyclovir therapy in varicella is recommended in patients with immune deficiencies, newborns and in complicated cases. When there is a justified need for prevention of varicella, oral acyclovir prophylaxis may be considered if immunoglobulin cannot be administered, and if it is too late for vaccination. Oral acyclovir treatment of herpes zoster may be beneficial to otherwise healthy patients with a rash in places other than the trunk and in patients over 50 years of age. In immunocompetent patients with herpes simplex infections, indications for treatment with oral acyclovir include primary (genital herpes, skin herpes in children with atopic dermatitis, ocular herpes simplex, severe gingivostomatitis, paronychia and pharyngitis) and recurrent infections. Intravenous acyclovir should be administered for herpes infections in neonates, immunocompromised patients and patients who develop complications including neurological.

Environmental contamination with Toxocara eggs and seroprevalence of toxocariasis in children of northeastern Poland.

Toxocariasis is a worldwide distributed zoonotic disease. Soil contaminated with Toxocara eggs appears to be the main source of infection for humans. The aim of our study was to estimate the environmental contamination with Toxocara eggs in public areas in northeastern Poland followed by the assessment of seroprevalence of toxocariasis in the children's population inhabiting the areas. A total of 168 soil samples were collected in June and September from public areas, and 28 from patients' residences. They were all examined for Toxocara eggs using the centrifugal flotation technique. Two-step serological tests comprising enzyme-linked immunosorbent assay (ELISA) and Western blot (WB) were performed in 190 children aged 2-17 without any symptoms of toxocariasis. The positive samples accounted for 36 and 32 % in the urban area, 39 and 18 % in the suburbs, and 39 and 46 % in parks, for June and September, respectively. All the sites located near the patients' residences with confirmed persistent toxocariasis were found contaminated with Toxocara eggs. A significant drop in the mean number of eggs was noted in the suburbs after summer (0.64 vs 0.18, p < 0.05). High and constant contamination was documented in soil from urban sandboxes and parks. The overall seroprevalence in children tested for toxocariasis was 4.2 % as determined by ELISA and WB (3.0 % in preschool children and 7.7 % in school children). The current study revealed high contamination of public areas in northeastern Poland with Toxocara eggs as well as marked seroprevalence in asymptomatic children. There is an urgent need to introduce and promote preventive health measures to limit spread of toxocariasis.

Exposure to environmental tobacco smoke and respiratory tract infections in pre-school children - a cross-sectional study in Poland.

INTRODUCTION AND OBJECTIVE: Knowledge of the harmful influence of environmental tobacco smoke (ETS) has a positive impact on changing social behaviours worldwide. In many homes smoking is totally prohibited; in some others, partial limitations of tobacco consumption have been introduced. OBJECTIVE: To study the correlation between the adopted rules of tobacco use in homes of 3-year-olds, and the kind and frequency of acute respiratory system infections within a 6-month period of attending pre-schools. MATERIALS AND METHODS: The study was performed among children attending municipal pre-schools in Bialystok, Poland. The data was collected by anonymous questionnaires completed by the parents of 302 children aged 3 years chosen randomly from 1,200 children attending 51 pre-schools. The exposure of children to tobacco smoke was measured by determining cotinine to creatinine ratio (CCR) in urine. RESULTS: In the 150 families of children who were surveyed, 210 were smokers. Every day, the smokers consisted of fathers (37.3%) and mothers (23.6%). The 3-year-old children were divided into 3 groups according to smoking habits in their homes: 28.5% of the children under examination came from homes where tobacco smoking was forbidden (mean CCR - 15.21 ng/mg, SD=11.86), 26.2% came from homes where tobacco was smoked in separate rooms (mean CCR - 65.75 ng/ml, SD=81.51), 45.4% lived in homes where no rules connected with smoking had been established (mean CCR - 61.75 ng/ml, SD= 70.29). During the analyzed period of 6 months, 85% of the children had at least 1 respiratory tract infection (60% - upper, 16.9% - lower, 16.5% - upper and lower, 7.1% - otitis media). CONCLUSIONS: The majority of the 3-year-old children who had lower respiratory tract infections required antibiotics and hospitalization. Living in a home where no tobacco rules were established may cause an increase of respiratory tract infections.

Conventional and molecular methods in the diagnosis of community-acquired diarrhoea in children under 5 years of age from the north-eastern region of Poland.

OBJECTIVES: The purpose of this study was to determine the main causative agents of community-acquired acute diarrhoea in children using conventional methods and PCR. METHODS: Stool samples were collected from 100 children under 5 years of age with acute diarrhoea during the autumn-winter period of 2010-2011. Rotaviruses and adenoviruses were detected by the stool antigen immunoassay, and Salmonella spp, Campylobacter spp, Shigella spp, Yersinia enterocolitica, Yersinia pseudotuberculosis, Clostridium difficile, enterotoxigenic Bacteroides fragilis (ETBF), and diarrhoeagenic Escherichia coli were detected by culture methods and PCR. RESULTS: Overall, enteropathogens were identified in 73% of the children. Bacteria, viruses, and mixed infections were noted in 37%, 24%, and 12% of diarrhoeal cases, respectively. The most common enteric pathogens were rotaviruses (31%), followed by C. difficile (17%), Campylobacter jejuni (13%), Salmonella spp (11%), and atypical enteropathogenic Escherichia coli (aEPEC) strains (10%). Compared with culture methods, PCR increased the overall detection frequency of the bacterial enteropathogens by 4%. CONCLUSIONS: The high prevalence of Campylobacter jejuni suggests that the number of campylobacteriosis cases in Poland may be underestimated; this pathogen should be investigated routinely in children with diarrhoea. Moreover, C. difficile might be considered a causative or contributing agent of diarrhoea in 14.8% of children aged >1 year.

Epstein-Barr virus effect on frequency of functionally distinct T cell subsets in children with infectious mononucleosis.

PURPOSE: Epstein-Barr virus is a common human pathogen which infects the great majority of population worldwide. A striking proliferation of CD8⁺ T cells is an immune response to EBV invasion of B lymphocytes during infectious mononucleosis. The aim of the study was to analyze frequencies of CD28⁺CD95⁻, CD28⁺CD95⁺, CD28⁻CD95⁺ T cell subsets putative naïve (T(N)), central (T(CM)) and effector memory (T(EM)) T cells in children with infectious mononucleosis. MATERIAL/METHODS: Multiparameter flow cytometric analysis of CD4⁺ and CD8⁺ T cell subsets was performed in 19 children with acute infectious mononucleosis. RESULTS: The CD4⁺/CD8⁺ ratio was found to be decreased (0.53) in children with infectious mononucleosis. Median T(N), T(CM), T(EM) frequencies were estimated to be 3.7, 4.5, 15.1% of CD8⁺ and 23, 59.3, 5.5% of CD4⁺ T cells, respectively. In the present study we demonstrated negative correlations between CD8⁺CD28⁺CD95⁺ and CD8⁺CD28⁻CD95⁺ T cells and both VCA IgM antibody titers and disease duration. However, no such correlation was found when subset of CD4⁺ T cells or CD8⁺CD28⁺CD95⁻ cells was compared. CONCLUSIONS: We conclude that there is a rapid decrease in the number of memory CD8⁺ T cells in early acute stage of infectious mononucleosis.

[Is vaccination against varicella efficacious and how long does the protection last?]. / Czy szczepiene przeciw ospie wietrznej jest skuteczne i jak dlugo utrzymuje sie ochrona przed zachorowaniem?

Despite the availability of varicella vaccines, few countries have introduced a  universal varicella vaccination to their national immunisation programmes. Major concerns are vaccine efficacy against varicella and herpes zoster as well as duration of post-vaccination protection. This review study presents up-to-date classification of varicella-zoster viral clades, sensitive laboratory tests used for assessment of humoral response against the vaccine-type virus OKA antigens in vaccinees, and benefits of universal varicella vaccination in the USA (since 1995) and in Germany (since 2004). Current views on potential rise in zoster incidence after implementation of routine varicella immunisation have been also analyzed.

[Rotaviruses as a cause of nosocomial infections in Poland--systematic review with metaanalysis of 11 studies]. / Rotawirusy jako czynnik etiologiczny zakazen szpitalnych w polsce--przeglad systematyczny z meta-analiza 11 badan.

BACKGROUND: Rotavirus infections have been important health problem of Polish children both as primary cause of hospital admissions and nosocomial infections. Due to the lack of acquired immunity in first years of life, (96,7%) in hospitalized children reported in Poland in 2009. A high incidence of hospital infections is explained by mass excretion of rotaviruses in feces, as well as high infectivity and stability of the rotavirus in the environment. Pediatric departments are regarded as a favorable environment for rotavirus transmission. The exact number of nosocomial rotavirus gastroenteritis (RVHI) is unknown, but several publication concerning this problem are available. OBJECTIVES. The aim of the paper was a systematic review of epidemiologic situation regarding hospital rotaviral infections In Poland. MATERIAL AND METHODS. Systematic literature search within databases (Pubmed, CINAHL, Cochrane, EMBASE) using key words: "biegunka szpitalna" OR "zakazenie wewnatrzszpitalne" OR "zakazenie wewnatrz-oddzialowe" OR "hospital infection" OR "hospital diarrhea" OR "nosocomial infection" AND "Rotavirus" AND "Poland" was performed in August 2011. The searching was limited to period from January 1988 to August 2011. Data were also searched using traditional methods as reference analysis and contact with authors of found studies. A total of 18 publications describing epidemiology of RVHI were found. Seven studies were excluded due to the lack of necessary data and 11 studies describing epidemic situation in period 1981-2009 were selected to perform meta-analysis. RESULTS: We estimated that 0,72% (95% CI 0,68-0,76%) of children In Poland acquired rotavirus infection during their stay in a hospital and RVHI accounted for 22,6% (95% CI 21,5-23,7%) of all rotaviral gastroenteritis in hospitalized children in Poland. CONCLUSIONS: Our meta-analysis confirmed frequent occurrence of RVHI in polish hospitals. Nosocomial rotavirus infections are responsible for the substantial proportion of rotaviral gastroenteritis in hospitalized children and are closely related to community infections. Due to susceptibility, hospital infections occur mainly in childrenwithin their first two years of life and prolong their stay in a hospital. The number of hospital rotaviral diarrhea episodes should be reduced with universal immunizations, prevention of rotavirus transmission and use of probiotics.

Analysis of clinical symptoms and selected hematological indices in hospitalized children with Ascaris lumbricoides infection from the northeastern region of Poland.

Ascariasis is the most common soil-transmitted helminth infection in the world. The objective of this study was to analyze the clinical symptoms and selected hematological indices of ascariasis in hospitalized children from the northeastern region of Poland. Patients in the Pediatric Ward hospitalized in the Regional Hospital in Dabrowa Bialostocka in the period of 2005-2007 were included in this retrospective study. The intestinal stage of ascariasis was diagnosed on the basis of positive coprological survey performed using the decantation technique. A total of 938 patients were included in the study, 1801 stool samples were evaluated, and A. lumbricoides-positive tests were obtained from 252 children. Ascaris-positive young children (< or = 3 yrs) accounted for 3.0% of all hospitalized children, Ascaris-positive preschool-aged children (4-7 yrs) accounted for 8.1% and school-aged children (8-18 yrs) for 15.8%. Seasonal patterns were observed in the prevalence of A. lumbricoides (maximum in August-December). There was no relationship between BMI z-score, hemoglobin levels and prevalence of infection with Ascaris lumbricoides. Significant predictors of intestinal stage ascariasis in a multivariate logistic regression model were: abdominal pain as a reason for hospital admission (OR-2.19; 95% CI 1.62-2.95; p < 0.001) and age from 4 to 7 years (OR-2.0; 95% CI 1.41-2.80; p < 0.001). The prevalence rate of ascariasis was not higher in the group of patients with atopic diseases (bronchial asthma, allergic rhinitis, atopic dermatitis) and co-existing ascariasis did not affect the eosinophil counts in the peripheral blood. Ascariasis is still a current pediatric clinical problem characterized by non-specific clinical manifestations, which should be taken into consideration in the differential diagnosis of children's diseases.

[Exposure to tobacco smoke and type of acute respiratory infections in children]. / Narazenie na dym tytoniowy a rodzaj ostrych infekcji ukladu oddechowego u dzieci.

Respiratory diseases are the most common cause of the child and family practice physicians are one of the main reasons for referral to a specialist clinic and hospital pediatric wards. The severity of respiratory disease in adolescence influenced by various factors, endo- and exogenous. Some of them, especially environmental factors can be eliminated or reduced and thus reduce the risk of developing this disease. The most common source of pollutants in dwellings is tobacco smoke. The aim of this study was to assess exposure to tobacco smoke in three years old children of attending local kindergartens in Bialystok and its influence on the type of recovery from acute respiratory infections by the respondents. The study included 313 children from among the 1,200 who attend the local 51-kindergartens in Bialystok. Information on the structure of tobacco use in three-years-old-children's families and respiratory illnesses among random children were obtained, based on anonymous questionnaires completed by their carers. Exposure to tobacco smoke was based on questionnaires and serum cotinine in relation to creatinine in the urine of patients (K/K). In the 150 families surveyed children found 210 smoking people. Every day smoked 37.3% of fathers and 23.6% of mothers. Of the children surveyed--34% of the houses which where there was a prohibition on tobacco use, 35% of the houses which were smoked in enclosed areas, in 31% of homes have not been established no-smoking rules. Children who during the six-month period to attend kindergarten gone lower respiratory tract infection had mean K/K (59.57 ng/mg) higher than the ones that were healthy and underwent upper respiratory tract infection. Used by the parents of the children tested in part to reduce the exposure to tobacco smoke in the home environment was ineffective and did not influence the decrease in the incidence of lower respiratory tract.

[Matrix metalloproteinases in the central nervous system: clinical significance and therapeutic prospects]. / Metaloproteinazy macierzy w osrodkowym ukladzie nerwowym: znaczenie kliniczne oraz perspektywy terapeutyczne.

Matrix metalloproteinases (MMPs) were originally described as proteases capable of degrading extracellular matrix components. Increasing evidence indicates a much more complex role of MMPs. Diverse functions of MMPs include cellular differentiation, migration, survival or death, angiogenesis and signalling. Metalloproteinases are crucially involved in a number of inflammatory conditions in the central nervous system facilitating blood-brain barrier breakdown, leukocyte recruitment and shedding of cytokines and growth factors. These enzymes contribute to pathogenesis of meningitis, multiple sclerosis and neurodegenerative disorders. While most studied in the context of disease, beneficial role of metalloproteinases during nervous system development and following injury is now being appreciated. The present study aimed at reviewing clinical relevance of these enzymes and potential therapeutic prospects for the coming future.

Preanalytical factors affecting the stability of matrix metalloproteinase-2 concentrations in cerebrospinal fluid.

BACKGROUND: Matrix metalloproteinases (MMPs) are crucially involved in central nervous system inflammation. This study assesses preanalytical factors on MMP-2 concentrations in cerebrospinal fluid (CSF). METHODS: The concentrations of MMP-2 in CSF obtained from 13 patients were measured using ELISA. Identical measurements were done from the samples of the CSF from the same collection that were successively stored in glass tubes, stored at room temperature (21 degrees C), or refrigerated (4 degrees C) and frozen and thawed five times. RESULTS: After 48 h of storage at room temperature and refrigeration, there was a significant decrease in the concentrations of MMP. Sample storage in polypropylene or glass tubes led to a comparable decrease in MMP-2 concentrations. The freeze-thaw cycles, which were repeated five times, did not significantly affect MMP-2 concentrations. CONCLUSIONS: The storage of CSF at room temperature or refrigeration significantly decreases MMP-2 concentrations. Subsequent freeze-thaw cycles or glass tube material did not influence MMP-2 concentrations. Samples of CSF should be frozen immediately after collection to ensure accuracy of MMP measurements.

[Clinical manifestation of Lyme borreliosis in children with positive and negatiwe western blot results]. / Manifestacja kliniczna boreliozy z lyme u dzieci z dodatnimi i ujemnymi wynikami testu potwierdzenia western blot.

BACKGROUND: In the afforested area of North-Eastern Poland the risk of Borrelia burgdorferi infection seems to be higher compared to the other regions. Because of unspecific clinical manifestation of Lyme borreliosis in children the positive ELISA IgM results should be confirmed with Western blot IgM tests. OBJECTIVE: Retrospective analysis of clinical signs and symptoms of Lyme borreliosis in children with positive ELISA IgM and positive Western blot IgM results and in children with positive ELISA IgM and negative Western blot IgM results. MATERIAL AND METHODS: The study included 20 children reactive with ELISA IgM (Bellco Biomedica, Austria), hospitalized in Pediatric Infectious Diseases Clinic in 2007 due to probable diagnosis of Lyme disease. All children were tested with B. burgdorferi Western blot IgM and/or IgG assay (DRG, Diagnostics, Germany) as a second-step diagnosis. In 10 (50% females, 50% males) out of 20 children the results were positive (borreliosis) and in other 10 (80% females, 20% males) the results were negative (controls). In both groups of patients the retrospective analysis of signs and symptoms was done. RESULTS: The most often clinical manifestation of Lyme borreliosis in children was neuroborreliosis. Children presented Lyme meningitis (30%), facial nerve palsy (10%) and chronic or recurrent headaches (40%), associated with vertigo (20%), weakness (30%), fever (40%), and fatigue syndrome (30%). One patient presented Lyme arthritis. Children of control group presented with unspecific symptoms like isolated headaches (40%), arthralgias (70%), myalgias (10%) and abdomen pain (20%) CONCLUSIONS: (1) The most frequent clinical presentation of Lyme borreliosis in analyzed children was neuroborreliosis; (2) Isolated arthralgias in children reactive with B. burgdorferi ELISA IgM need to be confirmed with Western blot assay before implementing the antibiotic therapy.

[The significance of immunoblot tests in diagnosis of Lyme borreliosis in children]. / Znaczenie testu immunoblot w diagnostyce boreliozy z lyme u dzieci.

OBJECTIVE: Verification of Lyme disease serodiagnosis in children by use of Western blot (WB) testing. MATERIAL AND METHODS: 24 children (8 males, 16 females) at the average age of 15,5y have been diagnosed from January 1st till December 31, 2007. All Lyme patients with positive or equivocal ELISA IgM and or ELISA IgG test results were included in the study. The ELISA (Bellco Biomedica, Austria)-Western blot (DRG, Diagnostics, Germany) two test protocol using sera of Lyme borreliosis patients was evaluated. RESULTS: Positive ELISA IgM results were confirmed in 20 out of 24 children (83,3%). In WB confirmation test, the positive results were obtained in 10 children (41,7%), equivocal results--in 22 (8.3%) and negative in 12 (50%) children. The quantitative accordance of both ELISA IgM-WB IgM tests was 50%. The higher quantitative accordance (96%) of both tests was obtained studying IgG serologic response. CONCLUSION: A positive ELISA IgM result very likely represents a false-positive result and should always be confirmed by WB assay and objective clinical signs of borreliosis before implementing the appropriate antimicrobial therapy.

[Norovirus infection in children hospitalized with acute gastroenteritis in northeastern Poland]. / Zakazenia norowirusowe u dzieci hospitalizowanych z ostra biegunka w pólnocno-wschodniej Polsce.

Noroviruses belonging to the family of Caliciviridae are a major cause of acute gastroenteritis in both children and adults. In the current study incidence of norovirus gastroenteritis was estimated in children hospitalized for acute gastroenteritis using commercially available ELISA tests. Epidemiological data were correlated with basic demographic findings. A hundred and forty nine children with acute gastroenteritis were enrolled in the study. Screening for common viruses causing gastroenteritis: rotavirus and adenovirus was performed and than stool samples were frozen and stored in <20 degrees C for future simultaneous testing with IDEIA Norovirus (Dakocytomation). Group I noroviruses were found in one child when 16 children were tested positive for Norowirus group two. In total noroviruses were found in 11.4% of children included in the study. Children with norovirus infection were 3 weeks to 15 years old (mean age 5.9 years). Seasonal peak of norovirus infection was seen in September through December. The infectious agent has not been identified in 43% of investigated children. Our results support important role of noroviruses as a causing agent of gastroenteritis in children in Northeastern Poland. The importance of noroviruses may grow as rotavirus infections are likely to be eliminated due to wide introduction of vaccine in the nearest future. Routine testing for noroviruses should be considered in clinical practice.