Comparison of four serological methods for the detection of diphtheria anti-toxin antibody.

The aim of this study was to compare four serological methods for the detection of Corynebacterium diphtheriae IgG anti-toxin antibodies (IgG-DTAb) in human serum. One hundred serum samples were evaluated for C. diphtheriae IgG-DTAb by four different methods: passive haemagglutination (PHA), latex agglutination test (LA), toxoid enzyme-linked immunosorbent assay (Toxoid-ELISA), and toxin-binding inhibition enzyme-linked immunosorbent assay (ToBI-ELISA). As the external standardisation the neutralisation test for C. diphtheriae toxin in Vero cells (TN Vero) was used. For internal standardisation of IgG-DTAb titres, the WHO standard serum of human diphtheria antitoxin was used. The study revealed a poor correlation between the reference test and the PHA (r=0.34 Pearson's correlation coefficient), an acceptable correlation for the LA (r=0.74), a good correlation for the Toxoid-ELISA (r=0.81) and a very good correlation for ToBI-ELISA (r=0.93). The sensitivity measurements of PHA, LA, Toxoid-ELISA and ToBI-ELISA tests, were 14, 100, 94, 96% respectively and the corresponding specificity characteristics were 86, 76, 94, 90 respectively. Of the four evaluated methods, the ToBI-ELISA could be recommended for scientific and precise laboratory assays of diphtheria antibody levels in humans. For screening purposes the Toxoid-ELISA could be used, but the accuracy of antibody titres below 0.1 IU/ml, considered as the limits of protection, is questionable. Both tests offer very useful alternatives to the in vitro diphtheria toxin neutralisation test in Vero cells. Because of their unsatisfactory correlation and sensitivity as compared to the reference method, PHA and LA should be avoided and replaced by one of the two enzyme immunoassays.

Hospital infection control in Poland.

During the last 10 years, as in other areas of the public sector in Poland, the healthcare system has undergone important changes presenting a challenge for medical staff and healthcare managers alike. Since 1997, the Polish Government has undertaken important healthcare reforms. New regulations have introduced decentralization of management and a financing system for hospitals. These changes have provided favourable conditions in which to implement an infection control system for hospitals. The most important recent initiatives are training courses and workshops for hospital staff organized in co-operation with microbiologists and epidemiologists as well as preparation of recommendations and guidelines for hospitals. Several non-governmental organizations have been set up to improve hospital hygiene, infection control and monitoring of antimicrobial resistance.

National and local antibiotic policies in Central and Eastern Europe.

To assess the antibiotic policies of Central European countries, we performed an overview of antibiotic stewardship, prescription habits and antibiotic prescription regulatory procedures. Since most Central European countries have had centralized health care and drug policies, the situation 10 years after decentralization is surprising. Only 3 of 10 Central European countries have some regulation of prescription of antibiotics, only 4 restrict some antibiotics, only 5 have hospital and only 3 national antibiotic policies. In all but 3 countries physicians can prescribe quinolones and/or 3rd generation oral cephalosporins as first-line antibiotics. Information on local and national antibiotic policies in Central and Eastern European countries is given including prescription guidelines for antibiotic use in community and hospital.

[Evaluation of susceptibility to antibiotics of Staphylococcus aureus strains resistant to methicillin]. / Ocena wrazliwosci na antybiotyki szczepów Staphylococcus aureus opornych na metycyline.

Methicillin-resistant strains of Staphylococcus aureus (MRSA) constitute a serious diagnostic and therapeutic problem. Over 500 strains of Staphylococcus aureus were tested for susceptibility to methicillin. By application of a screening method, 13.7% of these strains were classified as methicillin-resistant. Over 95% of these strains were isolated from hospital infections. Applying criteria of belonging of these strains to methicillin-resistance classes it was found that 49.3% belonged to class II, 31.2% to class III and 19.5% to class IV. Analysis of susceptibility to antibiotics of MRSA strains demonstrated significant differences between class II and between class III and IV in resistance to imipenem, gentamycin, erythromycin and tetracycline. All tested strains were susceptible to ciprofloxacin, ofloxacin, vancomycin and teicoplanin. The screening method (25 mg methicillin/l of TSA medium) results in obtaining of univocal results of determination of methicillin-resistance in S. aureus.

[Immunity against diphtheria and tetanus in the adult Polish population]. / Stan uodpornienia przeciwko blonicy i tezcowi u doroslych mieszkanców Polski.

The aim of the study was to evaluate immunity against diphtheria and tetanus in healthy adult population in Poland. For determination of antitoxin IgG antibody, toxoid enzyme-linked immunosorbent assay (Toxoid-ELISA) was used. Serum samples were obtained from different regions of Poland and titrated for diphtheria (n = 2442) and tetanus (n = 827) IgG antitoxin. For calibration of anti-toxins determination, the WHO standard of human diphtheria and tetanus antitoxin was used. About 32% (n = 787) of persons were non-protected against diphtheria (IgG-DTAb < 0.1 IU/ml) and 24% (n = 195) against tetanus (IgG-TTAb < 0.1 IU/ml). In 63% (n = 1528) individuals basic protection for diphtheria and 48% (n = 402) for tetanus (0.1-1.0 IU/ml IgG-DTAb and IgG-TTAb) were observed. Only 5% (n = 127) were fully protected for diphtheria and 28% (n = 230) for tetanus (IgG-DTAb and IgG-TTAb > 1.0 IU/ml). In adults between 30-64 years of age, not vaccinated at least during last 10 years, 43% of persons were non-protected. The study showed insufficient immunity against diphtheria in adults. We indicate booster immunisation for selected group of persons.

[Tubulointerstitial nephritis related to immunotherapy and immunostimulation: a report of two cases]. / Sródmiazszowe zapalenie nerek zwiazane ze stosowaniem immunoterapii i leków immunostymulujacych--opis 2 przypadków.

Two cases of tubulointerstitial nephritis (TIN) with renal failure related to immunotherapy (case 1) and immunostimulation (case 2) have been described. Case 1: 18 years old male patient with hay fever was admitted because of rapid increase of serum creatinine from 1.1 mg/dl to 5.5 mg/dl, fever, weight loss and anemia which developed during 6 months after second course of immunotherapy. Case 2: 12 years old boy was admitted because of fever, weight loss and rapid progression to renal failure after treatment of pharyngitis with antibiotics and immunostimulant drug. In both patients renal biopsy was performed and TIN with huge lymphocytes T infiltrates was diagnosed. After 6 months treatment with corticosteroids renal function turned back to previous levels in both patients. Pathogenesis and treatment of TIN is discussed.

[The influence of hepatitis B vaccine dose on direct results of hepatitis B vaccination in children with nephrotic syndrome]. / Wplyw wielkosci dawki szczepionki na bezposrednie wyniki szczepien przeciw wirusowemu zapaleniu watroby typu B u dzieci z zespolem nerczycowyn.

In the first phase of the study on the efficacy of vaccination against hepatitis B with a double dose of the vaccine in children with steroid-sensitive nephrotic syndrome (NS), the best results were obtained in the group of patients in remission of NS. The aim of the present study was to compare the efficacy of standard and double doses of the vaccine in patients in remission. After excluding HBV infection, recombinant hepatitis B vaccine was administered i.m. according to the 0, 1, 2 month protocol in a standard dose in group I and a double dose in group II. In both groups the seroprotection rate was similar (I group-96%, II group-93%), however the anti-HBs antibody level was significantly higher in group II during a 3 month observation period.

[Long-term efficacy of hepatitis B vaccine in children with chronic renal failure]. / Odlegle wyniki szczepien przeciw wirusowemu zapaleniu watroby typu B u dzieci z przewlekla niewydolnoscia nerek.

The aim of the study was to determine the duration of post vaccination immunity and antibody persistence in children in different stages of chronic renal failure. The study was performed in 25 children and time of observation was 12-36 months. After completing vaccination seroprotection rate was 92% in non-dialysed children and 77% in dialysed. After 36 months of observation seroprotection was found in 90% of patients, none of them was infected by HBV. We conclude that in case of decrease in antibody titer below 100 mIU/ml the booster dose of vaccine is indicated.

Outbreak of ceftazidime-resistant Klebsiella pneumoniae in a pediatric hospital in Warsaw, Poland: clonal spread of the TEM-47 extended-spectrum beta-lactamase (ESBL)-producing strain and transfer of a plasmid carrying the SHV-5-like ESBL-encoding gene.

In 1996 a large, 300-bed pediatric hospital in Warsaw, Poland, started a program of monitoring infections caused by extended-spectrum beta-lactamase (ESBL)-producing microorganisms. Over the first 3-month period eight Klebsiella pneumoniae isolates were identified as being resistant to ceftazidime. Six of these were found to produce the TEM-47 ESBL, which we first described in a K. pneumoniae strain recovered a year before in a pediatric hospital in Lódz, Poland, which is 140 km from Warsaw. Typing results revealed a very close relatedness among all these isolates, which suggested that the clonal outbreak in Warsaw was caused by a strain possibly imported from Lódz. The remaining two isolates expressed the SHV-5-like ESBL, which resulted from the horizontal transfer of a plasmid carrying the blaSHV gene between nonrelated strains. The data presented here exemplify the complexity of the epidemiological situation concerning ESBL producers typical for large Polish hospitals, in which no ESBL-monitoring programs were in place prior to 1995.

The antibodies against Bordetella pertussis in sera of patients with Parkinson's disease and other non-neurological diseases.

OBJECTIVES: It has been reported that the prevalance of parkinsonism might be associated with exposure to whooping cough. METHODS: Examination of levels of antibodies against Bordetella pertussis in serum using enzyme-linked immunosorbent assay (ELISA) tests [presence of IgG antibodies against filamentous hemagglutinin and pertussis toxin (PT)] were performed in 81 persons (including 45 patients with controls) (age-matched groups). RESULTS: Positive results were found in patients with Parkinson's disease (PD), patients with other non-inflammatory diseases, and controls (about 40-45% in each group). A detailed examination of separate responses (IgG and IgA antibodies against PT, and a whole cell immune response) and of the serum level of immunoglobulins IgG, IgA and IgM was also performed. CONCLUSION: Our results demonstrate numerous cases of whooping cough serum antibodies among the adult population (also among PD patients). The results of our research, i.e. a common occurrence of Bordetella pertussis infection do not provide evidence of relationship between PD and the above-mentioned infection.