Multifocal necrotizing fasciitis - case report.

PURPOSE: Necrotizing fasciitis (NF) is a rare, life-threatening soft-tissue infection, characterized by rapidly spreading inflammation, with secondary necrosis of the fascia and surrounding tissues. It is mostly caused by group A beta-haemolytic streptococci or multibacterial. A case of the 25-year-old man admitted on September 2006 to the Department of Dermatology and Venereology with suspicion of erysipelas of the left upper limb and left foot is presented. On admission the pain, erythema, diffuse oedema of the left upper limb and erythema of the left foot were observed. Laboratory results revealed elevated: ESR, acute phase parameters (C-reactive protein, D-dimer), CPK and fibrinogen. Within 72-hours, despite treatment with antibiotics and anticoagulants, the oedema and pain increased, initial necrosis of the skin and extreme local tenderness appeared. Suspecting NF the patient had been transported to the Department of Surgery from where, after surgical debridement of devitalized tissue, was moved to the Intensive Care Unit and then transferred to the National Centre of Hyperbaric Medicine of the Medical University of Gdansk. Despite of repeated debridement, aggressive antibiotic therapy and hyperbaric oxygen therapy, necrosis was spreading. The patient developed sepsis and acute respiratory distress syndrome. Amputation of the left upper limb was performed. Five months later patient was admitted to ICU in Bialystok after a suicide attempt. After next four months he died. The dramatic course of the disease is the evidence, that having an adequate knowledge about early symptoms of NF can save patient's life.

The influence of Chlamydia trachomatis infection on spontaneous abortions.

PURPOSE: The aim of the study was to evaluate the frequency of Chlamydia trachomatis (C.t.) infection among women who experienced a miscarriage. MATERIALS AND METHODS: Patients referred to the Centre for STD Research and Diagnostics in Bialystok from the Department of Perinatology and from gynaecological outpatient clinics, after spontaneous abortion were enrolled in the study. C.t. infection diagnostics were performed among 76 women with 1 miscarriage and 44 patients with > or =2 miscarriages in anamnesis. Forty-six patients in the 2nd and the 3rd trimester of normal pregnancy served as a comparative group. Endocervical swabs as well as blood serum were obtained. To detect chlamydial DNA, direct PCR method was performed (Roche, Molecular Systems, N.J., USA). To detect IgA and IgG specific anti-chlamydial antibodies we used immunoenzymatic assay (medac, Hamburg, Germany). RESULTS: In patients with 1 miscarriage (gr.1), C.t. infection by means of PCR was detected in 11.8% of women (p=0.029), in patients with > or =2 miscarriages (gr.2) in 9.1% (p=0.198) and in the comparative group (gr.0) in 2.2%. Specific anti-chlamydial antibodies IgA class were detected in: 7.9 (p=0.082) in group 1, 4.5% (p=0.236) in group 2 and in 0% in group 0, and IgG class in 21.1% (p=0.024), 36.4% (p=0.000) and in 4.4%, respectively. CONCLUSIONS: 1. C.t. infection is an important causative agent of miscarriages in women. 2. C.t. infection diagnostic procedures should be considered in screening tests during pregnancy.

Chlamydia trachomatis urogenital infection in women with infertility.

PURPOSE: The study objective was to evaluate the prevalence of urogenital Chlamydia trachomatis (C.tr.) infection in women with diagnosed infertility. MATERIAL AND METHODS: The study involved patients from the Department of Gynecological Endocrinology and from the Center for Reproductive Medicine "Kriobank" in Bialystok. Female patients (n=71), aged 23-41, were divided into two groups according to the main diagnosis: A--tubal infertility (23) and B--infertility of another origin (48). For direct testing, PCR method was used to detect C.tr. infection in cervical samples (Roche, Molecular Systems, N.J., USA). Specific IgA and IgG anti-chlamydial antibodies in the serum were determined by immunoenzymatic assay (medac, Hamburg, Germany). Diagnostic procedures were performed at the Centre for STD Research and Diagnostics in Bialystok. RESULTS: In group A, C.tr. infection was detected in: 8.7% patients, in group B--8.3%. Specific anti-C.tr. antibodies IgA were detected in: 13.0% in group A and 6.3% in group B, IgG respectively in 39.1% and in 10.4%. CONCLUSIONS: 1. C.tr. infection is very important etiological factor of female infertility. 2. The detection of specific antichlamydial antibodies is a valuable, noninvasive diagnostic procedure. 3. Infertile women should be routinely tested for C.tr. infection.

Prevalence of Chlamydia trachomatis infection in women with cervical lesions.

PURPOSE: The study objective was to evaluate the prevalence of Chlamydia trachomatis (C. trachomatis) infection in women with and without pathological lesions in the uterine cervix. MATERIAL AND METHODS: A total of 120 patients, aged 15-57 (mean age 29), recruited for the study, were referred by gynaecological clinics in the Podlasie province. Gynaecological examinations confirmed cervicitis accompanied by erosions in 75 patients (group I) and cervicitis alone in 45 women (group II). The comparative group (control) consisted of 35 women, aged 16-48 years (mean age 29), who had no clinical symptoms or pathological lesions in the cervix. Direct immunofluorescence tests (MicroTrack, Syva) or polymerase chain reaction assays (PCR, Roche) were used to detect C. trachomatis infection in cervical samples. Antichlamydial IgG antibodies in the serum were determined using an immunoenzymatic assay (C. trachomatis IgG, EIA medac). Two-frequencies test was used for the statistical analysis of results. P values of <0.05 were considered statistically significant. RESULTS: In the direct tests, C. trachomatis infection was found in group I in 9/75 women (12.2%), in group II in 9/45 (20%) and in the comparative group in 1/35 (2.9%) (group I vs control p > 0.1252; group II vs control p < 0.025). IgG specific antibodies were detected in group I in 17/49 patients (34.7%), in group 11 in 5/18 (27.8%) and in the comparative group in 2/35 (5.7%) women (group I vs control p < 0.0022; group II vs control p < 0.0319). CONCLUSIONS: Our results show a higher prevalence of C. trachomatis infection in female patients with cervical lesions as compared to unaffected women, thus suggesting that diagnostic tests for C. trachomatis infection should be included in the screening programs for women.