Aleksander Garlicki

Publications of Aleksander Garlicki

• Role of IL-6 and neopterin in the pathogenesis of herpetic encephalitis.

  Authors: Monika Bociąga-Jasik, Andrzej Cieśla, Anna Kalinowska-Nowak, Paweł Skwara, Aleksander Garlicki, Tomasz Mach

  Pharmacological reports : PR. 09/2011; 63(5):1203-9.

  Herpetic encephalitis (HSE) is one of the most severe infection of the central nervous system (CNS), connected with high mortality rate, even when appropriate therapy has been introduced. BetterHerpetic encephalitis (HSE) is one of the most severe infection of the central nervous system (CNS), connected with high mortality rate, even when appropriate therapy has been introduced. Better understanding of pathomechanisms responsible for neuronal injury during the course of the disease can be useful in the assessment of the risk of the occurrence of severe complications, as well as in potential introduction of additional therapeutic methods. The purpose of this study is to assess the correlation between concentration of neopterin and IL-6 in the CSF and serum, and the course of HSE. In this study, 36 patients with HSE were investigated, and the control group consisted of 32 patients in whom the infection of the CNS was excluded. We observed significantly higher concentration of neopterin and IL-6 in the CSF of patients with HSV as compared with the control group. Neopterin and IL-6 levels in the CSF correlated with the course of HSE. Higher values were connected with the risk of respiratory failure, development of permanent neurologic complications and patient death. Negative correlations between concentration of IL-6 and neopterin and patient condition assessed by Glasgow Coma Scale (GCS) were observed. Neopterin with high sensitivity and specificity allowed to predict the risk of death or severe neurological complications. Increased concentration of neopterin and IL-6 in the CSF and serum revealed reciprocal positive correlation. Assessment of the concentration of IL-6 and neopterin in the serum was not useful to predict the course of HSE.

• [Interleukin 8 and interferon gamma in ocular toxoplasmosis].

  Authors: Jacek Czepiel, Grazyna Biesiada, Iwona Sobczyk-Krupiarz, Grazyna Miklasszewska, Danuta Fedak, Bogdan Solnica, Tomasz Mach, Aleksander Garlicki

  Klinika oczna. 01/2011; 113(4-6):149-52.

  Toxoplasmosis is one of the most common parasitic infections in the world, it is caused by Toxoplasma gondii. The infection is typically asymptomatic or the symptoms are very mild. Approximately 10%Toxoplasmosis is one of the most common parasitic infections in the world, it is caused by Toxoplasma gondii. The infection is typically asymptomatic or the symptoms are very mild. Approximately 10% patients have limphadenopathy, involvement of the others organs, like eyes, nervous system, liver, heart, are observed more rarely. The aim of our study was to assess the level of selected cytokines in blood among patients with ocular toxoplasmosis. We have enrolled in the study 30 patients, 19-42 years old, treated for ocular toxoplasmosis, and 20 healthy volunteers, 20-48 years old, to the control group. Tests for blood morphology, C-reactive protein, the level of IL-8 and IFN-gamma were performed in all patients. The blood parameters in toxoplasmosis group were performed before antiparasitic treatment was given. The level of IFN-gamma in blood was lower among patients with ocular toxoplasmosis comparing with control group (1.52 vs. 4.18 pg/ml; p = 0.002). The level of IL-8 in blood was lower among patients with ocular toxoplasmosis comparing with control group (22.96 vs. 94.3 pg/ml; p = 0,007). There were no correlations between analyzed cytokines and blood morphology or CRP. The low level of IFN-gamma and IL-8 in blood is important factor leading to reactivation of the ocular toxoplasmosis.

• [Lipodystrophy and metabolic disturbances as complications of antiretroviral therapy].

  Authors: Monika Bociaga-Jasik, Beata Kieć-Wilk, Anna Kalinowska-Nowak, Tomasz Mach, Aleksander Garlicki

  Przegla̧d lekarski. 01/2010; 67(12):1332-4.

  Effective treatment of HIV infection with antiretroviral drugs significantly improve prognosis. Reduction of mortality and life prolongations in patients receiving such therapy have been alsoEffective treatment of HIV infection with antiretroviral drugs significantly improve prognosis. Reduction of mortality and life prolongations in patients receiving such therapy have been also connected with the risk of side effects development. Among these complications metabolic disturbances such as lipodystrophy, dyslipidaemia, and insulin resistance which are present according some authors in up to 50% of patients receiving HAART play an important role. In spite of different investigations molecular basis of lipodystrophy development during HAART have not be fully understood, and the latest research revealed a lot of new aspects connected w adipocyte tissue pathophysiology, which were not taken up to know into consideration. In the presented publication the most important information about pathogenesis of lipodystrophy development in HIV infected patients treated with ARV drugs have been presented.

• [Neurological complications among patients with zoster hospitalized in Department of Infectious Diseases in Cracow in 2001-2006].

  Authors: Grazyna Biesiada, Jacek Czepiel, Iwona Sobczyk-Krupiarz, Tomasz Mach, Aleksander Garlicki

  Przegla̧d lekarski. 01/2010; 67(3):149-50.

  Herpes zoster is an infectious disease caused by varicella zoster virus (VZV). After replication at the place of entry, VZV spreads via the blood into the skin and mucosa, causing the varicella. FromHerpes zoster is an infectious disease caused by varicella zoster virus (VZV). After replication at the place of entry, VZV spreads via the blood into the skin and mucosa, causing the varicella. From these regions VZV migrates into the sensory ganglia where it establishes a latent infection. The aim of our study was to analyze the localization of the skin changes and correlations of neurological complications among patient with zoster. We have reviewed medical documentation of the 67 patients with herpes zoster, hospitalized in our Department during the years 2001-2006. We have studied localization of the herpes zoster changes and frequency of neurological complications among these patients. Neuralgia was less intensive and last shorter time, when antiviral treatment had been started earlier. Neuralgia, meningitis, encephalitis and complications of the eye zoster were present more often among patients over 65 years old.

• [The analysis of epidemiology, clinical symptoms, serological tests in the course of borreliosis].

  Authors: Grazyna Biesiada, Jacek Czepiel, Maciej Leśniak, Aleksander Garlicki, Tomasz Mach

  Przegla̧d lekarski. 01/2010; 67(3):181-3.

  Lyme disease is an animal-borne disease, caused by spirochetes of the Borrelia burgdorferi (Bb). The infection is transmitted by ticks of the Ixodes ricinus species. Humans are infected through aLyme disease is an animal-borne disease, caused by spirochetes of the Borrelia burgdorferi (Bb). The infection is transmitted by ticks of the Ixodes ricinus species. Humans are infected through a tick bite to the skin. The aim of the study was evaluation of epidemiology, symptoms and serologic factors in Lyme disease. We have enrolled 39 patients from Malopołska region in the study treated for Lyme borreliosis. History of tick biting, clinical signs and symptoms and serological tests were evaluated. The most common symptoms were headaches and pain of the large joints. Patients with untreated erithema migrans (EM) more often developed symptoms from nervous system (83%) than joints (54%). We found abnormalities which confirmed inflammation in CSF in 24.3% of patients. Patients with positive IgG antibodies against Bb in CSF and confirmed their intrathecal synthesis had never had EM in the past. There is low percentage of the patients who were treated due to EM. Patients with untreated EM more often developed symptoms from nervous system than joints. The most common symptoms among our patients were headaches and pain of large joints.

• Levels of sVCAM-1 and sICAM-1 in patients with lyme disease.

  Authors: Grazyna Biesiada, Jacek Czepiel, Iwona Sobczyk-Krupiarz, Dominika Salamon, Aleksander Garlicki, Tomasz Mach

  Polskie archiwum medycyny wewnȩtrznej. 05/2009; 119(4):200-4.

  INTRODUCTION: Lyme disease is a multi-organ animal-borne disease caused by the spirochete Borrelia burgdorferi (Bb). OBJECTIVES: As the pathogenesis of Lyme borreliosis is not fully understood, theINTRODUCTION: Lyme disease is a multi-organ animal-borne disease caused by the spirochete Borrelia burgdorferi (Bb). OBJECTIVES: As the pathogenesis of Lyme borreliosis is not fully understood, the study has been designed to examine levels of soluble vascular cell adhesion molecule-1 (sVCAM-1) and soluble intercellular adhesion molecule-1 (sICAM-1) in serum and the cerebrospinal fluid (CSF) of patients with Lyme borreliosis and their associations with clinical signs and symptoms and anti-Borrelia burgdorferi (anti-Bb) antibody titers. PATIENTS AND METHODS: Sixty-four patients were enrolled in the study, including 39 patients treated for Lyme borreliosis and 25 without the disease (control group). In both groups sVCAM-1 and sICAM-1 levels were determined in serum and the CSF. RESULTS: Mean serum sICAM-1 and sVCAM-1 levels were higher in patients with Lyme borreliosis than in the control group. Serum sICAM-1 levels were significantly lower among patients with results positive for immunoglobulin M seroreactivity with Bb than among those with negative antibody responses. In patients with Bb-specific serum immunoglobulin G (IgG) antibodies, significantly higher serum sICAM-1 levels were found. Higher sVCAM-1 and sICAM-1 levels in the CSF were observed in patients positive for anti-Bb IgG antibody titers in the CSF. CONCLUSIONS: In patients with Lyme borreliosis, endothelial cell activation results in elevated levels of sICAM-1 and sVCAM-1 in serum and the CSF.

• [Brain abscess--modern diagnostics and therapeutic treatment]

  Authors: Anna Kalinowska-Nowak, Aleksander Garlicki, Monika Bociaga-Jasik

  Przegla̧d epidemiologiczny. 02/2009; 63(1):89-95.

  Brain abscess is one of the most serious diseases of the central nervous system. This condition is more common among men--twice to three times, and morbidity rate is highest in fourth decade of theBrain abscess is one of the most serious diseases of the central nervous system. This condition is more common among men--twice to three times, and morbidity rate is highest in fourth decade of the life. Etiologic agents of brain abscess are bacteria, fungus, protozoa and parasites. The development of the brain abscess can resulted from the spread of infection from local sites or bloodborne from distal sites. In 10-15% of cases multiple abscesses develop. Headache is the most common syndrome. The radiologic tests: computed tomography or magnetic resonance are tests of choice in diagnosis and monitoring of treatment. Treatment of brains abscesses required cooperation of different specialists: infectious diseases, neuroradiologist, neurologists and neurosurgeon. Decision about therapeutic methods depends on number, size and localization of lesions, and patient's condition. In conservative treatment empiric antibiotic therapy and supportive treatment are used. Actually two methods of surgical treatment are used: CT- guided stereotactic aspiration and incision of the brain abscess by craniotomy. Actually mortality rate is 6 to 24%. Among 30-56% patients permanent neurological complications are reported.

• [Malaria--a tropical disease imported to Poland--case report]

  Authors: Dominika Salamon, Aleksander Garlicki

  Przegla̧d epidemiologiczny. 01/2009; 63(2):317-9.

  We present a case of severe malaria caused by Plasmodium falciparum in a 54 year-old woman who stayed for a few of days in Western Africa. Following the case presentation the nature, the course, theWe present a case of severe malaria caused by Plasmodium falciparum in a 54 year-old woman who stayed for a few of days in Western Africa. Following the case presentation the nature, the course, the diagnosis, the treatment and the prevention of malaria were discussed.

• [Neopterin in serum and cerebrospinal fluid in Lyme disease].

  Authors: Grazyna Biesiada, Jacek Czepiel, Aleksander Garlicki, Tomasz Mach

  Przegla̧d lekarski. 01/2009; 66(9):508-10.

  Lyme disease is a multiorgan disease, caused by spirochetes of Borrelia species. Clinical picture is diverse, borreliosis can affect skin, nervous system, musculoskeletal system and heart. NeopterinLyme disease is a multiorgan disease, caused by spirochetes of Borrelia species. Clinical picture is diverse, borreliosis can affect skin, nervous system, musculoskeletal system and heart. Neopterin is a marker of cytotoxic lymphocytes T activities, it is produced by monocytes/macrophages stimulated with IFNgamma. The aim of our study was to evaluate the level of neopterin in serum and cerebrospinal fluid in borreliosis and correlate it with the symptoms, markers of inflammation in cerebrospinal fluid (CSF), and serological tests against Borrelia burgdorferi. We have enrolled in the study 39 patients treated for Lyme borreliosis. The level of neopterin in serum was assessed in all patients, among patient with suspicion of neuroborreliosis (n = 33) we assessed the level of neopterin, protein, glucose and chlorium in CSF. The level of neopterin in CSF was lower among patients who were treated due to presence of erithema migrans in their past regarding patients who had never had erithema migrans (p = 0.008). The level of neopterin in CSF was higher (6.6 nmol/l) in patients with the presence of inflammation in CSF versus patients with no changes in CSF (3.8 mmol/l; p = 0.019). There was no correlation between neopterin in serum or CSF and Westernblot test. Patients with neuroborreliosis who had lymphocytic meningitis had higher level of neopterin in CSF. We suggest the role of neopterin in pathogenesis on neuroborreliosis. Neopterin as a marker of cytotoxic lymphocytes T activities can be useful in borreliosis diagnosis but more studies regarding this problem should be done.

• [Analysis of Borrelia burgdorferi genostrains among patients with Lyme disease].

  Authors: Grazyna Biesiada, Jacek Czepiel, Dominika Salamon, Aleksander Garlicki, Anna Dziubek, Barbara Maziarz, Tomasz Mach

  Przegla̧d lekarski. 01/2009; 66(9):511-2.

  Lyme borreliosis is a zoonose which can be transmitted to the humans during Ixodes tick bite to the skin. The disease is caused by bacteria--spirochetes of the Borrelia species, classified asLyme borreliosis is a zoonose which can be transmitted to the humans during Ixodes tick bite to the skin. The disease is caused by bacteria--spirochetes of the Borrelia species, classified as Borrelia burgdorferi strain. In Poland Lyme borreliosis is caused by Borrelia garinii, Borrelia afzelii and Borrelia burgdorferi sensu stricto. The presence of Borrelia spielmani was recently reported. The study included 249 patients diagnozed in University Hospital in Krakow due to suspicion of Lyme borreliosis in 2005-2008. Results of serologic tests against borreliosis were analized using Elisa tests (Mikrogen), positive tests were confirmed using Western blot tests (Biomedica). It was found the high percentage of the antibodies in class IgM, which are important in acute phase of borreliosis, typical for Borrelia garinii, whereas in class IgG it was found the prevalence of protein typical for Borrelia afzellii and Borrelia burgdorferi sensu stricto. It was found the high prevalence of the presence VIsE reacting with IgG antibodies. It was noted the presence of Borrelia spielmani genostrain in Poland.

• Neuroborreliosis with extrapyramidal symptoms: a case report.

  Authors: Grazyna Biesiada, Jacek Czapiel, Iwona Sobczyk-Krupiarz, Aleksander Garlicki, Tomasz Mach

  Polskie archiwum medycyny wewnȩtrznej. 06/2008; 118(5):314-7.

  The disease of Lyme is a tick-borne infection. It involves skin, the nervous system, joints and the heart. Spirochaeta Borrelia burgdorferi is the etiologic agent of the disease. In the majority ofThe disease of Lyme is a tick-borne infection. It involves skin, the nervous system, joints and the heart. Spirochaeta Borrelia burgdorferi is the etiologic agent of the disease. In the majority of cases, clinical symptoms, like migrating erythema, occur from 3 to 30 days, sometimes to 3 months after a bite from a tick. The early disseminated infection involves multiple migrating erythema, neuroborreliosis, arthritis, myocarditis and other organ-related symptoms. The late stage of chronic infection involves chronic atrophic leg dermatitis, neurological and rheumatological symptoms, and other organ-related symptoms which persist for above 12 months. The diagnosis of the disease of Lyme is based upon specific clinical symptoms confirmed by serologic tests. The two-step diagnostic protocol including the ELISA method, confirmed by the Western-blot test, is optimal. The present article describes a case of a 59-year-old man, a computer specialist, who often spends his free time walking in woods for recreation, and who was bitten by a tick 3 years before hospitalization. The bite resulted in migrating erythema that subsided without antimicrobial treatment. In spite of this, the man had not changed his hobby exposing himself to bites from ticks. One year later, multiple migrating erythema and extrapyramidalis symptoms appeared without any other organ malfunctions. In the current year, the patient was admitted to the Infectious Diseases Hospital, and received antibiotics (ceftriaxon) with following neurological improvement. Several months later, extrapyramidal symptoms increased. On the day of admission to the hospital, the neurologic examination showed abnormalities of upper and lower limbs movements (propulsive walking and the right lower leg traction), the right hand tremor, pouts of the face, and sleepiness.

• [The case of Salmonella paratyphi A infection in Poland]

  Authors: Iwona Sobczyk-Krupiarz, Aleksander Garlicki, Grazyna Biesiada, Jacek Czepiel, Paweł Skwara, Dominika Salamon, Tomasz Mach

  Przegla̧d lekarski. 02/2008; 65(2):107-8.

  Paratyphoid fever is an acute infection caused by Salmonella paratyphi A, B or C. The disease is transmitted from person to person by fecal-oral way. Typical for typhoid fever are splenomegaly,Paratyphoid fever is an acute infection caused by Salmonella paratyphi A, B or C. The disease is transmitted from person to person by fecal-oral way. Typical for typhoid fever are splenomegaly, bradycardia, fever, constipation or mild diarrhoea oftten associated with abdominal tenderness. We present the case of patient who was infected by Salmonella paratyphi C while his travelling in Asia.

• [Invasive meningococcal disease--management and treatment].

  Authors: Aleksander Garlicki, Monika Bociqga-Jasik, Anna Kalinowska-Nowak

  Przegla̧d epidemiologiczny. 01/2008; 62 Suppl 1:39-44.

  Invasive meningococcal disease is life threatening disease and in fulminant cases mortality rate may be as high as 70%. Rapid introduction of treatment and monitoring on intensive care unit isInvasive meningococcal disease is life threatening disease and in fulminant cases mortality rate may be as high as 70%. Rapid introduction of treatment and monitoring on intensive care unit is crucial for prognosis. The understanding of patomechanism responsible for sepsis development allow to introduce supportive treatment including glicocorticoids and recombinant human activated protein C. Very important is suitable prophylaxis among risk groups with, additional considering vaccination in the case of infection caused by A, C, Y, W-135 serogroups.

• [Changes in cerebrospinal fluid in patients with tuberculosis of the central nervous system]

  Authors: Michał Jedrychowski, Aleksander Garlicki

  Przegla̧d lekarski. 01/2008; 65(7-8):332-4.

  The aim of the study was to analyze the parameters of the cerebrospinal fluid in patients with tuberculosis of the central nervous system confirmed by culture or molecular methods, in comparison toThe aim of the study was to analyze the parameters of the cerebrospinal fluid in patients with tuberculosis of the central nervous system confirmed by culture or molecular methods, in comparison to patients without such confirmation. The analysis of medical documentation of 13 patients with CNS tuberculosis, 10 male and 3 female who were hospitalized at the Clinic of Infectious Diseases in Kraków in years 2001-2006 was performed. Following parameters of the cerebrospinal fluid were taken into account in both groups of patients: cytologic analysis, protein, glucose and chloride concentration. Statistical analysis was done using the non-parametric Mann-Whitney U test. The only parameter for which statistically significant difference between the two groups of patients was found was the level of glucose in CSF (p<0.05). Lower glucose concentration was observed in the group with etiologically confirmed CNS tuberculosis. Moreover additional localisation of tuberculosis was observed in this group of patients. Introduction of the molecular biology methods in diagnosis allowed to detect the etiologic factor more often.

• [The modern therapy of lyme disease]

  Authors: Aleksander Garlicki

  Przegla̧d epidemiologiczny. 02/2007; 61(3):449-56.

  The modern therapy of Lyme disease, including newest Guidelines of the Infectious Diseases Society of America has been presented. Poland is endemic region for borreliosis and number of reported casesThe modern therapy of Lyme disease, including newest Guidelines of the Infectious Diseases Society of America has been presented. Poland is endemic region for borreliosis and number of reported cases have been increasing rapidly. Newest guidelines should help doctors, not only infectious disease specialist, but especially General Practicioners, solve problems assiciated with therapy of Lyme disease.

• [Efficacy of vaccination against hepatitis B in adult with HIV infection]

  Authors: Anna Kalinowska-Nowak, Monika Bociaga-Jasik, Aleksander Garlicki, Tomasz Mach

  Przegla̧d epidemiologiczny. 01/2007; 61(2):339-47.

  OBJECTIVES: The aim of the study was to evaluate the efficacy of vaccination against hepatitis B in HIV infected individuals and the influence of the stage of HIV infection and antiretroviral therapyOBJECTIVES: The aim of the study was to evaluate the efficacy of vaccination against hepatitis B in HIV infected individuals and the influence of the stage of HIV infection and antiretroviral therapy (HAART). Response for additional doses of hepatitis B vaccine among the patients who do not develop protective anti-HBs level after routine vaccination schedule was analysed. METHODS: Fifty-four HIV infected individuals, 20 women (37%) and 34 men (63%), 20 to 64 years old (mean age 32 years) were analysed. 32 patients (59.6%), 22 men and 10 women were treated with antiretroviral drugs. Stage of HIV infection was assessed on the basis of data derived from medical records (lowest CD4 cells count, highest viral load), and immunological status at the moment of introduction of vaccination (CD4 cells count, viral load). Efficacy of vaccination was compared with control group, which consisted of 56 healthy volunteers. In both groups hepatitis B virus infection was excluded by serologic tests. HBvaxPro vaccine produced by Merck Sharp & Dohme Company, dose registered for adults (10 ug) was injected at month 0-1-6. Patients with anti-HBs <10 IU/l have received booster doses of vaccine month intervals, no more then three. RESULTS: Protective level of antibodies was found in 52 (92.9%) persons from control group and 32 (63%) HIV infected individuals. Anti-HBs > 100 IU/l was twice more common in control group (80%) than in investigated group (46.3%) (p < 0.001). Protective level of anti-HBs had 14.3% patients with CD4 below 200 cells/pl, none of them had anti-HBs > 100 IU/l. Patients with higher CD4 cell count had better response for vaccination (p = 0.015). Differences between patients with high and low viral load were not statistically significant (p = 0.015). Patients with viral load below 10,000 copies/ml had slightly better response then those with higher viral load. Efficacy of vaccination was also associated with the level of distraction of immunological system before introduction of HAART. Patients with CD4 < 200 cells/microl or HIV-RNA > 50,000 copies/ml had worst immunological response for vaccination. After the fist additional dose of vaccine anti-HBs >10 IU/l had 79.7% patients, 87.1% after the second dose and 90.7% after the third dose. Anti-HBs >100 IU/l had subsequently 57.4%, 66.7%, 79.6% patients. CONCLUSIONS: We concluded that efficacy of the routine vaccination schedule was lower among HIV individuals in comparison with healthy volunteers. Influence of the progression of HIV infection on the response for vaccination was detected. Additional vaccine's doses have improved efficacy of immunisation which was comparable with general population.

• [Met-enkephalin in the cerebrospinal fluid as an indicator of central nervous system injury in meningitis and encephalitis]

  Authors: Andrzej Cieśla, Krystyna Pierzchała-Koziec, Tomasz Mach, Aleksander Garlicki, Monika Bociaga-Jasik

  Polski merkuriusz lekarski : organ Polskiego Towarzystwa Lekarskiego. 06/2005; 18(107):549-51.

  THE AIM: Assessment of met-enkephalin level in the cerebrospinal fluid (CSF) of patients with inflammatory process of the central nervous system (CNS) was performed to estimate the role of opioidTHE AIM: Assessment of met-enkephalin level in the cerebrospinal fluid (CSF) of patients with inflammatory process of the central nervous system (CNS) was performed to estimate the role of opioid system in viral and bacterial meningitis, and encephalitis. MATERIAL AND METHOD: The met-enkephalin level, protein concentration and pleocytosis were analysed in the CSF of 53 patients with viral or bacterial meningitis, encephalitis, and in the control group of patients without inflammatory disease of the CNS. RESULTS: The biggest differences have been observed between the groups of patients with bacterial meningitis and those without inflammatory disease of the CNS, but they were statistically insignificant. There was a lack of correlation between met-enkephalin level and some factors of inflammatory process in CSF, such as pleocytosis and protein concentration. We have not revealed any correlation between etiological agent of CNS infection and opioid system of the brain. CONCLUSION: Despite the fact that, we observed in the study statistically insignificant changes, we suggest to continue investigations, including additional parameters which are characteristic for the CNS diseases.

• [Concentration of proinflammatory cytokines (TNF-alpha, IL-8) in the cerebrospinal fluid and the course of bacterial meningitis]

  Authors: Monika Bociaga-Jasik, Aleksander Garlicki, Anna Kalinowska-Nowak, Tomasz Mach

  Przegla̧d lekarski. 01/2004; 61(2):78-85.

  Bacterial meningitis is still associated with high mortality rate and severe neurological sequels. The aim of the study was to assess correlation between concentration of proinflammatory cytokinesBacterial meningitis is still associated with high mortality rate and severe neurological sequels. The aim of the study was to assess correlation between concentration of proinflammatory cytokines (TNF-alpha, IL-1 beta, IL-8) in the cerebrospinal fluid (CSF) and patient condition described on the basis of Glasgow Coma Scale (GCS), changes in the CSF (pleocytosis, protein and glucose level), mortality rate and occurrence of neurological complications. 42 patients with bacterial meningitis have been analysed. Control group consisted of 25 patients with viral meningitis and 23 patients without meningitis. In analysed group with bacterial meningitis the correlation between number of scores aggregated by patients in GCS and outcome has been observed. Concentration of TNF-alpha, IL-1 beta, IL-8 in CSF of patient with bacterial meningitis was significantly higher (mean value; 705.2 pg/ml, 401.1 pg/ml and 1696.0 pg/ml) than in control group (viral meningitis: 7.93 pg/ml, 31.89 pg/ml, 405.28 pg/ml, without meningitis: 0.38 pg/ml, 2.55 pg/ml, 32.56 pg/ml). Negative correlation between concentration of investigated cytokines in the CSF of patient with bacterial meningitis and GCS has been observed. Furthermore TNF-alpha and IL-8 levels correlated with pleocytosis, and protein and glucose levels, whereas IL-1 beta correlated with pleocytosis and protein level in CSF. Connection between TNF-alpha and IL-1 beta but not IL-8 level and outcome of bacterial meningitis has been observed. High TNF-alpha in the CSF (median value 953 pg/ml) was associated with significant risk of patient death. IL-1 beta has been better prognostic indicator. Patients who developed neurological sequels had median value of IL-1 beta level 401.3 pg/ml, and those who died had 585.9 pg/ml vs 244.7 pg/ml in the group who survived without any complications. Analysis of the ROC curve-revealed, that concentration of IL-1 beta > or = 289.9 pg/ml with 88.9% sensitivity and 67.7% specifity differentiate cases who at risk for death. For TNF-alpha the cut-off was > or = 538.9 pg/ml. The sensitivity for determined critical point was 77%, and specificity was 68.7%. Our investigation confirm that TNF alpha, IL-1 beta, IL-8 are useful in differential diagnosis of neuroinfections. Assessment of patients with bacterial meningitis on the basis of GCS is helpful to establish prognosis, and CGS seems to correlate with the intensity of inflammation in the CSF. High concentration of TNF-alpha, and IL-1 beta in the CSF are associated with the risk of patient death during the course of bacterial meningitis, but IL-1 beta has been the better prognostic marker.

• [The effect of antiinflammatory therapy with dexamethasone and dexamethasone with pentoxifylline on the course of bacterial meningitis]

  Authors: Monika Bociaga-Jasik, Anna Kalinowska-Nowak, Aleksander Garlicki, Tomasz Mach

  Przegla̧d lekarski. 02/2003; 60(11):710-5.

  Despite of antimicrobial therapy mortality rate in the bacterial meningitis (BM) is high. The aim of the study was to assess the influence of anti-inflammatory treatment with dexamethasone andDespite of antimicrobial therapy mortality rate in the bacterial meningitis (BM) is high. The aim of the study was to assess the influence of anti-inflammatory treatment with dexamethasone and dexamethasone with pentoxifylline on the course of this disease and concentration of proinflammatory cytokines TNF-alpha, IL-1 beta, II-8 in the cerebrospinal fluid (CSF). 42 patients with the BM were analysed. They were divided into three groups on the basis of applied therapy: A--treated only with antibiotics, A+D--treated with antibiotics and dexamethasone, A+D+P--treated with antibiotics, dexamethasone and pentoxifylline. Anti-inflammatory therapy did not have impact on the resolution of inflammation (pleocytosis, protein and glucose level) in the CSF. However, it was established that adjuvant treatment with dexa-methasone and pentoxifylline has beneficial effect on the course of the BM. In this group 61.5% of patients recovered, in comparison with 28.6% in the group A+D and 26.7% in the group A. Mortality rate was: in the group A--33%, A+D--21.4%, A+D+P--7.7% (p = 0.01). Correlation between the outcome of the BM in the investigated groups and cytokines concentration in CSF was observed. In the group A+D+P all patients responded to the therapy with decrease of cytokine concentration, and coefficients of variation were low (TNF-alpha--1%, IL-1 beta--23.6%, IL-8--18.9%). Also in the group A+D decrease of cytokines concentration in the CSF was observed, however was not such significant in all cases. In the group of patients treated only with antibiotics concentration of cytokines in the CSF varied, even increased in some of them. Our investigation indicates that inhibition of cytokines production in central nervous system (CNS) with dexamethasone and pentoxifylline improves the outcome of BM and is associated with the reduction of neurological sequels and deaths.

• [Tuberculous meningoencephalitis--own observations]

  Authors: Aleksander Garlicki, Urszula Kluba-Wojewoda, Monika Bociaga-Jasik, Anna Kalinowska-Nowak, Iwona Sobczyk-Krupiarz, Tomasz Mach

  Folia medica Cracoviensia. 02/2003; 44(1-2):27-38.

  Nine cases of the tuberculous meningoencephalitis in adult men and women treated in years 1993-2000 have been presented. The diagnosis was established on the basis of clinical picture and examinationNine cases of the tuberculous meningoencephalitis in adult men and women treated in years 1993-2000 have been presented. The diagnosis was established on the basis of clinical picture and examination of the cerebrospinal fluid (CSF). Routine analysis of CSF was done, as well as the microscopic examination, biological assay, and culture on the Lowenstein-Jensena medium and using Bactec 460 TB system. Only in one case Mycobacterium tuberculosis was found in the smear of CSF stained by Ziehl-Nielsen method. In one case the biologic assay was positive and Mycobacterium tuberculosis was cultured on Lowenstein-Jensen medium. In another 4 cases the pathogen was detected by Bactec 460 TB technique. In 4 cases Mycobacterium tuberculosis was also cultured from the secretion of the respiratory tract, and in one patient urine. On chest X-ray characteristic changes for pulmonary tuberculosis were observed in 5 cases (56%). Seven patients (78%) had hydrocephalus detected on CT scan of the head. One patient died, one (11%) developed persistent complication in form of spastic paralysis of lower extremities and sphincters dysfunction. Seven patients (78%) recovered completely after the 12 months therapy with standard chemotherapeutic regimen for tuberculosis.