[Show abstract][Hide abstract] ABSTRACT: The purpose of this study was evaluation of the prevalence of co-infection with Borrelia species, A. phagocytophilum and Babesia spp. in patients with tick-borne encephalitis (TBE). At total of 110 patients with TBE were included in the study. Serological tests for tick-borne encephalitis virus (TBEV), PCR for Borrelia species, Anaplasma phagocytophilum and Babesia spp., blood smears for A. phagocytophilum and Babesia spp. and BLAST analysis for Babesia spp. were performed. Results showed a significant majority of patients co-infected with Borrelia species (30/110; 27 %), much less with A. phagocytophilum (12/110; 10.9 %) and with Babesia spp. (1/110; 0.9 %). The BLAST analysis of the 18S rDNA sequence obtained with the Babesia spp. specific primers indicated that the patient was infected with Babesia microti. Triple co-infections (TBEV-Borrelia species- A. phagocytophilum) were observed in three (3/110; 2.7 %) patients. Conclusions were such that differential diagnosis in patients after the tick bite, presenting with acute symptoms, should include not only TBE and Lyme disease, but also other diseases transmitted by ticks. In patients with low parasitemia in suspicion of Babesia spp. infection PCR seems to be a more sensitive method than blood smear. Co-infection with various tick-borne pathogens must be always considered, especially in endemic regions.
[Show abstract][Hide abstract] ABSTRACT: Erythema migrans (EM) is an early localized form of Lyme borreliosis (LB). EM appears 3-30 days after tick bite and presents as annular homogenous erythema, marked from unaffected skin. Typical EM has more than 5 cm in diameter, but there are reports of mini-EM in literature. Moreover, multiple or bullous EM are described. Diagnosis is based on clinical picture. In treatment antibiotics must be used. The aim of this paper was to draw attention to still existing problem of LB in Poland, not only in endemic areas and to the necessity of proper diagnosis, early implementation of antibiotics. It may prevent from late form of LB development, which may lead to irreversible damage, especially in nervous system or joints. EM presence in history increases the probability of subsequent LB forms such as neuroborreliosis or arthritis. Otherwise, symptoms may be misinterpreted, as they resemble the other in the course of more common diseases.
Polski merkuriusz lekarski: organ Polskiego Towarzystwa Lekarskiego 10/2013; 35(208):230-2.
[Show abstract][Hide abstract] ABSTRACT: Sepsis is a clinical syndrome that complicates severe infection. The incidence of sepsis is increasing worldwide. Aim of the study was evaluation of demographic data and clinical picture of patients hospitalized in Infectious Diseases Ward with a diagnosis of sepsis and severe sepsis. MATERIAL AND METHODS The retrospective study included 107 patients with sepsis and severe sepsis hospitalized in 1997-2010.
Sepsis was diagnosed in 48.6% of patients and severe sepsis - in 51.4% ofpatients. The mortality rate in patients with severe sepsis was 30.9%. Blood cultures were positive in 55.1% cases. Gram-positive bacteria were isolated most frequently - 71.7%. The most common source of infection overall was pneumonia (21.5%). Odontogenic infections (25%) and urinary tract infections (21.2%) dominated in patients with sepsis. 25.2% of patients developed bacterial meningitis.
Despite advances in diagnostics and treatment sepsis is still a major medical problem with high mortality. Patients with severe sepsis and meningitis should be treated in ICU setting. Decayed teeth should be considered as a potential source of sepsis of unknown origin.
[Show abstract][Hide abstract] ABSTRACT: Recently, a possible etiological connection between infection with Borrelia burgdorferi and various skin lesions, including morphea and systemic sclerosis (SSc), has been discussed. The aim of our study was the evaluation of frequency of skin thickening typical of SSc or morphea in the group of patients with Lyme disease (LD) with frequent exposition to tick bites. The group consisted of 110 patients with LD frequently exposed to tick bites form the northeastern Poland, which is an endemic area for this disease. To measure the skin lesions, the modified Rodnan total skin score (RTSS) was used. In the analyzed group, no skin changes typical of morphea or skin thickening were found. According to RTSS, all patients scored 0 points. Raynaud's phenomenon in all patients was not found. The relationship between scleroderma or morphea and LD is still a matter of controversy. Described by some authors, cases with LD and scleroderma may be associated with co-existence of B. burgdorferi infection with autoimmune
Rheumatology International 10/2011; · 2.21 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The aim of the study was to assess the concentration of chemokines: CXCL10, XCL11, CXCL12, CXCL13 in serum and cerebrospinal fluid (CSF) in patients with tick-borne encephalitis (TBE) before and after treatment. We evaluated also the usefulness of these molecules in diagnosis and monitoring of inflammation in TBE.
Twenty three patients hospitalized in The Department of Infectious Diseases and Neuroinfections of Medical University in Białystok, Poland were included in the study. Patients were divided into 2 groups: TBE group-patients with confirmed TBE and control group (CG): patients with excluded TBE and other inflammatory diseases of CNS. Concentration of CXCL10/IP-10, CXCL11/I-TAC, CXCL12/SDF-1α, CXCL13/BLC/BCA-1 in serum and CSF were measured with ELISA kits (R&D Systems, USA) according to the protocols.
The analysis of chemokines concentration in TBE patients before treatment and control group using ROC showed that serum CXCL10 and CXCL13 and CSF CXCL10, CXCL11, CXCL12 and CXCL13 differentiate both groups (p<0.05). The analysis of CXCL10, CXCL11, CXCL12 and CXCL13 before and after treatment showed that CXCL10 and CXCL11 in CSF and CXCL13 in serum differentiates both groups with p<0.05.
Concentration of CSF CXCL10, CXCL11, CXCL12, CXCL13 and serum CXCL10, CXCL13 may be good biomarkers of CNS inflammation caused by TBEV. Moreover concentration of CXCL10 in CSF and CXCL13 in serum may be used as indicators of patients recovery.
Advances in Medical Sciences 01/2011; 56(2):311-7. · 0.80 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Tick-borne encephalitis (TBE) is an emerging disease in Europe as in Poland, especially in north-eastern part of the country. The aim of the study was to characterize the epidemiology and clinical features of TBE in this region.
Clinical and epidemiological data of 687 patients hospitalized between 1993 and 2008 at the Department of Infectious Diseases and Neuroinfections with the diagnosis of TBE were analysed.
In the case of 59 patients (9.5%), the disease was job related (forestry workers, farmers). In the examined group, TBE presented with meningitis in 282 cases (41%), with meningoencephalitis in 353 cases (51.3%) and with meningoencephalomyelitis in 52 cases (7.6%). The most common neurological abnormalities were ataxia in 88 cases (14.17%) and pareses in 53 cases (8.53%). Four patients (0.6%) died, 144 patients (23.2%) were discharged with neurological sequelae of TBE. Two hundred and seventy-two patients (43.8%) required further psychiatric treatment. At least 38 patients (6.1%) developed long-term sequelae and required further hospitalizations. Dexamethasone in the dosage of 6-32 mg was administered in 407 patients for 1-64 days.
The diagnosis of TBE sometimes is difficult as the disease symptoms may be non-characteristic. Therefore, a detailed anamnesis is very important in the process of TBE diagnosis and may alone justify lumbar puncture conduction. Despite usually mild course of the disease, patients may develop neurological and psychiatrical sequelae.
European Journal of Neurology 12/2010; 18(5):673-9. · 4.16 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Lipid peroxidation products, malondialdehyde (MDA), 4-hydroxynonenal (4-HNE) and [Formula: see text], were determined in the plasma and urine of patients with Lyme arthritis and healthy people. The group consisted of 19 patients with Lyme arthritis (mean age 47 years) and the control group consisted of 16 healthy individuals (mean age 38 years). Diagnosis of Lyme disease was confirmed by epidemiological anamnesis, clinical manifestation of arthritis and serological examinations. Lipid peroxidation was estimated by the measurement of aldehydes (MDA and 4-HNE, determined by high-performance liquid chromatography [HPLC]) and prostaglandin derivatives (8 - isoPGF(2a), determined by liquid chromatography/mass spectrometry [LC/MS]). MDA and 4-HNE levels were increased about 2-4-fold in the plasma, while in the urine, the increases were about 2-fold. More significant increases were noted for the 8 - isoPGF(2a) total plasma level, which was enhanced over 4-fold, and for the urine 8 - isoPGF(2a) level, which was increased over 8-fold. The 8 - isoPGF(2a) total plasma level consists of free and esterified form. During infection, the ratio of free to esterified form is significantly smaller compared to healthy people. The ratio of free to esterified form of 8 - isoPGF(2a) may be a useful indicator of Lyme arthritis. Moreover, the complementarities of three lipid peroxidation product levels may be helpful in the diagnosis of Lyme arthritis.
European Journal of Clinical Microbiology 11/2010; 30(3):415-22. · 3.02 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Apoptosis of activated T lymphocytes is essential to immunoregulation and its abnormalities have been observed in immune system disorders and persistent infections. To asses Borrelia burgdorferi influence on the susceptibility of T lymphocytes to apoptosis, we have measured expression of the Fas death receptor on these cells after incubation with live B. burgdorferi.
Peripheral blood mononuclear cells from 23 LD patients (18 with Lyme arthritis, 5 with neuroborreliosis) and 13 healthy controls (C) were incubated for 48 hours with and without live B. burgdorferi spirochetes: B. afzelii, B. garinii or B. burgdorferi sensu stricto. After incubation, Fas expression on CD3+ cells was measured cytometrically with FITC-labeled monoclonal antibody.
Median fraction of Fas-expressing T lymphocytes increased under incubation with B. burgdorferi, with more cells expressing Fas after incubation with B. burgdorferi sensu stricto than with B. garinii. There was a tendency for a higher expression of Fas on T lymphocytes from LD patients then from controls, both in unstimulated and B. burgdorferi-stimulated cultures, but it did not reach a level of statistical significance.
B. burgdorferi seems to increase Fas expression on CD3+ T lymphocytes, which may render these cells more susceptible to apoptosis. This effect is stronger for B. burgdorferi s.s. than for B. garinii genospecies.
Advances in Medical Sciences 01/2010; 55(2):228-34. · 0.80 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Lysosomal exoglycosidases participate in the destruction of the articular cartilage by cleaving glycoside bonds in glycoproteins and proteoglycans. The aim of the study was to determine the activity of exoglycosidases: hexosaminidase, beta-glucuronidase, beta-galactosidase, alpha-mannosidase and alpha-fucosidase in serum and synovial fluid of patients with Lyme and rheumatoid arthritis. The study group consisted of 10 patients with chronic Lyme arthritis (age 18 - 74 y), 13 with rheumatoid arthritis (age 32 - 70 y) and 10 with juvenile idiopathic arthritis (age 8 - 17 y). The control group consisted of 9 healthy volunteers (age 24 - 62 y). The activity of the exoglycosidases was determined with the p-nitrophenyl derivatives of sugars as substrates. A significant increase of the activity of all the exoglycosidases in serum and in synovial fluid of the patients with different forms of arthritis was found. The ratio of synovial fluid/serum activity of exoglycosidases was above 2.0 in LA but not in JIA and RA patients. As the main source of exoglycosidases in the joint is the synovial membrane, this result supports the appropriateness of therapeutic synovectomy in chronic Lyme arthritis with knee effusion. The serum activity of hexosaminidase may be used in monitoring the course of Lyme arthritis and the efficiency of treatment.
[Show abstract][Hide abstract] ABSTRACT: The aberrant inflammatory response is probably involved in the pathogenesis of chronic Lyme borreliosis, including chronic Lyme arthritis and neuroborreliosis. Transforming growth factor-beta 1 (TGF-beta1) is an important anti-inflammatory and immunomodulatory cytokine and its deficient synthesis is linked to exaggerated inflammation and immune response.
Peripheral blood mononuclear cells (PBMC) from 25 patients with Lyme borreliosis and 6 controls were incubated for 7 days with suspension of Borrelia afzeli, B. garinii and B. burgdorferi sensu stricto spirochetes. TGF-beta1 concentration in culture supernatants was measured with ELISA. Results were analyzed according to disease duration (group I--chronic borreliosis, n=20; group II--early borreliosis, n=5) and clinical form (LA--arthritis, NB--neuroborreliosis).
TGF-beta1 concentration was increased in supernatants of PBMC cultures of patients with early neuroborreliosis, in comparison with chronic borreliosis and controls. In chronic, but not in early borreliosis, there was a tendency for decrease of TGF-beta1 synthesis under stimulation with B. burgdorferi spirochetes.
Impaired synthesis of TGF-beta1 by mononuclear cells seems to be present in patients with chronic forms of Lyme borreliosis when compared to those with early stage of the disease. It may be a factor contributing to the persistence of inadequate inflammatory response in patients in whom chronic form of the disease develops.
Advances in Medical Sciences 02/2007; 52:174-8. · 0.80 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: In recent years, the role of pro- and antiinflammatory cytokines in the development of Lyme arthritis (LA) has been widely discussed. The purpose of the present study was to determine the concentration of interleukin-18 (IL-18), interleukin-1beta (IL-beta) and its soluble receptor sIL-1RII in serum of patients with LA as well as the usefulness of serum C-reactive protein (CRP) determination in LA diagnosis and monitoring of its treatment.
The study group consisted of 20 patients with LA. Before and after antibiotic treatment, the serum levels of IL-18, IL-1beta and sIL-1RII were measured immunoenzymatically using standard kits and the CRP level was measured by immunoturbidimetric method.
Before treatment, the serum levels of IL-18, IL-1beta and sIL-1RII were significantly higher than in control group and after treatment the concentrations of IL-18, IL-1beta and sIL-1RII decreased significantly, but the level of IL-18 and sIL-1RII still remained higher than in control group. The elevated serum level of CRP was detected only in 6 of 20 patients and in 5 of them it returned to the baseline after treatment.
The results of our study suggest that IL-18, IL-1beta and sIL-1RII might be involved in the development of LA. CRP may be useful in differential diagnosis in patients with suspicion of Lyme arthritis.
[Show abstract][Hide abstract] ABSTRACT: To examine the role of lysosomal exoglycosidases in the pathogenesis of Lyme arthritis we studied a group of 18 patients aged 18-72 (mean: 46 yr) diagnosed with chronic arthritis in the course of borreliosis. The control group was composed of 20 healthy volunteers (health service employees) aged 25-65 (mean: 45 yr) with no detectable serum anti-Borrelia burgdorferi antibodies. We found that N-acetyl-beta-d-hexosaminidase (HEX) was significantly increased and beta-galactosidase and alpha-mannosidase also showed an increase in Lyme arthritis patients compared to healthy persons and normalised after treatment with doxycycline. Our results suggest that HEX is a sensitive enzymatic marker of Lyme arthritis and it may be used to monitor the course of the disease and the efficiency of treatment.
International Journal of Medical Microbiology 06/2006; 296 Suppl 40:280-2. · 4.54 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Chemokines, including a chemoattractant for mononuclear cells CCL3 (MIP-1alpha), are responsible for attracting leukocytes into central nervous system (CNS) and cerebrospinal fluid (CSF) in meningitis and encephalomeningitis. We investigated the possibility of the involvement of CCL3 in tickborne encephalitis (TBE) pathogenesis.
We studied 26 patients with TBE; 13 with meningitis (group I) and 13 with encephalomeningits (group II). Control group included 11 patients without infectious disease of the CNS. CCL3 concentration was measured by ELISA in serum and CSF on admission (examination 1) and after 2 weeks (examination 2) in TBE patients and once in controls.
In all control samples CCL3 concentration was below detection limit. In TBE, CCL3 serum concentration was: in group I--10.1 +/- 4.1 (mean +/- SD, ng/ml) in examination 1 and 12.4 +/- 4.8 in examination 2, and in group II--12.5 +/- 3.9 and 13.5 +/- 4.8, respectively. In CSF, CCL3 was detected: in group I in 5 patients in examination 1 (178 +/- 236 pg/ml) and 11 in examination 2 (457 +/- 215), in group II--in 8 (357 +/- 311) and 7 patients (326 +/- 330), respectively. There were no differences between group I and II. The comparison of CCL3 concentration gradient with albumin gradient between serum and CSF supported the possibility of intrathecal synthesis of CCL3.
1) Synthesis of CCL3, perhaps including intrathecal synthesis, is increased in TBE. 2) CCL3 concentration was much lower in CSF than in serum of the TBE patients, which argues against its significant role as chemoattractant in this condition.
Advances in Medical Sciences 02/2006; 51:340-4. · 0.80 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Platelet-endothelial cell adhesion molecule-1 (PECAM-1) is a glycoprotein involved in the transendothelial migration of leukocytes and MCP-1 is a proinflammatory protein, member of the 1 subfamily of chemokines, acting as activator of specific leukocytes. The expression of PECAM-1 and MCP-1 was studied in various pathological processes, but very little is known about the significance of these molecules during inflammatory reaction in viral diseases of the nervous system, including tick-borne encephalitis.
Cerebrospinal fluid was obtained from 17 patients with TBE, treated at the Department of Infection Diseases in Białystok. The level of sPECAM-1 and MCP-1 was evaluated by the ELISA method. The control group consisted of 18 patients in which the battery of tests, including CSF study, has excluded the organic character of the neurological syndrome. The U- Mann-Whitney test was applied to establish the statistical significance of the results.
The concentration of sPECAM-l and MCP-1 in cerebrospinal fluid of TBE patients was significantly increased in comparison with the. control group.
Elevated concentration of sPECAM-1 and MCP-1 may be a result of increased release from endothelical cells, activated T-cells, platelets and monocytes. Increased expression of sPECAM-1 is the significant but unspecific event in immunological processes in inflammatory reaction in TBE. The increased concentration of MCP-1 seems to be an essential event in the pathomechanism of inflammation in the central nervous system in TBE. It would be valuable in clinical conditions to search for the methods of inhibition of the increased expression of sPECAM-1 and MCP-1 in TBE to diminish the inflammatory reaction.
Polski merkuriusz lekarski: organ Polskiego Towarzystwa Lekarskiego 02/2006; 20(115):46-8.