[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.
Full-text · Article · May 2014 · European Journal of Clinical Microbiology
[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.
Full-text · Article · Dec 2013 · Przegla̧d epidemiologiczny
[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.
No preview · Article · Oct 2013 · Polski merkuriusz lekarski: organ Polskiego Towarzystwa Lekarskiego
[Show abstract][Hide abstract] ABSTRACT: Pathophysiology of Lyme disease (LD) is complicated and depends on various factors such as individual presentation of antigens, bacterial genotype, early proper diagnosis and response to treatment. Borrelia burgdorferi localised in the skin, is covered by a coat made of saliva proteins Salp, presents mostly OspC and blocks the complement system by using GRASP. Dendritic cells (DCs) act as the first line of specific immunological response, which influences the disease. The type of DCs, level of maturity, proportion of DCs and T lymphocytes influence the level and type of the immunological response. Lyme disease presents mainly immunological response on Th1 lymphocytes pathway, which is proven by the synthesis of interleukin 12 (IL-12) and interferon gamma (IFN-gamma) in the early phase of inflammation. In a later phase, Th2 response is activated with a secondary increase in specific cytokines IL-10 or IL-4. Therefore, DCs play one of the main functions in the pathogenesis of the disease in relation to the synthesis and stimulation of other cells to release inflammatory mediators. Bacterial ability to invade and disperse in the organism is additionally supported by their vector. Ticks, via local immunosuppressive activity, inhibit early antibacterial mechanisms connected with DCs and therefore favor the infection. This paper describes the role of DCs as important factors in the pathogenesis of LD in both non-specific and specific immunological response. We conclude, that considering a complex role of DCs in defense mechanisms and initiation process of direct immunological response, their role should be accounted in vaccination against-Borrelia burgdorferi.
No preview · Article · Jan 2013 · Central-European Journal of Immunology
[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.
Full-text · Article · Dec 2011 · Advances in Medical Sciences
[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
No preview · Article · Oct 2011 · Rheumatology International
[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.
No preview · Article · Dec 2010 · European Journal of Neurology
[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.
No preview · Article · Dec 2010 · Advances in Medical Sciences
[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.
Full-text · Article · Nov 2010 · European Journal of Clinical Microbiology
[Show abstract][Hide abstract] ABSTRACT: Herpetic encephalitis is an emerging disease associated with a high mortality rate and significant neurological, neuropsychological and neurobehavioral sequele. In this paper 4 cases of patients with various courses of herpetic encephalitis are presented. Based on study we conclude that herpetic encephalitis may start with non characteristic symptoms and different clinical course. In the course of herpetic encephalitis peripheral markers of inflammation may not by present. Not specific beginning of illness may influence a delay in diagnosis, when might cause treatment lag. In each case suspected of encephalitis treatment with the Acyclovir should be administrated. MRI examinations, because of high sensitivity should be used in each case suspected of herpetic encephalitis.
No preview · Article · Jan 2010 · International Review of Allergology and Clinical Immunology
[Show abstract][Hide abstract] ABSTRACT: The diagnosis of Lyme disease is based on epidemiological history, clinical symptoms and results of serological tests (two steps: ELISA test and then Western-blot or immunoblot). 67 years male patient, with the pain and swelling of the left knee after 2 weeks of the tick bite, successfully treated with antibiotics is introduced. Confirmation of the infection with regular test were negative, probably caused by prior cancer treatment. Applying broader panel of antigens "in vivo" in the IgG class in line blot tests was helpful in confirming infection with B.burgdorferi in this case. Diagnosis of seronegative Lyme borreliosis in many cases seems to be result the inadequacy of used tests. The enrichment tests for wider spectrum of borrelial antigens seems to be the right direction towards the improvement of diagnosis of Lyme disease.
No preview · Article · Jan 2010 · International Review of Allergology and Clinical Immunology
[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.
No preview · Article · Jul 2009 · Scandinavian Journal of Infectious Diseases
[Show abstract][Hide abstract] ABSTRACT: The aim of the study was to evaluate mRNA of PECAM-1 molecule expression on the neutrophils stimulated by TNF-α and IFN-γ and the concentration of its soluble form in the serum of patients with Lyme borreliosis. Material and methods. The study was carried out in 37 patients diagnosed with Lyme borreliosis. The diagnosis of Lyme borreliosis was based on the serological tests indicating IgM antibodies against Flagellum p 441 Borrelia burgdorferi antibodies. The expression of PECAM-1 was determined by PCR. Concentration of a soluble molecule of sPECAM -1 was determined by ELISA method. Results. A significantly increased expression of mRNA of PECAM-1 molecule was observed on the neutrophils in patients before treatment in comparison with the values obtained in controls. After antibiotic therapy, a slight decrease was revealed in the expression of the adhesion molecule designed as mRNA. Conclusions. The enhanced expression of PECAM-1 on PMN may contribute to the flow of these cells to the living sites of Borrelia burgdorferi spirochete and its elimination via phagocytosis. The increase of the expression of PECAM-1 on PMN may be caused by the activation of this adhesion molecule by the cytokines produced in the inflammatory process with Lyme borreliosis.
No preview · Article · Jan 2009 · International Review of Allergology and Clinical Immunology