[Botulism in the past and today--clinical aspects]

In this paper we review the most recent approach to clinical manifestations, diagnosis and treatment of botulism.

[Botulism in the past and today--etiological, epidemiological and pathogenic aspects]

In this paper we review the most recent approach to etiology, epidemiology and pathogenesis of botulism.

Vitiligo associated with pegylated interferon and ribavirin treatment of patients with chronic hepatitis C: a case report

The use of pegylated interferon (PEG-IFN) and ribavirin is considered standard therapy for patients with chronic hepatitis C. Many adverse effects of IFN appear to be of autoimmune origin. Vitiligo is a hypomelanotic disease, whose cause, despite many investigations, remains unknown, although some evidence points to an autoimmune pathogenesis. This report describes a case of vitiligo that occurred during the third month of treatment with PEG-IFN and ribavirin. The sustained virologic response was the result of a 52-week regimen; however, hypomelanotic cutaneous patches persisted. Autoimmune adverse effects of IFN therapy, which may include vitiligo, should be carefully monitored. The decision about whether to discontinue treatment should be discussed with the patient, who must be informed that the lesions may persist.

[Clinical and epidemiological analysis of patients with botulism hospitalized at the Department of Infectious Disease, Medical University of Lublin in 1990-2000]

In the paper we presented results of clinical and epidemiological analysis of 32 patients with botulism hospitalized at the Department of Infectious Diseases, Medical University of Lublin in 1990-2000. In the studied group, the relationships between botulism incidence and sex and place of residence were not significant. The incubation period ranged from 7 hours to 5 days (average 36 hrs). The clinical manifestations of botulism were typical in all cases. In one female patient the course of disease was complicated. She developed right-sided bronchopneumonia and left-sided purulent parotitis. The type B botulinum toxin occurred more frequently than the other types and the cases without serological confirmation (Chi 2 = 6.125 p = 0.01). It was found in serum of 23 patients (in 2 cases together with the type A toxin). The type E toxin was found in serum of one patient. The presence of toxin in serum was not detected in 8 patients. In all patients trivalent (types A, B and E) equine antitoxin was administered. The dose ranged from 50 to 150 cm3. Symptomatic treatment was given in all cases. Nobody required mechanical ventilation. The duration of hospitalization ranged from 5 to 28 days (average 16.6 days). A few patients complained of long-lasting blurred vision or dry mouth.

Evaluation of serum copper (Cu) level dynamics in measles patients

The aim of the present study was to estimate the cuprum(Cu) level in blood serum in patients ill from measles in the acute period of the disease and three weeks after regression of clinical symptoms in comparison with the control group. The investigations included 26 patients aged 14-34, hospitalised due to measles in the Department of Infectious Diseases of the Medical University of Lublin. The analysed group included patients without coexisting diseases, in which clinical improvement after the carried out treatment was obtained. All the patients had Cu concentration in the blood serum twice determined during hospitalisation period and once during the period of convalescence. The control group included 24 healthy persons aged 15-19, who had Cu concentration in blood serum only once determined. The obtained in numbers data were subject to a statistical analysis. Both in the acute period of measles and during convalescence a statistically significantly higher Cu level in blood serum in comparison to the control group was observed.

[Levels of soluble intracellular adhesion molecules 1 (sICAM-1) , soluble receptors for interleukin 2 (sIL-2R) and anti-Epstein-Barr viral capsid antigen (anti-VCA IgM) in blood serum during the course of infectious mononucleosis]

The clinical picture of infectious mononucleosis and the consequences of EBV infection are due to immune response mechanisms. The level of soluble form of IL-2 receptor (sIL-2R) is thought to be a marker of T-cell activity, especially CD8+. Intercellular adhesion molecule (ICAM-1, CD 54) plays an important role in the process of antigen presentation. The aim of this study was to assess the serum concentration of sIL-2R, ICAM-1 and anti-VCA IgM in patients with infectious mononucleosis. The study group comprised 42 persons: 20 healthy subjects as a control group and 22 individuals with infectious mononucleosis. The highest anti-VCA IgM serum level in all patients was during the 1st day of hospitalization, and decreased in the 8th day of hospitalization. The lowest antibody concentration was observed when the symptoms and sings ceased. The level of sIL-2R was significantly increased and during farther hospitalization we observed lower, but still elevated concentrations. Our study has demonstrated statistically significant elevation of sICAM-1 level during the entire period of hospitalization. This data indicates the importance of antigen presentation process. Although the serum concentration of immune response mediators does not reflect their contents in organism, but is a useful method for in vivo examination.

Epizootic situation and risk of rabies exposure in Polish population in 2000, with special attention to Lublin province

In Poland in 2000 a total of 2,221 cases of animal rabies were reported, including 1,874 (84.4%) of wild animals. The evaluation of epizootic situation in 2000 has shown a few cases of animal rabies in western provinces of Poland, so in regions where a programme aimed at oral vaccination of foxes was introduced. Most cases of animal rabies were identified in the northeastern region, as well as in eastern and central Poland. In October 2000 in Warminsko-Mazurskie province (northeastern region of Poland) rabies was responsible for the death of 59-year-old woman, bitten by a rabid cat, and refused post-exposure specific antirabies prophylaxis. Among domestic animals, the highest incidence of rabies occurred in cattle--167 cases (7.5%), cats--113 (5.1%) and dogs--61 (2.7%). In the group of wild animals, red foxes accounted for 1,587 (71.5%) cases, raccoon dogs for 210 (9.5%) and martens for 36 (1.6%). People have been vaccinated against rabies in all provinces of Poland. The number of people vaccinated against rabies in regions adjoining the western border was much smaller compared to other provinces of Poland. The highest rates of using post-exposure prophylaxis occurred in northeastern regions of Poland (Warminsko-Mazurskie province) and eastern and central parts of Poland. On the basis of analysis of cases consulted in the dispensary of rabies prophylaxis in the Department of Infectious Diseases in Lublin, it can be concluded that the number of people with exposure to rabid animals is rather small. Most vaccinations are carried out when animals suspected of being rabid bite patients. These are primarily domestic animals--dogs and cats.

Interferon and tumor necrosis factor production by peripheral blood leukocytes of patients with infectious mononucleosis

Blood samples from 29 patients with infectious mononucleosis (IM) in phases of acute disease and convalescence were obtained. Interferon alpha (IFN-alpha) and tumor necrosis factor alpha (TNF-alpha) activity was detected in sera of patients both in: acute and convalescence phase, however when IFN titers were higher in the acute than convalescence phase, TNF titers were the highest in convalescence. In the whole blood assay Newcastle disease virus (NDV), phytohemagglutinin (PHA) and concanavalin A (ConA) and lipopolysaccharide (LPS) were used as cytokine inducers. A significant decrease in IFN titer induced in vitro with NDV, PHA and ConA was observed in blood leukocytes of patients in the acute IM phase. In convalescence the ability of blood leukocyte of IM patients to produce IFN returned to normal, comparable with control. However, blood leukocytes of IM patients in the acute phase produced more TNF in response to LPS than in convalescence. The role of the observed overproduction of TNF in the course of IM similar to that in HIV infection should be elucidated.

Protein S and HIV infection. The role of anticardiolipin and anti-protein S antibodies

It has recently been reported that a large proportion of patients with HIV infection have low free protein S levels. In this study we show that protein S (PS) activity levels, as well as PS antigen (Ag), were significantly lower in 35 HIV-1 infected patients than in the control population (p < 0.001). When we divided HIV infected patients into three groups according to their CD4+ counts, we found that PS levels were significantly lower in patients with < 100 CD4+ cells/ul. In order to investigate the possible role of (auto)immune response in the pathogenesis of PS deficiency, the presence of anticardiolipin antibodies (aCL) and/or of the specific antibodies to protein S was evaluated. A high prevalence (77.1%) of aCL in both symptomatic and asymptomatic subjects was observed. The screening for specific anti-PS antibodies, performed by immunoblotting, showed an overall positivity of 28.6% in anti-HIV+ patients, with a higher prevalence in symptomatic than in asymptomatic patients. Interestingly, the prevalence of the positivity for anti-PS antibodies was found to be higher in anti-HIV+ patients with PS levels < 50%. Taken collectively, our findings suggest that at least one of the mechanisms through which PS levels are decreased in HIV infection, is due to the presence of specific autoantibodies.