The importance of sCD40 and sCD40L concentration in patients with chronic HCV infection and HIV co-infection

CD40 receptor is activated by ligand CD40L (CD154) which is synthesized in inflammation by NK cells, monocytes and lymphocytes B. TRAF proteins are activated in cells by CD40 stimulation and next they stimulate different enzymatic pathways. High concentrations of CD40L stimulate CD40, and consequently STAT enzyme system inhibits the expression ofnonstructural proteins ofHCV NS3 and NS5A and E2 core in infected human hepatocytes. PURPOSE. The aim of the study was to evaluate the concentration of soluble components of the complex: sCD40 and sCD40L in the serum of patients infected with HCV and HCV/HIV-1 co-infected. The effect ofHCV genotype, HIV and HCV viral load and rs12979860 polymorphism on serum sCD40 and sCD40L was established among the patients. The influence of the number of CD3+, CD4+ and CD8+ on the concentrations of sCD40 and sCD40L was evaluated in the HIV-1 infected group MATERIALS AND METHODS. Serum concentrations of sCD40 and sCD40L were determined using ELISA in 68 HCV infected patients including 39 HCV monoinfected and 29 HCV/HIV-1 co-infected. RESULTS. Serum concentration of sCD40 and sCD40L was significantly higher in HCV and HCV/HIV coinfected patients compared to healthy subjects (25.7 and 23.2 v. 8.5 pg/ml and 12.7 and 7.3 v. 0.79 ng/ml). The concentration of sCD40L in patients with genotype CC rs12979860 was significantly higher compared to patients with Non-CC genotypes (11.8 v. 7.6 ng/ml, p < 0.018). CONCLUSIONS. High levels of sCD40 and sCD40L were detected among patients with chronic HCV and HCV/ HIV-1 infection The high concentration of sCD40L correlates with CC rs12979860 genotype.

HBV mutations associated with lamivudine therapy

Lamivudine (LMV) is still the most commonly used nucleoside analogue in majority of the world. Its administration rapidly leads to resistance associated with mutations in HBV polymerase. THE AIM of the study was to assess the prevalence, nature and the time of LMV resistant variants appearence during a long term therapy.

PATIENTS AND METHODS

Study was carried out among 175 chronic hepatitis B patients treated with LMV. HBsAg, HBeAg as well as anti-HBe antibodies were detected by enzyme immunosorbent assay and HBV-DNA quantification was performed by RT-PCR. Mutations in HBV polymerase gen were detected by PCR using specific primers and direct sequencing. Liver biopsies were performed in 138 patients to evaluate grading and staging of chronic hepatitis by Scheuer's classification.

RESULTS

Mean pre-treatment viral load was comparable among HBeAg-positive and negative patients (4.24 x 10(8) vs. 1.26 x 10(8) IU/ml). Mutations in HBV polymerase gen were detected in 96 patients. After 5 years of LMV therapy the prevalence of mutations was 51.9% in HBeAg-positive and 56.1% in HBeAg-negative. The most common mutations were observed at position 180, followed by 204, 202, and 169 of HBV polymerase gen. After average treatment period of 25 months in HBeAg-positive and 35 months in HBeAg-negative additional mutation 204 was observed in 81% and 77% respectively.

CONCLUSIONS

Large majority of patients develop point mutations at positions 180 and 204 of HBV polymerase gene after 2 years of treatment with LMV. These mutations limit the efficacy of LMV but also yield cross-resistance with entecavir.

SNP RS12979860 related spontaneous clearance of hepatitis c virus infection in HCV/HIV-1 coinfected patients

CC genotype of SNP rs 12979860 promotes spontaneous HCV clearance in monoinfected patients. The aim of this analysis was evaluation of impact of rs12979860 polymorphism on HIV or HCV viral load, CD3, CD4 and CD8 count as well as HCV clearance among HCV/HIV coinfected patients.

MATERIALS AND METHODS

The study included 41 consecutive HCV/HIV coinfected patients. HIV RNA, HCV RNA, HCV genotype and rs12979860 polymorphism sequence as well as CD3, CD4 and CD8 cells count were analyzed in all patients.

RESULTS

CC genotype rs12979860 was identified in 16 from 41 patients. During at least 4 years follow-up, five genotype CC patients (31%) became HCV RNA undetectable, that was not a case in CT and TT patients. No statistical differences in HIV viral load and the number of CD3, CD4 and CD8 related to rs12979860 polymorphism were observed. The baseline level of HCV RNA in patients with CC genotype was significantly lower compared to patients with non-CC genotypes (88546 +/- 74181 vs. 726021 +/- 30709 IU/mL).

CONCLUSION

CC genotype related to SNP rs 12979860 can affect the lower level of HCV viral load compared to patients with CT and TT genotypes and promotes spontaneous clearance of HCV RNA in HCV/HIV coinfected patients.

[Predictive factors of virological response in chronically HCV infected]

Research on new antivirals drugs applied in the treatment of chronically HCV infected indicate that even the most perfect therapeutic molecules do not guarantee 100% efficacy. Since the beginning of the history of HCV infection treatment clinicians looked for predictors of treatment efficacy. Numerous studies confirm the high probability of cure in patients who cleared HCVinfectional 4 and 12 weeks of therapy. However despite of viral factors, recent research demonstrated predictive role of some host dependent factors. The most important role seems to play genetic factors including polymorphism rs12979860, as well as chemokins including first of all CXCL10 (IP-10). Very interesting seems to be also results of studies on association between vitamine D concentration and treatment efficacy. However in the future the most important predictive factor remain probably early on-treatment viral response.

[Occurrence of autoantibodies in patients with alcoholic liver disease]

Autoantigens are present in normal cells and tissues. However, in physiological conditions autoantigens pose no danger due to the phenomenon of immunologic tolerance. The loss of immunologic tolerance and following autoagression could result from the structure changes of autoantigens as an effect of the activity of chemical factors, such as acetaldehyde, which is metabolite of ethanol. The aim of the study was to evaluate of occurrence of autoantibodies in patients with alcoholic liver disease.

MATERIAL AND METHODS

Ninety-five patients with chronic alcoholic liver disease and 16 healthy controls were enrolled in this study. The presence of autoantibodies against liver proteins were assessed. The occurrence of studied autoantibodies was evaluated with regard to the degree of liver damage. Inclusion criteria were: age over 21 yrs, at least 3-yrs history of alcoholic liver disease, HBV and HCV-negativity, absence of autoimmunological diseases. The presence of autoantibodies AMA-M2, SLA/LP, LKM-1, LC1, anti-F-actin, desmin and miozin in serum was assessed by immunoblotting method and ANA by ELISA.

RESULTS

Autoantibodies were demonstrated in sera of 33% of patients. Single isolated autoantibodies were present in 24% of patients, whereas 9% of patients have several autoantibodies. The most prevalent were anti-F-actin (19%) and antinuclear antibodies (11%). Occurrence of anti-F-actin antibodies increased with degree of liver damage.

CONCLUSIONS

Concluding these results suggest that alcohol may contribute to the activation of autoimmune processes, and particularly against contractile filaments of cells for which F-actin antibodies are produced.

[Prevalence, clinical and therapeutical implications of active CMV infection in patients with chronic hepatitis C]

Infection with human cytomegaly virus (CMV) may lead to liver damage in immunocompromised individuals. Chronic hepatitis C is featured by impairment of innate and specific immunity as well apoptotic cell death. The aim of the study was to assess to frequency of CMV infection in patients with chronic hepatitis C. The influence of CMV infection on parameters of full blood count and early virologic response to the treatment were evaluated. Materials and methods. One hundred twenty three patients with chronic hepatitis C were enrolled in the study. Infection with CMV was diagnosed through the detection of CMV DNA in sera by means of RT-PCR method. The starters used in the study were specific for pp65 gene of CMV. Results. Active CMV replication was observed in 18/123 individuals (14.6%). Majority of them (16/18) have low level of CMV viraemia. There were no apparent correlations between HCV and CMV viral loads. Hemoglobin concentration, erythrocytes, leucocytes and platelet count, absolute neutrophil count and activity of alanine transaminase was similar in HCV and HCV/CMV-infected patients. Active CMV infection did not influence inflammatory activity and fibrosis in liver tissue. The early virologic response to anti-HCV therapy was independent of CMV infection. Conclusions. Active CMV infection affects over 14% of studied population of patients with chronic hepatitis C. Coinfection with CMV has not influence on the laboratory biochemical parameters and injury of liver tissue. Moreover, it does not affect the efficacy of anti-HCV treatment.

[Influence of cryoglobulinaemia on renal function in patients with chronic HCV infection]

HCV infection is a common cause of cryoglobulinaemia, characterized by existence of antibodies that show reversible precipitation at low temperatures. Deposition of cryoglobulines in glomerular vessels tends to induce development of membranous, or less commonly, mesangial glomerulonephritis with renal insufficiency as final consequence. Objective was investigating the existence of cryoglobulinaemia, its types and relation with renal impairment in patients chronically infected with hepatitis C virus.

METHODS

The research included 36 patients (9 women and 27 men) chronically infected with hepatitis C virus at the average age 38 years. Existence and types of cryoglobulines in serum were measured using electrophoresis and then immunofixation on cryogel by the method of Bence Jones (Sebia, France). Renal functioning was estimated with reference to serum urea and creatinine concentrations, glomerular filtration rate (GFR) and serum cystatin C concentration with immunoenzymatic method.

RESULTS

Cryoglobulinaemia was significantly more common among patients infected with genotype 1 than 3 (71% vs. 39%; p<0.05). Types II and III of cryoglobulinaemia existed in equal frequency. The most common heavy chains were gamma immunoglobulins (42%) and the light ones--kappa (54%). Urea and creatinine concentration were normal in all patients. Three patients diagnosed with cryoglobulinaemia and infected with genotype 1 had abnormal GFR. There was dependency between cryoglobulinaemia and elevated cystatin C concentration (R=0.4; p<0.013).

[Endocrinal dysfunctions in liver failure of different etiologies and during interferon therapy in patients with chronic hepatitis B and C]

Liver failure is decadent stage of its severe damage, in which, processes of detoxication, carbohydrate and lipid metabolism, nitrogen balance and synthesis of high-energy compounds are significantly diminished or even totally blocked. Moreover, these incorrect metabolic pathways as well as oxygen deficiency in hepatocytes are implicated in the pathogenesis of endocrine system diseases. The different endocrinal dysfunctions make worse patient's prognosis.

[Activity of cytokines in chronic HCV-infected patients]

Nonspecific immunology response and apoptotic pathways play the important role in development of chronic hepatitis C. HCV stimulates synthesis of many cytokines, mainly proinflammatory. In these processes, the activation of Thl and Th2 lymphocytes has a particular significance. Stronger activation of Th1 lymphocytes has an influence on dysregulation of cytokines' synthesis, affecting also the protraction of HCV infection. Cognition of HCV influence on the regulation of nonspecific immunology response and apoptotic pathways could bring nearer the comprehension of chronic hepatitis C development and indicate new treatment's directions.

Levels of HBV-DNA, sFas and sFasL among healthy HBsAg carriers in period of three years

PURPOSE

The object of the study was the usefulness of sFas and sFasL concentration in the prognosis of disease development in healthy HBsAg carriers.

PATIENTS

34 healthy HBsAg carriers were examined over a three-years period.

MATERIAL AND METHODS

HBV-DNA was extracted using the Gene Elute Mammalian Genomic DNA Miniprep Kit (Sigma, USA). HBV-DNA concentration and YMDD mutations were measured by RT-PCR based on TaqMan Universal Master Mix (Applied Biosystems, USA). HBeAg and anti-HBe in serum were detected by MEIA method (ABBOTT, Germany). The concentration of sFas and sFasL in serum was estimated by ELISA method (Bender MedSystems, Austria).

RESULTS

Within three year observation period the number of carriers with absent HBV-DNA increased from 19% to 33%. HBV-DNA above 105 copies/ml, which was detected in 63% of carriers, decreased to 11% (p < 0.05). After 3 years, a reduction of HBV-DNA levels was observed in 89% of carriers (p < 0.05). The occurrence of sFasL decreased from 56% to 48%. sFasL correlated with HBV-DNA (p < 0.05). The concentration of sFas decreased (p < 0.01). Chronic hepatitis B developed in 11% of men carriers, and 11% eliminated HBeAg, anti-HBe and HBV-DNA. YMDD mutant was not detected in any of the HBsAg carriers.

CONCLUSIONS

High concentration of sFasL in serum may suggest the development of chronic hepatitis and it seems that sFasL detection is never a good prognostic factor.

[The peripheral polyneuropathy in patients with chronic HCV infection treated peginterferon alfa with ribavirin]

IFN-alpha maybe stimulate to synthesis of autoantibodies which damaging of myelin sheath at peripheral neurons. We report the patient, man, with hepatitis C infection who was treated with peginterferon alfa-2a by one month and next with peginterferon alfa-2b by 3 months in combination with ribavirin. We observed paresis of hands and legs in fourth months of treatment. This patient's dust of difficulty with walking. In EMG investigation was detected demyelin damage of sensor motor nerves. These changes were on whole length or in distal part of neuron. It is qualified hard whether cause of peripheral polineuropathy: interferon's or pegylated part. The finished of antiviral treatments as well as use of steroids in therapy were reason of fast improvement of patients.

HBV-DNA and sFas, sFasL concentrations in serum of healthy HBsAg carriers

PURPOSE

Increased HBV-DNA concentration is a prognostic factor of disease progression in chronic hepatitis B patients. Moreover, active hepatic inflammation during HBV replication influences apoptosis intensification. The aim of this study was to estimate occurrence of HBV replication among carriers of HBsAg. Furthermore, we analysed the correlation between HBV replication and HBeAg or anti-HBe presence as well as known apoptosis indicators--sFas and sFasL concentration.

MATERIAL AND METHODS

The study included 34 HBV infected patients, aged 20-43 yrs defined as HBsAg healthy carriers. HBV-DNA was extracted from patients' serum using two different DNA isolation kits: the QIAamp DNA Mini Kit (QIAGEN Ltd, USA) and the Gene Elute Mammalian Genomic DNA Miniprep Kit (Sigma, USA). HBV-DNA concentration in serum was measured by RT-PCR based on TaqMan Universal Master Mix (Applied Biosystems). The detection limit of this system was as few as 10 HBV-DNA copies/mL of serum. HBV-DNA concentration was calculated from a linear standard curve obtained between 10 and 10(8) DNA copies/reaction. HBeAg and anti-HBe in serum were detected by MEIA method (ABBOTT, Germany). The concentration of sFas and sFasL in serum was-estimated by ELISA method (Bender MedSystems, Austria).

RESULTS

HBV active replication was detected in 79% HBsAg carriers. The HBV-DNA levels exceeding 10(5) copies/mL were observed in 64% patients. Among HBsAg carriers presenting HBeAg, HBV replication occurred more often and was more intensify than in HBsAg carriers presenting anti-HBe antibodies. The sFasL occurrence in serum of 56% HBsAg carriers shows an active apoptosis, independent from ALT and AST activity within normal ranges.

[Proton magnetic resonance spectroscopy in the liver of HIV and HCV coinfected patients]

The 1H MR spectroscopy (1H MRS) creates possibility of non-invasive study of morphological changes 1H MRS and metabolic disturbance of the liver. The aim of study was estimated of 1H MRS in investigation of liver metabolic changes, with special regard of lipids in patients with HCV and HIV/HCV infection.

MATERIAL AND METHODS

Research was moved among patients with HCV infection and in HCV/ HIV co infection. 1H MRS of the liver was moved with use of system Picker, Eclipse 1.5 T. Investigation were executed with use of tube of whole body, with use of sequence PRESS 35 (TE 35 ms, TR 1500 ms, nex 192). Suppression of water was made of MOIST method. Voxel about sizes 3x3x3 (27 cm3) were located in right piece of liver on basis of paintings T2- dependence in front and transverse planes.

RESULT

In group of HCV patients without HIV infection were observed over 6 x increase proportion of PME/TL (0.112; p = 0.001) and 2 x increase of Glx/TL (0.042; p = 0.02) in refer to control group. In patients with HCV and HIV infection were observed significance increase of Glu/ TL - 328%, Glx/TL - 458% and PME/TL 728% in comparison to control group. The patients with only HCV infection were statistical significance decrease of TL level in comparison to control group (43.2 +/- 9.4 v. 74.1 +/- 12.2; p = 0.09). The patients with HCV and HIV infection, level of TL was lowered in refer patients with only HCV infection (20.7 +/- 5.6; p < 0.05).

CONCLUSIONS

Proton magnetic resonance spectroscopy of the liver is useful diagnostic method in detecting of parenchyma liver damage and to make up supplement of histology diagnosis.

Search for hepatitis delta virus (HDV) infection in hepatitis C patients in north-eastern Poland. Comparison with anti-HDV prevalence in chronic hepatitis B

Hepatitis C virus and hepatitis D virus have been shown to suppress HBsAg synthesis. Thus it is possible that HDV infection occurs despite the lack of detectable HBsAg. The aim of our study was to (a) determine the prevalence of HDV infection in patients with chronic hepatitis C (b) compare it with the prevalence of HDV infection in HBsAg positive patients with hepatitis B. The study group consisted of 51 chronic hepatitis C patients, 30 HIV infected drug addicts (27 of them were also positive for anti-HCV) and 102 hepatitis B patients. The participants were tested for anti-HDV, anti-HCV and HBsAg. All anti-HCV positive patients were negative for anti-HDV. Four individuals with anti-HDV belonged to hepatitis B group and constituted 3.9% of all HBsAg positive subjects. We conclude that (a) there is currently no evidence of HDV infection among HCV infected patients in our region (b) hepatitis delta infection is rare in north-eastern Poland.

The levels of IL-1beta, IL-4 and IL-6 in the serum and the liver tissue of chronic HCV-infected patients

The pro-inflammatory interleukines play a major role in the progress of chronic hepatitis C. Among the patients with chronic hepatitis C virus (HCV) infection, the morphology of the liver was assessed and the levels of serum and liver-tissue IL-1beta, IL-4 and IL-6 were determined. The levels of the cytokines were related to the liver-tissue changes. RNA-HCV was measured by the RT-PCR method. Cytokine levels of the serum and liver tissue were measured by the Quantikine High Sensitivity test. The levels of serum IL-1beta, IL-4 and IL-6 (0.221, 0.104 and 1.393 pg/ml) in all HCV patients were higher in comparison with healthy adults (0.188, 0.025 and 0.600 pg/ml). The levels of liver tissue IL-1beta, IL-4 and IL-6 (4291.3, p<0.05; 1624.6, p<0.05; 1158.7 pg/g protein) in all HCV patients were higher compared with patients with liver cirrhosis without HBV or HCV infection (2319.9, 553.6 and 756.2 pg/g protein). Patients with HCV infection demonstrated a significant correlation between serum and liver-tissue levels of IL-1beta (Pearson: 0.61, p<0.05) and IL-4 (Pearson: 0.51). The level of serum IL-6 in patients with moderate chronic active hepatitis was higher when compared with patients with mild chronic persistent hepatitis. Among the patients with mild chronic persistent hepatitis, the levels of liver-tissue IL-6 were higher compared with those with moderate chronic active hepatitis. There was no correlation between histology changes and the levels of serum and liver-tissue IL-1beta and IL-4.

[Practical use of anti-HB immunoglobulins]

Viral hepatitis B remains a significant problem among iatrogenic infections. The development of transplantology met a barrier in the form of active hepatitis B. Wide but still inadequate prophylaxis against viral hepatitis B and the necessity of protection of patients after organ transplantation against secondary HBV infection require establishing indications for specific, passive immunotherapy.

[The joint changes and presence of HLA-B27 antigen in patients with ulcerative colitis]

The extra-bowel manifestation can be found among patients with ulcerative colitis (UC). The most common are the joint changes. A group of 18 patients with ulcerative colitis was investigated. The physical and radiological signs of joint inflammation and presence of HLA-B27 antigen in blood were examined. Appearance of HLA-B27 antigen among 28% of patients with ulcerative colitis can support involvement of autoimmunologic mechanism in joint inflammation. The joint changes (swelling of small joints of hand, presence of nodes, sacroileitis, and particularly spondyloarthritis) were observed in 50% of patients.

Efficacy of interferon therapy on patients with HCV infection in dependence from the time of treatment

Among 45 patients with chronic hepatitis C the efficiency of interferon alpha 2b treatment was evaluated. The efficiency of interferon therapy was determined after 6 months of treatment in the group of 28 patients (group I) treated for 6 months and 17 patients (group II) treated for 12 months. The side effects were investigated with respect to such a factor as time of treatment. 11 (39%) patients from group I had eliminated HCV RNA and 14 (50%) patients had normalized AlAT levels in the serum. Five (29%) patients from group II eliminated HCV RNA and 8 (47%) patients had normalized AlAT levels in the serum. The flu-like syndrome, thrombocytopenia, vision disorder, depression and somnolence were most often the side effects observed in treated patients. Proportionally to time of treatment vision disorder, depression and somnolence increased.

Plasmapheresis in the treatment of tropical malaria

A case of tropical malaria imported from Kenya was described. Plasmodium falciparum (an etiological agent of this disease) is often drug resistant, therefore pharmacological treatment of the patients was supplemented with plasmapheresis. Full recovery has been achieved. It is suggested that plasmapheresis may be recommended for a complex therapy of severe forms of tropical malaria.

[Use of plasmapheresis in patients with AIDS and peripheral polyneuropathy]

The plasmapheresis is procedure removal of plasma and simultaneously, together with plasma, toxins, incorrect metabolites, antigens and immunological complexes. In patients with HIV infection often appearance periphery polyneuropathy. This is connected with autoantibody action on the damage of neurone. The aim of this study was evaluation effectiveness of plasmapheresis in treatment patients with AIDS and polyneuropathy. Seven patients with AIDS--C3 and polyneuropathy coexistence were treatment by plasmapheresis. The symptoms of polyneuropathy decrease in all patients. Were don't influence on immunological system and side effect performance plasmapheresis.

[The neuropsychiatric side effects of the interferon therapy in patients with chronic hepatitis B and C]

Interferons are usage in therapy patients with chronic viral hepatitis (ch). Independently apart from therapy effects, lots of side effects are observed. The neuropsychiatrical side effects are most often and maybe hinder of interferon therapy. Among patients with ch B and C were estimated efficiency, type and frequency of side effects after interferon therapy. Especially symptoms disorders of central nervous system were observed between all side effects. The 67 patients: 20 with ch B, 45 with ch C and 2 with ch B retherapy by interferon were estimated. The lymphoblastoid interferon: alpha n1, Wellferon (Wellcome/Great Britain) and recombinant interferon alpha 2b, Roferon (Roche/Switzerland) and Intron-A (Schering-Plough/USA) were administrated. The efficiencies of treatment were observed after 6 month from finished interferon therapy. Elimination of polymerase HBV-DNA, antigens: HBs, HBe and antibody HBcIgM and normalization of aminotransferase activity in serum, were evaluated in patients with ch B. Elimination of HCV-RNA and normalization of aminotransferase activity in serum was evaluated in patients with ch C. Among neuropsychiatrical side effects was study. The frequently of irritability, fatigue neurosis, disorders of psychomotion activity, vegetative symptoms, somatic symptoms and disorder of higher mind processes. Grow excitability of sensorimotor, affective, irritability of vegetative system, were examined among irritability symptoms. Deficiency activity of polymerase HBV-DNA was observed in 40% patients with ch B. Deficiency of RNA-HCV in serum was observed in 31% patients with ch C. The flu-likely syndrome was observed at the beginning interferon therapy in 85% patients. Among patients treated with interferon were observed side effects: hair loss (29% patients), disorder of vision (29%), thrombocytopenia (< 50,000 mm3) (29%), leukopenia (< 2,000 mm3) (16%). The neurasthenia was detected in 60% patients with ch B and 50% patients with ch C. Neurasthenia most often manifested by irritable and quickly exhaustion of strength. 53% patients with ch B and 42% patients with ch C manifested disorders of psychomotion activity. Disorders of higher mind processes were in 50% patients with ch B and 33% with ch C. The neurological side effects were not influence on modification therapy. The flu-likely syndrome was observed at the beginning interferon therapy in majority patients treat with interferon. The neuropsychiatrical disorders are frequently watching of interferon therapy in patients with ch B and C.

[Epidemiological factors of mushroom poisoning in the north-east of Poland]

Mushroom poisoning (m.p.) are still real and increasing problems in Poland. Epidemiological characteristics, clinical picture and the outcome of the therapy with and without plasmapheresis are reported in 83 patients with mushroom poisoning. M.p. are occurring every year, between June and December. The most often m.p. cases occurred as collective intoxication (89%). The most often m.p. cases occurred as a collective intoxication (89%). The most severe cases are caused by the consumption of Amantia phalloides (31 cases), and deaths were reported only after consumption of that mushroom (6 deaths). Cases were also seen eating of not properly prepared eatable mushrooms (neurotoxins arisen from choline). Symptoms seen in our patients concluded: nausea, vomiting, abdominal pain, headache and fever. Particularly severe course of the disease was seen in children following intoxication with Amanita phalloides. Plasmapheresis was an effective therapy only when applied within 48 hours following intoxication.

Plasmapheresis in the treatment of trichinellosis

Four patients with severe form of trichinellosis were treated with plasmapheresis. We noticed clinical improvement and favourable alterations in laboratory profiles (morphology and immune response parameters in the blood). The effect of plasmapheresis therapy in patients with trichinellosis was considered beneficial. No major complications of plasmapheresis were observed.

[Infection with Legionella pneumophila among workers of Polish sea drilling platforms]

The epidemiology, clinic, diagnostic dates and treatment of Legionella pneumophila (L. pneumophila) were discussion. The our study were removal in 246 workers seas drill platforms. The antibody opposed of L. pneumophila were mean in 54 with 246 workers. Investigation were execution into conjunction of specifically job and life workers and frequently appearance of bronchitis. The antibody L. pneumophila were detection in 25% persons. These dates may suggest possibilities of L. pneumophila infections among workers of these professions.

[Acute clostridium difficile gastroenteritis infection in children: report of three cases]

The causes and clinical manifestations of Clostridium difficile infection in children are described in this report. The studies were performed on three children aged up to 3 years. Risk factors as well as possible diagnostic and therapeutic procedures are discussed.

[Current diagnosis, clinical course and treatment of acute colitis infection with Clostridium difficile]

Detection rate of G. intestionalis in feces with direct microscopy has been compared with the immuno-enzymatic technique detecting protein GSA 65 with Alexon Inc., ProSpec T/Giardia reagents kit. The results obtained with both methods have further been compared with those obtained by microscopic examination of the duodenal content. Detectability of Giardia intestinalis with EIA technique with the use of ready-made kit has been assessed. Feces have been collected from 371 patients. Protein GSA 65 has been present in 170 samples, 45.8%, examined with the use of ProSpec T/Gardia kit. Giardia intestinalis cysts have been detected microscopically in the feces of 37 patients, i.e. in 22.3%. Microscopic examinations carried out by three independent examiners have shown marked diversity in the rate of positive results, being 0.1% (examiner A), 28.6% (B), and 45.2% (C). Comparison of G. intestinale detectability of all 3 techniques used have shown absence of protein GSA 65 in 2 out of 9 examined patients. However, trophozoits have been present in the duodenal content. Test performed with kits made by Alexon Inc. and DIALAB have given 45.8% and 60.7% of the positive results, respectively.

Clostridium difficile colitis--diagnosis and therapy

Clostridium difficile is a Gram-positive bacillus which had been identified as the source of potent exotoxins: toxin A and toxin B. C. difficile infection usually follows antibiotic therapy and results from unrestrained growth of pathogenic strains of C. difficile in the colon. Typical clinical findings include: diarrhoea with blood and mucus, fever, abdominal pain, nausea, loss of body weight. In the past the diagnosis was based on positive result of stool culture but now several tests are available: latex-agglutination test, enzyme immunoassays and fluorescence-immunoenzymatic tests. Diagnostic methods enable quick and safe detection of C. difficile antigens or toxins and proper management. Poor susceptibility of C. difficile strains to common antibiotics hinders choosing the effective therapy.

[Occurrence and clinical picture of Clostridium difficile infections after antibiotic therapy]

39 patients with colon bowel inflammatory by C. difficile infection after antibioticotherapy were treated. The causes of antibioticotherapy most frequently former infection of the upper respiratory tract. The C. difficile infection were most frequently before therapy: poliantibiotics, Cephalosporins II generations and Linkomycin. In diagnosis of C. difficile infection the Enzyme Immuno-Fluorescence Test were practical utility confirmed. The symphtomaticotherapy patients with slight course of ills were sufficiently. The therapy of Metronidazol or/and Colestyramine in patients with mild or highly course of ills were efficacious.