Heart- and skeletal muscle-specific antigens recognized by trichinellosis patient sera.

The heart can be seriously affected in human trichinellosis, and cardiac involvement can cause death. Experimental infections in rats have suggested the possible participation of immunopathological processes. The aim of the present paper was to investigate the possible presence in trichinellosis patient sera of antibodies recognizing host tissues and particularly the myocardium. Nineteen sera from late period trichinellosis patients, who acquired infection in the Poznan region (Poland), were tested by immunoblot on extracts from normal rat or human heart ventricle wall, spleen, placenta, kidney and skeletal muscle. Patients' sera recognized several antigens that were not recognized by normal sera. On rat and human heart ventricle wall, a high proportion of sera (42%) reacted with a protein of 68 kDa (P < 0.05 compared to normal sera). The reactivity with this antigen, however, was not significantly different in patients with or without cardiac involvement. When sera were tested on skeletal muscle we found that 47% reacted with a protein of 27 kDa and 53% reacted with a protein of 41 kDa (P < 0.05 for both proteins, compared with normal sera). The reactivity against the 68 kDa antigen and against the 27 and 41 kDa skeletal muscle antigens was not observed on kidney, placenta and spleen extracts. Moreover, very few bands were observed on these tissues as compared to heart and skeletal muscle tissues, thus suggesting a high tissue specificity of the reactivity of trichinellosis sera. In conclusion, this study identifies organ-specific autoantibodies in trichinellosis patient sera, their role in the pathogenesis of cardiac involvement being still unclear.

Persistence of reactivity against the 45 k Da glycoprotein in late trichinellosis patients.

Over the years, the opinions of clinicians on the existence of the so-called chronic trichinellosis or late sequelae of infection have differed. However, the persistence of a humoral immune response against Trichinella in these late-stage patients has been confirmed using specific tests such as the competitive inhibition assay (CIA). We evaluated sera from late-stage trichinellosis patients (2--8 years from acute infection), for their reactivity against Trichinella spiralis antigens. The following tests were carried out: (i) indirect immunofluorescence assay (IFA), performed on muscle sections from mice, 30 days following synchronous infection by intramuscular injection with T. spiralis newborn larvae (NBL); (ii) enzyme immunoassay, employing a synthetic beta-tyvelose antigen conjugated to bovine serum albumin (BSA-Ag); and (iii) western blot (WB) with both an "in house" kit and a commercial kit. The results of IFA obtained by confocal laser microscopy showed that sera reacted against both surface and internal structures of L(1) larvae but at varying levels. Employing the synthetic antigen, EIA showed that 50% of sera tested were positive for the presence of specific antibodies against beta-tyvelose. By WB, all sera were reactive with the 45 k Da glycoprotein (45 gp). These data suggest that reactivity against the beta-tyvelosylated 45 gp persists even in very late stages of human trichinellosis.

Clinical appraisal of patients and detection of serum antibodies by ELISA and CIA tests in late periods of Trichinella sp. invasion.

Results of our studies using ELISA and competitive inhibition assay (CIA) tests fully confirmed the previously experienced trichinellosis and reflected persistent stimulation of antibody production due to the antigen release from Trichinella larvae, which had survived longer and undergone gradual destruction in the muscles. The studies proved that the tests complement each other, yielding concordant results in 86.7% of cases. Due to its higher specificity, the CIA test can help in interpreting pathological signs/symptoms and in evaluating humoral response activity at late and distant in time periods following the invasion.

New aspects of clinical pathology and electro-physiological muscle disturbances in patients with history of trichinellosis.

Clinical studies performed in 44 patients, one, three, four, six or seven years after they had experienced trichinellosis demonstrated the persistence of various general and motor ailments in 88.7% of the patients. The persisting for many years antibodies against E/S antigen of Trichinella in 86.4% of examined patients seem to reflect chronic stimulation by the larvae which, as shown by parasitological and histopathological tests, survived longer and underwent gradual destruction in muscles. Bio-electric disturbances in muscles were most frequently of a mixed type, with prevalence of a neural type record. These observations illustrate a disturbed function of motor neurones and of impulse transmission at the myoneural junction in patients chronically infected with Trichinella.

Principles of contemporary treatment in trichinellosis.

Principles of trichinellosis treatment were presented, based on contemporary parasitologic and clinical criteria. Significance of the Trichinella sp. life cycle, phase of the invasion and the disease was presented. The role of anthelmintics was stressed, as drugs of choice in eradication of the intestinal phase and in prevention against development of the muscular phase. Role of glucocorticoids was described in suppression of acute clinical signs/symptoms. Pathology of the late period oftrichinellosis and of the late invasion sequele were discussed.

[Neurotoxoplasmosis]. / Neurotoksoplazmoza.

Toxoplasmosis represents a clinical problem which focuses attention of several specialists due to the multiorgan pathology it induces and difficulties in evaluating the activity of the morbid process. The infection creates a particularly difficult problem in cases when central nervous system is involved, which frequently leads to unfavorable sequelae. Contemporary data have been presented which pertain to the morphology and life cycle of Toxoplasma gondii, sources of the infection and ways through which the protozoon penetrates the host organism. The pathomechanism of disturbances in the course of toxoplasmosis with involvement of central nervous system is described, as related to the stage of invasion and immune responses of cell-mediated or humoral type. The clinical pathology of congenital and acquired toxoplasmosis is presented, including that developing in patients with immune deficiencies. Diagnostic criteria are given, indispensable in evaluating the activity of toxoplasmosis process, based on contemporary laboratory techniques (antigen detection, detection of antibodies to T. gondii antigen, molecular tests, like PCR, and radiological techniques, like CT and MRI studies. The studies are important not only in evaluation of the primary infection and also for appraisal of reactivation of T. gondii invasion in conditions of acquired immunodeficiency (AIDS), in the course of systemic diseases, during immunosuppressive treatment and in patients who without treatment for toxoplasmosis in the first year of life.

Trichinellosis: human disease, diagnosis and treatment.

In this review, the pathological mechanisms of human trichinellosis are presented, including a discussion on organ pathology, with particular attention paid to intestinal and muscular invasion. The clinical pattern in the acute stage of trichinellosis is presented, together with a classification of trichinellosis relative to severity of the disease. In turn, complications and diagnostic criteria are discussed. Drugs employed in the contemporary treatment of trichinellosis are presented (mainly those of the benzimidazole group and glucocorticosteroids) as well as indications for administering them, as related to severity of the disease.

Clinical and parasitological appraisal of patients with imported malaria.

The study group comprised 118 patients suspected of malaria who underwent an examination following their return to Poland from the tropical countries. Evaluation of the admitted patients was based on epidemiological, clinical and parasitological criteria. The obtained data allowed to confirm acute malaria in 20 patients (16.9%) and malaria in the past, in 32 patients (27.1%). In the remaining 65 patients (55.1%) we excluded malaria. Malaria caused by P. vivax was confirmed in 5 patients, by P. falciparum in 9 patients. A mixed invasion was diagnosed in 6 patients including: P. falciparum and P. vivax in 3 cases; P. vivax, P. ovale and P. malariae in 2 cases; P. falciparum, P. vivax and P. ovale in 1 patient. We noted no relationship between the severity of the clinical course and IFA results. It was found an atypical clinical course of malaria and diagnostic difficulties in patients who used chemosuppression for malaria prophylaxis.

[Toxoplasmosis in families. I. Detection of T. gondii invasion and serological appraisal]. / Toksoplazmoza srodowisk rodzinnych. I Wykrywanie inwazji i ocena serologiczna.

Toxoplasmosis was studied in 102 families, in which index-cases manifested the fully symptomatic course of the acquired lymphnodular toxoplasmosis, confirmed by presence of IgM and IgG class antibodies (ELISA, Vidas, BioMerieux). The index-cases (group A) provided a rational index of the acquired invasion or its late sequele in other families members. The studies were performed in 388 persons, originating from Wielkopolska region, including 102 patients of a group A and 286 of families members of group B (167 children and 221 adults). In group A patients (including 49 children and 53 adults) immunoserological studies detected IgM class antibodies in 68.7% of cases and IgG class antibodies in 94.1% patients. In 286 family members (group B), presence of IgM class antibodies was found in 12.2% and IgG class antibodies was found in 55.2% studied persons; clinical pathology was noted in 46 patients (16.3%) including 3 pregnant women. The obtained results point to the need of complex evaluation of family environments based on analysis of serological tests (including estimation of IgM and IgG class antibodies) and accompanied by clinical analysis of studied children and adults.

[Toxoplasmosis in families. II. Clinical analysis]. / Toksoplazmoza srodowisk rodzinnych. II. Analiza kliniczna.

Clinical and serological analysis was conducted on 102 families including index-cases of lymphonodular toxoplasmosis (102 patients-group A) and 286 family members (group B). The studies included a total of 388 persons (167 children and 221 adults), originating mainly from Wielkopolska region (West Poland). The lymphonodular form of toxoplasmosis represented the dominating pattern among adult cases but among children the clinical pathology pattern was variable: in 14 out of 49 children (group A) lymphadenopathy was not dominating sign and clinically signs and symptoms of central nervous system or organ of vision involvement prevailed; in 6 cases clinical pattern pointed to congenital toxoplasmosis and in 8 cases it indicated sequele of acquired toxoplasmosis. In group B, among 35 children with lymphadenopathy, 7 presented also neurological signs/symptoms, in 5 children the pattern suggested acquired neurotoxoplasmosis in 2 cases congenital form of toxoplasmosis. In 11 adults of the group, lymphonodular form of the disease was diagnosed. In both groups (A and B), the pattern lymphonodular toxoplasmosis was detected also in 5 pregnant women (1.3% of studied persons and 2.7% of all adults). Four of the pregnant women manifested active stage of the disease, confirmed by the presence of IgM class antibodies. Thus, among 286 family members clinical pathology was demonstrated in 46 patients (16.1%) and in 35 patients (12.2%) activity of the disease presented indications for a specialistic therapy.

Detection of Trichinella SP. invasion and clinical appraisal of patients in the late stage of trichinellosis in a new epidemic focus in Wielkopolska.

A clinical and an epidemiological analysis was presented of a trichinellosis focus from Wielkopolska region. The studies included 20 persons and trichinellosis was diagnosed in 15 cases. The focus was characterized by asynchronous invasion with Trichinella sp. in individual affected persons in the course of a prolonged period (around 2.5 months) and by reporting of the patients to the Clinic during approximately 30 to 90 days after the disease signs/symptoms developed. Retrospective analysis and a set of specialized tests permitted to clarify causes of persisting complaints, presented by the patients, as well as to establish the diagnosis at late stages of trichinellosis.

Clinical aspects of late sequelae of trichinellosis.

Clinical analysis and the set of laboratory studies, performed in 25 patients one, two, three or six years after surviving acute period of trichinellosis, documented complaints in 22 patients (88.0%) in the form of muscle complaints (68.2%), cardiovascular complaints (45.4%), generalized weakness (40.9%) and fatigability (31.8%). No significant alterations were demonstrated in electrocardiographic records. In 71.4% examined patients lactic dehydrogenase activity was augmented. Presence of IgG antibodies against the E/S antigen of Trichinella sp. was disclosed in 24 (96%) patients, including 22 patients (88.0%), in whom high titres of the antibodies were found. Morphological studies on muscle tissue (performed in 5 patients) disclosed alterations typical of trichinellosis in 4 patients and presence of Trichinella larvae, calcified to a significant extent, in 2 patients. The long term persistence of IgG class antibodies against Trichinella antigen in patients who survived acute period of trichinellosis a few years earlier points to a chronic antigenic stimulation, probably reflecting progressive destruction of Trichinella larvae in muscle tissue. This may also be expressed in complaints reported by the patients. The problem requires further observations and clinical studies.

[Clinical pathology and diagnostic aspects of giardiasis]. / Patologia kliniczna i aspekty diagnostyczne giardiozy.

From the presented review of data on clinical pathology of giardiasis the authors conclude that type and variability of pattern and course of the disease are shaped by several factors. On one hand they are influenced by genetically distinct character of a given Giardia isolate, its pathogenicity, ability to colonize small intestine and releasing of secretory-excretory products; on the other hand the clinical variability reflects immune response of the host, development and intensity of pathomorphology in the intestine mucosa, secondary secretory disturbances in gastric mucosa and coexistence of pathogenic bacterial flora in small intestine. Application of not only the serological tests (ELISA, IF) to detect antibodies against Giardia but also use of tests detecting Giardia GSA65 co-proantigen and of analysis of parasite DNA represent significant progress in diagnosing Giardia invasion. The modern tests do not negate the need of performing morphological Giardia analysis which continues to represent a basic test in giardiasis.

[Contemporary problems in the epidemiology and clinical pathology of leprosy]. / Wspólczesne zagadnienia z zakresu epidemiologii i patologii klinicznej tradu.

Contemporary problems have been presented, related to pathogenesis, clinical pathology and epidemiology of leprosy. It has been stressed that intensity of cell mediated immune response in the patient determines not only resistance or susceptibility to infection with Mycobacterium leprae but also defines traits of clinical pathology in leprosy, thus providing the basis for modern clinical classification. Present aims and investigative methods in lepra epidemiology have been shown. Current data have been provided on spread of leprosy in various parts of the world, mainly those remaining under monitoring by the World Health Organization. The data point to significant decrease in registered leprosy cases in the regions beginning from 1986 and, in particular, in years 1990-1994. The decrease has resulted from adequate verification of the disease stage in the patients and from applying the recommended multidrug therapy. The needs and perspectives of actions aiming at combatting leprosy have been described, aiming at eradication of leprosy as the international health problem till the year 2000. It has been stressed that at present, leprosy is no longer a hopeless disease and that it can be cured when sufficiently early diagnosed and properly treated.

Focus of trichinellosis and factors determining its mild clinical course.

Present study aimed at analysing the set of epidemiologic, clinical and serological data in appraisal of trichinellosis focus in little town S., near Poznan. It was stressed, that parasitic testing of the consumed meat associated with biological appraisal of Trichinella spiralis represent valuable criteria, which are helpful in interpretation mild clinical signs and symptoms, serological data and in establishing management of patients.

[Tuberculosis of the lymphatic nodes and coexisting invasion with Toxoplasma gondii]. / Gruzlica wezlów chlonnych i wspólistniejaca inwazja Toxoplasma gondii.

Six cases of the peripheral lymphatic nodes tuberculosis with positive serologic reactions to Toxoplasma gondii antigen are presented. It was shown, that independently of a complex of clinical examinations histologic examination is decisive for the diagnosis of lymphatic nodes tuberculosis with coexisting toxoplasmosis. A positive serologic reaction with T. gondii antigen in patients with lymphatic nodes tuberculosis may reflect inactive infection with T. gondii. Use of anti-toxoplasmosis drugs may be not necessary in such cases.

[Sarcoidosis in coexistence with Toxoplasma gondii invasion]. / Sarkoidoza i wspólistniejaca inwazja Toxoplasma gondii.

Two cases of sarcoidosis with peripheral lymphatic nodes involvement and coexisting toxoplasmosis are presented. Both cases illustrate diagnostic and differentiating problems in patients with chronic lymphatic nodes enlargement and positive serological reaction to T. gondii antigen. An emphasis is on the importance of the histological examination of the lymphatic nodes for the sarcoidosis diagnosis and contribution of T. gondii to the disease. Positive serological reaction to T. gondii antigen in patients with sarcoidosis may reflect inactive toxoplasmosis; however, periodical serological tests are necessary monitoring the due immunosuppressive treatment used in patients with sarcoidosis.

[Trichinellosis focus resulting from consumption of wild boar meat]. / Ognisko wlosnicy spowodowane spozyciem miesa dzika.

The focus of trichinellosis was presented comprising 28 patients and resulting from consumption of the wild boar meat. Early confirmation of trichinellosis diagnosis in the first case (index case) and an accurate epidemiological analysis established that the patients became infected with Trichinella spiralis strain originating from natural environment. A severe clinical course was disclosed in the index case, moderate course of trichinellosis in 11 patients, a mild course in 15 cases and an abortive course in one patient. The most frequent trichinellosis symptoms included muscular pain (92.3% cases), fever above 38 degrees C (62.2% cases), conjunctivitis (53.3%), periorbital and facial oedema (42.9% cases); headaches and excessive sweating were less frequent (35.8%), while diarrhoea, hemorrhages to the fingernail beds and skin rush were noted in single cases only. No leukocytosis was detected in 15 patients (53.5%) and number of acidophilic granulocytes was normal in 8 patients (28.5%) including 5 patients with moderate course of the disease. Also, no full correlation was detected between severity of the clinical course and anti-Trichinella antibody titres. Increased activity of a muscular enzymes creatine kinase (CPK) could be detected in 27 patients and increased activity of lactic acid dehydrogenase (LDH) in 9 patients. The increase in muscle enzyme activity (CPK in particular) in some patients failed to correlate with the severity of the clinical course. In 10 patients parasitological and histological study of muscle tissue biopsies was performed to determine intensity of the invasion and the character of pathomorphological lesions.