Coordinated increase of miRNA-155 and miRNA-196b expression correlates with the detection of the antigenomic strand of hepatitis C virus in peripheral blood mononuclear cells.

A tight relationship has been revealed between cellular microRNAs (miRNAs) and the course of hepatitis C virus (HCV) replication in human hepatoma cells. Although the detection of the antigenomic HCV RNA strand in peripheral blood mononuclear cells (PBMCs) has provided evidence for viral replication in PBMCs, no reports have shown how miRNAs are affected upon HCV RNA synthesis in PBMCs. The aim of the present study was to assess if and how the expression levels of miRNA-155 and miRNA-196b in PBMCs are related to HCV replication in PBMCs of chronic hepatitis C (CHC) patients. Supporting analyses were performed to evaluate the expression of precursor pri-miR-155 (BIC) and Dicer protein. The genomic and antigenomic HCV RNA strands in PBMCs were detected by strand-specific qRT-PCR. The expression levels of miRNAs, BIC RNA and Dicer protein were assayed on PBMCs by qRT-PCR and Western blotting, respectively. miRNA-155 and miRNA-196b were detected in all studied PBMC samples, but their levels varied according to the presence of the antigenomic HCV RNA strand in PBMCs. Increased expression levels of miRNA-155 and miRNA-196b were associated with the presence of the antigenomic HCV RNA strand in PBMCs. In this group of patients higher frequency of BIC RNA and Dicer protein detection was also found. This study demonstrates that HCV RNA replication in PBMCs of CHC patients is connected with the increased and coordinated expression of miRNA-155 and miRNA-196b.

Interleukin-6 and the IL-6 (-174) C/G polymorphism in breast pathologies and in HIV-infected patients.

INTRODUCTION: Breast cancer and acquired immunodeficiency syndrome (AIDS) are key issues for modern medicine. The aim of the current study was to present how cytokines, in the example of IL-6 and its polymorphism, can affect these two conditions. MATERIAL AND METHODS: Thirty-one women with benign breast tumours, 42 breast cancer patients and 40 HIV-infected females were enrolled in the study. Serum IL-6 levels were determined by ELISA. The IL-6 polymorphism was genotyped by PCR-RFLP. RESULTS: Serum IL-6 in patients with benign breast tumours was significantly lower than in females with breast cancer (p = 0.017) and HIV-infected women (p = 0.032). We did not find statistically significant differences in serum IL-6 level between females with breast cancer and HIV-infected women (p = 0.749). Comparing the distribution of genotypes and frequency of the IL-6 (-174) C/G polymorphism between the three study groups - breast cancer patients, patients with benign breast tumours, and HIV-infected patients - we did not find any statistically significant differences. CONCLUSIONS: IL-6 can play an important role in pathogenesis of breast cancer and HIV infection and its level is higher than in the control group irrespective of distribution of genotypes and frequency of the IL-6 (-174) C/G polymorphism.

[Efficacy of vaccination against hepatitis A in HIV infected adults from Lodz region--preliminary report]. / Ocena skutecznosci szczepienia przeciwko wirusowemu zapaleniu watroby typu A w grupie doroslych osób zakazonych HIV z regionu lódzkiego--doniesienie wstepne.

OBJECTIVE: To estimate the prevalence of anti-HAV-T in the group of HIV-positive adults and to assess the efficacy of vaccination against viral hepatitis A. MATERIAL AND METHODS: In HIV-infected outpatients anti-HAV-T was determined (electrochemiluminescence method). Patients susceptible to HAV infection were qualified for vaccination. RESULTS: In the group of 175 HIV-infected patients, 70 persons (40%) were anti-HAV-T positive. Prevalence of anti-HAV-T was significantly higher in patients over 35 years of age. Anti-HAV-T were present in all individuals older than 50 years. So far 47 patients have completed vaccination. Good response (detectable anti-HAV-T 1 month after booster dose) was obtained in 73,0% patients. Individuals with actual CD4 count above 200 cells/ul responded better (81,2%) than persons with CD4 count 200 cells/ul or lower (20%). Nadir CD4 count above 50 cells/ul predicted better response than 50 cells/ul or below (78,8% and 25% respectively). One year after vaccination anti-HAV-T were still detectable in 21 patients (56,8%). CONCLUSIONS: 1. Most of studied HIV-positive patients (60%) were susceptible to HAV infection and should be vaccinated. 2. Good response to vaccination was obtained in 73% of patients and it was higher in persons with actual CD4 count above 200 cells/ul and nadir CD4 count above 50 cells/ul.

[Primary hepatotropic viral infections in Mongolia]. / Zakazenia wirusami HBV, HCV i HDV w Mongolii.

Mongolia is known for its high endemicity for viral hepatitis infections, accounted for 25% of infectious disease cases in 2000. Studies revealed these infections are prevalent among young adults in Mongolia. The infections are first and foremost nosocomial infections. The incidence of primary liver cancer, caused HBV, HDV and HCV chronic infections has increased in the last several years. Although viral hepatitis infections are recognized as a serious health problem in the country, not many epidemiological and clinical studies have been done. Few studies that were done were conducted among limited numbers of high risk subjects. These reports indicated that HBsAg prevalence was between 6.9% and 28.7% and anti-HCV prevalence was between 10.7% and 48% in different population samples and in different years. More studies are needed to determine the real magnitude of hepatitis infections in the general population and to isolate and reduce the exposures specific to at risk population groups. National programs controlling hepatitis infections includes primary prevention strategies such as education, vaccination and infection control particularly in hospital settings, must be implemented to improve the awareness about hepatitis infection especially among youth, women and blood donors.

Independent prognostic factors in patients with liver cirrhosis.

BACKGROUND/AIMS: Evaluation of the urgency of the liver transplantation in individual patients may help to prioritize patients at risk of death. Consequently we undertook the search for independent prognostic factors in patients with liver cirrhosis. METHODOLOGY: The study group was composed of 219 patients with liver cirrhosis, treated in our Department, from 1996 to 2005. Patients' files were examined for details of physical findings, results of laboratory examinations, and patients' survival. Prognostic significance of 15 variables was analyzed. All prognostic factors which turned out to be statistically significant in univariate analysis were included in the Cox proportional hazard model. RESULTS: Child-Turcotte-Pugh (CTP) score B (p<0.001; hazard ratio (HR): 13.33), CTP score C (p<0.001; HR=7.45), presence of hepato-renal syndrome (p<0.001; HR=3.54), history of esophageal bleeding (p=0.048; HR=1.63) and presence of peripheral edema (p=0.034; HR=1.61) were found to be independently associated with survival. Model of End-stage Liver Disease score, etiology of cirrhosis, sex, ascites, bacterial spontaneous peritonitis, encephalopathy, serum creatinine concentration, INR and serum bilirubin concentration were shown to be significantly associated with patients' prognosis, however not independently. CONCLUSIONS: Analysis of presence of common clinical symptoms is crucial for evaluation of patients' prognosis.

[The influence of interferon-alpha-2b on the effectiveness of the hepatitis B vaccine in patients suffering from chronic hepatitis C]. / Wplyw interferonu alfa-2b na odpowiedz humoralna po szczepieniu przeciwko wirus owemu zapaleniu watroby typu b u chorych na przewlekle zapalenie watroby typu c.

UNLABELLED: The aim of our study was to investigate the immunogenicity of hepatitis B vaccine in a group of patients suffering from chronic heaptitis C. Thirthy seven patients with chronic hepatitis C (anti-HCV+, HCV-RNA+, histological findings) were selected. Only those patients without serological markers for HBV infection (HBsAg (-), anti-HBcT(-), anti-HBs (-)) were vaccinated the hepatitis B vaccine. The recombinant vaccine (Engerix-B SKB 20 microg) was used according to a 0, 1,2 month regime. The vaccinees were divided into two groups. Group A-12 patients with HCV infection, were treated with interferon alpha 2b during vaccination. Group B-25 patients did not recive the interferon. The seroconversion rates and the concentrations of anti-HBs were taken at month 1, 2 and 3 after the first injection. RESULTS: Patients suffering from chronic hepatitis C react much less favorably to the hepatitis B vaccine than healthy subjects. Administration of the hepatitis B vaccine coupled with interferon-alpha treatment resulted in statistically significant improvement of the immunological response to the vaccine.

[The comparison of the humoral response among the patients with liver cirrhosis and steatosis of the liver after HBV vaccination]. / Porównanie odpowiedzi humoralnej na szczepienie przeciwko wirusowemu zapaleniu watroby typu B u chorych ze stluszczeniem watroby i z marskoscia watroby.

UNLABELLED: The goal of the study was the assessment of the effectiveness of the hepatitis B vaccine among patients with liver diseases. Only those patients without serological markers for HBV infection (HBsAg-, anti-HBcT-, anti-HBs-) were selected. Twenty nine patients were vaccinated. The recombinant vaccine (Engerix-B SKB 20 microg) was used according to a 0, 1, 2 month regime. Serum samples for seroconversion rates and concentration of antiHBs were taken at month 1,2 and 3 after the first injection. The vaccines were divided into two groups. Group 1-16 patients with liver steatosis. Group 2-13 patients suffering from liver cirrhosis. The seroconversion rates and the concentrations of anti-HBs were taken at month 1,2 and 3 after the first injection. Good response to the HBV vaccine was observed in the patients with liver steatosis. 93, 7% of serocoversion to anty HB-s was observed after vaccination. The GMT of anti- HBs was 97,37 IU/l. Patients suffering from liver cirrhosis responded much less favorably to the hepatitis B vaccine than patients with liver steatosis. Seroconversion rate after third dose was 38,5%only, and GMT of anti-HBs was 18,48 IU/l. CONCLUSION: Patients suffering from the liver cirrhosis react much less favorably to the hepatitis B vaccine than patients with the liver steatosis.

[Brain abscess: analysis of prevalence and clinical course]. / Bakteryjne ropnie mózgu jako problem oddzialu zakaznego.

The aim of the study was the analysis of the patients with bacterial meningitis and brain abscess who were treated in the Department of Infection Disease and Hepatology of Medical University in Lodz in years 1996-2005. We reviewed their clinical presentation, bacteriology treatment and outcome retrospectively. Among 135 patients who were confirmed cases of bacterial meningitis 16 identified as having brain abscesses. The prevalence rate of brain abscesses significantly increased in years: 2004-2005. The common predisposing factors were otic and teeth infections, sinusitis, penetrating head trauma, and bacterial endocarditis. Solitary abscess was found in 56% of the cases while in 44% of the cases multiple abscess were found. The most common presentation: headache, fever and neurological deficit were present in 37% of the cases. 75% of patients were disqualified from early neurosurgical intervention and antibiotic therapy were recommended. The antibiotic therapy was effective only in 1 patient. The mortality rate was 38% and 56% of the survivors had late neurological defects. The prevalence rate of brain abscesses significantly increased in years 2004-2005. Over all mortality was very high and antibiotic therapy hasn't been effective treatment in brain abscess at the late stage of its evolution. The early neurosurgical intervention is recommended. Late neurosurgical intervention strongly influences poor outcome in patients with brain abscess.

[Scleroderma-like lesions in the course of autoimmune hepatitis. Case report]. / Zmiany rzekomotwardzinowe w przebiegu autoimmunologicznego zapalenia watroby. Opis przypadku.

UNLABELLED: We present a case of a 31-year old man with a 17 year history of Raynaud's symptom and contractures of the both hands' interdigitalis joints, progressive skin sclerosis of the arms, forearms and hands, telangiectases on the face skin. Because of the painful leg ulcers on the outer surface of both shins and on the dorsal part of the right foot (they appeared almost 10 years ago) the patient finally was admitted to our Department. Physical examination revealed hepatosplenomegaly, in laboratory tests leukopenia, mild thrombocytopenia, elevated ESR, elevated serum levels of IgG, IgM, IgA, creatine kinase level and hypergammaglobulinaemia were found. Neither anti-HBV or anti-HCV or antiphospholipid antibodies were present. Immunofluorescence test (HEP-2 cells) revealed the presence of antinuclear antibodies in a titer of 1:2560 (homogenous and partially speckled pattern) and by immuno-diffusion-anti-Ro antibodies. Hepatosplenomegaly was diagnosed by USG examination. Endocrinological, neurological, surgical and pulmonological examinations gave no abnormalities. Liver biopsy showed features of chronic inflammation and autoimmune hepatitis was diagnosed. COMMENT: the presence of scleroedematous lesions of the skin accompanying chronic hepatic inflammation enabled us to establish the diagnosis of scleroderma-like lesions in the course of long lasting mild autoimmune hepatitis.

[Pegylated interferon-alfa 2a with ribavirin in chronic viral hepatitis C (final report)]. / Pegylowany interferon alpha-2a z rybawiryna w leczeniu przewleklego wirusowego zapalenia watroby typu C (raport koncowy z badan).

UNLABELLED: We evaluated the efficacy and safety of peginterferon alfa-2a [40KD] (Peg-IFNalpha-2a) plus ribavirin in patients with chronic hepatitis C in an open-label programme in a routine clinical setting in Poland. Patients received Peg-IFNalpha-2a 180mg/week plus ribavirin 800-1200 mg/d for 48 weeks. Sustained virological response (SVR) was defined as undetectable HCV RNA (<50IU/mL) at the end of follow-up (week 72). 466 adults were enrolled. Most patients (87.3%) had genotype 1 infection. 440 subjects (94,4%) completed treatment. The overall SVR rate was 55.7%. A higher SVR rate was obtained in treatment-naïve patients (58.7%) than in relapsers (47.8%; p=0,048). SVR rates in genotype 1 and non-1 patients were 51.1% and 88.5%, respectively (p<0.001). There were significant higher SVR rates in patients with lower baseline fibrosis (p=0,01). There were no differences in SVRs by gender or viral load. Hemoglobin, leukocyte and neutrophil levels decreased significantly during treatment, but returned to baseline after the end of treatment. ALT levels decreased significantly during treatment in patients with and without an SVR. 38.4% of patients experienced adverse events like neutropenia, anemia, thrombocytopenia, and other. There was one death (severe thrombocytopenia). CONCLUSIONS: The overall SVR achieved in this predominantly genotype 1 population was 55.7%. SVR rates were significantly higher in treatment-naïve patients, those with non-1 genotypes, and in patients with lower baseline fibrosis scores.

Reactive oxygen intermediates and serum antioxidative system in patients with chronic C hepatitis treated with IFN-alpha and thymus factor X.

INTRODUCTION: In this study, the chemiluminescence (CL) of peripheral blood polymorphonuclear leukocytes (PMNLs) and the serum total antioxidative system (TAS) were assessed in patients with chronic C hepatitis (CCH) before and after 3 and 6 months of treatment with interferon (IFN)-alpha and thymus factor X (TFX). MATERIAL/METHODS: The study included 26 patients with CCH aged between 25-63 years (mean: 42.67). Combined therapy with IFN-alpha 2a and a TFX preparation was applied. PMNL metabolic activity was assessed applying the whole-blood CL method. We measured CL response of neutrophils unstimulated and stimulated by opsonized zymosan, N-formyl-methionylleucyl-phenylalanine (N-fMLP), and phorbol-myristate-acetate (PMA) without and after priming with tumor necrosis factor alpha (10 ng/ml). The assessment of serum TAS was performed directly before the beginning of therapy with IFN-alpha and TFX and after 3 and 6 months of the treatment. A colorimetric method based on the reduction of the cationic radical ABTS*(+) (cation 2, 2'-azido-bis-[3-ethylobenzothiazolino-6-sulfonate]) in the presence of serum antioxidants was used. RESULTS: As a result of the treatment with IFN-alpha and TFX, the formation of free oxygen radicals by resting (unprimed) neutrophils increased statistically significantly both without stimulation and following stimulation by fMLP and PMA. A statistically significant increase in the serum antioxidant capacity was observed, which suggests the induction of compensatory processes. CONCLUSIONS: Increased in vitro reactive oxygen species production by both stimulated and unstimulated peripheral blood neutrophils of patients with CCH was observed. Treatment with IFN-alpha and TFX resulted in a compensatory increase in serum antioxidative capacity.

[Peginterferon alpha-2b in patients with chronic hepatitis C]. / Pegylowany intefeon alpha-62b i rybawiyna w leczen przewlekllego wirusoweg zapalenia watroby typu C.

150 adult patients were assigned pegylated interferon alpha-2b (once weekly 1.5 microg/kg) plus ribavirin (800-1200 mg depending on bodyweight). The treatment lasted 52 weeks and was completed by 139 persons (92.7%). Because of adverse events the treatment was interrupted in 7 persons, 4 other persons resigned. Periodical reduction of pegylated interferon doses was necessary in 19% and the reduction of ribavirin in 21% of patients. Six months after the completion of treatment HCV-RNA was negative in 82 (59%) patients. Neither hepatitis C virus genotype, nor viremia was marked in the study. The negative correlation between the degree of fibrosis in the liver tissue and the results of sustained virological response was stated. Degree of inflammation at liver tissue, sex, age over and less than 40 years did not correlate with the final virological results. The recurrence of infection happened at 7% of the treated persons (negative HCV-RNA directly after the treatment--positive 6 months after the completion). During the treatment period, and comparison with the results obtained before its implementation, statistically significantly decreased: hemoglobin concentration, the number of leukocytes, granulocytes and thrombocytes. They returned to the referential values half a year after the completion of treatment. The activity of enzymes (AIAT, AspAT, GGTP) was decreasing statistically significantly since the first weeks of the treatment till the end and remained significantly lower after 6 months. In both sexes statistically significant reduction of bodyweight was stated, while it increased during the six months after the completion of treatment. Adverse events, which mostly were mild and were not the cause of interruption of treatment, were numerous and occurred at different frequency, in the range from over 50% (flu-like) to 0.7%.

Immunogenicity of inactivated hepatitis A vaccine in children with chronic liver disease.

One and 6 months after vaccination with hepatitis A virus vaccine (HAVRIX 720 Junior), immunologic responses (anti-hepatitis A virus >/=20 mIU/ml) in children with chronic hepatitis C infection seroprotection were 92% (23/25) and 75% (9/12) in children with chronic hepatitis B infection 87% (21/24) and 88% (15/17) and in healthy children 91% (20/22) at both times. A booster dose induced seroprotection in all children.

99mTc-HEPIDA hepatic clearance as a diagnostic tool: usefulness of plasma and hepatic clearance for assessment of hepatic parenchyma performance.

Plasma clearance of (99m)Tc-HEPIDA (Cl(Pl)) has been used for two decades for assessment of liver function in patients with diseases of this organ. A specific determination of (99m)Tc-HEPIDA liver clearance (Cl(Hp)) has been developed that provides more direct possibility to evaluate performance of liver parenchyma. Both tests have been studied in healthy volunteers of varying age (48 individuals) and in 83 patients with varying degree of liver damage. The liver damage has been evaluated on the basis of 5 biochemical tests (AspAT, ALAT, GGTP, bilirubine serum concentration, proteinogram) and a score system used for total impairment, which was calculated for each patient. Normal range of Cl(Pl) and Cl(Hp) was determined from a study on healthy individuals (volunteers). The results seem independent of age, but show sex differences. The following values (mean +/- SD) of Cl(Hp) were found in males and females of: (181 +/- 31) ml//min/1.73 m(2) and (158 +/- 22) ml/min/1.73m(2), and of Cl(Pl) were (224 +/- 33) ml/min/1.73 m(2) and (202 +/- 25) ml/min/1.73 m(2) respectively. Accepted lower boundaries of both quantities (mean -2SD) are 115 ml/min/1.73 m(2) and 150 ml/min/1.73 m(2) correspondingly. Negative correlation of individual values of both clearances in all patients with individual score of liver damage were highly significant and correlation coefficients obtained were higher for Cl(Hp) (r = -0.63) than those for Cl(Pl) (r= -0.56). Factorial analysis was performed with the intention of seeing which of the studied factors had the highest factor loading for parenchyma performance that was assumed as the common factor responsible for correlations. The highest value was obtained for hepatic clearance (Cl(Hp)) of (99m)Tc-HEPIDA. In conclusion this quantity seems highly promising as a clinically useful test for assessment of liver performance, both in screening for liver damage and for monitoring of organ conditions during therapy and follow-up of patients.

Prevalence of markers of hepatotropic viruses A, B, C and the efficacy of vaccination against hepatitis A and hepatitis B among medical students.

BACKGROUND: Hepatitis A and B can be prevented by active immunization. The purpose of our study was to estimate the prevalence of viral markers of hepatitis A, B, and C among medical students, to assess the efficacy of vaccination against HBV infection after 4 years, and to evaluate the efficacy of vaccination against HAV infection. MATERIAL/METHODS: The study group consisted of 150 medical students, who were vaccinated with Engerix B at the beginning of medical studies. From this population we identified a subgroup of 45 students, in whom the presence of anti-HAV was not confirmed; they were then vaccinated with HAVRIX 1440. Viral markers for HAV, HBV, HCV were determined in this group. RESULTS: In the group of 150 persons, we found anti-HBc in 8 students (5.3%), and HBsAg in 1 (0.7%), who did not have either HBeAg or anti-HBe. Anti-HBs antibodies were found in 146 students (97.3%); anti-HCV in 3 cases (2%), and anti-HAV in 15 cases (10%). After 2-fold vaccination against viral hepatitis A, 100% of the students presented with anti-HAV. CONCLUSIONS: The incidence of HBsAg and anti-HCV among our students is the same as in the general population, while the incidence of anti-HAV is much lower (10%). The presence of anti-HBs 4 years after vaccination was detected in 97.3% of the students, and anti-HAV 1 month after the complete course of vaccination in 100% of cases.

[HLA class II alleles and response to hepatitis C treatment with interferon alpha2b]. / Antygeny zgodnosci tkankowej klasy II a odpowiedz na leczenie interferonem-alpha 2b przewleklego zapalenia watroby typu C.

BACKGROUND/AIMS: The mechanisms of humoral immunological response in chronic hepatitis C are not fully understood. It would be interesting to correlate HLA II alleles with the therapeutic response to interferon alfa2b treatment in patients with chronic hepatitis C. Such correlation has not yet been described. The purpose of the study was to correlate the presence of HLA alleles in chronic hepatitis C patients with results of interferon-alfa2b therapy. METHODS: We assessed HCV-RNA presence in serum by RT-PCR and HLA-DR B*1/alleles by PCR-SSP for locus I and II in 54 patients with chronic hepatitis C. All patients were treated with interferon alfa2b for six month. Results of the therapy were evaluated 18 months after the end of treatment. RESULTS: Based on the treatment results (TR--therapeutic response) patients were retrospectively qualified into three groups: sustained responders (SR)--18.6% (10/54), relapsers (R)--48.1% (26/54), non responders (NR)--33.3% (18/54). Allele DRB*1 07 and allele DRB1* 13 were more frequent among patients in NR and TR group, respectively. Observed differences were not statistically significant (p > 0.05). CONCLUSION: In the group of 54 adults with chronic hepatitis C no correlation between the presence of HLA-DRB1* alleles and response to interferon alfa2b therapy was found.

[Does the estimation of acute phase protein concentrations in cerebrospinal fluid and/or in serum in patients with viral meningitis carry diagnostic importance? Part I. Lymphocytic meningitis caused by epidemic parotitis]. / Czy oznaczanie stezen bialek ostrej fazy w plynie mózgowo-rdzeniowym lub/i w surowicy w wirusowym zapaleniu opon mózgowo-rdzeniowych u dzieci ma znaczenie diagnostyczne? Czesc I. Limfocytarne zapalenie opon mózgowo-rdzeniowych wywolane wirusem nagminnego zapalenia przyusznic.

OBJECTIVE: We examined whether an acute phase reaction could occur in children with lymphocytic meningitis of homogeneous etiology (parotitis epidemic from the Paramyxoviridae family), a sign of which would be an increase in concentrations of acute phase proteins (APP's) in cerebrospinal fluid (CSF) and/or in blood serum. We also tested the usefulness of the determination of selected APP's concentrations in CSF and serum in diagnosis and monitoring of the course of the disease, provided that an increase in concentrations of selected APP's were discernible. METHODS: Cases were 78 children with lymphocytic meningitis as a complication of parotitis epidemic. Controls were 30 healthy children (control group K1) and 19 children hospitalized with suspected meningitis (control group K2). The following APP's presence in CSF and serum were tested: C-reactive protein (CRP), alpha-2-haptoglobin (HPT), alpha-1-antitripsin (AAT) and alpha-1-acid glycoprotein (AAG), alpha-2-ceruloplasmin (CER) and alpha-2-macroglobulin (AMG). The results were compared and analyzed. RESULTS: The results of the research show a significant increase in all APP's determined, except for CRP and AAG, in children with parotidal meningitis. CONCLUSIONS: Determination of CRP concentration either in CSF or in serum is not useful in diagnosis of parotidal meningitis and in differentiation of lymphocytic and bacterial forms of the disease.

[Diagnostic difficulties in tuberculosis meningoencephalitis]. / Trudnosci diagnostyczne w przypadku gruzliczego zapalenia opon mózgowo-rdzeniowych i mózgu.

Tuberculous meningoencephalitis (TBM) is a rarely diagnosed form of tuberculosis. It is characterised with high mortality. Only rapidly started treatment allows to patient's survival. However, bacteriologic prove of the diagnosis is achieved only in 40% of cases. It was hoped that introduction of PCR to clinical practice, would allow rapid and unquestionable diagnosis. We present case of male with lymphocytic bacterial meningoencephalitis in whom tuberculous etiology was suspected. The diagnosis was abandoned when negative results of PCR was obtained. As cessation of treatment led to dramatic worsening of patients state, the antituberculosis therapy was restarted. After 2 months of therapy, complete clinical remission was achieved. Nevertheless, computed tomography of brain revealed clinically asymptomatic hydrocephalus. Presented case shows that the treatment is effective, it should not be ended even in case of negative results of PCR test.