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.

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.

Antistriational antibodies during Toxocara canis, Trichinella spiralis infections.

The parasitic infections (Toxocara can is, Trichinella spiralis) are characterized by general and local symptoms including fever, muscle pain and swelling. The question was asked whether the muscle changes that occur due to larva migrans give rise to the autoimmune response. The presence of antistriational antibodies (aStrAbs) was determined in the following groups of patients: group 1--66 patients with toxocariasis and the presence of anti-Toxocara antibodies, group 2--22 patients suspected of Toxocara canis infection without anti-Toxocara antibodies, group 3--20 patients with active trichinellosis confirmed by anti-Trichinella antibodies. As control 25 healthy persons (group 4) were studied. The aStrAb were tested by the indirect fluorescence using unfixed cryostat sections of human striated muscle. The following results were obtained: group 1--42 sera positive, group 2--5 sera were weakly positive, group 3--all sera showed the presence of aStrAbs, group 4--no aStrAbs. The presence of aStrAbs in patients with parasitic infections may suggest the occurrence of anti-muscle autoimmune response.

[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.

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.

[Congenital toxoplasmosis in the Poznan region]. / Toksoplazmoza wrodzona w województwie poznanskim.

Among 3,734 women, hospitalized for giving birth, 58.9% had a positive Toxoplasma serological test (DA). No clinical expression of congenital toxoplasmosis was observed in 4,311 newborns; seven had a false positive ISAGA test with cord blood. Only 24% of the women were aware of congenital toxoplasmosis and only 3% were serologically examined before. Health education should be intensified and serological tests more commonly performed especially in the risk groups.

[Clinical criteria and evaluation of the pathology and progress of lympho-nodular toxoplasmosis]. / Kryteria kliniczne i ocena obrazu oraz przebiegu toksoplazmozy wezlowej.

We aimed at analysis of the clinical pattern and the course of lympho-nodular toxoplasmosis taking into account the intensity and duration of the illness. Ninety seven patients (69 adults and 28 children) with lympho-nodular toxoplasmosis were examined. Toxoplasmosis was diagnosed by indirect immunofluorescence; the titres of antibodies of IgG and IgM classes were also estimated. Depending on the duration of the illness three periods: early, regression of symptoms and protraction of symptoms were defined; depending on the intensity of signs and symptoms of toxoplasmosis three courses of the disease: acute, subacute and chronic were defined. The analysis showed that clinical picture of lympho-nodular toxoplasmosis was characterized by swelling of various peripheral lymph nodes as well as by general clinical symptoms (88.7% of cases) the intensity and duration of which, to a large extent, determined course of the illness. No correlation between clinical course and duration (early and regression period) of lympho-nodular toxoplasmosis and titres IFA-IgG (before therapy) was found. Pathomorphology of lymph nodes in patients with toxoplasmic lymphadenopathy is a valuable complementary examination which renders it possible to determine the period of the disease.