Correlation between liver damage and degree of gastric mucose colonization by Helicobacter pylori in subjects with parenchymatous liver damage.

BACKGROUND: Helicobacter pylori (H. pylori) is an important factor responsible for chronic inflammatory conditions of the gastric mucosa. It has been demonstrated in numerous animal studies that some Helicobacter species may cause parenchymatous liver damage. The aim of the study was to investigate whether there is any correlation between the incidence of parenchymatous liver damage, and the incidence and degree of colonization of the gastric mucosa by H. pylori. MATERIAL AND METHODS: The study was carried out in the group of 30 patients (14 females, 16 males) whose mean age was 37 years, hospitalized because of parenchymatous liver damage without clinical symptoms of cirrhosis. All the patients had gastroscopy and urease tests performed, and mucosal biopsies were taken for immunomorphological investigations. The patients were divided into groups, group I comprising those with positive, and group II with negative urease test results. RESULTS: Positive urease tests were obtained in 26/30 patients (group I), 18/26 of whom demonstrated macroscopic changes of the gastric mucosa visible in gastroscopy. Group II with negative urease test results comprised 4/30 patients, 2/4 of whom had detectable changes in the gastric mucosa. The presence of H. pylori antigens was demonstrated by gastric mucosa immunomorphology in all 30 patients. The degree of invasion of H. pylori was visualized by immunofluorescence, which allowed to differentiate deep mucosal invasion of H. pylori (bacterial antigens present in lymph follicles and at the base of muciferous glands) observed in group I in 14/26 and in group II in 1/4 cases and superficial invasion (epithelium and mucosal surface) observed in group I in 12/26, in group II in 3/4. CONCLUSIONS: The obtained results may suggest more frequent H. pylori infections in subjects with parenchymatous liver damage than in the population without liver damage. Immunofluorescence seems to be a highly sensitive method allowing for detection of even small degrees of gastric mucosa colonization by H. pylori.

[Staphylococcus aureus sepsis--still life threatening disease]. / Posocznica gronkowcowa--choroba nadal zagrazajaca zyciu.

We report an analysis of clinical course of 18 patients presenting with Staphylococcus aureus sepsis. Community acquired infection was caused by Methicillin susceptible S. aureus (MSSA) in 11 patients. MSSA in 3 and Methicillin Resistant S. aureus strains (MRSA) in 4 patients, were the etiologic factor in 7 patients with nosocomial infection. From anamnestic data patients presented with: elevated body temperature--18/18, arthralgia and myalgia--9/18, headache--8/18, nausea--6/18, chills--2/18. Physical examination on admission revealed: meningismus--12/18, hepatomegaly--11/18, purulent and haemorrhagic skin lesions--7/18 and impaired neurological status (Glasgow Coma Scale < or = 12)--6/18. The mean APACHE III score, calculated from data collected at diagnosis of sepsis was 47 (7-114). Several complications had been observed: endocarditis--10, purulent meningitis--5, focal CNS lesions--5, pneumonia--8, pulmonary abscess--3, hydrothorax--1, abscesses of the spleen--5, renum--4, osteomyelitis--2. 11/18 patients required ICU treatment. Ventilator assistance of respiration was necessary in 7/18. Acute thrombocytopenia (< 100,000/ml) was diagnosed in 60%. In 5 patients suppurative meningitis had been diagnosed with a mean pleocytosis-837 (173-1898) microL. The results of treatment were satisfactory in 11 patients, 3 patients required further surgical treatment (2--cardiosurgery, 1--orthopedic surgery), 4 patients died. Infection caused by community acquired MSSA strains had been characterized by severe clinical course with increased incidence of endocarditis, organ failure and abscess forming. We conclude that Staphylococcus aureus sepsis is still a life-threatening disease, which should be treated at centers with immediate access to imaging techniques of CNS and circulatory system as well as intensive care and cardiosurgery. Community acquired S. aureus sepsis compared with nosocomial infection is characterized by more severe clinical course and higher mortality, despite of a great susceptibility to most antibiotics of causative S. aureus strains.

[Wegener's granulomatosis]. / Ziarniak Wegenera.

The authors present a case of Wegener's granulomatosis in a 22 year-old female patient. They observed multi-organic changes concerning upper and lower respiratory tracts, skin, oral cavity, joints, kidneys. The diagnosis was confirmed in the Department for Infectious Diseases after two years of the beginning of the disease. The diagnosis was based on a course of the disease, histopathological changes of the skin, an increase of cANCA levels. CTX, prednisolon, cyclosporin and immunoglobulins i.v. for 5 days were used in the therapy. Apart from this symptomatic treatment was also introduced. The 14-month remission of the disease was obtained.

[Borreliosis--Lyme disease--a growing clinical problem]. / Borelioza--choroba z Lyme--narastajacy problem kliniczny.

Clinical and epidemiological analysis of Lyme disease cases treated at the Infectious Diseases Clinic of the Medical University of Gdansk and the District Hospital of Infectious Diseases in the years 1993-1995 was done. The results were compared to data presented in the literature. The material consisted of 184 patients, 169 in I stage of the disease and 15 in the II stage. Out of 15 in the II stage, 2 patients presented with lymphocytoma benigna cutis, 7 with arthritis and 6 with neuroboreliosis. The Lyme disease diagnosis was confirmed with positive serological tests in 45% of patients in the I stage and in 100% of patients in the II stage. Over the analysed time interval, 1993-1995, the incidence of Lyme disease has increased markedly; 1993-38 cases, 1994-50 cases and 96 cases in 1995.

[Antibiotic-associated diarrhea in light of personal observations]. / Zespoly biegunkowe po antybiotykoterapii w swietle wlasnych obserwacji.

Examination was performed in a group of 539 adult patients with diarrhea admitted to the Department of Infectious Diseases in Gdansk from 1991 to 1994. The group of 17 patients with antibiotic-associated colitis (AAC) was analysed. The antibiotics responsible for AAC were lincosamides, cephalosporins and penicillins. AAC was diagnosed by anamnesis, medical examination and detection of toxin A Clostridium difficile in stool samples. The contrast enema, colonoscopy and histopathological examination of colon mucosa were performed only in severe, protracted cases. The course of disease was mild in 2 cases, moderate in 13 and severe in 2 patients. Relapses of AAC were observed in 2 cases. Initial treatment of AAC included discontinuation of the antibiotic therapy that precipitated the disease and the replacement of fluid and electrolyte losses. Moreover, oral metronidazole and oral vancomycin were administered. All patients made a complete recovery.

[Case of Wegener granuloma]. / Przypadek ziarniniaka Wegenera.

A case is presented of Wegener granuloma with lesion in the maxillary sinus, orbit, eye, lungs, kidneys and on the skin, observed in the Department of Infectious Diseases. The diagnosis was made after seven months of the disease, on the basis of clinical picture and histological examination. The applied treatment with cyclophosphamide and steroids led to regression of most symptoms. The permanent consequence was left eye amblyopia of significant degree. During 3.5 years of follow-up three recurrencies of the disease were observed which were associated with attempts at dose reduction of the drugs used. Presently, the patient is in a remission lasting 22 months. Five months passed as yet from the completion of the treatment. In view of the possibility of disease recurrence, the patient remains in further follow-up of the department.