Human alveolar echinococcosis in Poland: 1990-2011.

BACKGROUND: Alveolar echinococcosis (AE) caused by Echinococcus multilocularis infections is a dangerous old disease in the Northern Hemisphere. The aim of the paper was to collect and analyze data on human AE in Poland in the last two decades. METHODOLOGY/PRINCIPAL FINDINGS: The sources of data were both the cases officially registered and detected by an active field and laboratory surveillance. The cases were verified by clinical, epidemiological, and laboratory criteria. Altogether 121 human cases of AE were detected. Among these 83 (68,6%) cases were classified as confirmed, 16 as probable and 22 as possible. During the two decades a continuous increase in detection rate was noticed. The cases were 6-82 years old at the time of diagnosis (mean - 47.7 years). Sex ratio M/F was 0.86/1.0. The AE was fatal in 23 (19%) patients (mean age at death - 54.1 years). Family agglomeration of AE was found in 4 foci, involving 9 patients. Seventy six of the cases were diagnosed in an advanced stage of disease. In all cases the liver was the primary location of AE. In 30 (24.8%) patients a spread to other organs was observed. Ninety four of the patients were treated with albendazole. In 73 (60%) patients a surgical operation was performed, including 15 liver transplantations. CONCLUSIONS/SIGNIFICANCE: The studies confirmed that AE is an emerging disease in Poland, which is the fourth country in Europe with over 120 cases detected. The results also indicate the need of a wider national programme for implementation of screening in the highest AE risk areas (north-eastern Poland) with an effort to increase the public awareness of the possibility of contracting E. multilocularis, and above all, training of the primary care physicians in the recognition of the risk of AE to allow for an early detection of this dangerous disease.

The estimation of different ELISA procedures for serodiagnosis of human trichinellosis.

INTRODUCTION: The most important confirmative diagnostic test for trichinellosis is the presence of the muscle larvae in a tissue biopsy but this direct method has a low sensitivity of light and moderate infections. The aim of presented study was to compare the usefulness of the results obtained by three ELISA procedures for Trichinella spp. diagnosis in human outbreaks. MATERIALS AND METHODS: All sera (cases and controls) were tested for anti-Trichinella antibodies (immunoglobulin G) using commercially available Novatec KIT and two other ELISA procedures based on excretory-secretory (ES) antigens on Trichinella spiralis muscle larvae. The main differences in ELISA procedures were: the protein concentration in antigen, dilution of human serum samples, conjugate and the time of conjugate incubation. Additional differences were noticed in ES antigen preparation procedures as well as in T. spiralis isolates used in these procedures. Serum samples were obtained from 22 symptomatical patients from Poznafi region (West Poland), geographic area where human outbreak had occurred. Control serum samples were obtained from 20 patients from an open population from a non endemic trichinellosis area. RESULTS: The results were analyzed in terms of both: statistical and epidemiological point of view. Linear regression analysis and correlations coefficient r between OD values of total 22 patients obtained in three ELISA procedures were positive and high statistically significant. Three ELISA procedures revealed different cut-off values and positivity rates for outbreak. However, the majority of positive samples were found as positive in three procedures, but some of them were positive in two or one procedure only. These individual variability in sera reactivity observed in three ELISA procedures could be very important from epidemiological point of view.

[Risk of alveococcosis for humans in Poland]. / Zagrozenie bablowica wielojamowa (alweokokoza) dla ludzi w Polsce.

The paper presents data on occurrence, diagnosis and treatment of alveolar echinococcosis in humans as well as possible methods of its prevention. Studies done in 2001-2003 in Poland have shown the high prevalence of the tapeworm in red foxes in the north-east (34.5%) and south-east (39.3%) of Poland with foci of infection in some counties (up to 70% foxes infected). It makes the high potential risk for human infection in these areas.

[Evaluation of a risk of a cross-reactivity with Echinococcus multilocularis-specific Em2plus antigen in patients with liver cancer]. / Ocena ryzyka wystepowania niespecyficznych reakcji krzyzowych z antygenem Em2plus Echinococcus multilocularis u pacjentów z nowotworami watroby.

The incidence of non-specific reactions with E. multilocularis antigen in patients with liver malignancies, and the risk of a supradiagnosis of alveolar echinococcosis (AE) in space-occupying lesions in the liver due to neoplastic proliferative diseases were studied. Analysis of specific IgG serum antibody against Em2plus antigenic complex was performed in 11 AE patients in comparison to 76 individuals with malignant neoplasms of abdominal or extra-hepatic location, including some patients with primary hepatocellular cancer or distant metastases to liver, and 42 patients with benign hepatic lesions. Only one false borderline result was reported in a case with colorectal cancer, and dissemination to liver. Low risk of false positive results with E. multilocularis-specific Em2plus antigen in patients with liver malignancies makes the test valuable for practical reasons in a differential diagnosis of irregular tumor masses visualized by imaging techniques.

[Case definitions and clinical evaluation of patients infected with Echinococcus multilocularis treated in the Poznan centre]. / Kryteria rozpoznawania oraz oceny klinicznej pacjentów zarazonych Echinococcus multilocularis leczonych w osrodku poznanskim.

Recent epidemiological reports have shown an increasing risk of E. multilocularis infection among red foxes and humans in Poland. The aims of the study were: (i) to improve the early detection of alveolar echinococcosis (AE) in humans by implementation of clinical, imaging, immunodiagnostic, ultrastructural and molecular methods, (ii) to realize the parasitological verification of registered cases suspected of alveococcosis by the specialized, parasitological centres, and (iii) to standardize diagnostic and therapeutic procedures for this severe parasitic disease. Since 1993, eight cases of AE were registered in the Poznan centre. The final diagnosis was based on PAS-positive staining of lesions by histopathology or a detection of the parasite's DNA in liver sections. Collaboration with physicians of various medical specialities is crucial for an early and more effective recognition of AE. Alveococcosis should always be considered in the differential diagnosis of space-occupying lesions in the liver suggesting slow-growing cancer.

Molecular confirmation of human alveolar echinococcosis in Poland.

Infections of humans with Echinococcus multilocularis, the causative agent of alveolar echinococcosis (AE), a zoonosis, have been described with increasing frequency in Poland since 1994. In the attempt to verify these reports, we analyzed specimens obtained from a representative group of Polish patients. Liver lesions in patients with AE that was diagnosed on the basis of results of histological and serological tests contained E. multilocularis DNA, as shown by the presence of specific microsatellite sequences and mitochondrial 12S rDNA. The same tests clearly distinguished between AE and cystic echinococcosis, which is caused by Echinococcus granulosus. These data are unequivocal proof that human infections with E. multilocularis occur in Poland.

[Visceral leishmaniasis]. / Leiszmanioza trzewna.

Leishmanioses are widespread in 88 countries of the tropical and subtropical zone, including regions of the Mediterranean Sea basin of Southern Europe. Actually, approximately 350 million of people live in Leishmania endemic areas and about 12 million of individuals are infected. Visceral leishmaniosis (kala-azar disease, tropical splenomegaly) is caused by at least 3 species of Leishmania protozoa: L. donovani, L. infantum and L. chagasi. The incidence of the disease is estimated at 500,000 new cases annually. The infection is transmitted by Phlebotomus or Lutzomyia mosquitos bites, in which intestines forms invasive to humans are developed. Leishmania spp. have a predilection to the reticulo-histiocytary system cells, leading to their proliferation and disruption, and after spreading to the circulation they invade spleen, liver and bone marrow. Visceral leishmaniosis should be suspected in travelers returning from tropical and subtropical areas with signs of splenomegaly and twice temperature spikes in a day. We reported a case of the kala-azar disease in the 22 year-old Polish patient seasonally working in Italy. The clinical picture was expressed by two daily pikes of fever proceeded by chills, excessive sweat, hepatosplenomegaly, lymphadenopathy, general weakness, abdominal pain and nausea. The Leishmania infection was complicated by candidiosis. Laboratory tests showed anaemia, thrombocytopenia, leucopenia, hypergammaglobulinaemia and a suppression of immunological cellular response. The diagnosis was confirmed by a presence of amastigota forms in macrophages of the bone marrow aspirate and a detection of specific antibodies to L. infantum by Westernblotting. The patient was successfully treated with Glucantime.

[Diagnostic difficulties in febrile travellers returning from the tropics. Two cases of typhoid fever imported from India]. / Trudnosci diagnostyczne u goraczkujacych powracajacych z tropiku. Dwa przypadki duru brzusznego importowanego z Indii.

Typhoid fever is an acute infectious disease caused by Salmonella enterica serotype typhi. The infection is responsible for endemic or epidemic outbreaks in tropical and subtropical countries, especially in Indian subcontinent, Southeast Asia, Central and South Africa. Latin America, and it occurs sporadically in Poland. We reported two cases of imported typhoid fever after travelling to India and Nepal. In the tourists returning from the area hyperendemic for malaria, visceral leishmaniosis, amoebiasis and haemorrhagic fevers and not following tropical hygiene measures, persistent fever was a source of difficulties in differential diagnosis. In the first case, lack of anti-malarial chemoprophylaxis in the presence of anaemia and thrombocytopenia strongly suggested Plasmodium spp. infection. Two daily peaks of fever with splenomegaly, lymphadenopathy, leucopenia, high transaminases levels and co-existing positive serology for L. donovani pointed to visceral leishmaniosis. Late occurrence of specific anti-S. typhi agglutinins in the Widal test, cross-reactivity with S. paratyphi A and negative urine bacteriological culture were observed. In the second case, gastrointestinal disturbances, including pain, abdominal tenderness and diarrhoea gave a suspicion of amoebic colitis. Stool and urine cultures were negative for S. typhi and cross reactions with S. paratyphi A and C were reported. Typhoid fever was finally confirmed in both patients by an isolation of S. typhi from peripheral blood cultures. The effectiveness of treatment of choice with ciprofloxacin or ceftriaxone in a case of multidrug-resistant (MDR) strain of S. typhi was documented.