Sequence based typing and pre-absorption test in retrospective analysis of a pseudo-outbreak of Legionella infections differentiates true cases of legionellosis.

UNLABELLED: The aim of this study was elimination of false positive results obtained by the Chlamylege kit. Two serological kits (IgM ELISA L. pneumophila sgs1-7; ImmuView(TM) L. pneumophila sg1/sg3) and pre-absorption tests (with L. pneumophila sg1 and sg3 reference strains antigens) were used. 153 sera (79 patients) were examined. The high correlations were found between the results by both tests. Positive results by ELISA (sgs1-7) were found in 19/79 patients; by ImmuView(TM) (sg1+sg3) in 16/63. In 8 patients, the dynamics of the IgM in pairs of sera was high (ratio ≥2). In 5/8 of those patients seroconversion was determined. Selected pre-absorbed sera (15 pairs) were tested simultaneously by the same tests. In 8/15 pairs of sera, the reduction of IgM levels in pre-absorbed sera was higher than 10. The reduction of IgM differed in sg1 and sg3 tests. The probability of infections due to L. pneumophila sg3 (7 patients) and L. pneumophila sg1 (5 patients) was based on the results of pre-absorption tests. The correlation between ELISA and ImmuView(TM) tests of pre-absorbed sera was statistically significant (Po=0.0389). Moreover, genotyping of L. pneumophila (SBT) directly in the sera of selected 15 patients (high IgM reduction) was carried out. Completed 7 alleles profile (ST36) was determined in one patient. However, a second patient had the same profile of 5 alleles, and similar reactions in pre-absorption tests. At least 4 sources of infections were suggested on the base of genotyping and pre-absorption results. CONCLUSIONS: Positive results obtained by molecular techniques (eg.PCR) in the diagnosis of Legionella infections should be supplemented by other tests for confirmation of legionellosis. The sequence based typing carried out directly in clinical specimens seems to be a promising method.

[Today's threat of legionellosis]. / Wspólczesne zagrozenie legioneloza.

Hairy bacilli of Legionella pneumophila is widely widespread in the aquatic environment. Epidemiology of the disease in Poland is not known. In any case of sick of severe pneumonia not responding to treatment (antibiotics beta-lactams) one should think about Legionella infection. Very important is the initial assessment of the risk of exposure to infection. Preferred test for the diagnosis of infection in all patients hospitalized with a diagnosis of severe pneumonia is the determination of Legionella antigen in urine. In the case of confirmation of Legionella infection is recommended to take antibiotics from the group of fluoroquinolones. In patients intolerant to this group the macrolides are applied.

[Segregation and evacuation of victims caused by biological pathogens]. / Segregacja i ewakuacja w zagrozeniach spowodowanych czynnikami biologicznymi.

Threat of the use of biological pathogens is still real. The degree of preparation assistance at various stages directly affects the efficiency of operations in the event of mass cases. The need for and scope of assistance given in relation to current recommendations, and our own experience with patients with severe infections. Principle of segregation and evacuation steps included in the basic hospital procedures.

[The effects of amiodaron on the thyroid function]. / Wplyw amiodaronu na czynnosc tarczycy.

The use of several groups of medications may result in thyroid dysfunction including thyrotoxicosis or hypothyroidism of various degree (from subclinical to full-clinical syndrome). The mentioned disturbances may develop either on the basis of normal euthyroid gland or may overlap the previously-existing oceult changes (first of all different forms of autoimmune thyroiditis). Amiodarone is a widely used anti-arrythmic drug with considerable potential to cause thyroid dysfunction because of its 35% iodine content. Besides amiodarone particles are known to inhibit T4 to T3 conversion, they work as inhibitors of nuclear receptors for thyroid hormones, exert cytotoxic effect and induce immune/inflammatory process in thyroid gland. Both thyrotoxicosis (AIT - amiodarone induced thyrotoxicosis) and hypothyroidism (AIH - amiodarone induce hypothyroidism) may develop during amiodarone therapy. AIT appears to occur more frequently in geographical areas with low iodine intake, whereas AIH is more frequent in iodine-sufficient areas. Two forms of AIT are known. Their differentiation is very important for further therapeutical procedures. Because thyrotoxicosis and hypothyroidism symptoms during amiodarone therapy are scanty, there is need for periodic determination of thyroid function. Normal ranges for amiodarone patients differ from those for the rest of population. They are presented in this review. Treatment of AIT is very complicated. Sometimes there is need to use few methods together, especially when amiodarone treatment can not be stopped.

[Drugs affecting thyroid--part II]. / Leki wplywajace na czynnosc tarczycy - cz. II.

The use of several groups of medications may result in thyroid dysfunction. So far the best known medication is amiodarone. The role of other medications and diagnostic agents in causing thyroid dysfunction is quite often forgotten. We presented medications and diagnostic agents commonly used in medical day-to-day practice. We described other than amiodarone iodinated agents and quoted recently published European guidelines in using iodinate contrast agents. We focused on lithium and psychiatric drugs and mechanism of their toxic impact on thyroid gland. These agents are important as they are applied for years (including children). At the end the impact of cytokines on thyroid gland was discussed, medications ever more widely applied in anti-viral and anti-neoplastic therapy.