Clinical significance of asymptomatic [i]Clostridium difficile[/i] colonisation in patients undergoing antibiotic treatment.

BACKGROUND: [i]Clostridium difficile[/i] infections become a serious problem in terms of nosocomial infections, as well as a consequence of common use of antibiotics. AIM: The aim of the study was to evaluate [i]Clostridium difficile[/i] carriage in patients admitted to the Clinical Department of Infectious Diseases and Hepatology without acute or chronic diarrhea and to assess the impact of antibiotic treatment on the development of enteritis in hospital. Other factors that may affect the risk of infection were also analyzed. RESULTS: Fourteen patients (14%) were carriers of [i]Clostridium difficile[/i] at admission. Second assessment taken after fourteen days of antibiotic treatment showed decrease in GDH antigen prevalence to eight subjects (12.1%). Three patients (3%) had diarrhea during hospitalization, and the toxins A and/or B were found in them. CONCLUSIONS: The frequency of [i]Clostridium difficile[/i] carriage among adults in Poland may be underestimated. Screening for Clostridium difficile GDH antigen may be useful although do not provide definite prognosis of symptomatic disease during ceftriaxone treatment. The risk of Clostridium difficile infection may be reduced mainly by rationalizing antibiotic therapy and following appropriate procedures.

Effectiveness and safety of ledipasvir/sofosbuvir±ribavirin in the treatment of HCV infection: The real-world HARVEST study.

BACKGROUND: To evaluate the effectiveness and safety of ledipasvir/sofosbuvir (LDV/SOF)±ribavirin (RBV) regimen in a real-world setting. METHODS: Patients received a fixed-dose combination tablet containing LDV and SOF with or without RBV, for 8, 12 or 24 weeks. Patients were assessed at baseline, end of treatment, and 12 weeks after the end of treatment. The primary effectiveness endpoint was sustained virologic response 12 weeks after the end of treatment (SVR12). RESULTS: Of the 86 patients, aged 20-80 years, 82.6% were HCV genotype 1b-infected and 50.0% were cirrhotic. More than half (52.3%) had previously followed pegylated interferon-containing (PEG-IFN) treatment regimens, and 38.5% were null-responders. SVR12 was achieved by 94.2% of patients. All non-responders were cirrhotic: two demonstrated virologic breakthrough and the remaining three relapsed. All patients treated with an 8-week regimen achieved SVR12 despite having high viral load at baseline (HCV RNA of >1 million IU/mL in 8/10 patients, including one with a viral load of >6 million IU/mL). Adverse events were generally mild and transient. Most frequently, fatigue (22.1%), headache (15.1%), and arthralgia (7.0%) were observed. Laboratory abnormalities included anemia and hyperbilirubinemia. CONCLUSIONS: Treatment with LDV/SOF±RBV is an effective and safe option for patients with HCV, including those with advanced liver disease or a history of non-response to PEG-IFN-based therapy.

Acute liver failure during treatment of interferon alpha 2a chronic hepatitis B and coinfection of parvovirus B19

Parvovirus B19 infection is associated with a broad spectrum of clinical manifestations among which some are well known but others remain controversial. The role of this infection as a cause of acute hepatitis or exacerbation of chronic liver disease requires discussion regarding its significance in a strategy of prevention and treatment of patients with chronic hepatitis. Clinical importance of this infection in patients with chronic hepatitis B treated with pegylated interferon alpha 2a is still unclear but exactly in this population significant complications during treatment may arise. Parvovirus B19 infection is not rare among persons with chronic hepatitis B, therefore searching for co-infection should be placed in standard diagnostic procedures especially in case of exacerbation of chronic hepatitis, pancytopaenia or anaemia of unknown origin. Pegylated interferon alpha 2a still remains a gold standard of therapy of patients with chronic hepatitis B according to European (EASL) and Polish guidelines. We present a case of 35 years old woman treated with pegylated interferon alpha 2a who developed acute liver failure in 23rd week of chronic hepatitis B therapy. An exacerbation of hepatitis with encephalopathy and pancytopaenia have been observed. Parvovirus B19 and HBV co-infection does not increase the frequency of liver function abnormalities in patients with chronic hepatitis B. Further investigations should be done to describe the natural course of co-infection with parvovirus B19 and HBV and to establish possible association between parvovirus B19 infection and chronic hepatitis B and also the influence of interferon alpha 2a on the infections course.

Cerebrospinal fluid ferritin concentration in patients with purulent, bacterial meningitis ­ own observations / Stezenie ferrytyny w plynie mózgowo-rdzeniowym chorych z ropnymi, bakteryjnymi zapaleniami opon i mózgu - obserwacje wlasne

THE AIM: The aim of the study was to evaluate the usefulness of cerebrospinal fluid (CSF) ferritin concentration assessment in adults with purulent, bacterial meningoencephalitis. MATERIAL AND METHODS: The investigation was performed in 18 subjects hospitalized at the Clinical Ward of Infectious Diseases, Medical University of Silesia in Bytom from 2008 through 2012, for purulent, bacterial meningoencephalitis. The patients were divided into two groups, according to severity of their clinical condition: Group I ­ very severe course of the disease, group II ­ moderate and mild course of the disease. In all the individuals, CSF interleukin-6 concentration was evaluated during the first 24 hours of hospitalization. RESULTS: Mean CSF ferritin concentration in patients in very severe clinical condition (group I) was 314.71 ng/mL as compared to 162.13 ng/mL in subjects of group II with moderate and mild course of the disease. The difference between CSF mean concentration of this cytokine was statistically significant (p<0.01). Correlations between CSF ferritin and CSF protein and lactate were determined. The control assays performed in 6 patients from group I revealed only slightly decrease of CSF ferritin level in the fatal course of the disease. In survivals with recovery CSF concentration of this protein was decreased markedly as compared to the initial level. CONCLUSIONS: The obtained results indicate the usefulness of CSF ferritin concentration assessment in estimation of intensity of inflammation in the subarachnoid space, and indirectly, of severity of the patient's clinical condition. The level of this protein concentration also seems to be helpful as a prognostic marker in purulent, bacterial meningoencephalitis.

The epidemiological and clinical analysis of Clostridium difficile infections in patients hospitalized due to the infection at the Department of Infectious Diseases in Bytom.

UNLABELLED: Clostridium difficile infections are becoming a more serious problem as hospital-acquired infections and the consequence of common antibiotic therapy, also on an out-patient basis. AIM OF THE STUDY: The aim of the study was the epidemiological and clinical analysis of patients with Clostridium difficile-associated disease (CDAD) at the Clinical Department of Infectious Diseases and Hepatology, Bytom in 2014. MATERIAL AND METHODS: A retrospective analysis of the medical documentation of patients with the diagnosis of CDAD was performed. The study group was comprised of 24 patients. The following factors were analysed: gender, age, recent hospitalization, use of proton-pump inhibitors, H2-receptor inhibitors, use of antibiotics, co-morbidities, and the clinical course with consideration given to additional laboratory tests (CRP, creatinine, WBC count). RESULTS: All patients with diagnosed CDAD had been previously hospitalized and 75% of subjects were treated with antibiotics in the period preceding the onset of the disease. Recurrence of the disease was observed in 29% of cases, on average, 12.5 days after hospital discharge. In 16.7% of patients, CDAD resulted in death. Higher CRP concentrations on admission were observed in patients who died compared to the survivors (91.1 mg/l vs. 33.6 mg/l, p=0.015). Additionally, higher concentrations of CRP and leukocytosis were observed in patients with an unfavourable outcome of the disease. Respiratory insufficiency and hypotension were connected with a higher risk of death. CONCLUSION: Hospitalization, antibiotic therapy, advanced age and co-morbidities may contribute to the occurrence of CDAD. In our study, initially high concentrations of CRP, respiratory insufficiency and hypotension were the predictive factors of a fatal outcome of the disease. The dynamics of changes in the leukocyte value and CRP concentration were of lesser importance.

Therapeutic window for calcium-channel blockers in the management of dilated cardiomyopathy: a prospective, two-centre study on non-advanced disease.

OBJECTIVE: This study aimed to investigate the usefulness of the calcium-channel blocker verapamil in non-advanced dilated cardiomyopathy (DCM). METHODS: This was a randomised trial of 70 DCM patients treated with carvedilol (36 patients) and verapamil (instead of ß-blocker; 34 patients) for 12 months. The remaining heart failure (HF) therapy was constant in both groups. The primary outcomes were to determine selected echocardiography parameters and functional status of patients. The secondary outcome included death, heart transplantation and re-hospitalisation due to HF progression. RESULTS: Of the primary outcomes, only the mean ratio of early to late transmitral flow velocities increased significantly in the verapamil-treated patients as compared with the carvedilol-based therapy (1.1 ± 0.3 vs. 0.7 ± 0.2; 95% CI -0.6 to -0.1; p = 0.015). Simultaneously, the Minnesota Quality of Life improved significantly in the verapamil group (95% CI 5.2-19.9; p = 0.002). It was accompanied by the favourable effect of verapamil therapy on exercise capacity in the 6-min walk test (95% CI 21.3-110.7; p = 0.005). CONCLUSION: The addition of verapamil to angiotensin-converting enzyme and aldosterone inhibitors in non-advanced DCM patients has been shown to have a neutral or even positive effect in a few patients.

[EEG examination in patients with purulent, bacterial meningoencephalitis--literature review and own observations]. / Badania EEG u chorych z ropnymi, bakteryjnymi zapaleniami opon i mózgu- przeglad publikacji i obserwacje wlasne.

The study presents the literature review on EEG examination in purulent, bacterial meningoencephalitis as well as own observations carried out in 42 patients with this neuroinfection treated in I Department of Infectious Diseases of Medical University of Silesia in Bytom between 1989-2001. In 19 patients the result of the first examination was abnormal and the degree of EEG patterns pathology correlated with the severity of their clinical condition. Abnormal electroencephalogram was also noted in 7 cases in the control examination. Two of this group of patients died and in two cases pathological EEG patterns preceded epileptic seizures during further hospitalization. Besides, the conversion of normal at the beginning into abnormal EEG patterns was found in cases of purulent, bacterial meningoencephalitis various complications, e.g. brain abscess. The obtained results indicate that EEG examination carried out in the acute phase of purulent, bacterial meningoencephalitis may be helpful in the estimation of severity of patient's clinical state. Performing of EEG examination in series during and after hospitalization may be useful for monitoring the course of the disease and prognosis of its outcome.

[Snake bites in humans--observation recorded in Silesia region between 1999-2003]. / Przypadki ukaszen ludzi przez zmije--obserwacje z terenu Slaska w latach 1999-2003.

Between 1999 and 2003 there were 25 patients hospitalized due to viper (Vipera berus) bite at the Department of Infectious Diseases, Medical University of Silesia in Bytom. Usually snakebites were results of accidental contacts with adders, and rarely, of attempts to catch venomous snakes. Attention is paid to the fact that snakebites occur in areas located close to large cities. In the majority of cases the course of the disease was mild, whereas severe course was recorded only in 4 individuals. It is stressed, that proper direct management following a snake bite as well as during the transportation to a hospital, appropriate treatment (also quick antivenom administration) are essential for intensity of general and local symptoms of envenomation.

[Serum intercellular adhesion molecule ICAM-1 concentration in interferon alpha treated patients with chronic viral C hepatitis]. / Stezenie rozpuszczalnej formy czastki adhezyjnej ICAM-1 w surowicy chorych na przewlekle wirusowe zapalenie watroby typu C leczonych interferonem alpha.

Intercellular adhesion molecule is a protein regulating the inflammatory cells movement. An increase of ICAM-1 expression on hepatocytes and in serum has been observed in patients with chronic viral hepatitis. Interferon alpha treatment should lead to inflammatory response diminution and serum ICAM-1 concentration decrease. The aim of the study was the estimation of interferon alpha treatment influence on serum ICAM-1 concentration in patients with chronic viral C hepatitis. A group of 19 interferon alpha treated patients with chronic viral C hepatitis has been observed. ALT activity, the presence of HCV antibody and HCV-RNAas well as histological examination has been estimated in every patient. Patients have got 144 doses of interferon alpha in a schedule 5 MU three times a week. After three months of treatment control estimations have been conducted for initial evoluation of treatment efficacy. Differences in ALT activity have been observed between I and III trials. ICAM-1 serum concentration has decreased significantly from 1322 to 369 pg/ml, and differences in ICAM-1 serum concentration have been observed in all trials. Estimation of serum ICAM-1 concentration is an indirect parameter of attenuation of inflammatory reaction after interferon alpha treatment.

[Cases of ineffective anti-hepatitis B vaccination--own observations]. / Przypadki nieskutecznego szczepienia przeciw wirusowemu zapaleniu watroby typu B--obserwacje wlasne.

Between 1999-2001 there were 6 patients with acute hepatitis B, previously vaccinated according to the recommended schedule of anti-hepatitis B immunization for adults, hospitalized in the Department of Infectious Diseases (Bytom, Silesian University Medical School). The study presents epidemiological and clinical analysis of these cases. Special attention is paid to possibility of immune response failure in spite of anti-hepatitis B vaccination. It is emphasized, that efficiency of active hepatitis B prophylaxis should be verified by estimation of serum anti-HBs antibodies, especially in patients with planned surgery.

[Extra-salivatory glands manifestations of mumps--own observations]. / Powiklania nagminnego zapalenia slinianek przyusznych u chorych leczonych w latach 1985-2001 w Oddziale Chorób Zakaznych w Bytomiu.

A total of 808 patients with extra-salivary glands manifestations of mumps were treated in the Department of Infectious Diseases, Bytom, Silesian University Medical School in the period of 1985-2001. Mumps meningitis, testicular involvement (epidydymo-orchitis), and mild mumps pancreatitis were diagnosed in 762 (529 male; 69.4%), 24, and 22 (14 male; 63.6%) patients respectively. The patients' age ranged from 2 to 53 years. Mumps virus infection was the reason of transient (behavior disorders, cognition functions impairment) and permanent (hypoacusis, deafness) sequelae of the disease.