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Dirofilariosis caused by Dirofilaria (Nochtiella) repens is recorded sporadically among people in Europe, Asia and Africa. Still a worldwide controversy exist upon human parasite hosting. Herein, the first case of ocular dirofilariosis in Bulgaria caused by gravid female is presented. A single nematode was removed from the eye of the 76- year-old patient in the course of cataract surgery. Microscopic examination of the histological slides revealed microfilariae in the parasite’s uterus, but not in the blood. Knott’s method for detection of microfilariae in the peripheral blood was negative and the rest of laboratory blood and biochemical tests were within reference limits. A comprehensive review of the etiology, pathogenesis and clinical presentation of Dirofilaria repens infection is also highlighted.

Children are more susceptible to intestinal parasitic diseases than adults due to their lack of hygiene habits and close social interactions with their peers. We present a case of a 5-year-old boy with diarrhea and abdominal pain. The stool sample and perianal swab were examined in LINA laboratory, Burgas, Bulgaria. We detected four parasites Giardia (Lamblia) intestinalis, Blastocystis hominis, Hymenolepis nana and Entamoeba coli. Microbiological stool examination shows negative results for Candida spp., Salmonella spp. and Shigella spp. Patient's peripheral blood tests were normal. The calprotectin in faeces was tested establishing slightly increased values. The presence of four parasites in one patient in Bulgaria (in the 21st century) is a rare case. Lambliosis and hymenolepiosis are more likely to be found in this patient's region. Following the presence of Entamoeba coli and the transmission mechanism of the other three parasites it can be concluded that the child's hygiene is poor. This patient reveals typical clinical picture with mild symptoms and normal paraclinical results. The presence of parasites in a definitive host is not necessarily related with the development of pathological departures. The fight with parasitic diseases can be successful with a broad integral approach - recognizing and diagnosing the parasites promptly and using radical and suitable treatment.

Introduction. Rubella is a worldwide contagious disease with self-limited symptoms and a generalized rash. Epidemiology of rubella changed after licensing the vaccine in 1969. Children’s rubella is a self-limited infection, but when it occurs during pregnancy, there is a risk of severe damage to the fetus. Objectives. The aim of this study was to determine the immunity against rubella virus in pregnant women in Pleven Region, Bulgaria. Methods. A cross-sectional study was carried out on pregnant women hospitalized in a Clinic of obstetrics and gynecology, University Hospital-Pleven, Bulgaria. Quantitative determination of specific Immunoglobulin G (IgG) antibodies against rubella virus was performed by Enzyme-Like Immunosorbent Assay (ELISA). Data were analyzed using the Microsoft Office Excel 2007 software. Results. Between January 2018 and December 2018 there were collected and tested to Rubella virus IgG antibody 242 serum samples. Two hundred and four (84.30%) of them were positive, 29 (11.98%) were negative and 9 (3.72%) – equivocal. The age of examined women was between 14 and 45 years, average 27, sd±6.429. We found high seropositivity within age group 21-30 years of age. The immunization status of the investigated women shows – unimmunized – 79, selectively immunized with one dose of monovaxin – 58, immunized with combined (measles, mumps, rubella) vaccine one dose – 82, with a double immunization schedule – 23. In each group there were seropositive women. Conclusions. Data analysis shows that pregnant women have high immunity and a tendency for lower morbidity rates of acute rubella infection.

The health reform carried out in our country has resulted in a number of both positive and undesirable results in outpatient medical care, which requires an increase in the level of public health in the country. The introduction of free choice of GPs in our country made it possible for his patients to change freely. The purpose of this study is to analyze the patient's motives for changing P. Material/methods: A survey was conducted among respondents in the period 1-30 September 2018 in the Pleven region. Patients visited their GPs during the study period. A direct individual anonymous survey was conducted containing 35 questions, of which 29 closed questions, 4 semi-open and 2 open-ended questions. The results were processed through Microsoft Office Excel 2007. Results: The analysis of a number of authors, as well as our own empirical research, show the existence of a number of motives for changing the choice of patients for a personal physician. The patient's prior knowledge of the qualities and competencies of the chosen physician is very low. This choice of patients is most often spontaneous, random and not sufficiently substantiated with specific information. In any case, this reduces the effectiveness of the free choice of doctor. Conclusions: It is necessary to improve the organization of admission of patients by GPs.

Simple Summary Hard ticks transmit the etiological agents of numerous diseases. Kaylaka Park is a protected area, but part of it is designated for various outdoor activities. The aim of our study was to establish the presence of hard ticks in four urbanized areas and four areas that are not maintained and are natural wilderness areas (wild areas). The flagging method of collection was used. Temperature, relative humidity, both collection time and distance covered were measured during the sampling campaigns. The density of ticks collected was calculated, the number of ticks captured per minute was calculated and the results were compared between urban and wild areas over a five-year period (2016–2020). A total of 622 ticks were collected. All of them were identified as Ixodes ricinus. Significant differences between the urban and wild areas were observed in the number of ticks per minute and density of nymphs. The peak in questing tick activity has been established at the end of April. The highest yield was obtained at 20 °C and at 60% relative humidity. We found that the distribution of Ixodes ricinus ticks is widespread in Kaylaka Park. Their high density poses a serious risk to park visitors in both wild and maintained urban areas. Abstract (1) Background: Ticks are vectors of a large number of pathogenic microorganisms, which cause serious diseases in both humans and animals. Kaylaka Park is located in northern Bulgaria close to the city of Pleven. Part of the park is urbanized and visited daily by many citizens. The aim of our study was to determine the presence and distribution of hard ticks in the park area by surveying and comparing four urbanized with four wild areas. (2) Methods: Ticks were collected by flagging from 2016 to 2020 during the spring–summer season (March–July). Air temperature, relative humidity, collection time and flagging area were measured during the campaign. (3) Results: A total of 622 ticks were collected: 285 females (46%), 272 (44%) males and 64 (10%) nymphs. All were identified as Ixodes ricinus. Wild areas showed statistically significant higher values of ticks collected per minute (p = 0.009) and nymph densities (p = 0.003) compared to urbanized sampling sites. Other densities indices did not have a significant difference between urban and wild areas. Highest numbers of Ixodes ticks were collected at a temperature of 20 °C and at 60% relative humidity. The active questing began in March, peaked in end of April and declined in June. (4) Conclusions: In the present study, we found that ecological factors in the Kaylaka Park area are favourable for the development and distribution of tick populations. The results give us reason to consider that there is a high risk to visitors from tick bites in the Kaylaka Park area.

Summary This study aimed to determine the bacterial profile of vaginal samples from pregnant women and the prevalence of identified microorganisms. Materials and methods: A prospective epidemiological study was conducted on 150 pregnant women admitted to the Clinic of Obstetrics and Gynecology at Dr. G. Stranski University Hospital in Pleven. Vaginal secretion samples were collected from all the 150 women. Direct microscopy of native smears prepared by the wet mount method to detect Trichomonas vaginalis and direct microscopy of Gram-stained smears was performed. Aerobic culture studies were conducted to identify pathogenic bacteria and Sabouraud glucose agar (SGA) to detect the presence of Candida spp. Samples were also collected from 107 of the women for PCR tests for mycoplasma detection. Results: The highest relative share in the study was women aged 21 to 35 years 104 (69.33%). Of all the hospitalized and examined pregnant women, 87 (57.99%) had medical problems during the current pregnancy and postpartum complications, and 63 women (42%) gave birth without accompanying complications. In 86 (57.32%) of the women, bacteria were detected by direct microscopy of Gram-stained smears. Of these, 24 (16%) had gram-negative rods, 28 (18.66%) had gram-positive cocci. In 34 (22.66%), we found gram-negative and gram-variable pleomorphic bacteria. The aerobic culture study revealed microbiological growth in 44 (29.33%) of the women investigated. Conclusions: Studies on the profile of the vaginal microbiota in pregnant women and the spread of pathogenic microorganisms are essential for make prognoses for pregnancy outcome, evaluating the risk of developing a maternal-fetal infection, and discussing options for timely treatment.

Background The risk factors of cervical cancer are well established and the disease is preventable through vaccination and early detection by screening. The disease ranks as leading cause of female cancer in Bulgaria. The objective of the research was to describe the current burden of cervical cancer in Bulgaria and medical decisions to improve women's health. Methods The information were summarized at the national level on the basis of official on-line database from the annual reports of the of the immunoprophylaxis activities of the National Center of Infectious and Parasitic Diseases (NCIPD), National Center for Public Health and Analyzes (NCPHA). Data for morbidity and mortality rate and vaccine coverage were analyzed and presented in tables and figures. Results Cancer registration has been compulsory in Bulgaria since 1952. National program for the primary prevention of cervical cancer was applied in 2012 (2012-2016, 2017-2020). From the same year was uses immunization against HPVs for 12 -year-old girls. Through these measures, the state guarantees the right of citizens to affordable primary prevention without imposing obligations. Despite the preventive strategy, the expected results are not observed. In 2018, the total number of registered malignancies of the cervix was 15759. The incidence of 100,000 population was 435.8. Of these, the number of newly diagnosed cases were 850, the incidence was 23.5 per 100,000 population. HPV vaccination coverage in girls by birth cohort was 15.1% - 1st dose and 14.3% - 2nd dose for 12-year-old girls and 7% - 1st dose for 13-year-old girls. Conclusions Bulgaria has a leading position in the incidence and mortality of cervical cancer among European countries, requiring mandatory screening and immunization against the Human Papilloma viruses. Key messages Cervical cancer, incidence rate, mortality rate. Vaccination coverage, HPVs, Bulgaria.

Background Syphilis is a sexually transmitted infection whose significance to the public health does not lose its relevance. Changes in the epidemiology of the disease were observed in the last decade. This study describes the trends of syphilis in Pleven region (Bulgaria). Methods A retrospective study of the incidence of syphilis in Bulgaria and in the Pleven district was conducted. Documentary method was applied. A comparative analysis of statistical data from National Center of Public Health and Analyses -Sofia, Regional Health Inspectorate - Pleven, and annual reports on the work of the Consulting Room on Sexually Transmitted Infections - Pleven was carried out. The study extends over the period 2009-2018. Extensive and intensive indicators for data analysis were applied - number of cases (n), morbidity (per 100,000 population), sex and age distribution of cases reported. Results There were 119 cases of syphilis registered in the Pleven district during 2009-2018, with gender distribution showing a slight predominance of men - 66 (55%) versus 53 (45%) in women. All ages are affected, but the largest group is 25-29 years of age - 28 cases, followed by the age group 20-24 - 25 cases. Three cases of congenital syphilis were registered in the district of Pleven. Conclusions The reported incidence of syphilis probably does not correspond to the real one. The observed trend in the spread of the disease can be overcome by improving the effectiveness of control. Such can be accomplished by active search for patients, adequate treatment, monitoring in dispensary, individual approach to risk groups of population, and preventive activities. Key messages Syphilis is a disease that is subject to international surveillance and control. Trends of syphilis in Pleven region (Bulgaria).

Introduction: Syphilis is a sexually transmitted infection whose significance to public health has not lost its relevance. Changes in the epidemiology of the disease have been observed in the last decade. This study describes syphilis trends in the Pleven region (Bulgaria). Methods: Data from 2009 to 2018 were extracted from the National Center for Public Health and Analyses in Sofia and the Regional Health Inspectorate in Pleven and analyzed. Results: There were 3,602 cases of syphilis during the 10-year period in Bulgaria. The incidence rate (per 100,000) during the period observed varied from 4.2 in 2011 to a maximum rate of 7.5 in 2017. For the same period, 119 cases of syphilis were reported in the Pleven region, with highest incidence rate registered in 2009 (7.2), and the lowest rate registered in 2014 (2.6). The disease was more common in men. All ages are affected, but the largest group is 25 to 29 years old. During the study period, 219 cases of congenital syphilis were registered in the country, three of them in Pleven region. Conclusions: Retrospective observational data confirmed a rising trend in syphilis cases, especially among younger people. Further study of risk groups and the expansion of promotional activities among adolescents is needed.

Introduction Cervical cancer ranks as the fourth leading cause of female cancer in Bulgaria. The objective of the study was to describe the current burden of cervical cancer in Bulgaria for a one-year period and prevention options. Methods In this retrospective epidemiological study, online database from National Statistical Institute-Sofia, National Center of Public Health and Analyses-Sofia, National Center of Infectious and Parasitic Diseases-Sofia for one year were analyzed. Annual data were presented in numbers and per 100 000 of population. Results A total of 15,759 women in Bulgaria were diagnosed with cervical cancer in 2018. Morbidity is 23.5 of 100 000 population. Mortality of malignancy of the cervix in 2018 per 100 000 populations was 8.4 among women. Differences of mortality have been recorded as per statistical regions. A low immunization range has been recorded of vaccine against human papilloma virus (HPV) - 7.2% (girls 13 years of age) and 12.8% (girls 12 years of age) for first dose and 11.9% (girls 12 year of age) for second dose in 2019. Conclusions High morbidity and mortality from cervical cancer were registered in Bulgaria. The immunization coverage was low. The strategy for disease prevention through mandatory screening and mandatory immunizations needs to be rethought.

Background Warty carcinoma of the cervix is a rare subtype of squamous cell carcinoma. In general, it is not as aggressive as the other subtypes, and has a better prognosis. Aims The aim of this study was to investigate overall and recurrence-free survival rate in patients with Warty carcinoma of the cervix. Methods During the ten year period (2008–2017) in the Clinic of Gynaecologic oncology at the UMHAT - Pleven, Bulgaria were operated 714 cases with cervical cancer, 14 of which were histologically confirmed as a Warty carcinoma. Patients were investigated by retro- and prospective analysis for overall and recurrence-free survival rate. Results Warty carcinoma accounts for 1.94 per cent of all cervical carcinomas, operated in the clinic. The mean age of the patients was 48 years, ranging from 29–72 years. According to the FIGO staging systems for cervix, patients were staged as follows: in stage IB1 – 43 per cent and in stage IB2 – 57 per cent. Despite the high percentage of locally advanced process, only in one case out of all the patients there was local spreading of the lesion towards the uterine cavity and in one case there were metastases in the pelvic lymph nodes. Lymphovascular space invasion was not seen in any patient, and neither were perineural or perivascular invasion. Conclusion This report highlights a favourable course and good prognosis of Warty carcinoma of the cervix. It is necessary to reconsider the aggressive surgical treatment and subsequent chemotherapy in women with Warty carcinoma of the cervix.

Background and objectives: Lymphoepithelioma-like carcinoma of the uterine cervix (LELC) is a rare subtype of the squamous cell carcinoma with unclear viral carcinogenesis and prognosis. Aim: We aimed to investigate the status of HPV and EBV infection in a cohort of Caucasian women with LELC of the uterine cervix and to compare the results on prevalence, association with both viruses and methods of detection in this disease with the results of other studies. Materials and methods: We retrospectively evaluated all patients with LELC, diagnosed and treated at Department of Gynaecologic Oncology, Medical University Pleven, Bulgaria between 2008 and 2015. The status of infection with HPV and EBV was investigated on tumor tissue by polymerase chain reaction (PCR) and in situ hybridization (ISH). We compare the results with the results from a systematic search of the literature on this topic. Results: LELCs represented 3.03% (16 patients) of all stage I cervical carcinoma cases. Infection with HPV and EBV was investigated in 50% (8) of them. ISH and PCR testing detected HPV in 37.5% (3) and 50% (4) of the patients; EBV in 12.5% (1) and 75% (6). No cases of coinfection were found with ISH and 4 with PCR. In the literature are reported 98 cases of this disease and infection with EBV is found in 25.7% the tested patients. Conclusion: HPV and EBV strains and a co-infection of the two viruses are possible factors in genesis of LELC of the uterine cervix. Our data suggests that infection with EBV could be more common in Caucasians women with LELC, than previously reported.

Summary Human papillomaviruses (HPVs) are associated with the most common sexually transmitted infections. It is well documented that high-risk (HR)-HPVtypes are etiologically associated with some cancers. The aim of the study was to investigate HPV16-DNApositivity and prevalence of Ig Gantibody against HPV16 in patients with laryngeal carcinoma and precancerous lesions of cervix uteri in Pleven region, Bulgaria. Material/Methods: We performedacross-sectional study and investigated clinical materials. Attached is real-time PCR-analysis for detection of HPV16-DNA. HPVspecific antibody response by enzyme-linked immunosorbent assay (ELISA) test for detection and quantification of specific Ig Gantibodies in serum were used. Results: For the six-month period, 30 samples were collected and tested. Fourteen of them were found in patients with carcinoma of the larynx and sixteen - in patients with various lesions of cervix uteri.We found that six patients (42.8%) in the first group and eight patients (50%) in the second group were HPV16-DNA-positive. Different age groups were affected. The sera analyzed in this study showed that seven patients (50%) with carcinoma of the larynx were seropositive of whom four (57%) were males. Fourteen of the females with dysplasia (88%) were seropositive. Matching DNApositivity and antibody response were found in 29%of the patients with laryngeal cancer. The match was found in 50%of the females with cervical dysplasia. Conclusions: Real-time PCRisarapid, cost-effective method for detection of HPVs.Ahigh level of seropositivity was found in the two groups of patients.

Background: Laryngeal carcinoma is one of the most common form of head and neck cancer. During the last two decades, it has been recognized that this cancer is causally related to human papillomavirus (HPV). Objective: We presented a study on prevalence of human papilloma viruses (HPV) in patients with laryngeal carcinoma. Methods: This study consists of 43 patients with laryngeal carcinoma who were diagnosed and treated with surgical techniques in Department of Otorhinolaryngology, University Hospital, Pleven, Bulgaria. Immunohistochemistry of p16INK4a and Ki-67 were used to prove the relationship between high-risk-HPV (HR-HPV) and carcinogenesis. Results: Papilloma virus infection with high-risk oncogenic types of HPV was determined in more than 39.5% of surgically treated patients with histologically proven laryngeal cancer. HPV-induced carcinogenesis was assumed in 17 (13.9%) of all patients whose spouses were operated from cervical cancer. The patients with HPV-positive laryngeal carcinoma were younger than the others in the group (8 years on average). Risk factors for development of HPV-associated laryngeal carcinoma were related to higher number of sexual partners and the practice of oral sex. Frequently, in patients with HPV-associated laryngeal carcinoma we find data for so-called “family’s carcinogenesis”. The possibility of appearance (either preceding or following the treatment) of a second carcinoma and/or tumour recurrence is higher in HPV-positive laryngeal carcinomas. Conclusion: It is recommended to extend the diagnostic methods for laryngeal and hypo pharyngeal cancer with a routine search for high-risk oncogenic HPV strains.

Introduction: Bulgaria joined European Union (EU) on 1 January 2007. Since the accession all regulations, directives, decisions, recommendations, and opinions of the European Parliament, the Council of the European Union, and the European Commission are being implemented. Aim: The purpose of this study was to present the morbidity of acute hepatitis B virus (HBV) and acute hepatitis C virus (HCV) in Bulgaria before and after accession to the EU. Materials and methods: A retrospective study was performed. The morbidity of acute HBV and acute HCV infections in Bulgaria was analyzed over a period of sixteen years (2000−2016). The collected data were based on the National Center of Infectious and Parasitic Diseases (NCIPD) and the National Center of Public Health and Analyses (NCPHA). Results: Between 2000 and 2016, 11038 cases of acute HBV infection and 1681 cases of acute HCV infection were reported in Bulgaria. Before the accession to EU, the morbidity rates of acute HBV and acute HCV infections were 12.77 cases per 100 000 population (95% CI: 11.45–13.97) and 1.52 cases per 100 000 population (95% CI: 1.17–1.96), respectively. After the accession to the EU, the morbidity rates of acute HBV and acute HCV infections were 5.29 cases per 100 000 population (95% CI: 3.86–6.73) and 1.14 cases per 100 000 population, respectively. Conclusion: Analysis of the data suggests that there is a tendency for lower morbidity rates of acute HBV. The situation with acute HCV is relatively stable over the years regardless of EU membership.

Background and objectives: Lymphoepithelioma-like carcinoma (LELC) is a histological type of malignant tumor arising from the uncontrolled mitosis of transformed cells originating in epithelial tissue. It is a rare subtype of squamous cell carcinoma of the uterine cervix. There are significant differences in frequency, mean age, viral status, and outcomes in Asian or Caucasian patients. Materials and Methods: A retrospective study of all cases of lymphoepithelioma-like carcinoma of the cervix at the Clinic of Oncogynecology, University Hospital, Pleven, Bulgaria between 1 January 2007 and 31 December 2016 was performed. All patients were followed-up till March 2019. We analyzed some clinical characteristics of the patients, calculated the frequency of lymphoepithelioma-like carcinoma of the cervix from all patients with stage I cervical cancer, and looked at the overall survival rate, the 5-year survival rate, and the correlation between overall survival, lymph node status, and the size of the tumor. Results: The frequency of lymphoepithelioma-like carcinoma was 3.3% for all cases with cervical carcinoma at stage I. The mean age of the patients with LELC was 49.6 years (range 32&ndash, 67). Fourteen patients (82.4%) were in the FIGO IB1 stage, three patients (17.6%) were in the FIGO IB2 stage. Lymph nodes were metastatic in three patients (17.6%), non-metastatic in 13 patients (76.5%), and unknown in one patient. The overall survival rate was 76.47% for the study period and the 5-year survival rate of the patients that were followed-up until the 5th year (14 patients) was 69.23%. Conclusions: Lymphoepithelioma-like carcinoma is a rare SCC subtype, but it could be more frequent among western patients than previously thought. Our results do not confirm the data showing low risk of lymph metastasis and good prognosis of LELC, which is why we think that the treatment in these cases has to be more aggressive than is reported in the literature.

SUMMARY: During the years the role of viruses as a cause of oncological illness was known. One of them is cervical carcinomas, related to Human papilloma viruses (HPV’s). There are about 450000 new cases of cervical cancer worldwide each year, and 250000 deaths of this diagnosis. By the diagnosis cervical cancer get there with two procedures: after mass scrinning or clinical suspicious for ill. By the availability apparent tumor diagnosis is put with biopsy. By the discreet lesions require utilization modern diagnostic methods. One of them is immunohistochemical method. In situ hybridization (ISH) assays for high-risk human papillomavirus (HR-HPV) and immunohistochemical (IHC) assays for surrogate markers such as p16 INK 4a can be useful in detecting HR-HPV in cervical dysplasia. The aim of the following study was to find difference the level for expression of the tumor specific gene p16 INK 4a in reactive, dysplastic and invasive changes in biopsy specimens from uterine cervix. In the lesions of the uterine cervix, overexpression of p16 INK 4a is induced by HPV and is associated with the process of cancerogenesis in the epithelium. Almost 100% of the high grade lesions and the invasive carcinomas demonstrated high level of expression of p16 INK 4a while non displastic epithelium is always negative.

Objective: Lymphoepithelioma-like carcinoma of the uterine cervix is a rare subtype of squamous cell carcinoma (SSC) and it is more common in Asia-5.5%, than in Europe-0.7%. It is considered that LELC is associated with Epstein-Barr virus (EBV) infection in Asian and with Human papilloma virus (HPV) or no infection in Caucasian patients. Compared to the common cervical cancer LELC affects younger women, its outcome is better and it has to be with a lower frequency of regional lymph node metastasis and recurrence. Case report: We present three cases of LELC with lymph node metastasis and a follow- up of the patients. The diagnosis was confirmed histologically. All three cases have been examined Immunohistochemically for assessment of the viral status for both EBV and HPV. Two of them died from the cervical cancer and one is still alive without evidence of recurrence. The results of the immunohistochemical study showed that two of them were negative for both viruses and one was positive only for EBV. Conclusion: Our data shows that the immunohistochemical results for the viral status cannot be used as a predictive factor as opposed to the lymph node status and lymphovascular space invasion (LVSI).

Leptospirosis, a re-emerging zoonosis caused by pathogenic Leptospira, has a low incidence in Bulgaria. This paper reports a case of leptospirosis in Pleven, Bulgaria, in which the subject was infected after wading through irrigative canal in northern Greece. Two days later, he had a fever, myalgia and vomiting followed by jaundice, darkness of urine and oliguria. The patient was admitted to Clinic of Infectious Diseases at University Hospital-Pleven after returning to Bulgaria. The history and laboratory findings suggested icterohaemorrhagic leptospirosis. Penicillin G was prescribed and intensive supportive treatment was initiated. Dialysis was performed two hours after admission and was followed by poliuric stage of acute renal failure (peak urine output 16 600 mL/day). Microaglutination test (MAT) for sero-diagnosis was positive (L. hardjo 1:1600, L. icterohaemorrhagiae 1:800). The patient was discharged after sixteen days with improved renal and liver functions. In conclusion, The probability of leptospirosis should not be ignored in patients with fever after returning from abroad. The prompt dialysis and adequate treatment improve prognosis. Turkish Başlık: Yurtdışından Yeni Dönmüş Bir Adamda Gözlenen Ciddi Leptospiroz Anahtar Kelimeler: Leptospiroz, akut renal yetmezlik, diyaliz Leptospiroz, yeniden ortaya çıkan, patojenik Letpospira'nın neden olduğu bir zoonozdur, Bulgaristan'da düşük insidansa sahiptir. Bu yazıda Kuzey Yunanistan'da sulama kanalından geçtikten sonra enfekte olan bir kişide Bulgaristan, Plevne'de bir leptospiroz vakası rapor edilmektedir. İki gün sonra ateş, miyalji ve kusma; takiben sarılık, idrarda koyuluk ve oligüri vardı. Bulgaristan'a döndükten sonra hasta Plevne-Üniversite Hastanesi'nde Enfeksiyon Hastalıkları Kliniğine başvurdu. Öykü ve laboratuvar bulguları ikterohemorajik leptospiroz düşündürdü. Penisilin G reçete edildi ve yoğun destek tedavisi başlandı. Yatıştan iki saat sonra diyaliz yapıldı ve takiben akut renal yetmezlik poliüri evresi oldu (pik idrar çıkışı 16 600 mL/gün). Sero-tanı için mikroaglutinasyon test (MAT) pozitif idi (L. hardjo 1:1600, L. icterohaemorrhagiae 1:800). Hasta düzeltilmiş renal ve karaciğer fonksiyonları ile onaltı gün sonra taburcu edildi. Sonuç olarak, yurtdışından döndükten sonra ateşi olan hastalarda leptospiroz olasılığı göz ardı edilmemelidir. Acil diyaliz ve yeterli tedavi prognozu düzeltir.

Leptospirosis is a re-emerging zoonosis caused by spirochetes from the genus Leptospira and is typically associated with rural settings. Transmission occurs via contact with urine from infected animals; incubation period ranges from 4 days to 4 weeks. The clinical spectrum of leptospirosis may be mild and self-limited or severe with jaundice, renal failure, and bleeding manifestations (icterohaemorrhagic leptospirosis, so called Weil's disease). Mortality in severe forms remains high even when optimal treatment is provided. Early clinical suspicion and laboratory confirmation of leptospirosis is essential since delays in diagnosis may increase mortality. Alcohol-related toxicity and alcoholic hepatitis are common pathological processes, which can occasionally produce clinical syndromes similar to leptospirosis. There are few reports regarding the clinical course of leptospirosis in chronic alcoholics. Here, we describe two patients with Weil's disease, in whom alcohol abuse caused therapeutic difficulties. One of the cases was with lethal outcome.

SUMMARY: Tularemia is a zoonotic, acute, infectious disease caused by the bacterium Francisella tularensis. It is a major problem on the Europe and Balkan Peninsula. In Western Bulgaria two new foci originated during the last 10 years. Aims: To study epidemiology, ecology, nosogeography, conflict and prevention of tularemia that originated during 1997 - 2006 in Bulgaria. Materials and methods: Epidemiological method, Ecological method, Microbiological method, Clinical method, Statistical method. Results: During the last 10 years two endemic foci originated in the physic - geographic regions: Nishav - Borel (near Slivnitsa) and Kraishten (near Pernik) with 40 permanent noso - areas. The study determined that in the Sofia region the number of diseased with tularemia during 1997-2006 is 111 with morbidity 37,16%iii, and in Pernik region the number of the diseased during the same period is 137 with morbidity 80,38%iii. Conclusion: In the complex studies of both regions where tularemia developed we found out that the parasite system functioned with its components: a large number of sources and vectors, favourable climatic and geographic conditions and considerable number of factors of the ecologic socio - ecosystem.