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Dorota Zarębska-Michaluk,1 Jerzy Jaroszewicz,2 Magdalena Rogalska,3 Diana Martonik,3 Paweł Pabjan,1 Aleksandra Berkan-Kawińska,4 Beata Bolewska,5 Barbara Oczko-Grzesik,2 Dorota Kozielewicz,6 Magdalena Tudrujek-Zdunek,7 Justyna Kowalska,8 Anna Moniuszko-Malinowska,9 Krzysztof Kłos,10 Marta Rorat,11,12 Piotr Leszczyński,13,14 Anna Piekarska,4 Joanna Polańska,15 Robert Flisiak3 1Department of Infectious Diseases, Jan Kochanowski University, Kielce, 25-369, Poland; 2Department of Infectious Diseases and Hepatology, Medical University of Silesia, Katowice, 40-055, Poland; 3Department of Infectious Diseases and Hepatology, Medical University of Białystok, Białystok, 15-089, Poland; 4Department of Infectious Diseases and Hepatology, Medical University of Łódź, Łódź, 90-549, Poland; 5Department of Infectious Diseases, University of Medical Sciences, Poznań, 61-701, Poland; 6Department of Infectious Diseases and Hepatology, Faculty of Medicine, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, Toruń, 87-100, Poland; 7Department of Infectious Diseases and Hepatology, Medical University of Lublin, Lublin, 20-059, Poland; 8Department of Adults’ Infectious Diseases, Medical University of Warsaw, Warsaw, 02-091, Poland; 9Department of Infectious Diseases and Neuroinfections, Medical University of Białystok, Białystok, 15-089, Poland; 10Department of Infectious Diseases and Allergology, Military Institute of Medicine, Warsaw, 04-141, Poland; 11Department of Forensic Medicine, Wrocław Medical University, Wrocław, 50-367, Poland; 12First Infectious Diseases Ward, Gromkowski Regional Specialist Hospital in Wrocław, Wrocław, 51-149, Poland; 13Department of Rheumatology, Rehabilitation and Internal Medicine, Poznan University of Medical Sciences, Poznań, 61-701, Poland; 14Department of Rheumatology and Osteoporosis, Szpital im. J. Strusia w Poznaniu, Poznań, 61-285, Poland; 15Silesian University of Technology, Gliwice, 44-100, PolandCorrespondence: Dorota Zarębska-MichalukDepartment of Infectious Diseases, Jan Kochanowski University in Kielce, Ul. Radiowa 7, Kielce, 25-317, PolandTel +48 662441465Fax +48 41 3682262Email dorota1010@tlen.plPurpose: The pathogenesis of coronavirus disease 2019 (COVID-19) is complicated, and in addition to antiviral therapy and combating coagulopathy, treatment should also include inhibition of the proinflammatory cytokines overproduction. The purpose of this study is to compare the effectiveness of tocilizumab (TCZ) and dexamethasone (DEX) administered alone or in combination in patients with severe COVID-19.Patients and Methods: Patients were selected from the SARSTer database, containing 3330 individuals with COVID-19 treated between 1 March 2020 and 10 March 2021. The current study included adult patients with baseline oxygen saturation (SpO2) ≤ 90%, requiring regular or non-invasive high-flow oxygen supplementation.Results: Among included 460 patients, 59 were treated with TCZ, 125 with TCZ and DEX, 169 with DEX, and 107 did not receive TCZ nor DEX. The groups were balanced regarding demographics, coexisting diseases, baseline SpO2, and comedications with remdesivir or low-molecular-weight heparin. The death rate of 6.8% was significantly lower in patients receiving TCZ alone than each arm (19.6%– 23.1%), particularly in patients with interleukin-6 concentration exceeding 100pg/mL (5% vs 22.9%– 51.7%, respectively). Analysis of clinical improvement demonstrated doubled, significantly higher rate after 21 and 28 days in patients treated with TCZ alone (60% and 75%, respectively) compared to DEX (27.6% and 37.9%, respectively). The need for mechanical ventilation was similar in all arms.Conclusion: In patients with severe course of COVID-19, particularly those developing cytokine storm, administration of TCZ provides a significantly better effect than DEX regarding survival, clinical improvement, and hospital discharge rate. The combination of TCZ and DEX does not improve therapy effectiveness in patients with severe COVID-19 compared to the administration of TCZ alone.Keywords: SARS-CoV-2, COVID-19, tocilizumab, dexamethasone, cytokine storm

Purpose: Results of the low-dose radiation therapy (LDRT) in patients with pneumonia due to COVID-19 has been presented., Methods: Fifteen patients received a single-fraction radiation dose of 1 Gy to the bilateral lungs due to pre-ARDS pneumonia in the course of COVID-19. Follow-up was performed on days 1, 3, 5, 7, 14 after LDRT., Results: Eleven patients (73%) were released up until day 28. Median hospitalization was 20 days; 28-day mortality was 13%. Median O 2 saturation improved within 24 h after LDRT in 14/15, with median SpO 2 values of 84.5% vs. 87.5% p = 0.016, respectively. At day 14 of hospitalization, 46% did not require oxygen supplementation. Significant decline in CRP and IL-6 was observed within 24 h post LDRT. No organ toxicities were noted., Conclusion: LDRT is feasible, well tolerated and may translate to early clinical recovery in patients with severe pneumonia. Further studies are needed to determine optimal candidate, time and dose of LDRT for COVID-19 patients with pneumonia.

Data on the use of remdesivir, the first antiviral agent against SARS-CoV-2, are limited in oncologic patients. We aimed to analyze contributing factors for mortality in patients with malignancies in the real-world CSOVID-19 study. In total, 222 patients with active oncological disorders were selected from a nationwide COVID-19 study of 4890 subjects. The main endpoint of the current study was the 28-day in-hospital mortality. Approximately half of the patients were male, and the majority had multimorbidity (69.8%), with a median age of 70 years. Baseline SpO2 < 85% was observed in 25%. Overall, 59 (26.6%) patients died before day 28 of hospitalization: 29% due to hematological, and 20% due to other forms of cancers. The only factor increasing the odds of death in the multivariable model was eGFR < 60 mL/min/m2 (4.621, p = 0.02), whereas SpO2 decreased the odds of death at baseline (0.479 per 5%, p = 0.002) and the use of remdesivir (0.425, p = 0.03). This study shows that patients with COVID-19 and malignancy benefit from early remdesivir therapy, resulting in a decrease in early mortality by 80%. The prognosis was worsened by low glomerular filtration rate and low peripheral oxygen saturation at baseline underlying the role of kidney protection and early hospitalization.

Purpose: The aim of the study was to assess the coagulation and inflammatory markers connected with severe course of COVID-19 and no clinical improvement., Material and Methods: The study population included 2590 adult patients, diagnosed with COVID-19, selected from the SARSTer national database - an ongoing project led by the Polish Association of Epidemiologists and Infectiologists and supported by the Medical Research Agency. Clinical and laboratory parameters, such as C-reactive protein (CRP), white blood cells (WBCs), neutrophil and lymphocyte count, procalcitonin, ferritin, interleukin-6 (IL-6), D-dimer concentration and platelet (PLT) count were analyzed before and after treatment (remdesivir, tocilizumab, dexamethasone, anticoagulants)., Results: Significant differences between patients with mild and severe course of the disease were observed in all examined parameters before treatment (p ​< ​0.05). After treatment only ferritin concentration did not differ significantly. In patients with pulmonary embolism, CRP concentration, neutrophil count, D-dimer and IL-6 concentration were significantly higher than in patients without embolism (p ​< ​0.05). The significant differences between the groups with and without fatal outcome were observed within all analyzed parameters. Significant differences in all examined parameters before treatment were observed between patients with and without clinical improvement (p ​< ​0.05). Multivariate logistic regression showed that no clinical improvement was associated with: IL-6>100 ​pg/ml (OR-2.14), D-dimer concentration over 1000 ​ng/ml (OR-1.62) and PLT count below 150,000/μl (OR-1.57)., Conclusions: Severe course of the disease is associated with lower PLT and lymphocyte count, higher D-dimer, CRP, neutrophil count and IL-6 concentration. The best predictors of no clinical improvement in COVID-19 are: IL-6>100 ​pg/ml, D-dimer>1000 ​ng/ml and PLT<150,000/μl., Competing Interests: Declaration of competing interest The authors declare no conflict of interests., (Copyright © 2022 The Authors. Published by Elsevier B.V. All rights reserved.)

Air pollution can adversely affect the immune response and increase the severity of the viral disease. The present study aimed to explore the relationship between symptomatology, clinical course, and inflammation markers of adult patients with coronavirus disease 2019 (COVID-19) hospitalized in Poland (n = 4432) and air pollution levels, i.e., mean 24 h and max 24 h level of benzo(a)pyrene (B(a)P) and particulate matter <10 μm (PM 10 ) and <2.5 μm (PM 2.5 ) during a week before their hospitalization. Exposures to PM 2.5 and B(a)P exceeding the limits were associated with higher odds of early respiratory symptoms of COVID-19 and hyperinflammatory state: interleukin-6 > 100 pg/mL, procalcitonin >0.25 ng/mL, and white blood cells count >11 × 10 3 /mL. Except for the mean 24 h PM 10 level, the exceedance of other air pollution parameters was associated with increased odds for oxygen saturation <90%. Exposure to elevated PM 2.5 and B(a)P levels increased the odds of oxygen therapy and death. This study evidences that worse air quality is related to increased severity of COVID-19 and worse outcome in hospitalized patients. Mitigating air pollution shall be an integral part of measures undertaken to decrease the disease burden during a pandemic of viral respiratory illness., (Copyright © 2022 The Authors. Published by Elsevier Ltd.. All rights reserved.)

The COVID-19 vaccination has been the subject of unprecedented misinformation, false news, and public concerns. This study presents a unique analysis comprising persons who were not vaccinated and became ill. It investigates reasons for not vaccinating and evaluates how the personal experience of COVID-19 affected further attitudes and decisions related to health. The study included 730 consecutive unvaccinated patients hospitalized in 12 centers in Poland during the autumn 2021 pandemic wave. The most frequent reason behind the refusal to receive the vaccine was concern over the adverse effects, disbelief that the vaccine was sufficiently tested, and one's conviction that COVID-19 will not affect a patient. Online information, friends, spouse, children/grandchildren, and other family members were most often the source of discouragement from vaccination. Most individuals regretted their decision not to receive a vaccine (66.0%), declared to promote COVID-19 vaccination after discharge (64.0%), and to receive a COVID-19 vaccine in the time recommended for convalescents (69.5%). Individuals expressing no regrets of vaccine refusal more frequently revealed conspiracy beliefs. The study shows that personal experience with severe COVID-19 can influence the perception of vaccination, but approximately one-third of unvaccinated hospitalized patients still appear to express vaccine hesitancy.

Long-term analyses of demographical and clinical characteristics of COVID-19 patients can provide a better overview of the clinical course of the disease. They can also help understand whether changes in infection symptomatology, disease severity, and outcome occur over time. We aimed to analyze the demographics, early symptoms of infection, laboratory parameters, and clinical manifestation of COVID-19 patients hospitalized during the first 17 months of the pandemic in Poland (March 2020-June 2021). The patients' demographical and clinical data ( n = 5199) were extracted from the national SARSTer database encompassing 30 medical centers in Poland and statistically assessed. Patients aged 50-64 were most commonly hospitalized due to COVID-19 regardless of the pandemic period. There was no shift in the age of admitted patients and patients who died throughout the studied period. Men had higher C-reactive protein and interleukin-6 levels and required oxygenation and mechanical ventilation more often. No gender difference in fatality rate was seen, although the age of males who died was significantly lower. A share of patients with baseline SpO 2 < 91%, presenting respiratory, systemic and gastrointestinal symptoms was higher in the later phase of a pandemic than in the first three months. Cough, dyspnea and fever were more often presented in men, while women had a higher frequency of anosmia, diarrhea, nausea and vomiting. This study shows some shifts in SARS-CoV-2 pathogenicity between March 2020 and July 2021 in the Polish cohort of hospitalized patients and documents various gender-differences in this regard. The results represent a reference point for further analyses conducted under the dominance of different SARS-CoV-2 variants.

Background: Patients with kidney failure are at an increased risk of progression to a severe form of coronavirus disease 2019 (COVID-19) with high mortality. The current analysis was aimed to assess the impact of renal failure on the severity of COVID-19 and identify the risk factors of the fatal outcome in this population., Methods: The analysis included patients from the SARSTer database, a national real-world study evaluating treatment for COVID-19 in 30 Polish centers. Data were completed retrospectively and submitted online., Results: A total of 2322 patients were included in the analysis. Kidney failure was diagnosed in 455 individuals (19.65%), of whom 373 presented moderate stage and 82 patients, including 14 dialysis individuals, presented severe renal failure. Patients with kidney failure were significantly older and demonstrated a more severe course of COVID-19. The age, baseline SpO 2 , the ordinal scale of 4 and 5, neutrophil and platelet count, estimated glomerular filtration rate, and C-reactive protein concentration as well as malignancy and arterial hypertension were the independent predictors of 28-day mortality in logistic regression analysis., Conclusions: Underlying kidney disease in patients with COVID-19 is among the leading factors associated with a higher risk of severe clinical presentation and increased mortality rate.

Because the optimal treatment for COVID-19 is still unknown, it is important to explore every potential way of improving the chances of survival for COVID-19 patients. The aim of the study was to analyze the effectiveness of convalescent plasma on COVID-19 patients. The study population consisted of 78 patients diagnosed with COVID-19, selected from the SARSTer national database, who received convalescent plasma. The impact on clinical and laboratory parameters was assessed. A clinical improvement was observed in 62 (79%) patients, and 10 (13%) patients died from COVID-19. No side effects of the convalescent plasma treatment were observed. When plasma was administered earlier than 7 days from diagnosis, the total hospitalization time was shorter ( p < 0.05). Plasma efficacy was inferior to remdesivir in endpoints such as the necessity and duration of oxygen therapy, the duration of hospitalization, and mortality rate, and inferior to other drugs in the case of the duration of hospitalization and the necessity of constant oxygen therapy, but comparable in most other measured endpoints. A comparison of a 30-day mortality rate in patients who received plasma and remdesivir (4/25, 16%) and who received only plasma (6/53, 11%) showed no significant difference. Convalescent plasma efficacy is inferior to remdesivir when treating COVID-19 patients but the addition of remdesivir to plasma does not improve the treatment effectiveness. In most endpoints, plasma was comparable to other treatment options. In our opinion, convalescent plasma may be used as a supportive treatment in COVID-19 patients because of the low frequency of adverse effects and availability, but must be given as early from the diagnosis as possible.

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., (© National Institute of Public Health – National Institute of Hygiene / Narodowy Instytut Zdrowia Publicznego – Państwowy Zakład Higieny.)

Actinomycosis is one of the greatest 'chameleons' among infectious diseases. It may imitate inflammation, abscess or a neoplasmatic tumor. Moreover, correct diagnosis is even more challenging due to the fact that the disease takes on various forms like: cervicocephalic, abdominal, or affects the reproductive organs. In order to highlight the diagnostic difficulties of actinomycosis, we have decided to describe six cases of female patients (aged 31-73 years, mean age: 52 years) hospitalized due to actinomycosis in the Department of Infectious Diseases and Hepatology between 2014-2019. Additionally, a case of one patient was described in detail as the course of her disease was exceptionally non-specific. Only in 2 of 6 patients the primary diagnosis was correct. The four other patients were initially suspected with cancer or inflammation. Three of the patients were diagnosed with the abdominal form of actinomycosis, one - neck and head, and one presented both locations. Only histopathological examinations during invasive procedures allowed to state the final diagnosis. An adequate diagnosis was associated with a number of additional tests and delayed appropriate treatment. WBC and CRP were within normal range in all patients. Four patients completed treatment successfully after 60-192 days, one is still on therapy and one is lost to follow-up. In conclusion, common features of actinomycosis presented in this case series include predominance of female gender, abdominal localization and lack of typical symptoms. What is more, therapy with antibiotics, mainly doxycycline and beta-lactams resulted in complete regression of lesions in the majority of cases. Given the examples of our patients we believe that actinomycosis should be considered in the differential diagnosis of all abdominal tumors, especially in women. Abbreviations: WBC - white blood cells, CRP - C-reactive protein, CT - computed tomography, IUD - Intra-Uterine Device, i.v. - intravenous., (© National Institute of Public Health – National Institute of Hygiene.)

Introduction and Objective: Lyme borreliosis (LB) is a disease caused by the bacteria Borrelia burgdorferi. The most common symptoms are related to the skin, musculo-scelatal system, central and peripheral nervous system, rarely to the heart muscle and the eye, and may occur in the multistage course of the disease. LB may additionally be accompanied by psychopathological symptoms. The aim of the study is estimation of the cognitive and affective disorders occurence in patients with LB., Material and Methods: The study was carried out in the group of 121 patients (61 females, 60 males) aged 18-65; mean age 46 years. All patients were diagnosed with late-stage of LB: 46 patients (38%) with Lyme arthritis and 75 patients (62%) with neuroborreliosis. Evaluation of the cognitive and affective functioning of patients was performed on the basis of a standardized interview and test methods: the Mini-Mental State Examination (MMSE), Clock Drawing Test (CDT) and the Beck Depression Inventory (BDI)., Results: Cognitive disorders occurred statistically significantly more often in patients with neuroborreliosis (14.7%) than in patients with Lyme arthritis (4.3%). A group of females with neuroborreliosis and a group of males with the same diagnosis demonstrated cognitive deficits significantly more often (23.3% and 8.9%, respectively), compared to groups of patients with Lyme arthritis (6.5% in females and no cognitive deficits in males). A significantly higher percentage of depressive disorders was also noted in the group of males and females with neuroborreliosis (50.7%), compared to the group of patients with Lyme arthritis (39.1%). The symptoms of depression were particularly frequent in the females with neuroborreliosis (60%). The severity of depression measured by BDI was mild or moderate in most cases. In the examined groups, more patients with neuroborreliosis (44%), both in females (36.7%) and males (48.9%), demonstrated anxiety disorders. The obtained results showed a higher frequency of affective disorders compared to cognitive deficits, both in patients with Lyme arthritis and neuroborreliosis., Conclusions: An increased frequency of depressive and neurotic disorders was observed in patients with LB, particularly in patients with neuroborreliosis. Neurotic disorders, mainly adaptive, were most common in males with LB, while depressive disorders were more frequent in females. An increased frequency of cognitive deficits was observed in patients with neuroborreliosis, particularly in females.

The aim of this study was to determine the human leukocyte antigen (HLA)-DRB1 alleles in two groups of patients in Latvia: patients with Lyme borreliosis and patients with Lyme neuroborreliosis. The study included 216 patients with Lyme borreliosis, 29 patients with Lyme neuroborreliosis and 282 control persons. All surveyed persons were residents of Latvia. The HLA-DR genotyping was performed by polymerase chain reaction- sequence specific primer (PCR-SSP). The predisposition to the Lyme borreliosis is associated with the HLA-DRB1*07, -DRB1*17(03), -DRB1*04, -DRB1*15(02) alleles. The allele -DRB1*11(05), -DRB1*14(06) and -DRB1*13(06) were significantly more frequent in controls. In-group with Lyme neuroborreliosis differences were found for the -DRB1*07 and -DRB1*04 alleles, but only HLA-DRB1*07 allele was statistically significant after Bonferroni correction and associated with Lyme neuroborreliosis in Latvian patients., Competing Interests: The authors declare no conflict of interest.

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.

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.

The Aim: of the study was to evaluate the usefulness of cerebrospinal fluid chemokine CXCL13 concentration assay in diagnostics of neuroborreliosis in adults., Material and Methods: Investigations were carried out in 22 patients treated for neuroborreliosis , manifested as lymphocytic meningitis, at the Department of Infectious Diseases, Medical University of Silesia, in Bytom between 2011-2013. Based on the presence or absence of anti-borrelial antibodies in the cerebrospinal fluid, the examined individuals were divided into two groups on the day of admission: group I--patients with antiborrelial antibodies in the cerebrospinal fluid (confirmed diagnosis of neuroborreliosis), group II--patients without antiborrelial antibodies in the cerebrospinal fluid (possible diagnosis of neuroborreliosis). In all patients the cerebrospinal fluid CXCL13 level was assessed on the first day of hospitalization. Control tests were performed in both groups after 14 days of therapy with antibiotics., Results: Mean cerebrospinal fluid CXCL13 concentration in group I on the 1st day was 4123 pg/mL, and in group II--3422 pg/mL. Differences in mean concentrations of this chemokine were statistically insignificant. No correlations between examined mean CXCL13 concentrations and other cerebrospinal fluid inflammatory parameters were revealed. The control tests showed the evident decrease of CXCL13 level in cerebrospinal fluid in both groups. Besides, in individuals of group II anti-Borrelia burgdorferi antibodies appeared in cerebrospinal fluid, whereas in group I, the control results of this parameter were similar to preliminary values., Conclusion: The obtained results indicate a kind of usefulness of estimation of cerebrospinal fluid chemokine CXCL13 concentration in diagnostics of early, acute neuroborreliosis, manifested as lymphocytic meningitis, especially in case of anti-borrelia antibodies absence in cerebrospinal fluid. Changes in this chemokine concentrations, opposite to cerebrospinal fluid levels of anti-borrelia antibodies, may be prognostic in acute, early neuroborreliosis.

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.

Aim: This study aimed at evaluating the usefulness of determining cerebrospinal fluid (CSF) interleukin-6 (IL-6) concentration in adults with purulent, bacterial meningoencephalitis., Materialand Methods: A study group consisted of 16 patients hospitalized in the Department of Infectious Diseases of the Medical University of Silesia in Bytom in 2008 - 2012 due to purulent, bacterial meningoencephalitis. All of them were classified into two groups based on clinical severity, assessed on admission: group I - severe condition, group II - moderately severe or mild condition. CSF IL-6 concentration was measured in all patients on the first day of hospitalization., Results: Mean concentrations of IL-6 in CSF were assessed at 391.54 pg/mL and 110.51 pg/mL in patients in severe (group I) and moderately severe or mild condition (group II), respectively. Differences between CSF mean concentrations of this cytokine in both groups were statistically significant (p<0.01). No correlations between CSF IL-6 concentrations and other CSF inflammatory parameters were determined. Control testing performed in 5 patients of group I revealed only slight decrease of CSF IL-6 concentration in fatal cases. In case of patients who recovered from disease, IL-6 concentration in CSF was evidently decreased compared to its initial value., Conclusions: Results suggest the usefulness of determining CSF interleukin-6 concentration to estimate inflammation intensity in the subarachnoid space, and indirectly, patient's clinical severity. IL-6 concentration may be also of prognostic importance in purulent, bacterial meningoencephalitis.

Unlabelled: The aim of the study was evaluation of usefulness of cerebrospinal fluid (CSF) S100 B protein concentration assessment in adults with purulent, bacterial meningoencephalitis., Material and Methods: The investigation was performed in 16 subjects hospitalized at the Department of Infectious Diseases of Medical University of Silesia in Bytom in 2008 - 2012 due to purulent, bacterial meningoencephalitis. All patients were divided into two groups according to the severity of their clinical condition: I group - very severe course of the disease, II group - moderate and mild course of the disease. In all individuals CSF S100 B protein concentration was evaluated during the first 24 hours ofhospitalization., Results: Mean CSF S100 B protein concentration in patients in very severe clinical condition (group I) was 1215.63 pg/mL compared to 419.56 pg/mL in subjects of group II with moderate and mild course of disease. The difference between CSF mean concentration of this protein was statistically significant (p<0.01). No correlations were assessed between CSF S100 B protein concentrations and other CSF inflammatory parameters. Control assays performed in 7 patients from group I revealed only slightly decrease of CSF S100 B protein level in fatal course of the disease. In survivals with recovery CSF concentration of this protein was evident decreased compared to initial level., Conclusions: The obtained results indicate the usefulness of CSF S100 B protein concentration assessment in estimation of severity of the patient's clinical condition. The level of this protein concentration also seems to be helpful as prognostic marker in purulent, bacterial meningoencephalitis.

The case of community-acquired meningoencephalitis induced by Escherichia coli in a 89-year-old man was presented. The authors paid attention to possibility of occurring central nervous system infections caused by this bacterium also in adults, in community environment and without concomitant factors favourable to the infection.

The aim of the study was evaluation of usefulness of cerebrospinal fluid (CSF) serotonin level examination in diagnostics of post-Lyme disease syndrome. The study was performed in 16 subjects. In all individuals CSF serotonin concentration was estimated on the 1st day of hospitalization. In patients with depressive and cognitive impairments, proved in neuropsychological tests, - group I--mean CSF serotonin concentration was 1,26 ng/ml, whereas in subjects without abnormalities in tests--group II--respectively--3,87 ng/ml. The difference of mean CSF serotonin levels was statistically significant (p<0,01). The obtained results indicate usefulness of this CSF parameter, besides neuropsychological tests, in objective evaluation of clinical state in patients with post-Lyme disease syndrome.

The aim of the study was evaluation of usefulness of cerebrospinal fluid (CSF) creatine kinase (CK) activity assessment in diagnostics of purulent, bacterial meningoencephalitis in adults. The investigations were performed in 18 subjects. In all individuals CSF and plasma CK activity was estimated during the first 24 hours of hospitalization. Mean CSF CK activity in patients in very severe clinical state (group I) was 27,41 IU/L compared to 16,73 IU/L in subjects of group II with moderate and mild course of disease. The difference between mean CSF activities of this enzyme was statistically significant (p < 0,01). The obtained results indicate the usefulness of CSF CK activity assessment in estimation of severity of the patient's clinical state. The magnitude of this activity seems to be also helpful as prognostic marker in purulent, bacterial meningoencephalitis.

The aim of the study was evaluation of usefulness of cerebrospinal fluid (CSF) lactate dehydrogenase (LDH) activity assessment in diagnostics of purulent, bacterial meningoencephalitis in adults. The investigations were performed in 17 subjects. In all individuals CSF and plasma LDH activity was estimated during the first 24 hours of hospitalization. Mean CSF LDH activity in patients in very severe clinical state (group I) was 299,11 U/L compared to 163,67 U/L in subjects of group II with moderate and mild course of disease. The difference between mean CSF activities of this enzyme was statistically significant (p<0,001). The obtained results indicate the usefulness of CSF LDH activity assessment in estimation of severity of the patient's clinical state. The magnitude of this activity seems to be also helpful as prognostic marker in purulent, bacterial meningoencephalitis.

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.

The aim of the study was assessment of usefulness of cerebrospinal fluid (CSF) and plasma procalcitonin concentration estimation in differential diagnosis of neuroinfections in adults. Examinations were carried out in 17 subjects with purulent, bacterial meningoencephalitis and in 16 patients with lymphocytic meningitis. In all individuals CSF and plasma PCT concentrations were assessed on the 1st day of hospitalization. In patients with purulent, bacterial meningoencephalitis mean CSF concentration was 0,63 ng/mL, mean plasma PCT concentration--9,97 ng/mL. Mean CSF PCT concentration in patients with lymphocytic meningitis was 0,23 ng/mL and mean plasma PCT concentration--0,27 ng/mL. Differences of mean PCT concentrations between both groups of patients were statistically significant: CSF--p<0,05 and plasma--p<0,01. Obtained results indicate usefulness of plasma PCT concentration estimation in differential diagnosis of neuroinfections in adults. Cerebrospinal fluid PCT concentration seems to be of lesser importance in differential diagnosis of neuroinfections, but value of this parameter often correlates with the severity of the clinical state of the patients and may be taken into consideration in prognosis of the course and outcome of the bacterial meningoencephalitis.

Lyme borreliosis is increasing in Poland in both incidence and recognition with 655 cases reported in 1997 and 3574 in 2003. Approximately 4% of patients will develop cardiac manifestations--the least well documented complication of Lyme disease. Cardiac involvement usually occurs within weeks to months of the infecting tick bite and includes varying degrees of atrioventricular block as the commonest manifestation and tachyarrhythmias, myopericarditis, mild cardiac muscle dysfunction. There has been evidence that long standing dilated cardiomyopathy may be associated with chronic Borrelia burgdorferi infection. Patients with atrioventricular block have good prognosis. Most cases resolve within 1 to 2 weeks. Temporary, but almost never permanent, cardiac pacing may be required for some patients. Cardiac manifestations of Lyme disease are treatable with antibiotics. Lyme carditis should be taken into consideration in patients with acute as well as chronic heart diseases.

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.

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.

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.

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.

The influence of 3-month interferon-alpha (IFN-alpha) treatment on plasma erythropoietin (EPO) concentration in patients with chronic active hepatitis (CAH) induced by hepatitis B virus (HBV) infection was investigated. The study was carried out in 44 nonanemic patients divided into two groups: CAH B, 30 subjects not treated with IFN-alpha, and CAH B-IFN, 14 subjects treated with IFN-alpha for the first 3 months of the study (5 MU/m(2) body surface subcutaneously (s.c.) three times per week). In all patients, blood samples were taken at the beginning of the study (0) and after 1, 2, 3, 6, 9, and 12 months of observation. At the beginning, plasma EPO levels in the CAH B (27.8 +/- 2.21 mU/ml) and CAH B-IFN (27.3 +/- 3.04 mU/ml) groups did not differ significantly from each other and were significantly higher (p < 0.0001) than in healthy subjects (10.4 +/- 1.06 mU/ml). In patients in the CAH B group, plasma EPO concentrations did not change significantly during the whole observation period. In patients in the CAH B-IFN group, a transient, significant increase in plasma EPO level was found. The highest plasma EPO concentration in this group was noted after the third month of treatment (41.1 +/- 3.41 mU/ml). In conclusion, patients with CAH induced by HBV infection are characterized by increased plasma EPO concentrations, and IFN-alpha treatment in these patients causes a transient increase in the plasma EPO level.

A case of tuberculous meningoencephalitis in 63-year old man is presented. Symptoms of the disease were found in the course of bone and pulmonary tuberculosis. Attention is paid to diagnostic data that may play an important role in diagnostics of the central nervous system tuberculosis. The therapy of tuberculous meningoencephalitis and the problem of potential Mycobacterium tuberculosis resistance to antituberculous drugs used up to the present are also discussed.

Background: Epidemiological analysis of hepatitis C virus infections in children diagnosed and treated in the Hepatology Outpatient Clinic in Bytom between 1996 and 1999., Material and Methods: The study comprised 62 children with detected serum presence of anti-HCV antibodies (ELISA method) and/or HCV-RNA (RT-PCR method). Risk factors for the infection were thoroughly analysed on the base of questionnaires., Results: It was established that in 55 (88.7%) children high probability of infection existed in connection with past hospitalization and applied diagnostic and therapeutic procedures, such as: transfusion of blood and its preparations (24.19%), surgical procedures (22.58%), hospital treatment without invasive procedures and blood transfusions (19.35%). Familial exposure was a risk factor in 4.84% of cases, while in 6.45% of cases there were no burdens in the history., Conclusions: 1. In the evaluated group of children HCV infection was iatrogenic in character in majority of cases. 2. Hospitalization, even without invasive procedures, may be an important risk factor for HCV infection. 3. Familial exposure seems to be of secondary importance in transmission of HCV infection.

Background: Aim of the study was evaluation of HBV or HCV associated chronic liver diseases (HBV or HCV CHLD) influence on the course and outcome of purulent, bacterial meningoencephalitis (PBME), without symptoms of sepsis., Material and Methods: Between 1995-99 there were 8 patients with PBME, with chronic HBV (5 subjects) or HCV (3 subjects) infection, treated in our centre; mean age 43 years. Str. pneumoniae and N. meningitidis were etiologic factors of PBME in 25% and 12.5% of patients, respectively. In 62.5% of cases etiology of PBME remained unknown. In 2 patients HBV or HCV CHLD was diagnosed before PBME (1 case--chronic active hepatitis, 1 case--postinflammatory liver cirrhosis). During hospitalization due to PBME in 4 patients liver cirrhosis was diagnosed on the base of clinical picture and laboratory results, in 2 patients chronic hepatitis B or C was subject to further diagnostic procedures., Results: In 7 subjects (87.5%) significant increase of AlAT and AspAT activity was recorded during acute phase of neuroinfection as compared to results preceding the hospitalization (to 300-400 U/l). Together with recovery from PBME decrease of aminotransferases activity was noted. In 1 fatal case high AlAT and AspAT activity was observed for the whole time of the disease. In 2 other patients with liver cirrhosis, classified into class A of Child-Turcott-Pugh classification at the beginning of PBME, after transient insignificant aminotransferases increase sudden decompensation of liver functions during recovery from PBME was observed. Both patients died due to haemorrhage from esophageal varices. In all patients with PBME and HBV or HCV CHLD inflammatory parameters of cerebrospinal fluid were increased for longer than average time. It was the reason of longer hospital stay. The influence of HBV or HCV CHLD on PBME outcome was not observed., Conclusions: 1. In patients with PBME concomitant HBV or HCV CHLD may exert negative influence on the course of neuroinfection and extend the period of hospitalization. 2. The increase of aminotransferases activity in these patients may suggest other hepatotropic virus superinfection and require further diagnostics. 3. In the case of HBV or HCV associated postinflammatory liver cirrhosis PBME may be connected with rapid liver disease progression and even the death of a patient.

Between 1997-2000 there were 30 patients with bacterial sepsis treated at Department of Infectious Diseases of Silesian Medical University School in Bytom. Neisseria meningitidis (23.33%), Streptococcus pneumoniae (20%) and Staphylococcus aureus (3.33%) were most frequent etiological factors of the disease. The etiology of sepsis was not revealed in 53.34% of cases. Clinical state of patients was assessed using SSS and SAPS II score. All subjects were divided into two groups: group I--patients with septic syndrome symptoms (11 cases), group II--patients without septic syndrome symptoms (19 cases). The aim of the study was usefulness of plasma C-reactive protein estimation in the course of bacterial sepsis monitoring. Plasma CRP concentration was assessed by immunoturbidometric method (using RANDOX, UK kits). Blood samples were taken on th 1., 4. and 10. day of therapy. Plasma CRP levels were statistically significantly higher in patients of the group I in samples of the first and the second assay. CRP serum concentration correlated with severity of a patient's clinical state. Type of sepsis's etiological factor did not exert influence on plasma CRP level. In fatal cases high plasma CRP concentration was recorded during the whole time of hospitalization, whereas in cases of recovery fast decrease of this protein level was noted. The obtained result indicate, that estimation of plasma CRP concentration in patients with bacterial sepsis may be helpful in evaluation of clinical state severity, monitoring of the disease course as well as therapy efficacy.

A case of cerebellitis as a complication of varicella in a 5-year old child was described. Special attention was paid to severe course of the disease and therapeutic problems. Actually available possibilities of active and passive prophylaxis of varicella-zoster virus infections were also discussed.

Between 1988 and 1992 thirty patients with purulent infections of central nervous system in the course of bacterial septicaemia were treated in the Intensive Care Unit of the I Clinic of Infectious Diseases of Silesian School of Medicine in Bytom. These cases made about 32% of the total bacterial neuroinfections treated in the Clinic during that time. Imminent or existing acute respiratory insufficiency, increasing intracranial pressure, intensification of haemorrhagic diathesis and imminent septic shock were the indications to the hospitalization in the Intensive Care Unit. Neisseria meningitidis, Streptococcus pneumoniae and Escherichia coli were the most often found etiological factors in subsequently 53.33%, 33.33% and 3.34% of patients. In 10% of cases the etiological factors remained unknown. Intratracheal intubations and/or tracheotomies were carried out in over 60% of patients. About 40% of cases required assisted or controlled mechanical ventilation with the aid of ventilator (on the average 5 days). Mean time of hospitalization in the Intensive Care Unit closed in the period of 7 days. Mortality in the analyzed group was 23.33% (7 cases). Bacterial septicaemia with purulent infections of central nervous system often leads to the directly life threatening complications. Hospitalization in conditions of Intensive Care Unit affords possibilities for effective treatment and improvement of prognosis in patients suffering from these diseases.

Since 1986 to 1993 18 patients with bacterial, posttraumatic meningoencephalitis were hospitalized at the I Clinic of Infectious Diseases of Silesian Medical Academy in Bytom, and they made about 11.46% of the total purulent neuroinfections treated during that time. The group was composed of 16 men and one, 7-year-old girl, who was hospitalized twice. The course of the disease was very serious in 55.56% of cases and serious in the rest of patients. Permanent consequences subsequent to the disease like deafness, partial deafness and epilepsy were observed in 6 cases. Two patients died. After recovery gained by pharmacotherapy every patient was diagnosed with X-rays in order to find the spot of pathological connection between the cranium cavity and exterior environment, what afforded possibilities for neurosurgical or laryngological repair operation. The aim of the treatment was elimination of imminent recurrent infections of central nervous system. Accurate X-ray diagnostics and co-operation with surgical specializations enable us to improve prognosis and definitively restore patients to health after posttraumatic meningoencephalitis.

On the basis of our own material and the literature review the analysis of 10 cases of botulism is presented. A mild course of the disease was observed in 40%, a medium-severe course in 30% and a severe course also in 30% of patients. Fatal courses were not recorded. All patients were discharged from the Clinic in the good state of health. Etiopathogenesis, symptomatology and treatment of botulism is discussed. Attention is paid to new diagnostic method.