Prognostic value of serum amyloid A protein compared with C-reactive protein in patients with influenza

Introduction: Acute phase response represents an increase in hepatic production of the so-called acute phase proteins (APP). Until now, C-reactive protein (CRP) has routinely been measured as an indication of bacterial infections. Serum amyloid A (SAA) is a novel marker. It is a more conservative protein for viral etiology of the disease. We analyzed the dynamic changes of SAA and CRP during influenza infection and evaluated the role of SAA as a significant marker for viral infections.Materials and Methods: We studied 31 patients with clinically suspected and serologically proved influenza, hospitalized in the Department of Infectious Diseases at St. Marina University Hospital, Varna. Serum levels of SAA and CRP were measured on admission and 4.23±1.03 days later by immunoturbidimetric assays, adapted on Olympus AU 400.Results: The mean serum concentrations of SAA during the acute stage were 168.92 mg/L and those of CRP were 48.08 mg/L. In the group of bacterial complications, such as bronchitis, sinusitis and otitis media, the SAA levels were 5- to 9-fold greater than CRP. Analyses of the second measurement showed a tendency of serum SAA to disappear more quickly than CRP - 52.11 mg/L vs. 16.71 mg/L.  Conclusion: SAA is more sensitive APP than CRP in viral infection settings. In cases of bacterial superinfections, serum SAA is more predominant than CRP, indicating the necessity of an antibiotic therapy. Prompt downgrading of SAA in sera correlates with auspicious prognosis could be used as an effective treatment monitoring.

Changes in the sera levels of amyloid A protein in the course of influenza, chickenpox and infectious mononucleosis

Introduction: Until now, there has been no routinely measured laboratory marker, which indicates acute inflammation from viral origin. According to some authors, the serum amyloid A (SAA) protein is of great importance in such circumstances.Aim: The aim of this article is to establish the clinical significance of SAA as a potential laboratory marker for viral infections.Materials and Methods: Sera samples from 93 subjects with different viral infections, including influenza (n=31), infectious mononucleosis (n=31), and chickenpox (n=31) were analyzed. Levels of SAA were prospectively measured by immunoturbidimetry, adapted on Olympus AU 400. Thirty healthy subjects were included in the control group.Results: In comparison with the control group, the levels of SAA were significantly higher, reaching a mean concentration of up to 180.80±199.87 mg/L. During convalescence, the levels decreased dramatically achieving a level of up to 31.29±83.42 mg/L. The highest concentrations were registered in the cases with different complications, such as secondary bacterial infections. In comparison with erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and leukocytes, SAA levels were statistically significant for minor inflammatory stimuli, such as viral infections are.Conclusion: SAA increases significantly in the course of different viral infections, such as influenza, infectious mononucleosis, and chickenpox. Early normalization of its levels correlates with full recovery, lack of complications and auspicious prognosis of the disease

Oral cavity changes in the course of infectious diseases, during childhood

Introduction: A number of infectious diseases, occurring in childhood take its clinical course with typical changes in the oral cavity. Those changes are pathognomonic sign of the disease or increase the clinical thinking about the concrete disease. Aim: In the present review we introduce the infectious diseases in childhood that cause different changes in the mouth. In accordance with it we set some tasks: to introduce pathophysiological mechanisms for mucosa damage and its role about diagnosis.Materials and methods: We based on literature data about that problem. It is discussed in four aspects: diseases with enanthem, changes in the tongue, stomatitis and pharyngitis. Examples and pictures are given.Conclusions: Our review presents that the throat inspection in the children with infectious diseases is important stage of clinical examination, should not be missed and the changes have to be recognized in details because of their great diagnostic and differential diagnostic significance

Clinical manifestations of mixed infections between rotaviruses and other intestinal pathogens

Introduction: Rotaviruses are a leading cause of diarrheal mortality in children less than five years old. Mixed forms with other intestinal pathogens have been reported, interfering with the severity and outcome of the illness.Aim: The aim of this article is to analyze the characteristics of mixed infections among rotaviruses and other intestinal pathogens. Materials and Methods: Twenty-seven patients up to 5 years of age, diagnosed with a co-infection from the rotavirus group and other intestinal pathogens were analyzed during the period from March, 2016 to December, 2017. A clinical epidemiologic study was conducted. The diagnosis was made by stool cultures for bacterial pathogens/feces analyses for viral antigens in the microbiology/virus laboratory of the St. Marina University Hospital, Varna. Statistic methods were used for data processing.Results: For the aforementioned period, 483 patients, up to 5 years of age, with rotaviral gastroenteritis were hospitalized. Mixed forms of intestinal infection were registered in 27 children (5.59%). Early childhood (between 1 to 3 years of age) was the most commonly affected age group. Cases were separated into two groups: rotavirus-virus association and rotavirus-bacterium association. Cases with rotavirus-virus association were more predominant (55.6%) than rotavirus-bacterium ones (44.4%). The clinical presentation included fever, vomiting, diarrhea, and lasted 6.53±1.53 days among the patients in the first studied group. In rotavirus-bacterium mixed infections vomiting was not a generally present symptom, but distinct complications ordinary occurred (83.33%) and the average hospitalization period was 10±1.98 days.Conclusion: Mixed infections including rotavirus and other intestinal pathogens are rarely diagnosed and mainly affect young children. Compared with rotavirus-bacterium association, rotavirus-virus association is more commonly registered, its clinical course is milder, the prognosis of the disease is auspicious and the in-patient stay is shorter

Serum Amyloid A Protein Changes in the Course of Some Virus-Caused Infectious Diseases // Промени в серумния амилоид А протеин при някои инфекциозни заболявания с вирусна етиология

Serum amyloid A protein (SAA) is a major plasma protein circulating in the serum of all animals and humans when acute inflammation appears. Compared with other routinely measured acute phase proteins, it differs by its earliest expression, shortest plasma half-life, and highest serum concentration. Through the years, it has been mostly studied during bacterial infections. It has been proved that its sera concentrations, together with the sera concentrations of markers for acute inflammation such as C-reactive protein /CRP/, procalcitonin, etc., increases significantly and correlates with the establishment of an early diagnosis and with the effect of the implemented treatment. In the course of viral infectious diseases, SAA is poorly studied both around the world and in Bulgaria. Because such kinds of diseases are especially actual nowadays /due to emerging and reemerging strains and atypical clinical presentation/, there is a substantial necessity of introducing in the practice of a specific laboratory marker, which corresponds to minor inflammatory triggers such as viruses. This study aims to evaluate the dynamic changes in the sera concentrations of SAA in the course of some virus-caused infectious diseases and assess its significance as a diagnostic and prognostic marker of the severity of the disease and the treatment’s effect.Серумният амилоид А /SAA/ протеин представлява плазмен белтък, който се открива в серума на всички животински видове. В сравнение с останалите острофазови протеини, той се отличава с най-ранна експресия, най-кратък плазмен полуживот и най-висока серумна концентрация по време на остър възпалителен процес. През годините, клиничната му стойност е проучвана главно при бактериални инфекции, където заедно с останалите маркери за остро възпаление – С-реактивен протеин /CRP/, прокалцитонин и др., нараства в сигнификантни стойности, подпомага поставянето на ранна диагноза и корелира с ефекта от приложеното антибактериално лечение. При пациенти с вирусни инфекциозни заболявания, показателят е слабо проучен, както в световен мащаб, така и у нас. Предвид факта, че този тип патология се оказва с нарастваща актуалност в наши дни /поради поява на нови или възвръщане на стари етиологични агенти, а така също и вследствие честото атипично клинично протичане/, се появява и необходимостта от въвеждане в клиничната практика на специфичен лабораторен маркер, корелиращ с възпаление от вирусен произход и подпомагащ поставянето на ранна диагноза. С оглед на това, целта на настоящия дисертационен труд е свързана с проучване промените в серумната концентрация на SAA при някои инфекциозни заболявания с вирусна етиология и оценка приложимостта му в клиничната практика като лабораторен маркер, отчитащ тежест на основното заболяване и ефект от проведеното лечение

A case of mumps orchitis and pancreatitis in 25 years old man hospitalized in Clinic of infectious diseases - Varna

Introduction: Mumps is an acute infectious disease caused by mumps virus. The main pathologic feature is serofibrinous inflammation of the salivary glands, resulting in their swelling. In pre-puberty children the course of illness is usually benign, and approximately one third of the cases remain subclinical. Extrasalivary gland involvement, such as orchitis, meningitis, pancreatitis is possible. The inflammation of pancreas takes an auspicious course and lasting sequels, such as diabetes mellitus or pancreatic cancer, do not occur. Orchitis occurs in 15-40% of postpubertal males with mumps, and without treatment 30-50% of them develop testicular atrophy, which is associated with male infertility. The testicular atrophy after recovery from mumps orchitis is linked as a predisposing factor for testicular cancer. Objective: To present a case report of patient with multi-organ localization of mumps virus and to analyze the severity of the specific organ form of the disease. Case report: We present a case report of mumps, in combination with mumps orchitis and mumps pancreatitis in 25 years old man, hospitalized in the Clinic of infectious diseases - Varna. Diagnosis was established on the basis of clinical features of disease, epidemiological, biochemical and serological data, realized through the relevant laboratories in the St. Marina Hospital - Varna. Results: In the presented case, the disease started as a moderate form of mumps affecting both parotid glands, and 3 days after the onset of the symptoms, pancreatitis and orchitis occurred. Conclusion: multi-organ involvement in the clinical course of mumps, taking its with is usual manifestation of the disease. In spite of the multiple organ involvement in this case, the patient recovered without lasting sequels