HEMODIAPERFUSION IN LEPTOSPIROSIS

Comparatively have been studied laboratory parameters in severe cases of leptospirosis divided in two groups - with and without hemodiaperfusion (HD). The dynamical investigations of blood urea nitrogen (BUN), serum creatinine, and serum bilirubin levels reveal that hemodiaperfusion markedly decreases the levels of nitrogen parameters and is non effective for serum bilirubin. Hemodiaperfusion in oliguric phase of the acute renal failure of leptospirosis prevents brain edema and lung edema - significant tanatogenic factors

TANATOGENESIS IN LEPTOSPIROSIS

Comparatively have been studied laboratory parameters in severe cases of leptospirosis divided in two groups – with and without hemodiaperfusion (HD). The dynamical investigations of blood urea nitrogen (BUN), serum creatinine, and serum bilirubin levels reveal that hemodiaperfusion markedly decreases the levels of nitrogen parameters and is non effective for serum bilirubin. Hemodiaperfusion in oliguric phase of the acute renal failure of leptospirosis prevents brain edema and lung edema - significant tanatogenic factors

PANCREATIC INVOLVEMENT IN LEPTOSPIROSIS

The research includes 84 patients with leptospirosis treated in Clinic at Infectious Diseases – Pleven. Mild course in 52,38%, moderate in 19,05%, and severe in 28,57% are established. Serum amylase level has been investigated in 37 cases. Increased rates are measured in 41,67% of mild cases (av. 279 U/L), in 25% of moderate cases (av. 290 U/L), and in 88,24% of severe cases(av. 937 U/L). Significant difference between serum amylase levels of mild and severe cases is established (p < 0,02). Presumably immunological mechanisms of damage by participation of interleukins (IL1, IL6, IL8) and tumor necrosis factor (TNF-β) are in the base of increased serum amylase level in leptospirosis. The functional changes of pancreas in leptospirosis are not fully clear and further research is needed

RENAL INVOLVEMENT IN LEPTOSPIROSIS

Renal involvement is a common feature of leptospirosis. It is variable from mild to severe acute renal failure. Materials and methods: We performed analysis of 100 consecutive leptospirosis cases treated in Clinic of Infectious Diseases at University Hospital – Pleven (1976-2012) (90 male, age 37±18 years, lethal outcome in 13%), followed by comparative analysis of group with renal involvement (n1=59) versus group without renal involvement (controls: n2=41). Results: Fever (100%), hepatomegaly (92%), myalgia (86%), nausea and vomiting (84%), splenomegaly (74%), oliguria (69%), headache (67%), jaundice (63%), hypotension (49%), abdominal pain (41%), and hemorrhagic diathesis (37%) were the characteristic manifestations and had had a significantly higher prevalence in the group with renal involvement. Blood urea nitrogen (mean 27.9±16.9 mmol/L) and serum creatinine (mean 349.9±190.1 µmol/L) were the main laboratory parameters that expressed renal dysfunction in this group. Dialysis was performed in twelve severe cases. Conclusion: Leptospirosis with acute renal failure is a severe disease and requires early diagnosis and prompt treatment

Leptospirosis in elderly patients

Leptospirosis is a re-emerging zoonosis with broad clinical spectrum and high mortality in severe forms. The aim of this study was to analyze clinical manifestations, laboratory findings, epidemiological data, and management in elderly patients with leptospirosis. Toward that end, we performed a descriptive analysis of 15 leptospirosis elderly cases (age 60-78 years) treated at the Clinic of Infectious Diseases of University Hospital - Pleven (1976-2012). Patients were serologically confirmed by microscopic agglutination test. Twelve cases (80%) presented with the severe form of leptospirosis. Co-morbidity (hypertonic diseases, chronic pulmonary diseases, chronic alcohol abuse, and diabetes) was registered in 13 cases. All cases had fever, oliguria, conjunctival suffusions, hepatosplenomegaly. Jaundice (14/93%), hemorrhagic diathesis (13/87%), vomiting (11/73%), abdominal pain (10/67%), myalgia (7/47%) and hypotension (7/47%) also were observed. Renal dysfunction was expressed by increased blood urea nitrogen (mean 38.1 ± 24.1 mmol/L) and serum creatinine (mean 347.6 ± 179.8 µmol/L). Hepatic dysfunction was expressed by increased total serum bilirubin level (mean 274.6 ± 210.7 µmol/L) and slightly elevated aminotransferases (ASAT mean 125.8 ± 61.6 IU/L; ALAT mean 131.3 ± 126.5 IU/L). Five cases (33%) had a lethal outcome. In conclusion, leptospirosis in elderly patients is associated with severe course and higher risk for death, and requires prompt intensive treatment

Severe Leptospirosis Observed in a Man Who Had Just Returned from Abroad

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

Seroprevalence of IgG Antibodies against Mumps in Bulgarian Children under 18 Years of Age

Objective: The objective of this study was to determine the prevalence of IgG antibodies against mumps in a representative stratified sample of children under 18 years of age in Pleven district, Bulgaria. Study Design: Cross sectional study. Materials and Methods: A cross-sectional, sero-epidemiologic survey of 132 children aged under 18 years was conducted in Pleven district. They were distributed into two age groups: from 0 to 11 years old (n=80) and from 12 to 18 years old (n=52). An enzyme immunoassay (EIA) was performed for indirect evidence of specific IgG antibodies in the serum. Results: The results showed that 41% of the investigated children were negative in terms of mumps IgG antibodies, 11% had borderline values and the remaining, approximately 48%, were positive. In the group of children aged 0 to 11 years who had received one dose of the mumps vaccine, 50% were negative for mumps IgG antibodies. In the second group of children aged 12 to 18 years who had received two vaccine doses, the percentage of participants negative for mumps IgG antibodies decreased significantly. Conclusion: Our observations emphasise the need to conduct expanded sero-epidemiological investigations of the populations most affected by mumps and to immunise susceptible individuals

FLOWCYTOMETRY IN LEPTOSPIROSIS

Differential count of leucocytes and six lymphocyte populations and subpopulations were investigated by flow cytometry in fourteen cases with leptospirosis. Marked granulocytosis and lymphopenia were found in 100%. The percentage of the monocytes was significantly decreased (mean 6,65%; 0,7 to 14,0%; sd 5,49). Immunophenotypization of lymphocyte populations and subpopulations by flow cytometry was revealed prevalent tendencies for decreasing of the number of total T-lymphocytes, T-helpers, T-suppressors, T-helpers/T-suppressors index; increasing of the number of the activated T-lymphocytes, subpopulation of NK cells (CD3-/ CD16+56+), and B-lymphocyte. These data are suggested that cell-mediated immunity plays a role in later stages of the diseases

IL-6, D-DIMER AND HIGH-SENSITIVITY C-REACTIVE PROTEIN IN HIV INFECTION – PRELIMINARY STUDY

Combined antiretroviral therapy (cART) provides HIV-infected people life expectancy comparable with HIV-uninfected people and turns the disease into a manageable chronic condition necessitating the need for innovative inflammatory markers. Our purpose was to determine the correlation between IL-6, D-dimer and high-sensitivity C-reactive protein (hsCRP) levels among HIV-infected and the presence of chronic inflammation during general and immunological aging and drug exposure. Material and methods: Comparative prospective study was conducted at 37 HIV-positive persons from the Center for Monitoring and Treatment of HIV-positive Patients at the Clinic for Infectious Diseases, UMBAL “Dr. G. Stranski” – Pleven (target group) and 18 HIV-negative individuals from outpatient practice (control group), aged ≥18 years. Results: The median age of seropositive persons was 40 years (24÷70 years), of the control group – 51 years (29÷72 years); 78% of the target group and 61% of the controls are men. The average duration of ART is 4 years (1÷9 years). The study of specified biomarkers in the target group found increased IL-6 in 8.11% of patients (mean 3.67±1.86 pg/mL; range 1.5÷8.62; 95% CI 3.11-5.02), increased D-dimer in 8.11% (mean 0.37±0.28 µg/mL; 0.21÷1.96; 95% CI 0.3691-0.37459) and increased hsCRP in 10.81% (mean 2.10±1.99 µg/mL; 0.19÷7.0; 95% CI 1.89-2.31). In the control group IL-6 was not increased (mean 2.75±1.67 pg/mL; 1.5÷6.91), D-dimer was increased in 16.67% (mean 0.37±0.17 µg/mL; 0.09÷0.8) and increased hsCRP – in 5.56% (mean 1.76±1.75 µg/mL; 0.19÷5.66). Il-6 was significantly higher in the target group. Conclusion: The implementation of sensitive biomarkers is crucial in the general diagnostic-therapeutic approach in aging with HIV