Severe malaria – analysis of prognostic symptoms and signs in 169 patients treated in Gdynia in 1991-2005

In the period 1991-2005, 169 patients with the diagnosis of malaria were hospitalized in the Department of Tropical and Parasitic Diseases, Institute of Maritime and Tropical Medicine in Gdynia (from 2003 – the Academic Centre of Maritime and Tropical Medicine, Medical University of Gdansk). All the cases were analysed for severity, occurrence of complications and permanent sequelae of the disease.According to the criteria set by the WHO (5), malaria was classified as severe in 36 cases. All of them were Plasmodium falciparum infections or mixed infections: P.f. and another species of the parasite. Patients in this group developed a number of complications, inter alia shock, acute respiratory distress syndrome (ARDS), acute renal failure, blackwater fever, severe anemia, disseminated intravascular coagulation, myocarditis, consciousness disorders of varied degree, acute transient psychoses, and exacerbation of ischemic heart disease. In one case of a pregnant woman, necrosis of the fetus occurred in the course of disease in the 4th month of pregnancy. Moreover, meningoencephalitis was diagnosed in two patients – in one of them concurrently with symptoms and signs of malaria, while in the other one - 3 weeks after the symptoms subsided. In 6 patients, permanent sequelae of the disease developed and in 4 patients the disease was fatal. The cause of death was multi-organ failure, with the first sign of poor prognosis being rapidly progressing renal failure resistant to treatment in three men; in one case death resulted from cerebral malaria. In cases of suspected malaria, relapsing malaria or in mixed infections, molecular testing was a valuable complementary tool of diagnosis, which helped in beginning the appropriate treatment

Difficulties in the diagnosis of schistosomiasis in patients of the Departament of Tropical and Parasitic Diseases of the MUG

Between 2002 and 2006 in the Department of Tropical and Parasitic Diseases of the Medical University of Gdansk 40 hospitalized patients were suspected of schistosomiasis on the basis of clinical manifestations, epidemiological data and positive serology tests (ELISA IgG). In spite of multiple tests, schistosoma eggs were not identified neither in stool nor in urine of the patients. Histopathological examinations of liver and colon or bladder mucosal biopsy have not revealed schistosoma eggs in chosen patients. Diagnosis confirmation in case of negative parasitic tests requires serologic tests for schistosomiasis. ELISA serology tests for antibodies class G were performed in all 40 patients. In some cases the results were dubious – index in the upper limit or only slightly elevated. In those cases, cross reactions with Plasmodium spp. were taken into account. In 10 patients, serologic index for schistosomiasis was elevated during or a few weeks after treatment for malaria. In control tests, 4-8 weeks after the first examination, serologic indexes for schistosomiasis were significantly lower or normal without specific treatment with praziquantel (Biltricide, Cesol). Seven patients were lost from follow up. Because of diagnostic difficulties confirmation tests with Immuno-Blot IgG were introduced to verify ELISA. After final clinical and serologic analysis, human schistosomiasis was diagnosed in 23 patients who were treated with success

Dengue antibodies in Polish travellers returning from the tropics. Evaluation of serological tests

Dengue is a viral disease caused by an RNA virus of the genus Flavivirus, family Flaviviridae, occurring as four serotypes (DEN-1, -2, -3, -4). It is transmitted to humans by the Aedes mosquitoes, mainly A. aegypti. The occurrence of dengue is strictly related with their preferred breeding areas. Dengue endemic regions are inhabited by some 2.5 billion people. 50-100 million cases of dengue fever and up to 1 million cases of dengue haemorrhagic fever are noted worldwide in more than 100 countries every year. The aim of the reported examinations was to diagnose dengue virus infections in returning travellers. In the years 2006-2009 serological tests were performed in 753 persons. In the diagnostics we used ELISA to find IgM and/or IgG class of antibodies against dengue virus, rapid immunochromatographic (cassette) test, NS1 viral antigen detection by ELISA, and virus RNA detection by RT-PCR method. IgM or IgG class antibodies, and both classes simultaneously, were detected in 19.8% of the examined cases. The greatest number of infections came from India and the Far East, next from South and Central America, and the smallest number from Africa. Sixteen patients with diagnosed dengue, including three cases of dengue haemorrhagic fever, were hospitalized. Int Marit Health 2010; 61, 1: 36-4