Medical history among Bulgarian patients with fever of unknown origin and low-grade fever

Въведение: Персистиращият фебрилитет с неизвестен произход е предизвикателство пред медицинската общност. Целта на тази статияе да се представят анамнестичните данни при български пациенти с неясно фебрилно състояние (НФС) и субфебрилна температура.Материали и методи: За периода от 01.02.2012г. до 01.08.2015г. в Клиниката по инфекциозни болести към ВМА-София се проведе проспективно проучване на пациенти с НФС и субфебрилитет. Изследвани бяха общо 117 пациенти, от тях с НФС - 88 човека, със субфебрилитет 29 човека. В настоящата работа са използвани следните методи: библиографски метод, метод на сравнението и клинични методи.Резултати: Основните анамнестични данни, имащи принос към поставянето на окончателната диагноза при всички проучени пациенти, са следните - умора, изпотяване, втрисане, главоболие и артралгия.Заключение: Анамнезата е от съществено значение за крайния успех в диагностиката на фебрилитета с неизвестен произход. Тя се явява първа стъпка в диагностичния алгоритъм при НФС.Introduction: The persisting fever of indeterminate genesis is a challenging for the medical society. The aim of this paper was to present the medical history of Bulgarian patients with fever of unknown origin (FUO) and low-grade fever (non-FUO).Materials and methods: A prospective study of patients with FUO and non-FUO was done at the Department of Infectious Diseases, Military Medical Academy (Sofia, BG) for the period: 1st February 2012 - 1st August 2015. A population of 117 patients were analyzed, 88 - FUO, 29 - non-FUO. The following methods were applied: literature review, a method of comparison and clinical evaluation.Results: The main historical data which are leading to the final diagnosis in the whole analyzed group were: fatigue, sweats, chills, headache and arthralgia.Conclusion: The medical history is a basic key in the diagnostic pathway to the final diagnosis in case of fever of undetermined origin. This is the first step in the diagnostic algorithm

Infekcija virusom Zapadnog Nila s neurološkim poremećajima: prikaz slučaja i kratak pregled stanja u Bugarskoj

A case of a 66-year-old man with West Nile neuroinvassive disease manifested with fever, weakness, fa-tigue, consciousness disorders and underlying diabetes mellitus type 2 and cardiovascular diseases is pre-sented. Laboratory data showed elevated erythrocyte sedimentation rate and fibrinogen. Serological tests revealed West Nile virus specific antibodies of class IgM and IgG in serum. West Nile virus RNA was de-tected in urine sample. Supportive therapy was applied.Prikazuje se slučaj 66-godišnjeg bolesnika s neuroinvazivnom bolešću Zapadnog Nila koja se manifestirala grozni-com, umorom, poremećajem svijesti uz osnovnu bolest dijabetesa tipa 2 i kardiovaskularnom bolešću. Laboratorij-ski podaci pokazali su povišenu sedimentaciju i fibrinogen. Serološki testovi utvrdili su protutijela specifična za virus Zapadnog Nila klase IgM i IgG u serumu. Virusna RNA otkrivena je u uzorku mokraće. Primijenjena je suportivna terapija

Severe clinical forms of Mediterranean spotted fever: A case series from an endemic area in Bulgaria

Background/Aim. Mediterranean spotted fever (MSF) belongs to Rickettsioses, the Spotted fever group (SFG). The causal agent is Rickettsia conorii conorii and the transmission to humans occurs through dog tick Rhipicephalus sanguineus bites. The aim of this study was to describe clinical and laboratory characteristics in patients with severe form of Mediterranean spotted fever admitted to Bulgarian university hospital in endemic region. Methods. A retrospective study was conducted at Stara Zagora University Hospital (Southeastern Bulgaria) between April 2015 and August 2016. During the analyzed period, 58 cases had clinical and laboratory data for MSF. Serological tests were applied for the etiological diagnosis. MSF-specific immunoglobulin (IgM) and IgG antibodies were detected in serum by indirect immunoenzyme assay (ELISA IgG/IgM, Vircell, Spain) – R. conorii ELISA IgG sensitivity 85%, specificity 100% and R. conorii ELISA IgM sensitivity 94%, specificity 95%. Statistical analysis was made by MS Excel 2007 and SPSS Statistics, version 19.0. Results. Eighteen patients presented as severe forms. The predominant gender of them were males (78%) and 22% were females. The median age of the analyzed group was 55 years (range: 14– 78 years). Ten patients developed hepatic disorder while 4 had neurological signs. Laboratory data showed thrombocytopenia in 15 patients, mean value of platelet (PLT) count for the whole group was 108.6 ± 53.8 × 109/L. Liver enzymes were elevated with mean value of aspartate aminotransferase (AST) 161.4 ± 90.1 IU/L and alanine aminotransferase (ALT) 163.9 ± 81.5 IU/L. Acute phase reactant as C-reactive protein (CRP) had mean value of 140.3 mg/L (range: 9–230 mg/L). Kidney function was impaired in some cases; the mean value of creatinine for the studied group was 134.7 μmol/L (range: 78–313 μmol/L) and mean value of urea was 9.6 mmol/L (range: 4.2–27.4 mmol/L). Conclusion. Bulgaria is an endemic area for tick-borne diseases. Cases of MSF are reported annually. Severe forms of MSF are not rare. Typical clinical and laboratory markers for severity should be actively searched for. Early diagnosis and proper treatment is the key to avoid complications and enable patient recovery

Epidemiological characteristics and clinical manifestations of hepatitis E virus infection in Bulgaria: A report on 20 patients

Introduction. Hepatitis E is one of the leading clinical manifestations of acute viral hepatitis in developing countries. In industrialized countries, during the past several years, sporadic “autochthonous” cases of HEV infection have been increased. Objective. The aim of this study was to analyze the epidemiological, clinical and laboratory features of HEV infection among patients hospitalized at the Department of Infectious Diseases in Military Medical Academy, Sofia, Bulgaria. Methods. A retrospective study of 806 cases of acute viral hepatitis was performed at the Department of Infectious Diseases in Military Medical Academy, Sofia, Bulgaria, between December 2004 and September 2012. The etiological diagnosis was established by ELISA. The statistical analysis was performed using Excel 2007 (Microsoft, Redmond, Washington, USA) and SPSS Statistics 19.0 (IBM Corp., Armonk, New York, USA). Results. Specific reaction to anti-HEV-IgM and anti-HEV-IgG antibodies were detected in 20 (2.48%) of 806 patients. The most observed clinical presentations were jaundice (85%), fatigue (85%), anorexia (65%), abdominal discomfort (55%) and fever (40%). The mean values of aspartate transaminase and alanine transaminase were 521 IU/l and 881 IU/l, respectively. The cholestasis was slight, marked with mean values of gamma-glutamyl transferase and alkaline phosphatase, respectively 418 IU/l and 486 IU/l. Conclusion. We report twenty autochthonous sporadic cases of acute infection with HEV. The zoonotic etiology of the virus as well as the foodborne transmission of the infection is discussed. We found that aging and pre-existing underlying diseases are risk factors for a severe course of the HEV infection

Epidemiological characteristics and clinical manifestations of hepatitis E virus infection in Bulgaria: A report on 20 patients

Introduction. Hepatitis E is one of the leading clinical manifestations of acute viral hepatitis in developing countries. In industrialized countries, during the past several years, sporadic “autochthonous” cases of HEV infection have been increased. Objective. The aim of this study was to analyze the epidemiological, clinical and laboratory features of HEV infection among patients hospitalized at the Department of Infectious Diseases in Military Medical Academy, Sofia, Bulgaria. Methods. A retrospective study of 806 cases of acute viral hepatitis was performed at the Department of Infectious Diseases in Military Medical Academy, Sofia, Bulgaria, between December 2004 and September 2012. The etiological diagnosis was established by ELISA. The statistical analysis was performed using Excel 2007 (Microsoft, Redmond, Washington, USA) and SPSS Statistics 19.0 (IBM Corp., Armonk, New York, USA). Results. Specific reaction to anti-HEV-IgM and anti-HEV-IgG antibodies were detected in 20 (2.48%) of 806 patients. The most observed clinical presentations were jaundice (85%), fatigue (85%), anorexia (65%), abdominal discomfort (55%) and fever (40%). The mean values of aspartate transaminase and alanine transaminase were 521 IU/l and 881 IU/l, respectively. The cholestasis was slight, marked with mean values of gamma-glutamyl transferase and alkaline phosphatase, respectively 418 IU/l and 486 IU/l. Conclusion. We report twenty autochthonous sporadic cases of acute infection with HEV. The zoonotic etiology of the virus as well as the foodborne transmission of the infection is discussed. We found that aging and pre-existing underlying diseases are risk factors for a severe course of the HEV infection

Fatal Case of West Nile Neuroinvasive Disease in Bulgaria

To the Editor: West Nile virus (WNV) is a mosquitoborne flavivirus. Approximately 80% of human infections are asymptomatic, 10%\u201320% are characterized by an acute febrile illness, and <1% by involvement of the central nervous system (West Nile neuroinvasive disease). Sporadic human cases and small outbreaks of West Nile fever were reported in Europe until the mid-1990s, when the first large outbreak occurred in Romania in 1996. Since then, and especially in recent years, sporadic human cases and outbreaks have been reported in other countries in Europe and neighboring countries on the Balkan Peninsula. A large outbreak of WNV lineage 2 infection occurred in Greece in 2010. Outbreaks have also been reported in other countries in Europe, which showed spread of WNV lineage 2. Some probable cases of West Nile fever were reported to the Bulgarian Ministry of Health on the basic of serologic test results. We report a case of fatal West Nile neuroinvasive disease in a man in Bulgaria. This case was confirmed by detection of specific antibodies against WNV and sequencing of the full virus genome

Antibody dynamics and viral load in COVID-19: differences in mild, moderate and severe cases

AbstractIn this study, we investigated the potential association between the severity of COVID-19 (coronavirus disease 2019) and nasopharyngeal viral loads or serum antibody levels and evaluate the temporal dynamics of antibodies against SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2). Using ELISA (enzyme-linked immunosorbent assay), we determined the presence of IgA, IgM and IgG antibodies in 450 serum samples from 122 patients for a period of 9 months after disease onset. Viral burden was quantified by RT-PCR (reverse transcription polymerase chain reaction) in 270 nasopharyngeal swab samples from 122 patients for a period of 4 weeks after the onset of the symptoms. Higher antibody values were generally seen in patients with moderate and severe disease compared to patients with mild COVID-19. Significant differences were established in IgA and IgG antibody levels at weeks 3–4 and 5–13 after the disease onset. In all severity groups, seroconversion rates were high and a similar pattern was observed with IgM antibodies quickly decreasing after reaching peak levels and IgA and IgG antibodies persisting at high values up to 9 months. The mean viral loads were higher in the mild group during the first 2 weeks and in the moderate and severe groups later on. However, the differences were not statistically significant. The IgA and IgG antibody response was significantly stronger in patients with moderate/severe disease around the time of peak antibody production as well as in vaccinated patients. No definitive association between viral load levels and the severity of COVID-19 was observed