Józef Piotr Knap

Human Alveolar Echinococcosis in Poland: 1990–2011

Background Alveolar echinococcosis (AE) caused by Echinococcus multilocularis infections is a dangerous old disease in the Northern Hemisphere. The aim of the paper was to collect and analyze data on human AE in Poland in the last two decades. Methodology/Principal Findings The sources of data were both the cases officially registered and detected by an active field and laboratory surveillance. The cases were verified by clinical, epidemiological, and laboratory criteria. Altogether 121 human cases of AE were detected. Among these 83 (68,6%) cases were classified as confirmed, 16 as probable and 22 as possible. During the two decades a continuous increase in detection rate was noticed. The cases were 6–82 years old at the time of diagnosis (mean - 47.7 years). Sex ratio M/F was 0.86/1.0. The AE was fatal in 23 (19%) patients (mean age at death - 54.1 years). Family agglomeration of AE was found in 4 foci, involving 9 patients. Seventy six of the cases were diagnosed in an advanced stage of disease. In all cases the liver was the primary location of AE. In 30 (24.8%) patients a spread to other organs was observed. Ninety four of the patients were treated with albendazole. In 73 (60%) patients a surgical operation was performed, including 15 liver transplantations. Conclusions/Significance The studies confirmed that AE is an emerging disease in Poland, which is the fourth country in Europe with over 120 cases detected. The results also indicate the need of a wider national programme for implementation of screening in the highest AE risk areas (north-eastern Poland) with an effort to increase the public awareness of the possibility of contracting E. multilocularis, and above all, training of the primary care physicians in the recognition of the risk of AE to allow for an early detection of this dangerous disease.

Bacillus anthracis infections--new possibilities of treatment.

INTRODUCTION AND OBJECTIVE Bacillus anthracis is one of biological agents which may be used in bioterrorism attacks. The aim of this study a review of the new treatment possibilities of anthrax, with particular emphasis on the treatment of pulmonary anthrax. Abbreviated description of the state of knowledge. Pulmonary anthrax, as the most dangerous clinical form of the disease, is also extremely difficult to treat. Recently, considerable progress in finding new drugs and suitable therapy for anthrax has been achieved, for example, new antibiotics worth to mentioning, levofloxacin, daptomycin, gatifloxacin and dalbavancin. However, alternative therapeutic options should also be considered, among them the antimicrobial peptides, characterized by lack of inducible mechanisms of pathogen resistance. Very promising research considers bacteriophages lytic enzymes against selected bacteria species, including antibiotic-resistant strains. RESULTS Interesting results were obtained using monoclonal antibodies: raxibacumab, cAb29 or cocktails of antibodies. The application of CpG oligodeoxynucleotides to boost the immune response elicited by Anthrax Vaccine Adsorbed and CMG2 protein complexes, also produced satisfying therapy results. Furthermore, the IFN-α and IFN-β, PA-dominant negative mutant, human inter-alpha inhibitor proteins and LF inhibitors in combination with ciprofloxacin, also showed very promising results. CONCLUSIONS Recently, progress has been achieved in inhalation anthrax treatment. The most promising new possibilities include: new antibiotics, peptides and bacteriophages enzymes, monoclonal antibodies, antigen PA mutants, and inter alpha inhibitors applications. In the case of the possibility of bioterrorist attacks, the examination of inhalation anthrax treatment should be intensively continued.

Prevalence of Coxiella burnetii in environmental samples collected from cattle farms in Eastern and Central Poland (2011–2012)

Coxiella burnetii is the etiologic agent of Q fever. It may occur as two different morphological forms, a large cell variant (LCV) and a small cell variant (SCV). The SCV is characterized by unique resistance to physical and chemical factors and may survive in the environment for many months. The objective of this study was to examine environmental samples for the presence of C. burnetii using real-time PCR in areas where Q fever was previously reported and in randomly selected animal farms where Q fever was not reported. The samples were collected in the following provinces in Poland: Lublin, Subcarpathian and Masovian. Monitoring was performed with real-time PCR and serological methods. Of the 727 environmental samples, 33 (4.54%) contained the multi-copy insertion sequence IS1111, which is specific for C. burnetii. Subsequently, the presence of C. burnetii antibodies was determined using serological tests in selected herds in which positive genetic results were obtained. Serological analyses of 169 serum samples using CFT and ELISA were performed on Polish black-and-white Holstein-Friesian cows and one cow imported from Denmark. Using the CFT method, 11 samples were positive for phase I antibodies and six were positive for phase II antibodies. Moreover, in two cases, the presence of antibodies specific for both phase I and phase II antigens of C. burnetii was detected. However, of the 169 examined serum samples, 20 were positive by ELISA test, of which six were also positive by CFT. Additionally, multi spacer typing (MST) of isolated C. burnetii strains was performed. The MST results identified two new genotypes in Poland, ST3 and ST6. The results indicate that continued research regarding spread of this pathogen within a country is necessary.

Subspecies differentiation and genotyping of Francisella tularensis strains isolated from clinical and environmental samples

Molecular epidemiology is one of the most rapidly developing research area. In the light of past and modern technologies it has gained number of typing methods based on molecular biology techniques. In this report, the subspecies differentiation of Francisella tularensis and genotyping of strains isolated in Poland and other geographic locations were investigated using real‐time PCR and multispacer typing (MST) methods respectively. In total, 49 strains of F. tularensis included 15 strains from Poland, for subspecies differentiation the real‐time PCR method was applied. For molecular typing using MST method four intergenic spacers (IS) were sequenced and compared with those previously described and deposited in GenBank (NCBI). Phylogenetic testing was performed using with the UPGMA model using MEGA6 software. The real‐time PCR enables to distinguish five strains belonged to type A and 44 to type B among deposited F. tularensis strains. The MST revealed previously described genotypes, as well as 23 new genotypes were detected. The use of real‐time PCR and MST method are valuable in the analysis of F. tularensis.

The use of sensory perception of blind and visually impaired masseurs for the purpose of early-stage breast cancer screening by palpation (the “Breast-POL” project)

Introduction. Methodological assumptions as well as the initial stage of the execution of the project entitled “Breast-POL” — the use of sensory perception of blind and visually impaired masseurs for the purpose of breast cancer screening by palpation were presented. Materials and methods. A list of incentives to conduct this methodologically adequate study includes: 1. Encouraging and widely disseminated German reports (these reports, however, were of high generality and they did not provide the adequate methodology); 2. Theoretical data on the hypercompensation of other senses than vision in the blind; 3. Preliminary information on the involvement of the blind in breast cancer screening by palpation in developing countries. Results. Compared to people with normal vision, a statistically significant higher sensitivity (63.0 vs 47.5%) and lower specificity (89.6 vs 93.7%) in the detection of pathological lesions, using a phantom, was reported in the blind. Conclusion. Our study confirms that the detection of pathological breast lesions by the blind is highly effective, however, the ability to exclude such lesions was not of clinical significance.

Solec Spa – worldwide unique properties of Polish health resort in the service of rural medicine

Solec Spa is health resort in south-eastern Poland. Its unique balneorehabilitation significance worldwide is determined by chloride-iodine-sodium water with a high content of hydrogen sulphide. This water, classified as highly mineralized sodium-chloride (seltzer) sulphide, bromide, iodide, boron water, contains naturally approximately 0.9 g/l divalent sulphur compounds, which is the highest concentration noted among the mineral waters of the world. The effectiveness of the Solec waters is proven in: inflammatory and autoimmunological locomotor system diseases, degenerative joint disorders (osteoarthritis), post-traumatic and post-operative orthopedic diseases, skin diseases and allergic disorders. One of the main indications for balneotherapy in Solec Spa and Busko Spa is chronic brucellosis.

Epidemiological analysis of diseases of children and adolescents requiring neurological and mobility rehabilitation in the Świętokrzyskie Rehabilitation Center in Czarniecka Góra, Poland

INTRODUCTION AND OBJECTIVE Epidemiological analysis of the dynamics of admissions and patient characteristics is presented concerning 5,955 children and adolescents (3-18 years of age) hospitalized in 2007-2013 with neurological and mobility diseases in Świętokrzyskie Rehabilitation Centre (ŚRC) in southern Poland. MATERIALS AND METHOD Within the period of 7 years, 18,647 patients were admitted to the ŚRC, of whom 9,546 were admitted to the daily ward and 9,109 to the stationary wards. 5,955 were children and adolescents aged 3-18, 1,499 were children aged 3-13 and almost three times more were patients aged 14-18. The correlation between the number of admissions in each year and the number of those hospitalized depending on the age and diagnosis was examined. RESULTS In the discussed period, in both age ranges, the group of deforming dorsopathies dominated, while cerebral palsy was the second most common cause of hospitalization, and the and post-traumatic disorder the smallest number. In the diagnoses of cerebral palsy and post-traumatic disease, boys constituted most of the hospitalized. In contrast, girls dominated in the group of deforming dorsopathies. DISCUSSION Analysis of the material of 5,955 patients revealed a number of quantitative data which assisted in the analysis of the epidemiological situation of this group of diseases - necessary for the planning of highly specialized treatment and rehabilitation. The greatest needs in terms of admissions to the ŚRC concerned the group of adolescents aged 14-18. The results of combined rehabilitation indicated the full use of places in the Świętokrzyskie Rehabilitation Center and also indicated the need for similar provincial and even regional centres.

Ocena narażenia populacji wiejskiej Lubelszczyzny na zakażenie krętkami z rodzaju Leptospira, ze szczególnym uwzględnieniem terenów popowodziowych

Background. Leptospirosis, caused by Leptospira spirochetes, is considered the most widespread zoonosis worldwide. Morbidity may be increased by natural disasters such as floods or typhoons. Aim of the study. The aim of the present study was to investigate the epidemiological situation of leptospirosis in the Lublin Region (Eastern Poland) with consideration of the effects of flooding by the Vistula River, by investigating human population and various elements of the environment for the presence of Leptospira in two areas: ‘Area A’ exposed to flooding, and ‘Area B’ not exposed to flooding. Material and Methods. In the Areas A and B, sera of 100 and 98 inhabitants, sera of 32 and 41 pigs and sera of 41 and 40 cows were examined, respectively, for the presence of anti-Leptospira antibodies by the microscopic agglutination test (MAT), as well as 40 and 64 samples of water, 40 and 68 samples of soil, organ samples of 30 and 30 small mammals from 5 and 6 species, and 540 and 296 Ixodes ricinus ticks, respectively – for the presence of Leptospira DNA by the nested-PCR