Krzysztof Korzeniewski

Effectiveness of Immunoprophylaxis in Suppressing Carriage of Neisseria Meningitidis in the Military Environment

Neisseria meningitidis, etiological factor of invasive meningococcal disease, is a human commensal that colonizes the nasopharynx. Colonization is usually asymptomatic, but it is a prerequisite for disease. Asymptomatic carriers are the major source of infection. In the present study, a survey of N. meningitidis carriage was conducted between January and March 2013 in a military unit in Poland. Single-time throat culture samples were collected from professional 559 soldiers (302 unvaccinated vs. 257 vaccinated individuals with the quadrivalent conjugate vaccine ACYW-135). Bacterial identification was performed with classic microbiological methods (culture, incubation, identification). Non-culture method (PCR) was used for confirmation of detected strains of N. meningitidis and determination of serogroups. We found 29 carriers in the group of unvaccinated soldiers (9.6 % of examined individuals) whereas among vaccinated soldiers only 3 persons were carriers of N. meningitidis (1.2 %). The most frequently identified serogroups among the carriers serving in the same military facility were serogroup B (28 %), followed by Y (25 %), and C (22 %). In conclusion, the initiation of mass vaccination with the quadrivalent conjugate vaccine ACYW-135 in the military environment seems an effective method of suppressing N. meningitidis carriage.

Zika - another threat on the epidemiological map of the world.

Zika fever is an acute infectious disease caused by the Zika virus (ZIKV) of the Flaviviridae family and Flavivirus genus. It is transmitted by day-time active Aedes mosquitoes, and potentially by sexual contacts, blood transfusion, and from mother to foetus (resulting in microcephaly in a child). ZIKV was first isolated from a macaque monkey in the Zika forest in Uganda in 1947. The first case of the Zika fever in a human was recorded in Nigeria in 1954. Until 2007 only 14 cases of the disease were confirmed worldwide. In 2007, there was an outbreak of the Zika fever in Micronesia (Yap Island) with an estimated 5,000 cases. Between 2013 and 2015 a further outbreak of the disease occurred in the Pacific islands: in French Polynesia, New Caledonia, Cook Islands, Easter Island, and Solomon Islands. In 2015, the Zika fever spread to Brazil and more than 20 other countries in the South and Central America. Until March 2016, an estimated 1.6 million autochthonous cases of Zika have been reported globally, with approximately 1.5 million cases recorded in Brazil. Typically, 80% of Zika infections are asymptomatic. The most common symptoms of the disease include fever, maculopapular rash, muscle and joint pain, conjunctivitis. Zika fever can be diagnosed on the basis of clinical signs (it must be differentiated from dengue, chikungunya), ZIKV identification is also possible by the application of polymerase chain reaction in acutely ill patients and the detection of specific IgM and IgG antibodies to ZIKV. Until today, there is no effective antiviral treatment or an effective vaccine against Zika fever (in case of an infection only symptomatic treatment is applied). In August 2016 in Rio de Janeiro (Brazil) Summer Olympic Games will take place, attracting thousands of athletes and spectators. The fight against the Zika fever and the race against time have gained momentum.

Travel-related sexually transmitted infections

Sexually transmitted infections (STIs) are among the most common notifiable health problems worldwide, with particularly high rates in developing countries. Men and women with multiple sexual partners at home or a previous history of STIs are more likely to have casual sexual exposure (CSE) while travelling. Over the last several decades 5% to even 50% of short-term travellers engaged in CSE during foreign trips. It is estimated that only 50% of travellers use condoms during casual sex abroad. Sexual contact with commercial sex workers is an exceptionally high-risk behaviour. The common risk factor is also young age. Adolescents and young adults constitute 25% of the sexually active population, but represent almost 50% of all new acquired STIs. Many STIs are asymptomatic and therefore can be difficult to identify and control. The clinical manifestation of STIs can be grouped into a number of syndromes, such as genital ulcer or erosion, urethral or vaginal discharge, pelvic inflammatory disease. STIs are divided into curable infections caused by bacteria (gonorrhoea, chlamydiasis, syphilis, chancroid, lymphogranuloma venereum, granuloma inguinale) or protozoa (trichomoniasis) and incurable viral infections (genital herpes, genital warts, HIV). STIs are not only a cause of acute morbidity, but may result in complications including male and female infertility, ectopic pregnancy, cervical cancer, premature mortality or miscarriage. Monogamous sex with a stable, uninfected partner or sexual abstinence remains the only way to avoid the risk of becoming infected with STIs.

High altitude pulmonary edema in mountain climbers.

Every year thousands of ski, trekking or climbing fans travel to the mountains where they stay at the altitude of more than 2500-3000m above sea level or climb mountain peaks, often exceeding 7000-8000m. High mountain climbers are at a serious risk from the effects of adverse environmental conditions prevailing at higher elevations. They may experience health problems resulting from hypotension, hypoxia or exposure to low temperatures; the severity of those conditions is largely dependent on elevation, time of exposure as well as the rate of ascent and descent. A disease which poses a direct threat to the lives of mountain climbers is high altitude pulmonary edema (HAPE). It is a non-cardiogenic pulmonary edema which typically occurs in rapidly climbing unacclimatized lowlanders usually within 2-4 days of ascent above 2500-3000m. It is the most common cause of death resulting from the exposure to high altitude. The risk of HAPE rises with increased altitude and faster ascent. HAPE incidence ranges from an estimated 0.01% to 15.5%. Climbers with a previous history of HAPE, who ascent rapidly above 4500m have a 60% chance of illness recurrence. The aim of this article was to present the relevant details concerning epidemiology, pathophysiology, clinical symptoms, prevention, and treatment of high altitude pulmonary edema among climbers in the mountain environment.

Fresh fruits, vegetables and mushrooms as transmission vehicles for Echinococcus multilocularis in highly endemic areas of Poland: reply to concerns

Echinococcus multilocularis is a tapeworm that may cause alveolar echinococcosis (AE), one of the most dangerous parasitic zoonoses. As in the case of other foodborne diseases, unwashed fruits and vegetables, contaminated with dispersed forms of E. multilocularis, may serve as an important transmission route for this parasite. In this article, we reply to the incorrect interpretation of results of our study concerning the detection of E. multilocularis DNA in fresh fruit, vegetable and mushroom samples collected from the highly endemic areas of the Warmia-Masuria Province, Poland, to dispel any doubts. The accusations formulated by the commentators concerning our paper are unfounded; moreover, these commentators demand information which was beyond the purview of our study. Making generalisations and drawing far-reaching conclusions from our work is also unjustified. The majority of positive samples were found in only a few hyperendemic communities; this information corresponds with the highest number of both infected foxes and AE cases in humans recorded in this area. Our findings indicate that E. multilocularis is present in the environment and may create a potential risk for the inhabitants. These people should simply be informed to wash fruits and vegetables before eating. No additional far-reaching conclusions should be drawn from our data. We believe these commentators needlessly misinterpreted our results and disseminated misleading information. Nevertheless, we would like to encourage any readers simply to contact us if any aspects of our study are unclear.

Respiratory tract infections in the military environment

Abstract Military personnel fighting in contemporary battlefields as well as those participating in combat training are at risk of contracting respiratory infections. Epidemiological studies have demonstrated that soldiers deployed to the harsh environment have higher rates of newly reported respiratory symptoms than non-deployers. Acute respiratory diseases are the principle reason for outpatient treatment and hospitalization among military personnel, with an incidence exceeding that of the adult civilian population by up to three-fold. Adenoviruses, influenza A and B viruses, Streptococcus pneumoniae, Streptococcus pyogenes, coronaviruses and rhinoviruses have been identified as the main causes of acute respiratory infections among the military population. Although infective pathogens have been extensively studied, a significant proportion of illnesses (over 40%) have been due to unknown causative agents. Other health hazards, which can lead to respiratory illnesses among troops, are extreme air temperatures, desert dust, emissions from burn pits, industrial pollutants, and airborne contaminants originating from degraded soil. Limited diagnostic capabilities, especially inside the area of operations, make it difficult to accurately estimate the exact number of respiratory diseases in the military environment. The aim of the study was to discuss the occurrence of respiratory tract infections in army personnel, existing risk factors and preventive measures.

Skin lesions in returning travellers.

Skin lesions, apart from diarrhoeas, fever of unknown origin, and respiratory tract infections belong to the most frequent medical problems in travellers returned from tropical and subtropical destinations, accounting more than 10% of reported cases. Most dermatoses have their clinical onset during travel, although some of them can occur after return. Travel-related dermatological problems can have a wide spectrum of clinical picture, from macular, popular or nodular rash, linear and migratory lesions, to plaques, vesicles, bullae, erosions or ulcers. Skin conditions in returning travellers may be of infectious and non-infectious aetiologies. Infectious lesions may be originally tropical (e.g. dengue, chikungunya, schistosomiasis, leishmaniasis, myiasis, tungiasis, loiasis), although the majority are cosmopolitan (arthropod bites, sunburns, allergic rashes). The evaluation of skin lesions depends on many factors, including immune status of patients, use of medicines, exposure on health hazards (fauna, flora, risky behaviours), as well as the time, duration and location of travel. As the number of travellers to tropical and subtropical destinations has been continuously rising, the number of skin illnesses has also been increasing. This means that specialists in travel medicine need to extend their knowledge of epidemiology, clinical features and diagnosis of travel-related health problems including skin lesions in returning travellers.

Respiratory Infections in Travelers Returning from the Tropics

Respiratory tract infections (RTIs), beside diarrheas, skin lesions, and fevers of unknown origin, are one of the most common health problems acquired by travelers going to tropical and subtropical countries. Visitors to African, Asian, or South American destinations, typically characterized by harsh environmental conditions and poor sanitation standards, are at risk of exposure to a large number of pathogens causing infectious diseases. The infections are transmitted from contaminated food and water, through the air, direct contact, or by insects. The main modes of RTIs transmission include droplet infection and direct contact. The clinical spectrum of RTIs in travelers is broad, from upper respiratory tract infections, pharyngitis, bronchitis, pneumonia, to influenza-like illness. The spectrum of microbial agents causing respiratory infections include numerous viruses and bacteria, rarely fungi, and parasites. Most travelers complain of mild infections, only a small minority seek medical assistance and report to health care facilities. Because of the risk of importing pathogens into Europe or North America and transferring them onto the local population, it is important to present the scale of the problem in relation to rapid development of tourism industry and an increasing number of intercontinental journeys. The aim of the study was to discuss the occurrence of travel-related respiratory infections among representatives of temperate climate traveling to and returning from the tropics.

Selected epidemiological aspects of fresh whole blood application in the Polish Field Hospital in Afghanistan

Minimisation of blood transmitted diseases is a basic element of all blood transfusion strategies. Civilian health service standards used in peacetime may be difficult to implement in a battlefield. The risk of blood-borne diseases depends on the applied donor qualification procedures and the epidemiological situation in the areas of military operations. The authors discuss various epidemiological aspects considered when selecting potential donors of fresh whole blood for a Walking Blood Bank at the Polish Field Hospital in Afghanistan.

Prevalence of intestinal parasites in Afghan community on the example of patients treated in Ghazni Provincial Hospital

BACKGROUND This study concerns parasitological investigations estimating the prevalence of intestinal parasites in the Afghan community based on the example of patients, both children and adults, treated in the Ghazni Provincial Hospital, in the eastern part of the country. MATERIALS AND METHODS In total, 201 admitted patients with internal health problems were examined in the Afghan hospital in March 2012, including 164 children (1-17 years old) and 37 adults aged 18-80. Stool samples were tested in the Department of Epidemiology and Tropical Medicine at the Military Institute of Medicine in Gdynia, Poland using 3 parasitological methods: direct smear, decantation, flotation (light microscopy). RESULTS Intestinal parasitic infections caused mainly by Ascaris lumbricoides, Giardia intestinalis and Hymenolepis nana were confirmed in 81/164 (49.4%) children examined. Among adults, 9/37 (24.3%) patients were infected with intestinal parasites including Ascaris lumbricoides and Giardia intestinalis. CONCLUSIONS The Afghan community, living in poor sanitary conditions with limited access to health services, is one of the most infected populations in the world. The parasitological investigation focused on intestinal parasites performed by the Polish health service among the eastern Afghan inhabitants is still one of the few screening studies in this country.