Maria Szilagyiova

Costs analysis of the treatment of imported malaria

BackgroundTo document the status of imported malaria infections and estimate the costs of treating of patients hospitalized with the diagnosis of imported malaria in the Slovak Republic during 2003 to 2008.Case studyCalculating and comparing the direct and indirect costs of treatment of patients diagnosed with imported malaria (ICD-10: B50 - B54) who used and not used chemoprophylaxis. The target sample included 19 patients diagnosed with imported malaria from 2003 to 2008, with 11 whose treatment did not include chemoprophylaxis and eight whose treatment did.ResultsThe mean direct cost of malaria treatment for patients without chemoprophylaxis was 1,776.0 EUR, and the mean indirect cost 524.2 EUR. In patients with chemoprophylaxis the mean direct cost was 405.6 EUR, and the mean indirect cost 257.4 EUR.ConclusionsThe analysis confirmed statistically-significant differences between the direct and indirect costs of treatment with and without chemoprophylaxis for patients with imported malaria.

Clinical and serological study of human alveolar echinococcosis in Slovakia in relation to the outcome of chemotherapy

SummaryAlveolar echinococcosis (AE), caused by proliferating metacestodes of the parasitic fox tapeworm Echinococcus multilocularis, is a life-threatening disease in humans. In this study we report four human cases of AE in Slovak Republic with regard to various clinical manifestations and susceptibility to chemotherapy with albendazole or mebendazole. Patients were monitored serologically by ELISA test and Western Blots within 2–5 years after initiation of chemotherapy/surgery. Using computerized tomography (CT) we compared morphological changes of the parasitic lesions in the liver during the course of treatment.The parasitic lesions in the CT were manifested as nodular hyperplasia with hyper or hypodense zones and calcified foci within the lesion. In other cases the lesion was visualised as a hypodense poorly-delineated septated focus without calcifications. In the last case, the diagnosis of AE was confirmed only at surgery. Calcified foci found inside the main parasitic lesions were the only abnormality that was detected in two cases and were absent in other two cases. The levels of specific anti-parasitic antibodies followed the pathomorphological changes in the livers. Total IgG levels to Em2+ and EmP antigen declined gradually during the follow-up (1–5 years) and disappeared only in the patient receiving radical surgery (cured). In comparison with total IgG, concentration of the IgG4 antibody subclass seemed to correlate more adequately with the outcome of therapy as their levels decreased in improved/stabilised patients, but were elevated in “aggravated” patients. We showed that, in patients with AE in Slovakia, radical surgery of parasitic foci proved to be the most successful treatment and, in inoperable cases, albendazole and mebendazole were differently effective. Moreover. IgG4 levels rather than total IgG to protoscoleces antigens proved to be more sensitive serological marker of the progress of therapy.

Alveolar echinococcosis in a highly endemic area of northern Slovakia between 2000 and 2013

Long-term surveillance of Echinococcus multilocularis occurrence in red foxes in Slovakia revealed the existence of highly endemic areas, with an overall prevalence rate of 41.6 % in the northern part of the country. Between 2000 and 2013, 26 human cases of alveolar echinococcosis were detected and only three of them were not in endemic localities in northern Slovakia. Remarkable is the occurrence of the disease in eight people younger than 35 years, including three patients aged eight, 14 and 19 years. Occurrence of E. multilocularis in red foxes throughout the country and high incidence of alveolar echinococcosis in young people indicate high infectious pressure in the environment of northern Slovakia. It can be assumed that the real incidence of alveolar echinococcosis is significantly higher than recorded by official data due to the lack of existing registration and reporting system. For effective management of prevention and control strategies for this disease improvement of the national surveillance system and engagement of specialists outside the medical community are necessary. Our study presents a comprehensive picture of the epidemiological situation of E. multilocularis in northern Slovakia. In addition, we report the first list of confirmed human cases of this serious parasitosis in Slovakia.

Importance of complex diagnostic approach in differential diagnosis of alveolar echinococcosis

Summary Alveolar and cystic echinococcosis, serious parasitic diseases caused by larval stages of Echinococcus multilocularis and E. granulosus has been diagnosed in Slovakia for a long time. Study presents case of 49-years old patient with accidentally diagnosed one big (60 mm) and multiple small (2 - 24 mm) hypoechogenic structures localised in right liver lobe. According to positive serology to E. granulosus antigen and results of imaging examinations the patient was classifi ed as possible case of cystic echinococcosis and treated with mebendazole. Later, due to the worsening of clinical, laboratory and CT fi ndings surgical biopsy was performed and surgical biopsy and subsequent PCR examination of liver tissue confi rmed the diagnosis of alveolar echinococosis. Clinical picture of disease imitating cystic echinococcosis in presented case report, together with results of serological tests confi rmed importance of accurate differential diagnosis of echinococcosis. Each aspect of clinical and laboratory results should be considered responsibly, however, sometimes only molecular techniques can solve the problem of differential diagnosis.

Analysis of the direct and indirect costs of treatment of imported malaria in the Slovak Republic

This study analyzed the approximate cost of treatment of patients hospitalized with a diagnosis of imported malaria in Slovakia. Between 2003 and 2007, 15 patients with imported malaria were hospitalized. The mean direct cost of the treatment was 970.75 euros and the mean indirect cost was 53.15 euros. For the patient with the highest cost of treatment, the use of mefloquine prophylaxis would have represented only 0.5% of the total direct cost of treating the disease. Despite the partial resistance of plasmodia, malaria chemoprophylaxis is unequivocally a cheaper choice than subsequent treatment of malaria.

Lyme Borreliosis - Risk of Occupational Infection

Lyme Borreliosis - Risk of Occupational Infection Lyme borreliosis is the most frequent anthropozoonosis in the Northern Hemisphere. The primary vector of disease transmission is the tick Ixodes ricinus (in Europe), and given its seasonal activity, the highest incidence of the disease early stages is in summer. People professionally exposed to a tick and other insect bite have a higher prevalence of positive serum antibody levels compared to the general population. The aim of this prospective study was to determine the levels of positive antibodies in professional soldiers after a tick bite, and also to determine the risk of occupational infection - Lyme disease. We analyzed the serum samples taken from 95 professional soldiers, who were exposed to ticks in July 2010. The sera were taken 6 weeks after the exposure to ticks (Ixodes) in the mountains of Javorie. The ELISA method was used to examine the sera at the Institute of Microbiology in Ruzomberok, General Military Hospital. In the case of positive antibodies against Borrelia burgdorferi, the Western blot method was used. The risk of infection was 6.31 %.