Biomedical subjects
Publications and source records attributed to Elzbieta Kacprzak.
The paper presents data on occurrence, diagnosis and treatment of alveolar echinococcosis in humans as well as possible methods of its prevention. Studies done in 2001-2003 in Poland have shown the high prevalence of the tapeworm in red foxes in the north-east (34.5%) and south-east (39.3%) of Poland with foci of infection in some counties (up to 70% foxes infected). It makes the high potential risk for human infection in these areas.
The incidence of non-specific reactions with E. multilocularis antigen in patients with liver malignancies, and the risk of a supradiagnosis of alveolar echinococcosis (AE) in space-occupying lesions in the liver due to neoplastic proliferative diseases were studied. Analysis of specific IgG serum antibody against Em2plus antigenic complex was performed in 11 AE patients in comparison to 76 individuals with malignant neoplasms of abdominal or extra-hepatic location, including some patients with primary hepatocellular cancer or distant metastases to liver, and 42 patients with benign hepatic lesions. Only one false borderline result was reported in a case with colorectal cancer, and dissemination to liver. Low risk of false positive results with E. multilocularis-specific Em2plus antigen in patients with liver malignancies makes the test valuable for practical reasons in a differential diagnosis of irregular tumor masses visualized by imaging techniques.
Recent epidemiological reports have shown an increasing risk of E. multilocularis infection among red foxes and humans in Poland. The aims of the study were: (i) to improve the early detection of alveolar echinococcosis (AE) in humans by implementation of clinical, imaging, immunodiagnostic, ultrastructural and molecular methods, (ii) to realize the parasitological verification of registered cases suspected of alveococcosis by the specialized, parasitological centres, and (iii) to standardize diagnostic and therapeutic procedures for this severe parasitic disease. Since 1993, eight cases of AE were registered in the Poznań centre. The final diagnosis was based on PAS-positive staining of lesions by histopathology or a detection of the parasite's DNA in liver sections. Collaboration with physicians of various medical specialities is crucial for an early and more effective recognition of AE. Alveococcosis should always be considered in the differential diagnosis of space-occupying lesions in the liver suggesting slow-growing cancer.
Infections of humans with Echinococcus multilocularis, the causative agent of alveolar echinococcosis (AE), a zoonosis, have been described with increasing frequency in Poland since 1994. In the attempt to verify these reports, we analyzed specimens obtained from a representative group of Polish patients. Liver lesions in patients with AE that was diagnosed on the basis of results of histological and serological tests contained E. multilocularis DNA, as shown by the presence of specific microsatellite sequences and mitochondrial 12S rDNA. The same tests clearly distinguished between AE and cystic echinococcosis, which is caused by Echinococcus granulosus. These data are unequivocal proof that human infections with E. multilocularis occur in Poland.
Leishmanioses are widespread in 88 countries of the tropical and subtropical zone, including regions of the Mediterranean Sea basin of Southern Europe. Actually, approximately 350 million of people live in Leishmania endemic areas and about 12 million of individuals are infected. Visceral leishmaniosis (kala-azar disease, tropical splenomegaly) is caused by at least 3 species of Leishmania protozoa: L. donovani, L. infantum and L. chagasi. The incidence of the disease is estimated at 500,000 new cases annually. The infection is transmitted by Phlebotomus or Lutzomyia mosquitos bites, in which intestines forms invasive to humans are developed. Leishmania spp. have a predilection to the reticulo-histiocytary system cells, leading to their proliferation and disruption, and after spreading to the circulation they invade spleen, liver and bone marrow. Visceral leishmaniosis should be suspected in travelers returning from tropical and subtropical areas with signs of splenomegaly and twice temperature spikes in a day. We reported a case of the kala-azar disease in the 22 year-old Polish patient seasonally working in Italy. The clinical picture was expressed by two daily pikes of fever proceeded by chills, excessive sweat, hepatosplenomegaly, lymphadenopathy, general weakness, abdominal pain and nausea. The Leishmania infection was complicated by candidiosis. Laboratory tests showed anaemia, thrombocytopenia, leucopenia, hypergammaglobulinaemia and a suppression of immunological cellular response. The diagnosis was confirmed by a presence of amastigota forms in macrophages of the bone marrow aspirate and a detection of specific antibodies to L. infantum by Westernblotting. The patient was successfully treated with Glucantime.
Typhoid fever is an acute infectious disease caused by Salmonella enterica serotype typhi. The infection is responsible for endemic or epidemic outbreaks in tropical and subtropical countries, especially in Indian subcontinent, Southeast Asia, Central and South Africa. Latin America, and it occurs sporadically in Poland. We reported two cases of imported typhoid fever after travelling to India and Nepal. In the tourists returning from the area hyperendemic for malaria, visceral leishmaniosis, amoebiasis and haemorrhagic fevers and not following tropical hygiene measures, persistent fever was a source of difficulties in differential diagnosis. In the first case, lack of anti-malarial chemoprophylaxis in the presence of anaemia and thrombocytopenia strongly suggested Plasmodium spp. infection. Two daily peaks of fever with splenomegaly, lymphadenopathy, leucopenia, high transaminases levels and co-existing positive serology for L. donovani pointed to visceral leishmaniosis. Late occurrence of specific anti-S. typhi agglutinins in the Widal test, cross-reactivity with S. paratyphi A and negative urine bacteriological culture were observed. In the second case, gastrointestinal disturbances, including pain, abdominal tenderness and diarrhoea gave a suspicion of amoebic colitis. Stool and urine cultures were negative for S. typhi and cross reactions with S. paratyphi A and C were reported. Typhoid fever was finally confirmed in both patients by an isolation of S. typhi from peripheral blood cultures. The effectiveness of treatment of choice with ciprofloxacin or ceftriaxone in a case of multidrug-resistant (MDR) strain of S. typhi was documented.