Biomedical subjects
Publications and source records attributed to Jerzy Stefaniak.
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.
Multicentre and long standing (1964-2002) studies on clinical epidemiology of zoonotic parasitic invasions in humans and possibilities of its control in Poland are reviewed. The object of the studies were trichinellosis, taeniosis, giardiosis, toxoplasmosis, toxocarosis, as well as cystic and alveolar echinococcoses. In the control of these invasions very important was a close and long term cooperation of a clinical parasitological centre with veterinary scientific institutions and veterinary services in Poland as well as a collaboration between Polish parasitologists and leading parasitological centers in Europe and USA.
High seroprevalence of Toxoplasma and Toxocara spp. in populations of children and adults in Poland constitutes a significant risk of supradiagnosed parasitic eye infections. We described the clinical characteristics in relation to the analysis of comparative immunological profiles of T. gondii-specific antibodies in aqueous humour and serum samples in patients with reactivated retinochoroiditis, and of Toxocara spp. ones in cases with posterior granuloma, fibrotic and calcified tumor-like masses simulating retinoblastoma, detected by ophthalmoscopy and echography. Intraocular synthesis of specific IgG antibodies was detected in anterior eye chamber fluid in 1/2 and 2/3 of patients respectively, strongly suspected of ocular toxoplasmosis or toxocarosis. The evidence of a local production of specific antibodies in intraocular fluid shown by the Western blot seems to be a valuable immunodiagnostic method for a final confirmation of eye lesions of parasitic origin and crucial in the choice of an appropriate treatment regimen.
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.
Alveococcosis in humans is characterized by a tumor-like growth with a tendency to infiltration of neighbouring organs or metastases formation in the lungs and brain. The study aimed to improve on the clinical evaluation of patients with alveolar echinococcosis (AE) and to determine the risk of metacestode spreading to adjacent tissues or distant organs by a detection of adhesion molecules involved in the tumorigenesis process. Serum concentrations of sPECAM-1, sVCAM-1 and sE-selectin adhesion molecules were studied in 8 AE patients in comparison to 75 cases with malignant neoplasms, including cases with tumors of hepatic and extra-hepatic location. The adhesion molecules were found to be early predictive markers of the active, tissue infiltrated alveococcosis with the risk of parasite spreading through the circulation. High serum levels of soluble PECAM-1 molecule were strongly related to the advanced, progressive disease and the fatality of patients' clinical prognosis.
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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.
The results of multidisciplinary studies on cystic echinococcosis (CE) in Poznan region, Poland carried out in 1990-2000, in co-operation with CDC, Atlanta GA, USA, are summarised as follows. The distinct focality of Echinococcus granulosus (Eg) infections has been demonstrated on some private farms rearing pigs (refs 12, 13). A reduction in Eg prevalence rates in pigs has been achieved, from 13.0% in 1989 down to 0.5% in 1998. This was an effect of various factors, including free treatment of all dogs in the Eg foci, i.e. farms, supplying infected pigs (ref. 13). The experimental studies confirmed, that pig's strain of Eg has some distinct characteristics, in comparison with the other Eg strains (ref. 8). It also had a separate genotype, classified as G7 (G9) (refs 9, 10). It has been demonstrated, that pig's strain was the only one found in 16 patients with CE, hospitalised in the Clinic of Parasitic and Tropical Diseases in Poznan, Poland (refs 9, 10) The same genotype in pigs was found in Slovakia and Ukraine (ref. 10). In clinical research the fine needle aspiration biopsy (FNAB) has been introduced in the doubtful cases and confirmed to be a safe and useful diagnostic technique (ref. 11). The FNAB material was examined for Eg protoscolices as well as for the presence of antigen 5 (ref. 24). Studies with intradermal Multiest suggested, that development of Eg cysts depend much on immune system, especially a switch between Th1 and Th2 (ref. 19). It has been observed that FNAB may have a beneficial effect on treatment of CE with albendazole, which can be reduced to 1 month only in the patients treated after FNAB (refs 11, 25, 26). The studies carried out were a basis for one habilitation (ref. 11) and 3 MD dissertations (13, 19, 23).
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.