Przeglad epidemiologiczny最新文献

We present the case of a 71-year-old man who developed sepsis caused by Capnocytophaga canimorsus as a result of being bitten by his own dog. Positive blood cultures were obtained, but due to difficulties in determining the bacterial species, the patient was treated empirically with ceftriaxone and levofloxacin. After using the recommended empirical therapy, the patient's condition improved. Capnocytophaga canimorsus is difficult to identify, among others, due to its long growth time and specific development conditions (capnophiles). These Gram-negative bacilli cause a number of diseases in humans, ranging from infections of the skin and subcutaneous tissue, through peritonitis, to sepsis. The portal of infection with these bacteria is most often a wound caused by an animal bite. Additional risk factors that increase the risk of developing a severe infection and even death include older age, concomitant chronic diseases, and immunosuppression.

Background: Tularemia is a zoonotic disease caused by the bacterium Francisella tularensis. It may manifest itself in various clinical forms, but in Poland the ulcerative-glandular or glandular forms of tularemia predominate. One of the routes of infection with F. tularensis is through a tick or insect bite. A patient may show no symptoms or report flu-like symptoms and painful lumps adjacent to the bite site. The differential diagnosis of localized lymphadenopathy accompanied by flu-like symptoms should include tularemia, especially in endemic areas. Lymphadenitis usually requires surgical intervention and is often unsuccessfully treated with beta-lactam antibiotics before the diagnosis of tularemia is established.

Objective: The aim of the study was to analyze and present the epidemiology and clinical presentation of tularemia in a highly endemic area, in which ticks are an important vector of F. tularensis.

Material and methods: We have analyzed epidemiological and medical reports on the confirmed tularemia cases from Hajnówka County in 2014-2022. We describe three patients from the specific endemic area who were diagnosed with granular tularemia in 2022.

Results: We have found high local exposition to Francisella tularensis infection in the Narewka community, generally consistent with the seasonality of tick activity and human activity outdoors.

Conclusions: The medical practitioner in such endemic areas must be aware that tularemia should be considered when diagnosing of flu-like symptoms accompanied by lymphadenopathy in patients bitten by ticks or insects in the summer and early autumn months. Early diagnosis and targeted antibiotic therapy are the basis for effective treatment of tularemia.

Background: Despite the fact that the last cases of fully-symptomatic diphtheria were recorded in Poland in 1996 and 2000, infections caused by non-toxin-producing strains of Corynebacterium still occur. According to the epidemiological reports from ECDC in the second half of 2022, there was an increase in the number of diphtheria cases in European Union countries. As a result, the current issue becomes the appropriate preparation of microbiological laboratories for the diagnosis of Corynebacterium microorganisms.

Objective: Reidentification of diphtheria bacilli isolated from clinical samples and to assess the drug susceptibility of C. diphtheriae strains isolated in Poland.

Material and methods: The subject of the research were 18 strains isolated from clinical samples in Poland in 2023. Microbiological and genetic methods were used for the reidentification of the strains. Drug susceptibility was assessed using the disk diffusion method, following the new EUCAST recommendations effective from 2023.

Results: It was confirmed that all examined strains belonged to the genus Corynebacterium. It was de-monstrated that C. diphtheriae strains proved to be susceptible to increased exposure to benzylpenicillin and cefotaxime. Results obtained using ciprofloxacin allowed categorizing the strains into the intermediate susceptibility category WZE, except for one strain which was resistant to this antibiotic. All tested bacterial strains were susceptible to erythromycin. The C. ulcerans strain exhibited a similar antibiotic resistance profile to penicillin, cefotaxime, and ciprofloxa-cin, with additional detection of resistance to clindamycin. The toxigenicity of the tested strains was excluded.

Conclusions: Based on epidemiological data regarding the emergence of new cases of infections caused by Corynebacterium strains, it is advisable to prepare theoretically and practically laboratories for diagnostics to detect potentially toxigenic diphtheria bacilli. Effective methods for the microbiological diagnosis of diphtheria bacilli are available. It is recommended to monitor the susceptibility to antimicrobial agents in all C. diphtheriae isolates.

Background: The paper describes a diagnostically challenging case of recurrent fever with an atypical course in a 55-year-old man. The authors highlight the significant difficulty in reaching a correct diagnosis, as well as the doubts and problems associated with the diagnostics. They suggest considering brucellosis as a diagnosis based on the patient's history and the course of the disease characterized by fluctuating, intermittent, and nocturnal fever.

Objective: The aim of the study was to present an atypical and diagnostically challenging case of recurrent febrile episodes in a 55-year-old man.

Material and methods: A comprehensive diagnostic workup, including laboratory tests, imaging, and specialist consultations, was conducted. The patient's medical history, physical examination, and various diagnostic tests were analyzed.

Results: In a patient with recurrent episodes of fever, an infection with Brucella spp. was detected, which was effectively treated with long-term antibiotic therapy. Imaging and laboratory diagnostics, along with specialist consultations, helped rule out other potential causes of the symptoms. The patient achieved lasting improvement following the treatment.

Conclusions: There is a high probability that the patient was infected with Brucella bacteria. Diagnostic challenges and the rarity of the disease, considered non-existent in Poland, hinder prompt confirmation or exclusion of infection. The authors aimed to highlight the possibility of a higher frequency of brucellosis in Poland. They suggest that Brucella bacteria may still be present, causing chronic, unrecognized, recurrent fevers. Based on the case analysis, the authors indicate that the frequent occurrence of this disease in Poland might be higher than reported by statistics.

Cerebral nocardiosis is an extremely rare and serious disease that mainly affects immunocompromised adults. Due to the non-specific clinical symptoms and difficult and long diagnostics, the diagnosis is often made late, often resulting in serious complications and patient's death. The case report presented below concerns a young patient whose complete recovery was achieved thanks to an accurate diagnosis and quick initiation of targeted treatment. The study aimed to present a rare infectious disease, drawing attention to the value of bacterioscopic examination and the special need for cooperation between a clinician, a microbiologist and a radiologist.

Background: The war invasion of Ukraine in February 2022 led to mass migration. By January 3, 2023, nearly a million people sought refuge in Poland. The Polish Act on Assistance to Ukrainian Citizens provided comprehensive support, ensuring legal residence, free medical insurance, social benefits, and access to education and employment. Simultaneously, the global public health crisis persisted, with the fifth wave of the COVID-19 pandemic driven by the Omicron variant. The epidemic state in Poland was lifted on May, 2022.

Objective: This paper aims to summarize the epidemiological situation of HCV infections in Poland in 2022, a year characterized by dual crises.

Material and methods: Epidemiological surveillance case-based data on HCV for 2022, diagnosis rates from bulletins for the years 2014-2022, and the number of deaths for 2022 from Statistics Poland were compared with previous years' data.

Results: In 2022, the rate of new HCV diagnoses rose to 6.68 per 100,000, totaling 2,528 cases (a 46% increase from the previous year). Polish nationals accounted for 87% of cases. Gender distribution was equal. There was an overall increase in HCV diagnoses across all voivodeships, with a return to pre-pandemic trends observed only in Zachodniopomorskie. Diagnoses were predominantly made in primary healthcare (one-third) and during hospitalization (one-fourth). Twenty-six cases of acute hepatitis C (1%, PL definition) were identified. At diagnosis, 5.6% of infected showed signs of liver damage. Hepatitis C was responsible for 86 deaths. Imported infections accounted for 5.7% of cases. 2.7% of HCV infections in 2022 were diagnosed in refugees from Ukraine, mainly in women aged 40 to 59. All persons of Ukrainian nationality accounted for 10.4% of HCV cases detected in 2022.

Conclusions: Expanding the availability and accessibility of testing is essential, particularly addressing the needs of key populations, including non-Polish speakers. The strategy for HCV elimination should encompass comprehensive measures aimed at prevention, diagnosis, and treatment to effectively curb the virus's spread among subgroups and mitigate its long-term health impacts.

Oral health plays a crucial role in obesity management. Scientific evidence suggests an association between obesity and oral diseases, including periodontal disease, dental caries, tooth erosion, xerostomia, and dentinal hypersensitivity. Maintaining optimal oral health is essential for obese patients, as compromised dentition or oral discomfort can influence dietary habits. However, managing oral health in obese individuals can be challenging due to anatomical limitations and lifestyle choices. Profound knowledge of obesity and its manifestations, the oral health professionals need to raise awareness and provide patients with comprehensive care. Pocrescophobia also known as obesophobia, is an intense fear of gaining weight. It affects both adoloscent women and men, manifesting as an irrational dread associated with weight gain. Like other phobias, obesophobia falls under the umbrella of anxiety disrders, leading to exaggerated anxiety when discussing or thinking about weight gain. Individuals with this fear may go to extreme lengths to avoid weight gain, which can increase the risk of developing eating disorders. Stress can lead to bruxism, wears away the occlusal surfaces and incisal edges, resulting in flat, shorter teeth. Smooth V-shaped cavities arise when lateral stresses surpass physiological limitations, resulting in gum recession and tooth discomfort. Canker sores, xerostomia, and lichen planus have all been linked to stress. By addressing both obesophobia and obesity as well as oral health, patients' overall well-being and quality of life can be improved.

Introduction: Medical treatment of pediatric empyema consists of appropriate antibiotics, chest tube insertion, and intrapleural fibrinolytic drugs to facilitate pleural drainage. There is a lack of consensus about the drug of choice for fibrinolytic therapy, so this study was designed to evaluate the safety and efficacy of intrapleural alteplase in pediatric empyema.

Material and methods: The medical records of all children with empyema treated with intrapleural alteplase at a university hospital between January 2016 and December 2020 were retrospectively reviewed. Efficacy outcomes were assessed by chest tube output before and after the first dose of alteplase, pleural fluid volume before and after therapy, a need for surgical intervention, and length of hospital stay. Safety was assessed by the frequency and severity of side effects.

Results: 40 children aged 2 months to 9 years hospitalized with empyema received intrapleural alteplase. Thirty patients (75%) experienced full recovery after three doses of intrapleural alteplase. The median length of hospital stay was 16 days. Chest tube output increased significantly after the first dose of alteplase. Pleural fluid volume decreased significantly after treatment. The most common side effect was pain (30%). Two patients experienced severe complications: 1 had a pulmonary hemorrhage and the other experienced a bronchopleural fistula. These patients recovered fully spontaneously.

Conclusions: According to our results, the administration of intrapleural alteplase was safe and effective in facilitating pleural drainage in pediatric patients with empyema. However, further clinical trials will be needed to determine the optimal dose, frequency, and duration of intrapleural alteplase treatment.