[Detection of HCV infection among clients of an anonymous testing center for HIV infection]

The aim of the study was to determine the prevalence and risk factors for HCV infection among clients of the centre of anonymous testing for HIV infection. Two hundred and eleven clients of anonymous testing centre for HIV infection in Białystok were additionally tested for anti-HCV antibodies and the relationship between HCV infection and risk factors was analysed Main observations: Anti-HCV were detected in 6/211 individuals (2,4%). Increased risk of HCV infection was observed among intravenous drug users, unemployed, residents of other woiewodships (administrative regions), and in those who had been tested for HIV infection in the past. Centres for anonymous testing for HIV infection is also a feasible place for screening for HCV infection. It is reasonable to limit testing for HCV to patients with risk factors

[Bacterial vaginosis]

Bacterial vaginosis (BV) is one of the most common lower genital tract infections among women of childbearing age. This paper is a survey of literature data concerning epidemiology, pathogenesis, clinical and laboratory diagnostic criteria of this clinical syndrome.

Antichlamydial antibodies in the serum and expressed prostatic secretion in prostatitis

INTRODUCTION

The aim of the study was to evaluate the prevalence of anti-Chlamydia trachomatis (C.trachomatis) antibodies in serum and expressed prostatic secretion (EPS) in chronic prostatitis.

MATERIALS AND METHODS

Thirty-six patients with chronic prostatitis were examined. The presence of C. trachomatis was determined in urethral smears and EPS. Specific antibodies were determined in the serum (IgM, IgA, IgG) and in the EPS (IgA, IgG). In the direct diagnosis of chlamydial infection, the direct immunofluorescence method and the ligase chain reaction were employed, and for the serological diagnosis, the immunoenzymatic method.

RESULTS

C. trachomatis infection was detected in the urethra of 3 (8.3%) patients and in the prostatic gland of 3 (8.3%) patients; only one of these patients was found to have C. trachomatis in both the urethra and the EPS. In the control group, C. trachomatis was detected in the urethra of 1/50 (2%) of the men, but the EPS of all of them was free of C. trachomatis. Specific IgM antibodies were found in 7 (19.4%), IgA in 9 (25%), and IgG in 18 (50%) of the patients' serum, whereas IgAs were detected in 12 (33.3%) and IgGs in 13 (36.1%) of the patients' EPS. In the control group, anti-C. trachomatis antibodies of the IgG were detected in the serum of 2/35 (5.7%) of the men, whereas in the EPS neither IgA nor IgG antibodies were detected in any of these patients.

CONCLUSIONS

Serological tests of the serum and EPS are useful as a complementary method in the diagnosis of chronic prostatitis.

[Role of Chlamydia trachomatis infection in the pathology of male urogenital tract]

Based on literature data, the authors have presented the informations on epidemiology, pathogenesis, clinical picture, diagnostics and treatment of Chlamydia trachomatis urogenital infections in men.

[Oculogenital Chlamydia trachomatis infections in adults]

The aim of the research was to determine the prevalence of C. trachomatis (C.t.) conjunctivitis and urogenital infections coexistence in adults. The study was carried out on 222 patients (109 women and 113 men) with clinical signs of conjunctivitis. Conjunctival swabs were taken from all patients for evaluation and urogenital swabs as well as blood from the patients with confirmed infection. Direct diagnostics of chlamydial infections involved IF and LCR methods while serologic diagnostics (specific IgG antibodies) used EIA and indirect IF methods. The control group for conjunctival swabs included 52 volunteers who did not have any ophthalmological symptoms while for the serological tests the control group consisted of 103 blood donors. Ocular C.t. infection was diagnosed in 42 out of 222 (18.9%) patients with conjunctivitis symptoms and in 2 out of 52 (3.8%) patients of the control group. Chlamydial conjunctivitis was mostly (70%) found in young people (18-30 yrs) and it was twice more common in women. It was usually bilateral and chronic. Urogenital C.t. infection was diagnosed in 24 out of 42 (57.1%) patients and it was more common in men (14 patients) than in women (10 patients). Only 4 out of 42 (9.5%) patients suffered from any urogenital symptoms. Specific IgG antibodies were found in the serum of 29 out of 42 (69%) patients with chlamydial conjunctivitis and only in 6 out of 103 (5.8%) patients of the control group. The diagnostics of the ocular infections, which are resistant to routine treatment, should involve the consideration of etiological role of C.t. Due to common urogenital chlamydial infection coexistence both sexual partners should be diagnosed and treated.

The immunology of Chlamydia trachomatis

Chlamydia trachomatis (C. trachomatis) is one of the most common sexually transmitted bacterial agents. What distinguishes it from other organisms is its intracellular reproductive cycle. Up to now, four antigens have been identified in the Chlamydia genus: genus-specific antigen as well as species-specific, type-specific and subspecies-specific. C. trachomatis is a powerful immunogen which stimulates the host's immunological processes. The intracellular parasitism of the bacteria is the basis for both symptomatic or asymptomatic infection as well as for chronic ones. The primary infection leads to a local inflammatory reaction due to penetration and reproduction of the bacteria in the epithelial cells and to IgA secretory antibody production. In most cases the host's reaction to the primary infection is transient and does not cause tissue damage. In the course of chronic infection or reinfection, the most important processes are those of delayed hypersensitivity, which lead to a fast and intense immunological reaction of specifically sensitized Th1 lymphocytes. This reaction leads to progressive damage of the epithelial cells and to cicatrization and fibrosis, which means irreversible complications. Interferon gamma is of special importance in the process of C. trachomatis infection. High concentrations of it inhibit the bacteria's reproductive cycle, while lower concentrations promote the development of atypical, non-contagious forms of Chlamydia of diminished metabolic activity and altered antigenicity. The chlamydial heat shock proteins are considered to be of great importance lately. Their molecular weights of 60 and 10 kDa are a powerful stimulant of immunological reactions and show significant homology (40-90%) to human and other bacterial heat shock proteins.

[Ehrlichia chaffeensis antibodies prevalence among patients bitten by ticks]

Human ehrlichiosis is a tick-borne antropozoonosis which was described in 1987 but in Poland up to now has not been diagnosed. The purpose of our work was to present 11 cases where antibodies against Ehrlichia chaffeensis were detected in serum. In 2000 we examined 68 sera of patients who were referred to our department with suspected Borreliosis or Tick-Borne Encephalitis (TBE). The detection of antibodies against E. chaffeensis was performed by indirect immunofluorescence assay. Five (45.4%) patients of 11 were diagnosed as Lyme borreliosis confirmed by serum presence of antibodies against B. burgdorferi. Three patients (27.2%) showed serum presence of antibodies against TBE. In one case presence of antibodies against three tick-borne agents was stated. None of our patients presented leucopenia characteristic of ehrlichiosis. trombocytopenia or increased aminotransferase level.

Role of Chlamydia trachomatis in epididymitis. Part II: Clinical diagnosis

The aim of the research was to analyse the complaints and symptoms in acute Chlamydia trachomatis (C.t.) epididymitis. The analysis of data from history and physical examination was made in dependence on detected Chlamydia infection in the group of 39 patients with the symptoms of acute epididymitis (1--12 men C.t. (+), 2--27 men C.t.(-)). Chlamydial epididymitis more commonly occurred in younger patients, and the symptoms of the disease persisted for a longer time than in the patients with epididymitis of another etiology. None of the men had suffered from nongonorrhoeal epididymitis before, while two of them (16.7 percent) had had urethritis. The difference in etiology was also reflected in the patients' complaints. The discharge from the urethra was more common in the patients with Chlamydia infection (1--58.3 percent, 2--18.5 percent) while epididymis oedema and scrotum erythema where twofold scarcer. No exact correlation between C.t. presence and leukocyte reaction intensity in urethra was noticed. The occurrence of chlamydial epididymitis is not always preceded by symptoms of urethritis and only in some cases they are accompanied by the increase of polynuclear leukocytes in urethral discharge. Chlamydial epididymitis is of milder course when compared to epididymitis of another etiology.

Role of Chlamydia trachomatis in epididymitis. Part I: Direct and serologic diagnosis

The aim of the study was to evaluate the role of Chlamydia trachomatis (C.t.) in the etiopathogenesis of epididymitis. 39 patients with symptoms of acute epididymitis were examined. They were divided into two age groups: 1st--patients aged below 35 (24 patients) and 2nd--patients older than 35 yrs (15 patients). The patients' urethral swabs were examined and C.t., mycoplasma and other Gram-positive and Gram-negative bacteria were searched for as well as leukocyte count was assessed. Anti-Chlamydia trachomatis antibodies of IgG and IgM classes were assayed in serum. Direct immunofluorescence (antigen detection) and immunoenzymatic (antibodies detection) methods were used in C.t. infection diagnostics. C.t. infection in urethra was found in 30.8 percent of patients suffering from epididymitis, whereas in the control group in 2 percent. C.t. infection was significantly more commonly found in patients below 35 (45.8 percent) as compared with the older men (6.7 percent). The most common etiological factor in the younger group was C.t., while in the older group it was E. coli. IgG anti-C.t. antibodies were detected in the serum of 51.3 percent of the patients with acute epididymitis, as compared with 5.8 percent of the men in the control group. Specific IgG antibodies were found significantly more often in patients under 35 (66.7 percent) than in the older men (26.7 percent). Specific IgM antibodies were found in 15.4 percent of the patients, that is in 20.8 percent of the younger patients and in 6.7 percent of the older ones. C.t. is the main etiologic agent of epididymitis in men under 35.

[The role of Chlamydia trachomatis infections in women with urinary tract diseases]

The aim of our study was to determine the incidence of Chlamydia trachomatis (C. trachomatis) infections and its role in the etiopathogenesis of urinary tract infections in women. We studied 68 women, who where divided into two groups (I-with urethral syndrome, II-with other urologic diseases). With the use of direct diagnostic methods (immunofluorescence method, tissue culture) C. trachomatis infection was found in 25/68 (36.8%) women. In the group of women with urethral syndrome the percentage of positive results was higher in comparison to the second group, 53.8% and 26.2%, respectively. Specific antichlamydial antibodies of IgG class using direct immunoenzymatic method were found in 10/26 (38.5%) women with urethral syndrome. In the first group the infection was found more often in the urethra (urethra-85.7%, uterine cervix-50%) as in comparison to the second group. In the second group infection was found more often in the uterine cervix (urethra-45.5%, uterine cervix-72.7%). The incidence of C. trachomatis infection in women with urethral syndrome was in direct correlation with a larger number of polynuclear leukocytes in urine sediment (more than 3 in the viewing field). C. trachomatis infection was found in 76.5% of women with leukocyturia and 12.5% of women in which the number of leukocytes in urine sediment was less than 3 in the viewing field. The incidence of Ureaplasma urealyticum and Mycoplasma hominis infections between both study groups did not differ significantly. However, the incidence of yeast-like fungi infections in the group of women with other urologic diseases was double. The clinical sign most often found in women infected with C. trachomatis and with urethral syndrome was dysuria, which was present in all 14 women. In the group of women with other urologic diseases the clinical sign found most often was pollakisuria (72.7%).