TABLE OF CONTENT

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1. STUDY OF SERUM LEVELSOF IL4 AND IL10 IN PATIENTS WITH DIFFERENT TYPES OF ECHINOCOCCOSIS(HYDATID DISEASE)?

P. Tonchev

ABSTRACT
Echinococcosis is a severe parasitic disease, caused by larvae of cestodes Echinococcus granulosus. The immunological interaction between infected subject and E. granulosus is complex and depends on host’s immune response against parasitic invasion and suppression and modification of this response by the parasite. The aim of this study was to measure the levels of IL4 and IL10 using ELISA in serum of patients with different forms of Echinococcosis, and to find the relationship (if exist) between serum levels of IL4 and IL10 and the number, size and locations of E. granulosus-cysts. Sera were obtained preoperatively from 25 patients(15-f 10-m) age 11-76 (median 45,4 ±18) and from comparably designed control group of healthy subjects. There was a significant (p<00.5) difference in IL4 levels in patients with liver hydatid disease compared with controls. Our results show that the serum levels of IL4 are a useful marker in the foilow-up of patients with cystic disease.


2. VACCINE AGAINST CONGO-CRIMEAN HAEMORRHAGIC FEVER VIRUS-BULGARIAN INPUTIN FIGHTING THE DISEASE

I. Christova, T. Kovacheva, D. Georgieva, S. Ivanova, D. Argirov

ABSTRACT
Bulgaria is an endemic country for Congo-Crimean haemorrhagic fever (CCHF) as are also many of the countries on the Balkan Peninsula. A CCHFV vaccine for specific prophylaxis of the disease was developed in 1970. The vaccine is unique until today. In this study, we analyzed available data for the last 5 years about CCHFV vaccine application and officially reported CCHF cases in the 3 most endemic for CCHF regions in Bulgaria (Burgas, Haskovo, and Kardjali) to consider if any relationship exists. Summarizing the available data, we found that immunization tend to reduce the CCHF incidence. The more persons were vaccinated, the less CCHF cases were reported in the same year. In conclusion, after introducing the vaccination program, a 4-fold reduction in the number of annually reported CCHF cases was observed. Also, extrapolating from the 3 most endemic regions in Bulgaria, we concluded that increasing the number of vaccinated persons per year lead to reducing the number of reported CCHF cases for the same year.


3. NOSOCOMIAL URINARY TRACT INFECTIONS IN UROLOGIC PATIENTS: SHIFT IN PATHOGENS AND THEIR ANTIBIOTIC SUSCEPTIBILITIES

V. Popova, H. Hitkova, M. Sredkova, E. Kanjovska, V. Edreva, R. Kocev, V. Popov

ABSTRACT
Urinary tract infection (UTI) is the most common nosocomially acquired infection. Surveillance data report a shift in the etiology and resistance patterns of uropathogens. The aim of this study was to investigate etiologic agents of nosocomial UTIs in our institution and to study their susceptibility to antimicrobial agents. We evaluated retrospectively 97 nosocomial infections among the 1278 patients admitted to the Department of Urology for one year period from July 1st 2006 to June 30th 2007. The incidence of nosocomial infections (NIs) was 7.59%. NUTIs constitute 91.75% of them. Gramnegative bacteria were responsible for 70% of NUTIs. Two-third of NUTIs were caused by enterobacteria. E.coli, Klebsiella spp. and Enterobacter spp. were isolated in almost equal proportion (range 18 to 24%). The percentage of nonfermenters was relatively low (5.62%). Of the particular note was the emergence of Enterococcus spp. (28%) as important nosocomial uropathogen. Multidrug resistance was observed in 64.51% of gram-negative bacteria. Production of ESBL was detected in 37 (64.91%) of enterobacteria. Resistance to ciprofloxacin and trimethoprim-sulfamethoxazole (TMP/SMX) was observed in 88.7% and 90.3% of isolates respectively. Enterococcus spp. was the only gram-positive bacterium with a high incidence and one third of enterococci were multidrugresistant. The data reveal that gram-negative bacteria are still an important cause of NUTIs, but Enterococcus spp. play the leading role in our urologic population. Etiologic shift in NUTIs and upsurge of antimicrobial resistance of these pathogens are impressive and alarming. Multidrug resistance is a common problem in our Department of Urology. In order to prevent or decrease resistance to antibiotics the use of antimicrobials should be kept under supervision, should be given in appropriate doses and effective control programme for hospital infections should be carried out.


4. A POSITIVE CRIMEAN CONGO HEMORRHAGIC FIVER CONTROL REACTIONS BY DIFFERENT MOLECULAR TECNIQUES

N. Kalvatchev, I. Christova

ABSTRACT
Crimean - Congo hemorrhagic fever (CCHF) is a tick-borne disease caused by the arbovirus Crimean - Congo hemorrhagic fever virus (CCHFV). The disease now occurs sporadically throughout much of Africa, Asia, and Europe and results in an approximately 5-10% fatality rate. Bulgaria takes part of this endemic region and therefore prompt confirmation of CCHF diagnosis of the first suspected case is important. That is why, contemporary molecular techniques as Nested RT - PCR and Real time RT - PCR are needed. In this study, we present the elaboration and establishment of positive control reactions for CCHFV by the mentioned methods for the first time in our country.


5. SYBR GREEN BASED REAL-TIME PCR ASSAY FOR DETECTIONOF POLYOMAVIRUS JC

I. Tsekov, D. Ferdinandov, A. Petrova, Zl. Kalvatchev

ABSTRACT
Reactivation and replication of polyomavirus JC (JCV) in the oligodendrocytes results in loss of myelin and causes progressive multifocal leucoencephalopathy (PML). In order that PML is diagnosed, both clinical and laboratory criteria have to be met. Real-time polymerase chain reaction (PCR) assays have been suggested as the method of choice, allowing rapid and specific detection of viral sequences in the tested materials. In order to support the work of clinicians and to benefit the patient’s follow up we have introduced and approbated with specimens from the clinical practice a SYBR Green based system for detection of JCV in PML suspected cases.


6. HUMAN HEPATITIS VIRUSES B AND C AMONG HIV-INFECTED PATIENTS - CLINICAL AND EPIDEMIOLOGICAL FEATURES

N. Popivanova, O. Boykinova, I. Baltadzhiev, Y. Stoilova, S. Novakov, A. Dineva, V. Nikolov

ABSTRACT
Due to overlapping transmission routes, some individuals living with HIV are co-infected with multiple hepatitis viruses: hepatitis B (HBV) and/or hepatitis C (HCV) virus. Concomitantly with the survival time increase after the introduction of HAART for more than 17 years, hepatitis C-related liver disease has become a leading cause of death in HIV/AIDS patients. Approximately 30% of HIV-infected individuals in the U.S. and Europe are also infected with HCV. Studies indicate that HIV-HCV co-infected patients experience more rapid progression of liver cirrhosis and hepatocellular carcinoma than those with HCV mono-infection. Some researchers have argued that HIV disease is accelerated by HCV-related immune activation, and HIV-mediated immune suppression stimulate HCV replication and impair immune-mediated HCV clearance.

The aim of the study was to point on HIV/HCV and HIV/HBV infected patients, and pose some questions concerning the investigation, treatment and prevention of the diseases.

Among 48 HIV-patients 24(50%) were HCV/HBV negative, 21(43.75%) were infected with HCV, 1(2.08%) - with HBV and 2(4.16%) with HCV and HBV concomitantly. The prevalence of the male young people and I.V. drug users is noted. Because HBsAg is rarely positive, an occult viral hepatitis B might be supposed.

The authors focused on the need of screening, management and counseling for HCV and HBV infected HIV-individuals, immunization of HBsAg negative and adequate treatment of HIV-HCV/HIV-HBV patients.


7. PROTECTION OF THE ADULTS AND ADOLESCENTS AGAINST DIPHTHERIA, TETANUS AND WHOOPING COUGH IN BULGARIA

R. Alexiev, I. Todorova, K. Hadjiiski,A. Milanova, S. Malchanova, V. Demireva, PI. Nenkov

ABSTRACT
The investigation is done during the period 2001-2008 in Sofia. The aim of this study is estimation of immune status of population against diphtheria, tetanus and pertussis. For investigation were tested 9 934 human sera above 7 years of age. The ELISA methods developed in BB - NCIPD, Ltd are used for quantity assay. The comparison during the investigation period showed that the immunity against tetanus in different years in constantly levels. The results demonstrated that the full protected people are about 65%, the people with basic immunity are between 30% and the non protected sera are in up to 6%. The summarized results for diphtheria protection showed the persistence of immunity. The full protected people are more than 65%, the persons with basic immunity are about 10% and the sera with titers less than the protected level are less than 25%. The serological studies for pertussis showed that the best protection had seen in people up to 25 years old ( more than 85%). The increase of age in people leads to reduction of the percent of persons with full protection and increase of sera with basic immunity and non-protected people. 55% of the tested sera in age group over 56 years old are non-protected because the vaccination program in Bulgaria started since 1958. The prevalence of pertussis antibody in various age groups in the general population depends on the status of immunization against pertussis in childhood. Present results indicate a good immune status of the population against diphtheria, tetanus and pertussis in Bulgaria. This fact is a result of specific immunoprophylaxis by bacterial vaccines produced by BB - NCIPD, Ltd., Sofia.


8. ESTIMATION OF IMMUNE STATUS OF THE CHILDREN UP TO 6 YEARS OF AGE AGAINST DIPHTHERIA, TETANUS AND WHOOPING COUGH IN BULGARIA

R. Alexiev, I. Todorova, K. Hadjiiski, A. Milanova, S. Malchanova, V. Demireva, PI. Nenkov

ABSTRACT
The investigation is done during the period 2001-2008 in Sofia. The aim of this study is estimation of immune status of infants and children up to six years of age against diphtheria, tetanus and pertussis. The ELISA methods developed in BB - NCIPD, Ltd are used for quantity assay. The comparison during the investigation period showed that the immunity against tetanus in different years in constantly levels. The results demonstrated that the full protected children are about 86%, the people with basic immunity are more than 13% and the non protected sera are in up to 0.26%. The summarized results for diphtheria protection showed the persistence of immunity. The full protected children are more than 96%, the persons with basic immunity are about 0.25% and the sera with titers less than the protected level are less than 3.6%. The serological studies for pertussis showed that more than 53% of persons have full protection against whooping cough and in more than 43% of children the obtained titters showed basic immunity. In 2.88% of patients the titter of antibody is more than 1:321, which titter is used as a criteria of disease of human sera. Only in 0.25% of tested sera the level of antibodies is not enough for protection. Present results indicate a good protection against diphtheria, tetanus and pertussis in Bulgaria in children till 6 years old. This fact is a result of specific immunoprophylaxis of infants and children up to 2 years of age by DIFTETKOK (DTP) combined bacterial vaccine, produced by BB - NCIPD Ltd., Sofia Bulgaria.


9. CONTAINMENT OF TUBERCULOSIS IN PRISONS - A KEYPOINT OF THE GLOBAL POLICY

E. Keuleyan, D. Popov, E. Bachiyska, T. Anakieva, Sh. Tete

ABSTRACT
Prisons play a crucial role in epidemiology of tuberculosis (TB): an air-born infection, with a higher prevalence among lower socio-economical strata, HIV-infected and addicts. Conditions in prisons, incl. overcrowding, facilitate the spread of disease to other prisoners, personnel and visitors. Relative rate of MDR- and XDR- TB, and the conversion of latent TB to an active, is much higher than in society. Released prisoners before the accomplishment of treatment become a source of TB in the society.

In Bulgaria the legislation for ТВ-care in prisons is acting since 2003 and the National Program for Prevention and Control of TB (supported by the WHO, EuroTB, ECDC and the Global Fund), was accepted in 2007.

The item 4 under the Action Plan focuses on prisons, aiming at identification of TB cases, strengthening the infrastructure of hospitals and medical centers with the prisons. Another important goals are the delivering of modern medical apparatus, the associating of Healthcare sector and facilities of the Ministry of Justice to the information TB system, and the building of an equip to plan, coordinate, manage and control these activities.

The control of TB in prisons is difficult and complex. It requires a prompt identification of disease upon the entrance (screening), isolation, treatment (DOTS) and control of cases upon release out of prison. Microbiology diagnosis should be as rapid as possible, through real-time PCR, FISH diagnostic and other contemporary methods, incl. for susceptibility testing. The questions regarding the Infection Control in prisons are open: new or renovating facilities are required, with negative ventilation (Air-born Infection Isolation Rooms), air-born personal protective equipment (such as N95 respirators) etc. Care should be taken for the health of guards, the medical personnel and to the environment. The total program in prisons will require much more organization, education, coordination, ensuring appropriately trained staff and well equipped facilities, and obviously, more resources, than previously assumed.


10. INFLUENCE OF DRUG PRODUCTS ON ANTICOAGULANT BAITS EFFICIENCY

Z. Tsankova

ABSTRACT
The experiment aimed at achieving an express deratization effect in areas of infectious diseases. In order to reach this goal the possibility of activation of rodenticide baits based on bromadialon in two concentrations-0,0025% and 0,005% was examined. The rodenticide baits were combined with Calcium antagonist drugs- Nifedipine and non-steroidal anti-inflammatory drug Nimesulide.

Drug dosage was within the range of the recommended treatment dosages-mg/kg.m.

Deratization effect was carried out with white mice and rats. 100% mortality time decrease was observed in white mice. From 12 days the mortality time shortened to 8 days. However, the effect on the rats was different. The mortality time difference between the control and the experiment groups was not essential. This required new correlations between the drug dosages.


11. LAMBLIA (GIARDIA) INTESTINALIS SPECIFIC GSA 65 ANTIGENIN FECAL SAMPLESFROM CHILDREN WITH ASYMPTOMATIC LAMBLIOSISAND ITS DIAGNOSTIC VALUE

I. Angelov, I. Rainova

ABSTRACT
Stool specimens from 90 children were examined using two methods: with lugol’s solution (for Lamblia [Giardia] intestinalis cysts) and ELISA - GSA 65 (for stool lamblia antigen). The specimens tested with lugol’s solution were positive in 22 (24.4%) of the cases, and negative - in 68 (75.6%) cases. However, when the same samples were tested with GSA 65, it confirmed all positive results, and reveled other 10 positive cases in the group of 68 (14.7%) found as negative with the lugol’s solution test. The results obtained illustrate a higher sensitivity and specificity of the ELISA test using monoclonal antibody to detect GSA 65.


12. EMERGING ANTIBIOTIC RESISTANCE AND THE THERAPY OF URINARY TRACT INFECTIONS

E. Keuleyan, T. Anakieva, Sh. Tete

ABSTRACT
The aim
of this work was: 1) to survey the resistance of most frequent pathogens, 2) to analyze the antibiotic usage and 3.) to evaluate the current antibiotic therapy for urinary tract infections (UTI).

Methods: Study design: A retrospective 3-year analysis (2003-2005) of the etiologic structure of UTI and antimicrobial resistance. Microbiology was performed according to the Manual of Clinical Bacteriology, ASM, 2003; Antimicrobial susceptibility testing was done according to the CLSI. Antibiotic usage was calculated in DDD/100 patient/day (ABC Antibiotic Calc, D. Monnet).

Results: E. coli strains (2193), CoNS (510), K. pneumoniae (417), P. aeruginosa (304), Enterococcus spp (300), Proteus spp (241) and Enterobacter spp (155) represented the most frequent pathogens during the study period. The following rates of resistance to ciprofloxacin and co-trimoxazole (usual agents in the empiric therapy for UTI) were registered in 2005: 22% and 27% in E. coli, 27% and 31% in K. pneumoniae, 5% and 28% in Proteus spp and 20% and 40% in Enterobacter spp respectively. ESBL-producing strains of Enterobacteriaceae emerged and accounted for 2003, 2004 and 2005 for 2%, 3% and 6% of E. coli, while for 15%, 20% and 17% of K. pneumoniae. Poly-resistant P. aeruginosa strains exhibited resistance to the most useful antibiotics: amikacin (from 41% to 50%), ceftazidime (38% to 53%), ciprofloxacin (28%-58%), carbapenems (3% to 10%). During the last 5 years ceftriaxone, recommended by the national UTI guidelines, was used widely for complicated UTI; cephalosporins of 3rd generation accounted for 33% of this hospital cephalosporins usage (13- to 17.4 DDD/100 patient/day) and total antibiotic consumption was 45.9-, 42.8- and 46.2 DDD/100 patient/day for the last 3 years.

Conclusions: A re-evaluation of cephalosporins of 3rd generation use is needed, because of the rapid emergence and dissemination of ESBL-producing Enterobacteriaceae strains. The problem of poly-resistant P. aeuginosa requires special and corrmlex attention (therapeutic and Infection control).


13. CHANGES IN THE VIRAL HEPATITIS B (VHB) MORBIDITY 1987-2006

I. Baltadzhiev, J. Stoilova, N. Popivanova, H. Bazelova

ABSTRACT
Hepatitis-B virus is one of the more important human pathogens responsible for an enormity of chronic diseases worldwide. Availability of an effective and safe vaccine for VHB prevention is of considerable help for decrease morbidity/mortality of the disease. Aim of the study was to evaluate the number of VHB patients in different age groups, as well as the dynamics of the morbidity of VHB in Plovdiv-city and suburbs for 1987-2006.

For better compare the results the investigation time was divided into 4 periods of five years each: pre-immunization (1987-1991), intermediate (1992-1996), early post-immunization (1997-2001) and late post-immunization (2002-2006). There are evidences of substantial decrease in the overall HBV-morbidity from the first toward the last monitoring period (1534 patients vs. 578 patients). Particular HBV-morbidity decrease in the age groups up to 1 year (2.41% vs. 0.86%), to 3 years (4.88% vs. 1.55%) and to 7 years (10.36% vs. 0.69%) was marked. It is clear that when people receive HBV-vaccine, the burden of disease decreases significantly over time.


 

Editor-in-Chief
Prof. B. Petrunov, MD, DSc

Production Manager
Theodor Koshev

Editorial Board
Prof. H. Taskov, MD, DSc
Prof. P. Nenkov, MD, DSc
Assoc. Prof. R. Kurdova, MD, PhD
Assoc. Prof. R. Kotzeva, MD, PhD
Assoc. Prof. N. Gatcheva, MD, PhD
Assoc. Prof. T. Kantardjiev, MD, PhD

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