TABLE OF CONTENT

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1. ESBL-PRODUCING ENTEROBACTERIACAE - AN INCREASING PROBLEM AMONG PATIENTS WITH BACTEREMIA

E. Keuleyan, S. Tete, M. Valentinova, R. Markovska, T. Anakieva, I. Schneider, A. Bauernfeind

ABSTRACT
Emergence and spread of extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae present a challenge in antibiotic treatment of patients with bloodstream infections. The aim of this work was to analyze the incidence of ESBL-producing Enterobacteriaceae among patients with bacteremia 2003-2009 in a teaching multi-profile hospital and to evaluate the appropriateness of antibiotic therapy through antibiotic audits. Surveillance has shown that Еscherichia coli strains occupy one of first 3 top positions in bacteremia: in 2003, 1 of 8 strains produced ESBL, while in 2008 25 % of 24 Е. coli produced ESBL. In 2008 the relative rate of ESBL among Klebsiella pneumoniae reached 50 % of 12 cases, and 22 % of all 53 Enterobacteriaceae isolates. Enzymes of nine ESBL-producing strains isolated in 2003 showed pI of 8.2 and 8.4, gave positive PCR with SHV- and CTX-M specific primers and after sequencing were identified as SHV-12 and CTX-M-3 respectively. The audit of prescribed antibiotic therapy revealed that ~ 50 % of patients have received an appropriate therapy.
Rigorous measures should be undertaken in antibiotic policy (a limitation in use of (groups) of antibiotics, new guidelines for therapy (empiric therapy of sepsis), as well as in the control of infections, in order to contain the problem and improve the therapy.


2. ANTIMICROBIAL ACTIVITY OF TOBRAMYCIN AGAINST RESPIRATORY CYSTIC FIBROSIS ISOLATES OF PSEUDOMONAS AERUGINOSA

T. Strateva

ABSTRACT
Tobramycin solution for inhalation (TSI) is indicated for the management of cystic fibrosis (CF) patients aged six years and older colonized with Pseudomonas aeruginosa. It is not recommended as an alternative to intravenous antibiotics for the treatment of acute exacerbations of pulmonary disease. Inhaled administration of tobramycin assures high concentrations in CF lungs, improving the therapeutic ratio over that of parenteral tobramycin levels, particularly against P. aeruginosa. Conventional Clinical and Laboratory Standards Institute (CLSI) breakpoints only consider parenteral levels and do not take into account these high antimicrobial concentrations. Therefore, the Spanish Antibiogram Committee (The MENSURA Group) has defined specific breakpoint values for inhaled tobramycin when testing P. aeruginosa isolates from CF patients (susceptible, ≤64 μg/ml; and resistant, ≥128 μg/ml). In this study the antimicrobial activity of tobramycin against 40 respiratory CF P. aeruginosa isolates, prospectively collected from 25 patients, was determined by high range Etest strips (LIOFILCHEM, Italy). The MIC at which 50% of isolates were inhibited (MIC50) and MIC90 were 0.75 and 3 μg/ml, respectively. Applying MENSURA proposed breakpoints, 95% of the strains were categorized as susceptible to tobramycin. With CLSI breakpoints, susceptibility rate decreased to 92.5%. The tobramycin activity against non-mucoid P. aeruginosa was higher than that against mucoid isolates (MIC50=0.75 and MIC90=2 μg/ml vs. MIC50=1 and MIC90=4 μg/ml). Moreover, the isolates obtained from patients untreated with TSI were more susceptible to the drug than those from patients received a maintenance therapy with TSI (MIC50=0.75, MIC90=1.5 μg/ml and MIC50=1.5, MIC90=6 μg/ml, respectively). Duration of colonization with P. aeruginosa did not influence the tobramycin antimicrobial activity against the tested respiratory isolates. In conclusion, tobramycin revealed an excellent in vitro activity against the studied CF isolates. The antimicrobial activity was dependent on the isolate morphotype and pre-administration of TSI. Whenever TSI is considered for therapy, the CF P. aeruginosa strains categorized as intermediate or resistant to tobramycin according to the CLSI criteria should be recategorized by using the MENSURA interpretive criteria.


3. PROSTHETIC VALVE ENDOCARDITIS CAUSED BY CANDIDA RUGOSA

T. Kantardjiev

ABSTRACT
Here we described the first case in world practice of prosthetic valve endocarditis caused by Candida rugosa. Due to blocked prosthetic valve, operation required valve replacement. From the valve, a huge amount of Candida rugosa was isolated and etiological treatment was conducted. Nine months later, the valve was again affected and replaced and new C. rugosa strain was isolated.


4. SEROPREVALENCE OF POLIOVIRUS ANTIBODY IN BOURGAS REGION, BULGARIA

K. Parmakova, N. Korsun, M. Kojouharova, D. Georgieva, Z. Mladenova, A. Kurchatova

ABSTRACT
The last three cases of poliomyelitis in Bulgaria occurred in 2001 after 9-years period of zero-reported cases as a result of wild poliovirus importation from Indian subcontinent. In 1959 oral polio vaccine (OPV) was introduced for routine use for all eligible infants and children. In 2007, OPV was replaced by trivalent inactivated polio vaccine (IPV). The overall vaccination coverage using administrative method sustains regularly high - 94.24% (86.08-98.17). In order to estimate the herd immunity against polioviruses on a district level 250 hospitalized patients were tested for antibody presence for polioviruses types 1, 2 and 3 using microneutralization assays. The overall antibody prevalence for polioviruses types 1, 2 and 3 was 90.00%, 93.60% and 80.4% respectively. Increasing of antibody prevalence for all three types polioviruses by age was detected which revealed the necessity of national seroprevalence study for identifying seroprevalence of poliovirus antibody in population, immunization gaps and unprotected groups as well.


5. UPON SOME EPIDEMIOLOGICAL CLINICAL AND LABORATORY CHARACTERISTICS OF THE OUTBREAK OF MEASLES IN THE REGION OF PLOVDIV, FEBRUARY- JUNE 2010

Petrov A., Vatev N., Stoycheva M., Boev I., Venchev C

ABSTRACT
Introduction:
Measles as a highly infectious disease that can result in serious complications returned in Bulgaria. Launched in 2009 a major outbreak covered the majority of the population in the Roma districts of Plovdiv and the region. The reasons for this vary from high-risk populations unimmunized for cultural or religious beliefs to low knowledge of the means of transmission and severity of measles. Objectivity required accepting the fact that infectious diseases and responsibility of them challenge the health system to increase the immunization – coverage up to 95%.

Material and methods: During February and July, incl. 2121 cases of measles were registered and 1969 of them were hospitalized in the University Clinic of Infectious Diseases, town of Plovdiv. Laboratory tests were conducted on the standard methodology; virus and serological parameters were investigated in Regional Public Health Institute. The data were statistically processed with SPSS 14 analysis system, using parametric methods in Gaussian distribution and nonparametric when needed. As a significant difference interval was accepted p <0.05, guaranteeing 95% confidence.

Results and discussion: The highest incidence of measles was reported during April and May, 34.3% of hospitalized patients. Mainly medium – heavy forms of disease were observed. 65% of treated were children between 1 to 18 years. Measles complicated with pneumonia was found in 504 patients – 25.6%. Pronounced respiratory failure and need of oxygen therapy had 59 fellows. Antibiotics received all complicated cases. X – Ray control was achieved in 74.3 % of lung – affected. We observed complications of the nervous system in 7 patients, aged 8 months to 52 years. Measles, complicated with meningitis – two cases, viral encephalitis – 4 and one 8 years old boy with meningomyelitis.

Conclusion: Outbreak of measles in Plovdiv and the region in 2010 once again put reasonable challenges of organizational, financial, legal and social - legal aspect to epidemiologists and infectious diseases in particular and the healthcare system in the country as a whole. The neurological complications were rare – in analyzing study 0.36% with benign ending.


6. SUBCONJUNCTIVAL DIROFILARIASIS CASUED BY D. REPENS: A CASE REPORT

I. Angelov

ABSTRACT
Dirofilariasis caused by D. repens is a natural-focal zoonosis. Dogs are the main dead-end host and reservoir of the parasite, and mosquitoes of the Aedes, Anopheles и Culex families are vectors. Humans are non-specific, accidental host and not a source of infection. Canine dirofilariasis is found in the southern and eastern parts of Europe. Isolated cases of human dirofilariasis in Bulgaria have been reported during the last decades. We report a case of subconjunctival localization of dirofilariasis. A lithe helminth of cylindrical shape, 14 cm in length was extracted from the subconjunctival space. The histological examination of the helminth revealed a cuticle with longitudinal ridges with transverse striations. The size of the parasite, the typical localization and the morphology of the tegument made us assume that the case described was one of ophthalmic dirofilariasis caused by D. repens.


7. LIGHT MICROSCOPY DISTINCTIVE MORPHOLOGICAL FEATURES OF THE VACUOLE FORM OF BLASTO-CYSTIS HOMINIS

I. Angelov

ABSTRACT
Light microscopy of fresh stool samples most often helps detect the vacuolar form of Blastocystis hominis, which is at the basis of diagnosing blastocystosis. Computer processing and analysis were used to carry out a detailed study on 150 vacuolar forms in samples of 50 randomly selected patients. The morphological differences were assessed base on internal structure, the shape and size of the parasite cell, the number and location of nuclei, and the presence of other structures detectable by light microscopy. The morphological features found could be considered as species characteristics of B. hominis, applicable in differentiating it from other intestinal protozoa in human stool samples.


8. ANALYSIS AND EVALUATION OF SOMATIC ANTIGEN PRECIPITATED WITH 40% SATURATED AMMONIUM SULFATE FROM TOXOPLASMA GONDII

S. Zdravkova, I. Rainova, N. Tsvetkova

ABSTRACT
The aim of the present study was Toxoplasma somatic antigen, precipitated with ammonium sulphate (40 % saturation) and analyzed by dot-ELISA-IgG, ELISA-IgG and WB. In dot-ELISA and ELISA sensitivity and specificity were determined to be 96 % and 98 % in the first method and 100 % in second one, respectively. In WB obtained results showed a very complex antigen profile. Antigen yielded in WB several bands with molecular masses between 23-103 kDa. High recognized antibodies were from bands with MM 87, 50, 48, 44 and 35 kDa in IgG-WB and 35 kDa in IgM/IgA-WB.


 

Editor-in-Chief
Prof. T. Kantardjiev, MD, DSc

Editorial Board
Acad. B. Petrunov, MD, DSc
Prof. H. Taskov, MD, DSc
Prof. M. Kojuharova, MD, PhD
Prof. R. Kurdova, MD, PhD
Assoc. Prof. I. Christova, MD, DSc
Assoc. Prof. I. Rainova, MD, PhD
Assoc. Prof. P. Teoharov, MD, PhD

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