TABLE OF CONTENT

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1. MODERN METHODS IN THE RAPID DIAGNOSIS OF CHOLERA

V. Tolchkov, D. Galeva, R. Nenova, M. Marina

ABSTRACT
Cholera is an epidemic life threatening disease caused by Vibrio cholerae. Outbreaks of infections appear periodically in developing countries with a potential health risk for Bulgarian population as a result of the increasing number of refugees from the Middle East and Africa in the last 2 years. The fast diagnosis is critical for its proper treatment. is The introduction of modern molecular methods is very important for the detection of the causative agent on a strain and a toxinotype level. They are based on polymerase chain reaction and allow the medical professionals to get results in 2 to 3 h. This article considers the problems of the cholera, its causative agent – Vibrio cholerae, the epidemiology and modern diagnostics.


2. IMMUNE RESPONSE AND CRYPTOCOCCAL INFECTIONS

E. Hristozova, I. Haydoushka, M. Murdjeva

ABSTRACT
Cryptococci are universally spread and are commonly isolated from both patients and asymptomatic carriers. The evolution of cryptococcal infection is determined, on one hand, by the immune competence of the individual and the cellular immune response in particular and on the other hand, by the pathogen load and the virulence of the isolate.
Infections with Cryptococcus have been on the rise over the last 25 years as a results of the HIV pandemic, the expanding use of immune-suppressive drugs and the increased life expectancy of patients with hematologic malignancies. Cryptococcosis is diagnosed in 5-12% of the HIV patients and in 1-26% of the transplant recipients. Infection is acquired mostly via contaminated skin or by inhalation of conidia from sexually reproducing strains of C. neoformans. Cryptococcosis may affect any human organ; however it demonstrates specific lung and CNS tropism. Over the last years, the number of causative agents has expanded involving new infectious species as C. albidus, C. laurentii, C. curvatus, C. humicola and C. unniguttulatus.


3. GENETIC METHODS IN THE DETECTION OF ANAEROBIC MICROFLORA FROM SUBGINGIVAL DENTAL BIOFILM

V. Tolchkov, M. Marina, T. Bolyarova

ABSTRACT
Porphyromonas gingivalis is one of the relatively specific pathogens in cases with chronic periodontitis. This bacterium possesses the highest number of virulent properties such as the ability to suppress the migration of the polymorphonuclear leucocytes and to counteract their phagocytosis with the help of incapsulation. Its most aggressive property is observed on cell cultures – the ability to invade epithelial cells which results in an ability to be included in the formation of the atheromatous plaque – a highly risk factor for the development of sclerosis. Isolation and cultivation of P. gingivalis requests special expensive equipment and they are time and labor consuming but very important for proper diagnosis and treatment. In this study we optimized PCR protocol for the detection of P. ginigivalis in tooth and atheromatous plaques.


4. CLINICAL FORMS OF HEPATITIS A IN DIFFERENT AGE GROUPS – ANALYSIS FOR A TWO-YEAR PERIOD, 2011-2012

M. Pishmisheva, N. Vatev, M. Stoycheva

ABSTRACT
Introduction:
Hepatitis A is a fecal-oral transmitted disease demonstrating great differences in its epidemiology among countries with varying social and economic development as well as among the social groups within a single country. The disease is a topical health issue for Bulgaria as the morbidity in the country is the highest in the Europe Union. The clinical course of Hepatitis A varies from asymptomatic to fulminant forms and that depends on a number of factors, age being one of them. The objective of the study is to compare the specifics of the clinical course of Hepatitis A in different age groups.

Materials and methods: From 01.01.2011 to 31.12.2012, 325 patients with confirmed acute hepatitis A were treated at the Infectious Diseases Ward of the Multi-profile Hospital of Active Treatment – Pazarzhik. Serologically the disease was confirmed with the presence of anti HAV IgM in the patients’ serums (ELISA). The used methods included clinical observation, paraclinical tests, instrumental testing and epidemiologic surveillance.

Results: From 325 patients treated in the ward, 202 (62.15%) were children up to the age of 18 and the remaining 123 (37.85%) were adults. The largest number of the diseased were children, aged 3-7 years – 104 (32%) and the smallest – patients, elderly than 60 years – 6 (1.8%). A rise in morbidity was observed in the older age groups. Among 202 children treated in the ward, 140 (69.3%) were of Roma origin. In contrast, among the adults, from 123 patients with acute Hepatitis A, only 10 (8.2%) were Romani, while the rest 113 (91.8%) lived in neighbourhoods with good hygienic conditions.

Clinical manifestations (symptoms and signs): Astheno-adynamia among the children was observed more rarely – in 84 (41.6%) cases, while among the adults the number was 104 (84.5%) cases. The average increase of the total bilirubin among the children was much lower than that among the adults. The results obtained were identical in relation to the cytological enzymes (ALT and AST). Among all patients ultrasound examination of the abdominal organs was performed which demonstrated more pathological findings among the adults compared to the children. The average hospital stay among children was 5.2 days and for the adults it was 7.9 days.

Conclusions: Among the children the lighter forms prevailed and the stay in hospital was shorter. The adults have expressed clinical symptoms; the disease most often progressed as an icteric form and compared to the children the subjective complaints, paraclinical abnormalities, the average hospital stay and the convalescence period were more prolonged. Acute viral hepatitis A remains a health problem in Bulgaria. The Roma population gets the disease primarily during their childhood years while the other ethnic groups get sick in their adult years.


5. RELATION BETWEEN HEPATITIS B SURFACE ANTIGEN KINETIC AND VIRAL REPLICATION IN PATIENTS WITH RESOLVED HEPATITIS B VIRUS INFECTION

E. Golkocheva-Markova, I. Alexieva, P. Teoharova

ABSTRACT
Serum hepatitis B surface antigen (HBsAg) is a reliable marker in the diagnosis of hepatitis B virus infection. HBsAg levels reflect the transcriptional activity of the virus at the same time and are considered a surrogate marker of infected cells. The relationship between the presence of HBV DNA and HBsAg kinetics in sera of inactive carrier was analyzed in the present study; patient with treated HBV mono-infection; and patient with self-limited HBV mono-infection. The sera levels of HBsAg were measured by ELISA and HBV DNA concentration – by real time PCR. The HBsAg kinetics was modeled and correlation between these two parameters was evaluated in order to determine the importance of HBsAg kinetic as a marker for HBV infection clearance.


6. GASTROENTERAL OUTBREAK OF MIxED VIRUSES IN SAMOKOV, BULGARIA AUGUST-OCTOBER 2013

K. Parmakova, Z. Mladenova, G. Donkov, A. Stoyanova, V. Yoncheva, M. Kojouharova

ABSTRACT
Acute gastroenteritis (AGE) is a notifiable disease in Bulgaria in accordance with the national legislation. Annual CDs analyses of Sofia region show that for the last 7 years the incidence of acute gastroenteritis rises from 105.02 per 100 000 in 2006 to 193.94 per 100 000 in 2012 but the proportion of affected children less than 5 years old decreases from 68.5% in 2006 to 52.92% in 2012. Most of the cases are from Roma minorities living in the region which comprise 7.4% of all local population. The seasonality of the disease is from May to October and only people with severe illness are reported as cases of AGE based on their hospital admission to infectious wards.
The outbreak analysis was done by using data of conducted epidemiological investigations provided by Regional Health Inspectorate – Sofia region together with the results of laboratory testing performed by the National Reference Laboratory of Enteroviruses.
An outbreak of mixed viral gastroenteritis caused by norovirus genogroup II, enterovirus and rotavirus group A occurred in Samokov, Bulgaria affecting local Roma community between 1st of August and 16th of October 2013. Sixty-six per cent of the cases (56) were children < 5 years. The conducted outbreak investigation revealed that the most probable route of infection is a person-to-person transmission in the living area with poor hygiene conditions and an existence of illegal landfill sites.


7. SOIL – TRANSMITTED HELMINTH INFECTIONS IN BULGARIA: A RETROSPECTIVE STUDY OF SOME EPIDEMIOLOGICAL FEATURES

R. Harizanov, I. Rainova, I. Kaftandjiev, D. Jordanova, I. Marinova

ABSTRACT
Soil transmitted helminth infections are widespread throughout the world and represent a significant problem for the public health care in many countries. There are two parasitic diseases with local distribution in Bulgaria - ascariasis and trichuriasis (trichocephaliasis) but favorable climatic conditions for local distribution of ancylostomiasis and necatoriasis exist as well. We did a retrospective study of the prevalence of ascariasis and trichuriasis in Bulgaria for a 23 years period and compared our data to those collected in 1952-1954 when the first systematic studies on the subject were carried out.

Annual analyses of parasitic diseases in the country were used. The prevalent proportions for ascariasis and trichuriasis were calculated by year, by 5 - year periods, and also the average prevalence for the whole period 1990 – 2011.

The geographic and climatic conditions are favorable for the distribution and transmission of STH in 14 out of 28 districts in Bulgaria. Our study found out that a total of 17 020 persons (children and adults) with ascariasis and 3695 with trichuriasis were recorded for a period of 23 years (1990-2012). The average annual number of cases of ascariasis for the period was 740, and for trichuriasis - 161.

The prevalence of ascariasis and trichuriasis among Bulgarian population is low but some cases are registered annually in the country and their social and health significance can not be ignored as well as the need for measures of their surveillance, control and health education of the population.


8. ACTIVITY OF NITROFURANTOIN AGAINST UROPATHOGENIC ENTEROCOCCI

V. Popova, K. Ivanov, M. Sredkova, H. Hitkova, V Popov

ABSTRACT
Nitrofurantoin is an oral broad-spectrum antimicrobial agent recommended for treatment of urinary tract infections (UTIs). The drug is not used in the clinical practice in Bulgaria and local data are not available. The aim of the study was to assess activities of nitrofurantoin and compare commonly used antimicrobials against uropathogenic isolates of enterococci. A total of 88 non-duplicate enetrococcal strains, isolated from urine of patients hospitalized in University Hospital Pleven, Bulgaria during 2012, were investigated. Identification of enterococci to the species level was based on series of conventional physiological tests. Susceptibility to antimicrobial agents was determined by using the disc diffusion method according to the recommendations of Clinical Laboratory Standards Institute (CLSI). Nitrofurantoin demonstrated higher activity (88.64%) against uropathogenic isolates of enterococci, compared to ciprofloxacin and ampicillin (34.09 and 67.05%), respectively. It was more active against Enterococcus faecalis (100%) than against E. faecium (67.74%). Nitrofurantoin retained its activity against 60% of multidrug-resistant E. faecium strains with concomitant resistance to ciprofloxacin and ampicillin. Based on its superior activity we recommend this cheap antimicrobial agent for treatment and prevention of lower UTI.


 

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

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

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