TABLE OF CONTENT

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1. BRUCELLOSIS - AN UNKNOWN AND UNDERDIAGNOSED INFECTION IN BULGARIA

R. Nenova, I. Tomova

ABSTRACT
Brucellosis is still the most common zoonosis worldwide. Despite this, it is unknown and underdiagnosed infection in non-endemic areas. For some  parts of the world it became a re-emerging infection. After several decades brucellosis re-emerged in Bulgaria. In 2005 an outbreak of imported human  cases was detected and soon after, two autochthonous outbreaks occurred (2006 and 2015) with a total of 161 persons diagnosed.


2. INFECTION AND COMPLICATIONS AFTER DERMATOLOGICAL SURGERY

V. Kantardjiev

ABSTRACT
The purpose of this article is to present the possible complications occurring as a result of dermatological surgical interventions performed on patients of different age with existing formations of benign and malignant nature. Bleeding during surgical intervention can be due to blood factor disorders, some drugs or foods and connected with specific localisations. When the localisation of the skin formation is located near nerves and salivary glands, it is possible to affect them while using a deeper cut. In addition, some side effects are due to medical products used during the surgical intervention. Allergic reactions to the materials used for closure of the surgical wound are rare complications. Contact dermatitis that results from adhesive bandage use is common. Infection of the surgical wound poses a serious risk for the patients. Patients at high risk of wound infection should receive antibiotics. Patients must be informed of all possible risks and educated in the early recognition and reporting of adverse events.


3. GIARDIA DUODENALIS: THE MOST COMMON ENTERIC PROTOZOAN ORGANISM IN THE WORLD

A. Ivanova

ABSTRACT
Giardia duodenalis (syn. Giardia intestinalis, Giardia lamblia) is the most common enteric protozoan organism in the world. The organism is considered to be an important causative agent of waterborne, and rarely, foodborne infectious outbreaks of gastroenteritis. The parasite can infect not only humans but many other different species of mammals, birds, and reptiles. The life cycle of G.duodenalis includes two distinct morphological forms-infectious cyst and trophozoite (proliferating form). The transmission of the parasite is supported by both zoonotic and anthroponotic cycle. G.duodenalis is considered to be a complex of species that show small morphological differences between themselves but have remarkable genetic diversity. This species is divided into eight different genetic assemblages (A to H) but only the representatives of assemblages A and B infect humans.


4. RAPID MOLECULAR DIAGNOSIS OF PNEUMOCOCCAL BACTERAEMIA IN MINIMAL BLOOD SAMPLE VOLUME

V. Levterova, I. Simeonovski, H. Shivachev, V. Isaev, P. Perenovska, М. Dimova, М. Malcheva, Т. Kantardjiev

ABSTRACT
In patients with bacteraemia the concentration of pathogens in the blood is extremely low. Currently in Bulgaria, the diagnosis of invasive pneumococcal diseases is based on culture methods. They are time-consuming and have low sensitivity, especially when performed after antibiotic treatment. Molecular methods are highly sensitive and are not affected by antibiotics in the first 1-2 days as they do not require viable bacteria. In this study, 140 children between 6 months and 17 years of age were tested for the presence of pneumococcal DNA in the blood. For this purpose, we used realtime PCR targeting the LytA gene. Out of 140 children with fever up to 40°C, pneumonia, pleural empyema, pulmonary abscess, hydrothorax, and other diagnoses (sepsis, otitis media, tonsillitis, rhinitis), Streptococcus pneumoniae was detected in 22. In conclusion, realtime PCR is sensitive, specific, and can be used in routine diagnosis alongside standard culture methods.


5. SEROPREVALENCE OF TICK-BORNE ENCEPHALITIS VIRUS IN DOMESTIC ANIMALS IN BULGARIA

E. Panayotova, I. Christova, S. Chakarova, E. Taseva, I. Trifonova, T. Gladnishka

ABSTRACT
Serum samples from 732 cattle, 130 sheep, and 88 goats from all districts of Bulgaria were examined by ELISA method for IgG specific antibodies against Tick-borne encephalitis virus (TBEV). The seroprevalence rate was low - 0.42% (varying 0%-6.67% in different districts), which is in accordance with the seroprevalence rates among the healthy population of the country. Antibodies were found in Pernik, where most of the recent cases were reported, and Razgrad (with no history of TBE cases) districts. Additional 7 animal sera exhibited borderline reactions in the ELISA. These animals originated from west and northeast regions of the country. This study reflects the current seroprevalence rates of TBEV among domestic animals in Bulgaria.


6. CHARACTERISTICS OF CURRENT BACTERIAL NEUROINFECTIONS IN PLOVDIV REGION, 2013-2015

P. Argirova, I. Boev, I. Baltadzhiev, Ch. Venchev, M. Murdzheva, M. Stoycheva

ABSTRACT
Introduction: Bacterial meningitis and meningoencephalitis are severe diseases, with frequent complications, residual neurologic damages and still high mortality rate.
The purpose of this work is to examine etiological structure of contemporary bacterial neuroinfections, age characteristics of the patients, clinical, therapeutic approaches and outcomes with the purpose of an early diagnosis, and appropriate treatment.

Materials and methods: The study included 66 patients with bacterial neuroinfections (meningitis – 31, meningoencephalitis - 35) hospitalised at the Clinic of Infectious Diseases, University Hospital "St. George" Plovdiv, from 01.01.2013 to 31.12.2015 year. Methods of clinical and epidemiological analysis, hematological, biochemical, microbiological, and PCR tests and cranial imaging were used.

Results: The etiological structure is verified in 55% of the patients: Streptococcus pneumoniae - 14 (21%), Listeria monocytogenes - 7 (11%), Staphylococcus aureus - 6 (9%), Neisseria meningitidis - 4 (6%), Mycobacterium tuberculosis - 3 (5%), other Streptococcus spp. - 2 (3%). The incidence of the diseases is highest in children under 1 year. 50% of the patients had comorbidities. The main clinical symptoms of neuroinfection were: fever - 82%, vomiting - 72%, headache - 69% and hyperaesthesia - 25%; symptoms of meningo-radicular irritation in 90%, disturbances of consciousness - 57%. In 15% of the patients meningo-radicular syndrome is incomplete. The most common CSF constellation was: cell 1000.106/l (71%); protein up to 3 g/l (47%); glucose at a rate (58%). The most common initial antibiotic combination was: vancomycin, ceftriaxon or cefotaxim and amikacin. Outcomes: 62.1 % of the patients were cured; 18.2% had residual neurologic damages (motor and cognitive). The mortality rate in our patients was 19.7 %, especially high in L. monocytogenes meningitis - 71%.

Conclusions: The proportion of etiological unspecified bacterial neuroinfections remains unacceptably high, which requires optimizing the diagnostic process. The high frequency and lethality of L. monocytogenes meningitis require to optimize the starting empirical antibacterial therapy.


7. CHEMOTHERAPY OF HUMAN HYDATIDOSIS

G. Popovа, D. Vuchev

ABSTRACT
Human hydatidosis is a parasitic disease caused by the larval stage of Еchinococcus granulosus. It represents cysts which can be localized in all tissues and organs, most frequently in liver and lungs. Their development leads to extensive organ damages and human disability. Thаt determines the health significance аnd social importance of the disease and the need for effective radical treatment. Surgery was believed to be the only treatment of this parasitosis for a long time. Since introduction in clinical practice of chemotherapy with benzimidazoles and percutaneous treatment the therapeutic options have expanded. Conservative chemotherapy of hydatidosis with benzimidazole derivatives is an alternative to surgery in inoperable cases, recurrent disease, multiple hydatid cysts or multiple organ affection. Benzimidazoles are administered pre- and postoperatively or accompanying percutaneous treatment as chemoprophylaxis too, to prevent recurrences and secondary echinococcosis. From this drug group albendazole is the drug with a better pharmacokinetic profile compare to mebendazole that achieve better therapeutic results. Nevertheless it was observed that in 20-30% of the cases hydatid cysts do not respond to therapy with albendazole. In order to find alternative treatment options the search and study of other medications which to contribute to more rapid and effective conservative therapy of hydatidosis are continuing.


8. POINT PREVALENCE OF INTESTINAL PARASITES IN HOSPITALISED AND OUTPATIENTS WITH DIARRHOEA

K. Stoyanova, T. Cvetkova

ABSTRACT
Intestinal parasitic infections are generally presumed to affect children in low- and middle-income countries but recent reports expose their role as an actual and undermined problem in industrialized countries and in adult population.

The aim of this study is to evaluate the point prevalence of IP and other pathogens in patients with diarrhoea and other GI symptomsand to compare their distributionamong hospitalized and ambulatory treated children and adults.

Materials and Methods: The study includes 360 patients in 3 equivalentgroups: hospitalized and ambulatory patients with acute diarrhoea and a control group of patients tested on prophylactic basis.All samples were submitted for morphological identification of IPand viral and bacterial pathogens.

Results and discussion:104 (28,9%)of the samples were positive for intestinal pathogens – intestinal parasites diagnosed in 21,7% cases, enteric viruses in 9,2% and pathogenic bacteria in 2,5%. In hospitalized children, younger than 1 year,the Rotavirus was established as a major cause.In children, older than 1 year the highest point prevalence have the intestinal protozoans - G. duodenalis (6,22%), Blastocystis spp.(6,0%) and Cryptosporidiumspp. (2,0%) in similar rates in all of the investigated groups. The only identified intestinal helminth was E.vermicularis with highest prevalence of 10.0% in asymptomatic children.
The study demonstrates that the IP’s spectrum and prevalence in hospitalized individuals is significant and at least as high as in the all other groups. Therefore testing for IP should be included in the mandatory diagnostic panel of patients with acute intestinal diseases subject for hospitalisation.


 

Editor-in-Chief
Prof. Todor Kantardjiev, MD, PhD, DSc– NCIPD, Sofia, Bulgaria

Editorial Board:
Prof. Iva Christova, MD, DSc – NCIPD, Sofia, Bulgaria
Richard Anthony, PhD – RIVM, The Netherlands
Dale Barnard, PhD – Utah State University, USA
Roger Hewson, PhD – WHO Collaborating Centre for Virus Research & Reference, Porton Down, UK
Judith M. Hübschen – Luxembourg Institute of Health, Luxembourg
Emad Mohareb, PhD– U.S. Naval Medical Research Unit No.3, Egypt
Bruno Gottstein – Institute of Parasitology, University of Berne, Switzerland
Anton Andonov, PhD – Public Health agency, Canada
Anna Papa-Konidari, PhD- Aristotle University, Thessaloniki, Greece
Anna Erdei, DSc - Eötvös L. University, Budapest, Hungary
Lanfranco Fattorini – Instituto Superiore di Sanita, Italy
Hannes Stocklinger, PhD – Medical University, Vienna, Austria
Acad. Bogdan Petrunov, MD, DSc – NCIPD, Sofia, Bulgaria
Assoc. Prof. Iskra Rainova, MD, PhD – NCIPD, Sofia, Bulgaria
Assoc. Prof. Lubomira Nikolaeva-Glomb, MD, PhD – NCIPD, Sofia, Bulgaria

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