Infections of the 21st century (Zakażenia XXI wieku)

Issue 1, 2018

Mukormykoza – obraz kliniczny, diagnozowanie i leczenie

Mucormycosis – clinical manifestations, diagnosis and management

Maria J. Stefaniak

Zakażenia XXI wieku. 2018;1(1):1–9.

Mucormycosis is an uncommon but life-threatening, fungal infection caused by Mucorales spp. After aspergillosis and candidiasis, mucormycosis is the third most common cause of invasive fungal infections in patients with hematological malignancies and in transplant recipients. The incidence of mucormycosis appears to be increasing. The fungi of Mucorales spp. preferentially invade the endothelial cells. Intravascular thrombosis, tissue infarctions, and necrosis are hallmark features of mucormycosis. Based on the affected site, mucormycosis can be classified as one of 6 forms: rhino-orbito-cerebral, pulmonary, gastrointestinal, cutaneous, disseminated, and uncommon. The clinical and radiological manifestations of mucormycosis are unspecific. Thus, it is difficult to differentiate mucormycosis from aspergillosis, and these two diseases need different treatments. Amphotericin B, posaconazole, and isavuconazole are the only currently available antifungals active against Mucorales spp. We hope that new reliable laboratory tests for early and precise molecular diagnosis of mucormycosis will be widely available in near future. We should have A high index of suspicion for mucormycosis based on appropriate risk stratification in selected patients is important for early implementation of effective therapy and to improve treatment outcomes in patients with this devastating infection. Management of mucormycosis includes antifungal therapy, surgery, and control of underlying conditions. The purpose of this article is to review the epidemiology, risk factors, clinical and radiological features, and diagnostic and treatment recommendations for invasive mucormycosis in patients with hematological malignancies.

Chemoprewencja w nieswoistych chorobach zapalnych jelit

Chemoprevention in Inflammatory bowel diseases

Grażyna Rydzewska

Zakażenia XXI wieku. 2018;1(1):11–15.

Patients with inflammatory bowel disease (IBD) have an increased lifetime risk of developing colorectal cancer (CRC). Independent risk factors for CRC include long disease duration, extensive colonic involvement, young age at onset of IBD, severity of inflammation, primary sclerosing cholangitis, backwash ileitis, and a family history of CRC. Thus, it seems that intestinal inflammation is an underlying mechanism of CRC development in patients with IBD. Different strategies of CRC prevention or at least early detection, have been proposed. Endoscopic surveillance and treatment based on the individual CRC risk are recommended. A treat-to-target strategy is widely discussed in IBD because it can help to better control intestinal inflammation. Treatment with 5-aminosalicylic acid (5-ASA) may reduce mucosal inflammation and thus the CRC risk in patients with ulcerative c olitis; this reduction is possible because 5-ASA induces specific molecular mechanisms.

Czy program obowiązkowych szczepień ochronnych na rok 2018 zapewnia dostępność szczepionki PCV13 dla wszystkich dzieci z grup ryzyka?

Whether or not mandatory immunization program for 2018 provides access to PCV13 vaccine for all children at risk?

Ewa Bernatowska, Bożena Mikołuć, Małgorzata Pac

Zakażenia XXI wieku. 2018;1(1):17–20.

The Ministry of Health has ensured unlimited access to PCV13 vaccine for at-risk children under the 2018 mandatory immunisation programme. The availability of the vaccine will be guaranteed and the fact that a child belongs to a risk group will no longer have to be proven to Sanitary and Epidemiological Stations. At present, the rate of non-vaccinated children is too high. In the referenced publications, many authors emphasize that a child’s disease is not a contraindication for vaccination. On the contrary, PCV13 should be administered as soon as possible to such a child in order to protect them from pneumococcal infection. Children may be safely and effectively vaccinated in 3+1 scheme, or with 2 doses at age 2-5. Even if the response to vaccine is unsatisfactory, it should be remembered that immunological memory cells post PCV13 vaccination will be able to produce antibodies in a short time. PCV13, due to its increased immunogenicity, induces a reduction in carriage and it additionally limits the risk of infection in a vaccinated child and others. Currently, according to the vaccination schedule, access to PCV13 is guaranteed only to preterm infants born before pregnancy week 27. All preterm infants born before pregnancy week 37 are at the highest risk of pneumococcal infections. Recent genetic studies demonstrated that defective innate immunity results not only in the failure to inhibit inflammation, but also in increased susceptibility to bacterial infections. In such a situation the whole population of children born before pregnancy week 37 should be vaccinated with PCV13.

Zakłucia u personelu medycznego
– jak zminimalizować ryzyko zakażeń przenoszonych drogą krwi

Health care workers injuries – how to minimize the risk
of bloodborne infections

Anna Różańska

Zakażenia XXI wieku. 2018;1(1):21–25.

Health professionals are a group of individuals particularly at risk of exposure to harmful biological agents in their work environment. There is a high risk of exposure to blood-borne pathogens during procedures involving the disruption of skin integrity – both surgeries and routine procedures of blood collection, introduction of venous catheters or injections. According to official registers, about 5% of medical employees annually face this kind of exposure. Data from the questionnaire surveys reported however a range from 40 to 80%. As a result, preventing such events in the health care sector requires from the managers implementation of all available measures to limit the risk of sharp injuries and to provide access to various types of sharp tools with security mechanisms against injury.

Laktoferyna w profilaktyce i leczeniu zakażeń

Lactoferrin in prophylaxis and treatment of infections

Jolanta Artym, Michał Zimecki

Zakażenia XXI wieku. 2018;1(1):27–34.

Widespread occurrence of bacterial and fungal strains resistant to classic chemotherapeutics, poses an aggravating problem for the human population. Therefore, search for new substances, usually of natural origin, like plant extracts or milk-derived compounds, potentially efficient in prophylaxis and therapy, is an important challenge for pharmacy and medicinal chemistry. Such preparations usually show a broad spectrum of antimicrobial and immunomodulatory activity, and pathological microorganisms do not develop resistance to these agents. In addition, they do not exhibit side effects and may be used in monotherapy as well as an adjuvant to traditional antibiotic therapies. A good example of such a substance may be milk-derived lactoferrin. Lactoferrin is a protein with pleiotropic functions in the mammalian organism. It represents an important component of the immune system by protecting the host organism against infection, inflammation, allergy, autoimmune and neoplastic diseases. The protein is active towards all types of microorganisms such as bacteria, fungi, protozoa and viruses. It inhibits growth or kills these microorganisms directly or by activating other components of the immune system. Its action is bidirectional: pro-inflammatory by efficient combat of acute infection, and anti-inflammatory by protection against sustained inflammatory states and their complications. It also appears that its peptic fragments are equally or even more efficient than the native protein. Lactoferrin fulfills its preventive and therapeutic function when applied orally. It is present in fresh and pasteurized milk and, as a preparation isolated from bovine milk, is available in the market as a diet supplement.

Znaczenie dezynfekcji wstępnej wyrobów medycznych dla procesu dekontaminacji

The significance of initial disinfection of medical devices
for the process of decontamination

Elżbieta Kutrowska

Zakażenia XXI wieku. 2018;1(1):35–40.

Initial disinfection is an important stage of decontamination because it reduces the number of microorganisms on contaminated products and improves the safety of work environment of the personnel. At the same time, it prevents the multiplication of microorganisms on the tools and the creation of biofilms. During the initial disinfection, the impurities get wet, which improves the effectiveness of cleaning.

Analiza korzyści użytkowania kaniul obwodowych naczyń żylnych z mechanizmem zapobiegającym wypływowi krwi – Doniesienia wstępne

The analysis of profits from usage of peripheral venous vessel cannulas with a valve preventing from blood flow – preliminary information

Mirosława Dzikowska, Katarzyna Wojtas, Maria Kózka, Maria Budnik-Szymoniuk

Zakażenia XXI wieku. 2018;1(1):41–45.

Introduction. Cannulation of peripheral venous vessels has a wide application in the diagnostics and treatment of patients both at home and in hospital settings. The procedure of introducing a cannula as well as leaving it in a vessel is endangered with a high risk of infection of a patient and also the staff, mainly nurses. The costs of cannulation of venous vessels include the price of a cannula and indispensable medical products. Taking all those aspects into consideration, it seems essential to choose such a cannula which would be safe in use and economical. Aim of the study. The analysis of benefitsof theuse of peripheral venous cannulas of Introcan Safety 3 type. Material and methods. A comparative analysis was used to compare two types of cannulas: Introcan Safety 3 with a multi-access septum preventing from blood leakage, and cannulas without such a septum. Both kinds were used for cannulation of peripheral veins in patients treated at J. Dietl Specialized Hospital in Cracow in the years 2015–2017. Results. The analysis proves higher purchase costs of cannulas of Introcan Safety 3 type and lower costs connected with the use of medical products during cannulations. Conclusions. An essential benefit of the use of Introcan Safety 3 cannulas with a septum preventing from blood exposure is reduced contact with blood-derived pathogens.

Czystość mikrobiologiczna rękawic przed użyciem

Microbiological cleanliness of the gloves before use

Katarzyna Majda, Sławomir Gondek

Zakażenia XXI wieku. 2018;1(1):47–49.

Cross-infection prevention is extremely imprortant for patient safety, health care quality improvement and also for economic reasons associated with treatment complications and extended length of hospital stay. The Infection rate correlates closely with the type of procedures. Hospital cross-infection prevention procedures involve hand hygiene and proper use of gloves [1]. It turns out that in many cases non-sterile exam gloves delivered to hospital are already contaminated with bacteria e.g. Bacillus, Micrococcus or Staphylococcus. This type of contamination should be considered when choosing gloves for patients with an impaired immune system.

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