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Introduction: SARS-CoV-2 infection is spreading around the world, including countries from Southeastern Europe. The purpose of the study was to present the clinical manifestations of COVID-19 patients admitted to the Military Medical Academy, Sofia, Bulgaria. Materials and Methods: A retrospective study was conducted for a period of 3 months from March 2020 to June 2020 on this infection in our hospital. All participants were laboratory confirmed cases of COVID-19. RT-PCR was performed for etiological diagnosis. The hospitalized patients were divided into two groups on admission, that is, nonsevere and severe. Results: One hundred thirty-eight COVID-19 patients were hospitalized and analyzed during the study period. The mean age was 52.9 years. Male was the dominant sex (sex ratio: male/female = 1/0.6). The leading clinical signs were fever, fatigue, cough, and headache. On comparative analysis of both groups (nonsevere and severe) was measured significant elevation of white blood cells (odds ratio [OR] = 1.238; p value = 0.006), C-reactive protein (OR = 1.021; p < 0.001), creatinine (OR = 1.037; p < 0.001), aspartate aminotransferase (OR = 1.014; p = 0.040), lactate dehydrogenase (OR = 1.004; p < 0.001), ferritin (OR = 1.002; p < 0.001), fibrinogen (OR = 2.028; p < 0.001), and d-dimer (OR = 2.162; p = 0.002) in severe group than in nonsevere group. Interleukin 6 was tested in 17.4% of patients and high value was found-38.6 pg/mL (95% confidence interval: 16.5-60.7). Conclusion: The first Bulgarian retrospective study of COVID-19 hospitalized patients was presented. Older age, male sex, comorbidity, and signs of dyspnea and nausea were estimated as higher risk factors for severe form. Abnormality in inflammatory markers was associated with poor progression of the illness.
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COVID-19/diagnóstico , COVID-19/epidemiología , Hospitalización/estadística & datos numéricos , Adulto , Anciano , Bulgaria/epidemiología , Prueba de Ácido Nucleico para COVID-19 , Comorbilidad , Disnea/etiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Náusea/etiología , Estudios Retrospectivos , Factores de Riesgo , SARS-CoV-2/aislamiento & purificaciónRESUMEN
BACKGROUND: Over the past two decades, more thorough investigations for hepatitis E virus (HEV) infection have been done in the world. Reports from Southeast European countries have increased. AIM: The current article presents a critical analysis of all studies for HEV in Bulgaria. MATERIAL AND METHODS: A literature search was done using available medical databases. We analysed the literature in PubMed databases and Bulgarian medical databases for English and Bulgarian languages sources. Preference was given to the sources published within the past 24 years (January 1995 - September 2018). RESULTS: Two thousand two hundred and fifty-seven blood serums were tested for the analysed period (1995 - 2018), and 13.1% of them were positive for acute HEV (Mean ± SD: 20.38 ± 25.77%; 95% CI: 1.29 - 39.47%). The following subtypes were established in the country - HEV Subtype 3e, HEV Subtype 3f, HEV Subtype 3c, HEV Subtype 3i, HEV Subtype 3hi and HEV Subtype 1. CONCLUSION: We hope that the National Health Organizations will take adequate and timely measures to increase the knowledge and research for HEV among Bulgarian citizens.
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BACKGROUND: Fever of unknown origin (FUO) is a perplexing medical problem. The causes for FUO are more than 200 diseases. The aim of the study was to present human clinical cases of Coxiella burnetii infection debuting as FUO. METHODS: The following methods were conducted in the study: literature search, laboratory, imaging, and statistical methods. Criteria of Durack and Street were applied for FUO definition. For the etiological diagnosis indirect immunoenzyme assay (ELISA) for antibodies detection against Coxiella burnetii was used (cut-off = 0.481-0.519). RESULTS: From 2008 until 2015, nine patients with FUO caused by C. burnetii were hospitalized at the Military Medical Academy of Sofia. Male gender was predominant (male/female - 77.8% /22.2%), mean age was 48.78±14.52 years (range: 26-67), hospital stay was 9.78±2.95 days (range: 5-15), fever duration was 54.33±56.23 days (range: 21-180). Laboratory investigations estimated the elevation of erythrocyte sedimentation rate 49.11±31.74mm/h (95%CI = 13.09-111.31), C-reactive protein 37.68±37.62mg/L (95% CI = 36.07-111.42) and fibrinogen 5.69±1.59g/L (95% CI=2.57-8.81). The mean values of liver enzymes were in reference range. Among imaging tests, abdominal ultrasound and X-ray demonstrated 33.3% contribution to the final diagnosis. Transthoracic echocardiography found 22.2% contribution. Serological methods presented 100% contribution. CONCLUSION: C. burnetii infection was accepted as a final diagnosis among 9 patients with FUO based on the integrated information from the applied methods. Active search and establishment of this pathogen among FUO should lead to avoiding potential complications and consequences in case of untreated patients infected with C. burnetii.
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A case of a 66-year-old man with West Nile neuroinvassive disease manifested with fever, weakness, fatigue, consciousness disorders and underlying diabetes mellitus type 2 and cardiovascular diseases is presented. Laboratory data showed elevated erythrocyte sedimentation rate and fibrinogen. Serological tests revealed West Nile virus specific antibodies of class IgM and IgG in serum. West Nile virus RNA was detected in urine sample. Supportive therapy was applied.
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Monitoreo Epidemiológico , Enfermedades del Sistema Nervioso/epidemiología , Enfermedades del Sistema Nervioso/fisiopatología , Enfermedades del Sistema Nervioso/terapia , Fiebre del Nilo Occidental/fisiopatología , Fiebre del Nilo Occidental/terapia , Anciano , Bulgaria/epidemiología , Humanos , Masculino , Resultado del Tratamiento , Fiebre del Nilo Occidental/epidemiologíaRESUMEN
BACKGROUND: The patient's immune response is one of the major factors influencing HBV eradication or chronification, and it is thought to be responsible for the treatment success. AIM: Our study aimed to investigate whether cellular defense mechanisms are associated with the course of HBV infection (spontaneous recovery [SR] or chronification [CHB]) and with the therapeutic approach. PATIENTS AND METHODS: A total of 139 patients (118 with CHB, 21 SR) and 29 healthy individuals (HI) were immunophenotyped by flowcytometry. Fifty-six patients were treatment-naïve, 20 were treated with interferons and 42 with nucleoside/ nucleotide analogues. RESULTS: Deficiency of T lymphocytes, helper-inducer (CD3+CD4+), suppressorcytotoxic (CD8+CD3+) and cytotoxic (CD8+CD11b-, CD8+CD28+) subsets, activated T cells (CD3+HLA-DR+, CD8+CD38+) and increased CD57+CD8- cells, elevated percentages of B lymphocytes and NKT cells were observed in CHB patients compared with HI. In SR patients, elevated CD8+CD11b+, NKT and activated T cells were found in comparison with controls. The higher values of T cells and their subsets in SR patients than in CHB patients reflect a recovery of cellular immunity in resolved HBV infection individuals. In both groups of treated patients, reduced T lymphocytes, CD3+CD4+ and CD8+CD38+ subsets were found in comparison with HI. Higher proportions of cytotoxic subsets were observed in treated patients compared with treatment-naïve CHB patients, more pronounced in the group with interferon therapy. CONCLUSION: Our data demonstrate that cellular immune profiles may be of prognostic value in predicting the clinical course of HBV infection, and the determination of the therapeutic response.
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Subgrupos de Linfocitos B/inmunología , Hepatitis B Crónica/inmunología , Subgrupos de Linfocitos T/inmunología , Enfermedad Aguda , Adolescente , Adulto , Anciano , Antivirales/uso terapéutico , Estudios de Casos y Controles , Progresión de la Enfermedad , Femenino , Citometría de Flujo , Hepatitis B/inmunología , Hepatitis B Crónica/tratamiento farmacológico , Humanos , Inmunofenotipificación , Interferón-alfa/uso terapéutico , Masculino , Persona de Mediana Edad , Células T Asesinas Naturales/inmunología , Polietilenglicoles/uso terapéutico , Proteínas Recombinantes/uso terapéutico , Remisión Espontánea , Linfocitos T Citotóxicos/inmunología , Linfocitos T Colaboradores-Inductores/inmunología , Resultado del Tratamiento , Adulto JovenRESUMEN
INTRODUCTION: Hepatitis E is one of the leading clinical manifestations of acute viral hepatitis in developing countries. In industrialized countries, during the past several years, sporadic "autochthonous" cases of HEV infection have been increased. OBJECTIVE: The aim of this study was to analyze the epidemiological, clinical and laboratory features of HEV infection among patients hospitalized at the Department of Infectious Diseases in Military Medical Academy, Sofia, Bulgaria. METHODS: A retrospective study of 806 cases of acute viral hepatitis was performed at the Department of Infectious Diseases in Military Medical Academy, Sofia, Bulgaria, between December 2004 and September 2012.The etiological diagnosis was established by ELISA. The statistical analysis was performed using Excel 2007 (Microsoft, Redmond, Washington, USA) and SPSS Statistics 19.0 (IBM Corp., Armonk, NewYork, USA). RESULTS: Specific reaction to anti-HEV-IgM and anti-HEV-IgG antibodies were detected in 20 (2.48%) of 806 patients. The most observed clinical presentations were jaundice (85%), fatigue (85%), anorexia (65%), abdominal discomfort (55%) and fever (40%). The mean values of aspartate transaminase and alanine transaminase were 521 IU/l and 881 IU/l, respectively. The cholestasis was slight, marked with mean values of gamma-glutamyl transferase and alkaline phosphatase, respectively 418 IU/I and 486 IU/I. CONCLUSION: We report twenty autochthonous sporadic cases of acute infection with HEV. The zoonotic etiology of the virus as well as the foodborne transmission of the infection is discussed. We found that aging and pre-existing underlying diseases are risk factors for a severe course of the HEV infection.