BackgroundIn Poland, gonorrhoea has been a mandatorily reported infection since 1948, however, the reported incidences are likely underestimated. No antimicrobial resistance (AMR) data for Neisseria gonorrhoeae has been internationally reported in nearly four decades, and data concerning genetic characteristics of N. gonorrhoeae are totally lacking. The aims of this study were to investigate the AMR to previously and currently recommended gonorrhoea treatment options, the main genetic resistance determinant (penA) for extended-spectrum cephalosporins (ESCs), and genotypic distribution of N. gonorrhoeae isolates in Poland in 2010-2012.MethodsN. gonorrhoeae isolates cultured in 2010 (n = 28), 2011 (n = 92) and 2012 (n = 108) in Warsaw and Bialystok, Poland, were examined using antimicrobial susceptibility testing (Etest), pyrosequencing of penA and N. gonorrhoeae multi-antigen sequence typing (NG-MAST).ResultsThe proportions of N. gonorrhoeae isolates showing resistance were as follows: ciprofloxacin 61%, tetracycline 43%, penicillin G 22%, and azithromycin 8.8%. No isolates resistant to ceftriaxone, cefixime or spectinomycin were found. However, the proportion of isolates with an ESC MIC = 0.125 mg/L, i.e. at the resistance breakpoint, increased significantly from none in 2010 to 9.3% and 19% in 2012 for ceftriaxone and cefixime, respectively. Furthermore, 3.1% of the isolates showed multidrug resistance, i.e., resistance to ciprofloxacin, penicillin G, azithromycin, and decreased susceptibility to cefixime (MIC = 0.125 mg/L). Seventy-six isolates (33%) possessed a penA mosaic allele and 14 isolates (6.1%) contained an A501V/T alteration in penicillin-binding protein 2. NG-MAST ST1407 (n = 58, 25% of isolates) was the most prevalent ST, which significantly increased from 2010 (n = 0) to 2012 (n = 46; 43%).ConclusionsIn Poland, the diversified gonococcal population displayed a high resistance to most antimicrobials internationally previously recommended for gonorrhoea treatment and decreasing susceptibility to the currently recommended ESCs. The decreasing susceptibility to ESCs was mostly due to the introduction of the internationally spread multidrug-resistant NG-MAST ST1407 in 2011. It is essential to promptly revise the gonorrhoea treatment guidelines, improve the gonorrhoea laboratory diagnostics, and implement quality assured surveillance of gonococcal AMR (ideally also treatment failures) in Poland.

The incidence of pemphigus group in Podlaskie Province was within the range of the average incidence rates reported from other European countries. Surprisingly, the female to male ratio was the highest in Europe. Moreover, for the first time we have demonstrated that the incidence was higher in the population living in rural than in urban areas. Similar studies in other regions of Poland are needed.

Przegląd Dermatologiczny 2014/4 304 StreSzczenie Wprowadzenie. Mianem zespołu Stewarta-Trevesa (ang. Stewart-Treves syndrome -STS) określa się rzadkiego i agresywnego naczyniakomięsaka powstałego na tle przewlekłego obrzęku limfatycznego, rozwijającego się najczęściej po całkowitej mastektomii z limfadenektomią z powodu raka piersi. W piśmiennictwie opisano dotychczas około 400 przypadków STS. Rokowanie jest niekorzystne, a odsetek 5-letnich przeżyć nie przekracza 10%. Zalecaną metodą leczenia jest całkowita amputacja kończyny. Cel pracy. Przedstawienie przypadku STS o niekorzystnym przebiegu, który pojawił się w obrębie lewej kończyny górnej 12 lat po mastektomii. Opis przypadku. Pacjentka 65-letnia została przyjęta do Kliniki z powodu zmian skórnych o charakterze zlewnych krwotocznych plam i pęcherzy oraz sinofioletowych guzków zlokalizowanych w obrębie lewej kończyny górnej, od 6 miesięcy stopniowo powiększających się, z towarzyszącym nasilonym obrzękiem limfatycznym. Pacjentka przed 12 laty przebyła lewostronną mastektomię z usunięciem węzłów chłonnych pachowych z powodu raka piersi. Od tego czasu stale utrzymywał się zastój limfy w obrębie przedramienia i ramienia lewego. Na podstawie obrazu klinicznego oraz badania histopatologicznego rozpoznano STS. Ze względu na późne stadium nowotworu pacjentka została wykluczona z leczenia operacyjnego i zmarła miesiąc po postawieniu diagnozy. Wnioski. Z powodu agresywnego przebiegu STS oraz jak dotąd niesatysfakcjonujących metod leczenia nieodzowna jest profilaktyka obrzęku chłonnego w celu poprawienia rokowania u pacjentek z rakiem piersi. AbStrActIntroduction. Chronic lymphedema, mainly due to total mastectomy with axillary lymph nodes dissection for breast cancer, can induce development of rare and highly malignant cutaneous angiosarcoma. This condition is called Stewart-Treves syndrome (STS). There are only about 400 cases of STS reported in the literature. The long-term prognosis is poor; 5-year survival is up to 10%. Limb amputation appears to be the treatment of choice.

Przegląd Dermatologiczny 2015/3 StreSzczenieWprowadzenie. Niezdiagnozowana i nieleczona kiła w ciąży może skutkować powikłaniami, takimi jak poronienie, wewnątrzmaciczne obumarcie płodu, mała masa urodzeniowa noworodka oraz urodzenie dziecka z objawami kiły wrodzonej. Cel pracy. Przedstawienie dylematów diagnostycznych i terapeutycznych związanych z dodatnimi odczynami serologicznymi w kierunku kiły w ciąży. Opis przypadków. Przedstawiamy dwa przypadki pacjentek w ciąży hospitalizowanych w Klinice Dermatologii i Wenerologii w Białym-stoku, skierowanych z powodu dodatnich wyników odczynów serologicznych w kierunku kiły stwierdzonych podczas wizyty prenatalnej. Na podstawie wywiadu, badania przedmiotowego i analizy odczynów serologicznych u pierwszej pacjentki rozpoznano kiłę utajoną wczesną, u drugiej brano pod uwagę odczyny biologicznie mylne. Obie pacjentki otrzymały leczenie penicyliną prokainową. Wnioski. Badania przesiewowe w czasie ciąży jako stały element opieki prenatalnej oraz wdrożenie leczenia penicyliną stanowią najważniejsze czynniki eliminujące powikłania związane z prenatalnym zakażeniem krętkiem bladym. Istotne jest również zaadaptowanie współczesnych zaleceń europejskich dotyczących diagnostyki i leczenia kiły do polskich warunków. AbStrActIntroduction. Undiagnosed and untreated syphilis in pregnancy may result in subsequent complications: early fetal loss, stillbirth, low birth weight of infants and newborns with congenital syphilis. Objective. To analyze diagnostic and therapeutic dilemmas of positive results of serological tests for syphilis (STS) in pregnancy. Case reports. We present two cases of pregnant women, hospitalized in our department due to positive results of serological tests for syphilis, performed during the antenatal visit. On the basis of patients' history, physical examination and STS results, early latent syphilis was diagnosed in the first patient; biological false positive reactions were considered in the second one. Both patients received procaine penicillin treatment. Conclusions. Screening for syphilis in pregnancy as a part of antenatal care and appropriate treatment with penicillin are the most effective Problemy diagnostyczne i terapeutyczne związane z dodatnimi odczynami serologicznymi w kierunku kiły w ciąży -opis dwóch przypadków

Methods Between June 2010 and 2012, self-collected (SVS) and clinician-collected vaginal (CVS) swabs were obtained from 79 young reproductive age women attending the Prerana Reproductive Health Clinic in Mysore, India. The study was explained to each participant and a brochure illustrating how to collect vaginal swabs was handed to them. The Gram-stained smears and saline wet mounts prepared from the SVS and CVS were examined by a trained microbiologist and the clinician. Vaginal pH was recorded for each swab. Kappa coefficient was used to quantify agreement between the two sets of results. Results When compared with the CVS, the ability of the selfobtained Gram stain to diagnose bacterial vaginosis had a sensitivity of 100%, specificity of 98%, positive predictive value of 100% and negative predictive value of 100%. Only one pair was discordant in the results where the SVS showed the BV status as negative while the CVS found it to be intermediate stage BV. There was substantial agreement (kappa = 0.97) between the two collection methods in the ability to determine the grade of vaginal flora. Conclusion As compared with clinician collected vaginal smears, self-collected smears have substantial agreement in the diagnosis of bacterial vaginosis. With adequate education and instructions using simple visual illustrations, it is possible to have women sample and self collect vaginal swabs for diagnosis of lower genital tract infections. Background STD control efforts in the US and western Europe have had less than desirable impact, in part due to an inability to reach populations of men at risk for these diseases. We are currently conducting a study of programme options, including self-collection of specimens and community based access to test kits, that would increase men's utilisation of screening services. Methods Using peer-incentivized referral, a type of snowball sampling, beginning with men attending an STD clinic in the US, we are interviewing men in the community to determine the optimal combination of programme features that would encourage asymptomatic STD screening. To demonstrate the relevance of these men's opinions in terms of reaching a high prevalence group, they were tested for STDs at the time of their interview. Urine samples were collected and rectal sampling was offered to all men. STD testing was performed using nucleic acid amplification testing. Results To date, 25 men from the community have been enrolled and interviewed. 40% of participants were black, 40% were white, and 20% were Hispanic. The median age of participants is 24. Urine samples were available for testing from all 25 men and rectal samples were available from 5 men. 4 (16%) men tested positive for a STD: 2 (8%) men tested positive for chlamydia and 2 (8%) men tested positive for trichomonas. No gonococcal infections were detected. None of the rectal samples had a positive result. Conclusion While these results represent pilot data, the study is ongoing and given the nature of snowball sampling, the sample size will expand rapid...