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  • Author: V. Velev x
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Human dirofilariasis in Bulgaria between 2009 and 2018


Autochthonous Dirofilaria repens infections have been found in dogs and other carnivores in most European countries. In the same countries, reports of human dirofilariasis are becoming increasingly prevalent. We present 18 cases of people infected with D. repens for a 10-year period traced in our hospital. The data was collected from the observations and tests of all 18 patients from the whole country treated at the Specialized Hospital for Infectious and Parasitic Diseases in Sofia in the period 2009 – 2018. We used a morphological method, serology test and Knott’s method for microfilariae. The patients were 11 to 74 years of age, 12 female and 6 male. In most cases, patients have subcutaneous nodules or face, eyelid and eyes localization. The trend of increasing incidence in Bulgaria continues, with age and sex distribution and localization of the larva being similar to those in other European countries.

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Cost-Minimization Analysis of Non-Invasive and Invasive Mechanical Ventilation for De Novo Acute Hypoxemic Respiratory Failure in an Eastern European Setting


Introduction: In the light of constant pressure for minimizing healthcare costs we made a cost-minimization analysis comparing invasive mechanical ventilation (IMV) and non-invasive ventilation (NIV) as treatment for hypoxemic acute respiratory failure (ARF).

Aim: The primary objective was to estimate the direct medical costs generated by a patient on IMV and NIV. A secondary objective was to identify which aspect of the treatment was most expensive.

Material and Methods: This is a single center retrospective study including 36 patients on mechanical ventilation due to hypoxemic ARF, separated in two groups – NIV (n = 18) and IMV (n = 18). We calculated all direct medical costs in Euro and compared them statistically.

Results: On admission the PaO2/FiO2 and SAPS II score were comparable in both groups. We observed a significant difference in the costs per patient for drug treatment (NIV: 616.07; IQR: 236.68, IMV:1456.18; IQR:1741.95, p = 0.005), consumables (NIV: 16.47; IQR: 21.44, IMV: 98.79; IQR: 81.52, p < 0.001) and diagnostic tests (NIV: 351; IQR: 183.88, IMV: 765.69; IQR: 851.43, p < 0.001). We also computed the costs per patient per day and there was a significant difference in the costs in all above listed categories. In both groups the highest costs were for drug treatment – around 61%.

Conclusions: In the setting of hypoxemic ARF NIV reduces significantly the direct medical costs of treatment in comparison to IMV. The decreased costs in NIV are not associated with severity of disease according to the respiratory quotient and SAPS II score.

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Sebaceous Carcinoma – Unexpected Tumor of the Nasal Ala Dorsum


Today, the extraocular variant of sebaceous carcinoma is still being poorly recognized. This type of carcinoma is rarely diagnosed correctly, which, together with its aggressive behavior, contributes to its poor prognosis. We present a case of an 84-year-old man with a history of left nasal ala tumor formation, diagnosed morphologically and immunohistochemically as sebaceous carcinoma.

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Multiplex PCR Assay for Identifi cation and Differentiation of Campylobacter jejuni and Campylobacter coli Isolates


Introduction: Campylobacter spp. are important causative agents of gastrointestinal infections in humans. The most frequently isolated strains of this bacterial genus are Campylobacter jejuni and Campylobacter coli. To date, genetic methods for bacterial identification have not been used in Bulgaria. We optimized the multiplex PSR assay to identify Campylobacter spp. and differentiate C. jejuni from C. coli in clinical isolates. We also compared this method with the routinely used biochemical methods.

Aim: To identify Campylobacter spp. and discriminate C. coli from C. jejuni in clinical isolates using multiplex PCR assay.

Materials and methods: Between February 2014 and January 2015 we studied 93 stool samples taken from patients with diarrheal syndrome and identified 40 species of Campylobacter spp. in them. The clinical material was cultured in microaerophilic atmosphere, the isolated strains being biochemically diff erentiated (hydrolysis of sodium hippurate for C. jejuni, and hydrolysis of indoxyl acetate for C. coli). DNA was isolated from the strains using QiaAmp MiniKit (QIAGEN, Germany). Twenty strains were tested with multiplex PCR for the presence of these genes: cadF, characteristic for Campylobacter spp., hipO for C. jejuni and asp for C. coli.

Results and discussion: The biochemical tests identified 16 strains of C. jejuni, 3 strains of C. coli, and 1 strain of C. upsaliensis. After the multiplex PCR assay the capillary gel electrophoresis confirmed 16 strains of C. jejuni, 2 strains of C. coli and 2 strains of Campylobacter spp. - because of the presence of the gene cadF. C. jejuni has the gene hipO, and it is possible that this gene may not be expressed in the biochemical differentiation yielding a negative reaction as a result. In comparison, we can conclude that the genetic differentiation is a more accurate method than the biochemical tests.

Conclusion: The multiplex PCR assay is a fast, accurate method for identifi cation of Campylobacter spp. which makes it quite necessary in the clinical diagnostic practice.

Open access