Several relatively recently published studies have shown changes in plasma metabolites in various viral diseases such as Zika, Dengue, RSV or SARS-CoV-1. The aim of this study was to analyze the metabolome profile of patients during acute COVID-19 approximately one month after the acute infection and to compare these results with healthy (SARS-CoV-2-negative) controls. The metabolome analysis was performed by NMR spectroscopy from the peripheral blood of patients and controls. The blood samples were collected on 3 different occasions (at admission, during hospitalization and on control visit after discharge from the hospital). When comparing sample groups (based on the date of acquisition) to controls, there is an indicative shift in metabolomics features based on the time passed after the first sample was taken towards controls. Based on the random forest algorithm, there is a strong discriminatory predictive value between controls and different sample groups (AUC equals 1 for controls versus samples taken at admission, Mathew correlation coefficient equals 1). Significant metabolomic changes persist in patients more than a month after acute SARS-CoV-2 infection. The random forest algorithm shows very strong discrimination (almost ideal) when comparing metabolite levels of patients in two various stages of disease and during the recovery period compared to SARS-CoV-2-negative controls.

SummaryAlveolar echinococcosis (AE), caused by proliferating metacestodes of the parasitic fox tapeworm Echinococcus multilocularis, is a life-threatening disease in humans. In this study we report four human cases of AE in Slovak Republic with regard to various clinical manifestations and susceptibility to chemotherapy with albendazole or mebendazole. Patients were monitored serologically by ELISA test and Western Blots within 2 -5 years after initiation of chemotherapy/surgery. Using computerized tomography (CT) we compared morphological changes of the parasitic lesions in the liver during the course of treatment. The parasitic lesions in the CT were manifested as nodular hyperplasia with hyper or hypodense zones and calcified foci within the lesion. In other cases the lesion was visualised as a hypodense poorly-delineated septated focus without calcifications. In the last case, the diagnosis of AE was confirmed only at surgery. Calcified foci found inside the main parasitic lesions were the only abnormality that was detected in two cases and were absent in other two cases. The levels of specific anti-parasitic antibodies followed the pathomorphological changes in the livers. Total IgG levels to Em2+ and EmP antigen declined gradually during the follow-up (1 -5 years) and disappeared only in the patient receiving radical surgery (cured). In comparison with total IgG, concentration of the IgG4 antibody subclass seemed to correlate more adequately with the outcome of therapy as their levels decreased in improved/stabilised patients, but were elevated in "aggravated" patients. We showed that, in patients with AE in Slovakia, radical surgery of parasitic foci proved to be the most successful treatment and, in inoperable cases, albendazole and mebendazole were differently effective. Moreover, IgG4 levels rather than total IgG to protoscoleces antigens proved to be more sensitive serological marker of the progress of therapy.

: The HIV/acquired immunodeficiency syndrome (AIDS) pandemic has affected the health status of the population in many countries. Early symptomatic HIV infection includes persistent generalized lymphadenopathy (PGL), which can be associated with opportunistic infections, e.g., toxoplasmosis and Cytomegalovirus (CMV) infection. This study followed the occurrence of PGL, toxoplasmosis, and Cytomegalovirus infection in 32 HIV-positive patients and analyzed the clinical signs of disease in relation to the number of CD4 T lymphocytes. In monitored patients, the average number of CD4 T lymphocytes was 940.8 ± 396.7/µL of blood. Severe immunodeficiency was recorded in four persons, who also suffered from colitis and/or retinitis and pneumonitis. The number of CD4 T cells in patients with PGL was significantly lower than that in patients without lymphadenopathy. In 6 (18.8%) IgM and 11 (34.4%) IgG Toxoplasma gondii seropositive patients, the number of CD4 T lymphocytes was significantly lower than that in seronegative patients. The presence of IgM and IgG antibodies to Cytomegalovirus was recorded in all examined patients, and CMV infection clinically manifested in five persons. The occurrence of PGL, the higher viral load, and seropositivity to T. gondii were significantly related to decline in the CD4 T lymphocyte number. The clinical course of the diseases was influenced by the status of the patient’s immunodeficiency and suggests ongoing immunosuppression and possible reactivation of both infections in all patients.

SummaryWe report the case of a 4-year-old boy suffering from a cerebral form of toxocariasis. High serum titres of antiToxocara antibodies indicated that the primary infection was induced by a high number of Toxocara eggs and that the larvae did not penetrate to cerebrospinal fluid due to the hematoencephalic barrier. MRI of the patient´s brain showed multiple focal lesions spread diffusely in almost all parts of the brain, predominantly paraventricularly. These might be eosinophil-rich granulomatous infiltrates enclosing larvae. Extensive morphological changes were the cause of serious neurological symptoms, most of them being reversible after follow-up therapy. Radiology proved to be useful diagnostic method, but the specific serological assessment had a key role for the final diagnosis. In conclusion, diagnosis of this patient was intracranial primary Toxocara infection with central quadruparesis and parainfective myocarditis.

SummaryAlveolar and cystic echinococcosis, serious parasitic diseases caused by larval stages of Echinococcus multilocularis and E. granulosus has been diagnosed in Slovakia for a long time. Study presents case of 49-years old patient with accidentally diagnosed one big (60 mm) and multiple small (2 -24 mm) hypoechogenic structures localised in right liver lobe. According to positive serology to E. granulosus antigen and results of imaging examinations the patient was classifi ed as possible case of cystic echinococcosis and treated with mebendazole. Later, due to the worsening of clinical, laboratory and CT fi ndings surgical biopsy was performed and surgical biopsy and subsequent PCR examination of liver tissue confi rmed the diagnosis of alveolar echinococosis. Clinical picture of disease imitating cystic echinococcosis in presented case report, together with results of serological tests confi rmed importance of accurate differential diagnosis of echinococcosis. Each aspect of clinical and laboratory results should be considered responsibly, however, sometimes only molecular techniques can solve the problem of differential diagnosis.