Background:Serum amyloid A (SAA) protein is a major acute phase protein. Increased concentrations have been reported in many inflammatory diseases. In bacterial infections, high levels correlate with those of C-reactive protein (CRP). In viral infections, where CRP changes are weaker, SAA is of value for establishing early diagnosis, monitoring the severity, and the evolution of the disease.Objective:Evaluation of SAA as a marker for diagnosis of infectious mononucleosis, including severe forms.Material and methods:A total of 31 patients with non-complicated and severe, complicated infectious mononucleosis were examined. SAA and CRP were measured by immuniturbidimetric assays at the day of admission and 4.97 ± 1.35 days later.Results:SAA increases significantly than those in a control group, without correlation with the etiologic agent. It decreases when full recovery appears. In the subgroup of subjects with complications, we observed significant increased SAA when Epstein-Barr virus /EBV/ was the etiologic agent, in the course of bacterial and viral secondary infection. SAA is higher than CRP in non-complicated group. In cases of bacterial superinfections, both increase simultaneously and treatment have to be adapted. Second, serum sample for CRP is normal in patients without full recovery where SAA stay increased.Conclusion:In viral infections, high SAA concentrations are indicative for early diagnosis, severe course of the diseases, effect of the treatment, early recovery, and disease outcome. When SAA and CRP increase simultaneously, bacterial co-infection is suspected, and relevant antibiotic treatments have to be initiated.

Несмотря на существенный прогресс в тех-нологиях и инновациях в XXI в., инфекционный гастроэнтерит продолжает оставаться основной причиной заболеваемости и смертности в мире. Ежегодно глобально регистрируются 2,7 млрд случаев диареи [1], из них 1,7 млн заканчиваются летально [2]. Основная группа риска -дети до 5 лет, у которых кишечные инфекции являются при-чиной смерти в 9% случаев, занимая второе место после пневмонии [3]. По данным Всемирной орга-низации здравоохранения (ВОЗ), каждый день от диареи умирают 2195 детей -смертность, много-кратно превышающая таковую от СПИДа, маля-рии и кори вместе взятых в соответственной воз-растной группе [4].Этиологический спектр острых кишечных инфекций включает вирусы, бактерии и пара-зиты. Различные исследования указывают, что вирусные агенты представляют ведущую при-чину диареи среди населения развитых стран, вызывая заболевания лёгкой степени тяжести со значительно более низкой летальностью [5]. Бак-терии и паразиты как возбудители доминируют в развивающихся странах и нередко являются

INTRODUCTION: Acute phase response represents an increase in hepatic production of the so-called acute phase proteins (APP). Until now, C-reactive protein (CRP) has routinely been measured as an indication of bacterial infections. Serum amyloid A (SAA) is a novel marker. It is a more conservative protein for viral etiology of the disease. We analyzed the dynamic changes of SAA and CRP during influenza infection and evaluated the role of SAA as a significant marker for viral infections. MATERIALS AND METHODS: We studied 31 patients with clinically suspected and serologically proved influenza, hospitalized in the Department of Infectious Diseases at St. Marina University Hospital, Varna. Serum levels of SAA and CRP were measured on admission and 4.23±1.03 days later by immunoturbidimetric assays, adapted on Olympus AU 400. RESULTS: The mean serum concentrations of SAA during the acute stage were 168.92 mg/L and those of CRP were 48.08 mg/L. In the group of bacterial complications, such as bronchitis, sinusitis and otitis media, the SAA levels were 5-to 9-fold greater than CRP. Analyses of the second measurement showed a tendency of serum SAA to disappear more quickly than CRP-52.11 mg/L vs. 16.71 mg/L. CONCLUSION: SAA is more sensitive APP than CRP in viral infection settings. In cases of bacterial superinfections, serum SAA is more predominant than CRP, indicating the necessity of an antibiotic therapy. Prompt downgrading of SAA in sera correlates with auspicious prognosis could be used as an effective treatment monitoring.

Hemolytic uremic syndrome is a form of thrombotic microangiopathy which takes its clinical course by a triad of symptoms: microangiopathic hemolytic anemia, thrombocytopenia and acute renal failure. We review a considerable amount of literature about the mentioned problem.

INTRODUCTION AND AIM:The objective of this study is to determine the structure of the outpatient parasitology tests and the epidemiological significance of the resultant morbidity for intestinal and non-intestinal parasitic diseases in the Varna region, Northeastern Bulgaria.