The objective of the present study was to analyze the clinical pattern of contemporary Mediterranean spotted fever in children and to compare it with the clinical pattern in adults. The research involved 257 children. The more common symptoms in children were severe onset, fever, rash, "tache noire," swelling of lymph nodes and enlarged liver or spleen.

The present report describes for the first time comparative analysis of epidemiological features, clinical manifestations and laboratory findings of DOBV and PUUV infections in Bulgaria.

AIM: To study the cholestatic forms of viral hepatitis A that are described as unusual and very rare, but that are of great signifi cance because of their severe course and high morbidity rate. MATERIAL AND METHODS: We describe herein 17 cases of hepatitis A virus (HAV) infection with pronounced cholestasis treated in the Clinic of Infectious Diseases at St. George University Hospital between 2002 and 2006. They are taken from a contingent of 820 patients we studied in the course of the research: of these 400 were cases of sporadic disease and 420 patients were involved in an epidemic outbreak of the disease. All got this diagnosis based on an anti-HAV/IgM test. Eight parameters were analyzed: age, max TBil, max ALT, ALP, GGT, no urobilinogen in urine, ultrasound monitoring of hepatomegaly, and hospital stay. RESULTS: The 17 patients we discuss here are 2.07% of the total 820 patients with viral hepatitis A (VHA). In 14 the disease had a cholestatic component; 3 cases were a cholestatic form of the disease. The mean hospital stay was 49.1 ± 11.5 days, the longest - 75 days. The hyperbilirubinemia had high levels at the disease climax - the mean concentration was 356.6 μkmol/l, and remained greater than 150 μkmol/l for more than a month. In 10 patients (58.2%) transaminase activity was over 1400 U/l, (mean 2011 U/l). CONCLUSION: Viral hepatitis A ran with cholestatic syndrome in 2.07%; 23.5% of these cases were classifi ed as severe forms of the disease and 76.5% - as moderate. This is evinced by the enhanced transaminase activity, the elevated TBil, pronounced intoxication, the adynamia, vomiting, headache, the vertigo, all of these items in the objective severity score system we used.

No abstract

Background: Hepatitis A is a social disease and has great importance for public health in countries with high level of incidence rate. The problem is particularly serious for Bulgaria because the morbidity rate in the country is several times higher in comparison with the other countries of the European Union. The aim of the study is to establish the contemporary epidemiological characteristics of viral hepatitis A in Bulgaria. Methods: Analysis of the incidence rate and the age distribution has been done among two groups of the population differentiated depending on their hygienic living conditions: 1 st group-living in bad hygienic conditions; 2 nd group-living in good hygienic conditions. A large epidemic outbreak of hepatitis A with 1004 persons of Roma origin has been described. The comprehensive method for epidemiological research and serological methods for determining the diagnosis have been used. To study the risk factors the methods of case-control and multi-factor logistic regression are used. Results: Nine times higher incidence rate has been established in the 1 st group 450/100,000 in comparison with the 2 nd 50/100,000. The patients from the 1 st group are predominantly children aged 5-9 years and from the 2 nd adults aged 30-39 years. The level of significance of the risk factors for the biggest epidemic outbreak has been established-bad personal hygiene is of the greatest importance. The risk for travellers to countries and regions with high endemicity and during epidemic outbreaks has been shown. Conclusions: There are essential differences in the epidemiology of HAV between the groups with different hygienic living conditions. That is why the analyses of the incidence rate and age distribution of hepatitis A have to be done separately for different population groups. Recommendations for providing differentiated measures for prevention and control of hepatitis A among the two groups are given.