• Nie Znaleziono Wyników

Medycyna Weterynaryjna - Summary Med. Weter. 69 (8), 488-491, 2013

N/A
N/A
Protected

Academic year: 2021

Share "Medycyna Weterynaryjna - Summary Med. Weter. 69 (8), 488-491, 2013"

Copied!
4
0
0

Pełen tekst

(1)

Med. Weter. 2013, 69 (8)

488

Praca oryginalna

Original paper

Meat is indispensable for human nutrition as it

con-tains high biological value proteins, especially

exoge-nous amino acids. Nowadays, with new developments

in food technology (39), the variety of meat products

has increased. The growth of pathogenic bacteria in

meat and meat products is a potential source of risks

for human health. Consumers expect to purchase safe

meat but pathogens such as Salmonella spp., Listeria

monocytogenes and Escherichia coli O157 may cause

serious food safety problems for consumers. The poor

hygiene and sanitation conditions in the process of food

production encourage microbiological contamination,

survival and growth (21).

Salmonella spp., members of the Enterobacteriaceae

family, are Gram-negative, facultative anaerobes and

inhabit the intestinal tract of animals and constitute an

important pathogen for food industry and environment

(12). Beef and chicken are the foremost foods causing

salmonellosis (42). It was reported that Salmonella

infections cause approximately 1.4 million cases of

foodborne illness and more than 500 deaths per year

in the USA (6). In 2010, 99020 salmonellosis cases in

humans were reported in EU countries (15).

L. monocytogenes, which is a Gram positive, rod

shaped and psychrotrophic pathogen that is widely

distributed in the natural environment and in various

animal products, has been recognized as a causative

agent of listeriosis (9). L. monocytogenes can persist

and grow at low and high pH values, at low water

activity and at refrigeration temperatures (28).

Con-tamination with L. monocytogenes may occur during

slaughtering, processing and production processes of

meat and meat products. Immune-compromised adults,

pregnant women and neonates are included in high risk

groups for human listeriosis. In 2010, the number of

human listeriosis cases in EU countries was reported

as 1,601 (15). The illness has various symptoms such as:

fever, malaise, ataxia, endocarditis, endophthalmitis,

septic arthritis, osteomyelitis, peritonitis and in

pre-gnant humans, intrauterine infections, premature births

and abortions (13). Listeria was seldom detected

above the legal safety limit from ready-to-eat foods at

Prevalence of Salmonella spp.,

Listeria monocytogenes and Escherichia coli O157

in meat and meat products consumed in Istanbul*

)

ENVER BARIS BINGOL, EMEK DUMEN*, TOLGA KAHRAMAN,

MERYEM AKHAN*, GHASSAN ISSA**, OZER ERGUN

Department of Food Hygiene and Technology, Faculty of Veterinary Medicine, Istanbul University, Avcilar, 34320, Istanbul, Turkey

*Academic Hygiene KGaA, Training, Audit and Consulting Services, Kuþtepe Mahallesi, Tomurcuk Sokak, Ýzmen Sitesi, Sisli, 34387, Istanbul, Turkey

**Avrupa Vocational School, Culinary Programme, Kazlicesme, 34020, Istanbul, Turkey

Bingol E. B., Dumen E., Kahraman T., Akhan M., Issa G., Ergun O.

Prevalence of Salmonella spp., Listeria monocytogenes and Escherichia coli O157

in meat and meat products consumed in Istanbul

Summary

The present study was conducted to investigate the incidence of Salmonella spp., Listeria monocytogenes

and Escherichia coli O157 in 340 samples of meat and meat products (205 ground beef, 50 raw beef and 85

sausages) collected from producers and retailers in Istanbul. Salmonella spp. and Escherichia coli O157 analyses

were performed acoording to ISO standarts, while Listeria monocytogenes was confirmed according to FDA

methods. Salmonella spp. was detected in 1.18% samples. All samples were negative for L. monocytogenes

and E. coli O157. The results indicate that meat and meat products may be contaminated by pathogens which

can cause serious public health problems. Furthermore, the essential precautions should be undertaken to

ensure improving the quality of production technology.

Keywords: raw meat, meat product, Salmonella spp., Listeria monocytogenes, Escherichia coli O157

*) This work was supported by the Research Fund of the University of Istanbul,

(2)

Med. Weter. 2013, 69 (8)

489

retail, however, high mortality rate of disease (up to

20-30%) still threats the consumers’ health seriously

(13, 15).

E. coli O157:H7 or O157:nonmotile (E. coli O157)

is a neurotoxin producing enterohemorrhagic E. coli.

Typical illness may be life threatening, and

suscep-tible individuals show a range of symptoms including

haemorrhagic colitis and other complications, among

them haemolytic-uraemic syndrome and thrombotic

thrombocytopenic purpura (43). Cattle are natural

reservoirs of the pathogen and consumption of meat

of bovine origin is considered to be the main cause of

several outbreaks (38). A total of 4000 confirmed

verotoxigenic Escherichia coli (VTEC) infections were

reported and this number has been increasing since

2008 in the EU (15).

The present study was undertaken to determine the

presence of Salmonella spp., L. monocytogenes and

E. coli O157 in meat and meat products obtained from

retail markets and producers in Istanbul, Turkey.

Material and methods

Sample Collection. A total of 340 samples of meat and

meat products (205 ground beef, 50 raw beef and 85

sau-sages) were collected from producers and retailers in

Istan-bul. All samples were kept in sterile jars and immediately

transferred to the laboratory in cold boxes at 4°C.

Microbiological analysis. For the isolation of

Salmo-nella spp., pre-enrichment was performed by suspending

25 g of sample in 225 ml buffered peptone water (BPW –

Oxoid CM0509) followed by incubation at 37°C for 16-20 h.

0.1 ml mixture was transferred to Rappaport-Vassiliadis

(RVS – Oxoid CM0866) and 1.0 ml to Muller Kaufmann

Tetrathionate Broth (MKTTn – Oxoid CM0343). MKTTn

at 37°C and RVS broth at 42°C were incubated for 24 h.

After incubation samples were streaked on Hectoen Enteric

Agar (Oxoid CM0419) and XLD Agar (Oxoid CM0469),

incubated for 24 h at 37°C. The typical colonies were

iden-tified by biochemical tests and confirmed with Salmonella

antiserum (O and H-Vi polyvalent antiserum) (30).

For detection of L. monocytogenes, 25 g of food

sam-ples were pummelled with 225 ml of Listeria Enrichment

Broth (Oxoid CM0862), contaning Listeria selective

sup-plement (Oxoid SR 141). Samples were homogenised in

a stomacher bag for 60 sec. and incubated at 32°C for 24 h.

A 0.1 ml portion of the enrichment broth was streaked on

to Chromogenic Listeria Agar (Oxoid CM1080)

supple-mented with Listeria Selective Supplement (Oxoid SR0227)

and Listeria Differential Supplement (Oxoid SR0228). After

incubation typical colonies were transferred to Tryptic

Soy-Yeast Extract Agar (Oxoid CM0131) and incubated for

24-48 h at 30°C. The typical colonies were verified by Gram’s

staining, catalase reaction, tumbling motility at 20-25°C,

Methyl Red-Vogues Proskauer (MR-VP) reactions, CAMP

test, nitrate reduction and fermantation of sugars (27).

For detection of E. coli O157, each sample was carried

out by combining 25 g of each sample with 225 ml of

modified Tryptone Soya Broth with (Oxoid CM0989) into

a stomacher bag, homogenized for at least 2 min and

incubated at 37°C for 24 h. Enriched culture was streaked

on to Sorbitol MacConkey Agar (Oxoid CM0813)

sup-plemented with Cefixime Tellurite Selective Supplement

(Oxoid SR172) which were incubated at 37°C for 18-24 h.

Following the incubation period, the colorless colonies were

tested by E. coli O157 latex kit (Oxoid DR0620) (29).

Results and discussion

Salmonella spp. was detected in 1.18% of the tested

meat and meat products (Tab. 1). The isolated

sero-vars were S. anatum in ground beef and S. reading and

S. meleagridis in sausage samples All samples were

negative for L. monocytogenes and E. coli O157.

According to Turkish Food Codex (47), the presence

of Salmonella spp. and E. coli O157 in 25 g of raw

beef and ground beef, the presence of Salmonella

spp. and L. monocytogenes in 25 g of sausages is not

acceptable.

The prevalence of Salmonella spp. in ground beef

samples tested in this study was lower in comparison

to those detected by Pietzsch&Kawerau (41) in

Germany (45.2%), Al Rajab et al. (2) in Iraq (18.0%),

El-Leithy&Rashad (16) in Egypt (15.0%),

Wolde-mariam et al. (50) in Ethiopia (12.1%) and Baskaya et

al. (4) in Turkey (11.1%). On the other hand, Gokalp

et al. (22) reported the prevalence rate of Salmonella

spp. was 2.0% in 48 ground beef samples. Other

studies stated the presence of Salmonella spp. in 1.4%,

2.0% and 2.08%, respectively (1, 31, 44). Our findings

showed similarity with the mentioned results, whereas,

Hinton et al. (26) and Krause et al. (32) did not find

any Salmonella spp. These differences may be

origi-nated from detection methods, sampling procedures

and the sanitation applications.

In the present study, Salmonella spp. was not

detec-ted in raw beef samples. This result was in accordance

to the findings reported by Cetinkaya et al. (6) and

Aydin et al. (3). In Northern Ireland 1.5% of 200 and

in Australia 0.22% of 1063 beef samples were tested

Tab. 1. Incidence of Salmonella spp. and Listeria spp. in various meat samples

t a e M f o e p y T NumberofSamples Salmonellaspp. Salmonellaserotypes Listeiraspp. Listeiraserotypes f e e B d n u o r G 205 2(0.98%) S.anatum 18(5.29%) L.innocua,L.seeilgeir t a e M f e e B w a R 50 negaitve negaitve 4(1.18%) L.seeilger,iL.welshimeir e g a s u a S 85 2(2.35%) S.reading,S.meleagirdis 3(0.88%) L.innocua,L.welshimeir s e l p m a S l a t o T f o r e b m u N 340 4(1.18%) 25(7.35%)

(3)

Med. Weter. 2013, 69 (8)

490

contaminated with Salmonella spp. (34, 48). They

explained that the prevalence of Salmonella spp. was

related with different hygiene applications and poor

manufacturing processes during slaughtering.

The present study demonstrated that Salmonella spp.

was isolated from 2.35% of sausages. Regarding the

contamination rate, our results were somewhat similar

to the study obtained by Oksuztepe et al. (40) in

Soudjouck (2.0%) and Duffy et al. (14) in cooked meat

(1.0%). In another study, no Salmonella spp. was

isolated (24). Contrary to this, the studies which had

higher results (61.5%, 26.0%, 24.4% and 7.0%) than

ours were reported by other authors (17, 36, 37, 45).

The reason for high contamination rate should be

due to the use of contaminated raw materials, lack of

proper heating and inadequate packaging as indicated

in EFSA report (15).

Ground beef, raw beef meat and sausages have been

examined in several countries for the presence of

L. monocytogenes. In Spain 34.9% of raw meat (49),

in Portugal 17.7% of raw meat (35), in Turkey 11.0%

of ground beef (8) and in Canada 15.63% of sausages

(19) were reported to be contaminated with L.

mono-cytogenes. In ours study, L. monocytogenes was not

detected. Similar results were reported by other

au-thors (5, 23, 33, 46). Differences between the findings

obtained from several studies can be related to the

pro-duction techniques, contamination from propro-duction

processes, preservation conditions and inadequate

per-sonal hygiene as stated in EFSA journal of 2012 (15).

It was also found that Listeria species were detected

in 25 (7.35%) samples, of which 18 (5.29%) were

L. innocua, 4 (1.18%) were L. seeligeri and 3 (0.88%)

were L. welshimeri.

According to the results from this study, no E. coli

O157 was isolated. Likewise, in other studies E. coli

O157 in sausages, ground beef and raw beef samples

(11, 18, 20) could not be detected. In contrast,

Cone-dera et al. (10) and Heuvelink et al. (25) demonstrated

that E. coli O157:H7 was isolated from 0.43% and

1.1% of ground beef respectively. Also, in Argentina

4.8% of the 83 fresh sausages and 3.3% of the 30 dry

sausages were contaminated with E. coli O157:H7 (7).

E. coli O157 is present sporadically at very low levels

together with very high levels of competitor organisms,

which is why it is difficult to detect (15).

Conclusion

In conclusion, the result of this study confirmed that

meat and meat products may be contaminated with

pathogens which can cause serious public health

pro-blems. Therefore, it is essential that applying good

hygienic practices (HACCP or GMP and GHP) and

developing standard procedures of production would

be benefical for controlling foodborne pathogens and

enhancing the safety of food.

References

1.Aabo S., Andersen J. K., Olsen J. E.: Reseacrh note: detection of Salmonella in minced meat by the polymerase chain reaction. Lett. Appl. Microbiol. 1995, 21, 180-182.

2.Al-Rajab W., Al-Chalabi K. A., Sulayman S.: Incidence of salmonella in poultry and meat products in Iraq. Food Microbiol. 1986, 3, 55-57. 3.Aydin A., Colak H., Ciftcioglu G., Ugur M.: Changes in microbiological

properties of boneless beef in a one year study. Arch. Lebensmittelhyg. 2006, 57, 50-54.

4.Baskaya R., Karaca T., Sevinc I., Cakmak O., Yýldýz A., Yoruk M.: The histo-logical, microbiological and serological quality of ground beef marketed in Ýstanbul. Y.Y.U. Vet. Fak. Derg. 2004, 15, 41-46.

5.Buchanan R. L., Stahl H. G., Bencivengo M. M., Del Corral E.: Comparison of lithium chloride-phenylethanolmoxalactam and modified Vogel Johnson agars for detection of Listeria spp. in retail-level meats, poultry, and seafoods. Appl. Env. Microbial. 1989, 55, 599-603.

6.Cetinkaya F., Cibik R., Soyutemiz E. G., Ozakin C., Kayali R., Levent B.: Shigella and Salmonella contamination in various foodstuffs in Turkey. Food Control 2008, 19, 1059-1063.

7.Chinen I., Tanaro J. D., Miliwebsky E., Lound L. H., Chillemi G., Ledri S., Baschkier A., Scarpin M., Manfredi E., Rivas M.: Isolation and characteriza-tion of Escherichia coli O157:H7 from retail meats in Argentina. J. Food Protect. 2001, 64, 1346-1351.

8.Ciftcioglu G.: Kýyma, sucuk ve tavuk etlerinde L. monocytogenes’in mev-cudiyeti üzerine araþtýrmalar. Ý.Ü. Saðlýk Bilimleri Enstitüsü Doktora Tezi, Ýstanbul 1992.

9.Colak H., Hampikyan H., Ulusoy B., Bingol E. B.: Presence of Listeria monocytogenes in Turkish style fermented sausage (sucuk). Food Control 2007, 18, 30-32.

10.Conedera G., Dalvit P., Martini M., Galiero G., Gramaglia M., Goffredo E., Loffredo G., Morabito S., Ottaviani D., Paterlini F., Pezzotti G., Pisanu M., Semprini P., Caprioli A.: Verocytotoxin producing Escherichia coli O157 in minced beef and dairy products in Italy. Int. J. Food Microbiol. 2004, 96, 67-73.

11.Dontorou C., Papadopoulou C., Filioussis G., Economou V., Apostolou I., Zakkas G., Salamoura A., Kansouzidou A., Levidiotou S.: Isolation of Escherichia coli O157 from foods in Greece. Int. J. Food Microbiol. 2003, 82, 273-279.

12.Downes F. P., Ito K.: Compendium of methods for the microbiological

examination of foods. 4th Edition. American Public Health Association, USA

2001.

13.Doyle N. P., Beuchat L. R., Montville T. J.: Food Microbiology. ASM Press., Washington, DC 2001, pp. 383-410.

14.Duffy G., Cloak O. M. O., Sullivan M. G., Guillet A., Sheridan J. J., Blair I. S., McDowell D. A.: The incidence and antibiotic resistance profiles of Salmonella spp. on Irish retail meat products. Food Microbiol. 1999, 16, 623-631.

15.EFSA Journal.: The European Union Summary Report on trends and sour-ces of zoonoses, zoonotic agents and food-borne outbreaks in 2010. EFSA Journal 2012, 10, 2597.

16.El-Leithy M. A., Rashad F. M.: Bacteriological studies on ground meat and its products. Arch. Lebensmittelhyg. 1989, 40, 49-72.

17.Escartin E. F., Castillo A., Hinojosa-Puga A., Saldana-Lozano J.: Prevalence of Salmonella in chorizo andits survival under different storage temperatures. Food Microbiol. 1999, 16, 479-486.

18.Fantelli K., Stephan R.: Prevalence and characteristics of shigatoxin-pro-ducing Escherichia coli and Listeria monocytogenes strains isolated from minced meat in Switzerland. Int. J. Food Microbiol. 2001, 70, 63-69. 19.Farber J. M., Sanders G. W., Johnston M. A.: A survey of various foods for

the presence of Listeria species. J. Food Protect. 1989, 52, 456-458. 20.Ferreira V., Barbosa J., Vendeiro S., Mota A., Silva F., Monteiro M. J., Hogg T.,

Gibbs P., Teixeira P.: Chemical and microbiological characterization of alheira: A typical Portuguese fermented sausage with particular reference to factors relating to food safety. Meat Sci. 2006, 73, 570-575.

21.Forsythe S. J., Hayes P. R.: Food Hygiene, Microbiology and HACCP. An Aspen Publication, Gaithersburg, Mayland 1998, pp. 449.

22.Gokalp H. Y., Yetim H., Karacam H.: Some saprophytic and pathogenic bacteria levels of ground beef sold in Erzurum, Turkey. Proc. 2. World Congress of Foodborne Infections and Intoxications, Berlin 1982, pp. 310-313. 23.Grau E. H., Vanderlinde R. B.: Occurrence, numbers, and growth of Listeria monocytogenes on some vacuum-packaged processed meats. J. Food Pro-tect. 1992, 55, 4-7.

24.Günþen U., Büyükyörük Ý., Arlý V.: Bursa Ýli Askeri Birliklerinde Tüketilen Sucuk, Salam ve Sosislerin Mikrobiyolojik Kaliteleri. Pendik Vet. Mikro-biol. Derg. 2001, 32, 37-41.

(4)

Med. Weter. 2013, 69 (8)

491

25.Heuvelink A. E., Bleumink B., Van Den Biggelaar F. L., Te Giffel M. C.,. Beumer R. R., De Boer E.: Occurrence and survival of verocytotoxin produ-cing Escherichia coli O157:H7 in raw cow’s milk in the Netherlands. J. Food Protect. 1998, 61, 1597-1601.

26.Hinton M., Coombs E., Tucker V., Jones S., Ailen V., Hudson W. R., Corry J. E. L.: The Bacteriological Quality of British Beef 2. Frozen Minced Beef. Meat Sci. 1998, 50, 395-402.

27.Hitchins A. D., Feng P., Watkins W. D., Rippey S. R., Chandler L. A.: Escherichia coli and the coliform bacteria. Food and Drug Adminstrations. Washington, DC: AOAC International 2000, pp. 4.01-4.29.

28.Hobbs B. C., Roberts D.: Food Poisoning and Food Hygiene. Edward Arnold, London 1993.

29.ISO 16654:2001.: Microbiology of food and animal feeding stuffs – Hori-zontal method for the detection of Escherichia coli O157.

30.ISO 6579:2002.: Microbiology of food and animal feeding stuffs – Horizontal method for the detection of Salmonella spp.

31.Kleinlein N., Untermann F., Beissner H.: Zum Vorkommen von Salmonella-und Yersinia-Spezies sowie Listeria monocytogenes in Hackfleisch. Fleisch-wirtschaft 1989, 69, 1474-1476.

32.Krause P., Schmoldt R., Tolgay Z., Yurtyeri A.: Mikrobiologische und sero-logische Untersuchungen an Lebensmitteln in der Türkei. Fleischwirtschaft 1972, 52, 83-86.

33.Le Guilloux M., Dollinger C., Freyburger G.: Listeria monocytogenes: Sa frequence dans les prodcuits de charcuterie. Bull. Soc. Vet. Prat. France 1988, 64, 45-52.

34.Madden R. H., Espie W. E., Moran L., McBridge J., Scates P.: Occurrence of Escherichia coli O157:H7, Listeria monocytogenes, Salmonella and Campy-lobacter spp. on beef carcasses in Northern Ireland. Meat Sci. 2001, 58, 343--346.

35.Mena C., Almeida G., Carneiro L., Teixeira P., Hogg T., Gibbs P. A.: Inci-dence of Listeria monocytogenes in different food products commercialized in Portugal. Food Microbiol. 2004, 21, 213-216.

36.Mrema N., Mpuchane S., Gashe B. A.: Prevalence of Salmonella in raw minced meat, raw fresh sausages and raw burger patties from retail outlets in Gaborone, Botswana. Food Control 2006, 17, 207-212.

37.Murmann L., Santos M. C., Cardoso M.: Prevalence, genetic characteri-zation and antimicrobial resistance of Salmonella isolated from fresh pork sausages in Porto Alegre, Brazil. Food Control 2009, 20, 191-195.

38.Murphy R. Y., Beard B. L., Martin E. M., Keener A. E., Osaili T.: Predicting process lethality of Escherichi coli O157:H7, Salmonella and Listeria mono-cytogenes in ground, formulated and formed beef/turkey links cooked in an air impigement oven. Food Microbiol. 2005, 21, 493-499.

39.Norrung B., Buncic S.: Microbial safety of meat in the Eurepean Union. Meat Sci. 2008, 78, 14-24.

40.Oksuztepe G., Güran H. Þ., Ýncili G. K., Gül S. B.: Elazýð’da tüketime sunulan fermente sucuklarýn mikrobiyolojik ve kimyasal kalitesi. Fýrat Üniversitesi Saðlýk Bilimleri Veteriner Dergisi 2011, 25, 107-117.

41.Pietzsch O., Kawerau H.: Salmonellen in Schweineschlachtund- Zerlegebe-trieben sowie Schweinehackfleisch. Vet. Med. Heft. Nr.4, Bundesgesund-heitsamt, Berlin 1981.

42.Qiongzhen L., Sherwood J. S., Logue C. M.: The prevalence of Listeria, Sal-monella, Escherichia coli and E. coli O157:H7 on bison carcasses during processing. Food Microbiol. 2004, 21, 791-799.

43.Roberts T. A., Pitt J. I., Farkas J., Grau F. H.: Micro-organisms in food. Microbial ecology of food commodities. ICMSF, Blackie Academic&Pro-fessional, London 1998.

44.Scheelhaas C., Klein D., Kleickkmann A.: Vorkommen von Salmonellen in Hackfleisch und anderen Erzeugnissen aus rohem zerkleinertem. Fleisch. Flesichwirtschaft 1976, 56, 110-112.

45.Siriken B., Pamuk S., Ozakýn C., Gedikoglu S., Eyigör M.: A note on inci-dences of Listeria spp. and E. coli O157:H7 serotypes in Turkish sausage (Soudjouck). Meat Sci. 2006, 72, 177-181.

46.Ternstrom A., Molin G.: Incidence of potential pathogens on raw pork, beef, and chicken in Sweden, with special reference to Erysipelothrix rhusiopa-thiae. J. Food Protect. 1987, 50, 141-146.

47.Turkish Food Codex (TFC): Microbiological Criteria Notification. Ankara, Premiership Press. Gazette 2011, 2011/28157.

48.Vanderlinde P. B., Shay B., Murray J.: Microbiological quality of Australian beef carcass meat and bulk packed beef. Food Protect. 1998, 61, 437-443. 49.Vitas A. I., Garcia-Jalon V.: Occurrence of Listeria monocytogenes in fresh

and processed foods in Navarra (Spain). Int. J. Food Microbiol. 2004, 90, 349-356.

50.Woldermariam E., Molla B., Alemayeha D., Mckle A.: Prevalence and distri-bution of Salmonella in apparently healthy slaughtered sheep and goats in Debre Zeit, Ethiopia. Small Ruminant Res. 2005, 58, 19-24.

Corresponding author: Emek Dumen; e-mail address: emekdumen @yahoo.com

Cytaty

Powiązane dokumenty

The objective of the paper was to evaluate the en- ergy value and the content of basic nutrients in habitual diets of four-year-old children in terms of the adequate- ness of

– Early and late stages of diabetic nephropathy should be treated dissimilarly – the inhibition of RAA in early phase should be achieved with strict glucose control, and the

p.n.k.d.II – przewlekłe miażdżycowe niedokrwienie kończyny dolnej II stopnia wg skali Fontaine’a z.st.cuk.ndk. – zespół stopy cukrzycowej niedokrwiennej.. z.st.cuk.miesz.

We have determined the alleles of eleven minor histocompatibility antigens (mHAgs) and investigated the occurrence of immunogenic mHAgs mismatches between a donor and a recipient

Persistent cough as the sole manifestation of chronic eosinophilic leukemia (CEL) expressing FIP1L1-PDGFRA fusion gene.. Długotrwały kaszel jako jedyny objaw przewlekłej białaczki

W dużej analizie obejmującej 157 chorych z włóknie- niem szpiku, częstość mutacji JAK2 wynosiła 51%, a homozygotyczność częściej wykrywano u chorych z post-PV

ocena stop- nia zaawansowania choroby według skali ann arbor (tab. 3) jest bardzo ważna nie tylko dla wyboru leczenia pierwszej linii, ale ich powtórna ocena po

Do terapii drugoliniowej zachowawczej wprowadzo- no nową grupę leków – agonistów receptora trom- bopoetyny: stosowany podskórnie 1 raz w tygodniu peptyd romiplostim (Nplate)