[Epidemiology of Lyme borreliosis]. / Epidemiologija Lyme borreliosis.

Our prospective study covered 1093 patients with epidemiological features and demonstrable clinical manifestations of Lyme borreliosis from 1987 to 1992. Basic criteria for the inclusion of our patients in the study were: tick bite, erythema migrans and antibodies to B. burgdorferi in each patient's serum. Various clinical manifestations were found un 1034 (94.6%) patients out of whom 829 (80.2%) had a history of tick bite, 901 (87.1%) had erythema migrans and 217 (21.0%) had serologic confirmation of the diagnosis. Inapparent infection was discovered in 59 (5.4%) patients. Other Types of skin changes (II and III stage) were found in 123 (11.9%) patients. The disease resulted in neurologic, joint and cardiac manifestations in somewhat lower percentage of patients (6.3%, 6.6% and 1.5%, respectively). In the three-year period (1990-1992) microscopic examination of the ticks (Ixodes ricinus) collected at several green areas of Belgrade confirmed the presence of B. burgdorferi in 29.1 per cent.

[Epidemiologic characteristics and serologic findings in erythema migrans]. / Epidemioloske karakteristike i seroloski nalaz kod erythema migrans.

Our three-year research covered 417 patients with erythema migrans, of both sexes and all age groups. Among them 87.3% had a history of tick bite. Average attachment of tick to a patients skin was two days. Diameter of erythematous lesions was 1-50 cm (with an average of 15.1 cm). Magnitude of the lesion does not correlate with the further development of the Lyme disease. IFA test detected antibodies against Borreliae burgdorferi in 27.0% of our patients.

[Lyme borreliosis in Belgrade]. / Lyme borreliosis u Beogradu.

In the period 1990-1992 in Belgrade area a diagnosis of Lyme disease was registered in 487 patients. There were 195 men and 292 women. The disease was registered in all ages groups, median age 38 y. The tick bite has been confirmed in 379 (77.8%) patients. Erythema migrans was the first sign of illness in 387 (84.6%) patients. The disease resoted in neurologic symptoms in 1.8%, joint manifestation in 4.8% and cardiac involvement in 0.9%. Antibodies to Borrelia burgdorferi have been detected by indirect immunofluorescence microscopy in 23.4%. Lyme disease has been registered in all districts of Belgrade. Acarological investigations have detected an infection by Borrelia burgdorferi in 29.0% of investigated ticks.

[Modern immunologic tests in the diagnosis of Lyme borreliosis]. / Savremeni imunoloski testovi u dijagnostici lajm borelioze.

In this work we described the results that were obtained using various immunodiagnostic assays for the detection of lyme borreliosis. Sera of the patients that were in acute or chronical phase of the disease were analysed in indirect immunofluorescent, immunoenzyme and immunoblot assays which were prepared and carried out in our laboratory. As a control for the validity of these investigations, we used sera of the healthy people, as well as of the patients suffering of lues or rheumatoid illnesses. Results that we obtained pointed out the factors responsible for the nonspecific reactions in indirect immunofluorescent and immunoenzyme test. The advantage of the immunoblot analysis in detecting lyme borreliosis is described in this work.

[Lyme disease in human medicine]. / Problem i znacaj lajmske bolesti u humanoj medicini.

Six years of investigations of Lyme disease in our country has offered an opportunity for better understanding of this "new" illness, which is both a medical and a health problem. The number of patients with Lyme disease is found to be similar to the number of patients in other countries. Human infections occur in different areas, rural and urban settings. A high level of collected ticks with Borrelia burgdorferi, suggests a considerable risk of human infection after a tick bite. Difficulties in diagnosing of Lyme disease are connected with different clinical symptoms and signs of the illness a poor health service personnel knowledge og the disease, and the lack of reliable and more convenient laboratory tests for confirmation of the diagnosis. A team work and a multidisciplinary aspect in the investigations and the routine work provide a solid base for a better understanding and gathering much more experience in this field. The individual protection remains a basic control measure, and each person can do the most for self protection. An activity in the health education is also of a very great importance.

[Ecology of Borrelia burgdorferi]. / Ekologija Borelije burgdorferi.

Much still remains to be understood about ecology of Borrelia burgdorferi which is transmitted by a number of ticks belonging primarily to the Ixodes complex, known to feed on different animal hosts and humans. This article pretends to be a review of previous knowledge of Borrelia burgdorferi ecology. Special emphasis is placed on the preliminary results of an investigation conducted in Yugoslavia on the risk of developing lyme borreliosis after a tick bite (Ixodes ricinus). Lyme borreliosis was studied prospectively in 147 persons with tick fastened on them. Dark-field microscopic examination of tick mitgut revealed that 11 (7.9%) od 147 Ixodes ricinus were infected with Borrelia burgdorferi. Lyme borreliosis was demonstrated in only one (0.6%) of all persons bitten by ticks infected with Borrelia burgdorferi. In conclusion, these preliminary data indicate that in Yugoslavia lyme borreliosis infrequently occurred after a tick bite.

[Vectors of Borrelia burgdorferi]. / Vektori Borrelia burgdorferi.

During the period 1990-1992-5,915 ticks were collected and identified in the area of Belgrade. Identification has shown that 99.8% were Ixodes ricinus and 0.2% Dermacentor marginatus. Infection with Borrelia burgdorferi was found in 27.0% to 31.7%. Females were more often infected than males and nymphs more often than larvae. Tick infection was at lowest degree in parks, little bit higher in woods and highest in mixed park-wood areas. Out of 28 locations, six can not be defined as foci of Lyme borreliosis, two are defined as potential foci and 20 as active foci of Lyme borreliosis. In a three year period we have isolated Borrelia burgdorferi in five occasions; in one occasion from ticks collected in Barajevo and in four occasions from ticks collected in Kosutnjak.

[A theoretical model for the study of Lyme borreliosis]. / Teorijski model izucavanja lajm borelioze.

This article is a short review of: a) development of theory on natural foci of communicable diseases in man, b) methodological approach to the investigation of natural foci, e.g. theoretical model in their investigation, and c) the use of theoretical model in the investigation of Lyme borreliosis. A great number of multidisciplinary studies on natural foci zooanthroponoses conducted through many years, in which ecological approach and numerous methods were applied, commencing from studies of the processes at the level of molecules, genes, cells, tissues, organismus, populations and species, contributed to the knowledge that epizootical process of natural foci of zooanthroponoses is almost an ideal natural model. Its investigation allows the establishment of the rules of epidemiological process which, for many reasons (ethical above all), is not accessible for experimental studies. On these principles a general block model has been worked out, which serves for the estimation of epidemiological manifestations of natural foci zooanthroponoses, and which, applied to Lyme borreliosis, enables the determination of active and potential foci and the estimation of the degree of risk of man infection in determined foci. Data obtained in such a way allow planning and application of adequate preventive measures.

[Exposure to Ixodes ricinus bites among soldiers]. / Izlozenost vojnika ubodima Ixodes ricinusa.

Results of an investigation on the exposure to tick bites among soldiers in 6 permanent army structures on the territory of Belgrade are shown. Four army structures were found to be active foci of Lyme borreliosis. Infection rates among Ixodes ticks were from 10% in urban structures to 42.1% in rural structures. Exposure of soldiers to tick bites was the largest in rural army structures--3.40%, while in urban army structures it was 0.14%. Among 38 tick bitten army members, 1 developed clinical manifestation as Lyme borreliosis (2.6%).

[The first isolation of Borrelia burgdorferi in Apodemus flavicollis in Yugoslavia]. / Prva izolacija Borrelia burgdorferi is Apodemus flaviccolis-a u Yugoslaviji.

Small rodent species, as well as their ectoparasitic fauna, and the presence of Borrelia burgdorferi in their blood and internal organs (liver and spleen) was investigated, at two locations (Kosutnjak, Lipovicka suma) in Belgrade. Animals were caught between September 15-17, 1992. On location Kosutnjak two Apodemus flavicollis were trapped and Borrelia burgdorferi was isolated from the spleen of one of them. On location Lipovicka suma 13 rodents were trapped as follows: 10 Apodemus flavicollis, 2 Apodemus agrarius and one Mus musculus. In these the presence of Borrelia burgdorferi was not determined. Ectoparasits Ixodes ricinus, Nesopyllus fasciatus and Haemogamasus spp. have been found. The location Kosutnjak can be considered as an active focus of lyme borreliosis.

[Epidemiologic characteristics of hemorrhagic fever with renal syndrome in a military population]. / Epidemioloske karakteristike hemoragicne groznice sa bubreznim sindromom u vojnickom kolektivu.

In the period 1952-1990 there have been recorded 84 patients with hemorrhagic fever with renal syndrome (HFRS): 81 soldiers and 3 officers of the Y.P.A. The largest number of cases was recorded in three epidemics, 61 or 72.6%. In 94% of cases the infection occurred during camping of units. The disease appeared in all months, but 57.2% of cases occurred in June and July. The mean lethality was 2.4%, in epidemics 1.6% and as sporadic cases 4.3%. In an army unit staying for six months in HFRS focus, 9.8% of soldiers were infected by the causative agent of this infection and only in one case the clinical picture of HFRS was manifested. Serologic tests (IIF and ELISA) confirmed the diagnosis of HFRS. Virus strains of Hantaan, Puumala and Seoul groups were used as antigens.

Preventive medical protection in the Armed Forces of Yugoslavia during military conflicts.

Some experiences in preventive medical protection in the Armed Forces of the Yugoslav People's Army (Y.P.A.) in the blockade and combat operations in 1991 are presented. In garrisons which were in the total blockade the basic life-needs were threatened and in the same time personnel was exposed to combat operations of enemy forces. Owing to alterness and discipline of the whole staff the basic hygienic measures of health protection were maintained. In units which were engaged in combat operations the hygienic prophylactic measures were conducted based on our doctrinal principles in preventive medical protection. The decrease in the incidence of infectious diseases and lack of epidemics point to the successfully applied protection. The health service provided protection both of people and refugees and also a significant help was extended to the units of the Armed Forces.

[Ixodes ricinus proven as a vector of Lyme borreliosis in Yugoslavia]. / Ixodes ricinus dokazan vektor lajm borelioze i u Jugoslaviji.

263 fasting female Ixodes ricinus were examined for Borrelia burgorferi, the vector of Lyme borreliosis. Female ticks were collected by flagella in the biotopes (Belgrade and Osijek) in which ticks bite patients with Lyme borreliosis. Borrelia burgorferi was proved in 58 (22%) of 263 female ticks in the native preparations of the intestinal contents by darkfield microscopy. In macerates of two groups of 5 female ticks each, Borrelia burgorferi was isolated by cultivation in the modified Kelly nutrient media for borrelia. The supposition that Ixodes ricinus is the vector of Lyme borreliosis in Yugoslavia is confirmed.

[Hemorrhagic fever with renal syndrome in Yugoslavia 1951-1988]. / Hemoragicna groznica sa bubreznim sindromom u SFRJ u periodu od 1951. do 1988.

Data on hemorrhagic fever with renal syndrome (HFRS) incidence in SFRY 1950-1988 were analysed. Information sources were published papers and official reports of Federal and Republic Institutions for Public Health. Indirect immunofluorescence technique was used in testing 1.842 organs of small wild mammals to the presence of HFRS viral antigen. This antigen was found in the lungs of 11 species. Average incidence of the carrier state was 10.4% Registered were 613 cases within the period 1951-1988. Morbidity rate was 0.05-10.6:1.00.000 for years. Disease have been registered during the whole year with maximum incidence rate in summer months. Men most capable of working were the most frequently affected: farmers, wood workers, soldiers. Average lethality was 5.2%.

[Lyme disease in Yugoslavia]. / Lajmska bolest u Jugoslaviji.

Presented are results of the last five-year period study of the lyme disease in Yugoslavia. On the basis of published papers and professional communications over 2500 cases of lyme disease.were detected in our country within this period. Presented are common epidemiologic and clinical features of the disease and particularly cases diagnosed in Belgrade. Since 1987 a group of various specialists has been working on the research project in collaboration with many centres in the country. Indirect immunofluorescence test as the diagnostic laboratory technique has been introduced in the Military Medical Academy in Belgrade in 1987. First species of Borrelia burgdorferi from ticks Ixodes ricinus have been isolated and cultivated in May and June 1990. Current problems concerning research work, medical and epidemiological aspects of the lyme disease are presented.

[Surveillance methods in hospital infections]. / Nacini nadzora nad bolnickim infekcijama.

In the prevalence study of postoperative pyogenic-inflammatory disease in 1,000 operated patients three parallel controls have been undertaken: comprehensive prospective control, current state and standard control. Current prevalence control has been proved the most suitable, practical and for hospital personnel the most acceptable control method.