Rickettsia helvetica in Dermacentor reticulatus ticks.

We report on the molecular evidence that Dermacentor reticulatus ticks in Croatia are infected with Rickettsia helvetica (10%) or Rickettsia slovaca (2%) or co-infected with both species (1%). These findings expand the knowledge of the geographic distribution of R. helvetica and D. reticulatus ticks.

[Ocular manifestations of Lyme borreliosis in northwest Croatia]. / Ocne manifestacije lajmske borelioze u sjeverozapadnoj Hrvatskoj.

Ocular manifestations in patients with Lyme borreliosis in northwest Croatia that occurred during the period between 1992 and 2001 were retrospectively analysed. The diagnosis of Lyme borreliosis was based on medical history, clinical manifestations, epidemiological data about tick contact, determinations of antibodies to Borrelia burgdorferi by serological assays, immunoblot analysis, therapeutic results and exclusion of other infectious agents of ocular disease. Of the eleven patients reported here with clinical manifestations of ocular Lyme borreliosis, 6 had chorioretinitis, 1 papillitis, 2 iridocyclitis, 1 occlusion of the arteriae centralis retinae, 1 neuritis retrobulbaris and 1 neuroretinitis. Diagnostic confirmation of LB was in most patients done by serological tests and/or by immunoblot method in serum. In the last few years we have also done culture and molecular diagnostic methods polymerase chain reaction (PCR)) in serum and cerebrospinal fluid. The patients were treated with 2 g of ceftriaxon i.v. per day for 14-21 days and/or with doxucyclin orally in a daily dose of 2 x 100 mg for 2-4 weeks. The therapeutic effect was followed up by regression of clinical symptoms (better visual acuity of the infected eye) and in changing of the specific antibody titer in serological tests. The authors emphasise the more detailed diagnostic proceedings of ocular Lyme borreliosis in patients with suspected Lyme borreliosis, an algorithm which contains data about residence in endemic area for LB, positive contact with ticks and/or the history of erythema migrans or any other Lyme borreliosis-like symptoms. For diagnostic confirmation it is necessary to use enzymeimmunoassay and immunoblot methods in serum, cerebrospinal fluid and aqueous humor, and isolation by culture or PCR can be used in the same diagnostic samples. Ocular Lyme borreliosis is an underdiagnosed disorder, because it is often unrecognised by ophthalmologists and due to weak seropositivity and seronegativity in the late ocular Lyme borreliosis. This is especially important in a highly endemic area for Lyme borreliosis like northwest Croatia, a border area of the central European andemic area for Lyme borreliosis.

[Leptospirosis and hemorrhagic fever with renal syndrome in northwestern Croatia]. / Leptospiroza i hemoragijska vrucica s bubreznim sindromom u sjeverozapadnoj Hrvatskoj.

UNLABELLED: Leptospirosis is a worldwide spread zoonosis, therefore being also present in northwest Croatia. It has been recently discovered that hemorrhagic fever with renal syndrome (HFRS) is present throughout Croatia, not just in the previously well known epidemic foci. Because of the similar clinical presentation and epidemiology of the two diseases, it is important to know the exact etiology of the current disease. The aim of this study was to determine the presentation of HFRS in northwest Croatia and possible coinfection in patients with leptospirosis. PATIENTS AND METHODS: During the 1988-2000 period, 42 patients with leptospirosis from northwest Croatia were analyzed. Leptospiral infection was confirmed in all 42 patients by microagglutination test. Serology for hantaviruses was done by ELISA test in a few patients with leptospirosis and severe renal failure. RESULTS: In the majority of patients (37/42: 88%) acute renal failure was mild or moderate, with creatinine values below 500 mol/l. However, 12% of the patients developed severe acute renal failure, with creatinine values over 500 mol/l. The main therapeutic regime in all patients with leptospiral infection included body fluid replacement (electrolyte and glucose infusions) and antibiotic therapy. In patients with severe acute renal failure, it was necessary to introduce hemodialysis treatment. There was no fatal outcome in our patients. Over the last few years, antibody titers to hantaviruses were assessed by ELISA testing in five patients with leptospiral infection and severe form of acute renal failure, confirming HFRS persistence in northwest Croatia Testing for specific antibodies to hantaviruses has been suggested in all patients with leptospirosis and in whole Croatia, especially in northwest Croatia.