Clinical Manifestations of European Borreliosis on the Skin in Acute, Subacute and Chronic Disease.

Background: Lyme borreliosis is a multisystemic infection caused by the spirochete Borrelia burgdorferi. Erythema migras is the main clinical marker of the disease. Objective: This study aimed was to investigate the frequency and clinical manifestations of European borreliosis on the skin, and to determine the significance of these findings for diagnosis and therapy. Methods: A retrospective-prospective clinical study of outpatients treated and monitored in a private clinic of an infectologist was conducted over nine years from to 2013-2021. The study was clinical, descriptive and analytical in nature. Results: In the investigated period, 509 (30.8%) patients with borreliosis symptoms were treated. EM in our patients occurred under the following conditions: a) ringed redness, b) redness of target cels and d) continuous round or oval redness of different sizes of individual redness, or multiple occurrences with primary dissemination. Skin changes with multiorgan chronic symptoms of borreliosis occurred in 67.7% of cases the including: walking redness of different shapes and sizes, pink borreliosis stretch marks, white borreliosis stretch marks, borreliosis palms and soles, psoriatic changes, Acrodermatitis chronica atrophicans, Scleroderma circumscripta-morphae, Erythema nodosum, Granuloma anulare and Lichen striatus et atrophicans. Of the 509 patients treated for borreliosis, 32.3% with multi-organ symptomatology had no skin changes. Conclusion: The skin manifestations of European borreliosis are multi-layered and Erythema migrans are basic, but not the only markers of the disease. 'Pink borreliose stretch marks, "white borreliosis striae", "borreliosis palms or soles", and intermittent redness accompanied by itching are unique markers for the diagnosis of chronic borreliosis, if they are manifested.

Acute renal insufficiency and toxic hepatitis following scorpions sting.

Scorpion sting is a huge medical problem in countries of South America, Arabian Peninsula and Africa. In countries of Mediterranean region, where Bosnia and Herzegovina belongs, this problem is sporadic. Following the sting of very poisonous red scorpions, death may occur inside of 48 hours by reason of cardiac arrest and acute renal insufficiency (ARI). In our work we represent a case of 54-years old man. In his case, ARI and toxic hepatitis developed inside of 24 hours after the scorpion sting. Applied conservative therapy was not sufficient enough to solve ARI, so patient needed haemodialysis. With intensive conservative therapy and haemodialysis applied every other day, ARI and toxic hepatitis were solved within 25 days. After that, patient was released from hospital for ambulant treatment.

Brucellosis epidemiological and clinical aspects (Is brucellosis a major public health problem in Bosnia and Herzegovina?).

Brucellosis is primarily an animal disease, and in them it passes as an asymptomatic chronic infection. In humans, brucellosis can be acute, sub-acute and/or chronic disease, but its geographical distribution follows the pattern found in animals. After the last war, the first Brucella cases in Bosnia and Herzegovina were reported in 2000, in returnees, owners of donated livestock. The objective of this paper was to address an increased public health problem regarding brucellosis in Bosnia and Herzegovina and to initiate better cooperation among epidemiologists, veterinarians, microbiologists and infectologists and responsible authorities toward elimination and eradication of this severe disease. Retrospective analysis of Brucella case histories and treatment protocols of all the cases hospitalized in Clinic for Infectious Diseases, University of Sarajevo Clinics Center (CCUS) was conducted. All the patients hospitalized between 1 January 2000 and 1 July 2005 were included. The diagnoses were confirmed by laboratory tests, chemo culture or serologically. The Rose Bengal agglutination and ELISA tests were used as laboratory confirmation methods. The number of hospitalized cases over the last 5 years was compared with total number of reported cases in the first 6 months of 2005. The results of this study showed that Brucella infections in humans, compared to other zoonoses, was represented with 11.8%. Brucellosis was the second zoonose in a ranking of zoonotic diseases cases with steady increase in the number of reported cases each year. The number of cases treated in the first 6 months of 2005 already exceeded half of the total number of cases treated in the last 5 years. Human brucellosis is an increasing public health problem in Bosnia and Herzegovina, and it reflects spreading of the same disease in animals. The applied prevention measures have been insufficient, so it is necessary to mobilize all the available resources of human and veterinary medicine, as well as the authorities, microbiological laboratory diagnostics in order to identify foci of epidemics and to try to eliminate and eradicate this complicated disease.

[Prolonged forms of hepatitis "A"-- clinical and biochemical characteristics]. / Prolongirane forme hepatitisa "A"-- klinicko-biohemijske osobitosti.

UNLABELLED: Prolonged forms of HAV infection are atypical forms of diseases which occur in up to 24% cases. In clinical mean those forms of disease are described as relapses (recidivisms) and recrudescence. During the three-year multi-centric study we have explored prolonged forms of HAV infection, on two geographically separated and epidemiologically different regions, from every aspect. The purpose of this study, in clinical biochemical sense, was to explore all clinical forms of this disease and determine its biochemical characteristics. This research involved 60 patients with prolonged HAV infection (PTHA) and 30 patients with conventional hepatitis A. During conventional HAV-infection the disease ends in 4 to 8 weeks. Markers of HAV, HBV and HCV infection were determined using ELISA method. Antigen HAV in stool was determined using method of reversed immuno-electro-osmopforesis. Circulating immune complexes was determined photometrical in the sediment poliethylenglicole on rollers length of 450 nm. Research has shown that the PTHA manifests in three clinical forms: recrudescence, relapse and "prolonged hepatitis A from the beginning". All forms of PTHA were often significantly icteric with a clearly shown clinical pictures (p<0.05). Every new disease episode (relapse and/or recrudescence) is in average of smaller intensity than the initial infection. CONCLUSIONS: Clinically clear PTHA infection manifests through recrudescence in 66,8 % of cases, through relapse in 26,6 % of cases and "prolonged hepatitis A from the beginning" in 6,6 % of cases. Recrudescence appears significantly often one time rather than two or more times (p<0.001). Relapse never appeared:after recrudescence, and it was not noted more than once. "Prolonged forms of disease from the beginning" could represent relapse/recrudescence whose initial disease phase remained sub clinic. Average duration of PTHA is five times longer than in the control group. Men tend to fall ill from PTHA twice as much as woman.