[Clinical and diagnostic approaches to neurocysticercosis]. / Klinicki i dijagnosticki pristup neurocisticerkozi.

ETIOLOGY: Cysticercosis is a tissue infection caused by larvae of the cestode Taenia solium. Neurocysticercosis is a central nervous system form of this infection. Taenia solium invades tissues in a form of a cyst with a thin, semitransparent wall. It can reach 1-2 cm in diameter in muscles and brain tissue and up to 3-6 cm in brain chambers. EPIDEMIOLOGY: Pigs are the most common intermediate hosts. The infection occurs when the parasite eggs or proglottids are ingested. It is most common in regions where human feces is used as a fertilizer, or regions with poor sanitary conditions. The man is infected with contaminated food or water, or by autoinoculation. PATHOGENESIS: The Taenia solium eggs are hatched in the duodenum. Embryos invade the intestinal mucosa, and reach various parts of the body, disseminated by the blood circulatory system. The most common localizations of cysticerci are skeleton, muscles and brain. While alive, these cysts produce a minimal reaction in hosts. Inflammation occurs when they die, often a few years after infection. CLINICAL FEATURES: While presence of adult worms of Taenia solium in the gastrointestinal tract causes unspecific symptoms, clinical features of neurocysticercosis depend on the number, size and localization of cysts, as well as on the degree of granulomatous response. The most common manifestations of this infection are epileptic seizures, whereas intracranial pressure increase can be the earliest sign of the disease. Hydrocephalus, meningitis and spinal cord compression syndrome are the most usual complications. PROGNOSIS: The death rate is low in neurocysticercosis with parenchymal cysts and calcification without hydrocephalus. However, fatal outcome occurs in hydrocephalic patients, cases with huge supratentorial cysts, multiple granuloma, brain edema or cerebral infarctions. DIAGNOSIS: Informations about travels to endemic regions are valuable in diagnosing neurocysticercosis. Cytobiochemical finding of the cerebrospinal fluid is often normal. However, in 50% of patients, lymphocytic or eosinophilic pleocytosis is found, low glucose (in 25%) and elevated protein (in 40% of cases). Further testing includes serologic examination of blood and cerebrospinal fluid. Finding of specific antibodies in the sera or cerebrospinal fluid confirms the diagnosis, although false positive reaction may occur in patients with other helminths, especially other cestode. The enzyme-linked immunotransfer blot assay is proven to be sensitive and specific in patients with multiple cysticerci. Computerized tomography and magnetic resonance imagining are techniques mostly used in establishing neurocysticercosis. They reveal the localization of cysticerci, identify the atrophic or edematous fields and assess the degree of ventricular dilatation.

[Influenza--always present among us]. / Influenca--stalno medu nama.

INTRODUCTION: Influenza virus infects about 10 million persons worldwide each year. Two important characteristics of influenza are its epidemic outbreak and high mortality rate, mostly caused by complications. Influenza virus is characterised by a great antigenic variability. Major modifications, called antigenic shifts or type changes, occur approximately three times per century and result in worldwide epidemics--pandemics. Minor modifications, called antigenic drifts or strain changes demand new vaccine compositions each year. HISTORY: Pandemics and epidemics caused by influenza virus, such as the "Spanish Flu", the "Asian Flu", the "Hong Kong Flu" killed many people worldwide. Presently the epidemic, caused by influenza A virus Sydney/97 H3N2 is spreading over USA and most of Europe, including Yugoslavia. EPIDEMIOLOGY AND CLINICAL FEATURES: In humans influenza virus spreads over respiratory secretions, thrown out by coughing and sneezing. Children and older people, as well as immunosuppressed patients are prone to the infection. The onset of illness is sudden, with fever usually over 39 degrees C. Headache and myalgia are prominent. Other signs include fatigue, sore throat, nasal congestion and red eyes. Cough is a very important symptom, which starts as dry and progresses to wet with thick mucous. COMPLICATIONS: Pneumonia is the main cause of death among the high-risk patients. Bronchitis and tracheobronchitis also occur. Croup is a serious complication, often encountered in small children. Cardiac complications, especially myocarditis, are described as influenza complications. Neurological complications include encephalitis, encephalopathy, myelitis, Guillain-Barré syndrome, Reye syndrome, etc. Neurotropism of the influenza virus is under investigation. DIFFERENTIAL DIAGNOSIS AND DIAGNOSIS: Differential diagnosis of influenza includes all diseases which exhibit by increased body temperature, cough, headache, sore throat, myalgia and lethargy. Among serious diseases, pneumonia, sepsis, and meningitis should be considered. Various tests are used when diagnosing influenza: antigen detection, polymerase chain reaction, immunofluorescent tests, etc. THERAPY: Treatment of influenza by antiviral drugs can be prophylactic and therapeutic. Amantadine and rimantadine are older drugs effective in cases caused by virus type A. The newest generation of influenza antiviral agents are neuraminidase inhibitors--zanamivir and oseltamivir, effective against both virus types. The symptomatic therapy is still a basis of influenza treatment. PREVENTION: The main means of influenza prevention is a yearly vaccine. The three-valent vaccine is in common use. It is recommended that high-risk population should be vaccinated. If the composition of the vaccine is well matched with the prevalent virus strain, it is efficient in 50-80% of vaccinees. CONCLUSION: Influenza is the sixth cause of death in the world, the forth among the older population. The next pandemic can occur at anytime. It will be a different virus subtype, never before encountered by humans. Are we ready?

[Histiocytic necrotizing lymphadenitis (Kikuchi-Fujimoto disease)]. / Histiocitni nekrotizirajuci limfadenitis (Kikuchi-Fujimotova bolest).

INTRODUCTION: Histiocytic necrotizing lymphadenitis is a disease of unknown etiology, favourable course and outcome, mostly encountered in young women. It exhibits increased temperature and lymphadenopathy. The illness resolved spontaneously after a few months. A CASE REVIEW: In a 32-year-old patient the disease developed gradually, with pain in the right axilla, within enlarged lymph. Two weeks later, her temperature increased to 39 degrees C, accompanied by fever, shivering, malaise and loss of appetite. The ultrasonographic finding showed a conglomerate of hypoechogenic lymph nodes, with a few enlarged lymph glands. By immunohistochemical examination of a gland tissue sample the diagnosis was established Kikuchi-Fujimoto disease ("Histiocytica necrotizing lymphadenitis"--"Apoptotic lymphadenitis"). Corticosteroid therapy had been administered for one year, which resulted in both subjective improvement and regression of enlarged lymph nodes. DISCUSSION: A connection between this disease and viruses has not been proved. Presence of intracellular tubuloreticular formations suggests autoimmune etiology of histiocytic necrotizing lymphadenitis. It is considered as hyperimmune reaction of the organism induced by a viral infection. Differential diagnosis should consider taxoplasmosis, tuberculosis, lymphadenitis and malignant lymphoma. CONCLUSION: Although histiocytic necrotizing lymphadenitis is a rare disease, this case shows that it should be considered when lymphadenopathy, particularly cervical, occurs in young women, accompanied by increased temperature.

[Meningoencephalitis as the only manifestation of Epstein-Barr virus infection]. / Meningoencefalitis kao jedina manifestacija infekcije Epstein-Barrovim virusom.

INTRODUCTION: Epstein-Barr virus (EBV) infection is most often manifested as infective mononucleosis, which exhibits fever, tonsillopharyngitis, lymphadenopathy and hepatospleenomegaly, and presence of leucocytosis with lymphocytosis in the complete blood count. Neurological manifestations are rarely seen during EBV infection, in less than 1% of the diseased, most often under the features of serous meningitis, encephalitis, encephalomyelitis, transversal myelitis, neuritis, polyradiculoneuritis, convulsions etc. PATIENTS AND METHODS: The aim of the study was to investigate the frequency and clinical features of neurological manifestations in EBV infected patients treated at the Clinic for Infectious Diseases. Clinical Centre Novi Sad, during 1997. Etiologic diagnosis was confirmed by establishing presence of the viral capsid antigen specific antibodies--EBV VCA, IgM and IgG class, in the blood and cerebro-spinal fluid, as well as according to the dynamics of their titre. RESULTS: Most patients (94.64%), had the classic features exhibited by fever, angina, polylymphadenopathy and hepatospleenomegaly, while 5.36% of patients had neurological symptoms, that is meningoencephalitis as the only manifestation of EBV infection. Besides antibodies in sera, EBV antibodies in the cerebro-spinal fluid had been proved in these patients. In all patients, other viral etiology of meningoencephalitis had been excluded by serologic blood examination. Bacterial findings in the cerebro-spinal fluid had been negative as well. The outcome of the illness was favourable in all patients.

[Herpes simplex and lymphocytic choriomeningitis viruses in infections of the central nervous system--clinical and cerebrospinal fluid characteristics]. / Virusi herpesa simpleks i limfocitarnog horiomeningitisa u infekcijama centralnog nervnog sistema--klinicke i likvorske karakteristike.

INTRODUCTION: A great number of various viruses are stated as the cause of acute infections and damages of the central nervous system. In most cases these are minor damages which exhibit as meningeal syndrome and a specific finding in the cerebrospinal fluid. According to the dominant location, central nervous system infections can take a form of meningitis, encephalitis or myelitis. Since the inflammatory process of the meninges can not be separated from the inflammatory process of the brain, we usually speak of meningoencephalitis. The etiological diagnosis of meningitis and encephalitis is established by isolating the virus from the cerebrospinal fluid and by finding the presence of the specific antibodies in the blood and in the cerebrospinal fluid. The most common causes of the viral meningitis are Enteroviruses, the Mumps virus, Arthropode borne viruses, the Herpes viruses, Adeno viruses and the Lymphocytic choriomeningitis virus. The aim of our study was to establish the correlation between the clinical features and immunological and cerebrospinal fluid changes and the degree of the damage to the blood-brain barrier during the infections of the central nervous system, caused by the Herpes Simplex virus and the Lymphocytic choriomeningitis virus. MATERIAL AND METHODS: From a group of 103 patients, who had been treated for viral meningitis and meningoencephalitis, a group of 27 patients with established specific viral etiology--Herpes Simplex virus and Lymphocytic choriomeningitis virus, had been taken into the account. Herpes Simplex infection had been proven by the complement binding reaction and the neutralisation test of the even samples of serum. The diagnosis of Lymphocytic choriomeningitis was confirmed by the immunofluorescence test of the pharynx swabs and cerebrospinal fluid. The clinical features, such as body temperature, encephalitic signs, and electroencephalographic findings had been followed and compared. RESULTS: Herpes Simplex infection had been found in 20 patients, Lymphocytic choriomeningitis had been proven in 7 patients. All the patients had increased body temperature. Only four of the patients exhibited encephalitic signs, all infected by the Herpes Simplex virus. Patients from the Herpes Simplex group showed various degrees of consciousness disturbances, ranging from somnolence to coma, while the Lymphocytic choriomeningitis patients exhibited none. Higher pleocytosis and protein level had been found in the Lymphocytic choriomeningitis group. DISCUSSION: Viral diseases of the central nervous system are the result of the direct damage of the brain and meninges by the virus and immunological processes. Herpes Simplex meningitis usually has a good prognosis. Lymphocytic choriomeningitis has longer course of the disease and exhibits more severe clinical features. CONCLUSION: In cases of the central nervous system infections, caused by Herpes Simplex virus or Lymphocytic choriomeningitis virus, the correlation between the severeness of clinical features and the degree of damage of the blood-brain barrier, the level of pleocytosis and the increase of the cerebrospinal fluid proteins had been established.

[Chronic meningitis]. / Hronicni meningitis.

The paper presents the past knowledge of the etiology of chronic meningeal syndrome. The causes are divided into those of infective and those of noninfective etiology. Basic recommendations for general diagnostic approach, laboratory, clinical and radiological follow up of the patients have been given. A wide spectrum of differential-diagnostic possibilities has been pointed out, especially in relation to chronic systemic diseases. Characteristic syndromes of chronic meningitis have been separated and concisely described.

[Bacterial meningitis with a low leukocyte count at the beginning of hospital treatment]. / Bakterijski meningitisi sa snizenim leukocitima na pocetku bolnickog lecenja.

The clinical pictures and the course of bacterial meningitides in 7 patients with leukocytes in the peripheral blood below 6.0 x 10(9)/l was examined out of 7 patients 6 were female and 1 male, from 7 months to 56 years of age, the mean age X = 22.3 years. At the beginning of the hospital treatment, patients from this group were more frequently afebrile or subfebrile (5 patients) meningitic signs significant (4 patients). Parameters of nonspecific inflammatory response in blood, SE and fibrinogenaemia were less expressed, while the response in liquor to bacterial infection was normal. Gram-negative bacteria were more frequently isolated among etiologically established causes of meningitides. In patients with leukocytes below 6.0 x 10(9)/l, purulent meningitides were more often serious and very serious diseases (4). There were no complications in some patients and 5 patients were completely cured (71.42%), while in 2 patients (28.58%) there was a mild hyperproteinorrachia in the liquor at the time of leaving hospital.

[Leptospirosis at the Clinic for Infectious Diseases in Novi Sad 1984-1993]. / Leptospiroze na Klinici za infektivne bolesti u Novom Sadu u periodu 1984-1993. godine.

We examined the clinical picture and course of leptospiral infections in 50 patients treated at the Clinic during the period 1984-1993. Most patients were 11-20 years of age (9 years the youngest and 77 years the oldest, mean age being 25.16). The disease more often occurred in male patients, 44 (88%). There were 30 (60%) patients with gastrointestinal symptoms, while 21 (42%) had liver and kidney infections. Meningeal syndrome was established in 25 (50%) and serous meningitis in 13 (26%). Leptospiral infections represented average and serious infections with complications in 8 (16%) patients, successful treatment in 47 (94%) patients while 3 (6%) patients died due to hematorenal insufficiency.

[Hemorrhagic fever with renal syndrome in Vojvodina]. / Hemoragijska groznica s bubreznim sindromom u Vojvodini.

This paper presents 4 serologically confirmed cases of hemorrhagic fever with kidney syndrome. The objective of this study was to point to occurrence of unexpected hemorrhagic fever with kidney syndrome, to different clinical pictures and differential-diagnostic difficulties as well as to therapeutic procedures of serious cases. The disease had a sudden onset with general signs of infection in all our patients. 3 out of 4 patients had had a dominant symptomatology in regard to gastrointestinal tract, whereas signs of acute renal insufficiency appeared later. In 3 patients there was a complete recovery without consequences, while one female patient died on the twelfth day of the disease.

[Intrathecal synthesis of immunoglobulin G in patients of various ages with acute viral meningitis and meningoencephalitis]. / Intratekalna sinteza imunoglobulina G kod bolesnika razlicitog zivotnog doba u toku akutnih virusnih meningitisa i meningoencefalitisa.

Intrathecal antibody synthesis is a common local immunologic reaction in acute meningoencephalitis and encephalitis caused by Herpes group viruses, myxo and paramyxoviroses. The purpose of this study was to determine the quantity of de novo synthesized IgG during 24 hours in the liquor of patients of different ages suffering from acute viral meningitis and meningoencephalitis and to establish correlations between the dysfunction of blood-brain barrier and de novo IgG synthesis. We examined 73 patients of different ages divided into 5 groups according to their age. The state of blood-brain barrier was the most stable with high Qalb values of 225,596 for the youngest (from 2 to 6) and 193,190 for the somewhat older children (from 7 to 15). The most common damage of the blood-brain barrier was established in the oldest group of patients--over 40 years of age. The lowest intrathecal IgG production was established in the youngest group from 2 to 6 (6.631 mg/24 hours), and the highest (64.61 mg/24 hours) at the beginning of the disease in the group from 16 to 25 years of age. We established a correlation between damages of blood-brain barrier and de novo synthesis of IgG, especially in the youngest patients in the first days of the disease as well as 14 and more days later, when a low immunoglobulin production was established but a well preserved blood-brain barrier too. In the group of patients older than 40 years of age such a correlation was not found which points to a tissue synthesis of antibodies in the central nervous system.

[The Epstein-Barr virus and chronic fatigue syndrome]. / Epstein-Barrov virus i sindrom hronicnog umora.

Lately discovered chronic fatigue syndrome is associated with Epstein-Barr virus infection. The objective of this paper was to detect this syndrome in our patients. 31 patients with cured acute infective mononucleosis were examined by questionnaire, physical check-up and laboratory analyses in order to detect disorders characteristic for chronic fatigue syndrome. Six months after they had been cured, out of 7 patients 5 patients complained of frequent sore throat, fatigue and exhaustion, and a year later, all 5 patients were sleepy and tired all the time. More than a year after the acute illness 19 patients were examined and in 5.6% frequent sore throat and enlarged neck lymph nodes occurred. The gathered results point to disorders characteristic for chronic fatigue syndrome in a high percentage. This pilot study should only be the beginning of examinations of this kind.

[Therapy of salmonella gastroenterocolitis]. / Terapija salmoneloznog gastroenterokolitisa.

At the Clinic for infectious and dermatovenerologic diseases in Novi Sad a prospective randomized, simple, blind investigation of differently organized treatments of salmonellal gastroenterocolitis (symptomatic therapies, ampicillin, co-trimoxazole and ciprofloxacine) was carried out. It was established that there is no statistically significant difference in the length of febrile states in any of the compared therapeutic groups. However, ciprofloxacine significantly shortens diarrhea and excretion of germs comparing with other therapeutic treatments.

[Sensorineural impairment in the inner ear in epidemic parotitis]. / Senzorineuralno ostecenje unutrasnjeg uva u toku epidemicnog parotitisa.

During morbilli and mumps, classical forms of acquired deafness develop in childhood. The aim of the study was to investigate effects of mumps virus on cochlear function. Of 237 examined patients 71 had parotitis and 166 meningitis-meningoencephalitis. Audiometric analyses were carried out at the beginning of the treatment and after 6 months. Hearing loss above 30 dB was found in 109 patients (45.99%). Mild hearing impairment of sensorineural type was registered in the majority of patients, while total one-sided hearing loss was found in 2.53% of subjects. No correlation between clinical manifestations of parotitis or meningoencephalitis and hearing loss was found. Cytochemical liquor levels did not influence the development of hearing loss. 6 months later a recovery followed mainly in patients with mild impairments.

[Etiologic structure and clinical characteristics of acute viral infections of the central nervous system with hyperproteinorachia]. / Etioloska struktura i klinicke karakteristike akutnih virusnih infekcija centralnog nervnog sistema sa hiperproteinorahijom.

Clinical syndrome of acute viral meningitis and meningoencephalitis may be induced by different viruses. Etiologic diagnosis may be set by the isolation of the virus from the liquor and by the detection of specific antibodies in the blood and liquor. Our aim was to determine viral etiology of AVI with special reference to hyperproteinorachia. The study was conducted in 55 patients treated at the Clinic of Infectious Diseases in Novi Sad, with clinical picture of acute meningitis or meningoencephalitis, with pleocytosis above 50 ml in the cerebrospinal fluid. Depending on the levels of proteinorachia the patients were divided into the group with proteinorachia levels below 1g/l (34 patients) and above 1 g/l (21 patients). In the first group the most common was herpes simplex- and adenoviral etiology while in the second group most frequently found were choriolymphocytic meningitis virus (LCM) and herpes simplex virus. The protein level was in correlation with the severity of the clinical features and the duration of the treatment.

[Meningococcal sepsis and difficulties in differential diagnosis--case report]. / Meningokokna sepsa i diferencijalno-dijagnosticke teskoce--prikaz slucaja.

We report a case of meningococcal sepsis in a healthy immunocompetent sixteen year old boy who had developed upper respiratory tract acute infection 10 days before the admittance. Clinical manifestations were similar to those found in allergic hemorrhagic purpura (Schonlein's form of the disease). The clinical course of these two diseases is usually different but sometimes they cannot be easily differentiated. The acute onset of polyarthritis, temperature and skin manifestations in the form of erythematous maculopapular exanthema which within several hours evolved into hemorrhagic purpura is typical for the sepsis caused by Neisseria meningitides but these characteristics might be found in allergic Henoch-Schonlein' purpura as well. In our case the accurate diagnosis was set by the identification of the group C Neisseriae meningitides from the patient's blood. The first choice was penicillin therapy.

[The role of Epstein-Barr viruses as etiologic agents in the mononucleosis syndrome]. / Uloga Epstein-Barrovog virusa kao etioloskog cinioca u mononukleoznom sindromu.

Mononucleosis syndrome represents a number of symptoms with different etiology and pathogenicity with similar clinical features. The aim of the study was to investigate etiologic structure of mononucleosis syndrome, effects of etiologic factors and age on the severity of clinical features, clinical forms of the disease, complications and the outcome. The investigation was conducted in 46 patients treated at the Clinic who had been diagnosed as having mononucleosis syndrome. EBV-IM was confirmed in 43%, adenoviral IM in 13%, while in 44% of the patients etiology of the disease was not established. In both groups more severe forms were present in patients over 16 years of age, but more frequently in EBV-IM than in other patients with mononucleosis syndrome (40% vs 19.23%). Complications in the form of acute hepatitis were found only in patients with EBV-IM in 20% of the cases, mean age 17 years. We are of the opinion that EBV is a significant etiologic agent in mononucleosis syndrome, that the disease is more severe in older patients who also develop complications. The outcome for all the patients was favorable.

[Abdominal typhus today]. / Trbusni tifus danas.

Abdominal typhus is all the rearer disease among acute infectious diseases in Vojvodina. In the last ten years (1981-1990) 16 patients with abdominal typhus were treated at the Department of Infectious Diseases in Novi Sad, mostly young individuals from 6 to 30 years of age (13 patients). Positive epidemiologic features were found in 13 patients. In 80% of the cases the source of infection was outside Vojvodina. They usually were admitted at the Department on the first and second week of the disease (11 patients), and 3 patients were admitted on the third week. None of the patients was suspected of having abdominal typhus at the time of admittance. Delayed hospitalization and unrecognized abdominal typhus were most likely due to the atypical onset and course of the disease. Atypical features in the clinical picture occurred in all the patients with a sudden onset of the disease. The abrupt temperature elevation in 50% of the patients was followed by shivering, fever and shaking. Hepatosplenomegaly was found in 12 patients, abdominal meteorism in 10, typical typhus tongue in none. Typhus state was not found in any of the patients. Normal leucocyte count was found in 7 patients, positive Widal's agglutination reaction in 13, coproculture in 8 and hemoculture in 15 patients. The atypical clinical picture was the result of early administration of broad-spectrum antibiotics before the established etiology of the febrile state.

[Pneumococcal meningitis from 1974 to 1984]. / Meningitis pneumococcica u periodu 1974-1984. godine.

We examined a group of 22 patients presented with the acute infective meningeal syndrome. Lumbar punction confirmed diagnosed purulent meningitis--meningoencephalitis, and bacteriologic liquor culture identified Streptococcus pneumoniae as a cause of the disease. Patients were mostly aged over 30. Clinical picture revealed signs of general infection and the meningeal syndrome. The severity of the disease was assessed on the basis of apparent signs of general infection, state of consciousness and endotoxic shock symptoms. Severe consciousness disorders were present in 16 (72.72%) patients. In our patients possible pneumococcus infection foci were: sinusitis, otitis media, pneumonia, mastoiditis and adnexitis. Lethal outcome occurred in 5 (22.72%) patients. In the therapy we used penicillin, chloramphenicol and ampicillin along with corticosteroid administration.

[Mumps infection and disorders of glucose tolerance]. / Mumps infekcija i poremecaji glikozne tolerancije.

In the last few years there is a more frequent appearance of papers which suggest the viral etiology of juvenile diabetes mellitus, where the mumps virus is primarily pointed to as the etiological factor. Since there is a high incidence of diabetes in our Province as well as the presence of an epidemic appearance of mumps infections, we were of the opinion that there was good reason for us to study the influence of mumps infection on glucose tolerance. With our research we have proved that mumps leads to the disturbances of carbohydrate metabolism and this is the case not only in the acute stage of infection but also in the course of a two-year follow-up, and they develop as a consequence of the direct influence of the virus on the beta cells of the pancreas. Glucose tolerance disturbances were not in correlation with the changes on the exocrine part of the pancreas neither in the acute stage nor in reconvalescence. Hereditary factors also didn't influence the more frequent appearance of these disturbances in persons with a hereditary disease, which was confirmed statistically also (X2 = 0.67). By research we have proved that disturbances which take the course of the "slow virus infection" type also occur and that they are statistically more significant (X2 = 22.31) in relation to the glucose tolerance disturbances which develop due to a direct activity of the mumps virus.