Distribution of HCV genotypes among risk groups in Serbia.

Blood samples from 190 patients that were anti-hepatitis C virus (HCV) positive were genotyped and 165 were found to contain HCV-RNA. Genotyping was performed by PCR based on type-specific primers (117 isolates) and LiPA test (48 isolates) and verifying by sequencing. In Serbia, the most frequent genotype was 1b (49.1%), followed by genotype 3 (21.2%) and genotype 1a (8.5%). The frequency of genotypes 2 and 4 was below 5% and mixed infections were encountered in 9.1% of cases. Distribution of genotypes was monitored in different risk groups: intravenous drug abusers, patients under blood transfusion, patients with previous history of surgery, patients undergoing hemodialysis and those with unknown risk factors. Genotype distribution is essentially the same in all the groups, except for the patients undergoing hemodialysis and those with previous history of surgery where significant difference exists compared with the group with unknown route of transmission (p < 0.001 and p < 0.05, respectively). There exists significant age-dependent genotype 3 distribution in Serbian population (p < 0.01).

Estimation of chronic hepatitis C activity based on ultrastructural changes of hepatocytes.

Seventy four liver bioptic specimens of 66 patients with chronic hepatitis C were analyzed ultrastructurally and by light microscopy. According to histological activity of the disease, the patients were divided in groups with minimal activity (CPHa), mild activity (CPHb-CAHa), and moderate and severe activity (CAHb,c), respectively. The presence of lamelar, simple and complex lipid inclusions in the cytoplasm, as well as the presence of nuclear bodies and morphology of the nucleolus were analyzed by classic methods of transmission electron microscopy. Cytoplasmic lamelar inclusions were found in 84.6% of patients, and simple and complex lipid inclusions were noted in 85.1% of patients, without the differences related to histological and enzyme activity. Unaltered nucleolus was most frequently observed in patients with minimal disease activity (84.6%), viral changed in patients with mild activity (48.4%) and synthetic active in patients with moderate and severe activity (66%). Serum aminotransferase activity was significantly higher in patients with viral changed and synthetic active nucleolus. These results can indicate that HCV induces cytopathogenic and immunologic damage of hepatocytes. The presence of virus acts as toxic agent that damages hepathocytes' metabolism, thus resulting in occurrence of cytoplasmic lamelar, simple and complex lipid inclusions, respectively. Immunologic damages occur when the virus alters cell membrane of hepatocytes.

[Tonsillo-pharyngeal form of tularemia]. / Tonzilofaringealni oblik tularemije.

Clinical, laboratory and serologic features of tonsillopharyngeal form of tularemia in 14 patients were analyzed in the study. The disease was ignored under the diagnosis of typical tonsillopharyngitis followed by cervical lymphadenopathy. Routine laboratory analyses results were non-specific and didn't reveal the disease etiology, while microagglutination test (MAT) of F. tularensis in the second week of disease was positive in 86% of patients. Skin tularin test was positive in all the tested patients during the first week of the disease. The best results in the treatment were achieved by administration of streptomycin and doxycycline. Well timed therapy prevented the lymph nodes colliquation, disease recurrence and infection generalization. The authors point out the significance of this clinical form of tularemia in the differential diagnosis of tonsillopharyngitis and cervical lymphodenopathy.

[Viral hepatitis C. Personal experience with diagnostic, monitoring and epidemiologic studies]. / Virusni hepatitis C. Nasa iskustva u dijagnostici, pracenju i epidemioloskim ispitivanjima.

In the period from 1991 to 1993, 18 patients with the acute viral hepatitis type C were treated and followed up--13 men and 5 women, the average age of 42 years. The group of 6 patients (4 men and two women) with the "old" proven liver cirrhosis, whose etiology was unknown for 20 years, was analyzed. The investigations showed that the acute viral hepatitis type C usually began with the mild subjective disorders. The half of the patients did not have either jaundice or hepatomegaly, only half of them recover, and the first cases of cirrhosis could have been expected almost as early as a year after the beginning of illness. The developed liver cirrhoses remained compensated for years. About 58% of patients got infected parenterally, and the rest of them could have gotten infected in other manner. ELISA test showed great reliability in proving the antibodies against the viral hepatitis type C in the confirming the diagnosis of illness.

[Clinical manifestations of infectious erythema in adults]. / Klinicko ispoljavanje infektivnog eritema kod odraslih.

The infectious erythema is usually childhood disease associated with rash and caused by parvovirus B19. At the beginning of 1993., at the Clinic for infectious and tropical diseases of the Military Medical Academy 36 patients were treated for this disease, the average age 21 years. The prodromal phase of illness lasted approximately 2.9 days, the elevated temperature 5.2 days, and 17 patients had temperature above 39 degrees C. The rash was usually maculo-papullous and lasted about 6 days. Four patients had the recurrence of rash. The polyarthralgia appeared for short in six patients and in one patient lasted longer than 4 months. The mild anemia during infectious erythema was observed in 18 patients. IgM antiparvo B19 antibodies were proven in serum in 91.7%, and IgG antibodies in 58.3% of patients.

[Personal experience in the treatment of chronic viral hepatitis B with recombinant interferon B alfa-2]. / Nasa iskustva u lecenju hronicnog virusnog hepatitisa B alfa-2 rekombinantnim interferonom.

Twelve patients were treated with alpha-2 recombinant interferon during 4 months. Patients were given daily dose of 3 million units three times a week. Therapeutic effect expressed as the percentage of HBeAG seroconversion or by the loss of antibodies for the core antigen in IgM fraction and by the core antigen loss from hepatic tissue, was achieved in 41.6% of patients. Corticosteroids, administered before interferon, could improve therapeutic effect. Better response to therapy was observed in patients with higher serum transaminase levels and with histopathologically confirmed chronic hepatitis. Predictive value of each immunological parameter of therapeutic effect requires further study.

[Dissecting aortic aneurysm as a cause of fever of unknown origin]. / Disekantna aneurizma aorte kao uzrok nejasnog febrilnog stanja.

Dissecting aortic aneurysm is a clinical syndrome commonly with a dramatic course and a fatal prognosis. The disease often has a fatal ending at the very beginning, a few hours after the onset. High temperature happens sometimes, but is rarely a dominant symptom. We presented a case of a patient with a long term febrile state caused by dissecting aortic aneurysm, where pleuropneumenia covered the real nature of the disease. It has been pointed out that dissecting of aorta should be thought of in patients with unclear febrile states, especially if they have difficulties in the area of thorax.

[Endotoxemia in patients with food poisoning]. / Endotoksemija u bolesnika sa alimentarnom toksiinfekcijom.

In 22 patients with alimentary toxoinfection caused by salmonella and other gram-negative bacteria, endotoxemia was proved in 8 (36%) patients. The causative agent of the disease was proved in 11 (50%) of cases. In 6 (54%) patients the causative agent were from salmonella species: S. enteritidis, S. typhimurioum, S. hadar and S. heidelberg. Endotoxemia and positive coprocultures, that is, hemocultures were found in two patients respectively. In two patients with positive coprocultures and hemocultures, endotoxemia was found as well as in two patients with unknown causative agent. In patients with alimentary toxoinfection caused by salmonella and other gram-negative bacteria, endotoxemia occurred relatively often. Early detection of endotoxemia is important for application of urgent therapeutic measures and procedures, especially in immunocompromised patients.

[Clinical characteristics of Lyme disease]. / Klinicke karakteristike lajmske bolesti.

Clinical characteristics of Lyme disease were analysed in 22 patients. Erythema migrans was found in 20 (91%), arthralgia in 18 (81%), neuralgia in 8 (36%), encephalitis in 3 (13%), carditis in 2 (9%) and arthritis in 2 (9%) patients. The positive antibody titer was found in 14 (63%) patients. Favourable effects of antibiotic therapy was achieved in all patients. Erythema migrans has been manifested up to 12 days after tick sting and arthralgia, arthritis, neuralgia, hepatitis and chronic dermatitis within a year. Carditis and encephalitis have been developing from a month to ten years after tick sting. Lyme borreliosis is commonly manifested as a systemic disease. Together with the skin, most commonly have been involved ankle joints, heart and nervous system. The time from tick sting to the onset of first signs of the diseases varies by the involved organs.

[Changes in thyroid hormone levels in patients with acute viral hepatitis]. / Promene nivoa hormona stitaste zlezde u bolesnika sa akutnim virusnim hepatitisom.

In 10 patients with acute viral hepatitis A or B the dynamics of the concentrations of the thyroid hormones thyroxine (T4), triiodothyroxine (T3) and their coefficient T3/T4, and thyroid stimulating hormone (TSH) in all phases of hepatitis have been studied. In acute phase and in the fully developed clinical picture of the diseases, the increased T4 values and decreased values of T3, T3/T4 coefficient and TSH were found. These changes are explained by the slowed down deiodinization of T3 and T4 in hepatocytes as well as by the disturbed secretion of the thyroid hormone in hepatitis and they could be of some value in diagnosis and prognosis.

[Morphologic characteristics of HBV markers and products of iron metabolism in liver tissue in patients with hepatitis B virus]. / Neke morfoloske karakteristike markera HBV i produkata metabolizma gvozda u tkivu jetre bolesnika sa B virusnim hepatitisom.

In the histomorphologic analysis of 126 liver biopsies with hepatitis B virus (HBV) infection the authors have met some difficulties in the interpretation of findings of three biopsies which showed the presence of hemosiderine and ferritin deposits in hepatocytes. The lack of cells with the appearance of "ground glass", that is, ground glass hepatocytes which are one of the important features of HBV infection and aberration from the standard features in some histochemical stainings are noticed in all three biopsies. Since only few authors have noticed the same problem, it is possible that these results open new ways in the study of pathogenesis of HBV infection in the liver and its relationship with iron metabolism.

[Dissecting aortic aneurysm as the cause of a fever of unknown origin]. / Disekantna aneurizma aorte kao uzrok nejasnog febrilnog stanja.

Dissection of the aortic aneurysm is a clinical syndrome with the most dramatic course and bad prognosis. Fever is a frequent occurrence, but rarely a dominant symptom. The patient with a prolonged fever caused by dissecting aneurysm of the aorta in whom pleuropneumonia masked the real diseases has been presented.