[Family outbreak of cryptosporidiosis in Serbia: case report].

INTRODUCTION: Cryptosporidiosis is an acute infectious parasitic disease of the gastrointestinal tract, considered as zoonosis underestimated in immunocompetent population. The pathogen is primarily the cause of devastating diarrhea in AIDS patients. Solitary cases and small outbreaks in immunocompetent persons are rarely discovered. There is also a human strain of cryptosporidium. CASE OUTLINE: In December 2010, we examined three family members among whom each successively developed acute gastroenteritis. Their stools were liquid, light brown, without mucus or blood. All of them had abdominal cramps and generalized muscle pains. The daughter had fever and vomited during the first two days. The patients were administered symptomatic therapy. Complaints resolved after 10-17 days, with general condition moderately changed. Cryptosporidium was confirmed in the stool of patients who were second and third to contract the disease. We presumed that the first person released pathogen before the time of examination, although she still had diarrhea. All of them recovered completely. By epidemiologic survey we were unable to presume with certainty the source of infection. CONCLUSION: This is the first description of cryptosporidiosis in immunocompetent individuals in Serbia, which proves that it is present in our country, and that search for it should be included into a routine parasitological check-up of stool. Taking into account the distance in onset time complaints, all combinations are possible; from infection among family members (shortest incubation period) to family members infected from an identical source (different incubation period). Negative finding of the sample collected on the 7th day from the beginning of symptoms does not exclude the diagnosis in this particular situation. Further epidemiologic studies of this disease are necessary as it is clear that it exists in our population. At that moment we were unable to do typization.

[The efficacy of lamivudine in the treatment of reactivation of chronic hepatitis B virus infection in patients on immunosuppressive therapy].

INTRODUCTION: Reactivation of chronic hepatitis B virus (HBV) infection often occurs in hepatitis B surface antigen (HBsAg) positive patients undergoing immunosuppressive or chemotherapy, but can also occur in HBsAg negative, anti-HB core positive patients. Treatment of HBV reactivation with lamivudin results in favourable outcome in the majority of patients. The aim of the authors was to show the effect of lamivudin therapy to HBV reactivation caused by immunosuppressive therapy. OUTLINE OF CASES: The first patient was a 35-year-old woman with chronic hepatitis B virus infection who underwent prednisolone therapy for pulmonal sarcoidosis. Four months after the beginning of the therapy she presented with jaundice and a significant increase in serum aminotransferase level. Liver biopsy showed chronic viral B hepatitis of strong activity in the stage of rapidly developed cirrhosis. The patient was treated with lamivudine with slow reduction of prednisolone doses, which resulted in full clinical and biochemical recovery. The second patient was a 40-year-old HBsAg negative female with a previous history of resolved acute B hepatitis who received chemotherapy for non-Hodgkin lymphoma. After the third cycle of chemotherapy a significant increase in aminotransferase level occurred, chemotherapy was discontinued, but aminotransferase level still increased. At that moment she was found to be HBsAg positive, and PCR analysis detected a high viral load. Lamivudine treatment resulted in the patient's recovery and allowed further chemotherapy. CONCLUSION: In case of the reactivation of chronic HBV infection during immunosuppressive therapy, it should be stopped and antiviral therapy should be immediately initiated. The use of lamivudine results in rapid suppression of serum HBV DNA, improves the outcome and enables the continuation of immunosuppressive and chemotherapy.