Brucellosis in children in Bosnia and Herzegovina in the period 2000 - 2013.

AIM: To analyse clinical, laboratory and epidemiological characteristics of brucellosis in children in Bosnia and Herzegovina. METHODS: The study included 246 children aged 0-18 years, who were hospitalized in Clinics and Departments for Infectious Diseases in Tuzla, Sarajevo, Banja Luka, Zenica and Bihac in the period 2000-2013, in whom the diagnosis of brucellosis was established based on anamnestic data, clinical features and positive results from blood culture and/or positive results from one of the serological tests. RESULTS: In this period, a total of 2630 patients, 246 (9.35%) of whom were children, were treated from brucellosis at the Clinics and Departments in Bosnia and Herzegovina. In the majority of cases, the children were from rural parts of the country, 226 (91.87%);214 (87.04%) cases had direct contact with sick animals, sick family member or consumption of unpasteurized dairy products from farms where brucellosis had been already established. Male children predominated, 157 (63.82%). The most frequent clinical features in affected children were fever, 194 (78.86%) and joint pain, 158 (64.22%). The average duration of antimicrobial treatment was 42.85 ± 10.67 days. A total of 228 (92.68%) children were completely cured, while relapses occurred in 18 (7.32%) children. CONCLUSION: Since brucellosis is an endemic disease in Bosnia and Herzegovina, it is important that physicians in their daily practice consider brucellosis and establish proper diagnosis and therapy in children with prolonged fever, arthralgia, leukopenia and positive epidemiological data, especially in rural parts of the country.

The importance of serum procalcitonin in diagnosis and treatment of serious bacterial infections and sepsis.

The clinical utility of serum procalcitonin (PCT) levels continues to evolve. PCT is regarded as a promising candidate marker for making a diagnosis and antibiotic stewardship in patients with systemic infections. The aim of this review is to summarize the current evidence for PCT in different infections and clinical settings, and to discuss the reliability of this marker when used with validated diagnostic algorithms.

Therapeutic approach to chickenpox in children and adults--our experience.

INTRODUCTION: Chickenpox is highly contagious childhood disease which occurs as a result of varicella-zoster virus primary infection. Symptomatic therapy is usually adequate for chickenpox, but in some cases it requires combinations of antiviral drugs and antibiotics. OBJECTIVES: To present our expirience with chickenpox therapy in children and adult patients. MATERIAL AND METHODS: Study included 120 randomly chosen patients, 60 adults and 60 children, with confirmed chickenpox infection, hospitalised at Clinic for infectious diseases in Sarajevo. Observed period was 1st January 2005. to 30th June 2011. We compared used therapy and outcome of disease. RESULTS: We had 333 patients with confirmed chickenpox in mentioned period. Male sex prevailed. Antiviral (acyclovir) therapy was initiated in 8(13.5%) adults and 16(27%) children. Most frequently used antibiotic was Co-Amoxiclav in a group of adults and Ceftriaxone in a group of children. DISCUSSION AND CONCLUSION: We use different terapeutical approaches to chickenpox according to the severity of the clinical picture and the existence of underlying diseases. Symptomatic treatment is indicated in all immunocompetent patients with no signs of complications. Use of corticosteroids remains open dillemma. Our therapeutical approcach followed by actual guidelines proved to be usefull. No death cases were recorded in these

Osteoarticular manifestations of brucellosis.

INTRODUCTION: Osteoarticular manifestations of human brucellosis occur in 20-40% of patients while spondylodiscitis is the most severe form of the bone and joint structures involvements. AIM: The aim of this paper is tho show clinical and radiological caracteristics of osteoarticular forms of brucellosis, with special reference to spondylodiscitis. MATERIAL AND METHODS: The medical histories of 120 hospitalized patients at the Clinic for Infectious Diseases, Clinical Center of Sarajevo University, diagnosed with brucellosis, were analyzed. RESULTS: Osteoarticular manifestations had sixty-nine patients, representing 78.4% of all localized forms of the disease. Spondylodiscitis represents 40.6% of all osteoarticular manifestations of the disease. Nine patients (32.1%) had paravertebral and paraspinal abscess. Median diagnostic interval for spondylodiscitis (116 +/- 160 days) was almost twice prolonged compared to the arthritis and sacroilitis (p < 0.05). The most common radiological manifestations were erosions of the vertebral surface (67.8%). Computerized tomography confirmed inflammation in 85.2% of the patients, while magnetic resonance imaging (MRI) showed radiological alterations in all patients (100%). DISCUSSION AND CONCLUSION: Osteoarticular manifestations are the most common localised forms of brucellosis. The frequency of spondylodiscitis is in relation to duration of the diagnostic time. MRI shows a high degree of sensitivity to inflammatory changes of spine and "Pedro Pons' sign" is patognomic radiological alteration.

Cellulitis--epidemiological and clinical characteristics.

INTRODUCTION: Cellulitis is acute skin infection and/or infection of subcutaneous tissue, mostly caused by Streptococcus pyogenes and Staphylococcus aureus. Clinical preview is usually obvious and enough for diagnosis. Tretment is antimicrobial therapy. In recurrent cases a prophylaxis is very often needed. OBJECTIVES: Analysis some of the epidemiological and clinical characteristics of cellulitis. PATIENTS AND METHODS: Retrospective analysis of medical documentation of patients with clinical preview of cellulitis who were hospitalized in Clinic for infective diseases of Clinical Center of University of Sarajevo in last three years. RESULTS: In period of three years 123 patients were hospitalized with clinical preview of cellulitis in the broadest sense of the word. In 123 of cellulitises, 35/123 (28.45%) were erisipelases-superficial type and 88/123 (71,55%) were deep cellulitises. Men were more affected 56,09%, average of age was 50.22 years. Before hospitalization patients had ambulance treatment in average of 5.12 days, and hospitalization was long in average of 13.33 days. Risk factors wich contributes to the disease were found in 71.54% of cases. Due to localisation, skin disorders on lower limb were the most frequent 71.56%, cellulitis of upper limb were found in 12.19%, head and/or neck in 13.08%, trunk in 3.25%. Repetition of disease were found in 4.8% in patients wtih risk factors. Bacteremic isolats were confirmed in 27.64% of cases. In all patients empirical antibiotic treatment were started, in the 62.60% the first choice of medicine was antibiotic from the group of lincosamides. CONCLUSION: Cellulitis is very serious disease that can be prevented.

Brucella endocarditis in prosthetic valves.

CONFLICT OF INTEREST: none declared. INTRODUCTION: Brucella endocarditis (BE) is a rare but severe and potentially lethal manifestation of brucellosis. Pre-existing valves lesions and prosthetic valves (PV) are favorable for BE. CASE REPORT: We represent the case of a 46-year-old man who was treated at the Clinic for Infectious Diseases, Clinical Center of Sarajevo University, as blood culture positive (Brucella melitensis) mitral and aortic PV endocarditis. He was treated with combined anti-brucella and cardiac therapy. Surgical intervention was postponed due to cardiac instability. Four months later he passed away. Surgery was not performed.

Varicella Pneumonia in a 39-year-old Female in Third Trimester Twin Pregnancy.

CONFLICT OF INTEREST: none declared. INTRODUCTION: Chickenpox is disease caused by varicella-zoster virus (VZV), with possibly devastated consequences during pregnancy, for mother and neonate. Pneumonia is most common complication in pregnancy with very high mortality. CASE REPORT: A 39-year-old female in third trimester twin pregnancy, referred to Clinic for infectious diseases in Sarajevo, with five days history of illness. Before the admission her condition get worse, with fatigue, exhaustion, and shortness of breath. In a first three days patient was febrile, tachydispnoic and ortopnoic. We started therapy with acyclovir and antibiotic. After four days we had detoriation in patient's condition. Chest X-ray revealed infiltrative shadows in basal parts of lung. Antimicrobial therapy was changed and corticosteroids were associated. Significant improvement was noticed after five days of therapy. CONCLUSION: Varicella pneumonia during third trimester may have serious consequences for mother and child, with possible fatal outcome.

Complicated Varicella Infection at 8-year-old Boy with Pulmonary Agenesis.

CONFLICT OF INTEREST: none declared. INTRODUCTION: Varicella or chickenpox is highly contagious, childhood infectious disease caused by primary infection with varicella - zoster virus from the herpes family of viruses. Usually it has a mild clinical course, rarely with described complication, mostly affecting respiratory tract and rarely the central nervous system. CASE REPORT: The case present 8 year old boy hospitalized eighth day of disease with clinical pictures of varicella complication. Upon receipt tachydyspnea, high fever, tachycardia, hypotensive with positive findings on lung auscultation in the sense of pneumonia. Extremely high values of non-specific inflammatory parameters are implied on bacterial infection which is treated using triple antimicrobial therapy and antiviral. A detailed clinical, laboratory and radiological evaluation is determined of clinical disease complication under a picture of MODS that required prolonged multidisciplinary treatment in ICU. CONCLUSION: The disease had a favorable clinical outcome in terms of training completely without consequences but, with the detected congenital absence lower lobe of right lung and transposition of the brachiocephalic trunk.

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.

Brucella melitensis: review of the human infection case.

During the last several years, brucellosis has become an important public-health problem on a large territory part of Bosnia and Herzegovina. The disease belongs to the zoonosis group, and can be caused by several bacterium species from Brucella genus. For human and veterinarian medicine, B. abortus, B. melitensis, B. suis and B. canis from Brucella genus are important, while other brucella species are found only in animals. The results of laboratory process of isolating Brucella melitensis, as well as of detection of specific antibacterial antibodies, are presented in this work. Namely, B. melitensis was isolated from blood samples (chemo-culture), as a causal agent of disease in one sixty years-old patient, treated during 2001. In pair serum samples of the patient, the presence of specific anti-brucella antibodies was confirmed qualitatively and quantitatively. In the serum I, ELISA test confirmed the presence of specific IgM antibodies of 25,7 U/ml, and IgG antibodies of 252 U/ml. In the serum II, IgM antibodies of 24,9 U/ml, and IgG antibodies of 311 U/ml were found. These results suggest and confirm established work diagnosis, and etiology causality of the disease with isolated bacterium.

[Electron microscopy study and clinical characteristics of rotavirus disease]. / Elektronskomikroskopsko ispitivanje i klinicke karakteristike rotavirusne bolesti.

In this paper it is been described method of electronic microscopy applied for discovering characteristic morphology of rotaviruses in samples of stools of infected and hospitalized patients. To have electronic microscopy as standard method it is necessary to know morphology or structure of the researched microorganism. In the second part of the paper we have made clinical epidemiological analysis of the rotavirus infection on the examined samples, and made comparison with result of other researches. Out of 78 patients with diarrhea, in 15 or 19.2% have been proofed presents of rotaviruses in the stool samples. All hospitalized patients had diarrhea (100%), vomiting was present in 90.9%, high temperature to 39C in 63.6% and over 39C in 36.4% patients. Stomachache was registered in 36.3% and blood in stool has not been found. Majority of the hospitalized had some respiratory syndromes. Time of hospitalization was between 6 to 13 days with average of 9.5 days. Death of hospitalized was not registered.