Bivalvular Staphylococcus aureus endocarditis in a young pregnant woman without known previous risk factors – a case report

Infektivni endokarditis značajan je uzrok pobola i smrtnosti. Posebno je težak klinički entitet u trudnica s obzirom na određeni stupanj imunosupresije u trudnoći, kao i zbog značajnih promjena kardiovaskularne funkcije u trudnica. Većina infektivnih endokarditisa, pa i u trudnoći, uzrokovana je bakterijama, a dominantno je zahvaćen jedan srčani zalistak, najučestalije mitralnog ušća. U ovom radu je prikazan slučaj liječenja i ishoda endokarditisa mitralnog i aortnog zaliska uzrokovanog bakterijom Staphylococcus aureus u prethodno zdrave trudnice.Infectious endocarditis is a significant cause of morbidity and mortality. It is a particularly difficult clinical entity in pregnant women due to a certain degree of immunosuppression in pregnancy, as well as due to significant changes in cardiovascular function in pregnant women. Most infectious endocarditis cases, even in pregnancy, are caused by bacteria, with one heart valve, most commonly the mitral orifice, predominantly affected. This paper presents treatment and outcome of mitral and aortic valve endocarditis caused by Staphylococcus aureus in a previously healthy pregnant woman

The Many Faces of Cat Scratch Disease – A Report of Four Cases

Bolest mačjeg ogreba (BMO) infekcija je uzrokovana Gram negativnom, fakultativno intracelularnom bakterijom Bartonella henselae. Glavni rezervoar infekcije je mačka i oko 75% bolesnika ima podatak o ogrebu ili ugrizu mačke u anamnezi. Rjeđe se infekcija javlja u kontaktu s psom, posredovano mačjom buhom ili neizravnim kontaktom oštećene kože ili sluznice s površinom kontaminiranom mačjom slinom. Infekcija može proći asimptomatski, ali se i prezentirati spektrom kliničkih manifestacija. U 85-90 % bolesnika radi se o klasičnoj BMO s kožnom lezijom i samoograničavajućim, regionalnim limfadenitisom dok ostale, rjeđe kliničke manifestacije, mogu zahvatiti gotovo svaki organ i organski sustav. Prikazujemo četiri bolesnika s BMO liječenih u Klinici za infektivne bolesti Kliničkog bolničkog centra Rijeka te raspravljamo o dijagnostičkim i terapijskim izazovima ove bolesti.Cat scratch disease (CSD) is an infection caused by the Gram negative, facultative intracellular bacteria Bartonella henselae. The main reservoir of the infection is cat and about 75% of the patients have a cat scratch or a bite in anamnesis. Rarely, infection results from exposure to dogs, cat fleas or from contact with cat saliva through broken skin or mucosal surfaces. Infection can be asymptomatic or present with a number of clinical manifestations. In wast majority (85-90%) of the patients CSD presents as a cutaneous lesion and self-limiting, regional lymphadenitis near the site of organism inoculation, other seldom manifestations, however, can include virtually every organ and organ system. We present four patients with CSD treated at the Clinical Hospital Center Rijeka and discuss diagnostic and therapeutic challenges of the CSD

Tick-Borne Encephalitis Due to Consumption of Raw Goat Milk, Gorski kotar, 2019: Clinical Case Reports

Virus krpeljnog meningoencefalitisa (KME) najčešći je uzročnik infekcija središnjeg živčanog sustava u endemskim područjima srednje Europe. Radi se o prirodno žarišnoj zoonozi, čiji rezervoar čine šumski glodavci, domaće i divlje životinje, a čovjek se zarazi prigodno, ubodom inficiranog krpelja. U posljednje je vrijeme sve više izvješća o epidemijama KME povezanih s konzumacijom svježeg mlijeka i mliječnih proizvoda. Cilj je rada prikazati kliničke značajke i tijek bolesti kod oboljelih od KME u tijeku grupiranja u Primorsko- goranskoj županiji (lipanj 2019. godine), povezanog s konzumacijom nepasteriziranog kozjeg mlijeka iz istog izvora. Tri su bolesnika hospitalizirana s kliničkom slikom meningitisa, a kod dvoje se infekcija prezentirala kao febrilna bolest s mijalgijama i općom slabošću. Kod svih je bolesnika infekcija potvrđena serološkom obradom. Niti jedan bolesnik nije bio cijepljen protiv KME niti je imao podatak o ugrizu krpelja. Ovim radom želimo ukazati na zdravstvene opasnosti prehrambenih navika konzumiranja sirovog mlijeka koje u današnje vrijeme postaje sve popularnije, osobito među zagovornicima „zdrave hrane“.Tick-borne encephalitis (TBE) is the most common central nervous system (CNS) infection in the endemic areas of Central Europe. TBE is a zoonosis whose reservoir are forest rodents, and other mammals and vectors are Ixodes ticks. Humans become infected through a tick bite, but recently many TBE outbreaks after consumption of unpasteurized milk and dairy products from infected livestock have been described. The aim of this study was to analyze clinical characteristics of five TBE cases who were infected after consumption of unpasteurized goat milk and dairy products from a small family farm in Primorje-Gorski Kotar County (June 2019). Tree patients developed CNS infection while two had febrile illness. None of the infected patients reported a history of a tick-bite or were vaccinated against TBE. The infection was confirmed by detection of TBE specific antibodies. Since "healthy" lifestyle that encourages consumption of raw milk and dairy products is increasingly fashionable, we would like to point out the importance of pasteurizing or boiling milk before the consumption

Temporal Bone Actinomycosis Accompanied by Actinomycotic Meningitis and Cervical Lymphadenitis – a Case Report

Aktinomikoza predstavlja rijetku kroničnu infekciju uzrokovanu anaerobnom, Gram pozitivnom bakterijom koja pripada rodu Actinomyces. U ovom smo radu prikazali slučaj aktinomikoze temporalne kosti i meningitisa uzrokovanog Aktinomicetama te limfadenitisa vrata kod imunokompetentne bolesnice s anamnezom kroničnog supurativnog otitisa nakon traumatske perforacije bubnjića starijeg datuma. Liječenje je uspješno provedeno kombiniranom kirurškom i dugotrajnom antimikrobnom terapijom. Ovim prikazom želimo skrenuti pozornost na meningitis kojeg uzrokuje Actinomyces spp. te kojeg je, iako je rijedak, potrebno uključiti u diferencijalnu dijagnozu kroničnog meningitisa, osobito kod pacijenata s kroničnom upalom srednjeg uha i paranazalnih sinusa. Jednako tako, želimo skrenuti pozornost i na ostale manifestacije ove rijetke bolesti.Actinomycosis represents rare chronic infection caused by anaerobic, Gram positive bacteria belonging to Actinomyces genus. Here we present a case of temporal bone actinomycosis accompanied by meningitis and cervical lymphadenitis in imunocompetent patient with case history of chronic suppurative otitis media as a tympanic membrane perforation sequelae. The patient was successfully treated with both surgical and prolonged antimicrobial therapy. This case, although rare, implies cosideration of Actinomyces spp. in diferential diagnosis of chronic meningitis, especially in patients with case history of chronic otitis media or chronic sinusitis

Imunološki nadzor prirođene citomegalovirusne infekcije mozga u novookoćenih miševa - zaštitna uloga stanične imunosti i protuvirusnih protutijela : doktorski rad

Cilj istraživanja: analizirati koje stanice imunog sustava imaju ulogu u kontroli infekcije u mozgu novookoćenih miševa inficiranih mišjim citomegalovirusom (MCMV). Ispitati ulogu protutijela specifičnih za virus u sprječavanju ulaska virusa u središnji živčani sustav (SŽS), razvoja encefalitisa i posljedičnih neuroloških poremećaja u inficiranih novookoćenih miševa. Materijal i metode: novookoćene miševe intraperitonealno smo inficirali divljim tipom MCMV-a 6 do 12 sati po okotu u dozi od 5 x 102 infektivnih čestica virusa (engl. plaque forming units, PFU). Kinetiku MCMV infekcije (razmnožavanja virusa) u mozgu i parametre razvoja encefalitisa (infiltrati mononuklearnih stanica, zadebljanja stijenki krvnih žila, postojanje glijalnih čvorića, upalne promjene moždanih ovojnica) smo pratili tijekom tri tjedna po infekciji. Imune stanice smo izolirali iz mozga inficiranih miševa te protočnim citometrom pomoću specifičnih protutijela analizirali njihov fenotip i aktivacijski status. Neutralizirajuća protutijela specifična za virus injicirali smo inficiranim miševima petog ili devetog dana nakon infekcije te analizirali razinu virusne infekcije u mozgu, broj patohistoloških lezija nastalih tijekom razvoja encefalitisa i parametre neurološkog razvoja mozga (debljina vanjskog zrnatog sloja kore i veličina malog mozga te morfologija Purkinjeovih stanica). Rezultati: u novookoćenih miševa inficiranih MCMV-om sedmog dana po infekciji razvija se encefalitis karakteriziran infiltracijom mononuklearnih stanica, aktivacijom mikroglije i promjenom morfologije stijenki krvnih žila. Kao odgovor na nazočnost virusa u SŽS ulaze stanice imunog sustava. Prve stanice koje nalazimo u mozgu inficiranih životinja su prirodne ubilačke stanice (stanice NK), koje možemo izolirati iz mozga krajem prvog tjedna po infekciji. U drugom tjednu nakon infekcije u mozgu inficiranih novookoćenih miševa nalazimo aktivirane V mikroglija stanice, monocite i limfocite T. Najveći udio imunih stanica u inficiranom mozgu zauzimaju CD4+ i CD8+ limfociti T. CD8+ limfociti T brojčano su dominantne imune stanice u inficiranom mozgu te posreduju u rezoluciji aktivnog umnožavanja virusa u SŽS-u. Značajan udio CD8+ limfocita T jesu limfociti specifični za proteine MCMV-a i ove stanice ostvaruju svoj antivirusni učinak lučenjem interferona gamma (IFN-γ). CD8+ limfociti T izolirani iz mozga inficiranih novookoćenih miševa imaju zaštitni učinak na razvoj MCMV infekcije što smo pokazali prijenosom ovih stanica u odrasle imunodeficijentne miševe inficirane MCMV-om. U ovih životinja je titar virusa u organima bio značajno niži u odnosu na inficirane kontrolne miševe koji nisu primili izolirane stanice. Protutijela specifična za virus također su se pokazala zaštitnima pri infekciji mozga u novookoćenih miševa inficiranih MCMV-om. U životinja kojima smo prenijeli protuvirusna protutijela petog dana nakon infekcije umnožavanje virusa u mozgu bilo je značajno manje u odnosu na kontrolne životinje koje nisu primile protutijela. Također, životinje kojima smo prenijeli protuvirusna protutijela razvile su blaži oblik encefalitisa. Posljedično, u ovih životinja poremećaji razvoja malog mozga opisani u novookoćenih miševa inficiranih MCMV-om bili su manje izraženi u odnosu na inficirane novookoćene miševe koji nisu primili imunoterapiju. Zaključak: u ovom radu opisane su komponente imunog odgovora koje sudjeluju u nadzoru MCMV infekcije u mozgu novookoćenih miševa. Po prvi puta je dokazana uloga CD8+ limfocita T u nadzoru virusa u SŽS-u u novookoćenih miševa, kao i protektivni kapacitet ovih stanica, izoliranih iz mozga inficiranih novookoćenih miševa, da kontroliraju MCMV infekciju u odraslih imunodeficijentnih miševa. Nadalje, pokazana je zaštitna uloga protutijela specifičnih za virus u sprječavanju razmnožavanja virusa u mozgu. Posljedično, pokazali smo da životinje tretirane VI protuvirusnim protutijelima razvijaju blaži oblik encefalitisa što rezultira poboljšanim razvojem malog mozga.Objectives: to analyze the components of the immune response that play a role in the control of the infection in brain of newborn mice infected with murine cytomegalovirus (MCMV). To analyze the role of virus-specific antibodies in the prevention of MCMV infection in the central nervous system (CNS), development of encephalits and neurological disorders that accompany MCMV infection in brain of newborn mice. Material and methods: newborn mice were intraperitoneally infected with 5 x 102 PFU of MCMV (wild type, Smith strain) 6 to 12 hours after birth. Kinetics of virus replication and development of encephalitis was followed through three weeks period following infection. Immune cells were isolated from infected brains and analyzed by flow cytometry. Virus-specific antibodies were inoculated into infected newborn mice at day 5 or day 9 post infection in order tho analyze the effect of antibodies onto virus entry into the CNS, virus replication in the brain and development of encephalitis. Additionaly, we analyzed the role of antibody treatment on the cerebellum development of infected newborn mice (cerebellum external granular layer thickness and the morphology of Purkinje neurons). Results: in newborn mice infected with MCMV the virus can be detected in the CNS at day 7 post infection which is accompanied by development of encephalits. Inflammatory response is characterized with the infiltration of mononuclear cells, microglia activation and perivascular cuffing. Immune cells infiltrate into infecetd brain. First cells which can be detected in brain parenchyma are NK cells, already at day 7 post infection. Infiltration of NK cell is followed by activation of microglia cells, infiltration of monocytes and T lymphocytes. CD4+ and CD8+ T lymphocytes predominate in the brain of infected newborn mice, but CD8+ T cells highly VIII outnumber CD4+ T cells. Significant amount of CD8+ T lymphocytes is specific for several MCMV encoded proteins. These immune cells mediate their antiviral activity via production of IFN-γ. Activation of CD8+ T lymphocytes results in resolution of active virus replication in infected brain which makes these cells the key components of the immune response in control of MCMV infection in developing brain. CD8+ T lymphocytes isolated from brains of infected newborn mice showed protective capacity onto MCMV replication in various organs of infected adult immunodeficient mice. This result confirms that CD8+ T lymphocytes in newborn mice are fully competent immune cells to control MCMV infection. Virus-specific antibodies transferred into infected newborn mice showed to be protective in preventing virus replication in the brain and consequent development of MCMV-induced encephalitis. Infected newborn mice that received virus-specific antibodies on day 5 or 9 post infection had decreased virus titers in the brain, reduced inflammatory response and improved postnatal development of the cerebellum as compared to infected newborn mice that received control, non-specific antibodies. Conclusion: here we characterized the components of the immune response that play a role in control of MCMV-induced encephalitis in brains of infected newborn mice. We showed that CD8+ T lymphocytes have a predominant role in resolution of active virus replication in the newborn CNS and, when isolated from brains of infected newborn mice and passively transferred into adult immunocompromised recipients, are fully capable to control MCMV infection. Also, we showed that passive immunization of mice with virus-specific antibodies has a protective effect onto development of MCMV-induced encephalitis in newborn mice. Virus-specific antibodies reduce virus replication in newborn brain which results in decreased inflammatory response and improved cerebellum development. I

Imunološki nadzor prirođene citomegalovirusne infekcije mozga u novookoćenih miševa - zaštitna uloga stanične imunosti i protuvirusnih protutijela : doktorski rad

Cilj istraživanja: analizirati koje stanice imunog sustava imaju ulogu u kontroli infekcije u mozgu novookoćenih miševa inficiranih mišjim citomegalovirusom (MCMV). Ispitati ulogu protutijela specifičnih za virus u sprječavanju ulaska virusa u središnji živčani sustav (SŽS), razvoja encefalitisa i posljedičnih neuroloških poremećaja u inficiranih novookoćenih miševa. Materijal i metode: novookoćene miševe intraperitonealno smo inficirali divljim tipom MCMV-a 6 do 12 sati po okotu u dozi od 5 x 102 infektivnih čestica virusa (engl. plaque forming units, PFU). Kinetiku MCMV infekcije (razmnožavanja virusa) u mozgu i parametre razvoja encefalitisa (infiltrati mononuklearnih stanica, zadebljanja stijenki krvnih žila, postojanje glijalnih čvorića, upalne promjene moždanih ovojnica) smo pratili tijekom tri tjedna po infekciji. Imune stanice smo izolirali iz mozga inficiranih miševa te protočnim citometrom pomoću specifičnih protutijela analizirali njihov fenotip i aktivacijski status. Neutralizirajuća protutijela specifična za virus injicirali smo inficiranim miševima petog ili devetog dana nakon infekcije te analizirali razinu virusne infekcije u mozgu, broj patohistoloških lezija nastalih tijekom razvoja encefalitisa i parametre neurološkog razvoja mozga (debljina vanjskog zrnatog sloja kore i veličina malog mozga te morfologija Purkinjeovih stanica). Rezultati: u novookoćenih miševa inficiranih MCMV-om sedmog dana po infekciji razvija se encefalitis karakteriziran infiltracijom mononuklearnih stanica, aktivacijom mikroglije i promjenom morfologije stijenki krvnih žila. Kao odgovor na nazočnost virusa u SŽS ulaze stanice imunog sustava. Prve stanice koje nalazimo u mozgu inficiranih životinja su prirodne ubilačke stanice (stanice NK), koje možemo izolirati iz mozga krajem prvog tjedna po infekciji. U drugom tjednu nakon infekcije u mozgu inficiranih novookoćenih miševa nalazimo aktivirane V mikroglija stanice, monocite i limfocite T. Najveći udio imunih stanica u inficiranom mozgu zauzimaju CD4+ i CD8+ limfociti T. CD8+ limfociti T brojčano su dominantne imune stanice u inficiranom mozgu te posreduju u rezoluciji aktivnog umnožavanja virusa u SŽS-u. Značajan udio CD8+ limfocita T jesu limfociti specifični za proteine MCMV-a i ove stanice ostvaruju svoj antivirusni učinak lučenjem interferona gamma (IFN-γ). CD8+ limfociti T izolirani iz mozga inficiranih novookoćenih miševa imaju zaštitni učinak na razvoj MCMV infekcije što smo pokazali prijenosom ovih stanica u odrasle imunodeficijentne miševe inficirane MCMV-om. U ovih životinja je titar virusa u organima bio značajno niži u odnosu na inficirane kontrolne miševe koji nisu primili izolirane stanice. Protutijela specifična za virus također su se pokazala zaštitnima pri infekciji mozga u novookoćenih miševa inficiranih MCMV-om. U životinja kojima smo prenijeli protuvirusna protutijela petog dana nakon infekcije umnožavanje virusa u mozgu bilo je značajno manje u odnosu na kontrolne životinje koje nisu primile protutijela. Također, životinje kojima smo prenijeli protuvirusna protutijela razvile su blaži oblik encefalitisa. Posljedično, u ovih životinja poremećaji razvoja malog mozga opisani u novookoćenih miševa inficiranih MCMV-om bili su manje izraženi u odnosu na inficirane novookoćene miševe koji nisu primili imunoterapiju. Zaključak: u ovom radu opisane su komponente imunog odgovora koje sudjeluju u nadzoru MCMV infekcije u mozgu novookoćenih miševa. Po prvi puta je dokazana uloga CD8+ limfocita T u nadzoru virusa u SŽS-u u novookoćenih miševa, kao i protektivni kapacitet ovih stanica, izoliranih iz mozga inficiranih novookoćenih miševa, da kontroliraju MCMV infekciju u odraslih imunodeficijentnih miševa. Nadalje, pokazana je zaštitna uloga protutijela specifičnih za virus u sprječavanju razmnožavanja virusa u mozgu. Posljedično, pokazali smo da životinje tretirane VI protuvirusnim protutijelima razvijaju blaži oblik encefalitisa što rezultira poboljšanim razvojem malog mozga.Objectives: to analyze the components of the immune response that play a role in the control of the infection in brain of newborn mice infected with murine cytomegalovirus (MCMV). To analyze the role of virus-specific antibodies in the prevention of MCMV infection in the central nervous system (CNS), development of encephalits and neurological disorders that accompany MCMV infection in brain of newborn mice. Material and methods: newborn mice were intraperitoneally infected with 5 x 102 PFU of MCMV (wild type, Smith strain) 6 to 12 hours after birth. Kinetics of virus replication and development of encephalitis was followed through three weeks period following infection. Immune cells were isolated from infected brains and analyzed by flow cytometry. Virus-specific antibodies were inoculated into infected newborn mice at day 5 or day 9 post infection in order tho analyze the effect of antibodies onto virus entry into the CNS, virus replication in the brain and development of encephalitis. Additionaly, we analyzed the role of antibody treatment on the cerebellum development of infected newborn mice (cerebellum external granular layer thickness and the morphology of Purkinje neurons). Results: in newborn mice infected with MCMV the virus can be detected in the CNS at day 7 post infection which is accompanied by development of encephalits. Inflammatory response is characterized with the infiltration of mononuclear cells, microglia activation and perivascular cuffing. Immune cells infiltrate into infecetd brain. First cells which can be detected in brain parenchyma are NK cells, already at day 7 post infection. Infiltration of NK cell is followed by activation of microglia cells, infiltration of monocytes and T lymphocytes. CD4+ and CD8+ T lymphocytes predominate in the brain of infected newborn mice, but CD8+ T cells highly VIII outnumber CD4+ T cells. Significant amount of CD8+ T lymphocytes is specific for several MCMV encoded proteins. These immune cells mediate their antiviral activity via production of IFN-γ. Activation of CD8+ T lymphocytes results in resolution of active virus replication in infected brain which makes these cells the key components of the immune response in control of MCMV infection in developing brain. CD8+ T lymphocytes isolated from brains of infected newborn mice showed protective capacity onto MCMV replication in various organs of infected adult immunodeficient mice. This result confirms that CD8+ T lymphocytes in newborn mice are fully competent immune cells to control MCMV infection. Virus-specific antibodies transferred into infected newborn mice showed to be protective in preventing virus replication in the brain and consequent development of MCMV-induced encephalitis. Infected newborn mice that received virus-specific antibodies on day 5 or 9 post infection had decreased virus titers in the brain, reduced inflammatory response and improved postnatal development of the cerebellum as compared to infected newborn mice that received control, non-specific antibodies. Conclusion: here we characterized the components of the immune response that play a role in control of MCMV-induced encephalitis in brains of infected newborn mice. We showed that CD8+ T lymphocytes have a predominant role in resolution of active virus replication in the newborn CNS and, when isolated from brains of infected newborn mice and passively transferred into adult immunocompromised recipients, are fully capable to control MCMV infection. Also, we showed that passive immunization of mice with virus-specific antibodies has a protective effect onto development of MCMV-induced encephalitis in newborn mice. Virus-specific antibodies reduce virus replication in newborn brain which results in decreased inflammatory response and improved cerebellum development. I

Diagnostic accuracy of three SARS-CoV2 antibody detection assays, neutralizing effect and longevity of serum antibodies

Evidence is currently insufficient to know whether SARS-CoV-2 antibodies (Abs) protect from future infection and how long immunity will last. The kinetics of the immune response to SARS-CoV-2 infection and role of serology in estimating individual protective immunity is yet to be established. We evaluated diagnostic performances of three serological assays - Abbott Architect CMIA IgG, bioMerieux VIDAS ELFA IgG/IgM, and Diesse Chorus ELISA IgG/IgM, and analyzed longevity and potential neutralizing effect of SARS-CoV-2 Abs in COVID-19 patients. Clinical sensitivities of assessed IgG tests two to three weeks post symptom onset (PSO) were very high: 96.77 % for Architect, 96.77 % for Chorus, and 100.00 % for VIDAS. Sensitivities of two assessed IgM assays were moderate: 74.07 % for Chorus, and 76.92 % for VIDAS. Specificities were excellent for all assessed IgG assays: 99.01 % for Architect and 100 % for Chorus and VIDAS. Chorus and VIDAS IgM assays also achieved excellent specificity of 99.01 % and 100 %, respectively. In most cases IgG Abs were still present eight months PSO. Neutralizing antibodies were detected in majority of serum samples from convalescent patients. Serum samples from severe COVID-19 patients had higher antibody titers and higher neutralizing activity. We observed a strong positive correlation among SARS-CoV-2 IgG antibody titer and neutralizing activity. The strongest positive correlation to neutralizing activity was found for VIDAS IgG assay

Acute Pericarditis in Co-Infection with Anaplasma phagocytophilum and Borrelia burgdorferi - a Case Report

Lajmska borelioza i krpeljni meningoencefalitis (KME) najčešće su bolesti prenosive krpeljima u Republici Hrvatskoj. Isti vektor, krpelj roda Ixodes ricinus, odgovoran je i za prijenos humane granulocitne anaplazmoze (HGA) koja se u našoj zemlji rijetko dokazuje, a prvi slučajevi su potvrđeni 1998. godine u Koprivničko-križevačkoj županiji. HGA se najčešće klinički prezentira vrućicom s leukopenijom, trombocitopenijom, povišenim aminotransferazama i CRP-om, a potvrđuje se serološki, pri čemu se povremeno dokaže koinfekcija s virusom KME i/ili bakterijom Borrelia burgdorferi. Prikazujemo slučaj 44-godišnje bolesnice koja je ambulantno liječena u Klinici za infektivne bolesti Kliničkog bolničkog centra Rijeka zbog vrućice s bicitopenijom (leukopenija, trombocitopenija) i akutnog perikarditisa. Serološkom je obradom dokazana akutna koinfekcija uzročnicima Anaplasma phagocytophilum i Borrelia burgdorferi. Liječenje je provedeno doksiciklinom i nesteroidnim antireumaticima, čime je postignut povoljan klinički odgovor.Lyme borreliosis and European tick-borne encephalitis are the most common tick-borne infections in Croatia. The common vector, Ixodes ricinus, is also responsible for the transmission of human granulocytic anaplasmosis (HGA), which, in our country is rarely detected, and the first cases were confirmed in the Koprivnica-Križevci County in 1998. HGA most commonly presents as fever with leukopenia, thrombocytopenia and altered aminotransferases and C reactive protein. The diagnosis is usually confirmed serologically and coinfection with European tick-borne encephalitis virus and Borrelia burgdorferi is rarely diagnosed. We present a 44-year-old, previously healthy patient, treated for fever with bicytopenia (leukopenia, thrombocytopenia) and acute pericarditis. Acute coinfection with Anaplasma phagocytophilum and B. burgdorferi was established serologically. The patient was treated with doxycycline and nonsteroidal noninflammatory drugs with favourable clinical outcome

Epidemiology and Clinical Course of Haemorrhagic Fever with Renal Syndrome in New Endemic Area for Hantavirus Infection in Croatia

Background: Hantaviruses remain an important case of emerging and re-emerging infections in human medicine. This study aimed to analyse the epidemiology, clinical presentation, and outcome of hantavirus infections in the western part of Republic of Croatia, a new geographical area for hantavirus infections. Methods: Retrospective analysis of medical records of patients treated for hemorrhagic fever with renal syndrome (HFRS) at the infectious diseases Clinic of the Clinical Hospital Center in Rijeka, Croatia, from 1 January 2014, to 31 December 2021. Results: During the eight-year period, 251 patients were hospitalized and treated for HFRS, with epidemic outbreaks in years 2014 and 2021. Most patients had a typical clinical course of HFRS and received supportive care. Serological analysis revealed the Puumala Virus (PUUV) as the predominant etiology of the disease. Epidemiological analysis revealed clustering of infections in the region of Gorski Kotar and spread to the area on the Mediterranean coast (Adriatic Sea), which was previously considered an area free from hantavirus infections. Conclusions: The presented results indicate the spread of hantavirus infections in Croatia from the central low-lying parts of the country to the tourist-attractive western area adjacent to the Mediterranean coast, which was previously considered free of hantavirus infections

Validation of Diagnostic Accuracy and Disease Severity Correlation of Chest Computed Tomography Severity Scores in Patients with COVID-19 Pneumonia

The aim of our study was to establish and compare the diagnostic accuracy and clinical applicability of published chest CT severity scoring systems used for COVID-19 pneumonia assessment and to propose the most efficient CT scoring system with the highest diagnostic performance and the most accurate prediction of disease severity. This retrospective study included 218 patients with PCR-confirmed SARS-CoV-2 infection and chest CT. Two radiologists blindly evaluated CT scans and calculated nine different CT severity scores (CT SSs). The diagnostic validity of CT SSs was tested by ROC analysis. Interobserver agreement was excellent (intraclass correlation coefficient: 0.982–0.995). The predominance of either consolidations or a combination of consolidations and ground-glass opacities (GGOs) was a predictor of more severe disease (both p < 0.005), while GGO prevalence alone was not. Correlation between all CT SSs was high, ranging from 0.848 to 0.971. CT SS 30 had the highest diagnostic accuracy (AUC = 0.805) in discriminating mild from severe COVID-19 disease compared to all the other proposed scoring systems (AUC range 0.755–0.788). In conclusion, CT SS 30 achieved the highest diagnostic accuracy in predicting the severity of COVID-19 disease while maintaining simplicity, reproducibility, and applicability in complex clinical settings