Pisma uredništvu

Riječka infektologija u novom ruh

Antimicrobial treatment of infectious diarrhea and some intestinal parasitic diseases

Infektivni proljevi kao najučestaliji uzrok pobola i smrtnosti u svijetu, predstavljaju najvažniji svjetski javnozdravstveni problem. Klinička i epidemiološka analiza bolesnika ključna je u odluci izbora načina liječenja infektivnih proljeva. Iako je osnova liječenja infektivnog proljeva nadoknada izgubljene tekućine i elektrolita, stroge su indikacije za primjenu antimikrobne terapije. U članku ćemo prikazati najnovije smjernice u antimikrobnom liječenju infektivnih proljeva uz naglasak na korist i/ili moguće negativne posljedice primjene antibiotika u ovom kliničkom sindromu.Infectious diarrhea as a major cause of morbidity and mortality worldwide, is the most important global public health issue. Critical point in the treatment of infectious diarrhea is the definition of the type and the severity of the disease, based on clinical and epidemiological evaluation of the patient. Although adequate fluid and electrolyte replacement and maintenance are crucial in managing infectious diarrheal illness, antimicrobial therapy is indicated in a growing number of cases. Here we will review the latest guidelines in the antimicrobial therapy of diarrhea with the emphasis on the benefits and potential side-effects of the use of antibiotics in this clinical syndrome

Mycoplasma pneumoniae induced Stevens-Johnson syndrome

Stevens-Johnsonov sindrom (SJS) je teška bolest kože i sluznica karakterizirana target (iris) lezijama i nekrozom epidermisa kao posljedica reakcije preosjetljivosti potaknute lijekovima, infektivnim uzročnicima ili malignomima. Prikazujemo slučaj Stevens-Johnsonova sindroma u mlađeg muškarca potaknutog atipičnom upalom pluća uzrokovanom infekcijom Mycoplasma pneumoniae (M. pneumoniae). Primjena antimikrobne i kratkotrajne sistemske kortikosteroidne terapije uz simptomatske mjere rezultirala je izlječenjem bez zaostajanja trajnih posljedica.Stevens-Johnson syndrome (SJS) is a severe disease of the skin and mucous membranes characterized by target lesions and epidermal necrosis induced by hypersensitivity to medications, infections and malignancies. We present a case of Stevens-Johnson syndrome in a young male secondary to interstitial pneumonia caused by Mycoplasma pneumoniae (M. pneumoniae). Antimicrobial and short course systemic corticosteroid therapy combined with supportive measures resulted in a recovery without any long-term sequelae

Changes in hepatitis a epidemiology in Rijeka region (1992-1996)

Epidemiološke odlike hepatitisa A bile su dostatne za njegovo razlikovanje od ostalih virusnih hepatitisa. Posljednjih godina, međutim, javile su se nove rizične skupine i putovi prijenosa virusa. Ispitivanja na riječkom području pokazala su da se u potpunosti promijenila i dobna predispozicija bolesnka i najčešće se bolest registrira u skupini od 30. do 40. godine starosti.Epidemiological characteristics of hepatitis A were typical enough to distinguish it from other viral hepatitides. Recently, however, another epidemiologic sources important for disease spreading have been identified. Moreover our investigation in the Rijeka region showed that the age predisposing factor has changed, too. The age-group most commonly affected was between 30 and 40 years

Changes in hepatitis a epidemiology in Rijeka region (1992-1996)

Epidemiološke odlike hepatitisa A bile su dostatne za njegovo razlikovanje od ostalih virusnih hepatitisa. Posljednjih godina, međutim, javile su se nove rizične skupine i putovi prijenosa virusa. Ispitivanja na riječkom području pokazala su da se u potpunosti promijenila i dobna predispozicija bolesnka i najčešće se bolest registrira u skupini od 30. do 40. godine starosti.Epidemiological characteristics of hepatitis A were typical enough to distinguish it from other viral hepatitides. Recently, however, another epidemiologic sources important for disease spreading have been identified. Moreover our investigation in the Rijeka region showed that the age predisposing factor has changed, too. The age-group most commonly affected was between 30 and 40 years

Imported measles infection in an adult patient

Ospice ili morbili su visoko kontagiozna virusna osipna bolest. Dugogodišnje kontinuirano cijepljenje rezultiralo je eradikacijom morbila u većini zemalja svijeta. No, unatoč visokom cjepnom obuhvatu, morbili se i dalje sporadično pojavljuju u razvijenim zemljama, najčešće kao importirane infekcije. U ovom radu prikazan je slučaj odraslog bolesnika liječenog u Klinici za infektivne bolesti KBC Rijeka koji se prezentirao tipičnom kliničkom slikom morbila, bez komplikacija. Molekularnom dijagnostikom dokazan je virusni genom morbila u brisu nazofarinksa i urinu bolesnika dok je genotipizacija virusa pokazala da se radi o B3 genotipu morbila koji se endemski pojavljuje na Afričkom kontinentu. Epidemiološka anamneza i genotipizacija virusa dokazale su da se radi o importiranom slučaju morbila u odraslog bolesnika, pomorca, koji je akvirirao infekciju vraćajući se s radnog mjesta u Republiku Hrvatsku.Measles is a highly contagious viral infection mainly affecting children. Universal vaccination has significantly reduced measles incidence in developed world. However, imported cases, as well as smaller or larger epidemics still occur in highly vaccinated populations. Resurgence of measels is mainly the consequence of accumulation of susceptible subjects due to incomplete vaccination and anti-vaccinal movements. Here we present an adult patient treated at the Clinic for Infectious Diseases in Rijeka who presented with typical uncomplicated disease. Measles virus genome was detected in urine and genomic analysis has shown that the virus belongs to B3 genotype. Epidemiological and molecular analysis proved an imported case of measles in a patient who has occupationaly traveled outside Croatia

Significance of Continuous Medical Education of General Practitioners about Common Diseases – Iron Deficiency Anemia

Three years long, prospective study was performed in order to evaluate a possible influence of continuing medical education of general practitioners on managing the patients with common diseases such as iron deficiency anemia (IDA). Altogether 1586 patients that were referred to Hematology Outpatient Clinic, University Hospital Center Rijeka, Croatia due to diagnosis of IDA were examined by clinical hematologist during the first visit and follow up period, were questioned by the means of questionnaire and complete laboratory analyzes were performed in order to: evaluate physical condition and laboratory findings, to assess duration of anemia, possible other specialists’ consultation, iron supplementation therapy, and finally, determine the type of anemia present. Initial group of 983 patients was examined during one year period. Following the education campaign the same parameters were analyzed in comparable (final) group of 603 patients during next one year period. Following the education, the number of patients referred to Outpatient Clinic due to diagnosis of IDA was significantly decreased from 983 (61.97%) to 603 (38.02%) (p<0.05) as was the number of patients referred as having IDA but finally established to have a different type of anemia, from 661 (97.24%) to 149 (24.71%) (p<0.001). The number of patients started on iron supplementation therapy before establishing the type of anemia was significantly decreased from 543 (55.24%) to 76 (12.60%) (p<0.001) as well as duration of iron supplementation therapy administered in these cases (21±9.8 vs. 6±8.7 weeks) (p<0.001). We have detected a significant decrease in: time necessary for definitive diagnosis (49±19.2 vs. 28±9.1 weeks) (p<0.001), number of visits to other specialists (2.9±1.35 vs. 1.1±0.94) (p<0.05), duration of anemia before treatment initialization (41±29.8 vs. 26±18.7 weeks) (p<0.001). Average hemoglobin (Hg) level in patients referred to hematologist was significantly lower following education (98.9±15.5 vs. 82.6±14.2) (p<0.05). Continuing medical education of primary care physicians has significant role in diagnosis and treatment of patients with IDA. Education programs result in benefits for the patients and physicians

Mycoplasma pneumoniae induced Stevens-Johnson syndrome

Stevens-Johnsonov sindrom (SJS) je teška bolest kože i sluznica karakterizirana target (iris) lezijama i nekrozom epidermisa kao posljedica reakcije preosjetljivosti potaknute lijekovima, infektivnim uzročnicima ili malignomima. Prikazujemo slučaj Stevens-Johnsonova sindroma u mlađeg muškarca potaknutog atipičnom upalom pluća uzrokovanom infekcijom Mycoplasma pneumoniae (M. pneumoniae). Primjena antimikrobne i kratkotrajne sistemske kortikosteroidne terapije uz simptomatske mjere rezultirala je izlječenjem bez zaostajanja trajnih posljedica.Stevens-Johnson syndrome (SJS) is a severe disease of the skin and mucous membranes characterized by target lesions and epidermal necrosis induced by hypersensitivity to medications, infections and malignancies. We present a case of Stevens-Johnson syndrome in a young male secondary to interstitial pneumonia caused by Mycoplasma pneumoniae (M. pneumoniae). Antimicrobial and short course systemic corticosteroid therapy combined with supportive measures resulted in a recovery without any long-term sequelae

Ebola virus disease – emerging and re-emerging infectious disease

Ebola virusna bolest (EVB) je opasna, karantenska zarazna bolest čija se do sada najveća zabilježena epidemija pojavila u zapadnoj Africi krajem 2013.g. i početkom 2014.g. te se proširila u pet zemalja regije (Gvineja, Liberija, Nigerija, Sierra Leone i Mali). Tjekom kasnog ljeta 2014 je došlo do nepovezane epidemije u Demokratskoj Republici Kongo. Postoji pet vrsta virusa ebole [Zaire (EBOV), Sudan (SUDV), Bundibugyo (BDBV), Taï Forest (TAFV) i Reston (RESTV)] koji su svi endemski u Africi, osim soja Reston, koji je endemski i u dijelovima jugoistočne Azije i Kini. Rezervoarom virusa ebole smatraju se voćni šišmiši (ili letipsi), kod kojih su dokazana ebolavirusna RNA i antitijela, no nisu definitivno potvrđeni kao glavni rezervoari EBOV. Imunopatogeneza ebole je kompleksna i zahtijeva ozbiljna istraživanja. Teški oblici bolesti praćeni su brojnim komplikacijama, multiorganskim zatajenjem i znacima septičkog šoka. Smrtnost se kreće od 55 – 75%, ponekad i više. Preživjeli prolaze dugo razdoblje rekonvalescencije. Za sada nema odobrenog cjepiva, a medicinsko osoblje pri liječenju i zbrinjavanju bolesnika s EVB mora primjenjivati propisane striktne mjere osobne zaštite. Liječenje je simptomatsko uz po potrebi mjere intenzivnog liječenja. Bez obzira na moguću ekonomsku neprofitabilnost, jasno pokazana potreba za razvojem dijagnostika, cjepiva i lijekova za liječenje ebole i drugih hemoragijskih vrućica, koji bi predstavljali garanciju sprječavanja širenja ovih opasnih bolesti.Ebola virus disease (EVD) is a dangerous and highly contagiuos infectious disease. The largest recorded outbreak so far occurred in West Africa in late 2013 and in early 2014 and spread to five countries of the region (Guinea, Liberia, Nigeria, Sierra Leone and Mali). During the late summer of 2014 an unrelated outbreak of Ebola virus disease occured in the Democratic Republic of Congo. There are five types of Ebola virus [Zaire (EBOV), Sudan (SUDV), Bundibugyo (BDBV), Taï Forest (TAFV) i Reston (RESTV)] all of which are endemic in Africa, except Reston ebolavirus, which is also endemic in parts of South East Asia and China. The reservoir of Ebola virus are considered to be fruit bats, in which Ebola virus RNA and antibodies were detected, but they are not definitively confirmed as the main reservoirs. Immunopathogenesis of Ebola virus disease is complex and requires serious research. Severe forms of the disease are accompanied by numerous complications, multiorgan failure and signs of septic shock. Mortality ranges from 55 – 75%, and sometimes more. Survivors undergo a long period of convalescence. So far there is no approved vaccine, and medical personnel who treat and care for patients with EVD must apply strict measures of proposed personal protection. Treatment is symptomatic with, if necessary, measures of intensive treatment. Regardless of the possible economic unprofitability, the need for the development of diagnostics, vaccines and drugs for the treatment of EVD and other hemorrhagic fevers is clearly demonstrated and would represent a mean to prevent future outbreaks of this dangerous disease

Cell Apoptosis as Assessed by M30 Expression in Keratoacanthoma and Squamous Cell Carcinoma

Involution displayed by keratoacanthoma (KA) represents an important difference between KA and squamous cell carcinoma (SCC). It has been suggested that apoptosis plays a part in process of involution of KA. Altogether 150 specimens were included in this study, 30 cases of each; normal skin (NS), proliferative (pKA) and regressing keratoacanthoma (rKA), well differentiated (wdSCC) and poorly differentiated (pdSCC) squamous cell carcinoma. All samples were examined immunohistochemicaly for expression of M30 protein. A significantly lower number of M30 positive cells has been detected in NS as compared to skin tumors examined (p<0.001), except for rKA (p=0.057). The highest percentage of M30 positive cells was detected in pdSCC (p<0.001) as compared with all other examined groups. Keratinocytes of normal and changed epidermis expressing higher levels of M30 protein were predominately found in sun-exposed areas (c 2=14.93; p=0.060). There was an increasing trend of M30 protein expression with increasing age of the patient in NS and skin tumors examined. Majority of skin tumors with higher percentage of M30 positive cells tended to display higher Ki-67 expression. M30 expression was highly correlated with bak (r=0.811; p=0.048) and granzyme B expression in rKA (r=0.733; p=0.015). Cell apoptosis as assessed by M30 expression is, generally, increased in examined skin tumors and related to cell proliferation. Cell apoptosis mediated by bak and granzyme B expression could contribute to KA regression