Naravna povijest bruceloze u endemskom području kroz različita vremenska razdoblja

The aim of the study was to determine the evolution and outcome of human brucellosis in an endemic region in relation to time interval. Retrospective analysis was employed to compare demographic, epidemiological, clinical, laboratory features and the outcome of patients with brucellosis, treated at University Department of Infectious Diseases in Skopje during two different periods of time. A series of 159 patients were studied in the first (1990-1991) and 138 in the second (2003-2005) study period. Patients treated in the second period were older (34.6±20.9 vs. 30.0±17.7 years; P=0.041) and acquired brucellosis less frequently on ingestion of incriminated food (34.8% vs. 47.2%; P=0.031). Focal forms were more evident in the second period (66.7% vs. 50.3%; P=0.004), mainly due to osteoarticular localization. Post-treatment follow up was more efficient in the second group (76.1% vs. 61%; P=0.005). There was no difference according to disease outcome in spite of different therapeutic trials during the two study periods. In conclusion, the established differences showed an improvement in the understanding of the disease by the general population as well as upgrading of some aspects considering medical activities. Nevertheless, this endemic region still lacks the most important measure, i.e. development and implementation of an appropriate national program for efficient control of the disease.Cilj studije bio je utvrditi razvoj i ishod bruceloze kod ljudi u jednom endemskom području u odnosu na vremenski pomak. Demografski, epidemiološki, klinički i laboratorijski podaci te ishodi u bolesnika s brucelozom liječenih na Klinici za infektivne bolesti u Skopju kroz dva vremenska razdoblja uspoređeni su retrospektivnom analizom. U prvom razdoblju (1990.-1991.) ispitano je 159 bolesnika, a u drugom razdoblju (2003.-2005.) 138 bolesnika. Bolesnici iz drugog razdoblja bili su stariji (34,6±20,9 prema 30,0±17,7 godina; P=0,041) i rjeđe su obolijevali od bruceloze zbog unosa određene hrane (34,8% prema 47,2%; P=0,031). Žarišni oblici bili su očitiji u drugom razdoblju (66,7% prema 50,3%; P=0,004), uglavnom zbog koštano¬zglobne lokalizacije. Praćenje nakon liječenja bilo je bolje u drugoj skupini (76,1% prema 61,0%; P=0,005). Usprkos različitim terapijskim pristupima tijekom ispitivanih razdoblja nije zabilježena nikakva razlika u ishodu bolesti. Dakle, utvrđene razlike pokazale su napredak u vidu boljeg razumijevanja bolesti u općoj populaciji, kao i poboljšanja u nekim vidovima medicinskih postupaka. Ipak, u ovom endemskom području jo. uvijek nedostaje najvažnija mjera, a to je stvaranje i provedba boljeg nacionalnog programa za kontrolu ove bolesti

Bruceloza u trudnoći: prikazi slučaja s različitim ishodima u endemskom području

Different outcomes of brucellosis in pregnancy regarding the fetus/neonate and the mother are described. Medical records of five pregnant women with brucellosis were retrospectively analyzed. Patients were treated in several departments of infectious diseases in the Republic of Macedonia between 1995 and 2009. The diagnosis of brucellosis was based on clinical findings compatible with the disease supported by detection of specific antibodies. Pregnancy outcomes in patients were as follows: spontaneous abortion, intrauterine fetal death, premature delivery in two cases (one with twin pregnancy) and term delivery. One of the women experienced relapse. Follow-up results of neonates showed no infection and their normal growth and development. Brucellosis, especially if acquired in early pregnancy, can have an impact on pregnancy outcome. In endemic regions, in pregnant women with persisting fever and unspecific manifestations one should always have in mind brucellosis. In these areas, cases with unexplained spontaneous abortion, intrauterine fetal death and premature delivery should also be investigated for brucellosis.Opisuju se različiti ishodi bruceloze u trudnoći u odnosu na fetus/novorođenče i majku. Retrospektivno su analizirani medicinski zapisi za pet trudnica s brucelozom. Bolesnice su liječene u nekoliko klinika za zarazne bolesti u Republici Makedoniji u razdoblju od 1995. do 2009. godine. Dijagnoza bruceloze temeljena je na kliničkim nalazima sukladnima s bolešću i potkrijepljena otkrivanjem specifičnih protutijela. Ishodi trudnoće u ovih bolesnica bili su sljedeći: spontani pobačaj, intrauterina smrt fetusa, prijevremeni porođaj u dva slučaja (jedan s blizanačkom trudnoćom) i terminski porođaj. Recidiv je nastupio kod jedne od ovih žena. Rezultati praćenja novorođenčadi pokazali su odsutnost infekcije te normalan rast i razvoj. Bruceloza, osobito ako je stečena u ranoj trudnoći, može utjecati na ishod trudnoće. U endemskim područjima brucelozu treba uvijek imati na umu kod trudnica s ustrajnom groznicom i nespecifičnim manifestacijama. U ovim područjima testiranje na brucelozu treba provoditi i u slučaju neobjašnjenog spontanog pobačaja, intrauterine smrti fetusa i prijevremenog porođaja

Characteristics of an Outpatient Cohort with HBeAg-Negative Chronic Hepatitis B

Introduction: Patients with hepatitis Be antigen negative chronic hepatitis B (HBeAg-negative CHB) and patients inactive carriers (IC) have similar laboratory and serologic characteristics and are not always easy to distinguish. Aim: To characterize hepatitis Be antigen (HBeAg) negative chronic hepatitis B cohort based on their laboratory and virology evaluations at one point of time. Material and Methods:  A prospective non-randomized study was conducted on 109 patients with HBeAg negative chronic hepatitis B treated as outpatients at the Clinic for infectious disease and febrile conditions.   All patients underwent laboratory and serology testing, quantification of HBV DNA and HBs antigen (qHBsAg). Results: 56 patients were inactive carriers (IC) and 53 patients had HBeAg-negative CHB (AH). The mean values of ALT, HBV DNA and qHBsAg in IC were 29,13 U/L; 727,95 IU/ml and 2753,73 IU/ml respectively. In the AH group the mean values of ALT, HBV DNA and quantitative HBsAg were 50,45 U/L; 7237363,98 IU/ml and 12556,06 IU/ml respectively. The serum value of ALT was more influenced by qHBsAg than HBV DNA in both IC and AH groups (R=0.22 vs R=0.15) (p>0.05). Conclusion:  patients with inactive and active HBeAg-negative CHB have similar laboratory and serology profile. It is necessary to combine analysis of ALT, HBV DNA and qHBsAg for better discrimination between patients IC and patient swith HBeAg- negative CHB. Key words: chronic hepatitis B, inactive carriers, ALT, HBeAg, HBV DNA, quantitative HBsAg BACKGROUND: Patients with hepatitis Be antigen-negative chronic hepatitis B (HBeAg-negative CHB), and patients' inactive carriers (IC) have similar laboratory and serologic characteristics and are not always easy to distinguish. AIM: To characterise hepatitis Be antigen (HBeAg) negative chronic hepatitis B cohort based on their laboratory and virology evaluations at one point of time. METHODS: A prospective non-randomized study was conducted on 109 patients with HBeAg negative chronic hepatitis B treated as outpatients at the Clinic for Infectious Diseases and Febrile Conditions. All patients underwent laboratory and serology testing, quantification of HBV DNA and HBs antigen (qHBsAg). RESULTS: A group of 56 patients were inactive carriers (IC), and 53 patients had HBeAg-negative CHB (AH). The mean values of ALT, HBV DNA and qHBsAg in IC were 29.13 U/L; 727.95 IU/ml and 2753.73 IU/ml respectively. In the AH group, the mean values of ALT, HBV DNA and quantitative HBsAg were 50.45 U/L; 7237363.98 IU/ml and 12556.06 IU/ml respectively. The serum value of ALT was more influenced by qHBsAg than HBV DNA in both IC and AH groups (R = 0.22 vs R = 0.15) (p > 0.05). CONCLUSION: patients with inactive and active HBeAg-negative CHB have similar laboratory and serology profile. It is necessary to combine analysis of ALT, HBV DNA and qHBsAg for better discrimination between patient's IC and patient with HBeAg-negative CHB

Phenotypic characteristics and clinical outcome in hospitalized patients with COVID-19 and diabetes

Objectives. The aim is to describe the phenotypic, biological and clinical characteristics of hospitalized patients with COVID-19 and diabetes, and the association with the clinical outcome of the patients. Material and methods. This single-center, retrospective study was conducted on 200 patients. The primary endpoint was death observed within day 7, 14 and beyond day 14 of hospitalization, and secondary objective was to compare the survival group with non-survival group. The variables that demonstrated significant association with primary endpoint were subject to multivariate binary logistic regression analysis. Outcomes. The estimated prevalence was 17.87% of the total COVID-19 hospitalizations during this period (n=1119). The majority of the patients were with diabetes mellitus type 2 with a median age of 67 years and BMI of 27.8 kg/m2. On admission, 156 patients (78%) presented with severe/critical illness. A total of 93 patients (46.5%) met the primary endpoint, with most deaths occurring within day 7 of hospital stay. Non-survival group showed significantly higher levels of leucocytes count, more pronounced lymphopenia, higher CRP, LDH and D-dimer levels. Multivariate analysis identified four independent risk factors associated with death: age OR 1.05 (CI 95% 1.01-1.09), severity of disease at admission OR 0.22 (CI 95, 0.07-0.65), COVID-19 vaccination status OR 3.07 (CI 95%, 1.36-6.91) and LDH levels OR 1.00 (CI 95%,1.002-1.008). Conclusions. Diabetic patients admitted to hospital for COVID-19 infection tend to have high mortality rate. Severity of disease at admission, advanced age, not completed vaccination and increased LDH levels are independent risk factors for lethal outcome, irrespective of diabetes status

Testicular infection in brucellosis: Report of 34 cases

Background/Purpose: To present clinical and laboratory features, treatment options, and outcome in patients with brucellar testicular infection and to compare them with analogous in brucellar patients without testicular involvement. Methods: Thirty four brucellar patients with testicular infection treated in two general hospitals in the Republic of Macedonia, during the period 1998–2009, were retrospectively analyzed. Their clinical and laboratory characteristics were compared with analogous in 364 male brucellar patients without testicular infection, who were treated at the same hospitals during the same time period. Results: Brucellar testicular infection was evident in 34 (8.5%) out of 398 male patients with brucellosis. The median age of the patients was 46.5 years. In all patients testicular involvement was presented as an acute form with a median duration of 5 days (range, 2–14 days) prior to diagnosis. Twenty-three of the patients had at least one other simultaneous focal infection. After starting with the treatment testicular infection lasted a median 10 days, range 7–21 days. Brucellar patients with testicular infection when compared with other brucellar patients more frequently manifested fever (97% vs. 61%), concomitant spondylitis (32% vs. 16%), and urinary system involvement (12% vs. 2%). Also, the relapse rate in patients with testicular involvement was significantly higher (24% vs. 9%). Conclusion: In endemic regions brucellosis should be taken into consideration in any patient with testicular infection. Brucellar testicular involvement is usually characterized with a severe acute clinical presentation and a high percentage of relapses which entails the need of timely recognition and proper treatment duration of at least 60 days

Human Brucellosis in Macedonia – 10 Years of Clinical Experience in Endemic Region

Aim To present our 10-year clinical experience with brucellosis patients at the University Clinic for Infectious Diseases and Febrile Conditions in Skopje, Republic of Macedonia. Methods A total of 550 patients with brucellosis treated between 1998 and 2007 were retrospectively assessed for their demographic, epidemiological, and clinical characteristics and outcomes. Results Of the 550 patients, 395 (72%) were male. The median age was 34.5 years (range, 1-82). Direct contact with infected animals was recorded in 333 (61%) patients and positive family history in 310 (56%). The most frequently seen symptoms were arthralgia (438, 80%), fever (419, 76%), and sweating (394, 72%). The most common signs were fever and hepatomegaly, which were verified in 357 (65%) and 273 (50%) patients, respectively. Focal brucellosis was found in 362 patients (66%) and osteoarticular in 299 (54%). Therapeutic failures were registered in 37 (6.7%) patients. Of the 453 (82%) patients who completed a follow- up period of at least 6 months, relapses occurred in 60 (13%). Conclusion Due to non-specific clinical manifestation and laboratory parameters, brucellosis should be considered one of the differential diagnoses of any patient suffering from obscure involvement of various organs in a brucellosis- endemic region. High percentage of relapses and therapeutic failures in spite of the use of currently recommended therapeutic regimens indicates the seriousness of this zoonosis and the need to control it

The changing pattern of fever of unknown origin in the Republic of North Macedonia

Introduction. The study aimed to compare the etiologic spectrum of diseases causing fever of unknown origin (FUO) and methods for definitive diagnosis in a tertiary care hospital in the Republic of North Macedonia during two different time periods

CD150-dependent hematopoietic stem cell sensing of Brucella instructs myeloid commitment

International audienceSo far, hematopoietic stem cells (HSC) are considered the source of mature immune cells, the latter being the only ones capable of mounting an immune response. Recent evidence shows HSC can also directly sense cytokines released upon infection/inflammation and pathogen-associated molecular pattern interaction while keeping a long-term memory of previously encountered signals. Direct sensing of danger signals by HSC induces early myeloid commitment, increases myeloid effector cell numbers, and contributes to an efficient immune response. Here, by using specific genetic tools on both the host and pathogen sides, we show that HSC can directly sense B. abortus pathogenic bacteria within the bone marrow via the interaction of the cell surface protein CD150 with the bacterial outer membrane protein Omp25, inducing efficient functional commitment of HSC to the myeloid lineage. This is the first demonstration of direct recognition of a live pathogen by HSC via CD150, which attests to a very early contribution of HSC to immune response