Trenutna saznanja o epidemiologiji i kliničkoj prezentaciji koronavirusne bolesti 2019 (COVID-19)

Since it emerged in China in the late 2019, the SARS-CoV-2 virus has spread throughout the world and caused the newest pandemic. The epidemiological characteristics of the virus and the clinical manifestations of the COVID-19 disease are currently being studied. The new data is emerging continuously but not yet fully understood. So far, we have learned a lot about the virus and the disease but more research is needed as many issues are still being explored.Otkako se pojavio u Kini krajem 2019. godine, virus SARS-CoV-2 proširio se cijelim svijetom i izazvao najnoviju pandemiju. Epidemiološke značajke virusa kao i kliničke manifestacije bolesti COVID-19 su još uvijek predmet istraživanja. Neprestano dolazimo do novih spoznaja, ali još uvijek ne razumijemo u potpunosti SARS-CoV-2 virus i bolest koju uzrokuje. Do sada smo velikom brzinom naučili dosta o virusu i COVID-19 bolesti, ali je potrebno još više istraživanja, jer su mnoga pitanja još uvijek otvorena

Herpesviruses and Sexually Transmitted Diseases

Porodica Herpesviridae broji blizu 100 herpesvirusa od kojih 8 uzrokuje infekcije u čovjeka. Humani herpesvirusi su herpes simplex virusi tipovi 1 i 2 (HSV-1, HSV-2), varicella-zoster virus (VZV), Epstein-Barrov virus (EBV), citomegalovirus (CMV), humani herpesvirusi 6, 7 i 8 (HHV-6, HHV-7, HHV-8). Glavna biološka osobina herpesvirusa je doživotna latentna infekcija u ciljnim stanicama, s mogućnosti reaktivacije u stanjima imunodefi cijencije, pa se humanim herpesvirusima pridaje sve veća važnost, s obzirom na to da predstavljaju važan uzrok morbiditeta i mortaliteta u različitim skupinama imunokompromitiranih bolesnika. Spolno prenosive infekcije uzrokuju poglavito herpes simpleks virusi 1 i 2, dok se citomegalovirus, Epstein-Barrov virus te humani herpesvirus 8 mogu prenijeti spolnim putem, iako rjeđe nego drugim putovima prijenosa te uglavnom ne uzrokuju kliničke manifestacije od strane urogenitalnog sustava.Nearly 100 viruses belong to the Herpesviridae family, but only eight herpesviruses cause infections in humans. Human herpesviruses are herpes simplex virus type 1 and 2 (HSV-1, HSV-2), varicella-zoster virus (VZV), Epstein-Barr virus, cytomegalovirus, and human herpesvirus 6, 7, and 8 (HHV-6, HHV-7, HHV-8). The main biological characteristic of herpesviruses is a lifelong latent infection in specifi c target cells, with possibility of reactivation in immunocompromised patients. Therefore, human herpseviruses represent an important cause of morbidity and mortality in different groups of immunocompromised patients. Sexually transmitted infections are primarily caused by herpes simplex viruses 1 and 2. Cytomegalovirus, Epstein-Barr virus, and human herpesvirus 8 can be transmitted sexually, although more rarely than by other routes, but they are usually not clinically manifested in the urogenital system

Immunosupression and viral infections in rheumatic diseases

Infekcije su jedan od vodećih uzroka mortbiditeta i mortaliteta u bolesnika s reumatskim bolestima. Iako su bakterije najčešći uzroci infekcija u tih bolesnika, imunosupresivna terapija koja poglavito djeluje na staničnu imunost (kortikosteroidi, ciklosporin, ciklofosfamid, leflumomid dijelom TNF-alfa antagonisti), suvremena monoklonska protutijela), može dovesti do reaktivacije i teških kliničkih slika uzrokovanih latentnim virusima kao što su predstavnici porodice Herpesvirusa te hepatitis B i C virus. Osobit problem ovih infekcija je diferencijalno dijagnostička mogućnost zamjene s egzacerbacijom osnovne bolesti. U radu se ukratko prikazuju glavna klinička obilježja, dijagnostički i terapijski pristupi najčešćim virusnim infekcijama u imunosprimiranih reumatskih bolesnika.Infections are one of the leading causes of morbidity and mortality in patients with rheumatic disea­ses. Although bacterial pathogens are the most common cause of infections, a wide variety of viral pathogens can also cause serious clinical manifestations mostly due to immunosupressive therapy primarily targeting cellular immunitiy (steroids, cyclosporins, cyclophosphamid, leflunomid, TNF-alfa antagonists etc.). Depleted cellular immunity can lead to reactivation of latent viruses such as members of Herpesvirus family, or hepatitis B and C viruses. Symptoms of viral infection may mimic exacerbation of rheumatic disease. In this paper authors present the main clinical characte­ristics, diagnostics and tretment possibilities for most common viral infections in immunosupressed host with a rheumatic disease

76-godišnji bolesnik s legionarskom bolesti i osipom: prikaz slučaja

Legionella pneumophila is an important cause of atypical community- acquired pneumonia. Legionnaires’ disease usually manifests with high-grade fever and nonproductive cough, while the presence of diarrhoea, neurologic symptoms, hyponatremia and failure to respond to beta-lactam antibiotics can provide clues to diagnosis of Legionnaires\u27s disease. Cutaneous lesions in Legionnaires\u27 disease are very rare – a rash associated with the clinical manifestation of Legionella infection was described and evaluated in 10 cases according to literature. Herein we present a 76-year-old patient treated at the University Hospital for Infectious Diseases in Zagreb, Croatia because of Legionnaires\u27 disease and a petechial rash.Legionella pneumophila je važan uzročnik atipične domicilne pneumonije. Legionarska bolest najčešće se manifestira febrilitetom i suhim kašljem, a prisutnost dijareje, neuroloških manifestacija poput smetenosti, hiponatremije te neuspjeha terapije betalaktamskim antibioticima može uputiti na dijagnozu legionarske bolesti. Kožne manifestacije legionarske bolesti su izuzetno rijetke te je do sada opisano 10 takvih slučajeva u literaturi. U ovom smo radu prikazali 76-godišnjeg bolesnika s legionarskom bolesti koji je hospitaliziran u Klinici za infektivne bolesti zbog legionarske bolesti praćene petehijalnim osipom

Liječenje starijih bolesnika s kroničnim hepatitisom C: retrospektivno kohortno istraživanje

The prevalence of chronic hepatitis C increases in elderly patients. The aims of this study were to identify the factors associated with hepatocellular carcinoma (HCC) and end-stage liver disease development and to evaluate the efficacy and safety of pegylated interferon (PEG-IFNα) plus ribavirin (RBV) therapy in elderly patients. A retrospective cohort study included all consecutive patients with hepatitis C virus (HCV) infection treated with PEG-IFNα+RBV between 2003 and 2013. Elderly patients had a higher frequency of poor prognostic factors including genotype 1 infection, high fibrosis, and high fibrosis index based on four factors (FIB-4) score. The sustained virologic response (SVR) rate for genotype 1 was significantly lower (35.8% vs. 57.1%), while the frequency of PEG-IFNα (27.2% vs. 7.8%), RBV dose reduction (19.6% vs. 9.7%) and treatment discontinuation (13.0% vs. 4.1%) was significantly higher in elderly patients. However, age was not associated with SVR in multivariate analysis, and comparable SVR rates were achieved when adjusted for fibrosis score (Ishak ≤3: 66.7% vs. 69.8%). During the follow-up, HCC was diagnosed in 18 elderly patients (3 SVR+, 4 SVR- and 9 untreated patients). In conclusion, selected elderly patients can achieve comparable SVR rates as younger patients, but with a higher rate of side effects. Since complications of HCV infection occur more frequently in elderly patients, they should be given priority for antiviral therapy.Učestalost kroničnog hepatitisa C (KHC) raste u starijim dobnim skupinama. Ciljevi ovoga istraživanja bili su utvrditi čimbenike povezane s razvojem hepatocelularnog karcinoma (HCC) i dekompenzirane jetrene bolesti te procijeniti učinkovitost i sigurnost terapije pegiliranim interferonom (PEG-IFNα) i ribavirinom (RBV) u starijih bolesnika. Retrospektivna kohortna studija je uključila sve bolesnike s KHC koji su liječeni PEG-IFNα + RBV između 2003. i 2013. godine u Klinici za infektivne bolesti “Dr. Fran Mihaljević”. Bolesnici u dobi od >65 godina češće su imali nepovoljne prognostičke čimbenike, tj. HCV-1 genotip, uznapredovali stadij fibroze i viši zbir indeksa fibroze zasnovan na četiri čimbenika (fibrosis index based on four factors, FIB-4). Trajni virusološki odgovor (sustained virologic response, SVR) je bio značajno niži (35,8% prema 57,1%), dok je učestalost smanjenja doze PEG-IFNα (27,2% prema 7,8%), RBV (19,6% prema 9,7%) i prekida liječenja (13,0% prema 4,1%) bila značajno češća u starijih bolesnika. Dob nije bila povezana sa SVR u multivarijatnoj analizi, a stariji bolesnici su imali podjednaki SVR kao i mlađi bolesnici ovisno o stadiju fibroze (Ishak ≤3: 66,7% prema 69,8%). Tijekom praćenja HCC je dijagnosticiran u 18 bolesnika u dobi od >65 godina (3 SVR+, 4 SVR-, 9 neliječenih). Zaključno, stariji bolesnici imaju podjednaku vjerojatnost postizanja SVR kao i mlađi, ali uz češće nuspojave. Budući da se komplikacije infekcije virusom hepatitisa C češće javljaju u ovoj populaciji, stariji bolesnici trebaju imati prednost u primjeni antivirusne terapije

Treatment of chronic hepatitis C in Croatian war veterans: experiences from Croatian reference center for viral hepatitis

Aim. To examine the risk factors, comorbidity, severity of liver disease, treatment course, and outcome in Croatian war veterans with chronic hepatitis C, especially those suffering from posttraumatic stress disorder (PTSD). ----- Methods. We collected medical records of 170 adult men diagnosed with chronic hepatitis C who started treatment with a combination of pegylated interferon-alpha and ribavirin between January 2003 and June 2009 at the Croatian Reference Centre for Viral Hepatitis. ----- Results. Participants' mean age was 43±9 years. Among 170 participants, there were 37 war veterans (22%). The main risk factor in veteran patients were operative procedures with transfusions (46% vs 5% in non-veterans; P<0.001) and in non-veteran patients intravenous drug use (42.1% vs 13%; P<0.001). The average duration of infection was longer in war veterans (14.5±3.4 vs 12.2±7.2 years; P=0.020). The percentage of PTSD comorbidity in the whole group was 11% (18/170) and in the war veterans group 49% (18/37). The prevalence of sustained virological response in patients with PTSD was 50% and in patients without PTSD 56%. Treatment reduction in patients with PTSD (33%) was higher than in patients without PTSD (12%; P=0.030). ----- Conclusion. Croatian war veterans are a group with high risk of chronic hepatitis C infection because many of them were wounded during the Croatian War 1991-1995. Considerations about PTSD as a contraindication for interferon treatment are unjustified. If treated, patients with PTSD have an equal chance of achieving sustained virological response as patients without PTSD

Etiology and outcome of bacterial infections in patients with liver cirrhosis - a retrospective cohort study

Uvod: Bakterijske infekcije čest su uzrok komplikacija i dekompenzacije kod bolesnika s cirozom jetre. Cilj je ove studije proučiti etiologiju, kliničke manifestacije, tijek i ishod bakterijskih infekcija te identificirati prediktore mortaliteta kod bolesnika s cirozom jetre i sepsom. Materijali/metode: Proveli smo retrospektivnu kohortnu studiju u koju je uključeno 257 bolesnika s cirozom jetre koji su bili hospitalizirani u Klinici za infektivne bolesti „Dr. Fran Mihaljević“ (KZIB) u petogodišnjem razdoblju (2011. - 2015.). Analizirali smo demografske, kliničke te mikrobiološke podatke s ciljem identifikacije prediktora mortaliteta. Rezultati: Najčešći klinički sindrom kod prijema bolesnika bila je primarna bakterijemija nepoznatog ishodišta (40,8 %). Prethodno dijagnosticiranu kroničnu bolest jetre imalo je 39,2 % bolesnika. Kod 50 % bolesnika najčešći uzrok ciroze jetre bio je alkoholne geneze. Uzročnik je izoliran kod 71,4 % bolesnika, najčešće iz hemokultura (59,1 %). Korekcija empirijske terapije učinjena je u 11,2 % slučajeva, uzevši u obzir mikrobiološke izolate. Medijan do početka adekvatne antimikrobne terapije bio je 3 dana. Do komplikacija je došlo kod 62,2 % bolesnika. Ukupni mortalitet za vrijeme hospitalizacije iznosio je 28,5 %. Odgođena adekvatna antimikrobna terapija u razdoblju ≥ 72 sata, invazivna mehanička ventilacija i akutno bubrežno zatajenje pokazale su se neovisno povezanima sa smrtnim ishodom. Zaključak: Ovom smo studijom opisali epidemiologiju i etiologiju bakterijemija kod bolesnika s cirozom jetre u Hrvatskoj. S obzirom na to da je infekcija prvi prezentirajući znak ciroze u našoj kohorti, naglašava se potreba za sustavnijim probirom u svrhu ranog otkrivanja kronične bolesti jetre i sprječavanja komplikacija. Visoka stopa multiplo-rezistentnih infekcija iz opće populacije naglašava potrebu za izradom nacionalnih smjernica za empirijsko liječenje bakterijskih infekcija kod bolesnika s cirozom jetre.Introduction: Bacterial infections are a common cause of complications and decompensation in patients with liver cirrhosis. The objective of this study is to evaluate the etiology, clinical manifestations, course and outcome of bacterial infections and identify mortality predictors in patients with liver cirrhosis and sepsis. Materials/Methods: We conducted a retrospective cohort study involving 257 patients hospitalized at the University Hospital for Infectious Diseases, Zagreb over a five-year period (2011 - 2015). We analysed demographical, clinical, and microbiological data in order to identify the mortality predictors. Results: The most common clinical syndrome on admission was bacteremia of unknown origin. Chronic liver disease (CLD) was previously diagnosed in 39,2 % of patients. In 50,0 % of the cases, CLD was alcohol induced. The causative agent was isolated in 71,4 % of patients, mostly from blood cultures. Empirical therapy was corrected in 11,2 % of cases (according to microbiological findings). Median time of adequate antimicrobial therapy onset was 3 days. Complications occurred in 62,2 % of patients. Hospital stay mortality rate was 28,5 %. Delayed adequate antimicrobial therapy for a period ≥ 72 hours, invasive mechanical ventilation and acute renal failure were independently associated with fatal outcomes. Conclusion: This study describes the epidemiology and etiology of bacteriemia in liver cirrhosis patients in Croatia. Since infection is the initial sign of cirrhosis presence in our cohort, systematic screening for timely detection of CLD and prevention of complications is crucial. High rate of multiple drug resistant infections from the general population underscores the need to develop national guidelines for empirical treatment of bacterial infections in patients with liver cirrhosis