Human ehrlichiosis

Background. Human ehrlichiosis is a newly recognized disease. It is a tick-borne disease caused by several bacterial species of the genhus Erlichia. These are small gram-negative pleomorphic cocci, that are obligatory intracellular bacteria. Tick Ixodes is the principle vector in Europe, and Amblyomma americanum in the United States. Bacterial organisms replicate in a tick, and are transmited from infected cells in a vector to the blood cells of animals or humans. Human ehrlichiosis is a name for a group of diseases caused by different species of Ehrlichia. One of them is the disease named human monocytic ehrlichiosis, caused by Ehrlichia chaffeensis, and the other is a human granulocytic ehrlichiosis caused by Anaplasma phagocytophilia. Case report. We reported a 23-year-old patient admitted for the clinical treatment with the symptoms of high febrility (above 40 °C), headache, vomiting, general weakness and exhaustion, but without data on a tick bite. The patient was treated with trimetoprim-sulfamethoxazole for a week when Ehrlichia chaffeensis was confirmed by the immunofluoroscence test, and the therapy contimed with doxacyclin. Conclusion. Human ehrlichiosis is also present in our country, so this disease should be considered everyday, especially in infectology practice

Autoimmune pancreatitis type 1 and type 2: A report of two cases

Introduction. Autoimmune pancreatitis is a disease associated with autoimmune mechanisms, clinically manifested mostly as obstructive icterus with or with no entire or partial enlargement of the pancreas, histological lymphoplas-mocytic infiltration, fibrosis or granulocytic epithelial lesions with a favourable therapeutic response to the application of corticosteroids. Type 1 autoimmune pancreatitis is a systemic disease befalling the group of IgG4-related diseases in contrast to type 2 which is specific for pancreas disease. Case report. We presented two cases. The first one was a 64-year-old male patient with autoimmune pancreatitis complaining of abdominal pain, weight loss, weakness and exhaustion. Clinical examination showed a rare IgG4 autoimmune pancreatitis. The second one was a 37-year-old male patient complaining of abdominal pain with diarrhea. The diagnosis made revealed the presence of type 2 autoimmune pancreatitis. Following the diagnosis, immunosuppressive therapy was administered to both patients leading to the improvement of their general condition. Conclusion. Autoimmune pancreatitis is a rare disease, sometimes not easy to differ from pancreatic tumor or bile duct tumor with poor prognosis. Thus, early recognition of the disease is very important, since adequate treatment significantly increases the course and the outcomes of the disease

The influence of early antibiotic therapy on the clinical manifestations in patients with early Lyme disease

Introduction/Objective. Lyme borreliosis is a multisystem infectious disease caused by Borrelia burgdorferi spirochetes transmitted by the bite of an infected tick. The disease manifestations are very different, with the skin, joints, heart, and nervous systems being most often affected. The aim of this study was to find out whether there are significant differences in the appearance of symptoms and signs of the disease between the subjects who did / did not receive prophylactic, early antibiotic therapy, after the tick bite in patients diagnosed with the early phase of Lyme borreliosis. Methods. The study was carried out on 2,070 patients, who were treated or examined at the Clinic for Infectious and Tropical Diseases in the 1989–2004 period. The patients were divided into group А (n = 591), in which they were given early antibiotic therapy, and group B (n = 1,479), in which they were not. The antibiotic therapy was used within five days of a tick bite in patients with a probable infection, who, at the time, did not have any symptoms or signs. The applied antibiotics included cephalosporins, macrolides, tetracyclines, semisynthetic penicillins, repeatedly for seven or 14 days, or benzathine benzylpenicillin once only. Results. The disease developed in a statistically significantly larger number of patients who were not given early antibiotic therapy (537/1,479) than in those who received the therapy (10/951), i.e. the ratio was 36.3% vs. 1.7%. We concluded that only two antibiotics were sufficient for optimal prevention: doxycycline and ampicillin, administered for seven days. The applied antibiotics showed a high statistically significant efficacy, ranging from 93.7% (cephalosporins) to 99.4% (macrolides). Conclusion. The application of early antibiotic therapy after a tick bite was effective in preventing the early phase of Lyme borreliosis, while in the case of infection it prevented the development of extracutaneous manifestations

Clinical manifestations, therapy and outcome of pandemic influenza a (H1N1) 2009 in hospitalized patients

Background/Aim. Increasing number of epidemiological and clinical studies to date showed that the pandemic influenza A (H1N1) 2009, by its characteristics, significantly differs from infection caused by seasonal influenza. Therefore, the information about clinical spectrum of manifestations, risk factors for severe form of the disease, treatment and outcome in patients with novel flu are still collected. Methods. A total of 98 patients (mean age 32 ± 15 years, range 14-88 years) with the signs and symptoms of novel influenza were treated in the Clinic for Infectious and Tropical Diseases, Military Medical Academy. There were 74 (75.5%) patients with suspected influenza A (H1N1) 2009, 10 (10.2%) with the likelihood and 14 (14.3%) with the confirmed influenza. In all the patients we registered the basic demographic data, risk factors for severe disease, symptoms and signs of influenza, laboratory tests and chest radiography. We analyzed antiviral therapy use and disease outcome (survived, died). Results. The average time from the beginning of influenza A (H1N1) to the admission in hospital was 3 days (0-16 days) and from the moment of hospitalization to the Intensive Care Unit (ICU) admission was 2 days (0-5 days). There were 49 (50.0%) patients, 20-29 years of age and 5 (5.1%) patients older than 65. A total of 21 (21.4%) patients were with underlying disease, 18 (18.4%) were obese, 19 (19.4%) were cigarette smokers. All of the patients had fever, 81 (82.6%) cough, while dyspnea and diarrhea were registered in ¼ of the patients. In more than 75% of the patients laboratory tests were within normal limits. The realtime polymerase chain reaction (PCR) test for identification of influenza A (H1N1) 2009 was positive in 14 (77.8%), while pneumonia was verified in 30 (30.7%) of the patients. Six (6.1%) patients, mean age of 45 ± 14 years (31-59 years) were admitted to the ICU, of whom five (5.1%) had Adult Respiratory Distress Syndrome (ARDS). Risk factors were registered more frequently in the patients with acute respiratory failure (14.2% vs 4.9%, p < 0.05). A total of 67 (68.4%) patients received oseltamivir, 89 (90.1%) was applied to antibiotics and 64 (65.3%) were treated with a combined therapy. Antiviral therapy was applied to 43 (43.3%) patients in the first 48 hours from the onset of the disease, of whom only one (3.4%) developed ARDS. Fatal outcome was noted in 2.0% of the patients (2 of 98 patients) and in 33.3% of the patients treated in the ICU. Conclusion. Novel influenza A (H1N1) is most commonly manifested as a mild acute respiratory disease, which usually affects young healthy adults. A small number of the patients develop severe illness with acute respiratory failure and death. Patients seem to have benefit from antiviral therapy especially in first 48 hours