Characteristics of Influenza in Children

Iako se prema glavnim kliničkim karakteristikama influenca u djece ne razlikuje bitno od influence u odraslih, potrebno je naglasiti da influenca u djece ipak ima neke osobitosti. Djeca su najvažniji izvor širenja influence u zajednici. Klinička slika kod prematurne djece, novorođenčadi, dojenčadi i male djece može biti bitno različita od one starijih dobnih skupina. To se posebice odnosi na komplikacije influence. Unatoč visokom pobolu, u djece je smrtnost od influence srećom niska. U ovome kratkom preglednom članku osvrnut ćemo se na neke epidemiološke i kliničke osobitosti te na liječenje i prevenciju influence u djece.Although the main clinical features of influenza in children are not significantly different from those in adults, it is necessary to emphasize that influenza in children, however, has some specific characteristics. Children are the most important source of influenza transmission in the community. Clinical manifestations of influenza in premature children, newborns, infants and young children can be significantly different from those in older age groups. This particularly applies to complications of influenza. Despite high morbidity, the mortality rate of influenza in children is fortunately low. In this short overview we shall discuss some epidemiological and clinical characteristics of influenza, along with treatment and prevention options in children

Eosinophilic meningitis in children treated at the University Hospital for Infectious Diseases "Dr. Fran Mihaljević"

Eozinofilni meningitis rijedak je oblik meningitisa koji nastaje uslijed infekcije parazitima, bakterijama, gljivama i virusima, ali javlja se i zbog drugih neinfektivnih uzroka. Klinička prezentacija bolesti kao i liječenje ovisi o njenoj etiologiji, {to se posebno odnosi na slučajeve meningitisa uzrokovanih parazitima, koji su i najčešći. U ovom radu prikazat ćemo troje muške i troje ženske djece u dobi od 2 mjeseca do 7 godina koji su liječeni zbog eozinofilnog meningitisa u Klinici za infektivne bolesti "Dr. Fran Mihaljević". S obzirom na anamnestičke podatke kao i na učinjenu serološku i mikrobiološku obradu, kod navedene se djece radilo o neinfekcijskom meningitisu. Kod jednog bolesnika nije utvrđen uzrok, dok se u preostalih petero eozinofilija u likvoru javila kao reakcija na strano tijelo. Iako su ovakvi slučajevi u svakodnevnom radu rijetki, prikazani su zbog potrebe za širim diferencijalno dijagnostičkim pristupom, posebno u slučajevima nejasne etiologije. On tada mora uključivati, osim tipičnih neinfekcijskih i infekcijskih uzročnika, obradu i razmatranje mikroorganizama koji se ne smatraju čestim ili uobičajenim za tu vrstu meningitisa.Eosinophilic meningitis is a rare form of meningitis that occurs due to infection with parasites, bacteria, fungi and viruses, but also due to other non-infectious causes. The clinical presentation of disease depends on its etiology, which is particularly applicable to cases of meningitis caused by parasites, which are the most common. In this paper we present three male and three female children aged two months to seven years who have been treated for eosinophilic meningitis at the University Hospital for Infectious Diseases "Dr. Fran Mihaljević". Anamnestic data as well as serological and microbiological analysis confirmed diagnosis of noninfectious meningitis. In one patient the cause of disease was not found, while in the remaining five patients, eosinophilia in the fluid appeared as a foreign body reaction. Although such cases are rare in everyday clinical practice, they are presented here in order to stress the need for a broader differential diagnosis, especially in cases of unknown etiology. Besides typical non-infectious and infectious agents this approach must take into consideration other microorganisms that are not commonly assocciated with this type of meningitis

Bronchiolitis caused by respiratory syncytial virus in the period from 2003 to 2009

Respiratorni sincicijski virus (RSV) uzrokuje akutne respiratorne infekcije u osoba svih dobnih skupina. Donji dišni putovi češće su zahvaćeni u dojenčadi i male djece s primoinfekcijom te u starijih i imunokompromitiranih, dok su u ostalih obično zahvaćeni samo gornji dišni putovi. Većina djece preboli primoinfekciju do druge godine života, dok su reinfekcije uobičajene tijekom života. RSV je najvažniji uzročnik infekcija donjega respiratornog trakta, a pogotovo bronhiolitisa, u dojenčadi. Karakteristična je sezonska pojavnost od kasne jeseni do ranoga proljeća s vrhuncem tijekom siječnja i veljače. RSV uzrokuje febrilni respiratorni katar, otitis, traheobronhitis, bronhiolitis i pneumoniju. Virus se može dokazati izolacijom iz respiratornih sekreta, a danas se rutinski koriste brzi testovi visoke osjetljivosti i specifičnosti kojima se dokazuje antigen. Liječenje je simptomatsko (adekvatna hidracija, antipireza, kisik, dekongestija nosne sluznice). U liječenju bronhiolitisa koriste se inhalacijski bronhodilatatori (albuterol, salbutamol, racemični epinefrin) i kortikosteroidi iako kliničke studije nisu dokazale njihovu djelotvornost. Ribavirin u obliku aerosola preporučuje se u djece kod koje očekujemo težu bolest. U dijela bolesnika nakon preboljele RSV infekcije zaostaje pojačana reaktivnost dišnih putova. Primjena palivizumaba, monoklonskog antitijela protiv RSV-a, indicirana je kao profilaksa kod djece s rizikom za tešku RSV infekciju. U našoj Klinici tijekom razdoblja od šest godina liječeno je 422 djece zbog bronhiolitisa uzrokovanog RSV-om. Dobna, spolna i sezonska raspodjela odgovaraju očekivanima. U 17 djece (4% hospitaliziranih) provođena je mehanička ventilacija, dok je jedno dijete umrlo (smrtnost 0,24%). Više od polovice mehanički ventiliranih imalo je neki čimbenik rizika za težu bolest. Na varijacije u udjelu mehanički ventiliranih među hospitaliziranima vjerojatno utječe virulencija tipa virusa koji kruži u populaciji.Respiratory syncytial virus (RSV) causes acute respiratory tract illness in persons of all ages. Lower respiratory tract infection is usually the result of primary infection of infants and small children as well as secondary infection of older adults and immunodeficient persons. Healthy older children and adults typically have symptoms restricted to the upper respiratory tract. Almost all children acquire primary RSV infection during the first two years of life and reinfections occur throughout lifetime. RSV is the most important cause of lower respiratory tract infections, especially of bronchiolitis, in infants. Seasonal outbreaks are typically seen from late autumn to early spring peaking in January and February. RSV infection manifests as upper respiratory tract infection, acute otitis media, tracheobronchitis, bronchiolitis or pneumonia. The laboratory diagnosis of RSV infection is made by analysis of respiratory secretions with rapid assays utilizing antigen capture technology. Their sensitivity and specificity exceed 90 percent. Supportive care is the mainstay of therapy and sometimes includes oxygenotherapy. Bronchodilators and corticosteroids are widely used, although no convincing data exist for their efficacy. Nebulized ribavirin is reserved for severe infections. In some patients RSV infection is correlated with recurrent wheezing. Immunoprophylaxis with palivizumab, a humanized monoclonal antibody against the RSV F glycoprotein, is indicated for children at high risk for serious infection. During the period of six years 422 children with RSV bronchiolitis were treated at our hospital. We found expected age, sex and seasonal distribution of our patients. Seventeen children (4 %) required mechanical ventilation and one child died (mortality 0.24 %). More than half of the patients requiring mechanical ventilation had at least one risk factor for severe infection. Seasonal variations in the number of mechanically ventilated patients are probably the result of virulence of circulating strain of virus

Epidemiological and clinical characteristics of patients with invasive meningococcal disease hospitalized at the University Hospital for Infectious Diseases "Dr. Fran Mihaljevic", Zagreb

Restrospektivno su analizirane epidemiološke i kliničke značajke invazivne meningokokne bolesti (IMB) kod 108 hospitaliziranih bolesnika, u petogodišnjem razdoblju, od 2003. – 2007. godine, što je prosječno iznosilo 22 bolesnika godišnje. IMB je najčešća kod dojenčadi i male djece, te u djece školske dobi. Sveukupno 73% bolesnika bila su djeca u dobi do 15 godina, prosječne starosti 2,8 godina, a 27% su bili stariji bolesnici. Ukupna smrtnost među našim bolesnicima bila je 4,6% (3,7% među djecom do 15 godina, a u starijih bolesnika 6,8%). Bolest se klinički prezentirala kao meningitis kod 14 (13%), sepsa kod 28 (26%) ili sepsa s meningitisom kod 66 (61%) bolesnika. Etiološka dijagnoza bila je potvrđena kod svih bolesnika dokazom uzročnika iz primarno sterilnih materijala (krv i/ili cerebrospinalni likvor). Kultivacijom je uzročnik dokazan u 32%, a molekularnim metodama (PCR) u 74% bolesnika. Prevladavala je N. meningitidis serogrupe B (83%), zatim serogrupe C (12%) te serogrupa W 135 (1,8%), dok je kod 2,7% dokazan negrupabilan soj. Svi hospitalizirani bolesnici bili su sporadični slučajevi, nije zabilježena niti jedna epidemija. U razdoblju od 2003. do 2007. godine kod naših je bolesnika dokazano 7 izolata N. meningitidis smanjene osjetljivosti na penicilin. U svim se slučajevima radilo o izolatima serogrupe B. Uz već postojeća cjepiva protiv meningokoka (A, C, Y, W135), u tijeku su opsežna istraživanja u razvoju i primjeni djelotvornog cjepiva protiv N. meningitidis serogrupe B, koje će, nadamo se, doprinijeti smanjenju incidencije ove teške i potencijalno smrtonosne bolesti.We retrospectively analyzed epidemiological and clinical characteristics of invasive meningococcal disease (IMD) in 108 hospitalized patients in the period of five years, from 2003 to 2007. On average, 22 patients with meningococcal disease were treated per year. IMD was the commonest in infants and small children, and in school age children. Altogether 73 % of all patients were children up to 15 years of age (mean age 2,8 years) while the remaining 27% were older patients. The total mortality rate among our patients was 4,6% (3,7% among children up to 15 years of age, and 6,8% in older patients). The disease clinically presented as meningitis in 14 (13%), as sepsis in 28 (26%) or sepsis with meningitis in 66 (61%) patients. Etiological diagnosis from primarily negative samples (blood and/or cerebrospinal fluid) proved positive in all patients. N.meningitidis was confirmed by cultivation in 32%, and by PCR method in 74% of cases. In etiologically confirmed cases, the most common serogroup of N.meningitidis was serogroup B (83%), followed by serogroup C (12%) and serogroup W135 (1,8%), while in 2,7% of patients a non-groupable strain was isolated. All patients were sporadic cases. In the period from 2003 to 2007, N.meningitidis with reduced susceptibility to penicillin was detected in 7 isolates, all of them belonging to serogroup B. Along with currently available vaccine against meningococcus (A, C, Y, W 135), continuous efforts are undertaken worldwide to develop an efficient vaccine against N. meningitidis serogroup B, that would, we hope, contribute in reducing the incidence of this severe and potentially fatal disease

Clostridium neonatale kao uzročnik novorođenačkog meningitisa: prikaz bolesnika

Clostridia are rare causes of the central nervous system (CNS) infections in children. We present an unusual case of a successfully treated neonatal meningitis caused by the novel clostridial species, Clostridium neonatale. To the best of our knowledge, this is the first case report describing neonatal meningitis caused by this bacteria.Bakterije iz roda Clostridium rijetko uzrokuju infekcije središnjeg živčanog sustava (SŽS) u djece. U ovom radu prikazat ćemo slučaj uspješno liječenog meningitisa u novorođenčeta čiji je uzročnik bio Clostridium neonatale, novoopisana vrsta klostridija. Prema našim saznanjima, ovo je prvi prikaz slučaja koji opisuje novorođenački meningitis uzrokovan tom vrstom bakterija

Application of Novel Lossless Compression of Medical Images Using Prediction and Contextual Error Modeling

Conduction of tele-3D-computer assisted operations as well as other telemedicine procedures often requires highest possible quality of transmitted medical images and video. Unfortunately, those data types are always associated with high telecommunication and storage costs that sometimes prevent more frequent usage of such procedures. We present a novel algorithm for lossless compression of medical images that is extremely helpful in reducing the telecommunication and storage costs. The algorithm models the image properties around the current, unknown pixel and adjusts itself to the local image region. The main contribution of this work is the enhancement of the well known approach of predictor blends through highly adaptive determination of blending context on a pixel-by-pixel basis using classification technique. We show that this approach is well suited for medical image data compression. Results obtained with the proposed compression method on medical images are very encouraging, beating several well known lossless compression methods. The predictor proposed can also be used in other image processing applications such as segmentation and extraction of image regions

Application of Novel Lossless Compression of Medical Images Using Prediction and Contextual Error Modeling

Conduction of tele-3D-computer assisted operations as well as other telemedicine procedures often requires highest possible quality of transmitted medical images and video. Unfortunately, those data types are always associated with high telecommunication and storage costs that sometimes prevent more frequent usage of such procedures. We present a novel algorithm for lossless compression of medical images that is extremely helpful in reducing the telecommunication and storage costs. The algorithm models the image properties around the current, unknown pixel and adjusts itself to the local image region. The main contribution of this work is the enhancement of the well known approach of predictor blends through highly adaptive determination of blending context on a pixel-by-pixel basis using classification technique. We show that this approach is well suited for medical image data compression. Results obtained with the proposed compression method on medical images are very encouraging, beating several well known lossless compression methods. The predictor proposed can also be used in other image processing applications such as segmentation and extraction of image regions

Clinical and epidemiological characteristics of hospitalized patients with pandemic A(H1N1) 2009 influenza

Pandemijski virus influence A (H1N1) 2009 u nas se pojavio u srpnju, intenzivniji val bolesti zabilježen je u listopadu, studenome i prosincu 2009. godine, a bolest se pojavljivala sve do ožujka 2010. godine. U Hrvatskoj je registrirano 58 255 oboljelih od pandemijske gripe, a umrlo ih je 58, od toga 32 s laboratorijski dokazanim virusom. U razdoblju od 1. srpnja 2009. do 31. ožujka 2010. godine u Klinici za infektivne bolesti "Dr. Fran Mihaljević" u Zagrebu pregledano je 3 856 bolesnika s dijagnozom influence i/ili komplikacija. Od toga broja hospitalizirana su 562 (14,6 %) bolesnika. Od ukupnog broja hospitaliziranih, djece do 14 godina bilo je 140 (24,9 %), do 18 godina 154 (27,4 %), a odraslih gotovo triput više, odnosno 408 (72,6 %). U jedinicama intenzivne skrbi liječeno je 68 (12,1 %) bolesnika. Umrlo je 15 odraslih bolesnika, od kojih je 14 liječeno u jedinici intenzivnog liječenja. Stopa smrtnosti za sve hospitalizirane bolesnike (562) iznosi 2,7 %, za hospitalizirane odrasle (408) 3,7 %, a za odrasle liječene u jedinici intenzivne skrbi 26,4 %. Nije umrlo niti jedno dijete. Od 562 hospitalizirana bolesnika, virus pandemijske influence A(H1N1) 2009 dokazan je PCR metodom u njih 169 (30,1 %). Pandemijski virus influence otkriven je u 41,6 % hospitalizirane djece i u 25,7 % odraslih. U jedinicama intenzivne skrbi s dokazanim virusom liječeno je 35 (20,7 %) bolesnika, 22 odrasla i 13 djece. Prosječna dob svih bolesnika s dokazanim pandemijskim virusom (169) iznosila je 30,2 godina. U dječjoj skupini prosječna je dob bila 5,6 godina, a kod odraslih 45,2 godina. U odnosu na odrasle, djeca su prije dolazila i imala su znatno kraći boravak u bolnici, a u njih su zabilježene statistički značajno niže vrijednosti CRP-a, CK i sedimentacije eritrocita. U 169 bolesnika s dokazanim pandemijskim virusom influence ukupno je registrirano 227 rizičnih čimbenika, a zabilježeni su kod 95 (56,2 %) bolesnika. U odraslih su rizični imbenici zabilježeni znatno češće i u većem broju nego u djece. Najučestaliji rizični čimbenici bile su kronične plućne bolesti: astma u 29 (17,2 %) bolesnika i kronična opstruktivna plućna bolest (KOPB) u 27 (15,9 %) bolesnika. Registrirano je 240 komplikacija bolesti u 117 (69,2 %) bolesnika. Komplikacije su se češće pojavljivale i prosječno su bile teže u odraslih nego u djece. Pneumonija je bila najučestalija komplikacija, a registrirana je u 84/169 bolesnika, odnosno u svakog drugog hospitaliziranog bolesnika s dokazanim virusom pandemijske influence. Pneumonija je bila mnogo češća komplikacija u odraslih (66/105 ili 62,9 %) nego u djece (18/64 ili 28,1 %). Primarna virusna pneumonija registrirana je dvaput češće od sekundarne bakterijske (55:29 bolesnika). Zbog pandemijske influence 2009/10. godine hospitalizirano je 2,7 puta više odraslih nego djece (408:154), za razliku od deset prethodnih sezona influence kada su djeca bila 1,2 puta češće hospitalizirana od odraslih (759:656). Nameće se zaključak da je pandemijska influenca bila znatno teža i smrtonosnija bolest u usporedbi sa sezonskom, posebno u dobnim skupinama mlađih odraslih ljudi, iako pandemijom nije bio zahvaćen veći postotak pučanstva.Pandemic influenza A (H1N1) 2009 virus was first recorded in Croatia in July, and a more intense wave was recorded in October, November and December 2009, with the disease occurring throughout March 2010. Atotal of 58.255 pandemic influenza cases were recorded in Croatia, with 58 deaths, of whom 32 patients with laboratory confirmed virus. In the period from July 1, 2009 until March 31, 2010, a total of 3.856 patients with diagnosed influenza and/or complications were examined at the University Hospital for Infectious Diseases "Dr Fran Mihaljevic", Zagreb. Altogether 562 (14,6 %) patients were hospitalized, of whom 140 (24,9 %) children under 14 years of age, 154 (27,4 %) children aged between 14–18 years, with three times more adults hospitalized – 408 (72,6 %) in total. Atotal of 68 (12,1 %) patients were treated at intensive care unit (ICU). Fifteen adult patients died, of whom 14 treated in ICU. The mortality rate for all 562 hospitalized patients was 2,7 %, for 408 hospitalized adults 3,7 %, and for adults treated in ICU 26,4 %. No deaths were recorded among children. Out of 562 hospitalized patients, pandemic influenza A (H1N1) 2009 virus was detected by PCR method in 169 (30,1 %) patients. Pandemic influenza virus was detected in 41,6 % of hospitalized children and in 25,7 % of adults. In total, 35 (20,7 %) patients with confirmed virus were treated in ICU (22 adults and 13 children). The average age of all 169 patients with confirmed pandemic virus was 30,2 years. The average age of children was 5,6 years, and of adults 45,2 years. Compared to adults, children reported to hospital sooner and had a significantly shorter hospital stay, with recorded statistically significant lower values of CRP, CK and erythrocyte sedimentation rate. Out of 169 cases with confirmed pandemic influenza virus, altogether 227 risk factors were recorded in 95 (56,2 %) patients. Risk factors were more frequent and more numerous in adults than in children. The most commonly recorded risk factors were chronic pulmonary diseases – asthma in 29 patients (17,2 %) and chronic obstructive pulmonary disease (COPD) in 27 (15,9 %). We also recorded 240 disease complications in 117 (69,2 %) patients. Complications were more common and, on average, more severe in adults than in children. Pneumonia was the most frequent complication, and was recorded in 84/169 patients, i.e. in every second hospitalized patient with confirmed pandemic influenza virus. Pneumonia was more frequent complication in adults (66/105 or 62,9 %) than in children (18/64 or 28,1 %). Primary viral pneumonia was twice more frequent than secondary bacterial (55:29 patients). Due to pandemic 2009/10 influenza, 2,7 times more adults than children were hospitalized (408:154), while in ten previous influenza seasons, children were 1,2 times more often hospitalized than adults (759:656). Aconclusion is imposed that pandemic influenza was more severe and lethal disease compared to seasonal influenza, especially among younger adults, although the pandemic did not affect a higher percentage of the population

Epidemiological characteristics of respiratory syncytial virus infections during 2009 and 2010 in Zagreb and Zagreb County

Cilj: Određivanje epidemioloških karakteristika infekcija respiratornim sincicijskim virusom (RSV) u djece na području grada Zagreba i Zagrebačkoj županiji tijekom 2009. i 2010. godine. Metode: U istraživanju je sudjelovalo 467 hospitaliziranih bolesnika, starosti od 0 do 10 godina, s akutnom respiratornom infekcijom uzrokovanom RSV-om. Studija je trajala od 1. siječnja 2009. do 31. prosinca 2010. godine. Od svakog bolesnika uzet je klinički materijal (nazofaringealni sekret), te je detekcija virusa rađena pomoću komercijalnih monoklonskih protutijela u izravnom imunofluorescentnom testu. Rezultati: Infekcija RSV-om dokazana je u 238 (50,96 %) dječaka, odnosno 229 djevojčica. Najveći broj oboljele djece bio je u dobi od 0 – 6 mjeseci (202, tj. 43,25 %). RSV je bio uzročnik bronhiolitisa u 141/467 (30,19 %) slučajeva, te pneumonije u 63/467 (13,49 %) slučajeva. Rasprava i zaključci: Početkom 2009. godine RSV je bio u silaznom kraku zimske epidemije koja se nastavila iz prosinca 2008. godine. Tijekom 2010. godine javila se manja RSV-epidemija, s vrhom u proljeće, te uzlazni krak veće zimske epidemije krajem iste godine. Navedeni rezultati u skladu su s našim prijašnjim zapažanjima koja govore o tome da se u Hrvatskoj epidemije RSV-om odvijaju u dvogodišnjim ciklusima.Aim: To establish the epidemiological characteristics of respiratory syncytial virus (RSV) infections in children in the territory of Zagreb and Zagreb County during the 2009 and 2010 years. Methods: The research included 467 inpatients, aged 0-10 years, with acute respiratory infection. Study period was from 1st January 2009 to 31st December 2010. Clinical materials (nasopharyngeal excretions) were taken from each patient and the virus was detected using commercial monoclonal antibodies in direct immunofluorescence assay. Results: RSV infection was diagnosed in 238 (50.96 %) boys and 229 girls. RSV infections were the most frequent among the infants aged 0-6 months (202; 43.25 %). RSV proved to be the causative agent of bronchiolitis in 141 out of 467 patients (30.19 %) and pneumonia in 63/467 cases (13.49 %). Discussion and conclusions: In the first months of 2009 the RSV has been on a downward arm of the winter epidemics that continued from December 2008. During the 2010 there was a smaller RSV epidemic peak in the spring and the upward arm of a larger epidemic in late winter of that year. These results are consistent with our previous observations that RSV epidemics occur in two-year cycles in Croatia