Tick-Borne Encephalitis in the Area of Koprivnica-Križevci County – Prevalence and Spatial Distribution of those Affected in Settlements, in the Period from 1979 to 2011

Koprivničko-križevačka županija poznato je endemsko žarište krpeljnog meningoencefalitisa (KME) već punih 60 godina, iako je sigurno da je ta bolest u nas postojala i ranije. S posebnom pažnjom proučavali smo osobitosti KME-a i prikupili nova saznanja o epidemiologiji, klinici i dijagnostici te bolesti, no mnoga su pitanja i danas ostala otvorena. Svrha našeg rada bila je prikazati incidenciju i prostornu raspodjelu bolesnika s KME-om po naseljima, i ustanoviti jesu li se tijekom našeg istraživanja u incidenciji i prostornoj raspodjeli događale promjene. U razdoblju od 1979.godine do 2011. godine liječili smo u Djelatnosti za infektivne bolesti i Djelatnosti za pedijatriju Opće bolnice »Dr. Tomislav Bardek« u Koprivnici 714 bolesnika s KME-om, 599 odrasla i 115-ero djece, u dobi od dvije do 82 godine. Prevladavao muški spol. Svi su bolesnici stanovnici naše županije. Potječu iz 168 naselja. Prosječno smo na 162 stanovnika naše Županije zabilježili jednog bolesnika s KME-om. Iz 57 naselja potječe samo jedan bolesnik s KME-om, iz ostalih 111 između dvoje i 22 bolesnika. Naselja s najviše bolesnika u odnosu na broj stanovnika su: Dedina, Vinarec, Potok Kalnički, Selanec, Podvinje Miholečko, Karane, Sveta Ana, Brodić, Veliki Grabičani i Donji Maslarac. Najviše bolesnika u odnosu na ispitivano razdoblje potječe iz naselja Virje (22), Novigrad (20), Ferdinandovac (18), Molve (18), Hlebine (11), Rasinja (10), Dedina (20), Vinarec (16), Kalnički Potok (13), Selanec (9) i Sveti Petar Čvrstec (9). Obitavalište jedne petine (19,6%) bolesnika s KME-om su naši gradovi. Na temelju prikupljenih podataka ustanovili smo značajne promjene koje se su dogodile u incidenciji i prostornoj raspodjeli bolesnika s KME-om. U prvom promatranom jedanaestogodišnjem razdoblju prosječno smo godišnje liječili 29,6 bolesnika s KME-om u drugom 26,5 i u trećem se incidencija bolesti više od tri puta smanjila. Istražujući raspodjelu bolesnika prema mjestu prebivališta uočili smo sve izrazitiji pad incidencije na križevačkom području i sve učestaliju pojavu bolesti u naseljima uz rijeku Dravu. Pojedina, u početku istraživanja vrlo« aktivna« naselja s vremenom su se »ugasila«, pojedina su povremeno ili stalno ostala« aktivna«, a u posljednjih nekoliko godina aktivna su i nova (Kloštar Podravski npr.). Razlog tako značajnom padu incidencije KME-a i promjene u prostornoj raspodjeli bolesnika teško možemo objasniti. Možda objašnjenje jednim dijelom treba potražiti u, iz ekonomskih razloga smanjenoj dijagnostičkoj obradi, spoznaji kako se nešto događa u načinu življenja našeg stanovništva. Preventivne mjere koje ne obuhvaćaju široku populaciju stanovništva (u nas su u program imunizacije protiv KME-a uglavnom uključene samo rizične skupine stanovnika) ne mogu imati značajniji učinak na pad incidencije ove bolesti. I dok većina europskih endemskih područja (s velikom vjerojatnošću) povezuje porast incidencije i promjene u prostornoj raspodjeli s klimatskim promjenama prvenstveno s povećanjem temperature zraka, ti čimbenici, iako prisutni, ne mogu biti odgovorni za uočene promjene na području Koprivničko–križevačke županije.Koprivnica-Križevci County has been known as an endemic hotspot for tick-borne encephalitis (TBE) for the past 60 years, though it is certain that the disease was present here earlier. Special emphasis was placed on examining the specificity of TBE and in gathering new knowledge about its epidemiology, clinical signs and diagnosing the disease, though many issues have remained unknown to the present day. The objective of this study was to show the prevalence and spatial distribution of patients with TBE by settlements, and to determine whether the prevalence and spatial distribution has changed over the course of the study. Over the period from 1979 to 2011, a total of 714 patients with TBE (599 adults and 115 children, aged 2 to 82 years) were treated at the Infective Diseases ward and Paediatric Ward of the Dr. Tomislav Bardek Clinical Hospital in Koprivnica. There were more male than female patients and all patients were residents of the county, originating from 168 settlements. The average prevalence was one TBE patient per 162 residents in the county. Of the settlements, 57 had only one TBE patient, while the remaining 111 settlements had between 2 and 22 patients. The settlements with the highest number of patients to residents were: Dedina, Vinarec, Potok Kalnički, Selanec, Podvinje Miholečko, Karane, Sveta Ana, Brodić, Veliki Grabičani and Donji Maslarac. The highest numbers of patients in the investigated area originated from the settlements: Virje (22), Novigrad (20), Ferdinandovac (18), Molve (18), Hlebine (11), Rasinja (10), Dedina (20), Vinarec (16), Kalnički potok (13), Selanec (9) and Sveti Petar Čvrstec (9). One-fifth (19.6%) of all TBE patients lived in towns. Based on the collected data, significant changes were established in both the prevalence and spatial distribution of TBE patients. In the first examined 11-year period, a total of 29.6 patients per year were examined, which decreased to 26.5 in the second 11-year period, and decreased by more than three-fold in the third period. In examining the distribution of patients by place of residence, a pronounced drop in prevalence was observed for the Koprivnica area, with an increasing prevalence of the disease in settlements along the Drava River. Over time, several of the initially very “active” settlements, in terms of the disease, were “extinguished” over time, some occasionally or permanently remained “active”, while several new settlements have become active in recent years (e.g. Kloštar Podravski, etc.). The reason for such a significant drop in the incidence of TBE and changes in the spatial distribution of patients is difficult to explain. One possible explanation should be sought, due to the fact that diagnostic testing has been reduced due to the economic situation, that certain changes have been taking place in the lifestyle of the county’s inhabitants. Preventative measures that do not encompass the broader population (immunization programmes for TBE are aimed primarily risk groups of the population) cannot have a significant effect on the prevalence of this disease. And while the majority of Europe’s endemic areas associate (with high significance) an increase in the prevalence and changes in spatial distribution of the disease with climatic changes, primarily with increasing air temperature, these factors, though present, cannot be accountable for the changes observed in the territory of Koprivnica-Križevci County

LEPTOSPIROSIS IN KOPRIVNICA-KRIŽEVCI COUNTY: The incidence, spatial distribution, presence of likely infectious serovars and clinical symptoms – results of a study from 1970 to 2014

Našim dugogodišnjim istraživanjem leptospiroze dokazali smo promjene koje su se dogodile u učestalosti, prostornoj raspodjeli po naseljima, prisutnosti vjerojatnih infektivnih serovara i kliničkom obilježju te bolesti. Incidencija se kontinuirano smanjuje. Leptospiroza je najučestalija na koprivničkom području. Učestali su teški klinički oblici bolesti. Serovar icterohaemorrhagiae zauzima vodeće mjesto, najučestaliji je i u bolesnika s teškim obilježjima bolesti. Ustanovili smo značajan porast serovara Australis, poi i hardjo. Unatoč saznanja da prvi službeni klinički opis leptospiroze potječe iz 1886. godine (30), smatra se da je bolest prisutna u Europi još od 18. stoljeća. U Europu je vjerojatno unesena seobom štakora iz Euroazije), dosadašnjih brojnih istraživanja, uključujući i naše, neprekidno smo suočeni s novim nepoznanicama vezanim uz ovu zoonozu. Ne začuđuje da leptospirozu uspoređuju s Protejom – ima bezbroj lica i naravi. Nerijetko nas iznenadi težinom tijeka i ishodom ili se prezentira s tako laganim simptomima da ostane neprepoznata.The study included three groups of patients with a confirmed diagnosis of leptospirosis treated at the Infectious Diseases ward of Dr. Tomislav Bardek General Hospital in the period from 1970 to 1975, from 2000 to 2005 and from 2010 to 31 October 2014 (for the final group, only data on incidence, age, gender and spatial distribution of residence were available). The purpose of this study was to examine whether there have been changes in the frequency, spatial distribution, presence of likely infectious serovars and clinical properties of the disease over the course of this long-time study. The first group consisted of 113 patients (mean age 21 years), the second of 39 patients (mean age 46.1 years) and the third group of 13 patients (mean age 50.1 years). The overall ages of patients ranged from 6 to 81 years. Males were predominant. The main characteristic of the first group was that it was comprised largely of school aged children (59/113, 52.2%), while the second and third groups were comprised of adult patients (mean age 48 years). In comparing the results, a significant and continuous drop in the incidence of the disease was observed: virtually three-fold drop between the first and second groups, and a greater than three-fold drop between the second and third groups. The average number of patients per year was 18.8 in the first group, 6.5 in the second group and 2.6 in the third group. The patients resided in 67 different settlements in the county. A total of 44 patients originated from a single settlement each, while 2–26 patients originated from the remaining 23 settlements. The most patients originated from the towns of Koprivnica and Đurđevac, and the settlements of Virje, Novigrad Podravski, Velika Mučna, Reka and Koprivnički Bregi. The highest frequency of patients resided in the territory of the town of Koprivnica (100, 60.6%). During the survey, the towns of Koprivnica and Đurđevac alternated in terms of frequency, i.e. as the incidence dropped in Đurđevac, it increased in Koprivnica. The clinical signs of the disease also changed significantly over time. The first group was characterised by patients with mild (76.1%) symptoms, while the second group was marked by moderate (30.7%) and serious (35.8%) symptoms of the disease. There were four times as many patients in the second group with serious clinical symptoms. The most frequency infectious serovar was icterohaemorrhagiae, which was most often present in those patients with serious clinical symptoms of the disease. During the survey, a significant increase in the presence of the serovars Australis, Poi and Hardjo was observed. This long-term study of leptospirosis clearly outlines the changes that have occurred over time in the frequency, spatial distribution, presence of infectious serovars and clinical symptoms of the disease. Despite the current knowledge, including this study, there are still many unknowns concerning this zoonosis

Interleukine-8, monocyte chemotactic protein-1 and interleukine-10 in leptospiral and hantaviral infections

Leptospiroza i hemoragijska vrućica s bubrežnim sindromom (HVBS) su zoonoze rasprostranjene širom svijeta te je gotovo cijela Hrvatska, osim otoka i priobalja, endemsko područje za obje bolesti. Cilj našeg istraživanja bio je prikazati dolazi li pri akutnoj infekciji leptospirama do izlučivanja interleukina-8 (IL-8), monocitnog kemotaktičnog proteina-1 (MCP-1) i interleukina-10 (IL-10) te postoji li razlika u dinamici njihovog izlučivanja tijekom razvoja bolesti. Ujedno smo planirali prikazati dolazi li do izlučivanja ovih citokina u bolesnika s dokazanim akutnim HVBS-om te postoji li razlika u njihovoj razini u odnosu na bolesnike s leptospirozom. Razine IL-8 i MCP-1 su bile statistički značajno povišene u bolesnika s leptospirozom u odnosu na zdrave kontrole, a razina im se održavala u istim granicama tijekom cijelog trajanja bolesti. Razine IL-8 i MCP-1 su bile povišene i u bolesnika s HVBS-om, međutim nije bilo značajnih razlika u razini testiranih citokina između bolesnika s leptospirozom i HVBS-om.Leptospirosis and hemorrhagic fever with renal syndrome (HFRS) are zoonoses distributed worldwide and almost entire Croatia except its islands and seaside is endemic region for these diseases. The aim of our study was to analyze the levels of interleukine-8 (IL-8), monocyte chemotactic protein-1 (MCP-1) and interleukine-10 (IL-10) in patients with acute leptospirosis and to determine the dynamics of their production during the course of the disease. Moreover, we analyzed the levels of these cytokines in patients with acute HFRS and compared them with the levels found in patients with leptospirosis. In comparison to controls, significantly higher production of IL-8 and MCP-1 was found in patients with acute leptospirosis, but the levels were unchanged during the course of the disease. Significantly higher levels of IL-8 and MCP-1 were also found in patients with acute HFRS, however there was no significant difference in the measured cytokine level between patients with HFRS and leptospirosis

Infections associated with war injuries

U razdoblju od 1991. do 1994. godine liječeno je na kirurškom odjelu Opće bolnice Koprivnica 250 ranjenika. Autori iznose svoja zapažanja o učestalosti infekcija kod ranjenika, njihov klinički ishod, zatim najčešće izolirane bakterije i njihovu osjetljivost na antimikrobne lijekove. Većina je ranjenika premještena u našu bolnicu iz drugih ustanova. Dominirao je muški spol u dobi od 21 do 30 godina. Antimokrobna profilaksa je provedena u 192 (77%) bolesnika. Najčešći uzročnici izolirani iz bakterioloških uzoraka bili su: Enterobacteriaceae, Acinetobacter species, Pseudomonas aeruginosa, Staphylococcus aureus, od kojih su neki pokazivali izrazitu rezistenciju na antimikrobne lijekove.During 1992/1994, 250 injured persons were treated at the Department of Surgery of the General Hospital in Koprivnica. The authors report their observations upon the frequency of infections by war injuries, their clinical outstandings, the most common agents isolated from bacterial specimens and their reactivity upon antimicrobial medication. The majority of patients were transferred to our hospital from other institutions. Male patients in the age group 21-30 were predominant. Antimicrobial prophylaxis was conducted on 192 (77%) patients. All the infections were hospital-acquired infections. Wound infections were dominant. The most common agents from bacterial specimens were: Enterobacteriaceae, Acinetobacter species, Pseudomonas aeruginosa, Staphylococcus aureus, some of which showed remarkable resistance towards antimicrobial drugs

Infections associated with war injuries

U razdoblju od 1991. do 1994. godine liječeno je na kirurškom odjelu Opće bolnice Koprivnica 250 ranjenika. Autori iznose svoja zapažanja o učestalosti infekcija kod ranjenika, njihov klinički ishod, zatim najčešće izolirane bakterije i njihovu osjetljivost na antimikrobne lijekove. Većina je ranjenika premještena u našu bolnicu iz drugih ustanova. Dominirao je muški spol u dobi od 21 do 30 godina. Antimokrobna profilaksa je provedena u 192 (77%) bolesnika. Najčešći uzročnici izolirani iz bakterioloških uzoraka bili su: Enterobacteriaceae, Acinetobacter species, Pseudomonas aeruginosa, Staphylococcus aureus, od kojih su neki pokazivali izrazitu rezistenciju na antimikrobne lijekove.During 1992/1994, 250 injured persons were treated at the Department of Surgery of the General Hospital in Koprivnica. The authors report their observations upon the frequency of infections by war injuries, their clinical outstandings, the most common agents isolated from bacterial specimens and their reactivity upon antimicrobial medication. The majority of patients were transferred to our hospital from other institutions. Male patients in the age group 21-30 were predominant. Antimicrobial prophylaxis was conducted on 192 (77%) patients. All the infections were hospital-acquired infections. Wound infections were dominant. The most common agents from bacterial specimens were: Enterobacteriaceae, Acinetobacter species, Pseudomonas aeruginosa, Staphylococcus aureus, some of which showed remarkable resistance towards antimicrobial drugs

Global Warming, Climate Change and the Effect on Ticks and Tick borne Pathogens

U posljednjih nekoliko desetljeća suočeni smo s progresivnim globalnim zatopljenjem uzrokovanim prekomjernom koncentracijom stakleničkih plinova u atmosferi zbog ljudske aktivnosti. Globalno zatopljenje uzrokuje i široki raspon posljedica na ljudsko zdravlje, uključujući i promjene u širenju krpeljom prenosivih patogena. Vremenske i prostorne promjene temperature, oborine i vlaga imaju s velikom vjerojatnošću značajan učinak na biologiju i ekologiju krpelja-vektora, domaćina na kojem se krpelji hrane te mogućnost ransmisije uzročnika bolesti. Osnovni cilj ovog rada je ispitati i utvrditi imaju li promjene temperature učinak na sezonsku i prostornu raspodjelu krpeljnog meningoencefalitisa (KME) te kliničke osobitosti bolesti na području Koprivničko-križevačke županije. Retrospektivno smo prikupili i obradili demografske, epidemiološke i kliničke pokazatelje bolesnika, koji su zbog KME liječeni u Djelatnosti za infektivne bolesti Opće bolnice »Dr. Tomislav Bardek« u Koprivnici od 1979. do 2007. godine. Bolesnike smo ovisno o godini hospitalizacije radi mogućnosti uspoređivanja podataka raspodijelili u tri skupine: prva obuhvaća bolesnike od 1979. do 1988. godine, druga od 1989. do 1998. godine i tre}a od 1999. do 2007. godine. Temperatura zraka mjerena je na Meteorološkoj postaji Koprivnica koja se nalazi u mreži postaja Državnog hidrometeorološkog zavoda. Dijagnozu KME temeljimo na prisutnosti pleocitoze u lumbalnome likvoru (>5×106 stanica/litru) i prisutnosti specifičnih serumskih IgM, ili serokonverziji IgG protutijela, dva temeljna kriterija za uključivanje u studiju. Za dokaz serumskih protutijela koristio se enzimski imunotest (ELISA), a do njegovog uvođenja, test reakcije vezanja komplementa (RVK). Kriterij za isključivanje iz studije bili su bolesnici s pridruženom svježom infekcijom Borrelia burgdorfer sensi lato (BBSL). Tijekom provedenog istraživanja svježu infekciju virusom KME dokazali smo u 654 bolesnika, u dobi od 2 do 83 godine. Prevladava muški spol. U prvom desetljeću istraživanja oboljela su 304, u drugom 260, a u trećem 90 bolesnika. Bolest je (s izuzetkom siječnja) prisutna tijekom čitave godine, s najvećom incidencijom u lipnju i srpnju. Prvo promatrano desetljeće bilježi najveću incidenciju, dok se u posljednjem više od tri puta smanjila. U prvom desetljeću maksimum incidencije KME je u ljetnim, a minimum u zimskim mjesecima. Tijekom drugog desetljeća uočavamo izraziti pomak maksimuma incidencije prema proljetnim mjesecima. Jesenski mjeseci bilježe blagi porast, a u zimskim se incidencija više nego udvostručila. Obilježje trećeg promatranog razdoblja je značajan porast incidencije u jesenskim i zimskim mjesecima. U analiziranom razdoblju temperatura zraka prosječno je rasla 0,5 °C/10 godina. Povećanje temperature zraka bilježimo u svim mjesecima, osim u rujnu i prosincu. Najveće povećanje uočavamo u veljači i studenom, iako ni u ostalim mjesecima ona nisu zanemariva. Povećanje incidencije KME u proljetnim mjesecima i mjesecu listopadu, koju bilježimo tijekom posljednja dva promatrana razdoblja, može se povezati s povećnjem temperature u tim mjesecima. Ispitujući raspodjelu naših bolesnika prema mjestu prebivališta uočavamo sve izrazitiji pad incidencije na križevačkom području te sve učestaliji porast u nizinskim područjima naše županije. Klinički simptomi/znakovi bolesti su ostali isti. Promijenili su se klinički oblici – u prvom desetljeću prevladava aseptički meningitis, a u posljednja dva meningoencefalitis i meningoencefalomijelitis. Rezultati našeg dugogodišnjeg istraživanja pokazuju značajne promjene koje su se dogodile u sezonskoj i prostornoj raspodjeli bolesnika s KME, kliničkim oblicima bolesti. Učinak uočenih promjena, prvenstveno povećanje temperature zraka, naročito u jesenskom i zimskom razdoblju, bez obzira da li su one posljedica čovjekove aktivnosti, su važan, ali vjerojatno tek samo jedan u nizu znanih i neznanih čimbenika odgovornih za ove novonastale promjene u incidenciji KME na području Koprivničko-Križevačke županije.In the last several decades we have been facing a progressive global warming caused by an excessive concentration of greenhouse gases in the atmosphere as a result of human activities. Global warming also causes a wide spectrum of consequences on the human health, including changes in the spread of tick borne pathogens. Temperature changes in time and space, precipitation and humidity have with great certainty a significant impact on biology and ecology of ticks-vectors, tick hosts and possible transmission of disease pathogens. Basic goal of this paper was to examine and determine whether temperature changes have an impact on seasonal and regional distribution of tick-borne encephalitis (TBE), clinical characteristics of disease in the area of Koprivnica-Križevci County. We retrospectively collected and analyzed demographic, epidemiologic and clinical characteristics of patients treated for TBE at the Infectious Disease Department of the General Hospital »Dr.Tomislav Bardek« in Koprivnica from 1979 to 2007. Depending on the year of hospitalization, for comparative purposes, the patients were divided into three groups: the first group consisted of patients hospitalized from 1979 to 1988, the second group from 1989 to 1998 and the third group from 1999 to 2007. Air temperature was measured at the Meteorological Station Koprivnica, a member of the Croatian Meteorological and Hydrological Service network. The diagnosis of TBE was based on the presence of pleocytosis in the cerebrospinal fluid (>5×106 cells/liter) and the presence of specific serum IgM, or seroconversion of IgG antibodies, that presented two basic criteria for patient enrolment in the study. Enzyme-linked immunosorbent assay (ELISA) was used for detection of serum antibodies, and up to its introduction, complement-binding reaction test. Exclusion criteria were patients with recently acquired BBSL co-infection. During the conducted research, recent TBE viral infection was detected in 654 patient, aged 2 to 83 years. Males predominated. In the first decade researched, a total of 304 patients fell ill, in the second 260 and in the third 90. The disease (except in January) was present throughout the year, with the highest incidence recorded in June and July. The first observed decade recorded the highest incidence, while in the last decade the incidence decreased for more than three times. In the first decade the maximum incidence of TBE was in the summer and minimum in the winter months. In the second decade we have noticed that the maximum incidence shifted towards spring months. Autumn months record a slight increase in the incidence rates, and in the winter months the incidence has more than doubled. The most prominent characteristic of the third observed period is a significant increase in the incidence rates in autumn and winter months. In the analyzed period, air temperature increased on the average for 0,5 °C/10 years. Higher air temperatures are recorded in all months, except in September and December. The highest increase was observed in February and November, although the remaining months also record increases. The increase of TBE incidence in the spring months and October, recorded in the last two observed periods, can be related to increased temperatures in those months. By analyzing the distribution of our patients according to place of living we noticed a decreased incidence in the area of Križevci, and increased in the plain areas of our County. Clinical symptoms/signs of disease remained the same. Clinical forms of disease have changed – aseptic meningitis predominated in the first decade and in the last two decades meningoencephalitis and meningoencephalomyelitis. The results of our long-term research have shown significant changes that occurred in seasonal and locational distribution of patients with TBE, as well as clinical forms of disease. The effect of observed changes, primarily increased air temperature especially during autumn and winter period, regardless whether being caused by human activities, are an important, but probably only one in a series of known and unknown factors responsible for this newly occurring changes in the TBE incidence in the Koprivnica-Križevci County

Guillain-Barre Syndrome in Patients with Seroconversion of IgG Antibodies to Borrelia Burgdorferi sensu lato

A case of polyneuroradiculitis (Guillain-Barre Syndrome) is presented, which was diagnosed in a 62 year-old man after progressive weakness in the legs and arms and double vision, preceded by severe pain in the back. Diagnosis was made on the basis of electromioneurography, a specific finding of cerebrospinal fluid (albumino-citological dissociation), and the clinical course of the disease. Serological analysis of serum included Borellia Burgdorferi sensu lato (BBSL). Positive findings (slowing of conduction velocity of sensor and motor neurones, and marked albumino-citological dissociation), together with the dynamics of these findings on the 33rd, 67th and 101st days and one year and a half after the first clinical signs of disease, indicated the possibility of BBSL infection. Because of the absence of clear clinical and serological signs of other infections it was assumed that BBSL might be the possible trigger for Guillain-Barre Syndrome. The fact that there were no obvious clinical signs of infection with BBSL, only serological, suggests that in the case of unclear aetiology of Guillain-Barre Syndrome BBSL should not be excluded

Prognosis of severity of tick-borne encephalitis based on selected parameters

Svrha našeg rada bila je istražiti može li se u bolesnika s KME na temelju izabranih pokazatelja određenih kod primitka na bolničko liječenje predvidjeti težina tijeka akutne bolesti. Retrospektivnim istraživanjem uključili smo odrasle bolesnike s KME koji su od 1995. do 2005. godine obrađeni u Djelatnosti za infektivne bolesti Opće bolnice u Koprivnici. Sve podatke o pojedinom bolesniku prikupili smo iz povijesti bolesti. Akutna meningoencefalitička (ME) faza klasificirana je kao lagana ili teška, ovisno o prisutnosti meningealnih simptoma, težini znakova encefalitisa i prisutnosti žarišnih znakova središnjeg živčanog sustava (SŽS). Svi su bolesnici uglavnom pregledani i kategorizirani od istog liječnika. Izabrani i analizirani pokazatelji s mogućim učinkom na težinu bolesti uključuju: spol i dob bolesnika, podatak o višekratnim ubodima krpelja, sezonsku raspodjelu, vremensko razdoblje (u danima) od prvih simptoma do prvog pregleda, trajanje asimptomatskog razdoblja (u danima), stanje svijesti, tijek bolesti (bifazni, monofazni), nalaz lumbalnoga likvora i periferne krvi, pridruženu infekciju s Borrelia burgdorferi sensu lato (BBSL). Sa ciljem što bolje i ujednačenije obrade te lakše mogućnosti uspoređivanja, sve podatke o pojedinom bolesniku upisivali smo u posebno pripremljene anketne listiće (upitnike). Akutnu infekciju virusom KME dokazali smo u 133 bolesnika, u dobi od 16 do 76 godina. Prevladava muški spol (83/133, 62,4%). Višekratni ubodi krpelja zabilježeni su u 33 (38,4%) bolesnika, od kojih u 24 (48,0%) s laganim i devetero (25,0%) s teškim ME stadijem bolesti. Klinički se bolest najčešće očituje kao ME (66/49,6%), bifaznog tijeka u 94 (70,7%) bolesnika. Lagani ME prisutan je u 77 (57,8%), a teški u 56 (42,1%) bolesnika. Na početku bolesti samo kratko asimptomatsko razdoblje (P<0,001), poremećaj svijesti (P<0,001), povišena koncentracija ukupnih proteina u lumbalnom likvoru (P=0,009), leukocitoza periferne krvi (P=0,009) i povišena SE (P=0,002) mogući su prediktor nepovoljnog tijeka bolesti. Za ostale istražene pokazatelie nije zabilježena statistički značajna razlika između promatranih skupina. Potrebna su daljnja istraživanja za utvrđivanje dodatnih pouzdanih pokazatelja odgovornih za težinu tijeka KME.The main purpose of our study was to investigate whether the severity and course of acute illness in patients with tick-borne encephalitis can be predicted based on selected parameters determined on admission to hospital. This retrospective study included adult patients with TBE, who were treated at the Department of Infectious Diseases, General Hospital, Koprivnica, Croatia, between 1995 and 2005. Case records of all patients were reviewed. On admission to hospital the acute meningoencephalitic (ME) stage was classified as mild or severe, depending on the presence of meningeal symptoms, the severity of clinical signs of encephalitis and presence of focal central nerves systems (CNS) signs. The patients were generally examined and categorized by the same physician. We analyzed and compared selected parameters determined on admission to hospital including: sex and age, multiple tick bite, seasonal distribution, period of time (days) between the onset of first symptoms of disease and the first examination, duration of asymptomatic interval (days), state of mind, course of illness (biphasic, monophasic), cerebrospinal fluid and peripheral blood findings, concomitant infection with Borrelia burgdorferi sensu lato (BBSL). All data collected from patients were entered into specially prepared questionnaire. Recent infection with TBE was confirmed in 133 patients, 83 (62,4%) males and 50 (37,6%) females, aged 16 to 76. A history of tick-bite was noted in 86 (64,6%) of whom multiple in 33 (38,3%) patients. TBE presented as isolated meningitis in 50 (37,6%), as ME in 66 (49,6%) and as meningoencephalomyelitis (MEM) in 17 (12,8%) patients. A biphasic course of disease occurred in 94 (70,7%) patients. Mild ME stage was noticed in 77 (57,8%) and severe in 56 (42,1%) patients. On admission to hospital only a short period of time between finishing initial stage and beginning of second ME stage (p<0,001), altered consciousness (p<0,001), elevated total protein concentration in CSF (p=0,009), peripheral blood leukocytosis (p=0,009) and elevated ESR (p=0,002) might indicate an unfavorable course of TBE. Other parameters investigated in this study did not correlate with the severity of the illness. Further investigations of more reliable parameters are needed in order to predict the severity of TBE

Leptospirosis and characterization of Leptospira isolates from patients in Koprivnica-Križevci County, Croatia from 2000–2004

Introduction. Leptospirosis, caused by spirochetes of the genus Leptospira, is present in the Koprivnica-Križevci County area, Croatia. Clinical manifestation can range from asymptomatic, short-term mild, non-specific febrile disease, to severe forms with high mortality rates. Aim. The aim of the study was to valuate culture in front of microscopic agglutination test (MAT) for diagnosis of infection, and to evaluate clinical and laboratory features of the disease. Moreover, we want to characterize Leptospira strains involved in infection in Koprivnica-Križevci County, Croatia. Methods. We included 68patients with clinical presentation consistent with leptospirosis collected in a 5-year period (2000–2004). Clinical samples (blood, urine and cerebrospinal fluid, CSF) were inoculated in Kolthoff’s mediumspecies of isolated Leptospira strains was determined with Tm of real-time PCR, serogroup/serovar with MAT and NotI-RFLP analysis. Demonstration of specific antibodies in patients’ sera was done using microscopic agglutination test. Results. Leptospira was isolated from the blood of 14/51(27.5%) patients and the most often identified serogroup/serovar was Icterohaemorrhagiae (8/10, 80%) followed by Grippotyphosa (10%). Regarding to species level, 8/10 isolated belonged to L. interrogans sensu stricto and one to L. kirschneri species. MAT was carried out on 51patients with suspected leptospirosis, and was positive in 11/51(21.5%) patients. Most of our patients presented with moderate severe symptoms, were hospitalized from August to October, and were infected mainly during the work or recreation in our county. The frequency of particular clinical features and pathological laboratory findings correlated with the severity of the clinical condition. Conclusions. Leptospirosis can be confirmed microbiologically, culture and MAT contributed almost equally to the diagnosis of infection. Serovar Icterohaemorrhagiae was found as the dominant one, and L. interrogans sensu stricto as dominant species in our county. Epidemiological data shown that leptospirosis occurs seasonally, affects the rural population, and most commonly is presented with moderate severe clinical course

Multiple recurrent liver abscesses in an immunodeficient patient

Multipli recidivirajući jetreni apscesi su rijedak klinički entitet koji može predstavljati veliki dijagnostički i terapijski problem. Prikazali smo bolesnika koji je zbog septičnog stanja i recidivirajućih multiplih jetrenih apscesa u periodu od 1999. – 2007.god. višekratno liječen u više općih i kliničkih bolnica u Hrvatskoj. Učinjenom dodatnom imunološkom obradom dokazana je u prvom redu smanjena mikrobicidna aktivnost granulocitnih i monocitnih fagocita. U našem radu pokazali smo da se kod recidivirajućih multiplih apscesa jetre mora misliti na poremećaje u procesu fagocitoze, te je u takvih bolesnika u prvom redu potrebno uraditi funkcionalne testove fagocitoze, ali i T- i B-limfocita i NK-stanica. Primjena intravenskog imunoglobulina, koji ima ulogu u stimulaciji respiratornog praska i posljedično mikrobicidne aktivnosti, može smanjiti broj recidiva i povoljno utjecati na tijek bolesti.Multiple recurrent liver abscesses are uncommon clinical entity that can represent a significant diagnostic and therapeutic problem. We describe a patient who was, due to septic conditions and recurrent multiple hepatic abscesses, repeatedly treated in a number of general and clinical hospitals in Croatia in the period from 1999 to 2007. Additional immunological tests demonstrated a reduced microbicidal activities of granulocytes and monocytic phagocytes. Our paper shows that in patients with multiple recurrent liver abscesses, possible deficiencies in the process of phagocytosis have to be considered, and functional tests of phagocytes, T- and B-lymphocytes as well as NK-cells need to be performed. The administration of intravenous immunoglobulin, which has a role in stimulating the respiratory burst activity and, consequently, microbicidal phagocytic activity, can reduce the number of relapses, and favorably affect the course of disease