28 persons were exposed and trichinellosis was confirmed in 24 of them. This outbreak involved me... more 28 persons were exposed and trichinellosis was confirmed in 24 of them. This outbreak involved members of eight families, their relatives and friends. The infection, due to Trichinella spiralis (Owen, 1835), was associated with consumption of pork sausages procured in a local butcher's shop. The trace-back study revealed that the meat originated from swine that was raised on a small farm belonging to the owner of the shop, who did not have permission from the Veterinary Directorate for slaughtering animals and who put on the market sausages prepared from uninspected meat. Trichinellosis was accompanied by typical clinical symptoms. However, the unusual occurrence of high percentage of pulmonary complications was noticed. The description of this outbreak indicates that medical practitioners should initiate treatment immediately in cases of high suspicion of trichinellosis, even if the serology is negative, to prevent the complications of the disease. In spite of significant achievements in the control of Trichinella infection among domestic pigs and humans in the last 10 years, it is obvious that such cases of breeding animals under inappropriate conditions, slaughtering them without approval and placing uninspected pork on the market represent a source of sporadic outbreaks in Serbia.
Helicobacter pylori infection does not belong to the spectrum of opportunistic infections in peop... more Helicobacter pylori infection does not belong to the spectrum of opportunistic infections in people living with HIV (PLHIV). To evaluate the Helicobacter pylori infection prevalence rate trends in HIV co-infected individuals in comparison to the HIV-negative population, we compared histopathological findings of H. pylori positive gastritis (gastritis topography and histopathology) between 303 PLHIV and 2642 HIV-negative patients who underwent esophagogastroduodenoscopy (EGD) between 1993 and 2014 due to dyspeptic symptoms. The prevalence of H. pylori infection was significantly higher in HIV-negative controls than in PLHIV (50.2% vs. 28.1%). A significantly positive linear trend of H. pylori co-infection in PLHIV was revealed in the observed period (b = 0.030, SE = 0.011, p = 0.013), while this trend was significantly negative in HIV-negative patients (b = - 0.027, SE = 0.003, p < 0.001). Patients with HIV/H. pylori co-infection had significantly higher CD4+ T cell counts and mor...
Background: The global epidemic of nosocomial diarrhea caused by Clostridioides ( Clostridium) di... more Background: The global epidemic of nosocomial diarrhea caused by Clostridioides ( Clostridium) difficile started in 2003, with high mortality rates and emergence of a new hypervirulent strain NAP1/BI/027. The aim of this study was to assess the presence of ribotype 027 and other C. difficile ribotypes in a Serbian University Hospital, to compare the temporal variability of ribotypes three years apart, as well as to compare clinical, demographic and laboratory characteristics and disease outcome among patients infected with 027 and non-027 ribotype. This was a prospective observational study addressing four months time intervals during 2014/2015 and 2017/2018. Results: Ribotyping was performed in 64 non-duplicate C.difficile strains. Ribotype 027 was the most prevalent, and was detected in 53 (82.8%) patients (43/45 and 10/19 patients in 2014-2015 and 2017/2018, respectively). Other detected ribotypes were 001/072 in 4 (6,3%), 002 in 4 (6,3%), 014/020 in 2 (3,1%) and 176 in 1 (1,5%) ...
Acta Microbiologica et Immunologica Hungarica, 2019
Clostridium (Clostridioides) difficile infections (CDIs) are among the most frequent healthcareas... more Clostridium (Clostridioides) difficile infections (CDIs) are among the most frequent healthcareassociated infections in Serbia. In 2013, Serbia participated in the European Clostridium difficile Infection Surveillance Network (ECDIS-Net) who launched a pilot study to enhance laboratory capacity and standardize surveillance for CDI. Two clinics of Clinical Center of Serbia [Clinic for Infectious and Tropical Diseases (CITD) and Clinic of Orthopedic Surgery and Traumatology (COT)] from Belgrade and one general hospital from another metropolitan area of Serbia, Užice, participated. During a period of 3 months in 2013, all patients with diagnosed CDI were included. The CDI incidence rates in CITD, COT, and General Hospital Užice were 19.0, 12.2, and 3.9 per 10,000 patient-days, respectively. In total, 49 patients were enrolled in the study with average age of 72 years. A complicated course of CDI was found in 14.3% of all patients. Six (12.2%) of 49 patients died, but not attributable to CDI. Of 39 C. difficile isolates, available for ribotyping, 78.9% belonged to ribotype 027; other PCR ribotypes were 001, 015, 002, 005, 010, 014, and 276. Antimicrobial susceptibility testing revealed low levels of MIC 50 and MIC 90 for metronidazole (0.5 μg/ml both) and vancomycin (0.25 and 0.5 μg/ml), while 28 strains of ribotype 027 were resistant to moxifloxacin with MIC ≥4 μg/ml. National surveillance is important to obtain more insight in the epidemiology of CDI and to compare the results with other European countries. This study by ECDIS-Net gives bases for a national surveillance of CDI in Serbia.
Trichinellosis is the most common and most important parasitic zoonosis in Serbia. Complications ... more Trichinellosis is the most common and most important parasitic zoonosis in Serbia. Complications of this disease are frequent, and a fatal outcome is possible. A particularly significant complication is the involvement of the central nervous system-neurotrichinellosis. This case report presents a previously healthy, 51-yearold female from Belgrade, Serbia, a teacher by profession. The disease started with symptoms of gastroenteritis in April, after which symptoms and signs characteristic of trichinellosis occurred (myalgia, fever, bilateral eyelid edema, conjunctivitis). About two weeks before the onset of the first symptoms, the patient consumed pork sausages that had been purchased at a green market. Seven days after the disease started, she was hospitalized at the Clinic for Infectious and Tropical Diseases in Belgrade and the diagnosis of trichinellosis was established. Two days after admission, neurological symptoms appeared-confusion, apathy, right side weakness of the mimic and limb muscles. The medical imaging techniques (CT scan, MRI) showed multiple hypodense changes in different parts of the brain, which corresponded to vasculitis due to parasitic infection. She was treated with approved antiparasitic and corticosteroid therapy. Despite adequate treatment, neurological sequelae were maintained in the followup period, and control imaging techniques revealed residual changes in the brain.
Introduction. Trichinellosis is one of the most important foodborne diseases in Serbia. Most pati... more Introduction. Trichinellosis is one of the most important foodborne diseases in Serbia. Most patients with suspected trichinellosis in Belgrade are referred to the Clinical Center of Serbia for diagnosis and treatment, as are unclear and complicated cases from all across Serbia. Materials and Methods. A retrospective study of trichinellosis serology was carried out from 2009-2018 and included all outpatients and hospitalised patients from the Clinic for Infectious and Tropical Disease, Clinical Center of Serbia, who were serologically tested for Trichinella by the Parasitological Laboratory (n=1,565). Trichinella-specific IgG antibodies were detected in sera by a commercial ELISA test. We analysed the seroprevalence of Trichinella-specific IgG antibodies, antibody detection kinetics and cross-reactivity with other nematodes. Results and Conclusions. The number of patients who reported for serological testing varied greatly per year and month. Most patients were tested in December and March, DAKIĆ Zorica et al.: Serological screening of trichinellosis by ELISA 145 which coincides with the months with the most confirmed cases of trichinellosis. A total of 17.4% patients who were tested for trichinellosis had other parasitic infections. Altogether, 223 (14.2%) of tested patients were finally diagnosed with trichinellosis. We detected anti-Trichinella IgG in 68.8% (223) of patients with suspected trichinellosis on admission, which increased to 86.5%, 91.5% and 92.4% after later second, third and fourth testing, respectively. Final diagnoses of toxocariasis, strongyloidiasis, filariasis, and dirofilariasis were made for 2.4%, 0.3%, 0.3% and 0.1% of patients, respectively. Concurrent seropositivity for Trichinella and Toxocara was observed in 18.9% (7/37) of patients with clinical presentation of trichinellosis and who were also tested for toxocariasis. In 3/5 patients with imported filariasis, we found cross-reactivity with Trichinella. Potential cross-reactivity of this ELISA test with antibodies to the autochthonous nematode Toxocara canis demands the introduction of Western blot technology. Trichinellosis must be diagnosed by the combination of clinical, laboratory and epidemiological criteria.
International Journal of Infectious Diseases, 2019
As is the case for all of Southeast Europe, Serbia is an area traditionally endemic for Taenia sa... more As is the case for all of Southeast Europe, Serbia is an area traditionally endemic for Taenia saginata and Taenia solium infections. This study was performed to analyse the epidemiological data on taeniosis and cysticercosis in Serbia for the period 1990-2018. Methods: Data on cases of T. saginata and T. solium infection were collected via a systematic search of published articles, the grey literature, and official reports, as well as by performing clinical observational studies of patients treated in the departments for infectious diseases of hospitals and university clinics in Serbia. Results: A total of 212 cases of taeniosis were reported, all between 1997 and 2004 when taeniosis was notifiable (incidence range 0.04-0.9/100 000 population/year). From 1990 to 2018, 170 cases of cysticercosis (all but one of neurocysticercosis), were registered (incidence range 0-0.29/100 000 population/year), with a strong decrease since 2000 and a single case in the last 9 years. The annual number of cases of both taeniosis (Pearson's r = 0.914, p = 0.001) and cysticercosis (Pearson's r = 0.582, p = 0.014) correlated with the consumer price index. Conclusions: In Serbia, T. saginata and T. solium infections are autochthonous but occur only sporadically. However, the potential for re-emergence exists, depending on the socioeconomic state of the country.
The Journal of Infection in Developing Countries, 2018
Introduction: Pregnant women are at higher risk of developing severe influenza. Our aim was to an... more Introduction: Pregnant women are at higher risk of developing severe influenza. Our aim was to analyze clinical course and risk factors for fatal outcome in pregnant women with influenza (H1N1) infection. Methodology: This retrospective study enrolled eleven pregnant women with confirmed Influenza A (H1N1) infection treated in the Clinic for Infectious and Tropical Diseases, Belgrade, Serbia in a 6-years period. Results: The mean age of pregnant women was 28.9 ± 5.2 years, and mean gestational age was 23.1 ± 7.0 weeks. Nine (81.8%) pregnant women had pneumonia (six had interstitial and three had bacterial pneumonia). Pregnant women developed pneumonia more often than other women in the reproductive period, but without statistical significance (81.8% vs. 65.7%, p = 0.330, OR (95% CI) 2.35 (0.47-11.80)). Nine (81.8%) pregnant women recovered. None of them experienced preterm delivery or abortion. Two women (18.2%) died due to acute respiratory distress syndrome. In one of them fetal d...
The Journal of Infection in Developing Countries, 2018
Introduction: Chronic Hepatitis C Virus (HCV) infection leads to progressive fibrosis making fibr... more Introduction: Chronic Hepatitis C Virus (HCV) infection leads to progressive fibrosis making fibrosis staging necessary in the evaluation of such patients. Different fibrosis scores are emerging as possible non-invasive alternatives for liver biopsy. The Fibrosis-4 Index (FIB-4) and AST to Platelet Ratio Index (APRI) scores are the most widely used and the most extensively tested. This study aims to determine if it was possible to accurately use these to identify patients that are unlikely to have severe fibrosis. Methodology: One hundred and forty-two patients with chronic hepatitis C infection who underwent liver biopsy since January 1st 2014 until May 31st 2017 at the Hospital for Infectious and Tropical Diseases in Belgrade were analyzed. The FIB-4 and APRI scores were calculated for each patient and compared to histologically determined fibrosis stage. Results: A comprehensive statistical analysis was conducted in order to compare patients with and without severe fibrosis and t...
The rapid scientific interest in gut microbiota (GM) has coincided with a global increase in the ... more The rapid scientific interest in gut microbiota (GM) has coincided with a global increase in the prevalence of infectious and non-infectivous liver diseases. GM, which is also called “the new virtual metabolic organ”, makes axis with a number of extraintestinal organs, such as kidneys, brain, cardiovascular, and the bone system. The gut-liver axis has attracted greater attention in recent years. GM communication is bi-directional and involves endocrine and immunological mechanisms. In this way, gut-dysbiosis and composition of “ancient” microbiota could be linked to pathogenesis of numerous chronic liver diseases such as chronic hepatitis B (CHB), chronic hepatitis C (CHC), alcoholic liver disease (ALD), non-alcoholic fatty liver disease (NAFLD), non-alcoholic steatohepatitis (NASH), development of liver cirrhosis, and hepatocellular carcinoma (HCC). In this paper, we discuss the current evidence supporting a GM role in the management of different chronic liver diseases and potentia...
European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology, Jan 3, 2018
The aim of this study was to compare clinical cure rate, recurrence rate and time to resolution o... more The aim of this study was to compare clinical cure rate, recurrence rate and time to resolution of diarrhea in patients with severe and severe-complicated Clostridium difficile infection (CDI) treated with teicoplanin or vancomycin. This two-year prospective observational study included patients with first episode or first recurrence of CDI who had severe or severe-complicated CDI and were treated with teicoplanin or vancomycin. Primary outcomes of interest were clinical cure rate at discharge and recurrence rate after eight weeks follow up, and secondary outcomes were all-cause mortality and time to resolution of diarrhea. Among 287 study patients, 107 were treated with teicoplanin and 180 with vancomycin. The mean age of patients was 73.5 ± 10.6 years. One hundred eighty six patients (64.8%) had prior CDI episode. Severe complicated disease was detected in 23/107 (21.5%) and 42/180 (23.3%) patients treated with teicoplanin and vancomycin, respectively. There was no statistically s...
Helicobacter pylori (H. pylori) is one of the most common human bacterial infections with prevale... more Helicobacter pylori (H. pylori) is one of the most common human bacterial infections with prevalence rates between 10–80% depending upon geographical location, age and socioeconomic status. H. pylori is commonly found in patients complaining of dyspepsia and is a common cause of gastritis. During the course of their infection, people living with HIV (PLHIV) often have a variety of gastrointestinal symptoms including dyspepsia and while previous studies have reported HIV and H. pylori co-infection, there has been little data clarifying the factors influencing this. The aim of this case-control study was to document the prevalence of H. pylori co-infection within the HIV community as well as to describe endoscopic findings, gastritis topography and histology, along with patient demographic characteristics across three different periods of time during which antiretroviral therapy (ART) has evolved, from pre- highly active antiretroviral therapy (HAART) to early and modern HAART eras. T...
Uvod. Patološki procesi u jetri mogu biti difuznog karaktera (zapaljenski,metaboličke bolesti, he... more Uvod. Patološki procesi u jetri mogu biti difuznog karaktera (zapaljenski,metaboličke bolesti, hematološke bolesti, toksične bolesti) i fokalne (zapaljenske,parazitarne i tumorske). Cilj rada je prikaz fokalnih promjena u jetrinomparenhimu nakon ultrazvučne, laparaskopske i patohistološke dijagnostike.Metode. Retrospektivno-prospektivnim ispitivanjem je obuhvaćeno 147punoljetnih pacijenata oba pola. Fokalne promjene jetrinog tkiva su sagledaneultrazvučnom, laparoskopskom i patohistološkom dijagnostikom.Rezultati. Osnovne karakteristike ispitanika: muškaraca 71 i žena 76 sanajvećim brojem pacijenata (102 - 70%) životne dobi između 40 i 70 godina,sa ravnomjernom distribucijom za svakih deset godina starosti. Međutim,neobično je veliki broj pacijenata ženskog pola registrovan u četvrtoj decenijiživota, čak 14 (9,5%) od ukupnog broja ispitanika, odnosno 18% odispitanika ženskog pola. Metastaze čine 104 (71%) svih fokalnih lezija jetre.U većini slučajeva radilo se o metastazama karcinoma...
The Journal of Infection in Developing Countries, 2015
Introduction: Clostridium difficile is the leading cause of hospital-acquired diarrhoea. There is... more Introduction: Clostridium difficile is the leading cause of hospital-acquired diarrhoea. There is no defined protocol for treating severe Clostridium difficile infection (CDI) refractory to vancomycin or vancomycin and metronidazole combination therapy. The aim of this study was to evaluate the rate of clinical cure, time to resolution of diarrhoea and recurrence rate in patients with severe refractory CDI treated with oral teicoplanin. Methodology: A one-year prospective study was carried out in the Clinic for Infectious and Tropical Diseases, Clinical Center Serbia. Patients with severe and complicated CDI who failed to respond to oral vancomycin and intravenous metronidazole combination therapy were enrolled. They were given oral teicoplanin 100 mg bi-daily. Patients were followed for recurrence for eight weeks. Results: Nine patients with a mean age of 70.8±9.4 years were analyzed. All patients had pseudomembranous colitis, and five had complicated disease. In four patients intr...
Journal of gastrointestinal and liver diseases : JGLD, 2008
Liver disease is commonly present in human immunodeficiency virus (HIV) infection. The aim was to... more Liver disease is commonly present in human immunodeficiency virus (HIV) infection. The aim was to determine the frequency of liver enlargement and its association with opportunistic infections in patients with HIV infection. A total of 400 HIV-infected patients were investigated. Commercial kits (Ortho EIA; BioRad, ELISA) were used for detection of serum specific antibodies to HIV, hepatitis C virus, surface antigen of hepatitis B virus, and cytomegalovirus. Liver tissues were stained for various microorganisms. The electronic data base SPSS for Windows (version 10.0) was used for statistical analysis. A p <0.05 was considered significant. Ultrasonographic screening revealed liver enlargement in 63.75% of HIV patients. In 40.7% the right lobe size varied from 140 mm to 160 mm. Of those with hepatomegaly, 60.7% had AIDS. Hepatitis C and B viruses and Mycobacterium tuberculosis were detected in 50%, 29% and 18% of patients, respectively. Histological changes were mostly non-specifi...
International Journal of Infectious Diseases, 2014
Background: Trichinellosis is a zoonosis that can be prevented by veterinarian examination of mea... more Background: Trichinellosis is a zoonosis that can be prevented by veterinarian examination of meat and adequate cooking. Principal source of infection is meat of domestic or wild swine, infected with larval form of trichinella spiralis. The parasite is disseminated trough organism by blood stream,there is an inflammatory response in all tissues in which it is stuck, so any kind of complications can be expected, among them heart, brain and lung complications are tme most prominent. Methods & Materials: 53 patients were hospitalized. Illness was presented with swelling of the face, hands and feet, conjunctivitis or subconjunctival haemorrhages, with prominent muscle aches and fever. Suspicion was made on the basis of clinical findings and eosinophilia in peripheral blood count. Serology was performed as verification test. (ELISA method, Ridascreen and Novagnost). Results: Patients had 20 to 76 years (42.3 ± 14.5). Men/women ratio was 1:2,3 (p = 0,003). All were able to "blame" specific meat, to specify quantity, time and place when they eat infected meat. Time from beginning of symptoms to the suspicion was 3 to 30 days (11.09 ± 6.38). During that time they had fever, 60% had gastrointestinal symptoms, 27% eyelid swelling, 19% muscle aces. All patients (100%) had absolute eosinophilia and elevated C reactive protein (48,7 ± 31,1;norm. < 8). Lactat dechidrogenasis(LDH) was elevated in 90% of patients (682,2 ± 279,1;norm. < 400), creatin kinasis (CK) was elevated in 80% of patients (635 ± 351;norm. < 200). In two patients transitory EKG changes were seen, and another two patients had long time neurologic abnormalities. Hospitalization time was 15,6 ± 6 days. All of them were treated by albendasole or mebendasole. Highest number of cases was from January to March. Conclusion: Trichinellosis is constantly present in Belgrade aerie. It occurs relatively rarely, but we have to be aware of its presence and think of it before prominent features appear, in order to perform adequate early therapy, any delay in diagnosis could lead to worst illness. The most reliably tool is eosinophilia, supported by relevant epidemiologic data. Convalescent period during which muscle aches are prominent can last for years, what is especially important in sportsmen.
The Journal of Infection in Developing Countries, 2015
Introduction: Clostridium difficile infection (CDI) is the most common cause of hospital-acquired... more Introduction: Clostridium difficile infection (CDI) is the most common cause of hospital-acquired diarrhea. Severity of CDI is associated with advanced age and co-morbidities. The clinical spectrum varies from mild watery diarrhea to severe fulminant pseudomembranous colitis with complications. Methodology: This study conducted over a six-year period (2008 to 2013) included 510 patients treated at the University Hospital for Infectious and Tropical Diseases in Belgrade, Serbia. In patients with a history of previous hospitalization and/or treatment with antimicrobial agents who developed diarrhea, the diagnosis was established with rapid tests for C. difficile toxin A and B and by stool culture for C. difficile (454 patients) or by endoscopic examination and histological analyses of the biopsy samples taken from the colonic mucosa (56 patients). Results: The mean age of patients was 67.71± 13.34 years. A total of 67.8% patients were older than 65 years. Over half (58.7%) of the pati...
Introduction The objective of our study was to establish, through retrospective analysis of sonog... more Introduction The objective of our study was to establish, through retrospective analysis of sonographic findings obtained by portable ultrasound devices, the frequency of pathological findings of the gallbladder and common bile duct in a randomized group of patients with infectious diseases. Material and methods During five years (January 1, 2000 - December 31, 2004), gallbladder and common bile duct were examined by ultrasonography in 2691 adult patients (1440 males and 1251 females), mean age 48?17 years, ranging from 17 to 92 years at the Institute of Infectious and Tropical Diseases in Belgrade. The examination included the measurement of size and shape of the gallbladder, its wall and lumen, as well as measurement of caliber and content of the common bile duct. Conventional portable ultrasound devices, ALOKA SSD-500 and SSD-1000 (B-mod) with convex 3.5 and 5 MHz probes were used. Results The cholecyst was normal in size (<120x50 mm) in 2164 (80.4%), and enlarged in 65 (2.4%)...
Gastrointestinal (GI) diseases are common among patients infected with human immunodeficiency vir... more Gastrointestinal (GI) diseases are common among patients infected with human immunodeficiency virus (HIV), and may involve the entire GI tract. The aim of the article is to investigate the prevalence of various upper gastrointestinal abnormalities in patients with AIDS. Diagnostic esophago-gastro-duodenoscopy (EGD) was performed in cohort of AIDS patients (total 186) including non-ART, mono and/or dual ART and HAART treated subgroups. Clinical presentation, level of immunosupression and presence of H. pylori infection was also considered. Endoscopic findings included normal (29), esophageal candidiasis (22), esophageal erosions (16), gastritis/duodenitis (135), gastric/duodenal ulcers (7), erosions (6) and infiltration/tumor in the stomach (5). Thirty-nine patients (20.4%) had opportunistic infections/tumors including candida esophagitis, CMV esophagitis, CMV gastritis, gastric non-Hodgkin's lymphoma (NHL) and gastric cryptosporidiosis. H. pylori infection was present in 25.8% o...
Introduction. The number of humans infected by Fasciola hepatica is increasing worldwide. Humans ... more Introduction. The number of humans infected by Fasciola hepatica is increasing worldwide. Humans can become accidental hosts by ingesting drinking water or plants contaminated with metacercariae. Case report. We reported a case of a 68-year-old Serbian woman, in which the diagnosis of acute fasciolosis had been established after serious diagnostic concerns. Based on clinical picture (episodic right upper quadrant abdominal pain, febrility and generalized body pain) and biochemical analyses (high eosinophilia and high activity of alkaline phosphatase), she was appointed as suspected to the acute fasciolosis. Stool and duodenal aspirate exams were negative for Fasciola ova. In the absence of adequate serologic diagnostic for fasciolosis in Serbia, the diagnosis was confirmed using enzyme immunoassays and immunoblot at the Institute for Tropical Diseases in Hamburg, Germany. Soon after triclabendazole was administered, the symptoms disappeared and biochemical values returned to normal....
28 persons were exposed and trichinellosis was confirmed in 24 of them. This outbreak involved me... more 28 persons were exposed and trichinellosis was confirmed in 24 of them. This outbreak involved members of eight families, their relatives and friends. The infection, due to Trichinella spiralis (Owen, 1835), was associated with consumption of pork sausages procured in a local butcher's shop. The trace-back study revealed that the meat originated from swine that was raised on a small farm belonging to the owner of the shop, who did not have permission from the Veterinary Directorate for slaughtering animals and who put on the market sausages prepared from uninspected meat. Trichinellosis was accompanied by typical clinical symptoms. However, the unusual occurrence of high percentage of pulmonary complications was noticed. The description of this outbreak indicates that medical practitioners should initiate treatment immediately in cases of high suspicion of trichinellosis, even if the serology is negative, to prevent the complications of the disease. In spite of significant achievements in the control of Trichinella infection among domestic pigs and humans in the last 10 years, it is obvious that such cases of breeding animals under inappropriate conditions, slaughtering them without approval and placing uninspected pork on the market represent a source of sporadic outbreaks in Serbia.
Helicobacter pylori infection does not belong to the spectrum of opportunistic infections in peop... more Helicobacter pylori infection does not belong to the spectrum of opportunistic infections in people living with HIV (PLHIV). To evaluate the Helicobacter pylori infection prevalence rate trends in HIV co-infected individuals in comparison to the HIV-negative population, we compared histopathological findings of H. pylori positive gastritis (gastritis topography and histopathology) between 303 PLHIV and 2642 HIV-negative patients who underwent esophagogastroduodenoscopy (EGD) between 1993 and 2014 due to dyspeptic symptoms. The prevalence of H. pylori infection was significantly higher in HIV-negative controls than in PLHIV (50.2% vs. 28.1%). A significantly positive linear trend of H. pylori co-infection in PLHIV was revealed in the observed period (b = 0.030, SE = 0.011, p = 0.013), while this trend was significantly negative in HIV-negative patients (b = - 0.027, SE = 0.003, p < 0.001). Patients with HIV/H. pylori co-infection had significantly higher CD4+ T cell counts and mor...
Background: The global epidemic of nosocomial diarrhea caused by Clostridioides ( Clostridium) di... more Background: The global epidemic of nosocomial diarrhea caused by Clostridioides ( Clostridium) difficile started in 2003, with high mortality rates and emergence of a new hypervirulent strain NAP1/BI/027. The aim of this study was to assess the presence of ribotype 027 and other C. difficile ribotypes in a Serbian University Hospital, to compare the temporal variability of ribotypes three years apart, as well as to compare clinical, demographic and laboratory characteristics and disease outcome among patients infected with 027 and non-027 ribotype. This was a prospective observational study addressing four months time intervals during 2014/2015 and 2017/2018. Results: Ribotyping was performed in 64 non-duplicate C.difficile strains. Ribotype 027 was the most prevalent, and was detected in 53 (82.8%) patients (43/45 and 10/19 patients in 2014-2015 and 2017/2018, respectively). Other detected ribotypes were 001/072 in 4 (6,3%), 002 in 4 (6,3%), 014/020 in 2 (3,1%) and 176 in 1 (1,5%) ...
Acta Microbiologica et Immunologica Hungarica, 2019
Clostridium (Clostridioides) difficile infections (CDIs) are among the most frequent healthcareas... more Clostridium (Clostridioides) difficile infections (CDIs) are among the most frequent healthcareassociated infections in Serbia. In 2013, Serbia participated in the European Clostridium difficile Infection Surveillance Network (ECDIS-Net) who launched a pilot study to enhance laboratory capacity and standardize surveillance for CDI. Two clinics of Clinical Center of Serbia [Clinic for Infectious and Tropical Diseases (CITD) and Clinic of Orthopedic Surgery and Traumatology (COT)] from Belgrade and one general hospital from another metropolitan area of Serbia, Užice, participated. During a period of 3 months in 2013, all patients with diagnosed CDI were included. The CDI incidence rates in CITD, COT, and General Hospital Užice were 19.0, 12.2, and 3.9 per 10,000 patient-days, respectively. In total, 49 patients were enrolled in the study with average age of 72 years. A complicated course of CDI was found in 14.3% of all patients. Six (12.2%) of 49 patients died, but not attributable to CDI. Of 39 C. difficile isolates, available for ribotyping, 78.9% belonged to ribotype 027; other PCR ribotypes were 001, 015, 002, 005, 010, 014, and 276. Antimicrobial susceptibility testing revealed low levels of MIC 50 and MIC 90 for metronidazole (0.5 μg/ml both) and vancomycin (0.25 and 0.5 μg/ml), while 28 strains of ribotype 027 were resistant to moxifloxacin with MIC ≥4 μg/ml. National surveillance is important to obtain more insight in the epidemiology of CDI and to compare the results with other European countries. This study by ECDIS-Net gives bases for a national surveillance of CDI in Serbia.
Trichinellosis is the most common and most important parasitic zoonosis in Serbia. Complications ... more Trichinellosis is the most common and most important parasitic zoonosis in Serbia. Complications of this disease are frequent, and a fatal outcome is possible. A particularly significant complication is the involvement of the central nervous system-neurotrichinellosis. This case report presents a previously healthy, 51-yearold female from Belgrade, Serbia, a teacher by profession. The disease started with symptoms of gastroenteritis in April, after which symptoms and signs characteristic of trichinellosis occurred (myalgia, fever, bilateral eyelid edema, conjunctivitis). About two weeks before the onset of the first symptoms, the patient consumed pork sausages that had been purchased at a green market. Seven days after the disease started, she was hospitalized at the Clinic for Infectious and Tropical Diseases in Belgrade and the diagnosis of trichinellosis was established. Two days after admission, neurological symptoms appeared-confusion, apathy, right side weakness of the mimic and limb muscles. The medical imaging techniques (CT scan, MRI) showed multiple hypodense changes in different parts of the brain, which corresponded to vasculitis due to parasitic infection. She was treated with approved antiparasitic and corticosteroid therapy. Despite adequate treatment, neurological sequelae were maintained in the followup period, and control imaging techniques revealed residual changes in the brain.
Introduction. Trichinellosis is one of the most important foodborne diseases in Serbia. Most pati... more Introduction. Trichinellosis is one of the most important foodborne diseases in Serbia. Most patients with suspected trichinellosis in Belgrade are referred to the Clinical Center of Serbia for diagnosis and treatment, as are unclear and complicated cases from all across Serbia. Materials and Methods. A retrospective study of trichinellosis serology was carried out from 2009-2018 and included all outpatients and hospitalised patients from the Clinic for Infectious and Tropical Disease, Clinical Center of Serbia, who were serologically tested for Trichinella by the Parasitological Laboratory (n=1,565). Trichinella-specific IgG antibodies were detected in sera by a commercial ELISA test. We analysed the seroprevalence of Trichinella-specific IgG antibodies, antibody detection kinetics and cross-reactivity with other nematodes. Results and Conclusions. The number of patients who reported for serological testing varied greatly per year and month. Most patients were tested in December and March, DAKIĆ Zorica et al.: Serological screening of trichinellosis by ELISA 145 which coincides with the months with the most confirmed cases of trichinellosis. A total of 17.4% patients who were tested for trichinellosis had other parasitic infections. Altogether, 223 (14.2%) of tested patients were finally diagnosed with trichinellosis. We detected anti-Trichinella IgG in 68.8% (223) of patients with suspected trichinellosis on admission, which increased to 86.5%, 91.5% and 92.4% after later second, third and fourth testing, respectively. Final diagnoses of toxocariasis, strongyloidiasis, filariasis, and dirofilariasis were made for 2.4%, 0.3%, 0.3% and 0.1% of patients, respectively. Concurrent seropositivity for Trichinella and Toxocara was observed in 18.9% (7/37) of patients with clinical presentation of trichinellosis and who were also tested for toxocariasis. In 3/5 patients with imported filariasis, we found cross-reactivity with Trichinella. Potential cross-reactivity of this ELISA test with antibodies to the autochthonous nematode Toxocara canis demands the introduction of Western blot technology. Trichinellosis must be diagnosed by the combination of clinical, laboratory and epidemiological criteria.
International Journal of Infectious Diseases, 2019
As is the case for all of Southeast Europe, Serbia is an area traditionally endemic for Taenia sa... more As is the case for all of Southeast Europe, Serbia is an area traditionally endemic for Taenia saginata and Taenia solium infections. This study was performed to analyse the epidemiological data on taeniosis and cysticercosis in Serbia for the period 1990-2018. Methods: Data on cases of T. saginata and T. solium infection were collected via a systematic search of published articles, the grey literature, and official reports, as well as by performing clinical observational studies of patients treated in the departments for infectious diseases of hospitals and university clinics in Serbia. Results: A total of 212 cases of taeniosis were reported, all between 1997 and 2004 when taeniosis was notifiable (incidence range 0.04-0.9/100 000 population/year). From 1990 to 2018, 170 cases of cysticercosis (all but one of neurocysticercosis), were registered (incidence range 0-0.29/100 000 population/year), with a strong decrease since 2000 and a single case in the last 9 years. The annual number of cases of both taeniosis (Pearson's r = 0.914, p = 0.001) and cysticercosis (Pearson's r = 0.582, p = 0.014) correlated with the consumer price index. Conclusions: In Serbia, T. saginata and T. solium infections are autochthonous but occur only sporadically. However, the potential for re-emergence exists, depending on the socioeconomic state of the country.
The Journal of Infection in Developing Countries, 2018
Introduction: Pregnant women are at higher risk of developing severe influenza. Our aim was to an... more Introduction: Pregnant women are at higher risk of developing severe influenza. Our aim was to analyze clinical course and risk factors for fatal outcome in pregnant women with influenza (H1N1) infection. Methodology: This retrospective study enrolled eleven pregnant women with confirmed Influenza A (H1N1) infection treated in the Clinic for Infectious and Tropical Diseases, Belgrade, Serbia in a 6-years period. Results: The mean age of pregnant women was 28.9 ± 5.2 years, and mean gestational age was 23.1 ± 7.0 weeks. Nine (81.8%) pregnant women had pneumonia (six had interstitial and three had bacterial pneumonia). Pregnant women developed pneumonia more often than other women in the reproductive period, but without statistical significance (81.8% vs. 65.7%, p = 0.330, OR (95% CI) 2.35 (0.47-11.80)). Nine (81.8%) pregnant women recovered. None of them experienced preterm delivery or abortion. Two women (18.2%) died due to acute respiratory distress syndrome. In one of them fetal d...
The Journal of Infection in Developing Countries, 2018
Introduction: Chronic Hepatitis C Virus (HCV) infection leads to progressive fibrosis making fibr... more Introduction: Chronic Hepatitis C Virus (HCV) infection leads to progressive fibrosis making fibrosis staging necessary in the evaluation of such patients. Different fibrosis scores are emerging as possible non-invasive alternatives for liver biopsy. The Fibrosis-4 Index (FIB-4) and AST to Platelet Ratio Index (APRI) scores are the most widely used and the most extensively tested. This study aims to determine if it was possible to accurately use these to identify patients that are unlikely to have severe fibrosis. Methodology: One hundred and forty-two patients with chronic hepatitis C infection who underwent liver biopsy since January 1st 2014 until May 31st 2017 at the Hospital for Infectious and Tropical Diseases in Belgrade were analyzed. The FIB-4 and APRI scores were calculated for each patient and compared to histologically determined fibrosis stage. Results: A comprehensive statistical analysis was conducted in order to compare patients with and without severe fibrosis and t...
The rapid scientific interest in gut microbiota (GM) has coincided with a global increase in the ... more The rapid scientific interest in gut microbiota (GM) has coincided with a global increase in the prevalence of infectious and non-infectivous liver diseases. GM, which is also called “the new virtual metabolic organ”, makes axis with a number of extraintestinal organs, such as kidneys, brain, cardiovascular, and the bone system. The gut-liver axis has attracted greater attention in recent years. GM communication is bi-directional and involves endocrine and immunological mechanisms. In this way, gut-dysbiosis and composition of “ancient” microbiota could be linked to pathogenesis of numerous chronic liver diseases such as chronic hepatitis B (CHB), chronic hepatitis C (CHC), alcoholic liver disease (ALD), non-alcoholic fatty liver disease (NAFLD), non-alcoholic steatohepatitis (NASH), development of liver cirrhosis, and hepatocellular carcinoma (HCC). In this paper, we discuss the current evidence supporting a GM role in the management of different chronic liver diseases and potentia...
European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology, Jan 3, 2018
The aim of this study was to compare clinical cure rate, recurrence rate and time to resolution o... more The aim of this study was to compare clinical cure rate, recurrence rate and time to resolution of diarrhea in patients with severe and severe-complicated Clostridium difficile infection (CDI) treated with teicoplanin or vancomycin. This two-year prospective observational study included patients with first episode or first recurrence of CDI who had severe or severe-complicated CDI and were treated with teicoplanin or vancomycin. Primary outcomes of interest were clinical cure rate at discharge and recurrence rate after eight weeks follow up, and secondary outcomes were all-cause mortality and time to resolution of diarrhea. Among 287 study patients, 107 were treated with teicoplanin and 180 with vancomycin. The mean age of patients was 73.5 ± 10.6 years. One hundred eighty six patients (64.8%) had prior CDI episode. Severe complicated disease was detected in 23/107 (21.5%) and 42/180 (23.3%) patients treated with teicoplanin and vancomycin, respectively. There was no statistically s...
Helicobacter pylori (H. pylori) is one of the most common human bacterial infections with prevale... more Helicobacter pylori (H. pylori) is one of the most common human bacterial infections with prevalence rates between 10–80% depending upon geographical location, age and socioeconomic status. H. pylori is commonly found in patients complaining of dyspepsia and is a common cause of gastritis. During the course of their infection, people living with HIV (PLHIV) often have a variety of gastrointestinal symptoms including dyspepsia and while previous studies have reported HIV and H. pylori co-infection, there has been little data clarifying the factors influencing this. The aim of this case-control study was to document the prevalence of H. pylori co-infection within the HIV community as well as to describe endoscopic findings, gastritis topography and histology, along with patient demographic characteristics across three different periods of time during which antiretroviral therapy (ART) has evolved, from pre- highly active antiretroviral therapy (HAART) to early and modern HAART eras. T...
Uvod. Patološki procesi u jetri mogu biti difuznog karaktera (zapaljenski,metaboličke bolesti, he... more Uvod. Patološki procesi u jetri mogu biti difuznog karaktera (zapaljenski,metaboličke bolesti, hematološke bolesti, toksične bolesti) i fokalne (zapaljenske,parazitarne i tumorske). Cilj rada je prikaz fokalnih promjena u jetrinomparenhimu nakon ultrazvučne, laparaskopske i patohistološke dijagnostike.Metode. Retrospektivno-prospektivnim ispitivanjem je obuhvaćeno 147punoljetnih pacijenata oba pola. Fokalne promjene jetrinog tkiva su sagledaneultrazvučnom, laparoskopskom i patohistološkom dijagnostikom.Rezultati. Osnovne karakteristike ispitanika: muškaraca 71 i žena 76 sanajvećim brojem pacijenata (102 - 70%) životne dobi između 40 i 70 godina,sa ravnomjernom distribucijom za svakih deset godina starosti. Međutim,neobično je veliki broj pacijenata ženskog pola registrovan u četvrtoj decenijiživota, čak 14 (9,5%) od ukupnog broja ispitanika, odnosno 18% odispitanika ženskog pola. Metastaze čine 104 (71%) svih fokalnih lezija jetre.U većini slučajeva radilo se o metastazama karcinoma...
The Journal of Infection in Developing Countries, 2015
Introduction: Clostridium difficile is the leading cause of hospital-acquired diarrhoea. There is... more Introduction: Clostridium difficile is the leading cause of hospital-acquired diarrhoea. There is no defined protocol for treating severe Clostridium difficile infection (CDI) refractory to vancomycin or vancomycin and metronidazole combination therapy. The aim of this study was to evaluate the rate of clinical cure, time to resolution of diarrhoea and recurrence rate in patients with severe refractory CDI treated with oral teicoplanin. Methodology: A one-year prospective study was carried out in the Clinic for Infectious and Tropical Diseases, Clinical Center Serbia. Patients with severe and complicated CDI who failed to respond to oral vancomycin and intravenous metronidazole combination therapy were enrolled. They were given oral teicoplanin 100 mg bi-daily. Patients were followed for recurrence for eight weeks. Results: Nine patients with a mean age of 70.8±9.4 years were analyzed. All patients had pseudomembranous colitis, and five had complicated disease. In four patients intr...
Journal of gastrointestinal and liver diseases : JGLD, 2008
Liver disease is commonly present in human immunodeficiency virus (HIV) infection. The aim was to... more Liver disease is commonly present in human immunodeficiency virus (HIV) infection. The aim was to determine the frequency of liver enlargement and its association with opportunistic infections in patients with HIV infection. A total of 400 HIV-infected patients were investigated. Commercial kits (Ortho EIA; BioRad, ELISA) were used for detection of serum specific antibodies to HIV, hepatitis C virus, surface antigen of hepatitis B virus, and cytomegalovirus. Liver tissues were stained for various microorganisms. The electronic data base SPSS for Windows (version 10.0) was used for statistical analysis. A p <0.05 was considered significant. Ultrasonographic screening revealed liver enlargement in 63.75% of HIV patients. In 40.7% the right lobe size varied from 140 mm to 160 mm. Of those with hepatomegaly, 60.7% had AIDS. Hepatitis C and B viruses and Mycobacterium tuberculosis were detected in 50%, 29% and 18% of patients, respectively. Histological changes were mostly non-specifi...
International Journal of Infectious Diseases, 2014
Background: Trichinellosis is a zoonosis that can be prevented by veterinarian examination of mea... more Background: Trichinellosis is a zoonosis that can be prevented by veterinarian examination of meat and adequate cooking. Principal source of infection is meat of domestic or wild swine, infected with larval form of trichinella spiralis. The parasite is disseminated trough organism by blood stream,there is an inflammatory response in all tissues in which it is stuck, so any kind of complications can be expected, among them heart, brain and lung complications are tme most prominent. Methods & Materials: 53 patients were hospitalized. Illness was presented with swelling of the face, hands and feet, conjunctivitis or subconjunctival haemorrhages, with prominent muscle aches and fever. Suspicion was made on the basis of clinical findings and eosinophilia in peripheral blood count. Serology was performed as verification test. (ELISA method, Ridascreen and Novagnost). Results: Patients had 20 to 76 years (42.3 ± 14.5). Men/women ratio was 1:2,3 (p = 0,003). All were able to "blame" specific meat, to specify quantity, time and place when they eat infected meat. Time from beginning of symptoms to the suspicion was 3 to 30 days (11.09 ± 6.38). During that time they had fever, 60% had gastrointestinal symptoms, 27% eyelid swelling, 19% muscle aces. All patients (100%) had absolute eosinophilia and elevated C reactive protein (48,7 ± 31,1;norm. < 8). Lactat dechidrogenasis(LDH) was elevated in 90% of patients (682,2 ± 279,1;norm. < 400), creatin kinasis (CK) was elevated in 80% of patients (635 ± 351;norm. < 200). In two patients transitory EKG changes were seen, and another two patients had long time neurologic abnormalities. Hospitalization time was 15,6 ± 6 days. All of them were treated by albendasole or mebendasole. Highest number of cases was from January to March. Conclusion: Trichinellosis is constantly present in Belgrade aerie. It occurs relatively rarely, but we have to be aware of its presence and think of it before prominent features appear, in order to perform adequate early therapy, any delay in diagnosis could lead to worst illness. The most reliably tool is eosinophilia, supported by relevant epidemiologic data. Convalescent period during which muscle aches are prominent can last for years, what is especially important in sportsmen.
The Journal of Infection in Developing Countries, 2015
Introduction: Clostridium difficile infection (CDI) is the most common cause of hospital-acquired... more Introduction: Clostridium difficile infection (CDI) is the most common cause of hospital-acquired diarrhea. Severity of CDI is associated with advanced age and co-morbidities. The clinical spectrum varies from mild watery diarrhea to severe fulminant pseudomembranous colitis with complications. Methodology: This study conducted over a six-year period (2008 to 2013) included 510 patients treated at the University Hospital for Infectious and Tropical Diseases in Belgrade, Serbia. In patients with a history of previous hospitalization and/or treatment with antimicrobial agents who developed diarrhea, the diagnosis was established with rapid tests for C. difficile toxin A and B and by stool culture for C. difficile (454 patients) or by endoscopic examination and histological analyses of the biopsy samples taken from the colonic mucosa (56 patients). Results: The mean age of patients was 67.71± 13.34 years. A total of 67.8% patients were older than 65 years. Over half (58.7%) of the pati...
Introduction The objective of our study was to establish, through retrospective analysis of sonog... more Introduction The objective of our study was to establish, through retrospective analysis of sonographic findings obtained by portable ultrasound devices, the frequency of pathological findings of the gallbladder and common bile duct in a randomized group of patients with infectious diseases. Material and methods During five years (January 1, 2000 - December 31, 2004), gallbladder and common bile duct were examined by ultrasonography in 2691 adult patients (1440 males and 1251 females), mean age 48?17 years, ranging from 17 to 92 years at the Institute of Infectious and Tropical Diseases in Belgrade. The examination included the measurement of size and shape of the gallbladder, its wall and lumen, as well as measurement of caliber and content of the common bile duct. Conventional portable ultrasound devices, ALOKA SSD-500 and SSD-1000 (B-mod) with convex 3.5 and 5 MHz probes were used. Results The cholecyst was normal in size (<120x50 mm) in 2164 (80.4%), and enlarged in 65 (2.4%)...
Gastrointestinal (GI) diseases are common among patients infected with human immunodeficiency vir... more Gastrointestinal (GI) diseases are common among patients infected with human immunodeficiency virus (HIV), and may involve the entire GI tract. The aim of the article is to investigate the prevalence of various upper gastrointestinal abnormalities in patients with AIDS. Diagnostic esophago-gastro-duodenoscopy (EGD) was performed in cohort of AIDS patients (total 186) including non-ART, mono and/or dual ART and HAART treated subgroups. Clinical presentation, level of immunosupression and presence of H. pylori infection was also considered. Endoscopic findings included normal (29), esophageal candidiasis (22), esophageal erosions (16), gastritis/duodenitis (135), gastric/duodenal ulcers (7), erosions (6) and infiltration/tumor in the stomach (5). Thirty-nine patients (20.4%) had opportunistic infections/tumors including candida esophagitis, CMV esophagitis, CMV gastritis, gastric non-Hodgkin's lymphoma (NHL) and gastric cryptosporidiosis. H. pylori infection was present in 25.8% o...
Introduction. The number of humans infected by Fasciola hepatica is increasing worldwide. Humans ... more Introduction. The number of humans infected by Fasciola hepatica is increasing worldwide. Humans can become accidental hosts by ingesting drinking water or plants contaminated with metacercariae. Case report. We reported a case of a 68-year-old Serbian woman, in which the diagnosis of acute fasciolosis had been established after serious diagnostic concerns. Based on clinical picture (episodic right upper quadrant abdominal pain, febrility and generalized body pain) and biochemical analyses (high eosinophilia and high activity of alkaline phosphatase), she was appointed as suspected to the acute fasciolosis. Stool and duodenal aspirate exams were negative for Fasciola ova. In the absence of adequate serologic diagnostic for fasciolosis in Serbia, the diagnosis was confirmed using enzyme immunoassays and immunoblot at the Institute for Tropical Diseases in Hamburg, Germany. Soon after triclabendazole was administered, the symptoms disappeared and biochemical values returned to normal....
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Papers by Milos Korac