Tick-borne encephalitis in eastern Croatia.

92 patients treated for tick-borne encephalitis (TBE) in the Department for Infectious Diseases, University Hospital Osijek, over a 22-year period (1973-1995) were analysed. The patients were mostly forestry workers. The appearance of the disease followed the biological activity of the tick, with the largest number of affected individuals recorded between April and August. TBE in eastern Croatia is a relatively frequent infectious disease, appearing almost every year. In a smaller number (9.8%) of cases the clinical picture was aseptic meningitis, while in the majority of patients (90.2%) it presented as an acute meningoencephalomyelitic form. The course was relatively severe in the majority of the patients analysed, with disturbances of consciousness (32.6%) and transitory neurological signs (61.9%). Three patients died (3.3%) in the early phase of the disease. A monophasic course dominated. The clinical and epidemiological data were compared with the cases described in other parts of Croatia and regional differences were seen in the severity of illness. These variations could be due to the previously hypothesized different virus subtypes, or to some other unknown factors.

Azithromycin for treatment of community acquired pneumonia caused by Legionella pneumophila: a retrospective study.

A clinical, retrospective and non-comparative study was undertaken to assess the clinical efficacy and tolerability of azithromycin in the treatment of community-acquired pneumonia caused by Legionella pneumophila. A total of 16 patients with a serologically confirmed diagnosis of Legionnaires' diseases were included. Azithromycin was administered orally at a total dose of 1.5 g for either 3 or 5 days. All patients were no side-effects requiring discontinuation of the treatment. Further increase of abnormal baseline liver function was recorded in 2 patients and in 1 patient mild, transient eosinophilia. Equal clinical efficacy and tolerability were observed with the 3- and 5-day dosage regimen. These results indicate that azithromycin given at a standard dose of 1.5 g is effective and well tolerated in the treatment of Legionnaires' disease.

Lactate and glucose in cerebrospinal fluid heavily contaminated with blood.

To simulate a traumatic lumbar puncture, blood was added to 33 normal cerebrospinal fluid (CSF) specimens. A hypothesis was tested if the CSF glucose and CSF lactate were unchanged after contamination with blood. Lactate and glucose here measured in both normal and blood-stained CSF. The estimated contamination of the normal CSF with red cells ranged from 84000 to 676500 cells per cubic millimeter. CSF lactate was unchanged by the addition of blood (P = 0.8), whereas CSF glucose was significantly higher in the blood-stained CSF (P = 0.0005). Therefore, the determination of lactate levels in the CSF heavily contaminated with blood could be useful in differentiating viral from bacterial meningitis.

[Legionnaires' disease in Yugoslavia (an epicritical review of patients)]. / Legionarska bolest u nas (epikriticki pregled bolesnika).

A review of patients with Legionnaires' disease hospitalized in our Clinic from the first cases recorded in 1978 up to now has been given. The diagnosis was confirmed by indirect immunofluorescent method in 23 patients with pneumonia, using antigen and method of the Center for Disease Control Biological Products Division, Atlanta, Georgia, USA (Dr Wilkinson). Most of the patients (16) were sporadic cases and twice as less cases were from two epidemics (7). Two patients among sporadic cases developed a very severe form of the disease during the immunosuppressive therapy after kidney transplantation. Clinical, epidemiological and laboratory data of 10 patients hospitalized and treated during the last three years (1986-1988) were analyzed in details. Two thirds of these patients were above 40 years of age and the youngest one was 29 years old. Except the advanced age no other firm disposable factor was found in patients belonging to sporadic cases. In cases from epidemics the source of infection was probably water from water-pipes i.e. hotel devices (bathrooms, douches, drinking water, air-conditioning units, water used in kitchen for cooking etc). All patients recovered after a longer symptomatic and antibiotic treatment. Erythromycin and rifampicin were applied the most frequently. In some patients treatment with chloramphenicol was effective.

Cytomegalovirus mononucleosis in children compared with the infection in adults and with Epstein-Barr virus mononucleosis.

We report clinical and laboratory findings in 11 previously healthy children with cytomegalovirus (CMV) mononucleosis and compare them with those of 18 adults with CMV mononucleosis and with those of 22 age-matched children with Epstein-Barr virus (EBV) mononucleosis. Exudative pharyngitis was more common in children whereas prolonged fever was more common in adults. Prominent lymphadenopathy and exudative pharyngitis, however, were less frequent in children with CMV mononucleosis than in those with EBV mononucleosis. Nevertheless, children with CMV mononucleosis are more likely to resemble those with EBV mononucleosis than adults with CMV mononucleosis.

The clinical use of human leukocyte interferon in viral infections.

This review presents the results of the clinical use of human leukocyte interferon (HLI) in certain diseases with viral etiology. Viral infections with manifestations in the eye, skin, and/or mucous membranes and in the respiratory system were treated with HLI by local application. HLI was incorporated into ointment, oil suspension, powder, dilution for inhalation, and dilution for subcutaneous and subconjunctival injections. The treatment in some of the diseases yielded statistical results that were highly significant in favor of interferon.