Climate Variables Related to the Incidence of Human Leishmaniosis in Montenegro in Southeastern Europe during Seven Decades (1945-2014).

Leishmaniosis (or leishmaniasis) is a neglected parasitosis most commonly transmitted by the sandfly bite. Changes in temperature, precipitation, and humidity can greatly affect the vectors and reservoir hosts. This study aimed to determine the association between temperature, air humidity, and weather conditions with the incidence of leishmaniasis in Montenegro during a seven-decade period (1945-2014) and to statistically compare and correlate the obtained data. In the studied period, there were 165 registered cases of leishmaniosis, 96.4%, in the coastal and central region of Montenegro, with an average incidence rate of 0.45/100.000. The visceral form of leishmaniosis predominated (99% of the cases), with only one case of cutaneous disease. Climate factors (average temperature, air humidity, and precipitation) had an impact on the occurrence of leishmaniosis in Montenegro. Air temperature elevated by 1 °C in all regions of Montenegro was significantly correlated with an increased incidence of leishmaniosis, by 0.150 (0.013 to 0.287; p < 0.05). In order to improve prevention and control of this disease, it is also necessary to investigate other factors with a possible impact on the number of cases of this neglected parasitosis.

Subtyping Blastocystis in pigs and humans revealed unusual avian-specific subtype ST6 in humans in Serbia.

Blastocystis is a common protist colonizing the gastrointestinal tract of humans and various animals. The first subtyping of Blastocystis isolates in pigs and humans in Serbia revealed unusual avian-specific subtype ST6 in humans. In total, 48 pig faecal specimens collected on seven pig farms and 50 human faecal specimens positive to Blastocystis by microscopic examination were selected for the study. Eleven randomly selected PCR-positive pig samples and 10 samples from human patients (with gastrointestinal complaints) were subjected to SSU rDNA sequencing. Three subtypes were identified (ST3, ST5 and ST6) by phylogenetic analysis. ST5 was found in all pig samples; while in human samples, we detected ST3 and ST6. The latter subtype is relatively uncommon in Europe and highly adapted to avian hosts; therefore, the possibility of sporadic zoonotic transmission to human patients should not be ignored.

Long-lasting undetected neurocysticercosis.

Neurocysticercosis is the most common parasitic disease of the nervous system, nevertheless, it can remain undetected for a long period of time, especially if it occurs in non endemic areas and regions with low-endemicity. Inadequate diagnostic procedures and lack of clinician's dedication towards this health issue can lead to a missed diagnose. Herein, we present a case of a 51-year-old male, with a missed diagnosis of neurocysticercosis for more than two decades. A history of epilepsy had started twenty-one years earlier and was of unclear etiology. Recently, after neurological worsening and headaches, brain computed tomography and magnet resonance imaging was performed as well as Western blot immunoassay of serum and cerebrospinal fluid, surgery, and pathohistological examination of the extracted cysts. Neurocysticercosis was confirmed. Combined therapy that consisted of albendazole and prednisolone was administered for a period of four weeks. Also, antiepileptic therapy was continued. Both clinical status and brain imaging showed the apparent improvement in the patient's condition. Review of the literature was implemented in the discussion that deals with proper and adequate therapy option and outcome factors in neurocysticercosis patients. Over a long period of time, the majority of patients develop seizures as the most common symptom, which requires the administration of medications. Proper diagnostic procedures and adequate combination of surgery and conservative treatment areessential.

Anaphylactic shock due to unruptured hepatic hydatid cyst complicated by multiple intrahospital infections.

Anaphylactic shock due to unruptured hydatid cyst is a rare complication of hepatic echinococcosis. Here, we present an unusual case of unruptured hydatid cyst causing anaphylactic shock followed by appendicitis, ileus, and complicated by septic condition due to multiple intrahospital infections. Decision of the surgical cyst removal at the right moment and appropriate antimicrobial treatment are key factors for a positive outcome.

Canine Dirofilaria infections in two uninvestigated areas of Serbia: epidemiological and genetic aspects.

In 2009 canine filarial infections were investigated in two northern areas of Serbia (Pancevo and Veliko Gradiste), applying morphometry, biochemical staining, and immunological kit to detect Dirofilaria immitis antigens, and two home-made ELISAs to detect antibodies to D. repens and D. immitis somatic/metabolic polyproteins. Moreover, molecular tools were applied to analyze the phylogenetic relationships of the isolates. The microfilariae detected in 21/122 dogs (17.2%) were identified as D. repens (n=21) and D. immitis (n=2). D. immitis antigens were found in another 13 animals with occult infection. All of the 15 heartworm-positive dogs also had antibodies to this parasite, which were detected in another 13 subjects, indicating an overall D. immitis seroprevalence rate of 22.9%. Serology for D. repens revealed evidence of antibodies in 42.6% of the dogs, but was negative for 4 microfilaremic dogs. As for the two different areas, the prevalence of microfilariae and/or D. immitis antigens, mainly due to D. repens microfilaremic animals, was not significantly higher in Veliko Gradiste (33.3%) than in Pancevo (22%). However, serology showed a different epidemiological picture. Heartworm infection occurred more often in both areas, and antibodies to dirofilarial nematodes were detected in 72.9% of dogs living in Pancevo, a rate higher than in those living in Veliko Gradiste (57.1%). No risk factors for infection were found, confirming the uselessness of prophylactic drugs against D. repens, and suggesting the presence in these areas of sunrise- or sunset-biting mosquitoes as important vectors. The results indicate the need for both appropriate entomological studies and further research on the intra-species variability shown by D. repens.

[Immunopathogenesis of recurrent genital candidosis in women].

INTRODUCTION: There are more and more women that suffer from chronic recurrent genital candidiasis. At the beginning of the research in this field the researchers usually studied the properties of the microorganism then nonspecific resistance of the vaginal mucosa, possibility of endogenous and exogenous reinfection, hormonal status of women in order to determine the cause of the recurrent genital candidosis. After numerous studies, only the risk factors were determined, but not the very cause of the recurrence of this fungal infection. The following investigation encompassed examination of the immunity of the vaginal mucosa, as well as the influence of the system cellular immunity to the course of the vaginal fungal infection. Results of those studies show that neither hyporeactivity, nor the disregulation of the system cellular immunity has influence to the course of the recurrent genital candidosis. CONCLUSION: Based on the existence of the antigen presenting cells and phenotypically different T-lymphocytes in the vaginal mucosa, it was determined that this mucous membrane represents immunocompetent tissue, and accordingly, one may assume that the cause of the recurrent genital candidosis may lie in disregulation of the local immune response to the Candida sp. antigens.

[Overview of the scoring system for cardiovascular risk estimation: role and significance of lipids].

Practical recommendations for the regulation of hyperlipoproteinemia and the prevention of coronary disease and scoring systems for coronary disease risk estimation are based on the results of epidemiologic studies and international consensus guidelines. According to the Framingham point score the risk was defined as an absolute 10 year probability of myocardial infarction and coronary death, while the PROCAM function of risk was based on cardiovascular events: fatal and non-fatal myocardial infarction and sudden coronary death. The Third European Joint Task Force and other societies for the prevention of cardiovascular diseases revise the joint European guidelines and the recommendations for national population strategies. Global coronary disease risk is nowadays in Europe based on the SCORE system. The risk is defined as an absolute 10 year probability of afatal cardiovascular event, and high risk cut-off is at 5%.

[Primary pelvic hydatid cyst--case report].

INTRODUCTION: Primary hydatid cyst in the pelvis is an extremely rare site of the disease and occurs in approximately 0.7% of the patients with this disease. CASE REPORT: The case of a 65-year-old woman is reported, who was admitted for surgical treatment of incidentally detected pelvis tumor of unclear origin. Intraoperatively, it was noted that the tumor in the pelvis was cystic, resembling a hydatid disease, involving left pararectal space and extending to the sacroiliac joint. The total cystectomy with partial pericystectomy was performed. The section was sent to histopathology, which confirmed intraoperative findings. DISCUSSION AND CONCLUSION: A pelvic hydatid cyst is in most cases diagnosed intraoperatively but the disease should be taken into consideration in cases of cystic tumors of unclear origin, especially in endemic regions and in persons with positive history of pet keeping. Surgical management is the treatment of choice. The principal goal is the compromise between the need to completely remove the cyst and the fact that it is a benign disease so the patient should not be unnecessarily exposed to an increased operative risk.

Survey of canine dirofilariasis in Vojvodina, Serbia.

In 2006 and 2007, a total of 193 blood samples were collected from privately owned dogs housed predominantly outdoors, resident in four provinces in Vojvodina, Serbian Republic. Circulating microfilariae of Dirofilaria repens, Dirofilaria immitis and Acanthocheilonema reconditum were found in 49.2%, 7.2% and 2.1% of dogs, respectively. Two additional occult heartworm infections were revealed with an antigen test of 90 amicrofilaraemic dogs. Prevalence values were not influenced by sex and breed, but D. repens was significantly more prevalent in dogs > or =6 years old, and differences were observed between provinces. This is the first detailed survey on canine dirofilariasis in the continental part of the Balkans. Vojvodina is shown to have the northernmost limit of heartworm infection in the Balkan area and one of the zones in Europe with the highest prevalence of canine subcutaneous dirofilariasis. Chemoprophylaxis should be considered for resident dogs and dogs visiting this region.

Clinical importance and representation of toxigenic and non-toxigenic Clostridium difficile cultivated from stool samples of hospitalized patients

The aim of this study was to fortify the clinical importance and representation of toxigenic and non-toxigenic Clostridium difficile isolated from stool samples of hospitalized patients. This survey included 80 hospitalized patients with diarrhea and positive findings of Clostridium difficile in stool samples, and 100 hospitalized patients with formed stool as a control group. Bacteriological examination of a stool samples was conducted using standard microbiological methods. Stool sample were inoculated directly on nutrient media for bacterial cultivation (blood agar using 5% sheep blood, Endo agar, selective Salmonella Shigella agar, Selenite-F broth, CIN agar and Skirrow's medium), and to selective cycloserine-cefoxitin-fructose agar (CCFA) (Biomedics, Parg qe tehnicologico, Madrid, Spain) for isolation of Clostridium difficile. Clostridium difficile toxin was detected by ELISA-ridascreen Clostridium difficile Toxin A/B (R-Biopharm AG, Germany) and ColorPAC ToxinA test (Becton Dickinson, USA). Examination of stool specimens for the presence of parasites (causing diarrhea) was done using standard methods (conventional microscopy), commercial concentration test Paraprep S Gold kit (Dia Mondial, France) and RIDA®QUICK Cryptosporidium/Giardia Combi test (R-Biopharm AG, Germany). Examination of stool specimens for the presence of fungi (causing diarrhea) was performed by standard methods. All stool samples positive for Clostridium difficile were tested for Rota, Noro, Astro and Adeno viruses by ELISA - ridascreen (R-Biopharm AG, Germany). In this research we isolated 99 Clostridium difficile strains from 116 stool samples of 80 hospitalized patients with diarrhea. The 53 (66.25%) of patients with diarrhea were positive for toxins A and B, one (1.25%) were positive for only toxin B. Non-toxigenic Clostridium difficile isolated from samples of 26 (32.5%) patients. However, other pathogenic microorganisms of intestinal tract cultivated from samples of 16 patients. Examination of cultivated colonies revealed that most of cultivated species belonged to genera of Campylobacter spp., Salmonella spp., and Candida spp.. In control group, toxigenic Clostridium difficile cultivated from stool samples of two patients (2%) and non-toxigenic Clostridium difficile from samples of five patients (5%). This research confirmed clinical importance of toxigenic Clostridium difficile found in liquid stool samples of hospitalized patient, and the possibility of asymptomatic carriage in 2% of patients with formed stool.

[Effect of fosinopril on progression of the asymptomatic carotid atherosclerosis and left ventricular hypertrophy in hypertensive patients].

INTRODUCTION: The cardiovascular changes (vascular structure changes, hypertrophy of the left ventricle) contribute to both the increased cardiovascular morbidity and the mortality of essential hypertension. Therefore, modern treatment strategies should not only target blood pressure (BP) reduction but also normalize cardiovascular structure and function. OBJECTIVE: Aim of the study was to determine the effect of the ACE inhibitor Fosinopril on the intima-media thickness of the common carotid artery and on the left ventricle mass after 9-month treatment of hypertensive patients. METHOD: The study included 40 patients with the arterial hypertension and the left ventricle hypertrophy verified by echocardiography. The patients were randomized on A) ACE-inhibitor--Fosinopril and B) without ACE inhibitor--atenolol, and they were followed up 9 months. The groups were not different by age, sex, and metabolic status. Color Duplex ultrasonography of the carotid arteries was performed by Acuson Sequia C236 with high-frequency linear probe of 8 MHz. The intima-media thickness of the common carotids on the left and the right was measured in diastole at 1.5 cm from the highest point of bifurcation under maximal magnification. Using the same device, the left ventricle mass and other parameters of the left ventricle were determined in M-mode and by means of 2D image. RESULTS: After 9 months, BP in both groups was reduced in similar range (group A: systolic BP from 158 to 137 mmHg, and diastolic BP from 94 to 85 mmHg, and group B: systolic BP from 164 to 137 mmHg, and diastolic BP from 87 to 84 mmHg). The thickness of the intimomedial complex in patients using Fosinopril was decreased by 0.0278 +/- 0.03 mm, while in the group of patients that did not use the ACE-inhibitor, it was increased by 0.078 +/- 0.13 mm. The left ventricle mass in patients using Fosinopril was decreased by 5 grams (312 +/- 72 g vs. 307 +/- 77 g), while in group B patients, it was increased by 15 grams (323 +/- 79 g vs. 328 +/- 58 g. Diastolic function expressed through relation E/A was improved minimally in the group A, while it worsened by 0.1 in the group B. After 9 months, serious cardiovascular events were recorded (one infarction of myocardium and one hospitalization due to the unstable angina pectoris) in two patients of the group A, while four patients of the group B had serious CV events (1 cerebrovascular stroke and 3 hospitalizations due to unstable angina pectoris). CONCLUSION: The results of our study showed that the application of Fosinopril in patients with the arterial hypertension and the left ventricle hypertrophy could efficiently block further progression of the intima-medial thickness of the common carotid artery, reduce the left ventricle mass, and improve diastolic function of the left ventricle.

[Endogenous reinfection as a cause of recurrent genital candidiasis on women]. / Endogena reinfekcija kao uzrok rekurentnosti genitalne kandidoze zena.

The cause of primary, recurrent genital candidosis (RGC), that 5% of the female population was afflicted with, is still unknown. It is not clear whether RGC is a result of reinfection or infection recidive caused by Candida sp. The goal of the study is to examine Candida presence in women's genital and intestinal tract; by resistotypization of the same isolated species of Candida fungi to prove their identity as well as the validity of the stated thesis that endogenous reinfection may be one of the possible causes of RGC. The study included 70 women (T-group) afflicted with primary RGC who, at the moment of the examination, were in the phase of manifest infection. In the control group there were 70 women (C-group) not afflicted with RGC. The microbiological test consisted of the microscopic and culture examination of women's genital and intestinal material. The Candida species were differentiated according to the gemination test and the biochemical activity measured by commercial Candi-Fast-test (Mycoplasma International, France) and Vitec-AMS-system (bioMerieux, France). Candi-Fast test examined the sensitivity of Candida species to antimicotics and determined the resistotypes of isolated species. The study did not show statistically significant difference between examined groups in terms of the Candida presence in intestinal tract. The Candida colonization of intestinal mucosa was proved in 24 women (34.28%) with RGC. Eighteen women (25.71%) of the control group, had Candida sp. in intestinal tract. The most frequent RGC agent, as well as most frequent coloniser of intestinal mucosa is Candida albicans (C. albicans--RGC--84.28%; T-group--intestinal tract--C. albicans--87.50%; C-group--intestinal tract--C. albicans--94.44%). In 20 women with RGC there was a presence of identical resistotypes of isolated Candida sp. Identical resistotypes of C. albicans was found in 19 women of the test group, in their genital and intestinal tract. Only in one patient it was recorded the same resistance types of C. trapicalis. In four patients Candida species isolated from genital and intestinal material were not identical. In two women with RGC C. albicans on vaginal mucosa was accompanied by C. glabrata in intestinal tract, while in two more women the presence of various resistotypes C. albicans was identified in genital and intestinal tract.