Viruses today and tomorrow.

The current studies show that viral infections can cause not only acute, but also persistent viral diseases. A certain number of viruses are able to incorporate their nucleic acid into the genome of the host-cell, leading to rearrangement of the cell genes and formation of malignant tumors. Viral persistence can cause manifestations of latent or chronic infections, as well as prion-caused slow infections of the central nervous system. Defective Di particles play an important role in maintaining viral persistence. Viruses are important agents involved in various disorders of the immunological homeostasis of the organism.

[Morphologic manifestations of human papillomavirus infection in the vulvar and anogenital region]. / Morfoloske manifestacije infekcije humanim papiloma virusom na vulvi i anogenitalnoj regiji.

INTRODUCTION: Human papillomavirus (HPV) infection of the female genital tract is a sexually transmissible disease most frequently manifested by warts on the vulva, anogenital region, vagina and cervix. Precancerous lesions of vulvar intraepithelial neoplasia (VIN) as well as the development of invasive malignant neoplasms are also related to the infections caused by some HPV types. Infections with HPV-6 and HPV-11, the disease is often polycentric, sometimes reaching gigantic dimensions, elicit venereal warts. Amongst several histological criteria for diagnosing this change, the most typical is koilocytosis, with perinuclear halo formation with a thick cytoplasmic border. Precancerous changes of the vulva and anogenital region are displastic changes of the squamous epithelium, characterized by high mitotic activity, disturbance of nucleocytoplasmic relationship and lack of differentiation in the upper epithelial layers. The changes in the epithelium divided into thirds starting from basal membrane is the main criterion in estimating the degree of dysplasia, marked by VIN 1, VIN 2 and VIN 3. According to the nuclear and cytoplasmic characteristics. VINs are subclassified into three types: basaloid, verrucous (condylomatous) and well differentiated. Basaloid and verrucous (condylomatous) VIN types are morphological markers of HPV infection. The squamous cell carcinoma of the vulva and anogenital region is a morphologically heteregenous neoplasm with particular histological entities connected with HPV infection. CASE REPORTS: Four cases of patients with changes in the anogenital region in the form of small to gigantic polypoid formations were reported. The histological features corresponded to vulvar intraepithelial neoplasms (VIN lesions), as well as to neoplastic changes characteristic of HPV infection. The evolution of the changes from typical condylomas through VIN lesions to infiltrative neoplasms, taking place over the years, was also verified. DISCUSSION: Some histologically typical epithelial changes in the scope of VIN, as well as some histological types of malignant neoplasms, are associated with HPV-16 and HPV-18, and with HPV-31 to a smaller extent. The oncogenic potential of these viruses is established by in vitro cultures, but also by their finding in 50-90% of genital neoplasia in different series analyzed. The oncogenic potential of the virus depends on numerous heteregenous and complex factors denoted as risk factors. A typical, morphologically well-differentiated change is condyloma acuminatum, with the finding of acanthosis, hyperkeratosis, parakeratosis, dyskeratosis, and koilocytosis, which is always an accompanying morphological quality in these changes. In precancerous lesions and infiltrative neoplasms, koilocytosis is not a necessary finding. CONCLUSION: The HPV infection of the vulva and anogenital region is reflected in a spectrum of histological changes. Condylomatous verrucous lesions, smaller papular or plaque-like changes with VIN histological features, as well as infiltrative malignant neoplasia with certain histological properties, could be induced by different HPV types. In the absence of data of in situ hybridization and immuno-electron microscopy as the reliable evidence of the presence of a certain HPV genotype, histological changes mostly characteristic of HPV infection could serve as an indirect pathway.

[Congenital toxoplasmosis]. / Kongenitalna toksoplazmoza.

INTRODUCTION: Toxoplasma gondii is a ubiquitous parasite of all species of mammals and birds (1). Most often the infection in the immunocompetent persons is asymptomatic. Symptoms (if present) are usually mild and self-limited. Infection in the fetus and immunodeficient patients may lead up to clinically severe and often fatal toxoplasmosis (2). ETIOLOGY: Toxoplasma exists in three forms: oocysts, tissue cysts and tachyzoites. The definitive hosts of Toxoplasma are members of the cat family. They shed unsporulated oocysts in the feces. After sporulation oocysts become infectious. Tachyzoites are crescent-shaped forms responsible for manifestations of acute Toxoplasma infection in the intermediate hosts (6,7). Cysts are formed, particularly in brain, heart muscle and skeletal muscles. The cyst forms of the parasite are seen in the latent stage of the infection. Postnatally acquired toxoplasmosis is a consequence of infection from cysts (by ingestion of undercooked meat of infected animals), oocysts (by ingestion of soil, fruits, vegetables contaminated by cat feces) and tachyzoites (by blood transfusion). Congenital Toxoplasma infection causes congenital toxoplasmosis. PATHOGENESIS: Some authors represented the concept that latent (chronic) infection with Toxoplasma during pregnancy can result in congenital infection in the offspring (8-11). Now it is generally agreed that congenital transmission of Toxoplasma occurs only when the infection is acquired during gestation (6,7, 12-16). More than half of the fetuses escape infection, one-third are definitely infected, and the infection is more often subclinical than clinically obvious (15). The fetus is infected hematogenously from inflammatory foci in the placenta formed during parasitemia in the mother. CLINICAL MANIFESTATIONS: Approximately 75% of congenitally infected newborns are asymptomatic. Wilson's study indicates that nearly all such children will develop adverse sequelae (neurologic, intellectual, audiologic and ophthalmologic) 21). Severe forms of congenital toxoplasmosis occur only in 10% of infected offsprings. Clinical manifestations of congenital toxoplasmosis are different. Clinical findings in patients with congenital toxoplasmosis may include: chorioretinitis and other ocular findings, central nervous system abnormalities (such as microcephaly, hydrocephalus, encephalomyelitis, seizures and mental retardation), icterus, hepatosplenomegaly, rash, anemia, erythroblastosis, thrombopenia. INCIDENCE: Incidence of human congenital toxoplasmosis is different in different countries. The incidence in Britain is 0.6 subclinical infection and 0.09 severe illnesses per 1000 births (22). The incidence in USA is between 1/1000 and 1/8000 live births (23). In France the incidence is 1/2000. In Slovenia the incidence is 2.3 cases per 1000 births (25). DIAGNOSIS: Diagnostic methods are: 1. Isolation of the parasite from the placenta, blood, body fluids (by inoculation of specimens into mice or tissue cultures). 2. Histologically by demonstration of tachyzoites in tissue sections or smears of body fluids. 3. Serologic diagnosis. The most important diagnostic methods are serologic tests. For diagnosis of congenital toxoplasmosis determination of IgM antibody (in the serum of newborn infant) has the greatest importance. The fetus is able to produce IgM specific antibody. The presence of IgM antibodies in serum obtained from the neonate is an evidence of fetus infection in utero. Maternal IgM antibodies do not pass the placenta. IgM antibodies may be demonstrable by indirect fluorescent antibody test (IgM-IFA), enzyme linked immunosorbent assay (IgM-ELISA), double sendwich IgM enzyme-linked immunosorbent assay (DS-IgM-ELISA), IgM immunosorbent agglutination assay (IgM-ISAGA) and reversed enzyme immunoassay (REI). For diagnosis of congenital toxoplasmosis the next tests are also applied: Sabin-Feldman Dye test, indirect fluorescent antibody test for IgG antibodies (IgG-IFA) and enzyme

[Acute rubella virus infection in women of reproductive age in Vojvodina 1994-1995]. / Akutna infekcija zena generativne dobi virusom rubele u Vojvodini tokom 1994. i 1995. godine.

In order to establish rubella virus serologic status in 1034 women of reproductive age in Vojvodina during a two year period, 319 nonpregnant and 715 pregnant women were examined. The aim of this study was to examine the frequency of occurrence of acute rubella virus infections in women of reproductive age; to establish levels of sensitivity to rubella virus, as well as the impact of pregnancy on values of titer antihemagglutinine (HI--hemagglution inhibition) antibodies. By determining immune status against rubella in women of reproductive age high risk groups can be established so that severe consequences of congenital rubella can be prevented. On the basis of titer values of the virus rubella HI antibodies in even samples of sera it has been established that 97.3% of women of reproductive age in Vojvodina in 1994-1995 are immune to rubella. In this period 2.7% of women were established to be vulnerable to rubella virus infection. On the basis of established IgM antibodies acute rubella was detected in 0.31% of nonpregnant women. 26.85% of pregnant women made risky contacts considering whole period of pregnancy. In such circumstances the percentage of pregnant women with acute infection in Vojvodina during the period 1994-1995 is low and makes 0.28%.

[Viruses today and yesterday--oncogenic potential of viruses]. / Virusi danas i sutra--onkogeni potencijal virusa.

The contemporary researches show that viral infection can cause not only acute, but also persistent viral diseases. A certain number of viruses are able to incorporate their nucleic acid into the genome of the host-cell, leading to the rearrangement of the cell genes and formation of malignant tumours.

[Serologic diagnosis of infectious mononucleosis]. / Seroloska dijagnostika infektivne mononukleoze.

9,249 persons were examined by Paul-Bunnell-Davidson test and in 329 heterophile antibodies were established in titre > 1/40 which enables, with corresponding clinical-laboratory parameters, diagnosis of infectious mononucleosis caused by Epstein-Barr virus. In 271 persons diagnosis could not be established by testing only one sample of serum and performing only one test. That is why Epstein-Barr virus specific tests were recommended and their diagnostic possibilities in certain stages of Epstein-Barr virus infection have been theoretically considered.

[Personal experience in the treatment of maxillary sinus diseases treated with functional surgery--nasoantrostomy]. / Nasa iskustva u lecenju oboljenja maksilarnih sinusa funkcionalnom hirurgijom--nazoantrostomijom.

Authors analyzed results of functional surgery-low nasal antrostomy in treatment of certain maxillary sinus disease in 76 patients, 7-51 years of age. Advantages of this method were staded in relation to classical radical surgery of maxillary sinus from the aspect of simple procedures, preservation of surrounding region's integrity and absence of postoperative complications. The importance of the irrigation tube that is Foley catheter in the postoperative sinus lavage in children was pointed out. In our opinion this method is getting important due to increased use of endoscopic procedures concerning maxillary sinuses being easier because of previously performed nasal antrostomy. In order to achieve success, precise diagnose is necessary as well as right indications which results in 90% of cured patients.

[Subacute thyroiditis. A case report of an unusual etiology]. / Subakutni tireoiditis. Povodom jednog slucaja neuobicajene etiologije.

Occurrence of various forms of thyroiditis is getting higher in the last ten years. Subacute or granulomatous or thyroiditis de Quervain has, most certainly, the greatest practical and clinical importance. We present a case of subacute thyroiditis in a female patient 50 years of age in whom Q-fever was positively diagnosed. The disease had had a benign course nevertheless the cause and it passed without any consequences.

[Occurrence of group (genus) specific Chlamydia antibodies in the blood of patients with tonsillo-pharyngitis]. / Ucestalost nalaza grupno (genus) specificnih antitela za chlamydia organizme u krvnom serumu pacijenta obolelih od tonzilofaringitisa.

A prospective study of 108 persons form Novi Sad population aged from 1 to over 40 years with tonsylopharingitis, showed that in 21.3% of the throat smears pyogenic streptococcus was present. In the blood serum, both in streptococcus positive and streptococcus negative subjects we confirmed the presence of antistreptosolin-0-antibodies. The occurrence of these antibodies was higher (p < 0.05) in streptococcus positive patients, especially in those aged from 1 to 14 years. On the basis of simultaneously proved presence of group (genus) specific antibodies to Chlamydia organisms in 26.8% of the patients, in titre value > or = 1/64, the authors point to the necessity of further systematic studies on etiologic role of Chlamydia pneumoniae in the development of acute tonsylopharingitis.

[The role of Epstein-Barr virus in patients with mononucleosis syndrome and lymphadenopathy]. / Uloga Epstein-Barrovog virusa u bolesnika sa mononukleoznim sindromom i limfadenopatijom.

In a two-year period 117 patients with diagnosed mononucleosis sundrome and 207 patients with diagnosed lymphadenopathy were serologically examined. Of these 57 patients were immunodeficient and 267 immunocompetent. Acute infection with Epstein-Barr virus was proved in 17.09% of the cases with mononucleosis syndrome, 13.04% with lymphadenopathy i.e. 8.77% of the immunodeficient and 15.73% of the immunocompetent patients. The significantly highest rate was recorded among schoolchildren and adolescents (from 7 to 27 years of age). The occurrence of other viral (adeno-and cytomegalo-) and non-viral infections (toxoplasma gondii, chlamydia) in these patients has also been analyzed.

[Chlamydia trachomatis as a cause of infection in women]. / Chlamydia trachomatis kao uzrocnik infekcija u zena.

A sample of 596 women was examined by the direct immunofluorescent test (DIF) for the detection of chlamydia brachomatis antigens in the endocervical smear (with monoclonal antibodies), ELISA test for the detection of IgG antibodies against the group chlamydia-antigen. The chlamydia trachomatis infection was found in 30.20% of the cases, with a high positive rate in all age groups. These infections were more frequently found in women in whom sterility had been diagnosed, compared to other examined women. In relation to other inflammatory processes the significantly highest rate was found in women with changes in the cervix (endocervicitis and arythroplakia). A high rate of chlamydia positive (42.44%) was detected in women who had had pathological pregnancies and deliveries. Humoral immune response to the presence of chlamydia trachomatis infection was proved in 79.44% of the cases. We showed and analyzed diagnostic possibilities of the used diagnostic tests where a combination of the DIF test and ELISA was found the best. For a successful diagnosis two methods have been recommended: a direct one-for the detection of the cause (DIF test, isolation in the cell culture McCoy or Hela 229) and an indirect one for the detection of specific antibodies in the serum.

[Prophylaxis and therapy of infections in allogenic bone marrow transplantation in patients with hematologic diseases]. / Profilaksa i lecenje infekcije kod alogene transplantacije kosne srzi bolesnika sa hematoloskim oboljenjima.

Infection and acute graft versus host disease (GVHD) are the most common complications of allogeneic bone marrow transplantation, which compromise this therapeutical method for hematologic diseases. Beside the appreciation of customary preventive measures and the treatment of infections, it is necessary for every bone marrow transplantation center to analyze the development of bacterial, fungal and viral infections in the patients and to generate the most efficient and most rational program for their prevention and treatment. At the Hematology Department in Novi Sad seven allogenic bone marrow transplantations were performed in patients with malignant hematologic diseases and severe form of aplastic anemia. Prevention of the infection by isolation of the patient in a sterile unit, selective decontamination of the digestive tract with sterile food, skin and mucus hygiene and prophylactic drug administration proved rather beneficial and adequate for patients with the graft accepted, hematopoiesis recovered and immunity reconstructed. Risks of infections were increased by permanent vein catheter, acute GVHD and rejection of the bone marrow graft. Prompt isolation and identification of bacteria and fungi, especially in blood, the establishment of a minimal suppressing and bactericide antibiotic concentration, along with the assessment of their synergism, as well as early diagnosis of cytomegalovirus and administration of specific drugs, can significantly contribute to the more successful treatment of infections in transplanted patients.

[Chlamydia trachomatis in women]. / Chlamydia trachomatis kod zena.

The results of the prospective study of chlamydia trachomatis infection in women are presented. The study comprised 288 women aged from 19 to 67 years with the completed clinical and anamnestic data and the following tests have been performed: indirect immunofluorescence test for detection of Chlamydia trachomatis antigens in endocervical smears (using monoclonal antibodies), ELISA test for detection of IgG antibodies against Chlamydia trachomatis in the sera and complement binding reaction for detection of antibodies against grouped Chlamydia antigen. Chlamydia trachomatis infection was found in 29.51% of cases equally distributed in all age groups. The incidence of Chlamydia positive findings was analysed according to clinical diagnosis, parity, relevant data from gynecologic anamnesis and the results of vaginal secretion and Papanicolau's stain test. In order to establish a reliable diagnosis of Chlamydia trachomatis infection two methods should be regularly used: one direct-for detection of a causative agent in patients' materials, and the other-indirect, for detection of specific antibodies in the serum.

[Clinical manifestations of acute Q-fever]. / Klinicke manifestacije akutne Q-groznice.

The participation of asymptomatic infections and clinical forms of acute Q-fever were analysed, using the active epidemiological investigation of the population affected by Q-fever epidemics. Out of the total number of registered Q-fever cases, the asymptomatic infection was present in 8.36%. The occurrence of asymptomatic infection was statistically more frequent by significance in women than in men. Pulmonary form of Q-fever occurred in 65.20% of the diseased. This clinical manifestation was statistically more frequent by significance in men than in women. The difference between the morbidity rates of Q-fever in regard to sexes could be caused by both the difference in the intensity of exposure to the infection and the difference in clinical presentation and recognition of the disease.

[Chlamydia trachomatis infection in women]. / Infekcije hlamidijom trahomatis u zena.

A random specimen of 288 women was examined by the use of the indirect immunofluorescent test (IIF) for the proof of the Chlamydia trachomatis antigen in endocervical swabs (by the help of monoclonal antibodies), and with the ELISA test for the proof of IgG antibodies against Chlamydia trachomatis in serums, and the complement--fixation reaction for the proof of antibodies against the Chlamydia-group antigen. These women were previously examined anamnestically and clinically in detail. The Chlamydia trachomatis infection was determined in 29.51% of cases, with a high percentage of positive results in all age groups. These infections were more frequently proved, to a considerable extent, in women with the diagnosis of sterility than in all other examined women, and in relation to all other inflammatory processes it was most frequently diagnosed in women with uterine cervix changes (endocervicitis and erythroplasia). A high percentage of Chlamydia positive subjects (40.91%) was established in those examined women which had pathological pregnancies and births in their past medical histories. The humoral immune response to the presence of Chlamydia trachomatis infections was proven in 70.59% of cases. Presented and analyzed are the diagnostic possibilities of the used diagnostic tests, where the combination of the IIF and ELISA test has shown to be the best.(ABSTRACT TRUNCATED AT 250 WORDS)