Infectious mononucleosis (Epstein-Barr virus infection) and chronic hepatitis.

Aim To describe a case of an eight-year-old boy with chronic Epstein-Barr virus (EBV) hepatitis with incipient cirrhosis, rarely found in practice. Methods The diagnosis was based on findings of specific IgG serum antibodies and EBV positive liver biopsy. Other etiologies of hepatitis were excluded: autoimmune hepatitis, viral hepatitis A, B, or C, cytomegalovirus (CMV), herpes simplex virus (HSV), adenovirus infection, toxoplasma infection. Results A mild form of infectious mononucleosis with acute hepatitis without icterus was found in the boy first time at the age of three. He got sick again in april 2018 with fever, minor loss of appetite and weakness, skin and sclera were anicteric, no enlarged neck lymph nodes. Ultrasonography of the spleen revealed a spleen diameter of 10.7 cm, while the liver was 11.8 cm. Laboratory findings, sedimentation, blood count, C reactive protein (CRP) were all normal. Ten days and a month later an increase of aminotransferase was noticed. The liver biopsy and PCR EBV DNA were performed six months of disease onset. The disease had lasted for about one more year with loss of strength and an increase of aminotransferase with maximum value of 3-4 times higher than normal one. The therapy was supportive. Conclusion Chronic EBV hepatitis is very rare. In differential diagnosis of hepatitis and unclear febrile conditions, EBV infection should not be forgotten.

Public health significance of immunization and epidemic occurrence of measles.

Aim To investigate epidemiological characteristics of the measles epidemic (risk factors and reasons for its emergence) in order to establish better control and prevention of future epidemics as well as to determine an influence of poor collective immunization of children against measles on appearance of epidemic disease. Methods An open retrospective epidemiological study of measles infection was conducted during the epidemic in Zenica-Doboj Canton (ZDC) in the period 2014-2015. Disease reports, Disease Reporting Forms for measles and rubella cases and the Bulletin of the Institute for Health and Food Safety Zenica were used for data collection. Results A total of 325 patients with the diagnosis of measles were registered, 262 (80.61%) in 2014 and 63 (19.39%) in 2015 resulting in overall incidence of 81.25/100.000. The majority of patients were aged 0-6 (p<0.05). Of the total number of patients, only 13 (4.73%) were orderly vaccinated (p <0.05). In the period 2009- 2015 in ZDC 25.444 (83.34%) children (p <0.05) were vaccinated with measles, mumps, rubella (MMR) vaccine. Conclusion Results of the study show that the low level of vaccination of children continues to a risk of the emergence of epidemics of measles and other infectious diseases. Therefore, in order to prevent the disease there is a need for a better vaccination campaign.

Tobacco and alcohol usage as risk factors of non-communicable diseases among students of Zenica University (Bosnia and Herzegovina).

Aim To establish the presence of two risk factors, smoking and alcohol use, for non-communicable diseases among students at the University of Zenica. Methods The research was conducted at eight schools of the University of Zenica in the academic year 2016/2017 during the period from 1 December 2016 to 15 February 2017. The study involved 600 students 19-29 years of age (all years of study). The research was carried out with a standardized and validated questionnaire, the STEPS non-communicable Disease Risk Factors survey, developed by the World Health Organization. Results Tobacco was used by 145 (24.2%) students, 68 (46.9%) of them being males and 77 (53.1%) females (p<0.05). Males smoked 15.62 and females 13 cigarettes per day (p<0.05). On average, male participants were 16.56 years old, and female participants 16.71 when they started consuming cigarettes (p<0.05). A total of 289 (48.1%) students consumed alcohol, of whom 135 (70.2%) were males and 154 (37.7%) females (p<0.05). Conclusion There is evidence of high prevalence of smoking and alcohol usage as the risk factors for non-communicable diseases. Two levels of the prevention measures should be applied in order to reduce the prevalence of such risk factors: strategic level with a definition of the population, actors, activities, target population and anticipated results, and tactic level which will show contingency activities at the University.

Relationship of recovered hepatitis B infection with appearance of toxic propylthiouracil hepatitis.

Aim To investigate the relationship between recovered hepatitis B infection with appearance of toxic propylthiouracil (PTU) hepatitis and point out the growing importance of the use of drugs in the development of hepatitis. Methods A case of a 45-year-old female patient with suspicion of acute viral hepatitis who had polypragmasy of drugs in the last ten years, due to the polymorphism of symptoms/illnesses (diabetes mellitus, depression, hypertension, hypothyroidism) was presented. Results A female patient had hyperthyroidism after resolved viral hepatitis B with HBsAg seroconversion (HBsAg negative, antiHBs positive). PTU had the greatest potential for hepatotoxicity of all administered drugs. After corticosteroid therapy there was a significant improvement in liver function tests. In the course of the disease there was no change of hepatitis markers and exacerbations of hepatitis B. Conclusion Clinical practice should comprehensively monitor the effects of the intricate and tight connection between drugs, liver and endocrine system in order to better resolve all manifestations, complications and worsening of one or another organic system.

[HBsAg SEROCONVERSION IN THE TREATMENT OF CHRONIC HEPATITIS B WITH PEGYLATED INTERFERON].

The ideal goal of antiviral therapy or cure of chronic hepatitis B is HBsAg clearance and HBsAg seroconversion. According to modern guidelines of all Associations for liver diseases pegylated interferon alfa-2a and nucleos(t)ide analogues (entecavir, tenofovir) are first choice in the treatment of chronic hepatitis B. The aim of the study was to evaluate the success of the treatment of patients with chronic hepatitis B who received pegylated interferon. At the end of ten year period, HBV DNA <50 IU/ml and HBsAg seroconversion achieved 4 (4/55, 7.00%) patients. All were HBeAg negative. Additionally, is presented the case of patients, who, after the treatment, had the shortest period of healing. Patient is a man, aged 47 years, with the newly discovered HBeAg negative chronic hepatitis B and pronounced activity of serum aminotransferases. He was treated with pegylated interferon alfa-2a, 180 µg once a week, for 48 weeks. After antiviral therapy, the patient is HBV DNA negative, HBsAg negative and neat aminotransferases, and 12 months after completion of antiviral therapy comes to HBsAg seroconversion. The degree of cure of chronic hepatitis B, unfortunately, has not been entirely satisfactory, with the exception of the few individual cases.

Open Clinical Trial on Using Nifuroxazide Compared to Probiotics in Treating Acute Diarrhoeas in Adults.

BACKGROUND: Nifuroxazide is well known and often used anti-diarrhoeal medicine which has been pushed back from routine practice in recent years and often replaced with probiotics. Even probiotics are accepted and placed in some therapeutic guidelines for diarrhoea treatment, there are no enough evidence for its effectiveness and no comparative efficacy data with nifuroxazide in treatment of acute diarrhea. PATIENTS AND METHODS: In open, prospective observational study, the efficacy and safety of nifuroxazide were compared with a probiotic containing lactic acid bacteria in the treatment of acute diarrhoea. A total number of 169 adult patients were included in this study, who administered nifuroxazide in the dose of 200 mg/4 times a day, while they took preparation containing lactic acid bacteria (1,2 x 107 live lyophilised lactic-acid bacteria) three times a day for three days. RESULTS: Mean time to last unformed stool (TLUS) in a group which was treated with nifuroxazide was two days, while it took five days for the stool normalisation in the group using probiotic (p=0.0001). CONCLUSIONS: Orally administered nifuroxazide has demonstrated better efficiency as compared to probiotic in treating acute diarrhoea, and both medicines have shown the same safety and tolerance in this study.

Brucellosis in children in Bosnia and Herzegovina in the period 2000 - 2013.

AIM: To analyse clinical, laboratory and epidemiological characteristics of brucellosis in children in Bosnia and Herzegovina. METHODS: The study included 246 children aged 0-18 years, who were hospitalized in Clinics and Departments for Infectious Diseases in Tuzla, Sarajevo, Banja Luka, Zenica and Bihac in the period 2000-2013, in whom the diagnosis of brucellosis was established based on anamnestic data, clinical features and positive results from blood culture and/or positive results from one of the serological tests. RESULTS: In this period, a total of 2630 patients, 246 (9.35%) of whom were children, were treated from brucellosis at the Clinics and Departments in Bosnia and Herzegovina. In the majority of cases, the children were from rural parts of the country, 226 (91.87%);214 (87.04%) cases had direct contact with sick animals, sick family member or consumption of unpasteurized dairy products from farms where brucellosis had been already established. Male children predominated, 157 (63.82%). The most frequent clinical features in affected children were fever, 194 (78.86%) and joint pain, 158 (64.22%). The average duration of antimicrobial treatment was 42.85 ± 10.67 days. A total of 228 (92.68%) children were completely cured, while relapses occurred in 18 (7.32%) children. CONCLUSION: Since brucellosis is an endemic disease in Bosnia and Herzegovina, it is important that physicians in their daily practice consider brucellosis and establish proper diagnosis and therapy in children with prolonged fever, arthralgia, leukopenia and positive epidemiological data, especially in rural parts of the country.

[ACCIDENTAL POISONING WITH A PLANT COLCHICUM AUTUMNALE: REPORT OF TWO CASES]. / NENAMJERNO OTROVANJE BILJKOM MRAZOVCEM (COLCHICUM AUTUMNALE): PRIKAZ DVOJICE BOLESNIKA.

Colchicine poisonings are serious and highly fatal conditions that occur as a result of food poisoning from plants that contain this alkaloid or overdose with drug containing colchicine. The leaves of edible wild garlic because of their similarity are often replaced with highly poisonous leaves of autumn crocus, causing poisoning. Described are two cases of food poisoning with Colchicum autumnale, who had similar symptoms in the initial stage, but different clinical course and outcome. Signs of poisoning require early identification and intensive supportive therapy, which increases the chances of survival.

Epidemiological characteristics of meningococcal meningitis in the area of Zenica-Doboj Canton in period from 2008 to 2012.

INTRODUCTION: Meningococcal meningitis now represents a significant public health problem, not only in developing countries but also in developed ones. The disease usually occurs sporadically, and much less in smaller epidemics. Material and methods: We retrospectively analyzed the epidemiological characteristics of meningococcal meningitis in the area of Zenica-Doboj Canton in the five-year period from 2008 to 2012th. In total there were 38 reported and hospitalized patients, with an average of 7-8 patients per year. RESULTS: Most commonly disease occurred in infants and young children (28.9%). The highest number was recorded in 2011, 10 cases or (26.3%). Most patients in the monitored period were registered in the municipality of Zenica-12 cases (31.6%) and Zepce 8 cases (21.1%). All hospitalized patients were sporadic cases, there has never been an epidemic in the observed period. CONCLUSIONS: Epidemic Meningitis is a very serious disease and a significant public health problem that requires a serious medical scientific approach for its resolution, primarily in finding adequate vaccine and its administration.

Epidemiological characteristics of meningococcal meningitis in the area of zenica-doboj canton in period from 2008 to 2012.

INTRODUCTION: Meningococcal meningitis now represents a significant public health problem, not only in developing countries but also in developed ones. The disease usually occurs sporadically, and much less in smaller epidemics. MATERIAL AND METHODS: We retrospectively analyzed the epidemiological characteristics of meningococcal meningitis in the area of Zenica-Doboj Canton in the five-year period from 2008 to 2012th. In total there were 38 reported and hospitalized patients, with an average of 7-8 patients per year. RESULTS: Most commonly disease occurred in infants and young children (28.9%). The highest number was recorded in 2011, 10 cases or (26.3%). Most patients in the monitored period were registered in the municipality of Zenica-12 cases (31.6%) and Zepce 8 cases (21.1%). All hospitalized patients were sporadic cases, there has never been an epidemic in the observed period. CONCLUSIONS: Epidemic Meningitis is a very serious disease and a significant public health problem that requires a serious medical scientific approach for its resolution, primarily in finding adequate vaccine and its administration.

Diagnosis and treatment of chronic viral hepatitis B and C: doctrinary approach.

Association of Gastroenterologists and Hepatologists of Bosnia and Herzegovina based on the experiences of domestic and foreign centers operating in the field of hepatology and accepted guidelines of the European and the U.S. Association for Liver Diseases adopted the consensus for the diagnosis and treatment of chronic viral hepatitis B and C. The guidelines are intended for specialists in gastroenterology and hepatology, and infectious diseases physicians working in primary health care and family medicine, but also other physicians who are confronted with this disease in their practice, with the aim of facilitating and shortening the diagnostic and treatment protocols of patients with chronic viral hepatitis B and C. This ensures faster, more efficient, more rational and cost-effective care of patients with hepatitis, with an emphasis on stopping the deterioration of liver disease to liver cirrhosis and eventually hepatocellular carcinoma. Key words: Chronic hepatitis B and

[Serological and epidemiological confirmation of leptospirosis epidemic in the mine "Stara Jama" in Zenica in 2005]. / Sero-epidemioloska potvrda epidemije leptospiroze u rudniku "Stara jama"u Zenici 2005. godine.

INTRODUCTION: Leptospirosys belong to zoonoses that affects both humans and animals, and they are caused by the bacterias of leptospira sort. This is a relatively widely spread illness in the majority of countries around the world as well as in our country, whit often epidemic occurrence. The goal of the paper is to point out the importance of leptospira as a potential cause for individual or epidemic sickening of miners at the "Stara Jama" mine in Zenica. MATERIAL AND METHODOLOGY: This research is conducted on a sample of 31 respondents--miners at the "Stara Jama" mine in Zenica during the epidemic of leptospirosys from 1st august until 6th September 2005. Selection of suspected patients is done based on a clinical signs of illness. All hospitalized had high fever, headache and hepatorenal syndrome. All complete and relevant tests are done for the 30 respondents, and from 26 of them one or two serum samples are taken, while from 4 patient's three samples are taken. Serological examination is conducted by the standard method of microscopic agglutination - liza-test with 14 serotypes of leptospira, RESULTS: From the baseline of 30 respondents in 16 cases existed serological confirmation of leptospirosys etiology of illness. Among them also is determined a presence of specific antibodies in I, II and/or III serum sample for the certain serotypes of leptospira. Among other 14 hospitalized, from the sample of 30 respondents we did not find increase in titre for the specific antibodies within samples. Illness developed mainly among those in the age group between 24 and 56 years, and the highest frequency was between 20 and 50 years of age among male respondents. Antibody titre within the taken samples was in a solution 1:100 up to 1:16000, and the highest tested titres were for the L. Ballum, L. Tarassovi, L. Poi and L. Icterohaemorrhagiae. DISCUSSION AND CONCLUSION: Vectors for the leptospirosys in our environments are mainly rodents (mice's and rats, wild mice's, and voles) that lives in the vicinity of the settlements and which represents natural reservoir of illness. Epidemiological researches, especially in the environments such as mines, as one of the natural reservoirs, can be a significant indicator of frequency and development and this disease, which is one of the reasons why we choose to explore characterictics of the leptospirosys epidemic in the Mine "Stara Jama" in Zenica, and based on results and experience take adequate preventive actions in order to prevent some future occurrence of similar epidemic.

[The renal failure and capillary leak during the acute stage of (Dobrava) DOB and PUU (Puumala) infection]. / Bubrezna slabost i kapilarna propustljivost u akutnoj fazi DOB i PUU infekcije.

The target organ for Puumala (PUU) and Dobrava (DOB) viruses is the kidney, but the impact on renal function seems far more important in DOB infection than in PUU infections. Aim of study was to estimate the renal failure and capillary leak during the acute stage of DOB-infection and PUU-infection. 50 patients with serological conformed diagnosis of acute hantavirus infection were included in the study. Diuresis, serum urea and creatinine were measured. Size of kidneys and presence of ascites was followed by ultrasonography. Enlargement of both kidneys were found in all (100%) patients. Ascites was present in 8/25 (32%) DOB patients; in 1/25 (4%) PUU patient and pleural effusion in four 4/25 (16%) DOB patients. The statistically significant difference in the mean urinary output was during 5th, 6th and 7th day of hospitalization (P<0,05). Serum creatinine and urea levels were at significantly higher levels for DOB than for PUU patients (P<0,05). Acute haemodialysis was needed in 7/25 (28 %) of the DOB patients. One DOB patient died. DOB virus infection is associated with a more severe kidney function disorders than PUU virus infection. Capillary leak, which caused swollen of kidney and ascites is probably the pathogenesis key factor.

[Puumala and Dobrava viruses in the northeastern and central regions of Bosnia]. / Puumala i Dobrava virusi na podrucju sjeveroistocne i srednje Bosne.

UNLABELLED: Bosnia and Herzegovina has been known as a highly endemic region for Hantavirus infections for more than 50 years. Previous studies have shown that at least two different hantaviruses, the murine Dobrava (DOB) and avricoline Puumala (PUU) viruses, each carried by a different rodent species, have been circulating in the area. However, there is little information on rodent population density fluctuations in Bosnia over the past years as well as on the ratio of Puumala to Dobrava infection in humans. THE AIMS OF OUR STUDY WERE: to identify the rodent species which may serve as hantavirus reservoirs in the north-east and central Bosnia; to assess the geographical distribution, density and population dynamics of rodent species in the area; to assess the influence of climatic conditions on the size of rodent population; and to determine the ratio of Puumala to Dobrava infection in humans. METHODS: The epidemiologic and epizootic study in the north-east and central Bosnia was conducted during the 8-year period (1995-2003). The average yearly and monthly temperatures, air humidity and precipitation during the study period were analyzed. A total of 381 small rodents were caught during the epidemic years (1995 and 2002), and in-between the epidemic periods (1999 and 2000). The animals were caught by live-traps and identified by morphometric methods. The density of animals was estimated by counting the number of holes per 1000 m2. Sera of 311 patients with clinical signs and symptoms of hemorrhagic fever with renal syndrome (HFRS) were tested for the presence of antibodies reactive to the Dobrava, Puumala and Seoul viruses by using indirect immunofluorescence test (IIF), and IgG and IgM ELIS. Sera of 84 patients were tested using only IIF, and 227 sera were tested by IIF and -capture IgM ELIS tests. RESULTS: During the epidemic years, the average monthly temperatures in February were by 4.3 times higher than the average temperatures during the nonepidemic years, which may have influenced the early reproduction of rodents and development of "mouse years". The rodents were identified as: Apodemus flavicollis (n = 139), Apodemus sylvaticus (n = 89), Apodemus agrarius (n = 4), Clethrionomys glareolus (n = 117), Sorex araneus (n = 5), Pytimus subterraneus (n = 23), Mus musculus (n = 1), Mycrotus arvalis (n = 1) and Rattus norvegicus (n = 2). Clethrionomys glareolus was predominant in the regions with the altitude higher than 1160 meters and Apodemus species in the regions with the altitude lower than 670 meters. The rodent population density changes seasonally and cyclically. During the epidemic years, the rodent population density was marked as very high, whereas during the nonepidemic years it was designated from low to moderate. Well-known natural hosts of Hantaviruses (A. flavicolis and C. glareolus) are most widely spread species of small rodents, and the increase in their population is closely related with outbreaks of epidemics of HVBS-a. Puumala virus caused HVBS-a in 49.84% (155/311); Dobrava virus in 23.15% (72/311) of cases, whereas Hantaviruses serotype was not identified in 27.00% (84/311) of cases. Infections caused by Puumala virus were more frequent than the infections caused by Dobrava virus during both epidemic and nonepidemic periods. The proportion of humans infected with Puumala and Dobrava viruses correlated with the number of natural hosts of Hantaviruses in the areas of HVBS outbreaks. The study of the prevalence of hantavirus antibodies in the populations of rodents and humans, which had been under way, should elucidate these relationships.

[Analysis of amoxicillin-clavulanic acid (Xiclav) efficacy and the possibility of early switch from parenteral to oral therapy in the treatment of infections]. / Analiza efikasnosti djelovanja antimikrobika Amoksicilina + klavulanska kiselina (XICLAV) i mogucnosti ranog prelaska s parenteralne na oralnu terapiju u lijecenju infekcija.

Early transition from parenteral to oral antibiotic therapy switch therapy play a major role in treatment because of adverse reactions of long parenteral therapy. In the prospective, comparative and randomized clinical study the efficacy of two treatment regimens were analyzed: XICLAV (amoxicillin + clavulanic acid): parenteral regiment with early transition to oral therapy and parenteral regimen in patients with bacterial infections without transition to the oral dosage form, on the other hand. In our study we've analyzed 240 hospitalized patients in the Clinic of infectious Diseases in Tuzla and Sarajevo too, so in the Institution for infectious diseases in Zenica. The mean age of our patients was 39.6 years, 70.8% females. The major (50.5%) patients had urinary or respiratory tract infectious (bacterial pneumonia 38.8%) but several patients have had skin infections and sepsis. The first 120 patients were initially treated by Xiclav administered parenterally i.v. (adults at a dose of 3 x 1.2 gr i.v.; the children at a dose of 3 x 30 mg/kg) with early oral switch therapy (adults at a dose of 3 x 625 mg per os; the children at a dose of 3 x 25-50 mg/kg); whereas the others (120 patients) were treated parenterally by the regimen mentioned above. The mean length of i.v. therapy and hospitalization in the i.v. group was 4.12/10.21 days respectively (p > 0.05). The clinical efficacy switch of both therapeutic regimens was comparable. The resolution of all clinical symptoms and laboratory signs of infections was noted at 69% patients of both groups, with significant improvements at noted at 69% patients of both groups, with significant improvements at 21% patients and at 10% patients showed clinical failure. The tolerability of Xiclav was very good. The adverse reactions during treatment were observed at 5.2% patients. This study noticed satisfied clinical and bacterial efficacy so did tolerability of Xiclav in the treatment of bacteriological infections. Xiclav apply early transition from parenteral to oral therapy.