Genetic characterization of wild type measles virus isolated in Croatia during the 2003-2004 outbreak.

Viral epidemiology is determined by the movement of infected people within and between geographical areas. The genetic characterization of wild-type isolates combined with standard epidemiological methods may enable the identification of the source and transmission pathways and permit differentiation between indigenous and imported viruses. We investigated the genetic characteristics of the wild-type measles virus isolated in Croatia during a 2003-2004 outbreak. The results of this study indicate the presence of the D4 measles virus genotype in Europe. The isolated virus is closely related to virus isolates from the India-like subgroup of the D4 measles virus genotype. The virus responsible for this outbreak differs in the hemagglutinin gene sequence from other virus strains belonging to the D4 genotype. The hemagglutinin gene sequence also differs when compared to viruses from other genotypes that are known to circulate in Europe and from vaccine strains.

Establishment of an active laboratory-based surveillance for bacterial meningitis in Croatia and molecular characterization of Neisseria meningitidis isolates causing meningococcal disease that were collected in the year 2000, the first year of activity.

In 2000, 23 Neisseria meningitidis (meningococcal [Men]) isolates were collected in Croatia through an active laboratory-based surveillance for bacterial meningitis (17 Men serogroup B [MenB], 4 MenC, 1 MenW135, and 1 nongroupable isolate). Molecular characterization revealed a substantial level of diversity with only six isolates belonging to electrophoretic type 5 (ET-5) and ET-37 hypervirulent complexes.

[Neisseria meningitidis with a decreased sensitivity to penicillin in the Zagreb District]. / Neisseria meningitidis smanjene osjetljivosti na penicilin na podrucju zagrebacke Zupanije.

Of the total of 35 clinical isolates from blood and/or cerebrospinal fluid in patients from the Zagreb area in the period from 1996-1999 Neisseria meningitidis serogroup B was identified in 33 (94%). N. meningitidis strains with decreased susceptibility to penicillin have been occurring in Zagreb since 1998, and during the two-year period in this study we isolated 3/19 (16%) such strains (MIC, 0.12 microgram/ml). Molecular typization of strains with decreased susceptibility to penicillin shows that they do not belong to a particular meningococcal clonal group. All isolated N. meningitidis strains were susceptible to the third generation cephalosphorins, quinolones and chloramphenicol. A single strain (3%) was resistant to rifampin, but 13/35 (37%) were resistant to trimethoprim/sulfamethoxazole. Consequently, trimethoprim/sulfamethoxazole is not recommended for chemoprophylaxis of meningococcal disease. Initially patients with meningococcal disease should be treated with the third generation cephalosporins, and further treatment should be continued in accordance with the antimicrobial susceptibility testing results. This study emphasizes the utility and importance of meningococcal disease monitoring throughout the Republic of Croatia.

Doses in the vicinity of mobile X-ray equipment in a children's intensive care unit.

Most of the patients in the intensive care unit for children are newborns and infants having an infection of the central nervous system, with systemic septic and respiratory infections. Therefore, mobile X-ray equipment including mobile shields is routinely used for diagnosis of the respiratory tract, heart and endovascular catheterization. The aim of this work was to determine the radiation exposure to the children in the vicinity of the exposed patient in the same or next room. Three measurement runs were carried out with thermoluminescence dosimetry system. The results show that the homogeneity of the irradiation field is adequate, the exposure of children to radiation in the vicinity of the exposed patient in the same or next room is very low, practically in the range of the lowest detectable dose. The entrance dose on the breast of the patient was found to be 0.07 mSv. Therefore, there is no basis for the risk estimation of genetic, leukemogenic and cancerogenic detriment.

Opsoclonus-myoclonus syndrome in a child with neuroborreliosis.

Opsoclonus-myoclonus is a rare neurological syndrome affecting children and adults. In children it occurs as a parainfectious process or a paraneoplastic syndrome in association with neuroblastoma. Here we report it presenting as an unusual neurological manifestation of Lyme borreliosis. To our knowledge, this is the first report which describes recovery from this syndrome in a child.

Azithromycin: single 1.5 g dose in the treatment of patients with atypical pneumonia syndrome--a randomized study.

An open comparative study was undertaken in order to assess the efficacy and safety of a single dose of azithromycin in the treatment of community-acquired atypical pneumonia. A total of 100 adult patients with atypical pneumonia syndrome were randomized to receive 1.5 g of azithromycin as a single dose, or 500 mg once daily for 3 days. The presence of Mycoplasma pneumoniae, Chlamydia pneumoniae, Chlamydia psittaci, Coxiella burnetii, and Legionella pneumophila infection was diagnosed by serological tests. Control clinical examinations were performed 72 h, 10-12 days and 4 weeks after treatment initiation. Among 96 patients (48 in each group) who were evaluable for clinical efficacy M. pneumoniae infection was confirmed in 24, C. pneumoniae in nine, C. psittaci in five, C. burnetii in six, and L. pneumophila in five. Forty-seven patients (97.9%) in each group were cured. Side effects were observed in two patients in the single-dose group, and one patient in the 3-day group. In conclusion, a single 1.5 g dose of azithromycin may be an alternative to the standard 3-day azithromycin regimen in the treatment of outpatients with atypical pneumonia syndrome.

A case of fatal sepsis in a child due to highly resistant Streptococcus pneumoniae.

Infection with Streptococcus pneumoniae continues to be a significant cause of morbidity and mortality. Most of the pneumococci remain exquisitely sensitive to penicillin. However, S. pneumoniae with a reduced susceptibility to penicillin has been reported. To our knowledge, we present the first case in Croatia of fatal sepsis in a child due to Streptococcus pneumoniae that was highly resistant to penicillin.

[Tracheotomy or intubation, alternatives in the treatment of respiratory insufficiency during infectious diseases in childhood]. / Traheotomija ili intubacija, alternative u rjesavanju respiracijske insuficijencije tijekom infektivnih bolesti u djecjoj dobi.

Tracheostomy and endotracheal intubation are complementary methods in the management of acute respiratory failure (ARF). One hundred patients (n = 100) were treated at the Intensive Care Unit for Infants and Children, University Hospital of Infectious Diseases "Dr. Fran Mihaljevic" Zagreb, from 1987 to 1991. They mostly suffered from severe infectious diseases in the course of which ARF developed. Endotracheal intubation was performed in 95/100 patients, while tracheostomy was done in 11/100 patients. In the majority of subjects the course of the disease required mechanical ventilation (96%). Complications connected with tracheostomy or intubation developed in 49% of the intubated patients and in 100% of the patients with tracheostomy. 17% mortality rate among our patients was neither the result of tracheostomy or intubation nor of the respiratory support but of the adverse course of the disease and consecutive complications characteristic for newborns and infants. Most of our patients developed ARF as a result of inefficient gas transfer, particularly those suffering from central nervous system infection. Nasotracheal intubation appeared to be the method of choice in the treatment of ARF in infancy and childhood, while tracheostomy is only the supplement of substitute when particular indications are present. In most of our patients (83%) those methods contributed to the positive outcome of ARF treatment.

[Analysis of bacterial flora in burn patients]. / Analiza bakterijske flore opecenih bolesnika.

Bacterial flora of burn wound smears and hemocultures of 25 patients with burns have been followed up and analysed in the period of one year. Pseudomonas auruginosa have been most commonly isolated from burn wound smears, in 406 (5.6%) and Staphylococcus aureus, in 371 (47.14) samples. The most important hemoculture isolates has been Staphylococcus aureus found in 34 (57.6%) of samples. One multiresistant strain of Staphylococcus aureus represented 91% of all Staphylococcus aureus strains isolated from hemocultures and 84% from burn wound smears. Serologic and pyocin typing of Pseudomonas auruginosa proved the presence of several epidemic strains.

[Ceftazidime in the therapy of gram-negative meningitis in childhood]. / Ceftazidim u terapiji gram-negativnih meningitisa u djecjoj dobi.

Six cases of neonatal meningitis due to E. coli (3 cases), K. pneumoniae (1 case), P. aeruginosa (1 case) and S. marcescens (1 case), and eleven cases of suckling and little child meningitis caused by M. influenzae (10 cases) and N. meningitidis (1 case) were treated with ceftazidime. The susceptibility of agents was qualitatively tested according to the disk-diffusion method, and quantitatively according to biological dilution method on liquid broth. Ceftazidime concentrations in cerebrospinal fluid and sera were determined by the modified microbiological method using diffusion on agar. Efficacy of ceftazidime therapy was assessed by quickness of cerebrospinal fluid "sterilization", duration of antimicrobial therapy and outcome of the disease. In spite of very good agents susceptibility to ceftazidime determined by disk-diffusion method, notable differences were found in quantitatively determined susceptibility (minimal inhibitory and minimal bactericidal concentration). Antibiotic penetrability was various in proportion with individual intensity of blood brain barrier break down. Bactericidal effect and prompt "sterilization" of cerebrospinal fluid within 48 hours after the beginning of ceftazidime therapy was achieved in those patients in whom ceftazidime cerebrospinal fluid concentration was 10 and several times higher than the minimal bactericidal concentration (all cases due to H. influenzae, N. meningitidis and E. coli). In these cases the issue of the disease was also favourable and none of the patients died.(ABSTRACT TRUNCATED AT 250 WORDS)

[Antimicrobial treatment of Haemophilus influenzae meningitis in childhood]. / Antimikrobno lijecenje Haemophilus influenzae meningitisa u djecjoj dobi.

Antimicrobial treatment of bacterial meningitis should be done by antibiotic to which the causative agent is susceptible, which attained serum levels ensure adequate penetration across the blood-brain barrier and which bactericidal levels in cerebrospinal fluid are achieved. A total number of 61 child in age from 2 months to 7 years with bacteriologically proved Haemophilus influenzae meningitis was included in the study. The possibility and usefulness of application of various antibiotics used in the treatment of this disease as well as the results attained have been discussed. A total number of 40 patients was treated with only one antibiotic (ampicillin 6, chloramphenicol 6, cefuroxime 3, cefotaxime 18, ceftazidime 7) and 21 patients were treated with combinations of antibiotics (ampicillin + chloramphenicol 14, cefuroxime + chloramphenicol 7). The causative agent was susceptible to the applied antibiotic in all cases. The agent susceptibility was estimated qualitatively by disk diffusion method and quantitatively by methods of minimal inhibitory concentration (MIC) and minimal bactericidal concentration (MBC). Even 31.1% of H. influenzae strains were resistant to ampicillin. Penetration across the blood-brain barrier was monitored by estimation of antibiotic concentration in sera and liquor. Antibiotic concentrations in liquor attained the bactericidal levels. The same good results were attained with any of single applied antibiotics. In cases of delayed initiation of the antimicrobial therapy the appearance of neurological complications was more frequent, the outcome of the disease was worse and the duration of treatment was longer.(ABSTRACT TRUNCATED AT 250 WORDS)