Epstein - Barr Virus Salivary Shedding in Patients with Acute Infectious Diseases: A Pilot Study.

Background: Epstein-Barr virus (EBV) is a widely disseminated herpesvirus for which antibodies have been demonstrated in over 90% of adults worldwide. After subclinical primary EBV infections, as well as after infectious mononucleosis, the virus can be shed in saliva for a prolonged period of time. Aim: Diseases and disorders that can induce EBV salivary shedding include mental disorders and sex, connective tissue disease, multiple sclerosis, systemic lupus erythematosus, malaria and HIV infection. Since the occurrence of EBV in saliva during acute infectious diseases has not yet been systematically researched, we aimed to investigate the possible relationship between acute infectious diseases and salivary shedding of EBV. Material and methods: This pilot cross-sectional study included consenting adults hospitalized for acute infectious conditions and their peers free of acute infectious diseases. A total of 40 patients with acute infectious diseases were enrolled, along with 41 adults free of acute infections. Peripheral venous blood samples for serodiagnosis and saliva samples for EBV PCR testing were collected from both groups. We fitted logit and general linear models to proportions and to ln (viral copy counts) to generate adjusted proportions and geometric mean values in the two groups of subjects. We used SAS for Windows 9.4. Results: The most common acute infectious disease was COVID-19 pneumonia, followed by hemorrhagic fever with renal syndrome. Crude proportions of people with positive serological test results and those with saliva viral shedding were similar in the two groups. Conclusions: The presented preliminary data do not indicate acute infectious conditions as a marked "contributor" in increasing salivary EBV shedding.

Incidence, risk factors, and clinical findings of syphilis among men living with HIV in Croatia during the COVID-19 pandemic.

We conducted a nationwide longitudinal observational study to estimate the incidence of syphilis in a cohort of male persons living with HIV (MLWH) in Croatia in the pre-COVID-19 and COVID-19 years. Data were reviewed and extracted from the clinical database. We analyzed 1187 MLWH (≥ 18 years) in care in Croatia from 2018 to 2021 and used Poisson regression to calculate rates. We observed a 91.4% increase in incidence between 2019 and 2020; the overall rate was 6.0/100 person-years, and the annual rate ranged from 3.3/100 person-years in 2018 to 9.3/100 person-years in 2021. We found higher rates in men who have sex with men, MLWH with a baseline history of syphilis, MLWH with a more recent HIV diagnosis, and a lower rate in those who had clinical AIDS. The rate of syphilis serological testing was 3.5% lower in 2020 compared to 2019. Recurrent syphilis was more likely asymptomatic compared to the first episodes. In conclusion, during the COVID-19 epidemic years, there was a huge increase in syphilis. Results highlight the need for enhanced and novel prevention interventions.

Association between serological indicators of past contacts with Herpesviridae and a slower resolution of chronic spontaneous urticaria in children.

AIM: To evaluate the relationship between serological indicators of Herpesviridae infection and evolution of symptoms in children with chronic spontaneous urticaria (CSU). METHODS: In this observational study, consecutive children with CSU underwent, at presentation, clinical and laboratory work-up, autologous serum skin test (ASST) to identify autoimmune urticaria (CAU), disease severity assessment (urticaria activity score 7, UAS7), serological diagnostics for Epstein-Barr virus (EBV), cytomegalovirus (CMV), human herpes virus-6 (HHV-6), and parvovirus B19, as well as for Mycoplasma pneumoniae and Chlamydia pneumoniae. Children were re-assessed at 1, 6, and 12 months after the commencement of antihistamine/antileukotriene treatment. RESULTS: None of the 56 included children had an acute CMV/EBV or HHV-6 infection, but 17 (30.3%) had IgG antibodies against CMV, EBV, or HHV-6 (five were also seropositive for parvovirus B19); 24 (42.8%) suffered from CAU; and 9 (16.1%) were seropositive for Mycoplasma/Chlamydia pneumoniae. The initial symptom severity was moderate-to-severe (UAS7 quartiles 18-32) and comparable between Herpesviridae-seropositive and Herpesviridae-seronegative patients. At 1, 6, and 12 months, UAS7 was consistently higher in seropositive children. In a multivariable analysis (adjusted for age, baseline UAS7, ASST, mean platelet volume, and other serology), Herpesviridae seropositivity was associated with higher UAS scores: mean difference 4.2 score points (95% confidence interval 0.5-7.9; Bayes estimate 4.2, 95% credible interval 1.2-7.3) in a mixed model for repeated measures. This estimate was comparable between children with positive (CAU) and negative (CSU) ASST. CONCLUSION: A history of CMV/EBV/HHV-6 infection might contribute to a slower-resolving CSU in children.

Slower Waning of Anti-SARS-CoV-2 IgG Levels Six Months after the Booster Dose Compared to Primary Vaccination.

Anti-SARS-CoV-2 IgG titer decreases rapidly after primovaccination, leading to a mandatory booster vaccination. We analysed anti-SARS-CoV-2 Spike RBD IgG levels (positive ≥ 50 AU/mL) in 405 healthcare workers (3010 sera) who received a booster dose (BD) 9 months after two-dose BNT162b2 primovaccination. Median antibody titer at the time of BD (582.6 AU/mL) was 1.7-fold and 16.4-fold lower than the peak titer after the first (961.5 AU/mL) and the second vaccine dose (SVD) (10,232.6 AU/mL), respectively. One month after vaccination, IgG titer increased 40.6-fold after BD compared with a 10.8-fold increase after primovaccination. Three months after vaccination, post-booster antibodies decreased significantly slower (2.2-fold) than after primovaccination (3.3-fold). At six months, antibodies decreased slower after BD (4.5-fold; median 5556.0 AU/mL) than after primovaccination (9.6-fold; median 1038.5 AU/mL). Antibody titers before and one month after BD correlated weakly (r = 0.30) compared with a strong correlation (r = 0.65) between the corresponding post-primovaccination titers. Pre-vaccination COVID-19 had no effect on IgG levels after BD compared with a positive effect after primovaccination. Despite high post-booster IgG levels, 22.5% of participants contracted mild COVID-19. The trend of IgG decline indicates the need for further revaccination, but the vaccine type should be defined according to viral mutations.

Is Better Standardization of Therapeutic Antibody Quality in Emerging Diseases Epidemics Possible?

During the ongoing COVID-19 epidemic many efforts have gone into the investigation of the SARS-CoV-2-specific antibodies as possible therapeutics. Currently, conclusions cannot be drawn due to the lack of standardization in antibody assessments. Here we describe an approach of establishing antibody characterisation in emergent times which would, if followed, enable comparison of results from different studies. The key component is a reliable and reproducible assay of wild-type SARS-CoV-2 neutralisation based on a banking system of its biological components - a challenge virus, cells and an anti-SARS-CoV-2 antibody in-house standard, calibrated to the First WHO International Standard immediately upon its availability. Consequently, all collected serological data were retrospectively expressed in an internationally comparable way. The neutralising antibodies (NAbs) among convalescents ranged from 4 to 2869 IU mL-1 in a significant positive correlation to the disease severity. Their decline in convalescents was on average 1.4-fold in a one-month period. Heat-inactivation resulted in 2.3-fold decrease of NAb titres in comparison to the native sera, implying significant complement activating properties of SARS-CoV-2 specific antibodies. The monitoring of NAb titres in the sera of immunocompromised COVID-19 patients that lacked their own antibodies evidenced the successful transfusion of antibodies by the COVID-19 convalescent plasma units with NAb titres of 35 IU mL-1 or higher.

Decline of Anti-SARS-CoV-2 IgG Antibody Levels 6 Months after Complete BNT162b2 Vaccination in Healthcare Workers to Levels Observed Following the First Vaccine Dose.

Research on post-vaccination antibody dynamics has become pivotal in estimating COVID-19 vaccine efficacy. We studied anti-SARS-CoV-2 Spike RBD IgG levels in 587 healthcare workers (2038 sera) who completed BNT162b2 vaccination. Average antibody titer 3 weeks after the first dose in COVID-19-naïve participants (median 873.5 AU/mL) was 18-fold higher than the test threshold, with a significant increase 1 month (median 9927.2 AU/mL) and an exponential decrease 3 (median 2976.7 AU/mL) and 6 (median 966.0 AU/mL) months after complete vaccination. Participants with a history of COVID-19 prior to vaccination showed significantly higher antibody levels, particularly after the first dose (median 14,280.2 AU/mL), with a slight decline 1 month (median 12,700.0 AU/mL) and an exponential decline in antibody titers 3 (median 4831.0 AU/mL) and 6 (median 1465.2 AU/mL) months after vaccination. Antibody levels of COVID-19-naïve subjects after the first dose were moderately correlated with age (r = -0.4). Multivariate analysis showed a strong independent correlation between IgG levels 6 months after vaccination and both IgG titers after the first dose and 1 month after vaccination (R2 = 0.709). Regardless of pre-vaccination COVID-19 history, IgG levels 6 months after vaccination were comparable to antibody levels reached by COVID-19-naïve participants after the first vaccine dose.

Hepatitis A Outbreak in Men Who Have Sex with Men Using Pre-Exposure Prophylaxis and People Living with HIV in Croatia, January to October 2022.

The hepatitis A virus (HAV) is a highly hepatotropic virus transmitted mainly via the fecal-oral route. The purpose of this study is to describe a prolonged HAV outbreak in HIV-infected men who have sex with men (MSM) and pre-exposure prophylaxis (PrEP) users in Croatia in 2022. Croatia has a centralized system of HIV care and the PrEP service is only available at the University Hospital for Infectious Diseases (UHID), Zagreb. We reviewed all MSM living with HIV and MSM PrEP users at UHID and identified those diagnosed with HAV between January and October 2022. During this period, a total of 1036 MSM living with HIV and 361 PrEP users were followed, and 45 (4.4%) and 32 (8.9%) were diagnosed with HAV, respectively. Most cases were diagnosed in mid-February. A total of 70.1% (726/1036) MSM living with HIV and 82.3% (297/361) PrEP users were susceptible to HAV. Sequencing information was available for 34 persons; in all cases the HAV subtype IA was found. Our findings indicate that both MSM living with HIV and HIV-uninfected PrEP users are vulnerable to HAV infection and might be a potential source for a more widespread HAV epidemic.

Atypical adult-onset subacute sclerosing panencephalitis.

Although subacute sclerosing panencephalitis is almost exclusively a childhood disease, it can occur in adults as well. We present an atypical case of adult-onset subacute sclerosing panencephalitis. The disease was characterized by prolonged insidious course followed by accelerated and aggressive phase, atypical EEG findings, and absence of myoclonic jerks. The diagnostic and treatment-related pitfalls are discussed.

First evidence of hepatitis E virus infection in a small mammal (yellow-necked mouse) from Croatia.

Since the role of wild rodents/small mammals in hepatitis E virus (HEV) epidemiology has been a subject of considerable debate, this study was conducted to investigate the potential presence of HEV RNA in small rodents collected within their natural habitats and to detect if they can be potential reservoirs of the virus. A total of 483 small rodents were captured using snap traps placed at 11 regions in Croatia. Sampling was undertaken in 2008 and repeated from 2010 to 2014. Liver samples were tested for the presence of HEV RNA. HEV RNA was detected in only one liver sample (0.21%) originated from Apodemus flavicollis from the location Medvednica, nearby Zagreb collected in 2014. According to the sequence analysis, the isolate has shown to be a member of Orthohepevirus A species, genotype HEV-3. The genotyping results confirmed grouping into subtype 3a, general cluster 3abchij.The detected HEV strain showed to be genetically highly related to strains found in humans and/or domestic pigs and wild boars from Croatia. Our finding indicates that wild small mammals could play a role in the epidemiology of HEV-3 infection and therefore should be taken under consideration as potential reservoirs or/and transmitters of the disease. However, further investigation is needed to recognize their potential for maintaining the infection in natural conditions.

Hepatitis E seroprevalence and associated risk factors in Croatian liver transplant recipients.

INTRODUCTION: Solid-organ transplant recipients are at risk of hepatitis E virus (HEV) infection. We analyzed the seroprevalence/risk factors of HEV in Croatian liver transplant recipients. METHODS: Two hundred forty-two serum samples were tested for HEV immunoglobuline IgG/IgM and HEV RNA. Sociodemographic data and risk factors were collected using a questionnaire. RESULTS: HEV IgG seroprevalence rate was 24.4%. Positive/equivocal HEV IgM were found in two patients. HEV RNA was not detected. Logistic regression showed that older age, female gender, rural area/farm, water well, and septic tank were associated with HEV seropositivity. CONCLUSIONS: This study revealed a high exposure rate to HEV in Croatian liver recipients.

Genetic diversity of hepatitis E virus (HEV) strains derived from humans, swine and wild boars in Croatia from 2010 to 2017.

BACKGROUND: To fulfill epidemiological data and investigate possible interspecies transmission, this study shall attempt to sequence representative HEV strains of human, swine and wild boar origin collected from 2010 to 2017 in Croatia. METHODS: In total, 174 anti-HEV antibody positive human sera samples; 1419 blood or faeces samples of swine, as well as 720 tissue and/or blood samples of wild boar originating from different counties (18 in total) in Croatia were tested for the presence of HEV RNA. RESULTS: HEV RNA was detected in 26 human sera samples (14.9%; 95% CI 10.4-21.0%). HEV RNA was detected in 216 tested swine (15.2%; 95% CI 13.5-17.1%), regardless of age, farm breeding system or geographical origin. Viral RNA was also detectable in faeces samples which prove that swine actively participate in shedding HEV into the environment. Of the total of 720 tested wild boar samples, 83 were HEV RNA positive (11.5, 95% CI 9.4-14.1%) originating from six counties. According to the sequence analysis all strains have shown to be members of Orthohepevirus A genotype HEV-3, regardless of host. The genotyping results confirm grouping of sequences into four subtypes of HEV strains of which subtypes 3a and 3c belong to the general cluster 3abchij, and were predominately detected during the study, while subtypes 3e and 3f fall within cluster 3efg. Strains within subtypes 3a and 3e were found in humans, swine and wild boars; subtype 3c strains were derived from humans and swine, whereas subtype 3f strains were found only in humans. Strains belonging to subtypes 3a and 3c were derived during the entire investigated period and may be considered endemic in Croatia, whereas strains within subtypes 3e and 3f were detected sporadically indicating the possibility of newly imported infections. CONCLUSIONS: All detected strains show to be genetically highly related to strains found in humans and/or animals from other European Countries, indicating that trade of live animals or wild boar movement increases the risk of HEV infection spread. Furthermore, homologous strains found in different investigated species within this study indicate interspecies transmission of HEV and/or an existence of an accessible mutual source of infection.

Hepatitis E seroprevalence and associated risk factors in Croatian liver transplant recipients

Abstract INTRODUCTION Solid-organ transplant recipients are at risk of hepatitis E virus (HEV) infection. We analyzed the seroprevalence/risk factors of HEV in Croatian liver transplant recipients. METHODS Two hundred forty-two serum samples were tested for HEV immunoglobuline IgG/IgM and HEV RNA. Sociodemographic data and risk factors were collected using a questionnaire. RESULTS HEV IgG seroprevalence rate was 24.4%. Positive/equivocal HEV IgM were found in two patients. HEV RNA was not detected. Logistic regression showed that older age, female gender, rural area/farm, water well, and septic tank were associated with HEV seropositivity. CONCLUSIONS This study revealed a high exposure rate to HEV in Croatian liver recipients.

Imported brucellosis and Q-fever coinfection in Croatia: a case report.

The brucellosis and Q-fever coinfection is very rarely reported. To our knowledge, this is the first case report of concomitant brucellosis and Q-fever, most likely imported in Croatia. A 30-year-old male agricultural worker was hospitalized on 22 April 2017 after a ten days fever up to 40°C with chills, shivering, excessive sweating, general weakness, loss of appetite and headache. A month and a half prior to the hospitalization he lost 18 kg of body weight. Three weeks before hospitalization the patient returned from Kupres (Bosnia and Herzegovina) where he was working for the past year on a sheep farm and consumed unpasteurized dairy products of sheep origin. At admission, his condition was moderately severe due to pronounced dehydration. Routine laboratory tests showed slightly elevated erythrocyte sedimentation rate, anemia, thrombocytopenia and elevated liver transaminases. The chest X-ray showed an inhomogeneous infiltrate of the lower right lung. Three sets of blood culture were cultivated. After 48 hours incubation, bacterial growth was detected in aerobic bottles. Gram-stained smear revealed small, gram-negative coccobacilli. Specimens were subcultured on blood and chocolate agar plates. Using a Vitek GN identification card, the isolated organism was identified as Brucella melitensis. 16S rRNA gene sequencing of the isolate confirmed it as a Brucella sp. Rose-Bengal test was positive, while Wright agglutination test showed a significant increase in antibody titer from 80 to 640 in paired sera. Using indirect immunofluorescence assay (IFA), Coxiella burnetii phase II IgM/IgG titers were 50 and 1024, respectively indicating acute Q-fever. The patient was treated with doxycycline and rifampicin. So far, there has been no relapse or signs of chronic infection.

Correlates of anti-hepatitis C positivity and use of harm reduction services among people who inject drugs in two cities in Croatia.

BACKGROUND: We assessed correlates of anti-hepatitis C (anti-HCV) positivity and utilization of needle and syringe exchange programs (NSEP) and opioid agonist treatment (OAT) among people who inject drugs (PWID) in two Croatian cities. METHODS: We conducted a cross-sectional study using respondent-driven (RDS) sampling among PWID in Rijeka (N=255) and Split (N=399). We used RDS-weighted population estimates and multivariable logistic regression to explore correlates of anti-HCV positivity and NSEP and OAT utilization. RESULTS: Seventy-eight percent (78.0%) of PWID in Rijeka and 61.5% in Split had been tested previously for HCV, while 21.5% and 7.0%, respectively, were tested for HCV in the past 12 months. Among PWID who report being infected with HCV, 24.9% in Rijeka and 11.3% in Split received anti-HCV treatment. In Rijeka, PWID who utilized NSEP and, in Split, those who were ever imprisoned, had higher odds of anti-HCV positivity. In Rijeka, PWID on OAT were more likely to use non-sterile injecting equipment and to inject for longer than 10 years. PWID enrolled in NSEP were more likely to inject opioid agonist medication (OAM) and less likely to use non-sterile injecting equipment. More than half of PWID reported misuse of OAM in the past month, while out of PWID enrolled in OAT, 65.4% in Rijeka and 88.7% in Split injected OAM in the month prior to the survey. CONCLUSIONS: Key findings of the paper point to the need to scale up HCV testing and treatment, improve access to NSEP and the quality of OAT provisions in order to prevent its misuse among PWID.

HIV and hepatitis C prevalence, and related risk behaviours among people who inject drugs in three cities in Croatia: Findings from respondent-driven sampling surveys.

BACKGROUND: There are limited data on HIV and hepatitis C virus (HCV) epidemiology among people who inject drugs (PWID) in Croatia. This study aims to provide data on HIV and HCV prevalence and sexual and injecting risk behaviours among PWID in Zagreb, Split, and Rijeka. METHODS: Using respondent-driven sampling (RDS) we recruited from November 2014 to February 2015 a total of 176 PWID in Zagreb, 255 in Rijeka and 399 in Split. Participants provided biological specimens for HIV and HCV testing and completed a behavioural questionnaire. RESULTS: The proportion of female PWID ranged from 19.5% in Zagreb to 26.0% in Split. In the month before the survey, 2.5% of PWID in Split, 5.6% in Rijeka and 8.0% in Zagreb reported sharing non-sterile needles and syringes. Many PWID injected opioid substitution therapy (OST) in the month before the survey (57.0% in Zagreb and 57.5% in Split and Rijeka, respectively). Among PWID who had a casual sexual partner in the past 12 months (ranging from 39.2% in Split to 44.4% in Rijeka) condom use was low. Although HIV prevalence was low (0.2% in Rijeka and Zagreb, 0.3% in Split), HCV antibody prevalence was considerable (29.1% in Zagreb, 31.5% in Rijeka, 38.3% in Split). HIV and HCV testing coverage in the past 12 months was insufficient (6.8% and 7.0% in Split; 13.2% and 13.5% in Zagreb; 20.2% and 21.5% in Rijeka, respectively). CONCLUSION: We found a low-level HIV epidemic and a sizable HCV epidemic among PWID in Zagreb, Split and Rijeka. Presence of high-risk injecting and sexual behaviours together with inadequate HIV and HCV testing coverage call for development of a comprehensive approach to harm reduction and introduction of needle and syringe exchange programmes in prisons, as well as strengthening sexual health interventions.

[Post-encephalitic syndrome in patients with tick-borne encephalitis]. / Postencefaliticki sindrom u bolesnika s krpeljnim meningoencefalitisom.

BACKGROUND: It was 55 years ago when the first patients with tick-borne encephalitis (TBE) were diagnosed in the Koprivnica-Krizevci County. Since then, we have acquired some new knowledge about the disease. TBE is an endemic disease and the second most common tick-borne disease following Lyme borreliosis in our country, with an average morbidity rate of 12 patients per year and predominance of male individuals older than 50. There are no specific risk groups because such patients have been continuously vaccinated for the past 27 years. In 88.0% of patients, the infection is manifested as aseptic meningitis and meningoencephalitis with a biphasic course. As opposed to detailed descriptions of acute morbidity, there are few reports on the course of disease and its outcome. OBJECTIVES: The aim of the study was to assess the presence of post-encephalitic syndrome (PES) in patients with TBE, to evaluate its incidence and demonstrate its characteristics. PATIENTS AND METHODS: This prospective study was conducted from 1995 to 2008 and enrolled PES patients treated at Department of Infectious Diseases, Dr. Tomislav Bardek General Hospital in Koprivnica during the study period. The study included patients of both sexes older than 14 years with recent TBE virus infection, patients with clear temporal correlation between acute morbidity and PES onset, and patients where any other cause of PES was ruled out. The immunoenzyme linked assay (ELISA) was used for detection of serum IgM and IgG antibodies. Recent TBE virus infection was detected in 133 patients. Nine of these patients refused further cooperation, and the remaining 124 patients, 80 male (64.5%) and 44 female (35.4%), aged 16-76, were included in the study. We longitudinally examined the manifestation and characteristics of PES in each patient during a 3-year period (and longer if necessary). Study patients were divided into three groups of mild, moderate and severe PES based on data collected and entered into specially prepared questionnaire and by qualitative analysis of PES effect on their daily habits and activities. RESULTS: Out of 124 patients included in the study, 60 (48.3%) had no symptoms/signs of PES, or these were mild and of short duration 15 (12.0%). The remaining 49 (39.5%) patients developed moderate (30/47.0%) or severe (19/30.0%) PES lasting for 3-18 months, with significant impact on their daily habits and activities requiring some adjustment. The main characteristics of PES were mental disorders, balance and movement coordination disorders, headache, general malaise, and reduced working ability. PES was recorded in 35 (28.2%) patients with meningoencephalitis and 14 (11.2%) patients with meningoencephalomyelitis. Permanent sequels were left over in 11 (17.1%) patients: spinal nerve paresis in five (4.0%), hearing impairment in six (5.6%), dysarthria in two (1.6%) patients, and severe mental disorder in one (0.8%) patient. In three patients we recorded simultaneous permanent spinal nerve paralysis and permanent deafness. During our longitudinal study three (2.5%) patients died. CONCLUSION: The study undoubtedly confirmed the presence of PES in our patients with TBE. Moderate and severe PES has a significant impact on the patient quality of life, demands patient adjustment, and increases expenses of long-term sick-leave and rehabilitation.

Severe late-onset nosocomial pneumonia caused by Chlamydophila pneumoniae.

We report two cases of severe late-onset nosocomial pneumonia caused by Chlamydophila pneumaniae. The clinical course of the disease in these patients suggests that nosocomial pneumonia caused by this agent can lead to profound respiratory insufficiency and acute respiratory distress syndrome, particularly in patients with significant comorbidities and during the postoperative period. Intravenous azithromycin treatment was used to cure pneumonia in both of our patients.

Zoonoses and vector-borne diseases in Croatia - a multidisciplinary approach.

Emerging and re-emerging infectious diseases create constant and serious concerns for public health. The majority of emerging infectious diseases (EID) are wildlife zoonotic diseases and vector-borne diseases. Croatia has a long tradition in the control, management and research of EID zoonotic diseases and vector-borne diseases. There has also been a long and advantageous tradition in the collaboration of different experts and professionals in EID research in Croatia involving physician clinicians in infectious diseases, microbiologists, pathologists, veterinarians and animal scientists, ecologists, forestry experts, wildlife scientists, public health specialists and epidemiologists and laboratory scientists. The University Hospital for Infectious Diseases in Zagreb established the Centre for Emerging and Re-emerging Infectious Diseases in liaison with national and international partners from Europe and the United States. This Centre is working in line with the 'One Health initiative' which recognises the inter-relationships between human, animal and environmental health.

An unusual outcome in a child with hepatosplenic cat-scratch disease.

Typical cat-scratch disease (Bartonella henselae infection) in an immunocompetent child is usually associated with a history of scratch, bite or intimate contact with a cat. Most patients develop a non-tender papule in the scratch line after three to ten days. This may persist for only a few days or as long as two to three weeks. During the next two weeks or more, regional lymph nodes that drain the area gradually enlarge and then slowly resolve in more than 10% of patients. The nodes develop overlying erythema and may suppurate. Atypical forms of cat-scratch disease occur in a minority of cases and are characterized by ocular or neurological manifestations, hepatosplenic involvement, vertebral osteomyelitis, endocarditis etc. Immunocompromised individuals with B. henselae infection may develop bacillary angiomatosis, bacillary peliosis, and relapsing bacteremia. There have been several reports of hepatosplenic granulomas caused by B. henselae in immunocompetent children. We report a case of a 6-year-old boy with the hepatosplenic form of cat-scratch disease. Despite early diagnosis and long-term antimicrobial treatment, splenectomy could not be avoided.

Center for Disease Control (CDC) flow cytometry panel for human immunodeficiency virus infection allows recognition of infectious mononucleosis caused by Epstein-Barr virus or cytomegalovirus.

AIM: To analyze the distribution of lymphocyte subsets in the peripheral blood of patients with infectious mononucleosis caused by Epstein-Barr virus (EBV) and cytomegalovirus (CMV) and to investigate the possible diagnostic usefulness of flow cytometry panel recommended by the Center for Disease Control and Prevention (CDC) for HIV-1 infection. METHODS: The study included 130 immunocompetent adults with infectious mononucleosis caused by EBV (n=103) and CMV (n=27) and 50 controls. EBV-infected patients were divided into two groups based on typical (n=92) or atypical (n=11) clinical presentation of the disease. Lymphocyte subpopulations were determined by flow cytometry and a panel of monoclonal antibodies recommended by the CDC for the immunophenotyping of patients infected with human immunodeficiency virus (HIV). RESULTS: Patients with typical and atypical presentation of EBV-induced infectious mononucleosis showed increased percentages of total T-cells, cytotoxic-suppressor CD8(+) T cells and activated HLA-DR(+) T cells compared to healthy controls. Percentages of CD4(+) T cells, as well as CD4/CD8 ratio, were significantly decreased. Absolute counts of CD4(+) T cells and percentages of B cells did not differ from healthy controls. Pattern of changes in CMV-infected patients was completely identical to that in healthy controls, although less pronounced. CONCLUSION: Lymphocyte subpopulations represented in the CDC panel for HIV are sufficient for the recognition of patients with infectious mononucleosis caused by EBV and CMV. Flow cytometry can be useful support for reaching diagnosis in patients with atypical clinical presentation of EBV-induced infectious mononucleosis.