Epidemiological and clinical characteristics of imported falciparum malaria in the Republic of North Macedonia : A 13-year experience.

BACKGROUND: Plasmodium falciparum is the leading cause of imported malaria and the most common cause of death in returning travellers. AIM: To identify the main epidemiological and clinical characteristics of patients with imported falciparum malaria in the Republic of North Macedonia. MATERIAL AND METHODS: Retrospectively analyzed were the epidemiological and clinical features of 34 patients with imported falciparum malaria who were diagnosed and treated at the university clinic for infectious diseases and febrile conditions in Skopje from 2010 to 2022. Malaria diagnosis was based on the microscopic detection of parasites in thick and thin blood smears. RESULTS: All patients were male, with a median age of 36 years and a range of 22-60 years. Of the patients 33 (97.1%) acquired the disease in Sub-Saharan Africa. All patients except one stayed in endemic regions for work/business purposes. Chemoprophylaxis was completely applied in 4 (11.8%) patients. The median time of onset between the symptoms and diagnosis was 4 days, with a range of 1-12 days. Prevailing clinical manifestations were fever, chills, and splenomegaly in 100%, 94%, and 68% of patients, respectively. Severe malaria was noticed in 8 (23.5%) patients. In 5 (14.7%) patients the initial parasitemia was higher than 5%. On admission, thrombocytopenia, hyperbilirubinemia, and elevated alanine aminotransferase were registered in 94%, 58%, and 62% of patients, respectively. Out of the 33 patients with adequate follow-up, the outcome was favorable in 31 (93.9%). CONCLUSION: In every febrile traveller returned from Africa, imported falciparum malaria should be an essential part of differential diagnostic considerations.

Human brucellosis in Macedonia - 10 years of clinical experience in endemic region.

AIM: To present our 10-year clinical experience with brucellosis patients at the University Clinic for Infectious Diseases and Febrile Conditions in Skopje, Republic of Macedonia. METHODS: A total of 550 patients with brucellosis treated between 1998 and 2007 were retrospectively assessed for their demographic, epidemiological, and clinical characteristics and outcomes. RESULTS: Of the 550 patients, 395 (72%) were male. The median age was 34.5 years (range, 1-82). Direct contact with infected animals was recorded in 333 (61%) patients and positive family history in 310 (56%). The most frequently seen symptoms were arthralgia (438, 80%), fever (419, 76%), and sweating (394, 72%). The most common signs were fever and hepatomegaly, which were verified in 357 (65%) and 273 (50%) patients, respectively. Focal brucellosis was found in 362 patients (66%) and osteoarticular in 299 (54%). Therapeutic failures were registered in 37 (6.7%) patients. Of the 453 (82%) patients who completed a follow-up period of at least 6 months, relapses occurred in 60 (13%). CONCLUSION: Due to non-specific clinical manifestation and laboratory parameters, brucellosis should be considered one of the differential diagnoses of any patient suffering from obscure involvement of various organs in a brucellosis-endemic region. High percentage of relapses and therapeutic failures in spite of the use of currently recommended therapeutic regimens indicates the seriousness of this zoonosis and the need to control it.

The influence of illness duration before diagnosis on clinical characteristics and outcome in human brucellosis.

Our study assesses the influence of illness duration before establishing the diagnosis of brucellosis and initiating therapy on patients' main clinical characteristics and outcome in an endemic area. The medical files of 297 patients with brucellosis were retrospectively analysed. They were divided into four groups according to illness duration before initiating therapy: <10 days; 11-30 days; 31-90 days; and >90 days. There were significant differences in the occurrences of fever (P = 0.019), focal forms (P = 0.026), spondylitis (P = 0.034) and therapeutic failures (P = 0.006) between the groups. Duration of >30 days before treatment initiation is responsible for more serious clinical presentation and outcome, whereas illness duration of >90 days further worsens the clinical progression in human brucellosis.

The changing pattern of fever of unknown origin in the Republic of North Macedonia.

INTRODUCTION: The study aimed to compare the etiologic spectrum of diseases causing fever of unknown origin (FUO) and methods for definitive diagnosis in a tertiary care hospital in the Republic of North Macedonia during two different time periods. PATIENTS AND METHODS: There were analysed retrospectively the causes for FUO and final diagnostic approaches in 185 patients with classic FUO that were treated at the University Hospital for Infectious Diseases in Skopje during two time periods. Seventy nine patients were treated during 1991 to 1995 and 106 patients during 2011 to 2015. RESULTS: When comparing these two periods, infections were present in 46.8% and 29.2% (p = 0.014), non-infective inflammatory disorders in 22.8% and 25.5% (p = 0.674), neoplasms in 10.1% and 13.2% (p = 0.522), miscellaneous in 8.9% and 12.3% (p = 0.461) and undiagnosed cases in 11.4% and 19.8% (p = 0.124), respectively. The most common causes for FUO during the first period were abscesses (8.9%), tuberculosis and systemic lupus erythematosus (7.6% each), whereas in the second period the commonest causes were adult onset Still disease and solid organ neoplasm (7.6% each), polymyalgia rheumatica, abscesses and visceral leishmaniasis (5.7% each). The newer imaging techniques and clinical course evaluation had superior diagnostic significance during the second period. CONCLUSION: A changing pattern of diseases causing FUO during the examined periods was evident. Infections continue to be the most common cause but with decreasing incidence when compared to 20 years ago. Even nowadays clinical evaluation and follow-up still remain the vital diagnostic tools in determining the etiology of FUO.

Evaluation of a rotavirus acute gastroenteritis severity score in hospitalized children over a ten year period in a clinic of infectious diseases, Skopje, R. Macedonia.

UNLABELLED: Rotavirus infection is the most common viral infection of the gastrointestinal tract in children with the most severe clinical manifestations and rapidly progressive dehydration, especially in infancy and early childhood. Due to its characteristics of high contagiousness and being widespread in both developed countries and developing countries with a still high fatality rate, active prevention of the disease is recognized as the only successful measure for preventing severe forms of the disease. The assessment of the severity of the clinical picture with the corresponding severity scales, Vesikari or Clark, is essential for interpretation of the success of the applied vaccine. THE PURPOSE OF THE STUDY: A ten-year review of the frequency of appearance and laboratory features of Rotavirus Gastroenteritis in Paediatrics at the Infectious Diseases Clinic, Skopje, Macedonia. The goal of the study is to stress the constant presence of infection with severe clinical manifestations and the necessity of the introduction of vaccination. MATERIALS AND METHODS: Acute viral gastoenteritis patients were processed, whose clinical presentation indicated mandatory hospitalization. Biochemical laboratory parameters were required for all children, and they were grouped in appropriate severity groups depending on the values of the clinical parameters on the Vesikari and Clark scales. By taking a biochemical laboratory analysis using statistical methods we searched for an answer to whether and to what extent their values are predictive for assessment of the severity of the disease, and how much they influence the values in each of the scales. RESULTS: 1012 children at an average age of 19.51 months, treated from 2003 to 2012, tested with 12 parameters and grouped into scales, showed the existence of a correlation between the scales of 0.8277. Processing our results suggests the use of a modified Vesikari scale for clinical assessment of disease severity, and thus the ability to monitor the effectiveness of vaccination.