Importance of quick test for screening of former drug users.

INTRODUCTION: Most frequent mode of transmission of HCV today is with intravenous drug use. Former intravenous (IV) drug users present population group more exposed to HCV infection. Longer period of substance abuse, common syringe, more sexual partners (drug users) represent independent, statistically significant risk factors in this population. Diagnosis of HCV infection is based on history, epidemiological data, and clinical presentation, blood tests, histopathological and virology investigation. Hepagnost C is fast immunochromatography test for qualitative detection of HCV antibodies in blood, serum or plasma. Sensitivity of this test compared to EIA is >99% and relative specificity 98,6%. MATERIAL AND METHODS: At Clinic for Infectious diseases (Hepatology Department) voluntary testing with Hepagnost C test was done for 22 former drug users. Results of this cross-sectional study are processed with SPSS program for Windows. RESULTS: Most of the subjects were male (95,5%), average age of 33 +/- 3,5 years with average length of drug usage of 10 (7-12,5) years. All positive (9/22) were tested with EIA test and HCV infection was confirmed (9/9), therefore positive predictive value for Hepagnost C is 100%. We investigated relative risk (RR) with IV drug usage. Higher risk for infection (1,7 times) was among IV. drug users. Odds ratio was 2,4 (chance for HCV in iv. drug users group is 2,4 times higher). Common syringes increase relative risk for 4,5 times, and Odds ratio for infection 9 times. CONCLUSIONS: Hepagnost C test of high sensitivity and specificity showed 100% prediction. It is simple, inexpensive and comfortable test with results within 15 minutes. Demographic characteristics of tested persons as well as statistical results do not deviate significantly from results in available literature.

Serratia marcescens meningitis following spinal anaesthesia and arthroscopy.

We present case of nosocomial bacterial meningitis, caused by Serratia marcescens (ESBL), occurred following spinal anaesthesia. Although very rare bacterial meningitis is serious complication of spinal anaesthesia and early diagnosis as well as effective treatment is extremely important. Previously healthy individual, admitted to Orthopaedic Department for routine arthroscopy, approximately within 24 hours after operation was performed complained of headache and fever. Infectious Diseases physician was consulted, lumbar puncture was performed and purulent meningitis was confirmed. Cerebrospinal fluid and blood cultures of patient confirmed Serratia marcescens (ESBL), resistant pathogen and important nosocomial agent. Patient was successfully treated. Cases of spinal meningitis caused by Serratia marcescens are rare. Local resistance pattern is important and should be always considered when starting therapy. Infection control team was appointed because of similar case of meningitis one month before in the same Department, and after investigation discovered Serratia in anaesthetic vial used in procedures. New measures and recommendations regarding infection control were implemented at Orthopaedic Department. Meningitis as a complication should always be considered as a possible differential diagnosis with patients after spinal anaesthesia complaining on headache and fever. Early diagnosis and early treatment is extremely important. Knowledge and practice of infection control measures is mandatory and should be always emphasized to performing staff.

Cellulitis--epidemiological and clinical characteristics.

INTRODUCTION: Cellulitis is acute skin infection and/or infection of subcutaneous tissue, mostly caused by Streptococcus pyogenes and Staphylococcus aureus. Clinical preview is usually obvious and enough for diagnosis. Tretment is antimicrobial therapy. In recurrent cases a prophylaxis is very often needed. OBJECTIVES: Analysis some of the epidemiological and clinical characteristics of cellulitis. PATIENTS AND METHODS: Retrospective analysis of medical documentation of patients with clinical preview of cellulitis who were hospitalized in Clinic for infective diseases of Clinical Center of University of Sarajevo in last three years. RESULTS: In period of three years 123 patients were hospitalized with clinical preview of cellulitis in the broadest sense of the word. In 123 of cellulitises, 35/123 (28.45%) were erisipelases-superficial type and 88/123 (71,55%) were deep cellulitises. Men were more affected 56,09%, average of age was 50.22 years. Before hospitalization patients had ambulance treatment in average of 5.12 days, and hospitalization was long in average of 13.33 days. Risk factors wich contributes to the disease were found in 71.54% of cases. Due to localisation, skin disorders on lower limb were the most frequent 71.56%, cellulitis of upper limb were found in 12.19%, head and/or neck in 13.08%, trunk in 3.25%. Repetition of disease were found in 4.8% in patients wtih risk factors. Bacteremic isolats were confirmed in 27.64% of cases. In all patients empirical antibiotic treatment were started, in the 62.60% the first choice of medicine was antibiotic from the group of lincosamides. CONCLUSION: Cellulitis is very serious disease that can be prevented.

Evaluation of the clinical and analytical performance of the Seegene allplex™ SARS-CoV-2 variants I assay for the detection of variants of concern (VOC) and variants of interests (VOI).

BACKGROUND: High-throughput assays for the detection of SARS-CoV-2 variants of concern (VOC) and interest (VOI) are a diagnostic alternative when whole genome sequencing (WGS) is unavailable or limited. OBJECTIVE: This study evaluated the clinical and analytical performance of the Seegene Allplex™ SARS-CoV-2 Variants I assay, which detects the HV69/70 deletion, N501Y and E484K mutations of the S gene. METHODS: Genotyping was evaluated on -871 SARS-CoV-2 RNA positive specimens, 408 nasopharyngeal (NP) swabs and 463 saline gargle (SG) specimens, with WGS used as the reference standard. Analytical performance was assessed including stability, reproducibility, limit of detection (LOD), cross-reactivity and interference with various respiratory microorganisms. RESULTS: The clinical study revealed sensitivity of 100% (95% CI 99.27%-100%) and specificity of 100% (95% CI 98.99%-100%) for HV69/70 deletion, sensitivity of 100% (95% CI 99.55%-100%) and specificity of 100% (95% CI 93.73% - 100%) for N501Y, and sensitivity of 100% (95% CI 98.94% - 100%) and specificity of 98.10% (95% CI 96.53% - 99.08%) for E484K mutation. The E484Q mutation was detected in 10 specimens of the Kappa variant (B.1.627.1). Analytical performance demonstrated stability and reproducibility over 7 days, and LOD was calculated at 698 cp/mL for NP swab specimens, and 968 cp/mL for SG specimens. No interference or cross-reactivity with other microorganisms was noted. CONCLUSION: The Allplex™ SARS-CoV-2 Variants I assay is acceptable for clinical use for the detection of variant of concern and variant of interest.

Sonographically guided percutaneous catheter drainage versus needle aspiration in the management of pyogenic liver abscess.

OBJECTIVE: The purpose of this study was to determine the effectiveness of percutaneous catheter drainage (PCD) and to compare PCD with percutaneous needle aspiration in the management of liver abscess. SUBJECTS AND METHODS: Sixty patients with pyogenic liver abscess were randomly assigned to two groups in a prospective study. Antibiotics were administered for 10 days, starting the day of the beginning of percutaneous treatment. One group was treated with sonographically guided PCD and the other group with repeated percutaneous needle aspiration. Percutaneous needle aspiration was attempted a maximum of three times. Lack of response to the third aspiration was considered failure of treatment; these patients were treated with PCD but were not included in the PCD group for analysis. Patient demographics, duration of hospital stay, treatment outcome, and complications were analyzed. RESULTS: Percutaneous needle aspiration was successful in 20 (67%) of the 30 patients after one (n = 12), two (n = 7), or three (n = 1) aspirations. PCD was curative in all 30 patients after one (n = 24) or two (n = 6) procedures. All abscesses 50 mm or less in longest diameter were successfully managed, 10 by percutaneous needle aspiration and 12 by PCD. None of patients in the percutaneous needle aspiration group with multiloculated abscesses (n = 5) was successfully treated. Hospital stay did not differ significantly between the groups. There were no complications related to the procedure. CONCLUSION: PCD is more effective than percutaneous needle aspiration in the management of liver abscess. Percutaneous needle aspiration can be used as a valid alternative for simple abscesses 50 mm in diameter or smaller.

Analysis of comorbidity of the patients affected by staphylococcal bacteremia/sepsis in the last ten years.

CONFLICT OF INTEREST: none declared. INTRODUCTION: Staphylococcal bacteremia/sepsis is one of the most serious bacterial infections around the world. In individuals with pre-existing diseases, there is always an increased risk of infections occurring due to impaired immune system, a variety of drug therapy, exposure to a diagnostic and therapeutic procedure and frequent hospitalizations. OBJECTIVES: To analyze the prevalence of comorbidity in a patient with the staphylococcal bacteremia/sepsis according to the diagnosis, the site of infection and according to the isolated agent. PATIENTS AND METHODS: We analyzed the patients affected by the staphylococcal bacteremia/sepsis and treated in the Clinic for Infectious Diseases during a ten-year period. RESULTS: 87 patients were included, out of whom 20 (23%) with clinical signs of the bacteremia and 67 (77%) of sepsis. In the analyzed sample, in 36 (41.4%) were not registered comorbidity. Hospital infections are represented by the previous antibiotic, corticosteroid and chemo therapy, pressure ulcers, and different implants. In all comorbidity, the most common isolated bacteria was S. aureus primarily strain MSSA followed by MRSA strain which is more frequent in patients who were surgically treated (comorbidity-various implants). CONCLUSION: The results suggest the importance of being mindful of the staphylococcal etiology of the bacteremia/sepsis in patients with comorbidities due to the selection of an adequate initial empirical therapy and reducing the risks of the septic shock.

Complicated Varicella Infection at 8-year-old Boy with Pulmonary Agenesis.

CONFLICT OF INTEREST: none declared. INTRODUCTION: Varicella or chickenpox is highly contagious, childhood infectious disease caused by primary infection with varicella - zoster virus from the herpes family of viruses. Usually it has a mild clinical course, rarely with described complication, mostly affecting respiratory tract and rarely the central nervous system. CASE REPORT: The case present 8 year old boy hospitalized eighth day of disease with clinical pictures of varicella complication. Upon receipt tachydyspnea, high fever, tachycardia, hypotensive with positive findings on lung auscultation in the sense of pneumonia. Extremely high values of non-specific inflammatory parameters are implied on bacterial infection which is treated using triple antimicrobial therapy and antiviral. A detailed clinical, laboratory and radiological evaluation is determined of clinical disease complication under a picture of MODS that required prolonged multidisciplinary treatment in ICU. CONCLUSION: The disease had a favorable clinical outcome in terms of training completely without consequences but, with the detected congenital absence lower lobe of right lung and transposition of the brachiocephalic trunk.

Listeria meningoencephalitis in an immunocompetent person.

Listeria monocytogenes is a small, aerobic or facultative anaerobic, non-sporulating gram positive bacillus that can be isolated from soil, vegetation or animal reservoirs. There are six species of Listeria, and only L. monocytogenes is pathogenic for humans. Human disease occurs mainly in immunocompromised people, neonates and in pregnancy, while the cases in immunocompetent people are rare. CNS manifestations of the disease can be in form of meningitis, encephalitis, and also cerebritis and abscess since L. monocytogenes shows tropism for brain and brain stem as well for the meninges. In this case we presented 55 year old male patient with etiologically confirmed listerial meningoencephalitis, transferred from regional hospital tothe Clinic for Infectious Diseases with diagnosis of acute meningoencephalitis. Disease started 4 days before the admission. Prior to this the patient was completely healthy. In his history he denied any preexisting disease. At admittance he was febrile, with altered consciousness, disoriented, showing ocular deviation, dystaxia, and with completely positive meningeal signs. Neurologist diagnosis was rhombencephalitis. CSF analysis showed mildly opalescent liquor with pleocytosis 546/mm3 and polymorphonuclear cell predominance >70%. CSF culture showed positive isolate of L. monocytogenes. Initial therapy was: Penicillin G and Chloramphenicol, together with all other supportive and symptomatic therapy. After initial therapy and based on antibiogram, ampicillin was administered for4 weeks, followed by imipenemum for 10 days. Control CSF analysis showed pleocytosis and increased protein level and the patient was discharged as recovered with diagnosis of acute meningoencephalitis