In younger, immunocompetent individuals, in spite of the existent diagnostic and therapeutic problems, the subacute course of Listeria monocytogenes meningitis provides enough time for appropriate treatment and favorable disease outcome.
Visceral leishmaniosis (VL) has emerged as an important opportunistic parasitosis associated with human immunodeficiency virus (HIV) infection. The aim of this paper is to report the first case of Leishmania/HIV coinfection in a patient from Nis (Southeastern Serbia). Microscopical examination of Giemsa-stained bone marrow (BM) smears show the presence of Leishmania spp. amastigotes based on their morphological characteristics. In spite of the parasitological finding, the serological test applied gave negative results. Molecular analyses confirmed the infection and allowed us to identify the leishmania species as Leishmania infantum (100% identity). VL/HIV coinfection has important clinical, diagnostic and epidemiological implications. In fact, the failure of serological tests is expected in this condition, and the application of molecular diagnostics to the blood may offer, apart from an easy and non-invasive diagnostic opportunity, the possibility of warning about the risk of possible nosocomial infections. [Projekat Ministarstva nauke Republike Srbije, br. 41018 and br. 175034]
BACKGROUND AND OBJECTIVES:Published data on oxidative stress in children with acute hepatitis A are still very scarce. This study aims to evaluate the oxidant/antioxidant status of these patients.DESIGN AND SETTING:Prospective, case-control study, over 2.5 years in patients under hospitalized and ambulatory care.PATIENTS AND METHODS:The levels of a whole-blood antioxidant, reduced glutathione; and plasma antioxidants, β-carotene, retinol, ascorbic acid, α-tocopherol; and the biomarker of oxidative stress, malondialdehyde, were evaluated in 50 pediatric patients (age range, 5-16 years; 29 males and 21 females) with acute hepatitis A and in 50 healthy children as control subjects (age range, 5-16 years; 25 males and 25 females).RESULTS:Plasma levels of reduced glutathione, β-carotene, retinol, α-tocopherol and ascorbic acid were significantly lower, while malondialdehyde plasma levels were significantly increased in the patient group when compared to the controls (P<.0001 for all parameters).CONCLUSIONS:Our findings show that pediatric patients with acute hepatitis A were influenced by oxidative stress, resulting in significantly lower levels of plasma antioxidants and increased lipid peroxidation. In the absence of other therapeutic options, antioxidant vitamin supplements could be added to the therapy for these patients to help reestablish the oxidant status balance. Further investigations to confirm this suggestion are recommended.
An outbreak of trichinellosis affecting 13 individuals, of whom 8 with severe form presented as myocarditis, occurred in the village of Subotinac near the town of Aleksinac in Serbia. The source of this epidemic was smoked pork from a domestic pig that had not undergone meat inspection procedures. The most striking clinical features among all the 13 patients were muscular pain (84.6%), malaise (69.2%), upper eyelid edema (61.5%), and difficulty in chewing (53.9%). These symptoms and signs were associated with significant elevations of creatine phosphokinase and lactate dehydrogenase levels. As high as 61.5% of the patients with trichinellosis were diagnosed with myocarditis (determined by means of electrocardiography, echocardiography, troponin I and creatine kinase-MB measurements). The patients had Trichinella-specific IgG antibodies in an enzyme-linked immunosorbent assay and positive indirect immunofluorescence test results. Patients seemed to respond well to treatment with mebendazole. Corticosteroid therapy was administered to patients with myocarditis. Since high percentage of our patients presented with myocarditis, an infectious diseases specialist should always keep in mind doing cardiac biomarkers analyses, echocardiography and electrocardiography.
Central nervous system (CNS) infections are among the most dramatic medical conditions, not just because of their clinical presentations, possible ultimate consequences, but also because of the complexity of their diagnosis and treatment, and clinically they are manifested with meningeal syndrome, regardless of the type of causative agent. The aim of the study was to determine the correlation between certain clinical signs of meningeal syndrome and results of lumbar puncture which is used to diagnose the central nervous system infection. The study included a group of 54 patients who were treated at the Clinic for Infectious Diseases Clinical Centre Niš, with a clinical picture of bacterial meningitis. The diagnosis of the disease was based on a clinical picture, findings of lumbar puncture and isolation of the causative agent out of the cerebrospinal fluid. In all patients, there was pleocytosis in the cerebrospinal fluid with predomination of polymorphonuclears. There were 20 (37.0%) females and 34 (63.0%) males, with mean age 52.37 ± 18.10 years. The most dominant clinical symptoms in patients were headache in 74.1%, elevated temperature in 70.4%, stiff neck in 63.0% and Brudzinski's upper sign in 55.6%. Ethical verification from the cerebrospinal fluid was negative in 32 (59.3%) patients, Klebsiella, Pneumoccocus and Staphylococcus were found in 4 (7.4%) patients each. It was found that headaches with stiff neck, disturbance of consciousness and elevated temperature represent an absolute indication for lumbar puncture and are in direct correlation with the positive finding in the cerebrospinal fluid.
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