Risk assessment of central nervous system (CNS) infection patients is of key importance in predicting likely pathogens. However, data are lacking on the epidemiology globally. We performed a multicenter study to understand the burden of community-acquired CNS (CA-CNS) infections between 2012 and 2014. A total of 2583 patients with CA-CNS infections were included from 37 referral centers in 20 countries. Of these, 477 (18.5%) patients survived with sequelae and 227 (8.8%) died, and 1879 (72.7%) patients were discharged with complete cure. The most frequent infecting pathogens in this study were Streptococcus pneumoniae (n = 206, 8%) and Mycobacterium tuberculosis (n = 152, 5.9%). Varicella zoster virus and Listeria were other common pathogens in the elderly. Although staphylococci and Listeria resulted in frequent infections in immunocompromised patients, cryptococci were leading pathogens in human immunodeficiency virus (HIV)-positive individuals. Among the patients with any proven etiology, 96 (8.9%) patients presented with clinical features of a chronic CNS disease. Neurosyphilis, neurobrucellosis, neuroborreliosis, and CNS tuberculosis had a predilection to present chronic courses. Listeria monocytogenes, Staphylococcus aureus, M. tuberculosis, and S. pneumoniae were the most fatal forms, while sequelae were significantly higher for herpes simplex virus type 1 (p < 0.05 for all). Tackling the high burden of CNS infections globally can only be achieved with effective pneumococcal immunization and strategies to eliminate tuberculosis, and more must be done to improve diagnostic capacity.

Primary breast lymphoma is rare location of this disease. Diffuse large B-cell lymphoma is the most common histological subtype. We presented two cases of primary diffuse large B-cell lymphoma of the breast and reviewed a literature about this topic

Based on this survey, there is a large unmet need for the new treatment options for metastatic melanoma in Serbia. The development of national guidelines, and greater involvement in international clinical studies could lead to widening of treatment options for this chemotherapy resistant disease.

Background: Hepatitis C virus (HCV) infection is common among patients on haemodialysis (HD) therapy and is an important cause of morbidity and mortality. In patients with chronic kidney disease (CKD), the risks for negative outcomes are significantly higher in HCV-infected patients than in those without HCV infection, including progression to cirrhosis, hepatocellular carcinoma and liver-related mortality. Ombitasvir (OBV), paritaprevir (PTV), ritonavir (r), and dasabuvir (DSV) are all hepatically metabolized and, therefore, require no dose adjustment in patients with any degree of renal impairment. Aims: We studied the safety and efficacy of OBV/PTV/r + DSV in a small group of HCV infected patients on haemodialysis therapy. Methods: Treatment course with ombitasvir/paritaprevir/ritonavir and dasabuvir; (3-DAA regimen of OBV/PTV/r+DSV±RBV) was analysed. Pre-treatment evaluation of HCV infection included HCV RNA, genotype, and liver fibrosis assed by transient fibroelastography (FibroScan). The stage 5 CKD was defined as an eGFR of &lt;15 mL/min/1.73 m2, respectively; those on haemodialysis were considered to have stage 5 CKD or end-stage renal disease (ESRD). Demographic data and concomitant medication were retrieved from patients’ records. The primary endpoint was sustained virologic response at post-treatment week 12 (SVR12). We collected data on on-treatment adverse events (AEs), serious AEs, and laboratory abnormalities. Results: Among 7 treated patients, 6 were male and 1 female, all were infected with genotype 1 (5 GT1b, 2 GT1a). Patient had compensated liver cirrhosis and six patients did not have liver cirrhosis, none were liver transplant recipients. All of seven patients completed 12 weeks of treatment and achieved SVR12. Concomitant medication had to be modified with the treatment initiation in 5 out of 7 patients. One of the patients presented with a significant decrease in haemoglobin level, white blood cell and platelet count during the treatment period. The most frequent adverse events were nausea, diarrhoea. Adverse events were primarily mild, and no patient discontinued treatment due to an AE. Conclusions: Treatment with OBV/PTV/r +DSV ± RBV was well-tolerated and resulted in high rates of SVR12 (100%) for patients with HCV GT1b/1a on haemodialysis.

Uvod. Mumps je sistemska virusna infekcija koju karakteriše otok pljuvačnih žlijezda, najčešće parotidnih, a može zahvatiti i gonade, moždane ovojnice, gušteraču i druge organe. Cilj rada je bio analiza kliničkih i ultrazvučnih karakteristika mumps orhitisa kao i spermiograma kod pacijenata liječenih u Klinici za infektivne bolesti tokom epidemije od oktobra 2011. godine do decembra 2012. godine.Metode. U istraživanje je uključeno 90 bolesnika sa mumps orhitisom. Analizirani su klinički i laboratorijski parametri, ultrazvučne promjene (mjesec dana nakon infekcije) i spermiogram (šest mjeseci nakon infekcije).Rezultati. Prosječna dob oboljelih je bila 21,4 godine. Kod svakog trećeg bolesnika orhitis se pojavio u toku parotitisa, a kod preostalih nakon parotitisa. Unilateralni orhitis je imalo 84% bolesnika. Ultrazvučne promjene je imalo 74,4% bolesnika, od kojih su kod 68,9% promjene bile unilateralne. Prosječan CRP je bio 80,7 mg/L i bio je statistički značajno veći (p=0,014) kod pacijenata sa bilateralnim orhitisom. Prosječan ukupan broj spermatozoida je kod bolesnika sa unilateralnim orhitisom bio statistički značajno veći (p=0,011) nego kod bolesnika sa bilateralnim orhitisom, od kojih su tri bolesnika imala azoospermiju. Vrijednosti volumena sperme su kod bolesnika sa unilateralnim orhitisom u 58,8% bile ispod referentnih; za bolesnike sa bilateralnim orhitisom nismo imali dostupne podatke. Nije uočena statistički značajna razlika u pokretljivosti spermatozoida kod bolesnika sa unilateralnim i bilateralnim orhitisom (p=0,100).Zaključak. Pacijenti sa težom kliničkom slikom (bilateralni orhitis) su imali izraženije promjene u spermiogramu. Preporuka je da se odmah nakon pojave prvih simptoma orhitisa, prije svega bilateralnog, bolesnicima omogući krioprezervacija sperme kao moguće rješenje u slučaju gubitka plodnosti.

Climate change is definitely one of the greatest challenges of human development in the 21st century. Climate change is expected to increase the risk of communicable diseases in Europe. This impact will depend not only on local climatic conditions, but on other factors, such as current infrastructure, public health services, biodiversity specificity, etc. The population in Bosnia and Herzegovina, Croatia and Serbia has been severely affected by the floods caused by cyclone Tamara in 2014. The basic mode of transmission of the disease caused by the West Nile virus is the bite of the infected mosquito. The West Nile virus is not transmitted among humans through contact, nor can it be transmitted from infected birds to humans without mosquito bite. The aim of the study was to analyze and present the trend of this disease in the period 2014-2018 and to show the connection between the spatial occurrence of cases and location of the flooded area in 2014 in the Republic of Srpska. Using the descriptive method, the demographic data of the patients were analysed, the most common clinical form of the disease and the incidence of the disease in the period 2014-2018 was analysed. The cases were mapped and we analysed the connection of the case and location that was flooded. The incidence ranged from 0.79 in 2014 to 0.43 in 2018. Patients were of all age groups and both sexes, most commonly cases from rural areas (78%). The most common clinical form of the disease is shown, which were symptoms of the central nervous system infection. Out of the total number of patients, 94% were from flooded areas. All reported cases have been diagnosed at the Institute of Microbiology at the University Clinical Center of Republika Srpska and were reported as probable cases in accordance with the international case definition of communicable diseases. However, it is crucial to implement internationally endorsed procedures as a clinical alghoritm for the confirmation of the case in accordance with the laboratory criteria for the case definition. The occurrence, frequency and spatial distribution of cases indicates a possible connection with the floods in 2014.

Većina pacijenata je imalo povišenu tjelesnu temperaturu i kašalj, znatan broj mijalgije i glavobolju, a gastrointestinalne i neurološke simptome je imao manji broj pacijenata. Uglavnom su hospitalizovani pacijenti sa komplikacijama u smislu virusne ili bakterijske pneumonije (radiološki verifikovanu pneumoniju je imalo 115 pacijenata) i pacijenti sa neurološkom simptomatologijom. Potvrdili smo influenzu PCR-om kod 78 pacijenta. Oskigenoterapiju je zahtijevalo 59, a mehaničku ventilaciju devet pacijenata. Respiratorno insuficijentni pacijenti koji na oksigenoterapiju putem maske za lice ili nazalnog katetera nisu reagovali poboljšanjem saturacije hemoglobina kiseonikom, odmah su iz prijemne ambulante Klinike za infektivne bolesti upućivani u Kliniku intenzivne medicine za nehirurške grane (KIM), a devet pacijenata je po prijemu premješteno u KIM zbog razvoja akutnog respiratornog distres sindroma (ARDS-a). Većina pacijenata je liječena antibiotikom (179), dok je antivirotikom liječeno 76 pacijenata (zbog nedostatka antivirusne terapije, a određen broj se javio značajno kasnije od preporučenog vremena za ordiniranje antivirusne terapije i to zbog komplikacija u vidu bakterijske pneumonije). Od 181 pacijenta ozdravilo je 169, a bilo je 12 smrtnih ishoda.

Introduction: Mumps is a systemic viral infection characterized by swelling of salivary glands, especially the parotid ones. Gonads, meninges, pancreas and other organs may also be affected. Aims of the study: The aim of this study was to analyze the epidemiological characteristics of mumps meningitis in the last epidemic of mumps in the Republic of Srpska, and to analyze the frequency of mumps meningitis and vaccination status in patients who were supposed to be vaccinated against mumps in the war and early postwar period, and also in those patients who were supposed to be vaccinated before or after this period. Patients and Methods: The study included 175 patients divided in the experimental group (140 patients with mumps meningitis) and the control group (35 patients with serous meningitis of other etiology, probably enteroviral). We compared epidemiological characteristics of these patients and additionally we analyzed the differences in these characteristics in patients with different vaccination status. Results: The mean age of patients in the experimental group was 20.0 years (18.0-24.5; IQ), and in the control group 7.0 years (5.0-14.0; IQ) (p <0.001). Patients born between 1985 and 1996 more frequently suffered from meningitis (p <0.001) caused with mumps virus than other patients in the experimental group. There was no statistically significant difference in sex distribution between patients in the experimental and control group (p = 0.746), nor between patients in the experimental group with previously different vaccination status (p = 0.371). Most patients in the experimental group didn't have data of their immunization status. The subsequent are those patients who received only one dose of vaccine, followed by unvaccinated patients and those who were vaccinated correctly. Conclusion: The epidemic of mumps during 2011 and 2012 is a consequence of maintaining the virus in non-vaccinated population (mainly because of the omissions made during the war and early postwar period) and insufficient duration of protection after vaccination, especially in vaccination with one dose of vaccine.