Alveolar echinococcosis is a parasitic disease caused by the tapeworm larval stage of Echinococcus multilocularis. This zoonotic disease has not been known to occur in Croatia. We report a confirmed ...case of human alveolar echinococcosis in a patient in Croatia who had never visited a known E. multilocularis-endemic area.
The prevalence of chronic hepatitis C increases in elderly patients. The aims of this study were to identify the factors associated with hepatocellular carcinoma (HCC) and end-stage liver disease ...development and to evaluate the efficacy and safety of pegylated interferon (PEG-IFNα) plus ribavirin (RBV) therapy in elderly patients. A retrospective cohort study included all consecutive pa-tients with hepatitis C virus (HCV) infection treated with PEG-IFNα+RBV between 2003 and 2013. Elderly patients had a higher frequency of poor prognostic factors including genotype 1 infec-tion, high fibrosis, and high fibrosis index based on four factors (FIB-4) score. The sustained virologic response (SVR) rate for genotype 1 was significantly lower (35.8% vs. 57.1%), while the frequency of PEG-IFNα (27.2% vs. 7.8%), RBV dose reduction (19.6% vs. 9.7%) and treatment discontinuation (13.0% vs. 4.1%) was significantly higher in elderly patients. However, age was not associated with SVR in multivariate analysis, and comparable SVR rates were achieved when adjusted for fibrosis score (Ishak ≤3: 66.7% vs. 69.8%). During the follow-up, HCC was diagnosed in 18 elderly patients (3 SVR+, 4 SVR- and 9 untreated patients). In conclusion, selected elderly patients can achieve comparable SVR rates as younger patients, but with a higher rate of side effects. Since complications of HCV infection occur more frequently in elderly patients, they should be given priority for antiviral therapy.
To define the status of infectious diseases (ID) as an approved specialty in Europe; to enumerate the number of specialists (in general and in relation to the overall population) and specialist ...trainees and describe the content, delivery and evaluation of postgraduate training in ID in different countries.
Structured web-based questionnaire surveys in March 2021 of responsible national authorities, specialist societies and individual country representatives to the Section of Infectious Diseases of the European Union for Medical Specialties. Descriptive analysis of quantitative and qualitative responses.
In responses received from 33/35 (94.3%) countries, ID is recognized as a specialty in 24 and as a subspecialty of general internal medicine (GIM) in eight, but it is not recognized in Spain. The number of ID specialists per country varies from <5 per million inhabitants to 78 per million inhabitants. Median length of training is 5 years (interquartile range 4.0–6.0 years) with variable amounts of preceding and/or concurrent GIM. Only 21.2% of countries (7/33) provide the minimum recommended training of 6 months in microbiology and 30% cover competencies such as palliative care, team working and leadership, audit, and quality control. Training is monitored by personal logbook or e-portfolio in 75.8% (25/33) and assessed by final examinations in 69.7% (23/33) of countries, but yearly reviews with trainees only occur in 54.5% (18/33) of countries.
There are substantial gaps in modernization of ID training in many countries to match current European training requirements. Joint training with clinical microbiology (CM) and in multidisciplinary team working should be extended. Training/monitoring trainers should find greater focus, together with regular feedback to trainees within many national training programmes.
Late presentation to care is the major obstacle to receiving treatment for chronic hepatitis C (CHC). Our aim was to analyze the prevalence and trends of late presenters (LP) at first consultations ...in Croatia during a 10-year period. This retrospective cross-sectional study included all adult CHC patients (n = 854) entering specialist medical care at the University Hospital for Infectious Diseases Zagreb between 2009 and 2018. LP was defined as liver stiffness measurement ≥ 9.5 kPa or biopsy METAVIR F ≥ 3. During the study period, mean patients’ age increased from 37 to 52 years while HCV genotype distribution changed leading to the replacement of genotype 1b with 1a (g1b 32% to 21%; g1a 19% to 38%). A total of 320 (37.4%) were LP; they were older (47.5, IQR 40.5–57.6), and more commonly infected with g1b (34.1%) and g3 (42.5%). The prevalence of LP significantly increased from 31.9% in 2009 to 46.5% in 2018. Late presentation for care of CHC is increasing in Croatia suggesting a gap of diagnosing strategies in patients over 50 years.
Uvod: Bakterijske infekcije čest su uzrok komplikacija i dekompenzacije kod bolesnika s cirozom jetre. Cilj je ove studije proučiti etiologiju, kliničke manifestacije, tijek i ishod bakterijskih ...infekcija te identificirati prediktore mortaliteta kod bolesnika s cirozom jetre i sepsom.
Materijali/metode: Proveli smo retrospektivnu kohortnu studiju u koju je uključeno 257 bolesnika s cirozom jetre koji su bili hospitalizirani u Klinici za infektivne bolesti „Dr. Fran Mihaljević“ (KZIB) u petogodišnjem razdoblju (2011. - 2015.). Analizirali smo demografske, kliničke te mikrobiološke podatke s ciljem identifikacije prediktora mortaliteta.
Rezultati: Najčešći klinički sindrom kod prijema bolesnika bila je primarna bakterijemija nepoznatog ishodišta (40,8 %). Prethodno dijagnosticiranu kroničnu bolest jetre imalo je 39,2 % bolesnika. Kod 50 % bolesnika najčešći uzrok ciroze jetre bio je alkoholne geneze. Uzročnik je izoliran kod 71,4 % bolesnika, najčešće iz hemokultura (59,1 %). Korekcija empirijske terapije učinjena je u 11,2 % slučajeva, uzevši u obzir mikrobiološke izolate. Medijan do početka adekvatne antimikrobne terapije bio je 3 dana. Do komplikacija je došlo kod 62,2 % bolesnika. Ukupni mortalitet za vrijeme hospitalizacije iznosio je 28,5 %. Odgođena adekvatna antimikrobna terapija u razdoblju ≥ 72 sata, invazivna mehanička ventilacija i akutno bubrežno zatajenje pokazale su se neovisno povezanima sa smrtnim ishodom.
Zaključak: Ovom smo studijom opisali epidemiologiju i etiologiju bakterijemija kod bolesnika s cirozom jetre u Hrvatskoj. S obzirom na to da je infekcija prvi prezentirajući znak ciroze u našoj kohorti, naglašava se potreba za sustavnijim probirom u svrhu ranog otkrivanja kronične bolesti jetre i sprječavanja komplikacija. Visoka stopa multiplo-rezistentnih infekcija iz opće populacije naglašava potrebu za izradom nacionalnih smjernica za empirijsko liječenje bakterijskih infekcija kod bolesnika s cirozom jetre.
Hepatitis C vodeći je uzrok kronične bolesti jetre, hepatocelularnog karcinoma i važna indikacija za transplantaciju jetre. Glavni cilj liječenja je postizanje trajnog virološkog odgovora koji ...označava negativnu viremiju 12 tjedana nakon završetka liječenja (SVR, od engl. sustained virological response). Uvođenjem antivirusnih lijekova s izravnim djelovanjem, povećala se stopa SVR-a, skratilo vrijeme trajanja terapije i utjecalo se na stadij fibroze i steatoze jetre nakon liječenja. Cilj ovog rada bio je analizirati promjenu stadija fibroze (F1-F4) i steatoze (S0-S3) primjenom tranzijentne elastografije u prethodno neliječenih bolesnika s kroničnim hepatitisom C (n=205) koji su postigli trajni virološki odgovor, a bili liječeni isključivo direktno djelujućim antivirusnim lijekovima (DAA).
Sažetak. Kronični hepatitis C (KHC) prepoznat je kao javnozdravstveni problem visokog prioriteta. Svjetska zdravstvena organizacija (SZO) postavila je globalni cilj sniženja smrtnosti za 65% i ...prevalencije za 90% do 2030. godine. Preduvjet za ostvarenje ovog cilja jest otkriće izravno djelujućih antivirusnih lijekova (DAA). Cilj je ovog rada prikazati prva iskustva u liječenju kroničnog hepatitisa C (KHC) trojnom kombinacijom antivirusnih lijekova ombitasvir/paritaprevir/ritonavir + dasabuvir (PrOD) uz dodatak ribavirina. Upotrebom matematičkog modela procijenjeni su prevalencija i broj komplikacija terminalne bolesti jetre ovisno o broju liječenih bolesnika do 2030. godine. Uključeno je 117 bolesnika s infekcijom HCV-om genotipa 1 i genotipa 4 koji su liječeni terapijom PrOD ± RBV. Izlječenje je postignuto u 97% liječenih, bez znatnijih nuspojava i prekida terapije. Liječenjem 450 bolesnika na godinu postigao bi se cilj sniženja smrtnosti za 65%. Pojačanim probirom (screeningom) osoba s rizikom, udruženim epidemiološkim naporima za otkrivanje asimptomatskih bolesnika i njihovim pravodobnim uključivanjem u medicinsku skrb omogućilo bi se da Hrvatska bude među prvim zemljama koja može ostvariti ciljeve SZO-a u kontroli virusnih hepatitisa.
Otkako se pojavio u Kini krajem 2019. godine, virus SARS-CoV-2 proširio se cijelim svijetom i izazvao najnoviju pandemiju. Epidemiološke značajke virusa kao i kliničke manifestacije bolesti COVID-19 ...su još uvijek predmet istraživanja. Neprestano dolazimo do novih spoznaja, ali još uvijek ne razumijemo u potpunosti SARS-CoV-2 virus i bolest koju uzrokuje. Do sada smo velikom brzinom naučili dosta o virusu i COVID-19 bolesti, ali je potrebno još više istraživanja, jer su mnoga pitanja još uvijek otvorena.
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