Uvod: Leta 2013 mineva 60 let od izolacije virusa klopnega meningoencefalitisa (KME) v Sloveniji. Od takrat se slovenski infektologi, epidemiologi, virologi in drugi strokovnjaki strokovno in ...znanstvenoraziskovalno ukvarjajo s proučevanjem KME.
Ob jubileju so s historiografskimi metodami analizirali objave skozi ta čas in pripravili retrospektivno študijo pojavljanja te bolezni pri nas.
V nekaterih delih Slovenije se je v letih po drugi svetovni vojni začela pojavljati bolezen osrednjega živčevja, ki je do tedaj niso poznali. Leta 1953 so Milko Bedjanič in Slava Rus, oba infektologa, ter virologinja Jelka Vesenjak Zmijanac z osamitvijo virusa iz krvi bolnice dokazali, da je ta bolezen KME. Virologi so v naslednjih letih proučevali povzročitelja KME; številni epidemiologi so raziskovali njegove epidemiološke značilnost, entomologi in ornitologi ekosisteme arbovirusnih okužb, infektologi klinične in laboratorijske značilnosti okužb in potek okužb ter morebitne posledice bolezni. Mikrobiologi so izpopolnjevali možnosti diagnostike te okužbe. Razvili so tudi uspešno cepivo in zakonsko so določene skupine, ki se morajo obvezno cepiti.
Bolezen se je pri Slovencih ustalila kot endemski tip KME, ki jo kliniki sicer dobro obvladujejo, a je skupen trud epidemiologov in javnega zdravja usmerjen v zvišanje precepljenosti proti KME, saj je v Sloveniji ta odstotek zelo nizek in se bolezen še vedno prekomerno pojavlja.
Introduction: In the year 2013, we are celebrating the 60th anniversary of the isolation of the tick-borne encephalitis virus (TBE) in Slovenia. Ever since its isolation, Slovenian infectologists, epidemiologists, virologists and other experts have been researching this disease.
For this anniversary, we have historiographically analysed all qualified articles from this period and prepared a retrospective study of the appearance of the disease in Slovenia.
In certain parts of Slovenia, in the years following the Second World War, there was an increased presence of previously unknown diseases of the central nervous system. In 1953, Milko Bedjanič, Slava Rus and Jelka Vesenjak Zmijanac isolated a virus in the blood and thereby proved that the disease was indeed TBE. In the years that followed, virologists studied the cause of TBE, many epidemiologists researched its epidemic characteristics, entomologists and ornithologists studied the ecosystems of arboviral infections and infectologists studied the clinical and laboratory features of infections and the course of the disease as well as its possible consequences. Microbiologists perfected the technique of diagnosing this infection. They developed a vaccine and selected the groups that were legally obliged to be vaccinated.
the disease has stabilised as an endemic type of TBE that clinicians can control, but the common effort of epidemiologists and the public health service directed towards vaccinating people against this disease has not been very successful and the disease is still too common.
Izvleček
Uvod: Leta 2013 mineva 60 let od izolacije virusa klopnega meningoencefalitisa (KME) v Sloveniji. Od takrat se slovenski infektologi, epidemiologi, virologi in drugi strokovnjaki strokovno ...in znanstvenoraziskovalno ukvarjajo s proučevanjem KME.
Metode:
Ob jubileju so s historiografskimi metodami analizirali objave skozi ta čas in pripravili retrospektivno študijo pojavljanja te bolezni pri nas.
Rezultati:
V nekaterih delih Slovenije se je v letih po drugi svetovni vojni začela pojavljati bolezen osrednjega živčevja, ki je do tedaj niso poznali. Leta 1953 so Milko Bedjanič in Slava Rus, oba infektologa, ter virologinja Jelka Vesenjak Zmijanac z osamitvijo virusa iz krvi bolnice dokazali, da je ta bolezen KME. Virologi so v naslednjih letih proučevali povzročitelja KME; številni epidemiologi so raziskovali njegove epidemiološke značilnost, entomologi in ornitologi ekosisteme arbovirusnih okužb, infektologi klinične in laboratorijske značilnosti okužb in potek okužb ter morebitne posledice bolezni. Mikrobiologi so izpopolnjevali možnosti diagnostike te okužbe. Razvili so tudi uspešno cepivo in zakonsko so določene skupine, ki se morajo obvezno cepiti.
Zaključki:
Bolezen se je pri Slovencih ustalila kot endemski tip KME, ki jo kliniki sicer dobro obvladujejo, a je skupen trud epidemiologov in javnega zdravja usmerjen v zvišanje precepljenosti proti KME, saj je v Sloveniji ta odstotek zelo nizek in se bolezen še vedno prekomerno pojavlja.
To establish the frequency of isolation of Borrelia burgdorferi sensu lato from blood of children with solitary erythema migrans (EM) in Europe, to determine the strains of the isolated borreliae and ...to compare the clinical course and the outcome of the disease according to positive and negative blood culture result.
In the prospective study we included 134 consecutive patients younger than 15 years with solitary EM, referred to our institution in 1996 and 1997. One milliliter of blood was withdrawn before treatment and cultured in modified Kelly-Pettenkofer medium. Isolated borreliae were typed according to LRFP analysis. Patients were treated with either penicillin V or cefuroxime axetil for 14 days. The posttreatment course was surveyed by follow-up visits during 1 year.
B. burgdorferi sensu lato was isolated in 12 of 134 (9%) patients. Eleven blood isolates were typed: 10 were found to be B. afzelii and 1 was Borrelia garinii. Comparison of blood culture-positive and -negative patients revealed no differences in pretreatment characteristics or in posttreatment clinical course. However, worsening of local and/or systemic signs and symptoms at the beginning of antibiotic therapy (Jarish-Herxheimer's reaction) was identified more often in the blood culture-positive than in the blood culture-negative group (5 of 12 vs. 17 of 122, respectively; P = 0.0274).
The isolation rate of B. burgdorferi sensu lato from the blood of children with solitary EM was 9%. The majority of the isolates were B. afzelii. Blood culture-positive patients treated with oral antibiotics were not at greater risk for unfavorable course of the disease than patients with negative blood culture result.
To compare the clinical efficacy and drug-related adverse effects of 14 days of treatment with cefuroxime axetil 30 mg/kg/day or phenoxymethyl penicillin 100,000 IU/kg/day in the treatment of ...children with erythema migrans.
Consecutive patients younger than 15 years, referred to our institution in 1996 with solitary erythema migrans and without prior antibiotic therapy, were included in this prospective study. Basic demographic features and clinical data were collected by questionnaire. The efficacy of the treatment of acute disease, development of major and/or minor manifestations of Lyme borreliosis and drug-related adverse effects were surveyed at follow-up visits during the first year after the initiation of antibiotic treatment.
Forty-six patients received cefuroxime axetil (group C) and 44, phenoxymethyl penicillin (group P). The two groups differed in terms of age (patients in group C were younger), but no other differences in demographic and clinical pre-treatment characteristics were present. The clinical course during the post-treatment period revealed no significant differences between the two groups: the duration of erythema migrans (7.1 +/- 7.5 days in group C, 10.6 +/- 19.3 days in group P) and the appearance of minor manifestations of Lyme borreliosis (8.8% in group C, 9.1% in group P) were comparable; no major manifestations were recorded. Twelve months after antibiotic treatment all patients were free of symptoms. The patients treated with cefuroxime axetil had more drug-related adverse effects than did those treated with phenoxymethyl penicillin (26.1% versus 6.8%, p = 0.0301). "Herxheimer's reaction" at the beginning of treatment was identified more often in group C than in group P, but the difference was not statistically significant.
Cefuroxime axetil and phenoxymethyl penicillin are equally effective in the treatment of children with solitary erythema migrans; however drug-related adverse effects were more frequently observed with cefuroxime axetil.
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