Hemorrhagic fever with renal syndrome (HFRS) is an acute zoonotic disease caused by viruses of the Orthohantavirus genus. This syndrome is characterized by renal and cardiopulmonary implications ...detectable with different biomarkers. Here, we explored the role of serum and urine levels of lipocalin-2, endothelin-1 and N-terminal pro-brain natriuretic peptide (NT-proBNP) in HFRS pathology. A total of twenty-eight patients hospitalized due to a Puumala orthohantavirus infection were included, with serum and urine samples collected on patient admission (acute phase) and discharge (convalescent phase). In comparison to healthy individuals, patients exhibited significantly higher acute-phase serum and urine levels of lipocalin-2, serum levels of endothelin-1 and serum and urine levels of NT-proBNP. Patients in the convalescent phase showed a significant decrease in urine lipocalin-2, serum endothelin-1 and serum and urine NT-proBNP levels. We recorded a strong correlation between serum levels of lipocalin-2 and endothelin-1 and urine levels of lipocalin-2 with several kidney injury markers, such as serum creatinine, urea, urine white blood cell count and proteinuria. We also demonstrated an independent correlation of serum and urine lipocalin-2 levels with acute kidney injury in HFRS. All in all, our results show an involvement of NT-proBNP, lipocalin-2 and endothelin-1 in the renal and cardiac pathology of HFRS.
•First molecular and phylogenetic analyses of West Nile virus endemic in Croatia.•Description of 2013 West Nile neuroinvasive disease outbreak with 22 patients.•Outbreak occurred in and around ...capital, where no cases have been observed before.
This is the second subsequent year of West Nile neuroinvasive disease (WNND) outbreak in Croatia. Between July and October 2013, 22 patients presented with symptoms of WNND: all with meningitis and 18 additionally with encephalitis. In contrast to 2012, where six autochthonous infections were confirmed in eastern Croatia, the majority of this year's cases occurred in and around the city of Zagreb, where no West Nile virus infections have been observed before. Viral RNA was recovered from two patients and phylogenetic analyses revealed West Nile virus lineage 2. This represents the first molecular characterization and phylogenetic analysis of the circulating West Nile virus strain in Croatia.
...some differential MRI findings in favour of tuberculous spondylodiscitis have been suggested such as involvement of more than two vertebral bodies, thoracic spine involvement, severe vertebral ...destruction, mild disc destruction, a thin and smooth abscess wall, and subligamentous spread to three or more vertebral levels.2,3 In our Clinical Picture,1 MRI of the patient's lumbosacral spine showed high signal intensity of the vertebral disc and vertebral body at the L4 and L5 levels with an epidural abscess and granulation tissue; such findings are described in both tuberculous and pyogenic spondylodiscitis. The American Thoracic Society and the Centers for Disease Control and Prevention advocate treatments of 6-9 months for adults and 12 months for children with uncomplicated tuberculous spondylodiscitis caused by a fully sensitive M tuberculosis isolate.4 In our Clinical Picture,1 the patient's improvement started 10 days after the beginning of treatment, followed by a complete clinical recovery and return of systemic inflammatory markers to normal concentrations. 2 months after treatment in hospital, the follow-up MRI showed significant regression of the epidural abscess, which would have been highly improbable in tuberculous spondylodiscitis. ...in our opinion, the results suggest that C jejuni caused spondylodiscitis in the patient.
We describe the first reported case of Corynebacterium striatum (C. striatum) relapsing bacteraemia in a patient with peripheral arterial disease and proven Corynebacterium species colonization of a ...chronic foot ulcer, focusing on the difficulties in the management of the patient. We conclude that the optimal duration of the antibiotic treatment for relapsing C. striatum bacteraemia from a chronic ulcer should be 6 weeks together with surgical treatment.
Pneumonija iz opće populacije, odnosno stečena izvan bolnice vrlo je česta bolest uzrokovana brojnim mikroorganizmima s različitom kliničkom pojavnošću, težinom i prognozom te ima važan udio u ...pobolu i smrtnosti pučanstva s rastućim troškovima liječenja u cijelom svijetu. Izjednačavanje i poboljšanje liječenja odraslih bolesnika propisuju smjernice mnogih institucija i profesionalnih udruženja. Sve moderne smjernice za liječenje pneumonija iz opće populacije temelje se na kliničkoj dijagnozi pneumonije potvrđene rendgenskom slikom pluća i empirijskom izboru antibiotika. Poput ostalih najpoznatijih (američke, europske, britanske), naše smjernice s racionalnim pristupom baziraju se na procjeni težine bolesti, dobi bolesnika, popratnim kroničnim bolestima, rizičnim čimbenicima i epidemiološkim podatcima. Na osnovi težine bolesti propisuju dijagnostičke i terapijske postupke prema mjestu zbrinjavanja pneumonija: ambulantno, na bolničkom odjelu, odnosno u jedinicama za intenzivno liječenje. Liječenje pneumonija antibiotikom treba započeti odmah, odnosno u roku od četiri sata nakon postavljanja kliničke dijagnoze. Parenteralna primjena antibiotika može se zamijeniti peroralnom najčešće 48 – 96 sati od početka liječenja, čak i u bolesnika s težim oblikom bolesti ako su zadovoljeni kriteriji. Cijepljenje protiv influence i pneumokokne bolesti preporučuje se svim osobama s povišenim rizikom. U izradi smjernica sudjelovali su ekspertni predstavnici pet relevantnih društava HLZ-a i Hrvatskoga torakalnog društva te Referentnog centra za dijagnostiku i liječenje infektivnih bolesti Ministarstva zdravstva Republike Hrvatske. Namijenjene su liječnicima obiteljske medicine i specijalistima različitih struka koji liječe bolesnike s pneumonijom ambulantno ili u bolnici.
Hepatits E virus (HEV) je globalni patogen koji uzrokuje epidemijske i sporadične slučajeve akutnog hepatitisa u Aziji i Africi. Sporadični slučajevi bilježe se i u Europi, većinom u putnika iz ...endemskih zemalja. U studenom 2012. godine zaprimljen je bolesnik u dobi 62 godine zbog sumnje na bakterijsku pneumoniju. Bolest je započela dva tjedna pred prijam febrilitetom i respiratornim simptomima koji su regredirali tijekom ambulantnog liječenja cefuroksim-aksetilom. Šesti dan liječenja zbog pojave osipa bolesnik je hospitaliziran. Bolesnik je kod prijma bio ikteričan, s eritematoznim makuloznim osipom. Laboratorijskom obradom nađene su umjereno povišene vrijednosti upalnih parametara uz hiperbilirubinemiju i povišene vrijednosti transaminaza. Na sumacijskoj snimci torakalnih organa viđen je opsežan intersticijski infiltrat u desnom gornjem režnju pluća. Serološkim i molekularnim testovima dokazana je akutna infekcija HEV-om. Serološka dijagnostika za uzročnike atipične pneumonije ukazivala je na moguću istovremenu infekciju s C. pneumoniae. Simptomatskim liječenjem postignuto je izlječenje uz normalizaciju svih laboratorijskih nalaza nakon tri mjeseca praćenja, bez razvoja komplikacija. Ovim radom prikazali smo bolesnika iz Zagreba s ikteričnim oblikom akutnog hepatitisa E koji nije boravio izvan Hrvatske što je prema dostupnoj literaturi prvi opisani slučaj autohtonog hepatitisa E u Hrvatskoj. Bolesnik je tijekom bolesti razvio osip i pneumonični infiltrat koji se etiološki nisu mogli jasno definirati. Bolesnike s kliničkom slikom akutnog virusnog hepatitisa koji nije uzrokovan virusima hepatitis A, B ili C te EBV-om i CMV-om trebalo bi testirati i na HEV.