Prompt and adequate treatment of human brucellosis continues to be the most important strategy in its management, as eradication of animal brucellosis is not possible so far, and there is no adequate ...vaccine for humans. The goal of antibrucellar treatment is to alleviate and shorten the symptomatic period and reduce complications, relapses, and chronicity. Contemporary trends in the treatment of human brucellosis are postulated on the ability of
Brucellae
to persist in host macrophages through the inhibition of phagolysosome fusion and to survive for prolonged periods intracellularly without restricting basic cellular functions. As a result of this and despite satisfactory antibiotic treatment, relapses and therapeutical failures are inevitable to a certain degree. The current principles for the treatment of brucellosis advocate for a long enough treatment duration combined with antimicrobial regimens that possess activity in the intracellular acidic environment. In the future, other antimicrobial agents, immunomodulation, decrease in the intracellular acidic environment, or development of agents that would act on well-defined molecular bacterial targets, might be incorporated to improve the therapeutical effects.
Childhood brucellosis:Review of 317 cases Bosilkovski, Mile; Krteva, Ljiljana; Caparoska, Sonja ...
Asian Pacific journal of tropical medicine,
12/2015, Letnik:
8, Številka:
12
Journal Article
Recenzirano
Odprti dostop
Objective:To describe the main epidemiological,clinical,and laboratory features,treatment options and outcome in children with brucellosis.Methods:Retrospectively evaluated data were obtained from ...317 pediatric patients with brucellosis that were treated at the University Clinic for Infectious Diseases and Febrile Conditions in Skopje,during the period from 1989 to 2011.The medical records and follow-up protocols were used for evaluation.Results:Childhood brucellosis composed 317(18.7%) of 1 691 patients with brucellosis.The patients were median 9 years old,ranging from 7 months to 14 years,and 201(63.4%) were males.Family history was present in 197(62.1%),and direct contact with animals occurred in 140(44.2%) of the children.The dominant manifestations were fever in 248(78.2%),joint pain in228(71.9%) and hepatomegaly in 216(68.1%).Organ affection was present in 206(65.0%)of the patients.One hundred and six(33.4%) of the patients were treated with combination composed of two.and 211(66.6%) with three antimicrobial agents.Relapses were registered in 21(6.6%).and therapeutic failures in 3(0.9%) of the children.Conclusions:In endemic regions childhood brucellosis represents a significant part of human cases.Wide spectrum of clinical manifestations,frequent affection of various organ systems and possibility of relapses show that brucellosis could be a serious disease in this age group.The presence of fever,joint pain,sweating,and affection of various systems in children from endemic regions should alert pediatricians for the possibility of brucellosis.
Testicular infection in brucellosis: Report of 34 cases Bosilkovski, Mile; Kamiloski, Viktor; Miskova, Silvana ...
Journal of microbiology, immunology and infection,
February 2018, 2018-Feb, 2018-02-00, 20180201, 2018-02-01, Letnik:
51, Številka:
1
Journal Article
Recenzirano
Odprti dostop
To present clinical and laboratory features, treatment options, and outcome in patients with brucellar testicular infection and to compare them with analogous in brucellar patients without testicular ...involvement.
Thirty four brucellar patients with testicular infection treated in two general hospitals in the Republic of Macedonia, during the period 1998–2009, were retrospectively analyzed. Their clinical and laboratory characteristics were compared with analogous in 364 male brucellar patients without testicular infection, who were treated at the same hospitals during the same time period.
Brucellar testicular infection was evident in 34 (8.5%) out of 398 male patients with brucellosis. The median age of the patients was 46.5 years. In all patients testicular involvement was presented as an acute form with a median duration of 5 days (range, 2–14 days) prior to diagnosis. Twenty-three of the patients had at least one other simultaneous focal infection. After starting with the treatment testicular infection lasted a median 10 days, range 7–21 days. Brucellar patients with testicular infection when compared with other brucellar patients more frequently manifested fever (97% vs. 61%), concomitant spondylitis (32% vs. 16%), and urinary system involvement (12% vs. 2%). Also, the relapse rate in patients with testicular involvement was significantly higher (24% vs. 9%).
In endemic regions brucellosis should be taken into consideration in any patient with testicular infection. Brucellar testicular involvement is usually characterized with a severe acute clinical presentation and a high percentage of relapses which entails the need of timely recognition and proper treatment duration of at least 60 days.
Brucellosis is probably the commonest anthropozoonotic infection worldwide 1-3, but remains in various aspects an enigma in the 21st century 4. Brucella melitensis remains the major cause of human ...disease worldwide, followed by B. abortus and B. suis, while rare but persisting cases of B. canis human infection and disease by novel Brucella pathogens of marine mammals have also emerged. The disease is re-emerging as a significant cause of travel-related disease 5 and represents an index of poor socioeconomic status (Figure 1). Its treatment is largely based even today on the principles applied half a century ago by pioneer researchers 6 and few modifications have been made in the following years, despite the emergence of new antibiotic classes and different therapeutic approaches 7.
Despite the great advancements seen in medicine in recent years, fever of unknown origin (FUO) remains a serious diagnostic challenge. Regardless of the etiological elucidation in many cases of FUO ...and the progress seen in the management of these patients, there are currently many weaknesses in this area as a result of inconsistency in the definition and interpretation of key terminology and the utilization of different definitions and classifications. As a result, there is confusion among medical practitioners about FUO, which leads to laborious and difficult comparisons among different case series. This study outlines the mismatch in terminology and diversity found in the classification of the conditions that cause FUO and emphasizes the discrepancies between what some terminology intends to represent and what it actually represents in reality. Thus, we attempted to determine an appropriate solution for established inconsistencies. Keywords: Diagnostic approach, fever, fever of unknown origin, infection, neoplasm
Different outcomes of brucellosis in pregnancy regarding the fetus/neonate and the mother are described. Medical records of five pregnant women with brucellosis were retrospectively analyzed. ...Patients were treated in several departments of infectious diseases in the Republic of Macedonia between 1995 and 2009. The diagnosis of brucellosis was based on clinical findings compatible with the disease supported by detection of specific antibodies. Pregnancy outcomes in patients were as follows: spontaneous abortion, intrauterine fetal death, premature delivery in two cases (one with twin pregnancy) and term delivery. One of the women experienced relapse. Follow-up results of neonates showed no infection and their normal growth and development. Brucellosis, especially if acquired in early pregnancy, can have an impact on pregnancy outcome. In endemic regions, in pregnant women with persisting fever and unspecific manifestations one should always have in mind brucellosis. In these areas, cases with unexplained spontaneous abortion, intrauterine fetal death and premature delivery should also be investigated for brucellosis.
Cervical lymph nodes (CLN) are the first lymph nodes encountered by material taking the oral route. To study their role in orally acquired infections, we analyzed 307 patients of up to 14 years ...treated in the university clinic of Skopje, Macedonia, for brucellosis, a zoonotic bacterial disease frequently acquired by ingestion of contaminated dairy products. From these children, 36% had lymphadenopathy. Among orally infected children, lymphadenopathy with CLN being the only lymph nodes affected was significantly more frequent as compared to those infected by contact with animals (83% vs. 63%), suggesting a possible involvement of CLN during orally acquired human brucellosis. Using a murine model where bacteria are delivered into the oral cavity, we show that Brucella quickly and selectively colonize the CLN where they proliferate and persist over long periods of time for up to 50 days post-infection. A similar efficient though less specific drainage to CLN was found for Brucella, Salmonella typhimurium and fluorescent microspheres delivered by gavage, a pathway likely representing a mixed infection mode of intragastric and oral infection, suggesting a central pathway of drained material. Microspheres as well as bacteria drained to CLN predominately reside in cells expressing CD68 and no or low levels of CD11c. Even though no systemic response could be detected, Brucella induced a locally restricted inflammatory reaction with increased expression levels of interferon γ, interleukin (IL)-6, IL-12, granzyme B and a delayed induction of Nos2. Inflammation led to pronounced lymphadenopathy, infiltration of macrophages/monocytes expressing high levels of major histocompatibility complex II and to formation of epitheloid granulomas. Together, these results highlight the role of CLN in oral infections as both, an initial and efficient trap for bacterial invaders and as possible reservoir for chronic pathogens. They likewise cast a new light on the significance of oral routes for means of vaccination.
The aim of this study was to evaluate the ability of severity scoring systems to predict 30-day mortality in patients with severe community-acquired pneumonia.
The study included 98 patients aged ≥18 ...years with community acquired pneumonia hospitalized at the Intensive Care Unit of the University Clinic for Infectious Diseases in Skopje, Republic of North Macedonia, during a 3-year period. We recorded demographic, clinical and common biochemical parameters. Five severity scores were calculated at admission: CURB 65 (Confusion, Urea, Respiratory Rate, Blood pressure, Age ≥65 years), SCAP (Severe Community Acquired Pneumonia score), SAPS II (Simplified Acute Physiology Score), SOFA (Sequential Organ Failure Assessment Score) and MPM (Mortality Prediction Model). Primary outcome variable was 30-day in-hospital mortality.
The mean age of the patients was 59.08 ± 15.76 years, predominantly males (68%). The overall 30-day mortality was 52%. Charlson Comorbidity index was increased in non-survivors (3.72 ± 2.33) and was associated with the outcome. All severity indexes had higher values in patients who died, that showed statistical significance between the analysed groups. The areas under curve (AUC) values of the five scores for 30-day mortality were 0.670, 0.732, 0,726, 0.785 and 0.777, respectively.
Widely used severity scores accurately detected patients with pneumonia that had increased risk for poor outcome, but none of them individually demonstrated any advantage over the others.
Lyme borreliosis (LB) and tick-borne encephalitis (TBE) are important tick-borne diseases in Europe. This study aimed to investigate the seroreactivity against
and TBE virus (TBEV) in tick-infested ...individuals in North Macedonia and Serbia. Serum samples were collected from tick-infested individuals and from healthy individuals in the same regions. Samples were tested for anti-
IgG reactivity and TBEV-neutralizing antibodies. Results showed higher seroreactivity against
antigens in patients and healthy donors from Novi Sad compared to those from the Skopje region. However, there was no statistically significant difference between tick-infested patients and healthy donors within each region. No TBEV-neutralizing antibodies were detected in participants from Novi Sad or in the control groups, except for one person from North Macedonia who had a moderate TBEV-neutralizing reaction. The study highlights the need for improved surveillance and diagnostic capabilities for LB and TBE in these regions. It also suggests the potential existence of TBEV foci in North Macedonia. The findings provide a complementary understanding of the LB and TBE epidemiology in the studied regions; however, further research is needed to investigate the presence and distribution of
spp. and TBEV in ticks to assess the significance of detected seroreactivity.
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