Akutni perikarditis u koinfekciji uzročnicima Anaplasma phagocytophilum i Borrelia burgdorferi

Lajmska borelioza i krpeljni meningoencefalitis (KME) najčešće su bolesti prenosive krpeljima u Republici Hrvatskoj. Isti vektor, krpelj roda Ixodes ricinus, odgovoran je i za prijenos humane granulocitne anaplazmoze (HGA) koja se u našoj zemlji rijetko dokazuje, a prvi slučajevi su potvrđeni 1998. godine u Koprivničko-križevačkoj županiji. HGA se najčešće klinički prezentira vrućicom s leukopenijom, trombocitopenijom, povišenim aminotransferazama i CRP-om, a potvrđuje se serološki, pri čemu se povremeno dokaže koinfekcija s virusom KME i/ili bakterijom Borrelia burgdorferi. Prikazujemo slučaj 44-godišnje bolesnice koja je ambulantno liječena u Klinici za infektivne bolesti Kliničkog bolničkog centra Rijeka zbog vrućice s bicitopenijom (leukopenija, trombocitopenija) i akutnog perikarditisa. Serološkom je obradom dokazana akutna koinfekcija uzročnicima Anaplasma phagocytophilum i Borrelia burgdorferi. Liječenje je provedeno doksiciklinom i nesteroidnim antireumaticima, čime je postignut povoljan klinički odgovor.

COVID-19 in Children

COVID-19 in children accounts for up to 8% of all the cases and is less severe than in adults. This could be an underestimation. A significant number of children are asymptomatic. Symptomatic infection is hard to distinguish from other respiratory tract viral infections based on symptoms and laboratory results. Anosmia is the only symptom in children that is highly suggestive of COVID-19. Infected children mostly have a positive household member. However, the role of children in SARS-CoV-2 transmission is still controversial. Data suggest that schoolchildren have a greater impact in SARS-CoV-2 transmission compared to younger children. Multisystem inflammatory syndrome in children is a new entity reported since April 2020 and is considered a rare complication of SARS-CoV-2 infection. It occurs in previously healthy older children and adolescents presenting with multisystem involvement and elevated inflammatory markers. Most children respond well to immune-modifying therapy. Treatment of COVID-19 in children is based solely on data received from adults and consists of supportive treatment and, in rare occasions, antiviral therapy (remdesivir), corticosteroids (dexamethasone) and monoclonal antibodies (tocilizumab). Further studies in children are needed in order to better understand this disease. This article discusses clinical presentation and therapeutic options for COVID-19 in children.

Clinical Manifestations of Bartonella henselae Infection Among Children

Objectives: The aim of this study was to analyze clinical manifestations, epidemiology and laboratory parameters of B. henselae infection among children treated at the University Hospital for Infectious Diseases “Dr. Fran Mihaljević”, Zagreb from January 2014 until June 2019. Materials and methods: We retrospectively analyzed the epidemiology, clinical and laboratory characteristics among children with positive indirect immunofluorescence assay for B. henselae IgM and IgG or positive B. henselae polymerase chain reaction from lymph node aspirate. Results: A total of 104 patients, 47 (45,1%) female and 57 (54,8%) male were enrolled. The median age was 9,7 (range, 1,1 to 17,3 years). A history of cat contact was present in 101 (97,1%) children. Acute infection was serologically confirmed in 87 (83,6%), in 5 (4,8%) with PCR while both methods were positive in 12 (11,5%) patients. The presentation on B. henselae infection were regional lymphadenopathy , disseminated disease, encephalopathy and fever of unknown origin. Suppurative inflammation was the most common complication in patients with lymphadenopathy 12/92 (13%). Full recovery was the most frequent outcome (96,1%). Conclusion lesion: B. henselae infection among children is usually a mild disease presented as regional lymphadenopathy. Serology and polymerase chain reaction are useful tests for diagnosis. Treatment duration and choice of therapy depend on clinical manifestation and developed complications.

Preventing Healthcare-Associated Legionellosis with Rapid Reduction of High Concentrations of Legionella Using Mechanical Removal of Blind Ends and Intensive Hot Water Flushing

Background: The aim of this paper was to present the effectiveness of the mechanical removal of blind ends and flushing of hot water systems at outlets as the only possible emergency measures to reduce the concentration of Legionella spp in hot water. Methods: Two measures have been undertaken: mechanical removal of blind ends and intensive hot water flushing when the water has not been used for more than 7 days. Results: We detected Legionella pneumophila serogroup 1 in concentration of 1.000- 55.000 CFU/L at all samples sites. In the control sampling, after three weeks, we found seven sampling sites negative for Legionella and only two sampling sites positive. All nine sampling sites were negative after ten weeks. Conclusion: Establishing good water flow throughout the hospital seems to be the most important measure, in order to make the multiplication of Legionella in the hot water distribution systems unlikely.

Renal Failure Associated with Human Polyomavirus BK and Human Adenovirus in a Child with Acute Lymphoblastic Leukaemia

Immunocompromised patients are susceptible to multiple severe viral infections. This paper describes a 4-year-old boy with newly diagnosed B-cell precursor acute lymphoblastic leukaemia. The 4-year-old patient developed haemorrhagic cystitis, obstructive nephropathy and renal failure due to human polyomavirus BK and human adenovirus co-infection. Cidofovir should be used only in life-threatening cases.

Subacute Thyroiditis

Coronavirus disease 2019 (COVID-19) is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 ( SARS-CoV-2). It usually presents with mild common cold-like symptoms. However, it can lead to series of complications with some of them being fatal. One of the rare and potentially neglected manifestations of COVID-19 is subacute thyroiditis (SAT). Viral causes of SAT documented so far include several viruses, but according to the newest reports, SARS-CoV-2 should also be added to the list. The median time between COVID-19 diagnosis and the onset of SAT symptoms is reported to be 29 days. Patients mostly present with triphasic course of symptoms - thyrotoxicosis, followed by hypothyroidism and euthyroidism. Although limited number of SAT cases after SARS-CoV-2 infection are reported, physicians should consider SAT as a differential diagnosis in COVID-19 patients. The routine assessment of thyroid function in patients with clinical suspicion of SAT or with the suspicion of any other thyroid dysfunction is advised.

Percepcija rizika od spolnih bolesti i HIV-a, kiberohondrija i zdravstvena pismenost u doba pandemije COVID-19

Cilj ovog rada je prikazati pregled dosadašnjih znanstvenih spoznaja o percepciji rizika zaraze HIV-om i drugim spolno prenosivim bolestima, kiberohondrije i zdravstvene pismenosti s naglaskom na trenutnu situaciju pandemije COVID-19. Republika Hrvatska je još uvijek zemlja niskog rizika epidemije HIV-a, dijelom zahvaljujući osnivanju 10 Centara za dobrovoljno, anonimno i besplatno savjetovanje i testiranje na HIV (CST). Percepcija rizika zaraze spolno prenosivom bolešću se opisuje kao vlastita procjena mogućnosti dobivanja iste. Zdravstvena ponašanja, pa tako i percepcija rizika, mogu se objasniti različitim modelima i teorijama, a jedan od prihvaćenih modela je socijalno-kognitivni model uvjerenja vezanih uz zdravlje (engl. Health Belief Model – HBM). Zdravstvena pismenost se definira kao osobne, kognitivne i socijalne vještine koje određuju sposobnost pojedinca da pristupi podacima o zdravlju, razumije ih i koristi. Kiberohodrija je anksiozni poremećaj karakteriziran ekscesivnim istraživanjem zdravstvenih sadržaja preko interneta. Pandemija COVID-19 je veliki događaj digitalne ere, uzimajući u obzir poremećaj izazvan u svim područjima života širom svijeta. Zbog izazvanog straha predstavlja plodno tlo za kiberohondriju.

Coronavirus Disease 19 (COVID-19) Pharmacologic Treatment

Since the first cases of COVID-19 were reported from China the disease became pandemic within a few months. The viral genome was sequenced soon after the outbreak of COVID-19 which enabled development of diagnostic tests and therapeutic options. As the knowledge of SARS-CoV-2 virology increased, many potential drugs appeared. At this moment (January 12th 2021), 4426 studies of COVID-19 are registered, and more than 2680 studies are investigating therapeutic options. This is a short narrative review of currently available evidence on pharmacological treatment of COVID-19.

Plućni embolizam u pneumoniji

Plućni embolizam (PE) i pneumonija dijele zajedničke rizične faktore, uzajamno se potenciraju i slično radiološki manifestiraju. Klinička slika pneumonije može u potpunosti maskirati prateću PE što uz porast D-dimera uslijed upalnog zbivanja znatno otežava probir pacijenata koje je potrebno podvrgnuti slikovnim metodama dijagnostike. Još uvijek nije pronađeno neko karakteristično obilježje (niti granična vrijednost D-dimera) koje bi direktno sugeriralo prisutnost PE u osobe s pneumonijom. Prateća PE najčešće se javlja u starijih i bolesnika s komorbiditetima, a bol u prsima, dispneja i sinkopa češće su nego kod pneumonije bez PE. Pojavnost PE u bolesnika s pneumonijom uzrokovanom novim koronavirusom (COVID-19) značajno je veća nego u pneumonija uzrokovanih drugim uzročnicima i povezuje se s rizičnim faktorima poput muškog spola, višim razinama C-reaktivnog proteina te odgodom hospitalizacije. Primjena profilaktičke doze antikoagulantne terapije može reducirati učestalost PE u bolesnika s COVID-19 pneumonijom.