Herpes simplex encephalitis is an inflammatory brain disease that commonly manifests with severe clinical forms. Herpes simplex virus (HSV-1 and HSV-2) causes this disease with the most common localization in the temporal and the frontal lobe. The disease manifests as generalised or focal signs of cerebral dysfunction. Case lethality of untreated patients is 70 %, even treated cases can be left with neurological and psychological deficit. We present a case of a 20-year old female patient, hospitalized due to fever followed by quantitative disorder of consciousness which progressed during the physical examination, with negative meningeal signs. According to the heteroanamnestic data, seven days before hospitalization, patient had signs of general infectious syndrome. As admitted, the patient experiences a grand mal seizure while further progressing in quantitative and qualitative consciousness disorder and high body temperature non responsive to antipyretics. After a lumbar punction was preformed, antiviral drug (Acyclovir) and an antibiotic (Ceftriaxone) were immediately administered along with other symptomatic and supportive therapy. In the further course clinical condition aggravated, radiological examination (CT and MRI) show brain oedema, intracerebral haemorrhage and initial transtentorial herniation. Considering the malignant course of disease and the non responsive conservative antiviral and antioedematosal therapy, urgent craniectomy and transfer to the Department of Neurosurgery was indicated. A decompressive craniectomy was performed leaving the patient without a portion of cranium in the right frontoparietotemporal region. The conservative-surgical treatment cures the primary disease, but neurological consequences epilepsy and intellectual deterioration remained. In this case we emphasize the importance of initial antiviral therapy when herpes encephalitis is suspected and the importance of a decompressive craniectomy in case of non responsive conservative therapy, because of the numerous complications and high mortality rate.

INTRODUCTION While determining a diagnosis and during a disease follow-up, laboratory, or non-specific inflammatory parameters in particular, platelets reference values, nitrogen matters, and liver enzymes play a significant role because their values may indicate multiple organ failures. GOALS To analyse laboratory parameters in patients diagnosed with the staphylococcal bacteraemia/sepsis. PATIENTS AND METHODS Analysed patients have been treated at the Clinic for Infectious Diseases through the period often years. RESULTS Differences in average CRP values, leucocytes, neutrophils and platelets among the patients diagnosed with the sepsis and bacteraemia are not statistically relevant p > 0,05. Difference in the average sedimentation values of the erythrocytes between the patients diagnosed with the sepsis and the patients diagnosed with the bacteraemia are statistically relevant p = 0,035. Differences between the average INR values between the patients diagnosed with sepsis and the patients with bacteraemia are not statistically significant, but indicative p = 0,051. Differences in the average blood sugar values, urea, creatinine, bilirubin and ALT between the patients diagnosed with bacteraemia and sepsis are not statistically significant p > 0.05. CONCLUSION The results have showed that even in the course ofa bacteraemia, there is a significant increase in the non-specific inflammatory parameters indicating the gravity ofbacteraemia as well, with a constant risk of developing sepsis and septic shock. The importance of running and following-up the laboratory parameters herewith is emphasised for the purpose of detecting sepsis in a timely manner and administering an adequate therapy.

UNLABELLED Analyzing data in the literature, it is noted that in-hospital acquired infections are an increasing problem even in more developed countries. This increasing trend is related to the progress of medical science and introduction of new invasive diagnostic-therapeutic methods, as well as increase of multiresistant types of bacteria, including staphylococci in big percentages. GOALS To analyze frequency of in-hospital acquired staphylococcus bacteremia/sepsis. PATIENTS AND METHODS Anamneses of patients who were diagnosed with staphylococcus bacteremia/sepsis were analyzed within a ten-year period. RESULTS Within the analyzed period from 2001 to 2011, there were 87 patients with diagnosis of staphylococcus bacteremia/sepsis, out of which (20) 77% were diagnosed with sepsis, and (67) 23% with bacteremia. In-hospital outcome was present with 32 (36.8%) patients, while 55 (63.2%) were out of hospital. The chi-square test for independence showed that the diagnosis of bacteremia/sepsis and the place of the infection origin (in hospital/ out of hospital) were independent chi2 = 1.951 df= 1 p=0.162. The cause isolated from hemoculture depends on the place of the infection origin (out of hospital/in hospital); larger percentage of methicillin-resistant types was presented in in-hospital acquired infections chi2 11.352 df=1 p=0.001. And the chi-square test for independence showed both dependence of the preceding antibiotic treatment and the place of the infection origin in both categories of patients. Sepsis: chi2 = 22.92 df=1 p<0.0005; Bacteremia: chi2 = 9.89 df=1 p= 0.005. CONCLUSION The results showed larger percentage of methicillin-resistant types in in-hospital acquired infections, as well as significantly larger percentage of hospital infections with the preceding antibiotic therapy, which puts in focus possible rationalization of including antibiotic therapy.

INTRODUCTION Chickenpox is highly contagious childhood disease which occurs as a result of varicella-zoster virus primary infection. Symptomatic therapy is usually adequate for chickenpox, but in some cases it requires combinations of antiviral drugs and antibiotics. OBJECTIVES To present our expirience with chickenpox therapy in children and adult patients. MATERIAL AND METHODS Study included 120 randomly chosen patients, 60 adults and 60 children, with confirmed chickenpox infection, hospitalised at Clinic for infectious diseases in Sarajevo. Observed period was 1st January 2005. to 30th June 2011. We compared used therapy and outcome of disease. RESULTS We had 333 patients with confirmed chickenpox in mentioned period. Male sex prevailed. Antiviral (acyclovir) therapy was initiated in 8(13.5%) adults and 16(27%) children. Most frequently used antibiotic was Co-Amoxiclav in a group of adults and Ceftriaxone in a group of children. DISCUSSION AND CONCLUSION We use different terapeutical approaches to chickenpox according to the severity of the clinical picture and the existence of underlying diseases. Symptomatic treatment is indicated in all immunocompetent patients with no signs of complications. Use of corticosteroids remains open dillemma. Our therapeutical approcach followed by actual guidelines proved to be usefull. No death cases were recorded in these

INTRODUCTION Cellulitis is acute skin infection and/or infection of subcutaneous tissue, mostly caused by Streptococcus pyogenes and Staphylococcus aureus. Clinical preview is usually obvious and enough for diagnosis. Tretment is antimicrobial therapy. In recurrent cases a prophylaxis is very often needed. OBJECTIVES Analysis some of the epidemiological and clinical characteristics of cellulitis. PATIENTS AND METHODS Retrospective analysis of medical documentation of patients with clinical preview of cellulitis who were hospitalized in Clinic for infective diseases of Clinical Center of University of Sarajevo in last three years. RESULTS In period of three years 123 patients were hospitalized with clinical preview of cellulitis in the broadest sense of the word. In 123 of cellulitises, 35/123 (28.45%) were erisipelases-superficial type and 88/123 (71,55%) were deep cellulitises. Men were more affected 56,09%, average of age was 50.22 years. Before hospitalization patients had ambulance treatment in average of 5.12 days, and hospitalization was long in average of 13.33 days. Risk factors wich contributes to the disease were found in 71.54% of cases. Due to localisation, skin disorders on lower limb were the most frequent 71.56%, cellulitis of upper limb were found in 12.19%, head and/or neck in 13.08%, trunk in 3.25%. Repetition of disease were found in 4.8% in patients wtih risk factors. Bacteremic isolats were confirmed in 27.64% of cases. In all patients empirical antibiotic treatment were started, in the 62.60% the first choice of medicine was antibiotic from the group of lincosamides. CONCLUSION Cellulitis is very serious disease that can be prevented.

SUMMARY CONFLICT OF INTEREST: none declared. Introduction Chickenpox is disease caused by varicella-zoster virus (VZV), with possibly devastated consequences during pregnancy, for mother and neonate. Pneumonia is most common complication in pregnancy with very high mortality. Case report A 39-year-old female in third trimester twin pregnancy, referred to Clinic for infectious diseases in Sarajevo, with five days history of illness. Before the admission her condition get worse, with fatigue, exhaustion, and shortness of breath. In a first three days patient was febrile, tachydispnoic and ortopnoic. We started therapy with acyclovir and antibiotic. After four days we had detoriation in patient’s condition. Chest X-ray revealed infiltrative shadows in basal parts of lung. Antimicrobial therapy was changed and corticosteroids were associated. Significant improvement was noticed after five days of therapy. Conclusion Varicella pneumonia during third trimester may have serious consequences for mother and child, with possible fatal outcome.

SUMMARY CONFLICT OF INTEREST: none declared. Introduction Varicella or chickenpox is highly contagious, childhood infectious disease caused by primary infection with varicella – zoster virus from the herpes family of viruses. Usually it has a mild clinical course, rarely with described complication, mostly affecting respiratory tract and rarely the central nervous system. Case report The case present 8 year old boy hospitalized eighth day of disease with clinical pictures of varicella complication. Upon receipt tachydyspnea, high fever, tachycardia, hypotensive with positive findings on lung auscultation in the sense of pneumonia. Extremely high values of non-specific inflammatory parameters are implied on bacterial infection which is treated using triple antimicrobial therapy and antiviral. A detailed clinical, laboratory and radiological evaluation is determined of clinical disease complication under a picture of MODS that required prolonged multidisciplinary treatment in ICU. Conclusion The disease had a favorable clinical outcome in terms of training completely without consequences but, with the detected congenital absence lower lobe of right lung and transposition of the brachiocephalic trunk.

SUMMARY CONFLICT OF INTEREST: none declared. Introduction Staphylococcal bacteremia/sepsis is one of the most serious bacterial infections around the world. In individuals with pre-existing diseases, there is always an increased risk of infections occurring due to impaired immune system, a variety of drug therapy, exposure to a diagnostic and therapeutic procedure and frequent hospitalizations. Objectives To analyze the prevalence of comorbidity in a patient with the staphylococcal bacteremia/sepsis according to the diagnosis, the site of infection and according to the isolated agent. Patients and methods We analyzed the patients affected by the staphylococcal bacteremia/sepsis and treated in the Clinic for Infectious Diseases during a ten-year period. Results 87 patients were included, out of whom 20 (23%) with clinical signs of the bacteremia and 67 (77%) of sepsis. In the analyzed sample, in 36 (41.4%) were not registered comorbidity. Hospital infections are represented by the previous antibiotic, corticosteroid and chemo therapy, pressure ulcers, and different implants. In all comorbidity, the most common isolated bacteria was S. aureus primarily strain MSSA followed by MRSA strain which is more frequent in patients who were surgically treated (comorbidity–various implants). Conclusion The results suggest the importance of being mindful of the staphylococcal etiology of the bacteremia/sepsis in patients with comorbidities due to the selection of an adequate initial empirical therapy and reducing the risks of the septic shock.

INTRODUCTION Staphylococcal sepsis is one of the most serious bacterial infections in the world, in most cases accompanied by metastatic foci in various organ systems. OBJECTIVE analyze the metastatic foci patients suffering from staphylococcal sepsis. PATIENTS AND METHODS we analyzed the patients treated for staphylococcal sepsis during the ten year period. RESULTS 67 patients were included, of which 45 (67,2%) with the outpatient acquired infection and 22 (32.8%) hospital acquired. Male was present in higher percentage 58.2% and the average age of patients was 39 years. Meticillin-sensitive strains are present in 73.1% and resistant isolates in 26.9%. Chi square test of independence showed a dependence isolated pathogens in relation to the place of infection p = 0,003. From the total number of metastatic foci, 39 was in the lung, 32 in the skin and subcutaneous tissue, 24 in the abdomen, 15 in the bones and joints, 11 heart and brain 2. CONCLUSION The greatest number of metastases was in the lung. Significantly large number of patients had outpatient infection with predominance of meticillin sensitive strains while in hospital infections in a greater percentage were meticillin rezistent strains. Proven dependence of isolated pathogens in relation to the place of infection (outpatient/hospital).

INTRODUCTION Swine influenza is respiratory infection caused by virus influenza A H1N1. OBJECTIVE To show epidemiological and clinical characteristic of patients with confirmed influenza A H1N1 hospitalized at Clinic for Infectious Diseases of University Clinical Center Sarajevo. MATERIAL AND METHODS We analyzed 127 medical records of patients with microbiologically confirmed pandemic influenza A/H1N1 (nasopharyngeal swab analyzed by PCR method). RESULTS In our investigation female patients prevail (57%), age from 25 to 45 years old with medium difficult clinical picture (71.55%). Chi-square test showed significant dependence between sex and clinical status of patient (p < 0.05), dyspnea and clinical status of patient (p < 0.05), while statistical significance was nor proved related to comorbidity (p > 0.05), cough (p > 0.05), radiological confirmed pneumonia (p > 0.05), number of prehospital days of diseases (p > 0.05) and length of hospital care (p > 0.05). Significant impact on clinical status of patients is found related to age (p < 0.05), in a way that every year of age increase risk in 2.9% for more severe disease. CONCLUSION Clinical and epidemiological parameters can impute severity of clinical status and therefore the outcome of disease.