Introduction: Clostridium difficile (C. difficile) is currently the leading cause of healthcare-associated diarrhea, but almost nothing is known about the extent of C. difficile infection (CDI) in Bosnia and Herzegovina. Goal: We aimed to retrospectively analyze CDI in hospitalized patients at University Clinical Center (UCC) Tuzla, Bosnia and Herzegovina from January 2009 through June 2012. Methods: We analyzed all patients (except children ages 0-2), diagnosed with CDI based on anamnestic and epidemiological, clinical picture and microbiological tests (proof of toxins in the stool by enzyme-linked immunosorbent assay). Results: From a total of 989 patients tested for C. difficile toxin (60.2 per 10,000 inpatient days) 347 (35.08%) were positives. The mean incidence rate of CDI was 2.23 per 10,000 inpatient days (range 1.32-2.87). Annual rates of hospitalization were 15.68 per 10,000 admissions (range 8.99-20.35). Most patients had a previously identified risk profile of old age, comorbidity and recent use of antibiotics. 41/276 (14.86%) patients had died, and 11/41 (26.82%) were CDI-associated deaths. Complicated CDI were registered in 53/276 (19.21%) patients, and recurrent infections in 65/276 (23.55%). Conclusion: Our data suggest that CDI is largely present in our setting which represents a serious problem and points to the importance of international surveillance, detection and control of CDI.

INTRODUCTION Bacterial meningitis is one of the most serious infectious diseases in childhood. AIM To identify the most common causes of bacterial meningitis in children in Tuzla Canton. PATIENTS AND METHODS This is a retrospective study which included 140 children, aged from 1 month to 14 years, treated at the Clinic for Infectious Diseases Tuzla, in the period 1999-2009, who had clinical and laboratory parameters of bacterial meningitis. RESULTS In Tuzla Canton in ten year period were registered 140 cases of bacterial meningitis in children aged 1 month to 14 years. Prevalence was 1.53/1000. The average age of patients was 3.6 +/- 3.8 years. Male to female ratio was 1.3:1. April, May and November were the months with the most reported cases of bacterial meningitis (p = 0.02). Most affected were children 1-12 months of age (p < 0.001). The most common pathogens of bacterial meningitis were Haemophilus influenzae (13.6%), Neisseria meningitides (8.6%) and Streptococcus pneumoniae (5.7%) (p < 0.001). Mortality was 2.14%. CONCLUSION Bacterial meningitis is present in Tuzla Canton, and three major pathogens are Haemophilus influenzae, Neisseria meningitis and Streptococcus pneumoniae. The most affected were children 1-12 months of age, and most cases of bacterial meningitis occurred in spring.

INTRODUCTION The prevalence of human brucellosis in Bosnia and Herzegovina and the Tuzla Canton reached its peak in 2008, with a reported total of 994 cases within country, and with 104 cases within the Tuzla Canton. AIM to analyze the clinical and epidemiological features of human brucellosis in patients hospitalized at the University Clinical Center Tuzla during the period from 01/01/2000 till the 31/12/2010. METHODS We retrospectively analyzed the clinical symptoms, the laboratory and X-ray findings, the treatments, and the course and outcome of the disease. The diagnosis of brucellosis was based on anamnesis, clinical presentation, in correlation with a positive blood-culture, and/or serological tests. RESULTS The majority of patients (93.18%) were from rural regions. There were more males (79.54%) than females. Most of the patients were aged between 30 to 39 years (21% cases). Contact with infected animals was registered for 83.40% of the patients. The main symptoms and signs were fever, joint-pains, night sweating, anorexia, headaches, and hepatosplenomegaly. The important laboratory findings were increased erythrocyte sedimentation rates, increased values of C-reactive protein, and anemia. Adult patients were treated with a combination of gentamicin or streptomycin with doxycycline, and the children with a combination of gentamicin, and trimethoprim-sulfametaxasol, over at least 6 weeks. Complications were documented in 20.45% of the patients. Relapses were observed in 14.20%, and a chronic form of brucellosis in 5.11% of patients. There were no cases with lethal outcomes. CONCLUSION Brucellosis is a growing public health problem, not only within the Tuzla Canton, but throughout Bosnia and Herzegovina.

Objective – Research was undertaken with the aim of analyzing the frequency of causes of bacterial meningitis (BM) in children before and after introduction of the conjugate vaccine against Haemophilus influenzae type b (Hib vaccine), and to analyze the age of patients and disease outcome.  Materials and methods – Data from the medical records of patients, age 1 month to 14 years, who were treated for BM at the Infectious Diseases Clinic Tuzla, in the period from 01.05.1999 to 30.06.2009 were analyzed as a retrospective cohort study. In relation to the introduction of the Hib vaccine the patients were divided into prevaccinal and postvaccinal periods.  Results – 140 children were treated for BM. The most common pathogens were Haemophilus influenzae (13.6%), Neisseria meningitidis (8.6%) and Streptococcus pneumoniae (5.7%). In the prevaccinal period there were 94 and in the postvaccinal 46 children (13 of them had been vaccinated). The number of BM cases decreased from 17.1 (prevaccinal period) to 10.2 (postvaccinal period) per year. The number of children hospitalized with BM caused by Neisseria meningitidis significantly decreased in the postvaccinal period (Fisher’ exact test, p=0.009), and Streptococcus pneumoniae was the most common cause of BM in the postvaccinal period (Fisher’ exact test, p=0.015). The frequency of Haemophilus influenzae as a cause of BM also significantly decreased in the postvaccinal period (Fisher’ exact test, p=0.034). Eleven children were under one year, and eight children were from one to five years of age. Three children died.  Conclusion – The most common causes of BM in children aged 1 month to 14 years were Haemophilus influenzae, Neisseria meningitidis and Streptococcus pneumoniae. After the introduction of Hib vaccine the number of BM cases caused by Haemophilus influenzae and the total number of BM cases was reduced.