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M. Aljičević, E. Beslagić, S. Zvizdić, S. Hamzić, Sabina Mahmutović

Listeria monocytogenes is a Gram-positive, weakly pathogenic bacterium able to grow also at the temperature of 40 degrees C. A man most often gets affected by consuming contaminated food and water. Animals can carry bacteria although they have not to appear ill, then their meat and milk products are the source of infection of human being. The disease most often attacks with the weak immune system, newborns and pregnant women. That what is significant, listeria penetrates through the placenta and can lead to the fatal infection, which is characteristic by disseminated granulomatosis lesions of a newborn and micro abscess on the placenta. In a newborn can provoke the sepsis with the mortality of 50%. By the examination are encircled two groups of the reproductive age-totally 60. From these 30 had one or more spontaneous abortion, and 30 had no spontaneous abortion. By the serologic reaction the agglutination is discovered the presence of the antibodies in serum of the. The positive serologic answer was found in the first group in 18 (60%) and in that another group in 8 participants (26, 70%).

S. Hamzić, E. Beslagić, S. Zvizdić, M. Aljičević, O. Beslagić, Sandra Puvacić

The study involved 286 individuals from different regions of Bosnia and Herzegovina, whose sera were tested in the Laboratory for specific diagnosis of human brucellosis in Microbiology Department of Medical Faculty of University in Sarajevo, during the period from 2000. to 2003. Sera were tested using Brucelloslide Test, qualitative agglutination test Rose Bengal. Using the agglutination test, we serologically confirmed a diagnosis of human brucellosis in 59 (20.62%) seropositive individuals, whereof 38 (64.40%) men and 21 (35.60%) women. Individuals with human brucellosis were the most present in the age group of 31-40 (22.03%) and 41-50 (22.03%). One serologically confirmed death case was registered. The most seropositive individuals were from Zenica-Doboj Canton (32.20%), Sarajevo Canton (28.82%), Herzegovina-Neretva Canton (23.73%), Central Bosnia Canton (13.55%) and Una-Sana Canton (1.70%). During our four-year study, it was serologically confirmed that human brucellosis is present in Bosnia and Herzegovina and, through seropositive testing, we revealed the level of general exposition to Brucella spp. on wider area of Bosnia and Herzegovina.

S. Zvizdić, E. Kapić, S. Hamzić

Respiratory, gastrointestinal and skin diseases represent the most common diseases in infants and young children. Causal factors of these diseases are important infectious agents and causes of pathological conditions in children, but they are also very important for their parents, as well as for people in their close environment. Greater incidence of infections in infants and young children can be explained in different ways. A cause can be insufficient maturity of their immune system, but also their exposure to infections within collective accommodations (cribs, nurseries, pre-school institutions), where they are, at the same time, exposed to a number of unknown agents. Today, a great emphasis is devoted to the ways and kinds of children's nutrition. The problem of relation between infected young organism and infectious agent itself, is also reflected in a long resistance and excretion of microorganisms in their exterior environment. It is well-known that microorganisms resist and excrete much longer in younger organisms, compared to adults, where their resistance and excretion is much shorter or very rare. Actually, adults have already formed protective immunity against particular infectious agents. It doesn't prevent infections in adults, colonization of pathogens, nor eventual development of disease. Established immunity can shorten the time necessary for excretion of microorganisms in their exterior environment and, if disease gets developed, it is of shorter duration and slower progress.

S. Hamzić, E. Beslagić, Sandra Puvacić, M. Aljičević

THE AIM OF WORK To evaluate the incidence of human Q-fever in individual regions of Bosnia and Herzegovina, to determine the prevalence and areas at risk of Q-fever incidence, to assess Q-fever seroprevalence and to demonstrate seroprevalence ratings in regard to relevant criteria (sex, age, location of residence). METHODS The research has involved 708 individuals from different cantons, whose sera were tested in Laboratory for Specific Diagnosis of Human Q-fever on the Microbiology Desk of Medical Faculty of University in Sarajevo, during the period from July 2000-December 2003. Sera were tested by Indirect Immunofluorescence Assay (IFA), using commercial test kit, reagents for Q-fever IFA IgM and IFA IgG for in vitro diagnostic use (Focus technologies). THE RESULTS Specific anti-C. burnetii antibodies were detected in 249 (35.2%) individuals, whereof 75 (30.12%) female individuals, and 174 (69.9%) male individuals. Individuals suffering from Q-fever were mostly included in 31-40 aged group (26.8%). Most seropositive individuals were from Zenica-Doboj Canton (35.4%), then from Herzegovinian-Neretvian Canton (22.9%), from Sarajevo Canton (14.5%), from Una-Sana Canton (11.6%), and from Middle-Bosnian Canton (11.6%). CONCLUSIONS In our four-year study, it is serologically demonstrated that Q-fever is imminent in Bosnia and Herzegovina and that it is going to be the actual concern of public health. The number and distribution of seropositive individuals suggest that Q-fever is endemic phenomenon in Bosnia and Herzegovina.

M. Aljičević, E. Beslagić, S. Zvizdić, S. Hamzić, Sabina Mahmutović

OBJECTIVE Listeria monocytogenes (LM) is gram-positive bacteria linear shaped which grows good also at refrigerator temperature (4 degrees C). The bacteria is resistant on high and low temperatures. This bacteria can be found in the dirt, rotted vegetation, vegetables and fruit, milk and dairy products, and also in the meat and processed meat. This bacteria cause disease called Listeriosis. This bacteria attacks at first people with weak immune system like infants, pregnant women, people with chronic diseases, people with HIV and people who are 60 and over. Pregnant women can transfer Listeria through the placenta, from mother to child and that can cause premature delivery, premature birth, early rupture of placenta or still born. GOAL Find out if there is serological respond by female patients in the reproductive age who had spontaneous abortion and female patients in the reproductive age who never had the spontaneous abortion. By agglutination serologic method it had been researched if there is any antibody on Listeria monocytogenes. RESULTS Two groups were included in testing: experimental and control group with a total of 60 patients. In experimental group there were 18 (60%) positive samples. In control group there were 8 (26.70%) positive samples. CONCLUSION The results investigations have shown that there is serological respond to Listeria monocytogenes in the women of reproductive age. The number of positive patients was greater in women who had spontaneous abortion compared to women who never had the spontaneous abortion.

S. Zvizdić, Ines Rodinis-Pejić, Fadila Avdić-Kamberović, AnesaJerkovic Mujkic, S. Hamzić, Sandra Puvacić, S. Tandir, M. Kudumovic

S. Zvizdić, S. Telalbasić, E. Beslagić, S. Čavaljuga, J. Maglajlic, A. Zvizdić, S. Hamzić

Rotaviruses are the major causes of viral gastroenteritis in infant and the young children. There are a wide spectrum of clinical signs and symptoms of rotavirosis. Rotavirus infection is fecal-oral infection. Rotaviruses prove with Latex agglutination test and electron microscopy. In a four year period 943 stool samples out of 527 hospitalized patients had been analyzed. A presence of rotavirus is proved with a LA and EM tests at 170 (32,2%) patients age 0-7 years, in their stool samples. Analyzing age groups of these patients, it was found that the rotaviruses infection the most frequently occurred at age group from 7-24 months. From 170 positive patients, 122 or 71,8% were in this age group. At all patients was found diarrhea, vomiting in a 90,5% cases. Mild fever had 65,5% patients, signs of a respiratory infection appeared at 60,7% patients, abdominal pain at 13,3% patients. Severe dehydration had 49,9% patients and metabolic acidosis had 79,2% cases. Macroscopically blood in stool had 6,4% patients, slime in a stool 46,0% patients was found, and aholic stool had 8,4% patients. In all hospitalized patients disease lasted in average 12,6 days, and the hospitalization in average 10,2 days. None of the patient had any kind of complication, all of them very successfully cured. These results confirm that rotaviruses are important health problem among infant and the young children in Bosnia and Herzegovina.

Sabina Mahmutović, E. Beslagić, S. Hamzić, M. Aljičević

Microscopic demonstration of chlamydial inclusions within cells offered the first laboratory procedure supporting the clinical diagnosis of chlamydial infection. Our aim is to evaluate the usefulness of different endocervical staining methods in diagnosis of Chlamydia trachomatis (CT) infection within exfoliated cells of the endocervix. The cytological test for the detection of chlamydial inclusions in genital tract infection, though not as sensitive and specific as isolation in the cell culture monolayers, is still of the diagnostic value. The present study discusses the collection of clinical smears for microscopic examination, their preparation; fixation and staining of slides by a variety of staining methods that have been used to detect Chlamydia in clinical smears and biopsies. Most of these methods such as Giemsa stain, Papanicolaou, iodine, and immunofluorescence (IF) using monoclonal antibodies, are based on the combination of dyes designed to obtain optimum differentiation of the various structures. The utilization of different endocervical smear stains together with the clinical information can be used to identify women at high risk for CT infection.

Abstract: Q fever is caused by C. burnetii, an intracellular obligate bacterium. For clinical confirmation of Q fever, diagnosis of interstitial pneumonia is of significance. The acute disease varies in severity from minor to fatal, with the possibility of serious complications. Chronic endocarditis is a well‐known outcome. Symptoms of Q fever can vary; fixing diagnosis is done by serology with the phase I and the phase II antibody. We tested 44 sera of 31 clinically suspect patients. From these, 22 patients were taken to the infection clinic, 8 to the pulmonary clinic, and one to the general hospital. From the 31 patients, 21 patients had one serum, 7 patients, 2 sera, and 3 patients, 3 sera. Blood samples were collected by vein puncture, and serum samples were kept at −20°C until testing. All sera were processed by indirect imunofluorescent assay (IFA) Q fever IgM and IgG. Of 44 processed sera, 21 were seropositive. Specific IgM antibody was found in sera of 6 patients (19.4%), and specific IgG antibody in sera of 16 patients (51.2%). In sera of 15 clinically suspect patients (48.3%), no specific anticoxiella antibody was found. From these results we can confirm the importance of serology in laboratory diagnosis and clinical affirmation of suspect Q fever. Indirect imunofluorescent assay (IFA) is reliable and appropriate for daily, routine diagnosis of human Q fever.

E. Beslagić, S. Hamzić, Sandra Puvacić, Semra Cavaljuga-Hotic

AIMS In recent year's percutaneous drainage has been used successfully to treat the hydatid cysts. We performed a controlled trial to present the successful appliance of this method in the treatment of abdominal and retroperitoneal hydatid diseases. METHODS In a prospective study, we have assigned 84 patients (51 women and 33 men, average age 45.7 +/- 16.7 with hydatidosis to treatment with percutaneous drainage. Of these, 72 patients had hepatic cysts, seven had renal hydatid cysts and five patients had hydatid cyst in the spleen. Albendasole (10 mg per kilogram of body weight per day for eight weeks) was administered to the patients. Serial assessments included clinical and biochemical examinations, ultrasonography and serologic tests of echinococcal-antibody titers. RESULTS The mean hospital stay was 5.8 (+/- 3.1) days. Over a mean follow-up period of 24 months, the mean cyst diameter decreased from 81.4 (+/- 32.6) mm to 11.8 (+/- 14.5) mm. After 24 months follow-up period 62 cysts (74 percent) disappeared. After an initial rise, the echinococcal-antibody titers fell progressively and at the last follow-up were negative (< 1:160) in 73 patients (87 percent). There were procedure related complications in 29 patients (four patients had abscessus, six hypotension, seven urticaria, ten fever and two strong abdominal pain in the first hour after intervention). CONCLUSIONS Percutaneous drainage, combined with albendasole therapy, is an effective and safe method for the treatment of the abdominal and retroperitoneal hydatid cysts and requires a shorter hospital stay then surgery treatment.

S. Hamzić, E. Beslagić, S. Zvizdić, Z. Puvacić, D. Cengić

AIM Results of the serologic confirmation of hemorrhagic fever with renal syndrome (HFRS) in patients with clinical picture and overt symptoms of the disease from particular areas in Bosnia and Herzegovina during 2002 are presented. METHODS A total of 146 sera from 100 clinically suspected patients were tested. The sera were tested for the presence of specific IgM antibodies to Hantaan and Puumala antigens by Elisa IgM "capture" test, and for the presence of specific antibodies to Hantaan, Puumala and Dobrava antigens by Elisa IgG test. DISCUSSION Most of the positive IgM reactions were recorded as cross reactions to Hantaan and Puumala antigens, and most of the positive IgG reactions as cross reactions to Hantaan and Dobrava antigens. The finding of antibodies in the sera of patients from Europe that react with Hantaan antigen are not associated with the infection with Hantaan, but with the infection with viruses that are genetically related with Hantaan. To date, HFRS caused by Puumala and Dobrava viruses has been verified in Bosnia and Herzegovina. CONCLUSION Using Elisa IgM "capture" test, acute hantavirus infection was serologically confirmed in 38% of clinically suspected patients with manifested symptoms from different areas of Bosnia and Herzegovina in 2002. The distribution of human hantavirus infection in Bosnia and Herzegovina was confirmed by the presence of specific hantavirus antibodies in patient sera.

E. Beslagić, S. Hamzić, Sandra Puvacić, Semra Cavaljuga-Hotic

Q-fever is widely spread antropoozosis caused by Coxiellae burnetti, an intracellular compulsory microbe parasite. Two characteristics of Coxiellae burnetti are of crucial importance for appearance of Q-fever, especially in the circumstances when the cause of infection remains unclear. The first one is a high resistance of Coxiellae burnetti to environment changes and the second one is a small size of the infectious dose. The clinical manifestations of Q-fever can vary, so the making of diagnosis is still based on serology, with Phase I and Phase II antibodies and the difference between the acute and the chronic form of the disease. Serologic diagnostics presents the method of choice with Q-fever (IFT) in serums of patients with clinical suspicion to Coxiellae burnetti infection. We have tested the serums of patients from Canton of Sarajevo which were coming to our laboratory from January 2001-December 2001. Out of 58 processed serums the specific IgM antibodies were found in 10 serums and specific IgG antibodies in 27 serums.

E. Beslagić, S. Hamzić, S. Zvizdić, T. Bajrović, R. Velić

Q-Fever nowadays presents the most diffuse disease in the world, caused by the microorganisms from the family Risckettiacae. This disease is Coxiellae burnetii. The laboratory diagnosis of the Q-Fever can be stated either by the isolation of the causer from the patient material, either by the proving of the specifically antibodies. The serologic diagnostics presents the choile method in Q-Fever. The aim of this work is to illustrate the results of the detection of the serum in patients with the clinical symptoms at the infeçtion Coxiellom burnetii. We tested the sera of the patient from the region of the Federation Bosnia and Herzegovina, which arrived in our laboratory in the period of November 2000 till May 2001. From the total 174 prepared sera specific IgM of the antibodies we found in cases, and the specific IgG of the antibodies in 54 sera.

S. Zvizdić, T. Bajrović, E. Beslagić, Sandra Puvacić, R. Velić, Jasminka Maglajlia, S. Hamzić, E. Kapić et al.

Q-Fever is a worldwide zoonosis caused by Coxiella burnetti. C. burnetti is an obligate intracellular parasite. It lives in phagolysosome of the host cell. By its infection of the sensitive persons develops the acute noncharacteristic disease, which passes noncharacteristically, with the appearance of higher temperature, headache, fever, weakness of the organism or by the appearance of symptoms of the undifferentiated infection of the upper parties of the respiratory system. In the course of the infection is being developed the intersticial pneumonia, what is the reason of the infected hospitalization. Most often get sick the sheep, cows and goats, what showed also on our examined sample. In most animals the symptoms of this bacterial infection are not present, pass unobviously, and get turned out during their gravidity. The most important carriers of the causes of this disease on the domestic or wild animals are artropodes, in which within the kind is possible also the transvatial and transstadial transfer. The wild animals transfer the disease at the domestic ones, and people most often are infected by contact with these animals, their consuming of meat or milk or by contact with their secretions. Though, the most important way of getting infected of people is aerosol contaminated by the carrier as these bacteria for a long get kept in the contaminated dust, wool, animal skin, fur, straw and the excretions of the infected animals. In the illusorilly healthy and pregnant animals the bacteria are to be found in the fertile water, chorions, and placenta, that is C. burnetti becomes the cause of the premature birth or abortion in these animals. In this way comes to the bacterial contamination of the environment of the animal itself. The diagnosis of Q.-Fever is complement fixation test, indirect immunofluorescence assay (IFT) and enzyme immunoassay (EIA).

E. Beslagić, D. Cengić, R. Beslagic, S. Hamzić

OBJECTIVES After four years of Sarajevo siege, the deblocade started on July 1995. Many soldiers involved in the deblocade developed a clinical symptoms of hemorrhagic fever indicating a possible epidemic. METHODS Suspected patients were treated in the war hospital Igman-Fojnica. Blood samples of all the patients were processed on IgM and IgG antibodies with ELISA test, using "the double sandwich" technique. RESULTS IgM and IgG were performed on Puumala (PVV), Hantaan (HTN) and Dobrava antigens. 38 out of 45 treated serums had high antibody titres. Sera of 28 patients had high titres of specific IgM antibodies on Hantaan antigen (12,800). A ten patients had a same titre level for specific antibodies of Puumala antigen. A 20 patients had specific IgG antibodies on Dobrava antigen with the titre 400. Our results confirmed the epidemic for which were responsible two serotypes of HFRS-PVV and HTN. They also proved the existence of a new serotypes appearing for the first time in Sarajevo region. This epidemic confirms that BiH especially Sarajevo region are among the biggest epidemic areas of HFRS in Europa.

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