Background Data on the epidemiology of hepatitis B and C in Bosnia and Herzegovina (B&H) are lacking. Objectives To assess the prevalence of hepatitis B surface antigen (HBsAg) and anti-hepatitis C virus (anti-HCV) in blood samples of first time blood donors in a well-defined region of B&H. Our secondary goal was to estimate the prevalence of HBsAg and anti-HCV in the general population of the same region. Patients and Methods We evaluated 8196 blood samples for the presence of HBsAg and/or anti-HCV, adjusted for differences in gender, and used the ratio estimation method to determine the prevalence in the general population. Results We analyzed 1263 (15.4%) female and 6933 (84.6%) male blood donors (male-to-female ratio: 5.49 to 1). The adjusted prevalence of HBsAg among blood donors was 0.787% (95% CI = 0.535-1.038), while the prevalence of anti-HCV was 0.267% (95% CI = 0.016-0.519). There was no difference in the prevalence of HBsAg or anti-HCV between men and women. We estimate that the prevalence of HBsAg and anti-HCV in the general population is 1.057% to 1.535% and 0.29% to 0.89%, respectively. Conclusions The prevalence of HBsAg and anti-HCV among blood donors suggests that our region has low endemicity for both hepatitis B and hepatitis C.

Background Data on the epidemiology of hepatitis B and C in Bosnia and Herzegovina (B&H) are lacking. Objectives To assess the prevalence of hepatitis B surface antigen (HBsAg) and anti-hepatitis C virus (anti-HCV) in blood samples of first time blood donors in a well-defined region of B&H. Our secondary goal was to estimate the prevalence of HBsAg and anti-HCV in the general population of the same region. Patients and Methods We evaluated 8196 blood samples for the presence of HBsAg and/or anti-HCV, adjusted for differences in gender, and used the ratio estimation method to determine the prevalence in the general population. Results We analyzed 1263 (15.4%) female and 6933 (84.6%) male blood donors (male-to-female ratio: 5.49 to 1). The adjusted prevalence of HBsAg among blood donors was 0.787% (95% CI = 0.535-1.038), while the prevalence of anti-HCV was 0.267% (95% CI = 0.016-0.519). There was no difference in the prevalence of HBsAg or anti-HCV between men and women. We estimate that the prevalence of HBsAg and anti-HCV in the general population is 1.057% to 1.535% and 0.29% to 0.89%, respectively. Conclusions The prevalence of HBsAg and anti-HCV among blood donors suggests that our region has low endemicity for both hepatitis B and hepatitis C.

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.

INTRODUCTION Intrahospital infections in surgical wards pose a significant problem, particularly in patients with impaired natural defense potential. They significantly complicate and increase the cost of basic treatment of the patient and sometimes leave permanent damage. Active control of their appearance is of paramount importance in their prevention. GOAL By this study we try to determine the frequency of individual agents, their anatomical and gender distribution at the Clinic of Surgery, University Clinical Centre Tuzla in 2005.v. RESULTS Our study showed that gram negative bacteria were more common trigger of IHI (76.37%), and especially the urinary and respiratory tract and surgical wounds infections. We also showed that men from older age groups are more likely to have IHI. CONCLUSION Active surveillance and tracing for agents, especially in high-risk groups of patients is the best method of prevention of IHI occurrence.

Urinary tract infections (UTI) cause a great number of morbidity and mortality. These infections are serious complications in pregnancy, patients with diabetes, polycystic kidneys disease, sickle cell anaemia, kidney transplant and in patients with functional or structural anomalies of the urinary tract. The aim of this investigation was to determine a dominant causative agents of UTI and some of the clinical and laboratory characteristics of acute community-acquired UTI in adult hospitalised patients. We studied 200 adult patients with acute community-acquired UTI hospitalised in the Clinic for Infectious Diseases Tuzla from January 2006 to December 2007. The patients were divided into two groups: a group of patients with E. coli UTI (147) and a group of patients with non-E. coli UTI (53). In these two groups, the symptoms and signs of illness, blood test and urine analysis results were analysed. Our results have shown that the patients with E. coli UTI frequently had fever higher than 38,5 degrees C (p<0,0001), chills (p=0,0349), headache (p=0,0499), cloudy urine (p<0,0001), proteinuria (p=0,0011) and positive nitrite-test (p=0,0002). The patients with non-E. coli UTI frequently had fever lower than 38,5 degrees C (p<0,0001) and urine specific gravity <1015 (p=0,0012). There was no significant difference in blood test results between patients with E. coli and non-E. coli UTI. These clinical and laboratory findings can lead us to early etiological diagnosis of these UTI before urine culture detection of causative agents, which takes several days. Early etiological diagnosis of the E. coli and non-E. coli UTI is necessary for an urgent administration of appropriate empirical antibiotic treatment. This is very important in prevention of irreversible kidney damage, prolonged treatment, complications, as well as recidives and chronicity of the illness.

Prevalence of hepatitis C virus (HCV) genotypes in Bosnia and Herzegovina (B&H) is an issue that is not sufficiently researched and there is a need for studies that would explore this in detail.The aim of this study was to determine the distribution of HCV genotypes in the group of patients with chronic hepatitis C and also in the group of first time blood donors that tested positive for anti HCV antibodies during the blood screening process. Our secondary goal was to compare the proportions of HCV genotypes between these two groups.We analyzed 75 blood samples of patients with confirmed chronic hepatitis C. We also analyzed 13/16082 blood samples of first time blood donors found to be HCV positive during the blood screening process. We also determined HCV genotype in HCV RNA positive samples.We have found that genotype 1b was more prevalent in chronic hepatitis C patients (52/75; 69,3%) than in first time blood donors (6/13; 46,1%), however this difference was not statistically significant (c2=1,721; df=1; p=0,19). Genotype 1a was more prevalent in the group of first time blood donors (3/13; 23,1%) than in the group of chronic hepatitis C patients (3/75; 4%), but this was also with limited statistical significance (c2=3,71; df=1; p=0,054). We have not found any significant difference in prevalence of genotypes 1a (p=0,2) and genotypes 3 (p=0,70) when compared between chronic patients (3/75 and 16/75; respectively) and first time blood donors (3/13 and 4/13; respectively). Our study confirmed domination of genotype 1b in the region of northeastern B&H which is in accordance with HCV genotype prevalence in other countries in our part of Europe.

Background: Accurate estimations of hepatitis B virus transmission risk for any region in Bosnia and Herzegovina are not clearly established. We aimed to determine levels of risk associated with intrafamilial transmission of hepatitis B infection within families in our region. Patients and Methods: Family members of 81 chronic carriers of hepatitis B surface antigen (>6 months positive and considered as index case) were tested for hepatitis B markers. For family members, we recorded their age, sex, and family relationship to the index case, and vaccination status. Results: The proportion of HBsAg positive family members was 25/207 (12.1%), while the proportion of family members with evidence of exposure to HBV was 80/207 (38.6%). Only 17/207 (8.2%) family members had evi--dence of past HBV vaccination. Age was found to be a significant predictor of HBV exposure of family members (odds ratio 1.05, 95% CI 1.03-1.07, P< .001). In a multivariate analysis, HBsAg positivity was associated with a female index case (odds ratio 11.31, 95% CI 3.73-34.32, P< .001), HBeAg positivity in the index case (odds ratio 5.56, 95% CI 1.80-17.23, P< .005) and being a mother of the index case (odds ratio 9.82, 95% CI 2.43-39.68,P< .005). A female index case (odds ratio 4.87, 95% CI 2.21-10.72, P< .001), HBeAg positivity in the index case (odds ratio 3.22, 95% CI 1.15-9.00, P< .05) and being a mother of the index case (odds ratio 3.72, 95% CI 1.19-11.64, P< .05) were also risk factors for HBV exposure among family members. The combination of HBeAg positivity and female index case was a significant predictor for HBsAg positivity of family members (odds ratio 70.39, 95% CI 8.20-604.61, P< .001). Conclusions: Children of HBeAg positive mothers are at highest risk for becoming chronic carriers them--selves and generally, the combination of female sex and HBeAg positivity dramatically increases the chances of HBV transmission within the family.

INTRODUCTION Etiological factors of community-acquired urinary tract infections (UTI) are specific for age, gender, season, complication of UTI and type of UTI. Their prevalence and susceptibility to antimicrobial agents shows geographic and time variability. PURPOSE To evaluate etiological characteristics of acute community-acquired UTI in hospitalised patients. PATIENTS AND METHODS This retrospective-prospective study included 200 adult patients with community-acquired UTI who were, in view of the serious clinical picture and unsuccessful ambulatory treatment, hospitalised in the Clinic for Infectious Diseases in Tuzla, for a period of two years (2006 and 2007). The data concerning the age, gender, season, complication of UTI and type of UTI were collected from the patient's records. Urine analysis was done following standard microbiological methods, and the antibiogram was done following standard disc-diffusion method on the Mueller-Hinton agar. WORK RESULTS The dominant etiological factors of UTI were: E. coli (73.5%), Klebsiella spp. (8.5%), Proteus mirabilis (5.5%), Pseudomonas aeruginosa (4.5%) and Enterococcus faecalis (3%). The predominant etiological factor of this UTI was E. coli (P < 0.0001). E. coli was significantly more frequent etiological factor of UTI in females (P < 0.0001). There was no significant difference in the frequency between etiological factors of UTI for different age groups of patients (P = 0.173), or for different seasons (P > 0.05). All etiological factors are significantly more frequent during warmer periods of the year (P < 0.05). E. coli is a significantly more frequent etiological factor in complicated and non-complicated pyelonephrytis and cystourethritis (P < 0.05), but there was no significant difference of frequency between etiological factors of prostatitis (P = 0.7163). By analyzing the susceptibility for antimicrobials, we found that E. coli has good susceptibility for Cephalosporins of the third generation, for Gentamycin, Nitrofurantoin, Norfloxacin, Ciprofloxacin and Pipemidin acid (susceptibility higher than 88.7%), Klebsiella spp. for Imipenem and Meropenem (susceptibility 100%), Proteus mirabilis for Imipenem (susceptibility 100%) and relatively for Amikacin (susceptibility 81.8%), Pseudomonas aeruginosa for Imipenem (susceptibility 100%) and for Meropenem (susceptibility 87.5%) and Enterococcus faecalis for Vancomycin (susceptibility 100%) and relatively for Ampicillin, Amoxicillin, Ciprofloxacin, Doxicyclin and Nitrofurantoin (susceptibility 83.4%). CONCLUSION Etiological characteristics of UTI are specific for different regions. Evaluation of these characteristics in our region is the basis for empirical antimicrobial therapy of UTI, which is necessary for a timely and successful treatment of UTI.

Retrospektivno su analizirane klini~ke i epidemiolo{ke karakteristike bruceloze u 91 bolesnika koji su bili hospitalizirani u Klinici za infektivne bolesti u Tuzli od 1.1.2000. godine do 1.8.2008. godine. Definitivna dijagnoza bruceloze postavljena je na temelju pozitivnih rezultata hemokulture i/ili nekog od relevantnih serolo{kih testova (ELISA test, ROSE-BENGAL aglutinacija). Ve}ina bolesnika bila je iz 5 op}ina Tuzlanskog kantona: @ivinice, Tuzla, Lukavac, Kalesija, i Srebrenik, ukupno (81,3 %) bolesnika. Najve}i broj bolesnika (93 %) bio je iz ruralne regije. Bilo je znatno vi{e mu{karaca (82,4 %). Ve}ina bolesnika bila je u dobi od 20 – 29 godina i 50 – 59 godina po 25,3 %. Najvi{e bolesnika bilo je hospitalizirano u proljetnim mjesecima, travnju 24,1% i svibnju 23,0 %. Kontakt s inficiranim `ivotinjama registriran je kod 82,4 % bolesnika. Vode}i simptomi i znaci bolesti bili su povi{ena temperatura, bolovi u zglobovima, op}a slabost, no}no znojenje, glavobolja, hepatosplenomegalija, a najva`niji patolo{ki laboratorijski nalazi ubrzana sedimentacija eritrocita i povi{ena vrijednost C-reaktivnog proteina. Bolesnici su lije~eni kombinacijom streptomicina ili gentamicina s doksiciklinom u odraslih, ili gentamicinom i trimetoprim-sulfametoksazolom u djece, u trajanju 6 tjedana. Komplikacije su dokumentirane u 23,0 % mu{karaca i 1,1 % `ena. Orchiepididimitis je utvr|en u 6,5 %, pneumonija 4,3 %, periferni artritis 4,3%, spondilitis 3,2 %, sakroileitis 2,1 %, epiduralni absces u 2,1 % i spondilodiscitis u 1 % bolesnika. Relaps je zabilje`en u 13,1 % bolesnika. Svi bolesnici su izlije~eni. Bruceloza je rastu}i javno-zdravstveni problem u Tuzlanskom kantonu, ali i {ire u Bosni i Hercegovini.

Objective To determine (i) the prevalence of HBV infection in families of confirmed chronic carriers, (ii) possible routes of transmission and risk factors for the intrafamilial transmission, (iii) vaccination rate among family members of chronic carriers and (iv) family members with highest risk for infection. Methods A total of 172 family members of 67 hepatitis B surface antigen chronic carriers were tested for hepatitis B markers; 716 first-time blood donors from the same area were used as controls. Results Prevalence of hepatitis B surface antigen was higher (P<0.001) among family members of index cases (12.2%; 21/172) than among controls (3.6%; 26/716) with relative risk of 3.3 (95% confidence Intervals=1.9–5.8; P<0.05). Rate of exposure among family members was 37.8% (65/172); only 8.7% (15/172) had been vaccinated for hepatitis B virus. Difference (P<0.001) in exposure existed among family members; exposure increased with age (ρs=0.34; P<0.001). Prevalences of hepatitis B surface antigen positivity and hepatitis B virus exposure were higher among parents of index cases (P<0.005) and among offspring of female index cases (P<0.001). There were more (P<0.001) hepatitis B surface antigen-positive family members among those with mother–children relationship with index case (13/31; 41.9%) than among those with father–children (19/85; 22.4%) and horizontal (siblings and spouses) relationship (2/56; 3.6%). Significantly more (P<0.001) hepatitis B surface antigen-positive and hepatitis B virus-exposed offspring were found in families where only mother was hepatitis B surface antigen positive. Among family members of HBeAg-positive cases more hepatitis B surface antigen-positive cases and hepatitis B virus-exposed cases have been found (P<0.001). Combination of HBeAg positivity and female sex of index case significantly increased risk for chronic carriage among family members (relative risk=24.06; 95% confidence interval=8.88–65.21; P<0.05). Conclusion In the area studied, both horizontal and vertical transmission exists, but maternal route is predominant. Female sex, HBeAg positivity of index carrier and presence of hepatitis B surface antigen-positive mother inside family increased risk for hepatitis B surface antigen positivity and exposure among family members. Vaccination rate of family members of index cases is alarmingly low.

Hepatitis C infection is important global health problem with wide spectrum of health, social and economic consequences. The goal of this research was to estimate prevalence of hepatitis C virus infection in risk groups, and to determine association hepatitis C virus (HCV) infection and risk factors. Research included 4627 subjects divided in two groups. Test group included 2627 subjects divided in 4 subgroups with risk for HCV infection: those who received blood transfusion without screening on HCV (it was introduced in 1995) (700); intravenous drug users (60); patients on hemodialysis (168) and health care workers (1699). Control group included 2000 healthy volunteer blood donors. In all subjects anti-HCV antibodies were tested with third generation ELISA test. Positive serum samples were tested for presence of HCVRNA, using reaction of reverse transcription and polymerase chain reaction. In all anti-HCV positive subjects further epidemiological and clinical workup was performed. Prevalence of HCV infection in risk groups was: 4.6% in subjects who have received blood transfusions without HCV blood screening, 35% in intravenous drug users, 58.9% in patients on chronic dialysis, and 0.4% in health care workers. In control group prevalence was low (0.2%). In the group of 158 anti-HCV positive subjects, 73.4% had HCVRNA. The largest number of subjects with HCV infection was in the age group of 30-49 years (45.8%). This study showed that multiple blood transfusions before introducing the blood screening for HCV, longer duration of intravenous drug abuse, longer duration of hemodialysis treatment, larger number of accidental injuries in health care workers are independent and statistically significant risk factors for those groups examined. Results of this study confirm that general screening for HCV infection is recommended in risk groups for HCV infection in order to identify to prevent and to treat it.

PURPOSE It is estimated that 10-20 % patients on hemodialysis therapy have hepatitis C virus infection with big geographic and individual variability in HCV prevalence between different hemodialysis centers. OBJECTIVES To determine prevalence of HCV infection among hemodialysis patients in Hemodialysis Unit of General Hospital Gracanica and to make epidemiological, clinical, biochemical and virusological analysis in anti-HCV positive patients. WORK METHODS: 58 patients that were hemodialyse during 2000 year in Hemodialysis Unit Gracanica were included in this study. All patients were tested on anti-HCV antibody and further planed analyses were done. WORK RESULTS Prevalence HCV infection in Dialysis Unit Gracanica was 46.5 %. The most number of HCV positive patients were in age of 40-49 years 40.7 % or (11/27 patients). The more often HCV positive patients were male 59.3 % or (16/27 patients). In group of anti-HCV positive patients, in 85 % (23/27) have detected HCV RNA. It means that 39.60 % patients in Hemodialysis Unit Gracanica have chronic HCV infection, but 6.80 % patients had past infection. Receiving of blood transfusion, as risk factor, for HCV infection were more often found in group anti HCV + patients (81.5 %) than in group anti-HCV negative patients (51.6 % patients). The length of dialysis therapy were longer in group anti HCV + patients and it was 6.8 years than in group of anti-HCV negative patients that was 1.6 years. HCV infection was not associated with significant biochemical parameters of liver lesion or with manifested clinical symptoms in the time of this study. CONCLUSION The observed Unit for Hemodialysis can be concerned as unit with high prevalence of HCV infection. It is courage fact that there was no new registered HCV seroconversion since beginning of work this unit until time of this study. Implementation of general and specific measures for prevention of HCV infection and introduction of regular control can decrease risks for HCV infection inside hemodialysis unit.

UNLABELLED Meningococcal disease is the most significant cause of morbidity and mortality even in the most developed socio-economic surroundings. Meningococcal sepsis and meningitis are caused by Neisseria meningitidis (NM), which is surrounded by polysaharide capsule, which is the main factor of virulence. THE GOAL OF THE WORK was to confirm the frequency and characteristics of meningococcal disease as well as the justification of introducing vaccination. Through retrospective analysis of the history of the disease, a total of 87 patients with meningococcal sepsis hospitalized at the hospital for infectious in Tuzla in the period 1995 to 2004. diseases were included. Out of 87 hospitalized patients, 34 patients (39%) had meningococcal sepsis, meningococcal sepsis and meningitis had 50 patients (57.6%), and only 3 patients (3.4%) had only meningitis. The diseases most frequently appears in males, 54 patients (62.0%), and in females, 33 patients (38.0%). The largest number of diseased is in the period 0-12 months, 39 patients (44.8%), and then in the period from 13-24 months, 19 diseased (21.8%), from 3-6 years of age 12 patients (13.8%), after sixth year of age meningococcal disease appears in a smaller percent. The youngest patient was 3 and a half months old, and the oldest was 23 years old. Diagnosis was established based on the history of the disease, clinical examination, lab researches, biochemical and bacteriological search of liquid. Etiological cause was proved through liquor culture in 24 cases (27.5%), hemoculture in two cases (2.29%). Death was the result in eight cases (9.1%), one patient (1.1%) resulted in the amputation of a finger, and the rest of 78 patient (89.6%) are cured without sequel. Patients are treated with the Penicillin G, Ampicillin, and in a case of the resistance, were treated with cephalospores of third generation. CONCLUSION the meningococcal disease, and especially its form of Waterhause-Friderichsen syndrome represents a hard disease which in 50% of cases has a death as the result.