Tuberculous meningitis (TBM) is a severe consequence of Mycobacterium tuberculosis infection. Early clinical manifestations are often non-specific. In this case study, we showed tuberculous meningitis with tuberculous granulomas in a female patient during and after pregnancy, with all diagnostic and therapeutic dilemmas we had during her treatment. The patient was treated for 18 months. Our diagnostic findings showed extended pleocytosis and high protein level in cerebrospinal fluid (CSF), development of tuberculous granulomas in brain with relatively low inflammation parameters. Since it has been only a several days from the onset of the first symptoms to the beginning of treatment, the first signs of recovery showed very soon, despite development of the tuberculous granulomas. In the first 12 months tuberculostatic (TS) treatment was continuous, but after that period, treatment was intermittent for the next 6 months. After the treatment, a patient’s clinical and neurological status was normal as well as CSF analysis and neuroradiological findings. Olja Čuković1 Antonija Verhaz1 Tatjana Roganović1 Irena Katan1 Zorislava Bajić2 1 Klinika za infektivne bolesti UKC RS Banja Luka, BiH 2 Medicinski fakultet Univerziteta u Banja Luci, BiH Prikaz bolesnika/Case report Adresa za dopisivanje: Olja Čuković e-mail: olja.cukovic@kc-bl.com Ključne riječi: tuberkuloza tuberkulozni meningitis tuberkulozni granulom

INTRODUCTION Experience with lamivudine treatment for acute severe hepatitis B is limited. Fulminant hepatitis develops in 1% of immunocompetent patients with acute hepatitis B. OBJECTIVE The aim of this study was to evaluate the efficacy of lamivudine in the treatment of severe acute hepatitis B (SAHB) in immunocompetent adult patients. METHODS Between January 2006 and May 2013 at the Clinic for Infectious Diseases Banja Luka, 13 patients with SAHB were treated with lamivudine at a dose of 100 mg per day. All 13 patients fulfilled at least two of three default criteria: 1. hepatic encephalopathy; 2. total bilirubin greater than 210 μmol/L; and 3. severe coagulopathy (international normalized ratio--INR ≥1.5 or prothrombin time--PT <40%). The criteria were defined according to the experiences reported in the study of Schmilovitz-Weiss et al. "Lamivudine treatment for severe acute hepatitis B". Nine patients had a rapid rise in the total bilirubin and decrease of alanine aminotransferase level, which escalated risk for development of fulminant hepatitis. RESULTS Within 1-6 months, HBsAg was undetectable in 12 of 13 examined patients. Protective anti-HBsAg developed in 10 of them during 2-14 months. Two patients did not develop protective antibodies, but the result of the analysis of PCR HBV DNA was repeatedly negative. Corticosteroids were shortly used in two patients. One patient died four days after starting the therapy. Lamivudine treatment was well tolerated by all patients. CONCLUSION Early treatment with lamivudine can reduce the risk of progression to fulminant hepatitis in patients with SAHB.

INTRODUCTION Catheter-associated urinary tract infections (CAUTI) are the most common nosocomial infections. The worldwide data show the increasing resistance to conventional antibiotics among urinary tract pathogens. AIM To evaluate the adequacy of initial antimicrobial therapy in relation to the antimicrobial resistance of pathogens responsible for CAUTI in Clinical Center of Banja Luka. METHODS A retrospective study on major causes of CAUTI, antibiotic resistance and treatment principles was conducted at four departments of the Clinical Center of Banja Luka from January 1st, 2000 to April 1st, 2003. RESULTS The results showed that 265 patients had developed CAUTI. The seven most commonly isolated microorganisms were, in descending order: E. coil (31.0%), Pseudomonas aeruginosa (13.8%), Proteus mirabilis (12.9%), Gr. Klebsiella-Enterobacter (12.3%), Enterococcus spp. (5.2%), Pseudomonas spp. (4.3%), Serratia spp. (4.0%). The most common pathogens were highly resistant to ampicillin (64-100%), gentamycin (63-100%), and trimethoprim-sulfamethoxazole (68-100%), while some bacterias, like Pseudomonas aeruginosa and Serratia spp. showed rates of ciprofloxacin resistance as high as 42.8% and 72.7%, respectively. In 55.5% of the cases, the initial antibiotic therapy was inadequate, and was corrected latter on. There were no standard therapeutic protocols for this type of nosocomial infections. CONCLUSION The results of this study emphasized an urgency of the prevention and introduction of clinical protocols for better management of CAUTI. Treatment principles should better correspond to the antibiotic sensitivity of uropathogens.