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).

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.

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 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.

INTRODUCTION Osteoarticular manifestations of human brucellosis occur in 20-40% of patients while spondylodiscitis is the most severe form of the bone and joint structures involvements. AIM The aim of this paper is tho show clinical and radiological caracteristics of osteoarticular forms of brucellosis, with special reference to spondylodiscitis. MATERIAL AND METHODS The medical histories of 120 hospitalized patients at the Clinic for Infectious Diseases, Clinical Center of Sarajevo University, diagnosed with brucellosis, were analyzed. RESULTS Osteoarticular manifestations had sixty-nine patients, representing 78.4% of all localized forms of the disease. Spondylodiscitis represents 40.6% of all osteoarticular manifestations of the disease. Nine patients (32.1%) had paravertebral and paraspinal abscess. Median diagnostic interval for spondylodiscitis (116 +/- 160 days) was almost twice prolonged compared to the arthritis and sacroilitis (p < 0.05). The most common radiological manifestations were erosions of the vertebral surface (67.8%). Computerized tomography confirmed inflammation in 85.2% of the patients, while magnetic resonance imaging (MRI) showed radiological alterations in all patients (100%). DISCUSSION AND CONCLUSION Osteoarticular manifestations are the most common localised forms of brucellosis. The frequency of spondylodiscitis is in relation to duration of the diagnostic time. MRI shows a high degree of sensitivity to inflammatory changes of spine and "Pedro Pons' sign" is patognomic radiological alteration.

SUMMARY CONFLICT OF INTEREST: none declared. Introduction Brucella endocarditis (BE) is a rare but severe and potentially lethal manifestation of brucellosis. Pre-existing valves lesions and prosthetic valves (PV) are favorable for BE. Case report We represent the case of a 46-year-old man who was treated at the Clinic for Infectious Diseases, Clinical Center of Sarajevo University, as blood culture positive (Brucella melitensis) mitral and aortic PV endocarditis. He was treated with combined anti-brucella and cardiac therapy. Surgical intervention was postponed due to cardiac instability. Four months later he passed away. Surgery was not performed.

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

Organized by the Association of Infectologists of Bosnia and Herzegovina and the Clinic of Infectious Diseases, Clinical Center of Sarajevo University in the period from 30th May untill 2nd of June in Konjic was held the 4th Congress of Infectologists of B&H with international participation. This was the biggest meeting of infectious disease and allied disciplines specialists in the last six years, with the presence of more than 100 participants. The Congress was held under the auspices of the Clinical Center of Sarajevo University and the Federal Ministry of Health. In addition to infectologists the Congress was attended by a large number of experts from related medical fields: microbiologists, epidemiologists, orthopedists, gastroenterologists, nephrologists, neurosurgeons, pediatricians, audiologists, oncologists. Topics were current and were related to sepsis, endocarditis, osteomyelitis, nosocomial infection, pediatric infectious diseases, emergent and re-emergent diseases, therapeutic protocols for the presentation of new knowledge in these fields. A total of about 90 papers were presented, while participants of the Congress were experts from Bosnia and Herzegovina, neighboring countries (Croatia, Serbia, Montenegro, Macedonia) but also Turkey and Germany. Congress by the participants was rated as very successful and well organized, with arrangements for the continuation and improvement of cooperation and possible joint organization of symposia and seminars with colleagues from abroad

SUMMARY The 4th Congress of Infectiologists of Bosnia-Herzegovina with international participation was held in Konjic, on 30. May to 02. June 2012. In addition to the prominent infectious disease experts from almost all university centers in B&H, the teachers at medical schools in Bosnia-Herzegovina, infectious disease specialists who work in health institutions in B&H, this Congress was attended by infectious disease experts from Serbia (12 participants), Turkey (3 participants), Croatia (3 participants), Macedonia (3 participants), Germany (2 participants) and Montenegro (2 participants). Topics included: Infections of the skin, soft tissue and bones, Sepsis and endocarditis, Infectious diseases emergencies and pediatric infectology, Emerging and reemerging infectious diseases, Hospital infections, Sexualy transmitted diseases, Infectious diagnostic and therapeutic protocols. Participating invited speakers were following professors: Salih Hosoglu (Turkey), Hakan Leblebicioglu (Turkey), Resat Ozaras (Turkey), Karsten Plötz (Germany), Ilija Kuzman (Croatia), Bruno Baršić (Croatia), Goran Tešović (Croatia). In addition to experts in infectious diseases at this Congress, their works were presented by experts from other medical disciplines, but with infectious character issues (Professors: Sead Ahmetagić, Ismet Gavrankapetanović, Zora Vukobrat-Bijedić, Senija Rašić, Halima Resić, Adnan Kapidžić, Ivo Curić, Jelena Ravlija, Amela Begić, Izet Mašić, Sadeta Hamzić, and others). Some of the papers that were presented at this Congress have been published in extenso, in the Medical Archives and Materia Socio Medica. One part as abstracts (both journals are indexed in over 10 databases), and will be electronically available to the general scientific community in Bosnia-Herzegovina, Europe and worldwide. In this way, the Bosnian infectious disease experts, as a science and profession, will be worthily represented to the colleagues from other countries in the region and beyond.

Listeria monocytogenes is a small, aerobic or facultative anaerobic, non-sporulating gram positive bacillus that can be isolated from soil, vegetation or animal reservoirs. There are six species of Listeria, and only L. monocytogenes is pathogenic for humans. Human disease occurs mainly in immunocompromised people, neonates and in pregnancy, while the cases in immunocompetent people are rare. CNS manifestations of the disease can be in form of meningitis, encephalitis, and also cerebritis and abscess since L. monocytogenes shows tropism for brain and brain stem as well for the meninges. In this case we presented 55 year old male patient with etiologically confirmed listerial meningoencephalitis, transferred from regional hospital tothe Clinic for Infectious Diseases with diagnosis of acute meningoencephalitis. Disease started 4 days before the admission. Prior to this the patient was completely healthy. In his history he denied any preexisting disease. At admittance he was febrile, with altered consciousness, disoriented, showing ocular deviation, dystaxia, and with completely positive meningeal signs. Neurologist diagnosis was rhombencephalitis. CSF analysis showed mildly opalescent liquor with pleocytosis 546/mm3 and polymorphonuclear cell predominance >70%. CSF culture showed positive isolate of L. monocytogenes. Initial therapy was: Penicillin G and Chloramphenicol, together with all other supportive and symptomatic therapy. After initial therapy and based on antibiogram, ampicillin was administered for4 weeks, followed by imipenemum for 10 days. Control CSF analysis showed pleocytosis and increased protein level and the patient was discharged as recovered with diagnosis of acute meningoencephalitis