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Kovačević N, Lendak D, Popović M, Plećaš Đuric A, Pete M, Petrić V, Sević S, Tomić S, Alargić J, Damjanov D, Kosjer D, Lekin M. Clinical Presentations, Predictive Factors, and Outcomes of Clostridioides difficile Infection among COVID-19 Hospitalized Patients—A Single Center Experience from the COVID Hospital of the University Clinical Center of Vojvodina, Serbia. Medicina (Kaunas) 2022; 58:medicina58091262. [PMID: 36143939 PMCID: PMC9504333 DOI: 10.3390/medicina58091262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 08/25/2022] [Accepted: 08/31/2022] [Indexed: 11/16/2022]
Abstract
Background: This study aimed to investigate the clinical form, risk factors, and outcomes of patients with COVID-19 and Clostridioides difficile co-infections. Methods: This retrospective study (2 September 2021-1 April 2022) included all patients with Clostridioides difficile infection (CDI) and COVID-19 infection who were admitted to the Covid Hospital of the University Clinical Center of Vojvodina. Results: A total of 5124 COVID-19 patients were admitted to the Covid Hospital, and 326 of them (6.36%) developed hospital-onset CDI. Of those, 326 of the CDI patients (88.65%) were older than 65 years. The median time of CDI onset was 12.88 days. Previous hospitalizations showed 69.93% of CDI patients compared to 38.81% in the non-CDI group (p = 0.029). The concomitant antibiotics exposure was higher among the CDI group versus the non-CDI group (88.65% vs. 68.42%, p = 0.037). Albumin levels were ≤ 25 g/L among 39.57% of the CDI patients and 21.71% in the non-CDI patients (p = 0.021). The clinical manifestations of CDI ranged from mild diarrhea (26.9%) to severe diarrhea (63.49%) and a complicated form of colitis (9.81%). Regarding outcomes, 79.14% of the CDI patients recovered and 20.86% had fatal outcomes in-hospital. Although a minority of the patients were in the non-CDI group, the difference in mortality rate between the CDI and non-CDI group was not statistically significant (20.86% vs. 15.13%, p = 0.097). Conclusions: Elderly patients on concomitant antibiotic treatments with hypoalbuminemia and with previous healthcare exposures were the most affected by COVID-19 and CD co-infections.
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Affiliation(s)
- Nadica Kovačević
- Faculty of Medicine, University of Novi Sad, 21137 Novi Sad, Serbia
- Clinic for Infectious Disease, University Clinical Center of Vojvodina, 21137 Novi Sad, Serbia
| | - Dajana Lendak
- Faculty of Medicine, University of Novi Sad, 21137 Novi Sad, Serbia
- Clinic for Infectious Disease, University Clinical Center of Vojvodina, 21137 Novi Sad, Serbia
- Correspondence: ; Tel.: +381-648059383
| | - Milica Popović
- Faculty of Medicine, University of Novi Sad, 21137 Novi Sad, Serbia
- Clinic for Nephrology and Clinical Immunology, University Clinical Center of Vojvodina, 21137 Novi Sad, Serbia
| | - Aleksandra Plećaš Đuric
- Faculty of Medicine, University of Novi Sad, 21137 Novi Sad, Serbia
- Clinic for Anesthesiology, Intensive Care and Pain Therapy, University Clinical Center of Vojvodina, 21137 Novi Sad, Serbia
| | - Maria Pete
- Faculty of Medicine, University of Novi Sad, 21137 Novi Sad, Serbia
- Clinic for Infectious Disease, University Clinical Center of Vojvodina, 21137 Novi Sad, Serbia
| | - Vedrana Petrić
- Faculty of Medicine, University of Novi Sad, 21137 Novi Sad, Serbia
- Clinic for Infectious Disease, University Clinical Center of Vojvodina, 21137 Novi Sad, Serbia
| | - Siniša Sević
- Faculty of Medicine, University of Novi Sad, 21137 Novi Sad, Serbia
- Clinic for Infectious Disease, University Clinical Center of Vojvodina, 21137 Novi Sad, Serbia
| | - Slavica Tomić
- Faculty of Medicine, University of Novi Sad, 21137 Novi Sad, Serbia
- Clinic for Infectious Disease, University Clinical Center of Vojvodina, 21137 Novi Sad, Serbia
| | - Jelica Alargić
- Emergency Department, University Clinical Center of Vojvodina, 21137 Novi Sad, Serbia
| | - Dimitrije Damjanov
- Faculty of Medicine, University of Novi Sad, 21137 Novi Sad, Serbia
- Clinic for Gastroenterology and Hepatology, Clinical Center of Vojvodina, 21137 Novi Sad, Serbia
| | - Dijana Kosjer
- Faculty of Medicine, University of Novi Sad, 21137 Novi Sad, Serbia
- Clinic for Gastroenterology and Hepatology, Clinical Center of Vojvodina, 21137 Novi Sad, Serbia
| | - Milica Lekin
- Faculty of Medicine, University of Novi Sad, 21137 Novi Sad, Serbia
- Clinic for Endocrinology, Diabetes and Metabolic Disorders, University Clinical Center of Vojvodina, 21137 Novi Sad, Serbia
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Banović P, Díaz-Sánchez AA, Đurić S, Sević S, Turkulov V, Lendak D, Mikić SS, Simin V, Mijatović D, Bogdan I, Potkonjak A, Savić S, Obregón D, Cabezas-Cruz A. Unexpected TBEV Seropositivity in Serbian Patients Who Recovered from Viral Meningitis and Encephalitis. Pathogens 2022; 11:pathogens11030371. [PMID: 35335695 PMCID: PMC8951648 DOI: 10.3390/pathogens11030371] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 03/15/2022] [Accepted: 03/16/2022] [Indexed: 12/12/2022] Open
Abstract
The tick-borne encephalitis virus (TBEV) causes a life-threatening disease named Tick-borne encephalitis (TBE). The clinical symptoms associated with TBE range from non-specific to severe inflammation of the central nervous system and are very similar to the clinical presentation of other viral meningitis/encephalitis. In consequence, TBE is often misclassified by clinical physicians, mainly in the non-identified high-risk areas where none or only a few TBE cases have been reported. Considering this situation, we hypothesized that among persons from northern Serbia who recovered from viral meningitis or encephalitis, there would be evidence of TBEV infection. To test this hypothesis, in this observational study, we evaluated the seroreactivity against TBEV antigens in patients from northern Serbia who were hospitalized due to viral meningitis and/or viral encephalitis of unknown etiology. Three cases of seroreactivity to TBEV antigens were discovered among convalescent patients who recovered from viral meningitis and/or encephalitis and accepted to participate in the study (n = 15). The clinical and laboratory findings of these patients overlap with that of seronegative convalescent patients. Although TBE has been a notifiable disease in Serbia since 2004, there is no active TBE surveillance program for the serologic or molecular screening of TBEV infection in humans in the country. This study highlights the necessity to increase the awareness of TBE among physicians and perform active and systematic screening of TBEV antibodies among patients with viral meningitis and/or encephalitis.
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Affiliation(s)
- Pavle Banović
- Ambulance for Lyme Borreliosis and Other Tick-Borne Diseases, Department of Prevention of Rabies and Other Infectious Diseases, Pasteur Institute Novi Sad, 21000 Novi Sad, Serbia;
- Department of Microbiology with Parasitology and Immunology, Faculty of Medicine in Novi Sad, University of Novi Sad, 21000 Novi Sad, Serbia
- Correspondence: (P.B.); (A.C.-C.)
| | | | - Selena Đurić
- Faculty of Medicine in Novi Sad, University of Novi Sad, 21000 Novi Sad, Serbia; (S.Đ.); (S.S.); (V.T.); (D.L.); (S.S.M.)
| | - Siniša Sević
- Faculty of Medicine in Novi Sad, University of Novi Sad, 21000 Novi Sad, Serbia; (S.Đ.); (S.S.); (V.T.); (D.L.); (S.S.M.)
- Clinic for Infectious Diseases, Clinical Center of Vojvodina, 21000 Novi Sad, Serbia
| | - Vesna Turkulov
- Faculty of Medicine in Novi Sad, University of Novi Sad, 21000 Novi Sad, Serbia; (S.Đ.); (S.S.); (V.T.); (D.L.); (S.S.M.)
- Clinic for Infectious Diseases, Clinical Center of Vojvodina, 21000 Novi Sad, Serbia
| | - Dajana Lendak
- Faculty of Medicine in Novi Sad, University of Novi Sad, 21000 Novi Sad, Serbia; (S.Đ.); (S.S.); (V.T.); (D.L.); (S.S.M.)
- Clinic for Infectious Diseases, Clinical Center of Vojvodina, 21000 Novi Sad, Serbia
| | - Sandra Stefan Mikić
- Faculty of Medicine in Novi Sad, University of Novi Sad, 21000 Novi Sad, Serbia; (S.Đ.); (S.S.); (V.T.); (D.L.); (S.S.M.)
- Clinic for Infectious Diseases, Clinical Center of Vojvodina, 21000 Novi Sad, Serbia
| | - Verica Simin
- Department of Microbiology, Pasteur Institute Novi Sad, 21000 Novi Sad, Serbia; (V.S.); (I.B.)
| | - Dragana Mijatović
- Ambulance for Lyme Borreliosis and Other Tick-Borne Diseases, Department of Prevention of Rabies and Other Infectious Diseases, Pasteur Institute Novi Sad, 21000 Novi Sad, Serbia;
| | - Ivana Bogdan
- Department of Microbiology, Pasteur Institute Novi Sad, 21000 Novi Sad, Serbia; (V.S.); (I.B.)
| | - Aleksandar Potkonjak
- Department of Veterinary Medicine, Faculty of Agriculture, University of Novi Sad, 21000 Novi Sad, Serbia;
| | - Sara Savić
- Scientific Veterinary Institute “Novi Sad”, 21000 Novi Sad, Serbia;
| | - Dasiel Obregón
- School of Environmental Sciences, University of Guelph, Guelph, ON N1G 2W1, Canada;
| | - Alejandro Cabezas-Cruz
- Anses, INRAE, Ecole Nationale Vétérinaire d’Alfort, UMR BIPAR, Laboratoire de Santé Animale, F-94700 Maisons-Alfort, France
- Correspondence: (P.B.); (A.C.-C.)
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Banović P, Obregón D, Mijatović D, Simin V, Stankov S, Budakov-Obradović Z, Bujandrić N, Grujić J, Sević S, Turkulov V, Díaz-Sánchez AA, Cabezas-Cruz A. Tick-Borne Encephalitis Virus Seropositivity among Tick Infested Individuals in Serbia. Pathogens 2021; 10:301. [PMID: 33807559 PMCID: PMC8001322 DOI: 10.3390/pathogens10030301] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 02/13/2021] [Accepted: 03/02/2021] [Indexed: 12/12/2022] Open
Abstract
Tick-borne encephalitis (TBE), caused by the TBE virus (TBEV), is a life-threatening disease with clinical symptoms ranging from non-specific to severe inflammation of the central nervous system. Despite TBE is a notifiable disease in Serbia since 2004, there is no active TBE surveillance program for the serologic or molecular screening of TBEV infection in humans in the country. This prospective cohort study aimed to assess the TBEV exposure among tick-infested individuals in Serbia during the year 2020. A total of 113 individuals exposed to tick bites were recruited for the study and screened for anti-TBEV antibodies using a commercial indirect fluorescent antibody test (IFA) test. Blood samples from 50 healthy donors not exposed to tick bites were included as a control group. Most of the enrolled patients reported infestations with one tick, being I. ricinus the most frequent tick found in the participants. The TBEV seroprevalence was higher (13.27%, 15 total 113) in tick-infested individuals than in healthy donors (4%, 2 total 50), although the difference was not significant. Notably, male individuals exposed to tick bites showed five times higher relative risk (RR) of being TBEV-seropositive than healthy donors of the same gender (RR= 5.1, CI = 1.6-19; p = 0.007). None of the seropositive individuals developed clinical manifestations of TBE, but the first clinical-stage of Lyme borreliosis (i.e., erythema migrans) was detected in seven of them. Potential TBEV foci were identified in rural areas, mostly in proximity or within the Fruška Gora mountain. We conclude that the Serbian population is at high risk of TBEV exposure. Further epidemiological studies should focus on potential TBEV foci identified in this study. The implementation of active surveillance for TBEV might contribute to evaluating the potential negative impact of TBE in Serbia.
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Affiliation(s)
- Pavle Banović
- Ambulance for Lyme Borreliosis and Other Tick-Borne Diseases, Pasteur Institute Novi Sad, 21000 Novi Sad, Serbia;
- Faculty of Medicine, University of Novi Sad, 21000 Novi Sad, Serbia; (Z.B.-O.); (N.B.); (J.G.); (S.S.); (V.T.)
| | - Dasiel Obregón
- School of Environmental Sciences, University of Guelph, Guelph, ON N1G 2W1, Canada;
- Center for Nuclear Energy in Agriculture, University of São Paulo, Piracicaba, SP 13400-970, Brazil
| | - Dragana Mijatović
- Ambulance for Lyme Borreliosis and Other Tick-Borne Diseases, Pasteur Institute Novi Sad, 21000 Novi Sad, Serbia;
| | - Verica Simin
- Department of Microbiology, Pasteur Institute Novi Sad, 21000 Novi Sad, Serbia; (V.S.); (S.S.)
| | - Srdjan Stankov
- Department of Microbiology, Pasteur Institute Novi Sad, 21000 Novi Sad, Serbia; (V.S.); (S.S.)
| | - Zorana Budakov-Obradović
- Faculty of Medicine, University of Novi Sad, 21000 Novi Sad, Serbia; (Z.B.-O.); (N.B.); (J.G.); (S.S.); (V.T.)
- Blood Transfusion Institute Vojvodina, 21000 Novi Sad, Serbia
| | - Nevenka Bujandrić
- Faculty of Medicine, University of Novi Sad, 21000 Novi Sad, Serbia; (Z.B.-O.); (N.B.); (J.G.); (S.S.); (V.T.)
- Blood Transfusion Institute Vojvodina, 21000 Novi Sad, Serbia
| | - Jasmina Grujić
- Faculty of Medicine, University of Novi Sad, 21000 Novi Sad, Serbia; (Z.B.-O.); (N.B.); (J.G.); (S.S.); (V.T.)
- Blood Transfusion Institute Vojvodina, 21000 Novi Sad, Serbia
| | - Siniša Sević
- Faculty of Medicine, University of Novi Sad, 21000 Novi Sad, Serbia; (Z.B.-O.); (N.B.); (J.G.); (S.S.); (V.T.)
- Clinic for Infectious Diseases, Clinical Center of Vojvodina, 21000 Novi Sad, Serbia
| | - Vesna Turkulov
- Faculty of Medicine, University of Novi Sad, 21000 Novi Sad, Serbia; (Z.B.-O.); (N.B.); (J.G.); (S.S.); (V.T.)
- Clinic for Infectious Diseases, Clinical Center of Vojvodina, 21000 Novi Sad, Serbia
| | | | - Alejandro Cabezas-Cruz
- Anses, INRAE, Ecole Nationale Vétérinaire d’Alfort, UMR BIPAR, Laboratoire de Santé Animale, F-94700 Maisons-Alfort, France
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Doder R, Čanak G, Stefan Mikić S, Sević S, Potkonjak A, Doder D, Vračar V. Clinical case series of nine patients with tuberculousmeningitis in the Clinical Centre of Vojvodina, Novi Sad, AP Vojvodina, Serbia 2001-2010. Med Glas (Zenica) 2014; 11:283-288. [PMID: 25082241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Accepted: 05/21/2014] [Indexed: 06/03/2023]
Abstract
AIM To determine immediate risk factors of developing tuberculous meningitis, to assess the practical importance of clinical signs and findings in the cerebrospinal fluid (CSF) when opting for the specific therapy, and to predict the outcome of disease in relation to the beginning of treatment. METHODS A retrospective clinical case series of nine patients with tuberculous meningitis who were treated from April 2001 until November 2010 at the Department of Infectious Diseases in Novi Sad, Serbia was presented. Data of patients' medical records and presentation of clinical and laboratory features, neuroradiologicalfindings and outcome were used. RESULTS The factors of immediate risk/predisposition for the development of tuberculous meningitis were found in two (22.2%) patients. The duration of symptoms prior to admission was 9 days on average (from 3 to 20 days). The most frequent symptoms on admission were headache and fever in eight (88.9%) patients, whereas two patients (22.2%) were presented with stiff neck and photophobia. Consciousness was preserved in six patients (66.7%), two patients were somnolent and one was in coma. Two(22.2%) patients had concurrent pulmonary tuberculosis. Neuroradiological signs of the disease were present in two patients. CONCLUSION The duration of symptoms before admission, clinical examination and CSF analysis can be helpful in identifying patients who are at high risk of developing tuberculous meningitis.
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Affiliation(s)
- Radoslav Doder
- 1School of Medicine, University of Novi Sad, 2Department of Infectious Diseases, Clinical Centre of Vojvodina,3Department of Veterinary Medicine, Faculty of Agriculture, University of Novi Sad, 4Provincial Institute of Sports Medicine and Sports; Novi Sad, Serbia
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Sević S. [Serologic diagnosis of acute infectious mononucleosis]. Med Pregl 1997; 50:403-8. [PMID: 9471540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
This paper deals with data on 48 patients with diagnosis of infectious mononucleosis hospitalized at the Clinic for Infectious Diseases in Novi Sad in the period October 1995 to October 1996. Tests like Paul-Bunnell-Davidson's, Monospot and ELISA were performed on samples of acute serum taken from every patient. Analyzing these results it has been established that majority of patients were 16-20 years of age, that the disease occurs in both sexes equally, and that most patients had a severe clinical picture with a typhoid form of the disease. Paul-Bunnell's test was positive in 50.49% of patients, Monospot in 56.25%, while all 48 patients had positive IgM EBV VCA. 11 patients had a positive IgG EBV VCA too, while none of the examined patients was IgG EBV NA positive. Statistical analysis revealed a statistically significant difference in reliability of diagnosis made by specific serologic tests and tests which confirm the existence of heterophile antibodies. Characteristic changes of the differential blood picture, such as lymphomonocytosis with virocytes have been found only in 28 (58.33%) patients, so that in diagnosis of this disease hematological findings must be questioned.
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Affiliation(s)
- S Sević
- Katedra za infektivne bolesti, Medicinski fakultet, Novi Sad
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