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Rotavirus A (RVA), in countries like Croatia with low vaccination coverage, represents an important healthcare burden due to frequent hospitalizations. The aim of the study was to investigate rotavirus diversity in hospitalized children in Croatia and to evaluate the potential zoonotic background of circulating strains. During three consecutive RVA seasons (2018-2021), we have collected 602 RVA positive samples from children admitted to three regional hospitals. Multiplex semi-nested RT-PCR and Sanger sequencing were applied for VP7/VP4 genotyping. For G1 and G3 strains, NSP5 and VP6 segments were additionally genotyped and selected strains were further analyzed by NGS on Illumina platform. Overall, we detected eight and five different G and P genotypes, respectively. In descending order, G3, G9, G2, G1, G4, G6, G8, G10 and P[8], P[4], P[9], P[6], P[14]. The G3 genotype was predominant (54%) with rising season-to-season prevalence of G3 equine-like (G3e) lineage. Furthermore, P[8] genotype was detected in 79% of samples. Interestingly, a high share (15%) of mixed G genotypes was observed. On the contrary, strains with zoonotic background were infrequent (1.6%). The NSP5/VP6 genotyping and NGS confirmed the emergence of intergenogroup reassortant strains ; G1P[8] and G3eP[8], both in DS-1-like and Wa-like constellations. Notable genetic heterogeneity and sporadic detection of RVA strains with zoonotic background were reported in hospitalized children in Croatia. A significant finding is the circulation of intergenogroup reassortant strains. These results provide a valuable source of knowledge prerequisite in considering potential introduction of vaccination in the national immunization program.

Takayasu’s arteritis (TA) affects the aorta and its branches. Immunosuppressants are the usual course of therapy, while surgery has been used in acute cases. There is only scant information on TA in infancy, and the nonspecific symptoms in the initial stage of the disease make the diagnosis difficult and delayed, thus increasing the mortality rate. We describe a case of aggressive progression of TA in an infant. This child was the youngest to be affected with the disease as reported in the literature. A 3.5- month-old boy presented with cyanosis of both legs, tachycardia and antithrombin III deficiency. Computed tomography angiography (CTA) revealed thrombosis of distal aorta and both iliac arteries. Thrombectomy was performed at the level of both common femoral arteries. In addition, thigh amputation of the left leg had to be performed. TA was diagnosed postmortem with thrombosis of the distal aorta, its branches and upper mesenteric artery which was not occluded on previous CTA, glomerulonephritis and pulmonary parenchymal granulomatous infiltrations.

Rani neonatalni mortalitet (RNM) predstavlja smrtnost na 1000 sve živorođene djece neovisno o dobi trudnoće ili o porodnoj težini u prvih sedam dana života (168 sati).

Rotavirus A (RVA) is the main causative agent of viral gastroenteritis in children and young animals worldwide. Molecular epidemiology is primarily based on genotyping the VP7 and VP4 genome segments which gives a binary classification (G and P genotypes). Molecular diversity of RVA strains in humans is high and some of those strains have zoonotic origin. During season 2018/2019 we have tested 188 faecal samples from hospitalized patients (mostly children under the age of five years, among which 22 newborns) in Zagreb, Osijek and Split. All patients were positive for RVA by immunochromatographic assay. Semi-nested multiplex PCR for VP7 and VP4 RVA genotyping coupled with Sanger sequencing of amplified VP7, VP4 and VP6 RT-PCR fragments were applied. The G or P genotype was determined in 187 samples and G/P genotype combination in 169 samples. The most common G genotypes were G3 (55.1%), G1 (12.9%), G2 (6.4%), G9 (2.7%), G4 (1.6%), G10 (1.1%), mixed G genotypes (16%) and untypeable G genotype (4.8%). The P genotypes were predominantly P[8] (86.1%), followed by P[4] (4.8%), P[9] (0.5%), mixed P genotypes (3.7%) and untypeable P genotype (4.8%). In total there were nine G/P combinations ; G3P[8], G1P[8], G2P[4], G4P[8], G9P[8] and less common G10P[8], G2P[8], G9P[4] and G3P[9]. Among G3 strains 48.5% were the emerging G3 equine-like intergenogroup reassortant RVA strains. Another notable finding is the first detection of unusual DS-1-like G1P[8] intergenogroup reassortant strains in Europe. G10 strains detected in children from eastern Croatia are possibly having the zoonotic bovine origin. However, other G genotypes shared between humans and animals in Croatia (G2, G4, G9) show different evolutionary direction. The ongoing studies on spatio-temporal molecular epidemiology of RVA strains in Croatian ecosystem will fill the knowledge gaps and provide useful database when considering the potential introduction of RVA vaccines in national immunisation program.

Rani neonatalni mortalitet (RNM) predstavlja smrtnost na 1000 sve živorodene djece neovisno o dobi trudnoće ili o porodnoj težini u prvih sedam dana života (168 sati).