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Introduction. Castleman's disease (CD) or angiofolicullar lymph node hyperplasia is a rare pathologic process characterized by non-neoplastic reactive proliferation of lymphoid tissue. Mimicking clinical and laboratory signs of infection, it could be a great diagnostic problem for an infectologist. Case report. We report a case of a 39-year old man who was initially clinically suspected to have an infectious central nervous system (CNS) affection, having most similar appearance to neurotuberculosis. Malignancy with bone metastases and lymphoma were also among many possible diagnoses. The patient was later histologically confirmed to have Castleman's disease, analyzing the enlarged inguinal lymph node, which was the key point in rejecting the suspicion of malignancy and tuberculosis. By further analyses, the patient was diagnosed to have mixed connective tissue disorder (MCTD). Vasculitis of mesencephalon and thalamus was detected by magnetic resonance imaging. Conclusion. CD with CNS involvement is very rare as well as CD with MCTD association, making this case even more unique. This case report underlines the importance of definitive histological diagnosis in patients with lymphadenopathia associated with systemic involvement and the need of additional immunological and radiological examinations, as well.

Tularemia is a serious bacterial zoonosis caused by the highly infectious agent Francisella tularensis. Microbiological diagnosis of tularemia mainly relies on serology. The occurrence of a tularemia epidemic in the Southeast of Serbia in 1998/999 initiated an epidemiological as well as a clinical and microbiological research in this area. Objective was establishing the correlation between the clinical-epidemiological and serological diagnosis of tularemia as well as the clinical and serological follow-up of patients in the period from 1 to 12 years since the disease onset. From the beginning of 1999 until the end of 2011, 113 patients diagnosed with tularemia were examined. The control group was formed of 111 patients with lymphadenopathy of different origins. The following serological methods were used: microagglutination test (MAT), immunoensyme assays: ELISA (VMA, Belgrade), Serion ELISA IgG i IgM, Serazym ELISA and ELISA in house and immunochromatographic test (ICT). Clinical-epidemiological diagnosis of tularemia was confirmed serologically in all 113 patients. The high sensitivity and specifity were found for all the examined tests. IgG Virion ELISA demonstrated the highest sensitivity (97.4%) and specificity (93.1%). IgG and IgM class of antibodies remained positive in the serum in a high percentage, even as long as 12 years from the infection. Oropharyngeal form (93.8%), with predominant unilateral cervical lymphadenopathy (91.5%), was the most common clinical form. Complications, such as suppurative lymphadenitis and recurrent lymphadenitis, were seen in 41.6% of patients. A positive correlation between clinical-epidemiological and serological diagnosis of tularemia has been established. Serological findings must be interpreted only within the clinical picture of tularemia. A finding of IgM and IgG class antibodies or total antibodies of F. tularensis in the sera of patients without clinical disease manifestations, from one to 12 years from the disease onset, does not indicate an acute but a past infection.

Background/Aim. In hepatitis C virus infection, oxidative stress and antioxidant imbalance are major triggers for the disease occurrence and its progression. The aim of the research was to determine the erythrocyte antioxidative enzymes activities, superoxide dismutase (SOD), glutathione peroxidase (GPx) and catalase (CAT), before and after therapy with pegylated interferon alpha-2a and ribavirin and to evaluate their clinical significance as potential diagnostic markers of sustained virological response (SVR). Methods. The study included 53 patients with chronic hepatitis C (CHC) and 56 healthy controls. SOD, GPx, CAT, aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels were measured in patients both before and after the treatment. Results. SOD, GPx and CAT activities prior to the treatment were significantly lower in CHC patients compared to the controls (p < 0.001), and they were significantly higher after the treatment (p < 0.001). A significant positive correlation existed between SOD, GPx, and CAT activites, before and after the treatment (p < 0.001) and with those of aminotransferases prior to the treatment (p < 0.001). After the treatment, only GPx activity showed significant negative correlation with that of aminotransferases (p < 0.001). Receiver operating characteristic curve analysis for SOD, GPx and CAT showed following values: area under the curve of 0.975, 0.988, and 0.817 respectively; sensitivity of 93.5%, 71.7%, 100% respectively and specificity of 100% for all, respectively. Forty six SVR achievers had significant increase of SOD, GPx and CAT activities (p < 0.001 for all), unlike 7 SVR non-achievers (p = 0.31, p = 0.717, p = 0.85, respectively). Conclusion. Oxidative stress is the initiator of onset and progression of CHC. The combined antiviral therapy leads to the restoration of antioxidant balance. GPx, SOD and CAT may be diagnostic markers of CHC treatment outcome.

Introduction. Botulism is a neuro -intoxication caused by a toxin secreted by Clostridium botulinum. Due to extremely high toxicity and lethality, this toxin can be used as an agent in a biological warfare. Case report. We presented six patients, mean age 28.8 years, who ate canned food and in whom the diagnosis of disease was made based on the typical clinical picture. Predominant symptoms were blurred vision, double vision (diplopia), dry mouth and constipation which were present in all patients. The patient whose disease was recognized only after 23 days and who did not receive the anti botulinum serum underwent the longest hospital treatment. All the patients received antibiotics and 4 patients received antitoxin. Neostigmine and enemas were used for the treatment of the disorder of intestinal motility and constipation. Conclusion. The diagnosis of botulinum was made based on afebrility, preserved states of consciousness, double vision, dry mouth and history data on consumption of suspicious food. Polyvalent serum anti botulinum should be applied as soon as possible because it reduces the occurrence of complications, length of hospital stay and mortality rate.

The Ebola virus is a cause of the serious disease that causes hemorrhagic fevers - illnesses marked by severe bleeding (hemorrhage), organ failure and, in many cases, death. The virus is native to Africa, where sporadic outbreaks have occurred for decades. The current outbreak is the largest and there have been more cases of deaths in this outbreak than all others combined. Various degrees of hepatocellular necrosis have been reported in infected people and non-human primates; however, the hepatocellular lesions are generally not serious enough to explain the cause of death. Importantly, hemorrhagic tendencies could be related to decreased synthesis of coagulation and other plasma proteins because of severe hepatocellular necrosis. Supportive carerehydration with oral or intravenous fluids - and treatment of specific the symptoms improves the survival. There is as yet no proven treatment available for EVD.

Introduction. Streptococcus pneumoniae is one of the most common causes of respiratory infections. The aim was to study the susceptibility to antimicrobial agents of respiratory isolates of Streptococcus pneumoniae obtained from hospitalized children. Material and Methods. A total of 190 respiratory pneumococcal isolates obtained from children aged from 0 to 14 years were isolated and identified by using standard microbiological methods. Susceptibility to oxacillin, erythromycin, clindamycin, tetracycline, cotrimoxazole, ofloxacin and rifampicin was tested by disc diffusion method. Minimal inhibitory concentrations for amoxicillin and ceftriaxone were determined by means of E test. The macrolide-resistant phenotype was detected by double disc diffusion test. Results. All tested isolates were susceptible to amoxicillin and ceftriaxone. The minimal amoxicillin concentration inhibiting the growth of 50% of isolates and of 90% of isolates was 0.50 ?g/ml and 1.0 ?g/ml, respectively and the minimal ceftriaxone concentration inhibiting the growth of 50% of isolates and of 90% of isolates was 0.25 ?g/ml and 0.50 ?g/ml, respectively. Susceptibility to erythromycin and clindamycin was observed in 21.6% and 29.47% of isolates, respectively. The resistence to macrolides - M phenotype was detected in 10.07% of isolates and constitutive macrolide-lincosamide-streptogramin phenotype (constitutive MLS phenotype) was found in 89.93% of isolates. All tested isolates were susceptible to ofloxacin and rifampicin. Conclusion. Amoxicillin could be the therapy of choice in pediatric practice. The macrolides should not be recommended for the empirical therapy of pneumococcal respiratory tract infection in our local area.

Background and Objectives: Published data on oxidative stress in children with acute hepatitis A are still very scarce. This study aims to evaluate the oxidant/antioxidant status of these patients. Design and Setting: Prospective, case-control study, over 2.5 years in patients under hospitalized and ambulatory care. Patients and Methods: The levels of a whole-blood antioxidant, reduced glutathione; and plasma antioxidants, β-carotene, retinol, ascorbic acid, α-tocopherol; and the biomarker of oxidative stress, malondialdehyde, were evaluated in 50 pediatric patients (age range, 5-16 years; 29 males and 21 females) with acute hepatitis A and in 50 healthy children as control subjects (age range, 5-16 years; 25 males and 25 females). Results: Plasma levels of reduced glutathione, β-carotene, retinol, α-tocopherol and ascorbic acid were significantly lower, while malondialdehyde plasma levels were significantly increased in the patient group when compared to the controls (PConclusions: Our findings show that pediatric patients with acute hepatitis A were influenced by oxidative stress, resulting in significantly lower levels of plasma antioxidants and increased lipid peroxidation. In the absence of other therapeutic options, antioxidant vitamin supplements could be added to the therapy for these patients to help reestablish the oxidant status balance. Further investigations to confirm this suggestion are recommended.