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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.

Introduction: HIV-infected patients are affected significantly more frequently by all types of lymphoma, with diffuse large B-cell lymphoma (DLBCL) as the most prevalent histological type. Since the introduction of combination antiretroviral therapy (cART) morbidity and mortality of DLBCL has been markedly reduced, which is primarily interpreted as a result of the drug-mediated immune reconstitution. Case Report: We present a previously healthy, 44-year-old HIV-infected man with DLBCL of the oral cavity, treated with immunochemotherapy and cART. During HIV-directed treatment, despite the successful virologic response, a satisfactory immunological response was not achieved. However, the patient had a 2-year complete remission after first-line treatment of DLBCL. Conclusion: Response to cART strongly predicts outcome in patients with DLBCL. Close monitoring of HIV-directed therapy efficacy, especially as to achievement of successful virologic response, independently associated with prolonged survival, is essential for estimating future DLBCL treatment strategies.

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.

Anaphylactic shock due to unruptured hydatid cyst is a rare complication of hepatic echinococcosis. Here, we present an unusual case of unruptured hydatid cyst causing anaphylactic shock followed by appendicitis, ileus, and complicated by septic condition due to multiple intrahospital infections. Decision of the surgical cyst removal at the right moment and appropriate antimicrobial treatment are key factors for a positive outcome.

Hepatitis C virus (HCV) usually evades the host’s immune system and persists as a chronic infection. Intravenous drug users (IVDU) represent the majority of patients infected with HCV Combined therapy of chronic hepatitis C (CHC) with peginterferon a-2a and ribavirin can be successful even when patients continue the intravenous drug use. In this study, we compared the characteristics of age, gender, genotype, and stage of fibrosis and the therapy outcome among IVDU and patients with no history of drug use. The study included 69 patients diagnosed with chronic hepatitis C, evaluated and treated at the Clinic for infectious diseases in Nis from 2005 to 2009. HCV RNA was detected by a polymerase chain reaction and the determination of genotypes was undertaken. Liver biopsies were examined histopathologicaly. Patients received a combined treatment of peginterferon alfa-2a and ribavirin. Therapy efficiency was evaluated based on the achievement of the sustained virological response (SVR). A comparison of characteristics was performed with the use of Mann-Whitney U test, chi-square (χ2) test and logistic regression. IVDU were significantly younger than patients in the control group. Prevalence of stage 1 fibrosis was significantly higher among IVDU. The therapy outcome is influenced by the patient’s age and HCV genotypes. Each year added to one patient decreased the therapy efficiency by 8.1%, while genotypes 2 and 3 experienced a therapy which was 2.08 times more efficient than in other cases. IVDU represent a specific population different from non-using patients. However, they can be treated effectively if an adequate patient-doctor relationship is established.

The number of CD4 lymphocytes defines the evolutional stage of HIV-infection and is the most important for a reliable estimation of the individual risk of developing AIDS. However, it is difficult to predict the degree of immune reconstitution during antiretroviral therapy, as it varies significantly from one person to another. Further investigations to better understand the limitations of immunological success are necessary to improve the response to treatment and regimen durability. The current study includes HIV-infected patients in Southeastern Serbia with achieved virologic suppression of HIV infection. The CD4 count was determined by flow cytometry, and was correlated with the duration of treatment, initial number of CD4 cells, type of antiretroviral therapy, mode of transmission of infection, age and gender of examinees. The resulting arithmetic mean and standard deviation of CD4 number was 473±259 cells/µl (range, 1130 cells/µl). There was no statistically significant correlation between the values of CD4 count and length of treatment, stage of the infection at which the therapy was started, treatment profile, method of infection, age or gender. The obtained results are comparable with the existing studies that follow immunological response to antiretroviral therapy and primarily point out the issue of substantial individual response variability, which has not yet been fully elucidated.

Introduction. Listeria monocytogenes is the third most frequent cause of bacterial meningitis in adults. It commonly affects persons with defective cell-mediated immunity or advanced age, and only a few patients with no underlying predisposition have been reported. Case report. We presented an previously healthy, 18-year-old man with typical clinical features of meningitis. On the account of earlier treatment with ceftriaxone and cerebrospinal fluid finding, an assumption of partially treated bacterial meningitis was made. The initial treatment with vancomycin and ceftriaxone, substituted on day 4 with meropenem, did not produce any clinical effect. On day 6 Listeria monocytogenes was isolated and, even as late as that, the administration of ampicillin was followed by complete recovery of the patient. Conclusion. In younger, immunocompetent individuals, in spite of the existent diagnostic and therapeutic problems, the subacute course of Listeria monocytogenes meningitis provides enough time for appropriate treatment and favorable disease outcome.

Early diagnosis of the central nervous system (CNS) infections is a precondition of their successful treatment. However, the essential standard examination of the cerebrospinal fluid (CSF) is sometimes neither specific enough to define their basic nature, nor sufficient to differentiate them from processes of non-infectious origin. Supposing that the released surface molecules of activated immunocompetent cells could better define the character of inflammatory reaction, the levels of soluble CD4 antigens (sCD4) were determined with enzyme-immunosorbent test in the CSF of the patients with various CNS diseases. In contrast to cerebrovascular insults toxic-metabolic, and other conditions in control group, detectable sCD4 concentrations in acute encephalitis (24 ? 11U/ml) were verified at the beginning of the disease, being also present in cytologically diagnosed normal CSF findings. They were significantly higher (p