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HPV infection is considered to be the most important etiologic factor in cervical cancer development. In this retrospective study, which included the period from 2000 to 2012, the results of two molecular techniques used in the detection of HPV infection among women of the South Bačka District were analyzed. By using the technique of in situ hybridization and the rPCR method, the proportion of high-risk HPV among women with normal cytology was determined to be 19.8% and 32.7%, respectively, and among women with abnormal cytology 43.1% and 61%, respectively. Among the analyzed women, HPV type 16 was the most prevalent, followed by HPV types 31, 51 and 18. Application of molecular HPV diagnosis is valuable because it increases the sensitivity of the screening test, so that the application of both tests to detect cervical cancer is a true prevention of malignancy.

Viral gastrointestinal syndrome is a cause of morbidity and death worldwide. Infection is spread through contact with an infected person, as well as through contaminated food and water. A lethal outcome is possible in infants and young children due to dehydration and electrolyte imbalance. The study included 141 patients with gastroenteritis from Vojvodina. Real-Time PCR method in stool samples was used to determine the presence of rota-, noro-, and astrovirus nucleic acid. Out of 141 patients with gastroenteritis, 60.3% were confirmed to have one of the three viruses. Rotavirus was significantly more common in children up to 3 years of age (43.3%). Norovirus was more frequently detected in patients older than 20 (50%). These infections started in collectives. Astrovirus was detected in four patients (2.8%). The results confirm the necessity to implement PCR in routine diagnostics for the proper treatment of patients.

The West Nile virus is an arthropod borne or ARBO virus from the Flaviviridae family, which is maintained in nature in the transmission cycle between hosting birds and ornithophilic mosquito vectors. The virus is capable of infecting different vertebrate species and 60 mosquito species. The infection in humans can be asymptomatic or it can have different clinical manifestations ranging from light febrile diseases to fatal meningoencephalitis. This paper presents recent findings on the activity of the West Nile virus in Europe, the USA and Serbia. Presented are the results of serological testing of human populations and animals in Serbia, and the methods of molecular diagnostics to prove the existence of the virus. [Projekat Ministarstva nauke Republike Srbije, br. TR31084 i br. TR43007]

The currently dominant SARS-CoV-2 omicron variant, while causing mild respiratory symptoms, exhibits high transmissibility, drug resistance, and immune evasion. We investigated whether the presence of the SARS-CoV-2 affected the dynamics of fecal microbial composition isolated in culture in moderate COVID-19 patients. Blood, stool, and medical records were collected from 50 patients with confirmed SARS-CoV-2 infection. Two samples were taken per patient, at disease onset (within 5 days) and after symptom resolution (30-35 days). The part of the gut microbiota identifiable using MALDI-TOF MS was analyzed, and inflammatory cytokines and blood markers were measured in serum. The analysis identified 566 isolates at the species level, including 83 bacterial and 9 fungal species. Our findings indicate a change in the gut microbiota composition isolated in culture during the initial phase of infection, characterized by the proliferation of opportunistic bacteria such as Enterococcus spp. and Citrobacter spp., at the expense of beneficial commensal bacteria from the genus Bacillus and Lactobacillus . Additionally, the enrichment of fungal pathogens in fecal samples collected 30 days after the cessation of disease symptoms might suggest a prolonged disruption of the gut microbiota even after the resolution of COVID-19 symptoms. This study contributes to a growing body of evidence on the systemic effects of SARS-CoV-2 and highlights the importance of considering gastrointestinal involvement in the management and treatment of COVID-19.

This study aimed to estimate the serological status and dynamic changes in the prevalence of Parvovirus B19 (PVB19) antibodies within the general population residing in the northern part of the Republic of Serbia (Province of Vojvodina) during a 16-year period. Serum samples were analyzed for Human PVB19-specific IgM and IgG antibodies using enzyme-linked immunosorbent assay (ELISA). Throughout the study period, the overall seroprevalence was 49.51%. Approximately 10% of patients exhibited a serologic profile positive for PVB19 IgM antibodies. Notably, seroprevalence varied significantly, ranging from 9.12% in the pediatric cohort (ages 1-4 years) to 65.50% in the adult demographic (40-59 years old). Seroprevalence was higher (51.88%) among women compared to men (42.50%). Immunologically naive pregnant women in the age groups 26-36 and 36-45 years had 45% (OR = 0.55, 95% CI: 0.31-1.00) and 52% (OR = 0.48; 95% CI: 0.24-0.94) lower odds of having negative IgM and IgG compared to those in age group 16-25 years old. Improved knowledge of the epidemiology of PVB19 may assist clinicians in the differential diagnosis of PVB19 clinical manifestations. The PVB19 detection is particularly important for monitoring individuals in risk groups such as women of reproductive age, medical staff, patients with hematological disorders, and those with immunodeficiency.

Objectives: The aim of the study was to evaluate the immune status of young people from the Vojvodina province, Serbia, through the detection of IgG antibodies specific for the L1 protein of HPV types 6, 11, 16, and 18 contained in quadrivalent vaccine., Methods: The study enrolled 514 healthy persons of both genders, aged between 18 and 30 years. All potential participants were informed about the project's aims by trained interviewers before venous blood collection. Also, participants completed a specially designed anonymous questionnaire to identify socio-demographic characteristics and individual behaviours associated with HPV seroprevalence. VPL HPV L1-specific IgG antibodies were measured using a semi-quantitative HPV IgG ELISA kit (Dia.Pro, Italy)., Results: A total of 472 (91.8%) young subjects had no detectable antibodies against high- and low-risk HPV types covered by the quadrivalent vaccine. A slightly higher number of seropositive individuals were detected in the age group of 26-30 years compared to younger than 25. Multivariate analysis showed that the number of lifetime sexual partners was the most powerful predictor of HPV seropositivity (OR = 3.483, 95% CI: 1.294-9.379)., Conclusions: Obtained data point out low levels of naturally induced HPV-specific serum antibodies among the target population in the Vojvodina province. The present work highlights the significance and potential benefits of HPV vaccination. Routine HPV vaccination should be the public health priority in our country and should be included in the national immunization programme as soon as possible.

Rotaviruses (RV) are the leading cause of gastroenteritis in infants, young children, and adults, responsible for serious disease burden. In the period 2012-2018, a cross-sectional study was conducted using stool samples collected from patients with acute gastroenteritis from Vojvodina, Serbia. We described age and gender distribution, as well as seasonal patterns of RV prevalence. Out of 1853 included stool samples, RV was detected in 29%. Hospitalized children between 1-2 years old were especially affected by RV infection (45%). The highest prevalence of infection was observed during the colder, winter/spring months. We compared sequenced representative G and P genotypes circulating in Serbia with vaccine strains and determined their genetic similarity. Genotype combination G2P[4] was the most prevalent (34.6%), followed by G2P[8] (24.1%) and G1P[8] (21.1%). Given that several epitopes were conserved, neutralization motifs among circulating strains can be characterized as sufficiently matching vaccine strains Rotarix™ and RotaTeq™, but existing antigenic disparities should not be overlooked. The present results contribute to a better insight into the prevalence of rotavirus infection in our region and point out the need for epidemiological surveillance of rotaviruses before the introduction of vaccines. These data can help formulate future vaccine strategies in Serbia.

Motivated by the One Health paradigm, we found the expected changes in temperature and UV radiation (UVR) to be a common trigger for enhancing the risk that viruses, vectors, and diseases pose to human and animal health. We compared data from the mosquito field collections and medical studies with regional climate model projections to examine the impact of climate change on the spreading of one malaria vector, the circulation of West Nile virus (WNV), and the incidence of melanoma. We analysed data obtained from ten selected years of standardised mosquito vector sampling with 219 unique location-year combinations, and 10 years of melanoma incidence. Trends in the observed data were compared to the climatic variables obtained by the coupled regional Eta Belgrade University and Princeton Ocean Model for the period 1961-2015 using the A1B scenario, and the expected changes up to 2030 were presented. Spreading and relative abundance of Anopheles hyrcanus was positively correlated with the trend of the mean annual temperature. We anticipated a nearly twofold increase in the number of invaded sites up to 2030. The frequency of WNV detections in Culex pipiens was significantly correlated to overwintering temperature averages and seasonal relative humidity at the sampling sites. Regression model projects a twofold increase in the incidence of WNV positive Cx. pipiens for a rise of 0.5°C in overwintering TOctober-April temperatures. The projected increase of 56% in the number of days with Tmax ≥ 30°C (Hot Days-HD) and UVR doses (up to 1.2%) corresponds to an increasing trend in melanoma incidence. Simulations of the Pannonian countries climate anticipate warmer and drier conditions with possible dominance of temperature and number of HD over other ecological factors. These signal the importance of monitoring the changes to the preparedness of mitigating the risk of vector-borne diseases and melanoma., Competing Interests: All authors except MP have declared that no competing interests exist. Commercial affiliation of MP is to Avia-GIS NV (commercial funder) in which she is under an employment contract since September 2016. Avia-GIS NV provided support in the form of salaries for author (MP) but did not have any additional role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Although rubella is usually a mild childhood disease, this infection in early pregnancy poses a serious problem due to its teratogenic effect. The goal of interrupted circulation and elimination of rubella virus was achieved in many countries in the world. The aim of this study was to determine the status of rubella immunity in Vojvodina and evaluate Serbia's progress toward this goal. A total of 3404 residual serum samples from patients of all ages (1 to 84 years) were included in the study. Samples were collected between May 2015 and December 2017 in Vojvodina. Rubella IgG antibodies were determined using an indirect chemiluminescent immunoassay. Percentage of participants seropositive for rubella antibodies was 92.9% in the entire sample. The highest number of seronegatives was in the youngest (1 year) age group (44.7%), followed by the group aged 24-49 (6.4%) and 2-11 years (6.2%). The absence of a higher percentage of children with protective anti-rubella antibodies in the group aged 2-11 can be explained by a lower immunization coverage during certain years. Participants in the group aged 24-49 were born during the pre-vaccination period with lower rubella incidence, leading to the conclusion that not all individuals of that age came into a contact with the virus. Comparing levels of anti-rubella IgG antibodies of seropositive males and females of different ages reveals that the immunity after a contact with the virus and a previously acquired infection is stronger than the immunity after the vaccination. Although the incidence rate of rubella in Vojvodina has been low for the last ten years, there is still a risk of an outbreak due to a decrease in immunization coverage. This study shows that the percentage of susceptible individuals is high, especially considering women aged 24-49, and that additional ("catch-up") immunization is required., Competing Interests: The authors have declared that no competing interests exist.

A suspicion on West Nile virus (WNV) in Serbia was first reported in 1972 by a seroprevalence study, after which no data were available for four decades. We report full sequence of the isolate obtained for the first time from a human sample in Serbia. The closest clustering was obtained with lineage 2 WNV identified in Greece in 2010. Since WNV lineage 2 emerged in Europe in 2004, a cocirculation of lineages 1 and 2-as observed in Hungary and Italy-cannot be excluded. The reinforcement of surveillance will be required to investigate the possible cocirculation of the two lineages and the burden of WNV in the local population.

Efforts to detect West Nile virus (WNV) in the Vojvodina province, northern Serbia, commenced with human and mosquito surveillance in 2005, followed by horse (2009) and wild bird (2012) surveillance. The knowledge obtained regarding WNV circulation, combined with the need for timely detection of virus activity and risk assessment resulted in the implementation of a national surveillance programme integrating mosquito, horse and bird surveillance in 2014. From 2013, the system showed highly satisfactory results in terms of area specificity (the capacity to indicate the spatial distribution of the risk for human cases of West Nile neuroinvasive disease - WNND) and sensitivity to detect virus circulation even at the enzootic level. A small number (n = 50) of Culex pipiens (pipiens and molestus biotypes, and their hybrids) females analysed per trap/night, combined with a high number of specimens in the sample, provided variable results in the early detection capacity at different administrative levels (NUTS2 versus NUTS3). The clustering of infected mosquitoes, horses, birds and human cases of WNND in 2014-2015 was highly significant, following the south-west to north-east direction in Vojvodina (NUTS2 administrative level). Human WNND cases grouped closest with infected mosquitoes in 2014, and with wild birds/mosquitoes in 2015. In 2014, sentinel horses showed better spatial correspondence with human WNND cases than sentinel chickens. Strong correlations were observed between the vector index values and the incidence of human WNND cases recorded at the NUTS2 and NUTS3 levels. From 2010, West Nile virus was detected in mosquitoes sampled at 43 different trap stations across Vojvodina. At 14 stations (32.56%), WNV was detected in two different (consecutive or alternate) years, at 2 stations in 3 different years, and in 1 station during 5 different years. Based on these results, integrated surveillance will be progressively improved to allow evidence-based adoption of preventive public health and mosquito control measures., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

Introduction: Literature data concerning risk factors for severe influenza in post-2009 pandemic period, from low- and middle-income Central and Eastern European countries are very limited., Objective: The aim of this study was to investigate the risk factors for severe A(H1N1)pdm09 and A(H3N2) influenza during the post-2009 pandemic period., Methods: During four consecutive seasons of 2010/2011–2013/2014, nasopharyngeal or nasal and pharyngeal swab samples from 153 patients with mild and 147 patients with severe influenza were tested using real-time reverse transcription polymerase chain reaction (real-time RT PCR) assays., Results: The study indicated three statistically significant risk factors of influenza severity, including presence of chronic underlying illness/condition [odds ratio (OR) of 15.2, 95% confidence interval (CI) of 1.8–125.4, p = 0.001), age ≥15 years (OR 9.2, 95% CI 3.5–24.1, p < 0.001), and delay in medical care of more than two days after the symptoms onset (OR 3.2, 95% CI 1.6–6.4, p = 0.001)., Conclusion: Obtained results confirmed that patients with chronic underlying illness/condition and older than 15 years had the highest risk for serious complications from influenza and highlighted the importance of start of antiviral therapy within the first two days of illness in order to reduce the risk for the most severe outcomes of influenza, such as acute respiratory distress syndrome and lethal outcome.

Introduction: Tick-borne meningoencephalitis virus is a flavivirus that causes the most important vector-borne central nervous system infection in many countries of Europe and Asia. There are three subtypes of tick-borne encephalitis virus: European, Siberian and the Far-Eastern subtype., Transmission: In endemic areas, the virus remains in transmissive cycles between Ixodes ticks and small rodents., Clinical Picture: In most cases (70-98%) infection goes asymptomatically. In about one-third of meningitis cases, meningoencephalitis or meningomyelitis is developed. Postencephalytic syndrome may be the complication of the infection, presenting with neurological symptoms., Diagnosis: Etiologic diagnosis of tick-borne meningoencephalitis is only made on basis of laboratory analyses. Reverse transcription-polymerase chain reaction is used for determining the presence of virus in the blood and cerebrospinal fluid. Antibodies in blood and cerebrospinal fluid can be detected by serological tests., Prevention: The most efficient way to control this potentially severe disease with possible serious long-term consequences is vaccination. It should be recommended to persons who live or travel to endemic areas., Conclusion: In Serbia, tick-borne encephalitis virus infection belongs to the list of reportable diseases; however, there are no reported cases because the diagnostics is not performed routinely. We believe that the significance of this zoonosis must be examined in our country and some of its parts because of preliminary positive serological findings found out in Vojvodina as well as because of reported cases in neighboring countries such as Hungary and Croatia and its worldwide distribution.

Background/aim: West Nile virus (WNV) is a neurotropic RNA virus particle which belongs to the Flaviviidae family, genus Flavivirus. It is sustained in arthropods within the transmission cycle between the mosquitoes and birds. Most commonly (80% of cases) WNV infections are asymptomatic among people. Less than 1% of patients develop neuroinvasive forms of the disease--meningitis, encephalitis, or acute flaccid paralysis. The aim of the research was to determine most common clinical and laboratory manifestations, to emphazise the presence of comorbidities and outcomes of treatment among patients with WNV infection., Methods: This retrospective study, which was conducted in the period from January 1, 2012 to December 31, 2013, evaluated 32 patients who were diagnosed with WNV infection based on clinical findings, laboratory, and serological tests. To assess statistical significance we used χ2, and t-test., Results: The study involved 22 (69%) males and 10 (31%) females aged from 31 to 65 years. On admission, there were 16 (50%) febrile individuals, 27 (84.4%) with positive meningeal signs, 17 (53.2%) with pathological neurological signs, and 10 (31.3%) with consciousness disorders. WNV infection was confirmed by the method enzyme linked immuno sorbent assay (ELISA) in all the patients, while Reverse Transcription Polymerase Chain Reaction (RT-PCR) test was positive in 3 (30%) of the tested patients. Cardiovascular comorbidities dominated in 7 (21.9%) of the cases. Full recovery was accomplished in 87.5% of the cases., Conclusion: The results of our study show that the absence of meningeal signs and fever on the day 7 of hospital treatment are indicators of good course and prognosis of neuroinvasive forms of WNV infection. Comorbidities do not increase the risk of disease. ELISA test is a sovereign diagnostic method. In most cases, after the administered symptomatic therapy, the complete recovery of patients was achieved.

Introduction: The aim of this study was to determine the percentage of seropositive pregnant women, i.e. of pregnant women infected with Toxoplasma gondii in order to provide an insight into the risk of developing congenital toxoplasmosis in our community., Material and Methods: In the period of two years, 662 pregnant women from Vojvodina were examined serologically. The enzyme-linked immunosorbent assay tests were performed to determine IgM and IgG antibodies against Toxoplasma gondii and the complement fixation test was done to detect total antibodies against Toxoplasma gondii., Results and Discussion: Seropositivity was determined in 180 pregnant women (27.19%). Of 135 pregnant women examined in the routine control in pregnancy, 16.30% were seropositive and out of five proven, completely new Toxoplasma gondii intfections, three were detected in pregnant women who had undergone the routine check-up for no specific symptoms. A detailed analysis of the frequency of seropositive findings in relation to clinical diagnoses and the place of residence of pregnant women (urban and rural areas) was performed. At the same time, the results from the serological reactions were presented, commented and interpreted, and recommendations were given for the implementation of additional examinations (eg, IgG antibody avidity test) in order to make the accurate diagnosis., Conclusion: It can be concluded that the occurrence of congenital toxoplasmosis is still a problem in our community and that the best prevention is the prompt and adequate examination of pregnant women for the presence of Toxoplasma gondii infection.

Introduction: Human enteroviruses represent the most common etiological agents of aseptic meningitis. Rapid diagnosis of aseptic meningitis affects the management of patients., Objective: The aim of this work was to assess the efficacy of rapid antigen detection (RAD) assay for the confirmation of human enteroviruses in comparison to that of the conventional cell culture (CCC), and to identify the serotypes associated with aseptic meningitis cases in the Autonomous Province of Vojvodina., Methods: RAD assay was carried out using centrifugation of inoculated Vero, RD and HEp-2 cell cultures and indirect immunofluorescence with Pan-Enterovirus 2E11 reagent (Millipore-Chemicon). CCC was performed using the same type of cells and the same immunofluorescence reagent for enterovirus confirmation., Results: Out of 70 analyzed samples (29 cerebrospinal fluid specimens, 27 stool specimens, 9 rectal and 5 throat swabs), 36 (51.4%) were positive by immunofluorescence after CCC and 34 (48.6%) by the RAD assay. The sensitivity of RAD assay was 94.4% and specificity 100%. Detection time of enteroviruses by the RAD assay was 3 days, and by CCC varied from 3 to 13 days (mean time 6.1 days). Within 72 h from inoculation, a cytopathic effect (CPE) occurred in only 19 (47.5%) of 40 CPE positive samples. Serotyping revealed 11 types of enteroviruses: coxsackievirus A16, B3, B4, B5, and echovirus 2, 4, 6, 11, 13, 16 and 30., Conclusion: The RAD assay was slightly less sensitive than CCC and significantly shortened the detection time of enteroviruses, so it may be useful in rapid diagnosis of enteroviral meningitis.

Introduction: Bacteria from genus Enterococcus may cause infections mostly in those who are immunocompromised and those who underwent endoscopic or surgical procedures. Endocarditis is caused by enterococci in 5-10% of cases. Its clinical presentation does not differ from endocarditis of other bacterial origin. Previous susceptibility testing is needed for appropriate choice of antibiotics against enterococci. The treatment recommendations for enterococcal endocarditis were given by American Heart Association recently., Case Report: A case ofenterococcal endocarditis in a young female person hospitalised at Clinic for infectious diseases was reviewed. The disease was diagnosed during an extensive diagnostic procedure. Multiply repeated echocardiographic examination helped to find out bacterial vegetations on the mitral valve. Enterococcus species was isolated from several blood cultures. Despite powerful antibiotic treatment, the additional valvular replacement had to be done., Discussion: A case of enerococcal endocarditis in a young female person was reviewed. The right diagnosis was based on a thorough clinical examination in cooperation with cardiologists using repeated transthoracic and transesophageal echocardiography. Echocardiography, even if it is transesophageal, has limited sensitivity and specificity, so it is sometimes necessary to be repeated for several times in diagnosing endocarditis. The source of endocarditis was not identified. The combined antimicrobial and surgical treatment led to the complete recovery of patient., Conclusion: Enterococcal endocarditis rarely occurrs in young females. Infective disease specialists sometimes face enterococcal endocarditis in their practice, mostly when they have to cope with fever of unknown origin. An appropriate approach to such conditions includes careful search for heart valve changes by repeated echocardiographic finding, if necessary.

VIRUS: West Nile virus is a single-stranded RNA virus of the family Flaviviridae, genus Flavivirus., Epidemiology: West Nile virus is maintained in the cycle involving culicine mosquitoes and birds. Humans typically acquire West Nile infection through a bite from infected adult mosquito. Person to person transmission can occur through organ transplantation, blood and blood product transfusions, transplacentally and via breast milk. Human cases of West Nile infections were recorded in Africa, Israel, Russia, India, Pakistan. In Romania in 1996 West Nile fever occurred with hundreds of neurologic cases and 17 fatalities. First human cases in the United States were in New York City where 59 persons were infected and had fever, meningitis, encephalitis and flaccid paralysis. CLINICAL MANIFESTATION: Most human cases are asymptomatic. The majority of symptomatic patients have a self limited febrile illness. Fatigue, nausea, vomiting, eye pain, headache, myalgias, artralgias, lymphadenopathy and rash are common complaints. Less than 1% of all infected persons develop more severe neurologic illness including meningitis, encefalitis and flaccid paralysis., Laboratory Diagnosis: Diagnosis of West Nile virus infection is based on serologic testing, isolation of virus from patient samples and detection of viral antigen or viral genom. ELISA test and indirect immunofluorescence assay are used for detecting IgM and IgG antibodies in serum and cerebrospinal fluid., Treatment: In vitro studies have suggested that ribavirin and interferon alfa-2b may be useful in the treatment of West Nile virus disease., Prevention: The most important measures are mosquito control program and personal protective measures.

The investigation included 91 patients in who an acute or previous EBV infection was established by ELISA test. All patients were also subjected to the Paul-Bunnell-Davidsohn test, while 20 patients were tested by the rapid screening test Clearview IM. The diagnosis of acute infective mononucleosis was in 61 patients (67%) confirmed by the Elisa test, and in 12 patients (19.67%) by the Paul-Bunnell-Davidsohn test, while the rapid screening test Clearview IM demonstrated too low a detection of heterophile antibodies. The rapid screening test was not reliable. In 25% cases, the test was invalid, at early infection stages the rapid test failed to diagnose any case of the EBV virus infection. Paul-Bunell-Davidsohn was often negative, especially with young children. Therefore, priority should be given to virology tests based on the detection of specific antibodies to EBV antigen.

Introduction: Group A streptococci is the causative agent in 80 percents of human streptococcal infections. The only member of this group is Streptococcus pyogenes. CLINICALFEATURES OF GAS INFECTIONS: The various clinical entities and related complications caused by pyogenic streptococci are reviewed in the article. Pharyngitis, scarlet fever, skin and soft tissue infections (pyoderma, cellulitis, perianal dermatitis, necrotising fasciitis) and streptococcal toxic shock syndrome are described., Diagnosis of Gas Infections: The way of setting the diagnosis including epidemiological data, clinical features and the course of illness, laboratory findings and supportive diagnostic methods are represented in the article., Differential Diagnosis: The most important clinical entities which should be discussed in differential diagnosis of diseases caused by pyogenic streptococci are listed., Treatment of Gas Infections: The major principles of etiologic treatment through widely accepted strategies related to first choice antibiotics and alternatives are reviewed.

Introduction: Human parvovirus B19 is found worldwide. It causes various infections, including fifth disease (erythema infectiosum) in small children, acute arthropathy in adults, transient aplastic crisis and chronic anemia in immunocompromised patients and even fetal infection, which may result in intrauterine fetal death or fetal hydrops. Many of these manifestations of B19 infection are caused by infection of erythroid precursor cells in bone marrow., Material and Methods: The aim of this paper was to establish the frequency of parvovirus B19 infection in the population of Vojvodina, as well as to indicate the significance of further investigations particularly in highly vulnerable population groups such as small children, pregnant women and immune deficient persons. A total of 244 serum samples of out- and in-patients of different age were analyzed using SERION ELISA classic parvovirus B19 IgG/IgM quantitative and qualitative tests for identification of specific antibodies against human parvovirus B19., Results: Acute infection was found in 35% of examinees, whereas parvoviurs B19 was identified in 32% of examined persons. Our tests results proved that 20% of examined pregnant women in our surroundings have acute HPB19 infection. At the same time, 45% of pregnant women have no specific antibodies, so they are at risk of infection during pregnancy. Acute infection was diagnosed in 41 children (43%): 22 samples (23%) were positive only to IgG antibodies and in 32 samples (34%) neither IgM nor IgG antibodies were identified. Acute infection was more frequently found in preschool children, i.e. in children aged 4 to 6 years (29%)., Conclusion: In the absence of complete data on the frequency of particular diseases caused by this virus in our population, tests for human parvovirus B19 are strongly recommended.

Introduction: Influenza A viruses can infect humans, some mammals and especially birds. Subtypes of human influenza A viruses: A(H1N1), A(H2N2) and A(H3N2) have caused pandemics. Avian influenza viruses vary owing to their 15 hemagglutinins (H) and 9 neuraminidases (N)., Human Cases of Avian Influenza a: In the Netherlands in 2003, there were 83 human cases of influenza A (H7N7). In 1997, 18 cases of H5N1 influenza A, of whom 6 died, were found among residents of Hong Kong. In 2004, 34 human cases (23 deaths) were reported in Viet Nam and Thailand. H5N1 virus-infected patients presented with fever and respiratory symptoms. Complications included respiratory distress syndrome, renal failure, liver dysfunction and hematologic disorders. Since 1999, 7 cases of human influenza H9N2 infection have been identified in China and Hong Kong., The Importance of Human Infection With Avian Influenza Viruses: H5N1 virus can directly infect humans. Genetic reassortment of human and avian influenza viruses may occur in humans co-infected with current human A(H1N1) or A(H3N2) subtypes and avian influenza viruses. The result would be a new influenza virus with pandemic potential. All genes of H5N1 viruses isolated from humans are of avian origin., Prevention and Control: The reassortant virus containing H and N from avian and the remaining proteins from human influenza viruses will probably be used as a vaccine strain. The most important control measures are rapid destruction of all infected or exposed birds and rigorous disinfection of farms. Individuals exposed to suspected animals should receive prophylactic treatment with antivirals and annual vaccination.

Introduction: Lack of exact clinical studies on effects of corticosteroids in therapy and prevention of herpes zoster-related pain, elicited many controversies in the past. The aim of our study was to estimate effects of prednisone on frequency, intensity and duration of postherpetic neuralgia., Material and Methods: 68 immunocompetent herpes zoster patients, 8-90 years of age (37 females and 31 males, mean age 55.7 years) were enrolled for study; 30 patients were treated with acyclovir (5 x 800 mg daily for a 7-day period) and prednisone (initial daily dose 60 mg, tapering over 14 days), and the control group of 38 patients with acyclovir only. Patients were clinically followed up for 3 months after complete resolution of skin lesions. Chi-square test was used in statistical data analysis., Results: The difference regarding incidence of postherpetic neuralgia in acyclovir/prednisone group and acyclovir group (although slightly less in the former one) was not significant. Duration of postherpetic neuralgia over 3 months was similar in both groups. Mild postherpetic pain was more common in the acyclovir/prednisone group (44.4%) than in the acyclovir group (28.6%); however, statistical validation requires more patients to be studied., Discussion: Results of our study didn't confirm efficiency of prednisone regarding occurrence and characteristics of postherpetic neuralgia. Failure of prednisone therapy may be partly contributed to advanced age of patients and delayed onset of therapy., Conclusion: Use of corticosteroids in zoster patients gives neither reliable protection from appearance of postherpetic neuralgia, nor shortens its duration. Further investigations are necessary to estimate their effects on postherpetic pain.

Aim: Hepatitis A remains a common cause of morbidity in developing countries, sometimes affecting adults. The aim of this study was to determine the age and sex distribution of adult hepatitis A patients, the seasonal appearance of disease and the possible peripheral blood count (PBC) disorders at the beginning of the icteric phase in different clinical forms of the disease., Methods: The retrospective study was carried out during 1987-1990, with 106 adult hepatitis A patients assigned to 1 of 3 subgroups: typical (74 patients), prolonged (28 patients) and cholestatic forms of hepatitis A (4 patients) whose PBC was analysed at the beginning of the icteric phase of the disease. The hypothesis of the study was that there were significant differences between mean values of PBC in different subgroups. In data analysis, Student's ''t''-test was performed where appropriate., Results: Fifteen (53.8%) males and 49 (46.2%) females were involved in the study (median age 24.7 years). Most of them were hospitalized at the end of Summer and Autumn. Significant differences were observed neither in mean values of red blood count (RBC) nor platelet count among studied groups. Mild leucopenia was found in the vast majority of patients. In the differential count, only the monocyte count showed a slightly significant difference between prolonged form (4%) and typical form (3%), (t=2.35, p<0.05)., Conclusions: There is no single reason to use peripheral blood count as a specific diagnostic marker in setting the diagnosis of hepatitis A, except for its importance as a relative laboratory indicator of infection of viral origin.

Introduction: Herpes zoster is a world-wide disease of older age commonly presenting with preherpetic pain. The aim of the study was to determine clinical characteristics of preherpetic neuralgia and its influence on occurrence of postherpetic neuralgia., Material and Methods: A prospective, controlled trial included 88 patients with preherpetic neuralgia. 44 herpes zoster patients without preherpetic neuralgia were included in the control group. All of them were clinically followed-up for three months after complete healing of skin lesions., Results: Older age (> 60 years) was significantly predominant (59.1%) compared with other age groups (p < 0.01) as well as female sex (59.9%) compared with the male sex (p < 0.01). There was no significant predominance of any type of preherpetic neuralgia (stabbing, burning, itching, dull pain). More intense preherpetic pain (reported as "severe" and "moderate") was established more often than mild pain. The mean duration of preherpetic pain was 4.4 days (ranged between 1-20 days). Postherpetic neuralgia developed in 36/88 patients with preherpetic neuralgia (affecting predominantly older than 50 years of age--31/36), but there was no significant difference in proportion of postherpetic neuralgia (PHN) according to those without preherpetic neuralgia., Discussion and Conclusion: People older than 60 years are the most common age group among herpes zoster patients suffering from preherpetic neuralgia. Sex distribution of patients with preherpetic pain reveals highly significant predominance of female sex. Opposite to some other authors' reports, preherpetic neuralgia and its severity have not been proven as risk factors for postherpetic neuralgia in patients involved in our trial.

Introduction: It is well known that varicella, a clinical entity of primary varicella-zoster virus infection, is most commonly a mild, benign disease of preschool and school children. However, in spite of progress in diagnostic approach and up-to-date treatment based on specific antiviral agents, many clinicians face cases of life-threatening varicella with uncertain course and prognosis, in adult and immunocompromised patients predominantly. ETIOPATHOGENESIS AND HISTOPATHOLOGY: Varicella-zoster virus (VZV) is a member of the Herpesviridae family. The portal of entry is nasopharyngeal mucosa, sometimes conjunctiva. VZV causes a generalized infection and has dermal tropism. Histopathological findings include degenerative changes of epithelial cells such as ballooning, multinucleated giant cells and eosinophilic intranuclear inclusions. CLINICAL FEATURES AND COMPLICATIONS: The evolution of varicella includes 3 stages of disease and is characterized by gradual onset, constitutional symptoms, signs of upper respiratory tract and polymorphous rash. According to the severity of clinical presentation, there is a number of mild forms and severe, even life-threatening forms of varicella. According to etiology, varicella complications are divided in viral and bacterial ones. Immunocompromised patients often develop serious, life-threatening forms of varicella. Especially the prognosis of visceral dissemination commonly followed by liver and brain involvement is dubious. The course of varicella in pregnancy may be severe because of changed immune response and more frequent appearance of complications in adults. The probability of vertical transmission of VZV is 25%. The early infection of embryo may lead to abortion. The symptomatic intrauterine infection appears in about 3% of all cases of varicella of pregnant women and is called a "congenital varicella syndrome". Vertical transmission of VZV in the late pregnancy may result in preterm delivery or perinatal varicella (varicella in the newborn)., Diagnosis: The diagnosis is made by history and physical examination. Atypical cases of varicella require laboratory confirmation of diagnosis including virus/viral antigen detection, virus isolation and identification or serological diagnosis (detection of specific anti-VZV antibodies in patient's sera)., Prevention: Prevention of varicella includes active and passive immunization. Passive immunization is based on the use of varicella-immunoglobulin (VZIG). A live, attenuated vaccine was developed by Takahashi and colleagues in Japan. This vaccine is recommended, first of all, to seronegative immunodeficient children. Vaccine virus is sensitive to acyclovir and is not transmissible to non-vaccinated children. The duration of vaccine-induced immunity is at least 6-10 years in the majority of vaccinees., Therapy: Hygiene is the most important principle in the management of varicella, particularly bathing and use of a stringent soaks to avoid secondary bacterial skin infection. The patient should be isolated in a well-ventilated room with regular change of bed, linen and light food should be provided. Indications for, acyclovir (and other antiviral agents) treatment are, individuals who have suffered from severe forms of varicella and those, belonging to the high-risk group of patients (adults, viral, complications, immunocompromised host).

History: There has been considerable interest in varicella-zoster virus in the middle of the twentieth century. Virus isolation in 1958 had made it possible to find out the complete DNA sequence of the varicella-zoster virus. Molecular identify of the causative agents of varicella and shingles had been proved. ETIOPATHOGENESIS AND HISTOPATHOLOGY: Varicella-zoster virus is a member of the Herpesviridae family. After primary infection which results in varicella, the virus becomes latent in the cerebral or posterior root ganglia. Some of these individuals develop shingles after several decades because of virus reactivation. It is caused by decline of cellular immune response. Circumstances such as old age, hard work, using of steroids or malignancies contribute to the appearance of shingles. Histopathological findings include degenerative changes of epithelial cells such as ballooning, multinucleated giant cells and eosinophilic intranuclear inclusions., Epidemiology: Shingles occur sporadically, mainly among the elderly who have had varicella. There is no seasonal appearance of shingles. Individuals suffering from shingles may be sometimes contagious for susceptible children because of enormous amount of virus particles in vesicle fluid., Clinical Features: Clinically, shingles is characterized at first by pain or discomfort in involved dermatome, usually without constitutional symptoms. Local edema and erythema appear before developing of rash. Maculopapular and vesicular rash evolves into crusts. The most commonly involved ganglia are: lumbar, thoracic, sacral posterior root ganglia, then geniculate ganglion of the VIIth cranial nerve and the trigeminal ganglion. The most common complication, postherpetic neuralgia, may last for as long as two or three weeks, sometimes even one year or more. Other complications that may be seen in shingles, but more rarely, are ocular (keratitis, iridocyclitis, secondary glaucoma, loss of sight), neurological (various motor neuropathies, encephalitis, Guillain-Barre syndrome), secondary bacterial infection of vesicles. Immunocompromised patients often develop more severe disease lasting up to two weeks, skin lesions are more numerous and often with hemorrhagic base and there is a high possibility for cutaneous dissemination and visceral involvement including viral pneumonia, encephalitis and hepatitis. Chronic shingles may also be found in immunocompromised hosts, particularly in those with a diagnosis of HIV infection. In patients with HIV infection, shingles is often characterised by radicular pain and itching several days before appearance of skin lesions. Those patients may have two or more dermatomes involved and recurrences of shingles cannot be quite infrequent in those patients. But visceral involvement is rarer than in other immunocompromised patients. Shingles may occur in the second half of pregnancy and usually have a mild course. However, congenital abnormalities has been described in few cases., Diagnosis: The diagnosis of shingles is usually made by history and physical examination. Exceptionally, for example in zoster sine herpete and atypical forms of shingles, virus isolation and serological tests must be used., Differential Diagnosis: Some other diseases may cause similar skin lesions and rash (varicella, erysipelas, impetigo, enteroviral infections, herpes simplex infections). These diseases are excluded by using detailed history taking and physical examination, laboratory findings, virus isolation and commercially available serological tests., Therapy: The vast majority of immunocompetent persons with shingles should be treated only by symptomatic therapy. Predominantly it is directed toward reduction of fever and avoiding secondary bacterial skin infection in immunocompetent hosts. Acute neuritis and post-herpetic neuralgia require administration of various analgesics, even like amitriptyline hydrochloride and fluphenazine hydrochloride. Acyclovir therapy is limited to ophthal

Introduction: Toxoplasma gondii is a ubiquitous parasite of all species of mammals and birds (1). Most often the infection in the immunocompetent persons is asymptomatic. Symptoms (if present) are usually mild and self-limited. Infection in the fetus and immunodeficient patients may lead up to clinically severe and often fatal toxoplasmosis (2)., Etiology: Toxoplasma exists in three forms: oocysts, tissue cysts and tachyzoites. The definitive hosts of Toxoplasma are members of the cat family. They shed unsporulated oocysts in the feces. After sporulation oocysts become infectious. Tachyzoites are crescent-shaped forms responsible for manifestations of acute Toxoplasma infection in the intermediate hosts (6,7). Cysts are formed, particularly in brain, heart muscle and skeletal muscles. The cyst forms of the parasite are seen in the latent stage of the infection. Postnatally acquired toxoplasmosis is a consequence of infection from cysts (by ingestion of undercooked meat of infected animals), oocysts (by ingestion of soil, fruits, vegetables contaminated by cat feces) and tachyzoites (by blood transfusion). Congenital Toxoplasma infection causes congenital toxoplasmosis., Pathogenesis: Some authors represented the concept that latent (chronic) infection with Toxoplasma during pregnancy can result in congenital infection in the offspring (8-11). Now it is generally agreed that congenital transmission of Toxoplasma occurs only when the infection is acquired during gestation (6,7, 12-16). More than half of the fetuses escape infection, one-third are definitely infected, and the infection is more often subclinical than clinically obvious (15). The fetus is infected hematogenously from inflammatory foci in the placenta formed during parasitemia in the mother., Clinical Manifestations: Approximately 75% of congenitally infected newborns are asymptomatic. Wilson's study indicates that nearly all such children will develop adverse sequelae (neurologic, intellectual, audiologic and ophthalmologic) 21). Severe forms of congenital toxoplasmosis occur only in 10% of infected offsprings. Clinical manifestations of congenital toxoplasmosis are different. Clinical findings in patients with congenital toxoplasmosis may include: chorioretinitis and other ocular findings, central nervous system abnormalities (such as microcephaly, hydrocephalus, encephalomyelitis, seizures and mental retardation), icterus, hepatosplenomegaly, rash, anemia, erythroblastosis, thrombopenia., Incidence: Incidence of human congenital toxoplasmosis is different in different countries. The incidence in Britain is 0.6 subclinical infection and 0.09 severe illnesses per 1000 births (22). The incidence in USA is between 1/1000 and 1/8000 live births (23). In France the incidence is 1/2000. In Slovenia the incidence is 2.3 cases per 1000 births (25)., Diagnosis: Diagnostic methods are: 1. Isolation of the parasite from the placenta, blood, body fluids (by inoculation of specimens into mice or tissue cultures). 2. Histologically by demonstration of tachyzoites in tissue sections or smears of body fluids. 3. Serologic diagnosis. The most important diagnostic methods are serologic tests. For diagnosis of congenital toxoplasmosis determination of IgM antibody (in the serum of newborn infant) has the greatest importance. The fetus is able to produce IgM specific antibody. The presence of IgM antibodies in serum obtained from the neonate is an evidence of fetus infection in utero. Maternal IgM antibodies do not pass the placenta. IgM antibodies may be demonstrable by indirect fluorescent antibody test (IgM-IFA), enzyme linked immunosorbent assay (IgM-ELISA), double sendwich IgM enzyme-linked immunosorbent assay (DS-IgM-ELISA), IgM immunosorbent agglutination assay (IgM-ISAGA) and reversed enzyme immunoassay (REI). For diagnosis of congenital toxoplasmosis the next tests are also applied: Sabin-Feldman Dye test, indirect fluorescent antibody test for IgG antibodies (IgG-IFA) and enzyme

In order to establish rubella virus serologic status in 1034 women of reproductive age in Vojvodina during a two year period, 319 nonpregnant and 715 pregnant women were examined. The aim of this study was to examine the frequency of occurrence of acute rubella virus infections in women of reproductive age; to establish levels of sensitivity to rubella virus, as well as the impact of pregnancy on values of titer antihemagglutinine (HI--hemagglution inhibition) antibodies. By determining immune status against rubella in women of reproductive age high risk groups can be established so that severe consequences of congenital rubella can be prevented. On the basis of titer values of the virus rubella HI antibodies in even samples of sera it has been established that 97.3% of women of reproductive age in Vojvodina in 1994-1995 are immune to rubella. In this period 2.7% of women were established to be vulnerable to rubella virus infection. On the basis of established IgM antibodies acute rubella was detected in 0.31% of nonpregnant women. 26.85% of pregnant women made risky contacts considering whole period of pregnancy. In such circumstances the percentage of pregnant women with acute infection in Vojvodina during the period 1994-1995 is low and makes 0.28%.

9,249 persons were examined by Paul-Bunnell-Davidson test and in 329 heterophile antibodies were established in titre > 1/40 which enables, with corresponding clinical-laboratory parameters, diagnosis of infectious mononucleosis caused by Epstein-Barr virus. In 271 persons diagnosis could not be established by testing only one sample of serum and performing only one test. That is why Epstein-Barr virus specific tests were recommended and their diagnostic possibilities in certain stages of Epstein-Barr virus infection have been theoretically considered.

A sample of 596 women was examined by the direct immunofluorescent test (DIF) for the detection of chlamydia brachomatis antigens in the endocervical smear (with monoclonal antibodies), ELISA test for the detection of IgG antibodies against the group chlamydia-antigen. The chlamydia trachomatis infection was found in 30.20% of the cases, with a high positive rate in all age groups. These infections were more frequently found in women in whom sterility had been diagnosed, compared to other examined women. In relation to other inflammatory processes the significantly highest rate was found in women with changes in the cervix (endocervicitis and arythroplakia). A high rate of chlamydia positive (42.44%) was detected in women who had had pathological pregnancies and deliveries. Humoral immune response to the presence of chlamydia trachomatis infection was proved in 79.44% of the cases. We showed and analyzed diagnostic possibilities of the used diagnostic tests where a combination of the DIF test and ELISA was found the best. For a successful diagnosis two methods have been recommended: a direct one-for the detection of the cause (DIF test, isolation in the cell culture McCoy or Hela 229) and an indirect one for the detection of specific antibodies in the serum.

In a two-year period 117 patients with diagnosed mononucleosis sundrome and 207 patients with diagnosed lymphadenopathy were serologically examined. Of these 57 patients were immunodeficient and 267 immunocompetent. Acute infection with Epstein-Barr virus was proved in 17.09% of the cases with mononucleosis syndrome, 13.04% with lymphadenopathy i.e. 8.77% of the immunodeficient and 15.73% of the immunocompetent patients. The significantly highest rate was recorded among schoolchildren and adolescents (from 7 to 27 years of age). The occurrence of other viral (adeno-and cytomegalo-) and non-viral infections (toxoplasma gondii, chlamydia) in these patients has also been analyzed.

A random specimen of 288 women was examined by the use of the indirect immunofluorescent test (IIF) for the proof of the Chlamydia trachomatis antigen in endocervical swabs (by the help of monoclonal antibodies), and with the ELISA test for the proof of IgG antibodies against Chlamydia trachomatis in serums, and the complement--fixation reaction for the proof of antibodies against the Chlamydia-group antigen. These women were previously examined anamnestically and clinically in detail. The Chlamydia trachomatis infection was determined in 29.51% of cases, with a high percentage of positive results in all age groups. These infections were more frequently proved, to a considerable extent, in women with the diagnosis of sterility than in all other examined women, and in relation to all other inflammatory processes it was most frequently diagnosed in women with uterine cervix changes (endocervicitis and erythroplasia). A high percentage of Chlamydia positive subjects (40.91%) was established in those examined women which had pathological pregnancies and births in their past medical histories. The humoral immune response to the presence of Chlamydia trachomatis infections was proven in 70.59% of cases. Presented and analyzed are the diagnostic possibilities of the used diagnostic tests, where the combination of the IIF and ELISA test has shown to be the best.(ABSTRACT TRUNCATED AT 250 WORDS)