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Introduction/Objective Vaccination against seasonal influenza is the most effective way to prevent infections, hospitalization, morbidity and mortality. The objective of the study was to assess the knowledge, attitude and practices of the North Macedonia adult population towards seasonal influenza vaccine Methods A prospective cross-sectional study in November-December 2022 among the adult population of North Macedonia was conducted. A total of 1012 respondents filled in the 4-item semi-structured questionnaire. The questionnaire collected information on demographics, knowledge, attitudes, and practices towards the influenza vaccine. The chi-square test was used to test for associations and logistic regression was used to determine the effect of variables on the possibility of vaccination. Results The median age of the respondents was 36 years, predominantly female (73.5%). Only 7.8% of respondents received the influenza vaccine in the previous season (2021/2022) and 12.4% planned to vaccinate in the current season. A statistically significant difference between the vaccinated and non-vaccinated individuals was established in terms of age groups and the presence of comorbidity (χ2 = 11.246, p = 0.004). The main source of information for vaccinated respondents were official sources such as MH, WHO, and CDC for information about the influenza vaccine compared to non-vaccinated (χ2 = 8.099, p = 0.004). The vaccinated respondents significantly more often tend to consider the influenza vaccine as safe (χ2 = 5.026, p = 0.025) and effective (χ2 = 11.247, p = 0.001). Respondents who had comorbidities, who considered the vaccine as effective were 3 times and 1.9 times more likely respectively to have received an influenza vaccine. Conclusion The study discovered that in North Macedonia the coverage with influenza vaccine is low. Addressing influenza vaccine safety, efficacy, patient-specific recommendations and encouraging effective physician communication and counselling are some of the key areas for increasing knowledge and awareness.

Cat scratch disease (CSD) is the main clinical manifestation caused by Bartonella henselae in immuno-competent patients. The bacterium is transmitted to humans from cats via scratches or bites. In this case report, we are presenting to our knowledge the first etiologically confirmed case of CSD in our country. Here we describe the case of a previously healthy adult female patient presenting with fever and axillar lymphadenopathy over 1-month period. She underwent numerous clinical and paraclinical investigations for potential etiologies associated with lymphadenopathy and fever. Finally, serological testing for B.henselae was performed with titers for IgG 1:1024 and 1:160 for IgM, which confirmed the diagnosis. Five-day treatment with azithromycin resulted with good clinical response and complete recovery. We proved that CSD is a reality in our country and this report should raise awareness in medical doctors, especially infectious disease specialist. Also, CSD should be included in differential diagnosis in patients with fever of unkown origin (FUO), who are presenting with regional lymphadenopathy, with or without history of cat contact.

Introduction. The study aimed to compare the etiologic spectrum of diseases causing fever of unknown origin (FUO) and methods for definitive diagnosis in a tertiary care hospital in the Republic of North Macedonia during two different time periods. Patients and methods. There were analysed retrospectively the causes for FUO and final diagnostic approaches in 185 patients with classic FUO that were treated at the University Hospital for Infectious Diseases in Skopje during two time periods. Seventy nine patients were treated during 1991 to 1995 and 106 patients during 2011 to 2015. Results. When comparing these two periods, infections were present in 46.8% and 29.2% (p = 0.014), non-infective inflammatory disorders in 22.8% and 25.5% (p = 0.674), neoplasms in 10.1% and 13.2% (p = 0.522), miscellaneous in 8.9% and 12.3% (p = 0.461) and undiagnosed cases in 11.4% and 19.8% (p = 0.124), respectively. The most common causes for FUO during the first period were abscesses (8.9%), tuberculosis and systemic lupus erythematosus (7.6% each), whereas in the second period the commonest causes were adult onset Still disease and solid organ neoplasm (7.6% each), polymyalgia rheumatica, abscesses and visceral leishmaniasis (5.7% each). The newer imaging techniques and clinical course evaluation had superior diagnostic significance during the second period. Conclusion. A changing pattern of diseases causing FUO during the examined periods was evident. Infections continue to be the most common cause but with decreasing incidence when compared to 20 years ago. Even nowadays clinical evaluation and follow-up still remain the vital diagnostic tools in determining the etiology of FUO.