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Švitek L, Lišnjić D, Grubišić B, Zlosa M, Schönberger E, Vlahović Vlašić N, Smajić P, Sabadi D, Rolić T, Kralik K, Mandić S. GDF-15 Levels and Other Laboratory Findings as Predictors of COVID-19 Severity and Mortality: A Pilot Study. Biomedicines 2024; 12:757. [PMID: 38672113 PMCID: PMC11048158 DOI: 10.3390/biomedicines12040757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 03/24/2024] [Accepted: 03/27/2024] [Indexed: 04/28/2024] Open
Abstract
Growth differentiation factor 15 (GDF-15) is a stress-induced cytokine associated with acute and chronic inflammatory states. This prospective observational study aimed to investigate the prognostic roles of GDF-15 and routine clinical laboratory parameters in COVID-19 patients. Upon the admission of 95 adult hospitalized COVID-19 patients in Croatia, blood analysis was performed, and medical data were collected. The patients were categorized based on survival, ICU admission, and hospitalization duration. Logistic regression and ROC curve methods were employed for the statistical analysis. Logistic regression revealed two independent predictors of negative outcomes: CURB-65 score (OR = 2.55) and LDH (OR = 1.005); one predictor of ICU admission: LDH (OR = 1.004); and one predictor of prolonged hospitalization: the need for a high-flow nasal cannula (HFNC) upon admission (OR = 4.75). The ROC curve showed diagnostic indicators of negative outcomes: age, CURB-65 score, LDH, and GDF-15. The largest area under the curve (AUC = 0.767, specificity = 65.6, sensitivity = 83.9) was represented by GDF-15, with a cutoff value of 3528 pg/mL. For ICU admission, significant diagnostic indicators were LDH, CRP, and IL-6. Significant diagnostic indicators of prolonged hospitalization were CK, GGT, and oxygenation with an HFNC upon admission. This study reaffirms the significance of the commonly used laboratory parameters and clinical scores in evaluating COVID-19. Additionally, it introduces the potential for a new diagnostic approach and research concerning GDF-15 levels in this widespread disease.
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Affiliation(s)
- Luka Švitek
- Clinic for Infectious Diseases, University Hospital Centre Osijek, 31000 Osijek, Croatia
- Department of Infectology and Dermatovenerology, Faculty of Medicine Osijek, J. J. Strossmayer University of Osijek, 31000 Osijek, Croatia
| | - Dubravka Lišnjić
- Department of Infectology and Dermatovenerology, Faculty of Medicine Osijek, J. J. Strossmayer University of Osijek, 31000 Osijek, Croatia
- Faculty of Dental Medicine and Health Osijek, J. J. Strossmayer University of Osijek, 31000 Osijek, Croatia
| | - Barbara Grubišić
- Clinic for Infectious Diseases, University Hospital Centre Osijek, 31000 Osijek, Croatia
- Faculty of Medicine Osijek, J. J. Strossmayer University of Osijek, 31000 Osijek, Croatia
| | - Mihaela Zlosa
- Clinic for Infectious Diseases, University Hospital Centre Osijek, 31000 Osijek, Croatia
- Faculty of Medicine Osijek, J. J. Strossmayer University of Osijek, 31000 Osijek, Croatia
| | - Ema Schönberger
- Faculty of Medicine Osijek, J. J. Strossmayer University of Osijek, 31000 Osijek, Croatia
- Department of Endocrinology, Internal Medicine Clinic, University Hospital Centre Osijek, 31000 Osijek, Croatia
| | - Nika Vlahović Vlašić
- Clinic for Infectious Diseases, University Hospital Centre Osijek, 31000 Osijek, Croatia
- Department of Infectology and Dermatovenerology, Faculty of Medicine Osijek, J. J. Strossmayer University of Osijek, 31000 Osijek, Croatia
| | - Petra Smajić
- Clinic for Infectious Diseases, University Hospital Centre Osijek, 31000 Osijek, Croatia
- Department of Infectology and Dermatovenerology, Faculty of Medicine Osijek, J. J. Strossmayer University of Osijek, 31000 Osijek, Croatia
| | - Dario Sabadi
- Clinic for Infectious Diseases, University Hospital Centre Osijek, 31000 Osijek, Croatia
- Department of Infectology and Dermatovenerology, Faculty of Medicine Osijek, J. J. Strossmayer University of Osijek, 31000 Osijek, Croatia
- Faculty of Dental Medicine and Health Osijek, J. J. Strossmayer University of Osijek, 31000 Osijek, Croatia
| | - Tara Rolić
- Faculty of Medicine Osijek, J. J. Strossmayer University of Osijek, 31000 Osijek, Croatia
- Institute of Clinical Laboratory Diagnostics, University Hospital Centre Osijek, 31000 Osijek, Croatia
| | - Kristina Kralik
- Department of Medical Statistics and Medical Informatics, Faculty of Medicine Osijek, J. J. Strossmayer University of Osijek, 31000 Osijek, Croatia
| | - Sanja Mandić
- Polyclinic LabPlus, 31000 Osijek, Croatia
- Department of Chemistry, Biochemistry and Clinical Chemistry, Faculty of Medicine Osijek, J. J. Strossmayer University of Osijek, 31000 Osijek, Croatia
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Zidovec-Lepej S, Bodulić K, Bogdanic M, Gorenec L, Savic V, Grgic I, Sabadi D, Santini M, Radmanic Matotek L, Kucinar J, Barbic L, Zmak L, Ferenc T, Stevanovic V, Antolasic L, Milasincic L, Hruskar Z, Vujica Ferenc M, Vilibic-Cavlek T. Proinflammatory Chemokine Levels in Cerebrospinal Fluid of Patients with Neuroinvasive Flavivirus Infections. Microorganisms 2024; 12:657. [PMID: 38674602 PMCID: PMC11052399 DOI: 10.3390/microorganisms12040657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 03/17/2024] [Accepted: 03/21/2024] [Indexed: 04/28/2024] Open
Abstract
Tick-borne encephalitis virus (TBEV) and West Nile virus (WNV) are the most important neuroinvasive arboviruses detected in Europe. In this study, we analyzed cerebrospinal fluid (CSF) concentrations of 12 proinflammatory chemokines (CCL2, CCL3, CCL4, CCL11, CCL17, CCL20, CXCL1, CXCL5, CXCL8, CXCL9, CXCL10, and CXCL11) in 77 patients with neuroinvasive diseases (NIDs). Flavivirus infection was confirmed in 62 patients (TBEV and WNV in 31 patients each), while in 15 patients the etiology of NID was not determined (NDE). Similar patterns of high-level expression of chemokines regulating monocyte/macrophage responses (CCL2), neutrophil recruitment (CXCL1 and CXCL8), and interferon-inducible chemoattractants for leukocytes (CXCL10 and CXCL11) have been observed in WNV and TBEV groups. None of the tested chemokines significantly differed between patients with TBEV or WNV. Concentrations of CCL17, CCL20, CXCL5, CXCL10, and CXCL11 were significantly lower in both WNV and TBEV groups compared to NID NDE patients. The logistic regression model showed that CSF concentrations of CXCL11, CXCL5, and CXCL10 could potentially be used for the classification of patients into the WNV or TBEV group versus groups with other NIDs. This study identified, for the first time, similar patterns of CSF chemokine expression in WNV and TBEV infections, suggesting common immunopathogenic mechanisms in neuroinvasive flavivirus infections that should be further evaluated.
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Affiliation(s)
- Snjezana Zidovec-Lepej
- Department of Immunological and Molecular Diagnostics, University Hospital for Infectious Diseases “Dr. Fran Mihaljevic”, 10000 Zagreb, Croatia; (S.Z.-L.); (L.G.); (I.G.); (L.R.M.)
| | - Kristian Bodulić
- Research Department, University Hospital for Infectious Diseases “Dr. Fran Mihaljevic”, 10000 Zagreb, Croatia;
| | - Maja Bogdanic
- Department of Virology, Croatian Institute of Public Health, 10000 Zagreb, Croatia; (M.B.); (L.A.); (L.M.); (Z.H.)
| | - Lana Gorenec
- Department of Immunological and Molecular Diagnostics, University Hospital for Infectious Diseases “Dr. Fran Mihaljevic”, 10000 Zagreb, Croatia; (S.Z.-L.); (L.G.); (I.G.); (L.R.M.)
| | - Vladimir Savic
- Poultry Center, Croatian Veterinary Institute, 10000 Zagreb, Croatia;
| | - Ivana Grgic
- Department of Immunological and Molecular Diagnostics, University Hospital for Infectious Diseases “Dr. Fran Mihaljevic”, 10000 Zagreb, Croatia; (S.Z.-L.); (L.G.); (I.G.); (L.R.M.)
| | - Dario Sabadi
- Department of Infectious Diseases, Clinical Hospital Center Osijek, 31000 Osijek, Croatia;
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia
| | - Marija Santini
- Department for Infections in Immunocompromised Patients, University Hospital for Infectious Diseases “Dr. Fran Mihaljevic”, 10000 Zagreb, Croatia;
- School of Medicine, University of Zagreb, 10000 Zagreb, Croatia;
| | - Leona Radmanic Matotek
- Department of Immunological and Molecular Diagnostics, University Hospital for Infectious Diseases “Dr. Fran Mihaljevic”, 10000 Zagreb, Croatia; (S.Z.-L.); (L.G.); (I.G.); (L.R.M.)
| | - Jasmina Kucinar
- Department of Serology and Immunology, Istria County Institute of Public Health, 52100 Pula, Croatia;
| | - Ljubo Barbic
- Department of Microbiology and Infectious Diseases with Clinic, Faculty of Veterinary Medicine, University of Zagreb, 10000 Zagreb, Croatia; (L.B.); (V.S.)
| | - Ljiljana Zmak
- School of Medicine, University of Zagreb, 10000 Zagreb, Croatia;
- Department of Microbiology, Croatian Institute of Public Health, 10000 Zagreb, Croatia
| | - Thomas Ferenc
- Department of Diagnostic and Interventional Radiology, Merkur University Hospital, 10000 Zagreb, Croatia
| | - Vladimir Stevanovic
- Department of Microbiology and Infectious Diseases with Clinic, Faculty of Veterinary Medicine, University of Zagreb, 10000 Zagreb, Croatia; (L.B.); (V.S.)
| | - Ljiljana Antolasic
- Department of Virology, Croatian Institute of Public Health, 10000 Zagreb, Croatia; (M.B.); (L.A.); (L.M.); (Z.H.)
| | - Ljiljana Milasincic
- Department of Virology, Croatian Institute of Public Health, 10000 Zagreb, Croatia; (M.B.); (L.A.); (L.M.); (Z.H.)
| | - Zeljka Hruskar
- Department of Virology, Croatian Institute of Public Health, 10000 Zagreb, Croatia; (M.B.); (L.A.); (L.M.); (Z.H.)
| | - Mateja Vujica Ferenc
- Department of Obstetrics and Gynecology, University Hospital Centre Zagreb, 10000 Zagreb, Croatia;
| | - Tatjana Vilibic-Cavlek
- Department of Virology, Croatian Institute of Public Health, 10000 Zagreb, Croatia; (M.B.); (L.A.); (L.M.); (Z.H.)
- School of Medicine, University of Zagreb, 10000 Zagreb, Croatia;
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Švitek L, Grubišić B, Schonberger E, Zlosa M, Sabadi D, Lišnjić D, Canecki-Varžić S, Bilić-Ćurčić I, Mandić S. Syndrome of inappropriate antidiuretic hormone secretion as an adverse reaction of ciprofloxacin: a case report and literature review. Biochem Med (Zagreb) 2024; 34:010803. [PMID: 38125612 PMCID: PMC10731729 DOI: 10.11613/bm.2024.010803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 11/16/2023] [Indexed: 12/23/2023] Open
Abstract
Antidiuretic hormone (ADH) is secreted by the posterior pituitary gland. Unsuppressed release of ADH leads to hyponatremia. This condition is referred to as syndrome of inappropriate antidiuretic hormone secretion (SIADH). Hereby, a case report is presented on ciprofloxacin-induced SIADH. A 67-year-old male patient was examined in the emergency room with symptoms of lethargy, headache, lack of attention, and a generally depressed mood lasting for three days. One week prior, empirical antimicrobial therapy involving ciprofloxacin for prostatitis was initiated. Laboratory analysis showed no relevant abnormalities except for hyponatremia (Na = 129 mmol/L). Chronic hyponatremia, thyroid dysfunction, and adrenal dysfunction were ruled out. Serum osmolality was 263 mOsmol/kg, urine osmolality was 206 mOsmol/kg, and urine sodium was 39 mmol/L. Given that all criteria for SIADH were met, ciprofloxacin was discontinued, and fluid restriction was advised. Four days later, the patient's serum sodium concentrations nearly normalized (Na = 135 mmol/L), and all symptoms resolved. The Naranjo Scale yielded a score of 8, supporting the likelihood of a probable adverse reaction to ciprofloxacin. This case is presented to raise awareness among clinicians about the potential of ciprofloxacin to cause even mild hyponatremia.
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Affiliation(s)
- Luka Švitek
- Clinic for Infectious Diseases, University Hospital Centre Osijek, Osijek, Croatia
- Department of Infectology and Dermatovenerology, Faculty of Medicine Osijek, J. J. Strossmayer University of Osijek, Osijek, Croatia
| | - Barbara Grubišić
- Clinic for Infectious Diseases, University Hospital Centre Osijek, Osijek, Croatia
- Department of Infectology and Dermatovenerology, Faculty of Medicine Osijek, J. J. Strossmayer University of Osijek, Osijek, Croatia
| | - Ema Schonberger
- Faculty of Medicine Osijek, J. J. Strossmayer University of Osijek, Osijek, Croatia
- Department of Endocrinology and Metabolism Disorders, Internal Medicine Clinic, University Hospital Centre Osijek, Osijek, Croatia
| | - Mihaela Zlosa
- Clinic for Infectious Diseases, University Hospital Centre Osijek, Osijek, Croatia
- Faculty of Medicine Osijek, J. J. Strossmayer University of Osijek, Osijek, Croatia
| | - Dario Sabadi
- Clinic for Infectious Diseases, University Hospital Centre Osijek, Osijek, Croatia
- Department of Infectology and Dermatovenerology, Faculty of Medicine Osijek, J. J. Strossmayer University of Osijek, Osijek, Croatia
- Faculty of Dental Medicine and Health Osijek, J. J. Strossmayer University of Osijek, Osijek, Croatia
| | - Dubravka Lišnjić
- Department of Infectology and Dermatovenerology, Faculty of Medicine Osijek, J. J. Strossmayer University of Osijek, Osijek, Croatia
- Faculty of Dental Medicine and Health Osijek, J. J. Strossmayer University of Osijek, Osijek, Croatia
| | - Silvija Canecki-Varžić
- Department of Endocrinology and Metabolism Disorders, Internal Medicine Clinic, University Hospital Centre Osijek, Osijek, Croatia
- Department of Pathophysiology, Faculty of Medicine Osijek, J. J. Strossmayer University of Osijek, Osijek, Croatia
| | - Ines Bilić-Ćurčić
- Department of Endocrinology and Metabolism Disorders, Internal Medicine Clinic, University Hospital Centre Osijek, Osijek, Croatia
- Department of Pharmacology, Faculty of Medicine Osijek, J. J. Strossmayer University of Osijek, Osijek, Croatia
| | - Sanja Mandić
- Institute of Clinical Laboratory Diagnostics, University Hospital Centre Osijek, Osijek, Croatia
- Department of Chemistry, Biochemistry and Clinical Chemistry, Faculty of Medicine Osijek, J. J. Strossmayer University of Osijek, Osijek, Croatia
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Vilibic-Cavlek T, Krcmar S, Bogdanic M, Tomljenovic M, Barbic L, Roncevic D, Sabadi D, Vucelja M, Santini M, Hunjak B, Stevanovic V, Boljfetic M, Bjedov L, Masovic V, Potocnik-Hunjadi T, Lakoseljac D, Al-Mufleh M, Savic V. An Overview of Tick-Borne Encephalitis Epidemiology in Endemic Regions of Continental Croatia, 2017-2023. Microorganisms 2024; 12:386. [PMID: 38399790 PMCID: PMC10891638 DOI: 10.3390/microorganisms12020386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Revised: 02/08/2024] [Accepted: 02/10/2024] [Indexed: 02/25/2024] Open
Abstract
Tick-borne encephalitis (TBE) represents an important public health problem in Europe. We analyzed the epidemiology of TBE based on data from humans, animals, and Ixodes ricinus ticks in endemic regions of continental Croatia. In the period from 2017 to 2023, cerebrospinal fluid (CSF) and serum samples of 684 patients with neuroinvasive diseases, 2240 horse serum samples, and 300 sheep serum samples were tested for TBEV. In addition, 8751 I. ricinus ticks were collected. CSF samples were tested using RT-PCR. Serological tests (serum, CSF) were performed using commercial ELISA, with confirmation of cross-reactive samples by a virus neutralization test. Eighty-four autochthonous human TBEV cases were confirmed. The majority of patients were in the age group of 40-69 years (58.3%) with a male predominance (70.2%). TBE showed a bimodal seasonality with a large peak in April-August and a small one in October-November. In addition to humans, TBEV IgG antibodies were found in 12.2% of horses and 9.7% of sheep. Seasonal tick abundance corresponds to the reported number of human infections. Continental Croatia is still an active natural focus of TBE. Continuous monitoring of infections in humans, sentinel animals, and ticks is needed for the implementation of preventive measures.
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Affiliation(s)
- Tatjana Vilibic-Cavlek
- Department of Virology, Croatian Institute of Public Health, 10000 Zagreb, Croatia;
- School of Medicine, University of Zagreb, 10000 Zagreb, Croatia;
| | - Stjepan Krcmar
- Department of Biology, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia;
| | - Maja Bogdanic
- Department of Virology, Croatian Institute of Public Health, 10000 Zagreb, Croatia;
| | - Morana Tomljenovic
- Department of Epidemiology, Teaching Institute of Public Health of the Primorje-Gorski Kotar County, 51000 Rijeka, Croatia; (M.T.); (D.R.); (D.L.)
- Department of Social Medicine and Epidemiology, Faculty of Medicine, University of Rijeka, 51000 Rijeka, Croatia
| | - Ljubo Barbic
- Department of Microbiology and Infectious Diseases with Clinic, Faculty of Veterinary Medicine, University of Zagreb, 10000 Zagreb, Croatia; (L.B.); (V.S.); (V.M.)
| | - Dobrica Roncevic
- Department of Epidemiology, Teaching Institute of Public Health of the Primorje-Gorski Kotar County, 51000 Rijeka, Croatia; (M.T.); (D.R.); (D.L.)
- Department of Public Health, Faculty of Health Studies, University of Rijeka, 51000 Rijeka, Croatia
| | - Dario Sabadi
- Department of Infectious Diseases, Clinical Hospital Center Osijek, 31000 Osijek, Croatia;
- Medical Faculty, University of Osijek, 31000 Osijek, Croatia
| | - Marko Vucelja
- Department of Forest Protection and Wildlife Management, Faculty of Forestry and Wood Technology, University of Zagreb, 10000 Zagreb, Croatia; (M.V.); (M.B.); (L.B.)
| | - Marija Santini
- School of Medicine, University of Zagreb, 10000 Zagreb, Croatia;
- University Hospital for Infectious Diseases “Dr. Fran Mihaljevic”, 10000 Zagreb, Croatia
| | - Blazenka Hunjak
- Department of Bacteriology, Croatian Institute of Public Health, 10000 Zagreb, Croatia;
- Department of Microbiology, University of Applied Health Sciences, 10000 Zagreb, Croatia
| | - Vladimir Stevanovic
- Department of Microbiology and Infectious Diseases with Clinic, Faculty of Veterinary Medicine, University of Zagreb, 10000 Zagreb, Croatia; (L.B.); (V.S.); (V.M.)
| | - Marko Boljfetic
- Department of Forest Protection and Wildlife Management, Faculty of Forestry and Wood Technology, University of Zagreb, 10000 Zagreb, Croatia; (M.V.); (M.B.); (L.B.)
| | - Linda Bjedov
- Department of Forest Protection and Wildlife Management, Faculty of Forestry and Wood Technology, University of Zagreb, 10000 Zagreb, Croatia; (M.V.); (M.B.); (L.B.)
| | - Viktor Masovic
- Department of Microbiology and Infectious Diseases with Clinic, Faculty of Veterinary Medicine, University of Zagreb, 10000 Zagreb, Croatia; (L.B.); (V.S.); (V.M.)
| | | | - Danijela Lakoseljac
- Department of Epidemiology, Teaching Institute of Public Health of the Primorje-Gorski Kotar County, 51000 Rijeka, Croatia; (M.T.); (D.R.); (D.L.)
- Department of Public Health, Faculty of Health Studies, University of Rijeka, 51000 Rijeka, Croatia
| | - Mahmoud Al-Mufleh
- Department of Infectious Diseases, County Hospital Cakovec, 40000 Cakovec, Croatia;
| | - Vladimir Savic
- Poultry Center, Croatian Veterinary Institute, 10000 Zagreb, Croatia
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Šahinović I, Mandić S, Mihić D, Duvnjak M, Loinjak D, Sabadi D, Majić Z, Perić L, Šerić V. Endocannabinoids, Anandamide and 2-Arachidonoylglycerol, as Prognostic Markers of Sepsis Outcome and Complications. Cannabis Cannabinoid Res 2023; 8:802-811. [PMID: 35649233 PMCID: PMC10589499 DOI: 10.1089/can.2022.0046] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: One of the major challenges in improving sepsis care is early prediction of sepsis complications. The endocannabinoid system has been intensely studied in recent years; however, little is known about its role in sepsis in humans. This study aimed to assess the prognostic role of endocannabinoids, anandamide (AEA) and 2-arachidonoylglycerol (2-AG), as early predictors of mortality, invasive mechanical ventilation (IMV) requirement, and length of stay (LOS) in patients with sepsis. Materials and Methods: In total, 106 patients with confirmed sepsis were enrolled in this study. The patients were divided into groups according to mortality outcome (survival, N=53; nonsurvival, N=53), IMV requirement (IMV group, N=26; non-IMV group, N=80), and LOS (LOS <10 days, N=59; LOS ≥10 days, N=47). Patients' clinical status was assessed along with laboratory biomarkers as well as AEA and 2-AG concentration measurements early on admission to emergency units. AEA and 2-AG levels were measured by enzyme-linked immunosorbent assay (ELISA) using an ELISA processor, EtiMax 3000 (DiaSorin, Saluggia, Italy). The predictive value of AEA and 2-AG for the studied sepsis outcomes and complications was analyzed using univariate and multivariate analyses and receiver operating characteristic (ROC) curve analysis. Results: Two endocannabinoids showed no significant difference between survivors and nonsurvivors, although an AEA concentration <7.16 μg/L predicted mortality outcome with a sensitivity of 57% (95% confidence interval [CI] 42-71) and specificity of 80% (95% CI 66-91). AEA concentrations ≤17.84 μg/L predicted LOS ≥10 days with sensitivity of 98% (95% CI 89-100) and specificity of 34% (95% CI 22-47). When analyzing IMV requirement, levels of AEA and 2-AG were significantly lower within the IMV group compared with the non-IMV group (5.94 μg/L [2.04-9.44] and 6.70 μg/L [3.50-27.04], p=0.043, and 5.68 μg/L [2.30-8.60] and 9.58 μg/L [4.83-40.05], p=0.002, respectively). The 2-AG showed the best performance for IMV requirement prediction, with both sensitivity and specificity of 69% (p<0.001). Endocannabinoid AEA was an independent risk factor of LOS ≥10 days (odds ratio [OR] 23.59; 95% CI 3.03-183.83; p=0.003) and IMV requirement in sepsis (OR 0.79; 95% CI, 0.67-0.93; p=0.004). Conclusion: Low AEA concentration is a prognostic factor of hospital LOS longer than 10 days. Lower AEA and 2-AG concentrations obtained at the time of admission to the hospital are predictors of IMV requirement.
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Affiliation(s)
- Ines Šahinović
- Department of Clinical Laboratory Diagnostics, University Hospital Osijek, Osijek, Croatia
- J.J. Strossmayer University of Osijek, Faculty of Medicine Osijek, Osijek, Croatia
| | - Sanja Mandić
- Department of Clinical Laboratory Diagnostics, University Hospital Osijek, Osijek, Croatia
- J.J. Strossmayer University of Osijek, Faculty of Medicine Osijek, Osijek, Croatia
| | - Damir Mihić
- J.J. Strossmayer University of Osijek, Faculty of Medicine Osijek, Osijek, Croatia
- Department of Pulmonology and Intensive Care, Clinic of Internal Medicine, University Hospital Osijek, Osijek, Croatia
| | - Mario Duvnjak
- J.J. Strossmayer University of Osijek, Faculty of Medicine Osijek, Osijek, Croatia
- Clinic of Infective Diseases, University Hospital Osijek, Osijek, Croatia
| | - Domagoj Loinjak
- J.J. Strossmayer University of Osijek, Faculty of Medicine Osijek, Osijek, Croatia
- Department of Pulmonology and Intensive Care, Clinic of Internal Medicine, University Hospital Osijek, Osijek, Croatia
| | - Dario Sabadi
- J.J. Strossmayer University of Osijek, Faculty of Medicine Osijek, Osijek, Croatia
- Clinic of Infective Diseases, University Hospital Osijek, Osijek, Croatia
| | - Zlatko Majić
- Department of Pulmonology and Intensive Care, Clinic of Internal Medicine, University Hospital Osijek, Osijek, Croatia
| | - Ljiljana Perić
- J.J. Strossmayer University of Osijek, Faculty of Medicine Osijek, Osijek, Croatia
- Clinic of Infective Diseases, University Hospital Osijek, Osijek, Croatia
| | - Vatroslav Šerić
- Department of Clinical Laboratory Diagnostics, University Hospital Osijek, Osijek, Croatia
- J.J. Strossmayer University of Osijek, Faculty of Medicine Osijek, Osijek, Croatia
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Vilibic-Cavlek T, Stevanovic V, Krcmar S, Savic V, Kovac S, Bogdanic M, Mauric Maljkovic M, Sabadi D, Santini M, Potocnik-Hunjadi T, Al-Mufleh M, Barbic L. Detection of Bhanja Bandavirus in Patients with Neuroinvasive Disease of Unknown Etiology in Croatia. Microorganisms 2023; 11:2155. [PMID: 37763999 PMCID: PMC10534515 DOI: 10.3390/microorganisms11092155] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 08/23/2023] [Accepted: 08/24/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND Although the Bhanja bandavirus (BHAV) is widely distributed in some European countries, human infections are rarely reported. This study analyzed the prevalence of BHAV antibodies in patients with neuroinvasive diseases of unsolved etiology. METHODS A total of 254 Croatian patients who developed neurological symptoms during the four consecutive arbovirus transmission seasons (April 2017-October 2021) were tested. Cerebrospinal fluid (CSF) and urine samples were tested using RT-qPCR. In addition, CSF and serum samples were tested using a virus neutralization test. RESULTS BHAV RNA was not detected in any samples, while neutralizing (NT) antibodies were detected in serum samples of 53/20.8% of patients (95% CI = 16.0-26.3). In two patients, BHAV NT antibodies were detected in the CSF, indicating a recent infection. Both patients were inhabitants of rural areas in continental Croatia, and one reported a tick bite two weeks before symptoms onset. The seropositivity was high in all age groups (15.2-29.1%). The majority of seropositive patients (94.3%) resided at altitudes less than 200 m above sea level. The prevalence rates correlated positively with population density and negatively with certain climate parameters (temperature, number of hot/warm days). CONCLUSIONS The presented results indicate that BHAV is distributed in Croatia. Further studies are needed to determine the clinical significance of this neglected arbovirus.
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Affiliation(s)
- Tatjana Vilibic-Cavlek
- Department of Virology, Croatian Institute of Public Health, 10000 Zagreb, Croatia;
- School of Medicine, University of Zagreb, 10000 Zagreb, Croatia;
| | - Vladimir Stevanovic
- Department of Microbiology and Infectious Diseases with Clinic, Faculty of Veterinary Medicine, University of Zagreb, 10000 Zagreb, Croatia; (S.K.); (L.B.)
| | - Stjepan Krcmar
- Department of Biology, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia;
| | - Vladimir Savic
- Poultry Center, Croatian Veterinary Institute, 10000 Zagreb, Croatia;
| | - Snjezana Kovac
- Department of Microbiology and Infectious Diseases with Clinic, Faculty of Veterinary Medicine, University of Zagreb, 10000 Zagreb, Croatia; (S.K.); (L.B.)
| | - Maja Bogdanic
- Department of Virology, Croatian Institute of Public Health, 10000 Zagreb, Croatia;
| | - Maja Mauric Maljkovic
- Department for Animal Breeding and Livestock Production, Faculty of Veterinary Medicine, University of Zagreb, 10000 Zagreb, Croatia;
| | - Dario Sabadi
- Department of Infectious Diseases, Clinical Hospital Center Osijek, 31000 Osijek, Croatia;
- School of Medicine, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia
| | - Marija Santini
- School of Medicine, University of Zagreb, 10000 Zagreb, Croatia;
- Department for the Immunocompromised Patients, University Hospital for Infectious Diseases “Dr. Fran Mihaljevic”, 10000 Zagreb, Croatia
| | | | - Mahmoud Al-Mufleh
- Department of Infectious Diseases, County Hospital Cakovec, 40000 Cakovec, Croatia;
| | - Ljubo Barbic
- Department of Microbiology and Infectious Diseases with Clinic, Faculty of Veterinary Medicine, University of Zagreb, 10000 Zagreb, Croatia; (S.K.); (L.B.)
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7
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Vilibic-Cavlek T, Ferenc T, Vujica Ferenc M, Bogdanic M, Potocnik-Hunjadi T, Sabadi D, Savic V, Barbic L, Stevanovic V, Monaco F, Listes E, Savini G. Cross-Reactive Antibodies in Tick-Borne Encephalitis: Case Report and Literature Review. Antibodies (Basel) 2022; 11:antib11040072. [PMID: 36412838 PMCID: PMC9703958 DOI: 10.3390/antib11040072] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 11/01/2022] [Accepted: 11/16/2022] [Indexed: 11/22/2022] Open
Abstract
Flaviviruses are a heterogeneous group of viruses that may induce broad antigenic cross-reactivity. We present a patient who was admitted to the infectious disease department with symptoms suggestive of aseptic meningitis. During the clinical workup, the patient reported a tick bite two weeks before the disease onset. High titers of IgM and IgG antibodies to tick-borne encephalitis virus (TBEV) were found in both serum and cerebrospinal fluid (CSF) samples, indicating acute TBEV infection. West Nile virus (WNV) and Usutu virus (USUV) IgM and/or IgG antibodies were also detected, and a virus neutralization test (VNT) was performed. A high titer of TBEV neutralizing (NT) antibodies (640) was detected, which confirmed acute TBE. However, NT antibodies to WNV and USUV were also detected (titer 80 for both viruses). After TBEV and WNV IgG avidity evaluation, previous flavivirus infection was highly suspected (avidity index 82% and 89%, respectively). Blood, CSF, and urine samples were negative for respective viruses’ RNA. The presented case highlights the challenges in flavivirus serodiagnosis. In the published literature, different degrees of cross-reactivity or cross-neutralization between TBEV and dengue, louping ill, Omsk hemorrhagic fever, Langat, and Powassan virus were also observed. Therefore, the serology results should be interpreted with caution, including the possibility of cross-reactivity. In areas where several flaviviruses co-circulate VNT is recommended for disease confirmation.
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Affiliation(s)
- Tatjana Vilibic-Cavlek
- Department of Virology, Croatian Institute of Public Health, 10000 Zagreb, Croatia
- School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
- Correspondence: (T.V.-C.); (T.F.)
| | - Thomas Ferenc
- Clinical Department of Diagnostic and Interventional Radiology, Merkur University Hospital, 10000 Zagreb, Croatia
- Correspondence: (T.V.-C.); (T.F.)
| | - Mateja Vujica Ferenc
- Institute of Emergency Medicine of Krapina-Zagorje County, 49000 Krapina, Croatia
| | - Maja Bogdanic
- Department of Virology, Croatian Institute of Public Health, 10000 Zagreb, Croatia
| | | | - Dario Sabadi
- Department for Infectious Diseases, Clinical Hospital Center Osijek, 31000 Osijek, Croatia
- Medical Faculty, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia
| | - Vladimir Savic
- Laboratory for Virology and Serology, Poultry Center, Croatian Veterinary Institute, 10000 Zagreb, Croatia
| | - Ljubo Barbic
- Department of Microbiology and Infectious Diseases with Clinic, Faculty of Veterinary Medicine, University of Zagreb, 10000 Zagreb, Croatia
| | - Vladimir Stevanovic
- Department of Microbiology and Infectious Diseases with Clinic, Faculty of Veterinary Medicine, University of Zagreb, 10000 Zagreb, Croatia
| | - Federica Monaco
- Department of Virology, OIE Reference Center for West Nile Disease, Istituto Zooprofilattico Sperimentale “G. Caporale”, 64100 Teramo, Italy
| | - Eddy Listes
- Laboratory for Diagnostics, Croatian Veterinary Institute, Veterinary Institute Split, 21000 Split, Croatia
| | - Giovanni Savini
- Department of Virology, OIE Reference Center for West Nile Disease, Istituto Zooprofilattico Sperimentale “G. Caporale”, 64100 Teramo, Italy
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8
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Zidovec-Lepej S, Vilibic-Cavlek T, Ilic M, Gorenec L, Grgic I, Bogdanic M, Radmanic L, Ferenc T, Sabadi D, Savic V, Hruskar Z, Svitek L, Stevanovic V, Peric L, Lisnjic D, Lakoseljac D, Roncevic D, Barbic L. Quantification of Antiviral Cytokines in Serum, Cerebrospinal Fluid and Urine of Patients with Tick-Borne Encephalitis in Croatia. Vaccines (Basel) 2022; 10:1825. [PMID: 36366333 PMCID: PMC9698853 DOI: 10.3390/vaccines10111825] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 10/24/2022] [Accepted: 10/26/2022] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND Tick-borne encephalitis virus (TBEV) is one of the most significant arboviruses affecting the human central nervous system (CNS) in Europe. Data on cytokine response in TBEV infection are limited. METHODS We analyzed the cytokine response in serum, cerebrospinal fluid (CSF) and urine samples of patients with TBE. The control group consisted of patients with 'febrile headache' who had normal CSF cytology. The panel included 12 cytokines: TNF-α, IL-6, Th1 (IL-2, IFN-γ), Th2 (IL-4, IL-5, IL-13), Th9 (IL-9), Th17 (IL-17A, IL-17F), Th22 (IL-22) cytokines and IL-10. RESULTS TBE patients were more likely to have increased levels of IL-6 and IFN-γ in CSF compared to controls (85.7% vs. 58.8% and 85.7% vs. 47.1%, respectively). However, concentrations of IL-6 (the most abundant cytokine in the CSF of both groups), IL-10 and IL-9 were lower in TBEV patients compared with controls, but the difference was statistically significant for IL-9 only (p = 0.001). By analyzing the cytokine levels in different clinical samples, all measured cytokines were detected in the serum, with the highest concentrations found for IFN-γ, TNF-α, IL-10, IL-17F and IL-22. Higher concentrations of cytokines in the CSF compared with serum were observed for IL-5, IL-6 and IL-22. All cytokines except IL-13 were detectable in urine but in a small proportion of patients, except for IL-22, which was detectable in 95.8% of patients. CONCLUSIONS Cytokine composition in different clinical samples of TBE patients reveals a different network of early innate immune response cytokines, Th1, Th2, Th9, Th22, Th17 and anti-inflammatory cytokines.
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Affiliation(s)
- Snjezana Zidovec-Lepej
- Department of Immunological and Molecular Diagnostics, University Hospital for Infectious Diseases “Dr Fran Mihaljevic”, 10000 Zagreb, Croatia
| | - Tatjana Vilibic-Cavlek
- Department of Virology, Croatian Institute of Public Health,10000 Zagreb, Croatia
- Department of Microbiology, School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
| | - Maja Ilic
- Department of Epidemiology, Croatian Institute of Public Health, 10000 Zagreb, Croatia
| | - Lana Gorenec
- Department of Immunological and Molecular Diagnostics, University Hospital for Infectious Diseases “Dr Fran Mihaljevic”, 10000 Zagreb, Croatia
| | - Ivana Grgic
- Department of Immunological and Molecular Diagnostics, University Hospital for Infectious Diseases “Dr Fran Mihaljevic”, 10000 Zagreb, Croatia
| | - Maja Bogdanic
- Department of Virology, Croatian Institute of Public Health,10000 Zagreb, Croatia
| | - Leona Radmanic
- Department of Immunological and Molecular Diagnostics, University Hospital for Infectious Diseases “Dr Fran Mihaljevic”, 10000 Zagreb, Croatia
| | - Thomas Ferenc
- Clinical Department of Diagnostic and Interventional Radiology, Merkur University Hospital, 10000 Zagreb, Croatia
| | - Dario Sabadi
- Clinic for Infectious Diseases, Clinical Hospital Center Osijek, 31000 Osijek, Croatia
- Medical Faculty, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia
| | - Vladimir Savic
- Laboratory for Virology and Serology, Poultry Center, Croatian Veterinary Institute, 10000 Zagreb, Croatia
| | - Zeljka Hruskar
- Department of Virology, Croatian Institute of Public Health,10000 Zagreb, Croatia
| | - Luka Svitek
- Clinic for Infectious Diseases, Clinical Hospital Center Osijek, 31000 Osijek, Croatia
- Medical Faculty, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia
| | - Vladimir Stevanovic
- Department of Microbiology and Infectious Diseases with Clinic, Faculty of Veterinary Medicine, University of Zagreb, 10000 Zagreb, Croatia
| | - Ljiljana Peric
- Medical Faculty, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia
| | - Dubravka Lisnjic
- Clinic for Infectious Diseases, Clinical Hospital Center Osijek, 31000 Osijek, Croatia
- Medical Faculty, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia
| | - Danijela Lakoseljac
- Primorje-Gorski Kotar County Teaching Institute of Public Health, 51000 Rijeka, Croatia
| | - Dobrica Roncevic
- Primorje-Gorski Kotar County Teaching Institute of Public Health, 51000 Rijeka, Croatia
| | - Ljubo Barbic
- Department of Microbiology and Infectious Diseases with Clinic, Faculty of Veterinary Medicine, University of Zagreb, 10000 Zagreb, Croatia
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9
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Vilibic-Cavlek T, Stevanovic V, Savic V, Sabadi D, Peric L, Bogdanic M, Tabain I, Miklausic B, Santini M, Hunjak B, Potocnik-Hunjadi T, Dvorski E, Butigan T, Kolaric-Sviben G, Benvin I, Ferencak I, Barbic L. Prevalence and Epidemiological Characteristics of Neuroinvasive Zoonoses in Croatia, 2017-2020. Int J Infect Dis 2022. [DOI: 10.1016/j.ijid.2021.12.163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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10
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Sabadi D, Peric L, Savic V, Rubil I, Baraban V, Tabain I, Barbic L, Duvnjak M, Bogdanic M, Stevanovic V, Capak K, Vilibic-Cavlek T. Fatal case of West Nile encephalitis associated with acute anteroseptal ST elevation myocardial infarction (STEMI): a case report. New Microbiol 2020; 43:51-53. [PMID: 32334492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Accepted: 04/04/2020] [Indexed: 06/11/2023]
Abstract
Cardiac involvement has rarely been reported in West Nile (WNV) infection. We report a fatal case of WNV encephalitis associated with an acute anteroseptal ST elevation myocardial infarction. The patient was hospitalized with a fever, headache, nausea and vomiting. The physical examination revealed positive meningeal signs and an altered level of consciousness. High levels of cardiac enzymes (creatine phosphokinase/MB fraction, lactate dehydrogenase, myoglobin and cardiac troponin I) and ST elevation on electrocardiogram were found. Both CSF and urine samples were positive for WNV RNA. This case highlights the need of awareness of the possibility of a WNV-related myocardial infection, including myocardial infarction.
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Affiliation(s)
- Dario Sabadi
- Clinic for Infectious Diseases, University Hospital Center Osijek, Osijek, Croatia
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
| | - Ljiljana Peric
- Clinic for Infectious Diseases, University Hospital Center Osijek, Osijek, Croatia
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
| | - Vladimir Savic
- Poultry Centre, Croatian Veterinary Institute, Zagreb, Croatia
| | - Ilija Rubil
- Clinic for Infectious Diseases, University Hospital Center Osijek, Osijek, Croatia
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
| | - Vedrana Baraban
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
- Department of Cardiovascular Diseases, University Hospital Center Osijek, Osijek, Croatia
| | - Irena Tabain
- Department of Virology, Croatian Institute of Public Health, Zagreb Croatia
| | - Ljubo Barbic
- Department of Microbiology and Infectious Diseases with Clinic, Faculty of Veterinary Medicine University of Zagreb, Zagreb, Croatia
| | - Mario Duvnjak
- Clinic for Infectious Diseases, University Hospital Center Osijek, Osijek, Croatia
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
| | - Maja Bogdanic
- Department of Virology, Croatian Institute of Public Health, Zagreb Croatia
| | - Vladimir Stevanovic
- Department of Microbiology and Infectious Diseases with Clinic, Faculty of Veterinary Medicine University of Zagreb, Zagreb, Croatia
| | - Krunoslav Capak
- Environmental Health Department, Croatian Institute of Public Health, Zagreb, Croatia
| | - Tatjana Vilibic-Cavlek
- Department of Virology, Croatian Institute of Public Health, Zagreb Croatia
- School of Medicine University of Zagreb, Zagreb, Croatia
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11
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Vilibic-Cavlek T, Stevanovic V, Tabain I, Betica-Radic L, Sabadi D, Peric L, Bogdanic M, Vilibic M, Kolaric B, Kudumija B, Petrovic G, Mrzljak A, Karabuva S, Hrstic I, Capak K, Kucinar J, Savic V, Barbic L. Severe acute respiratory syndrome coronavirus 2 seroprevalence among personnel in the healthcare facilities of Croatia, 2020. Rev Soc Bras Med Trop 2020; 53:e20200458. [PMID: 32876319 PMCID: PMC7451497 DOI: 10.1590/0037-8682-0458-2020] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 07/21/2020] [Indexed: 02/07/2023] Open
Affiliation(s)
- Tatjana Vilibic-Cavlek
- Croatian Institute of Public Health, Department of Virology, Zagreb,
Croatia
- University of Zagreb, School of Medicine, Zagreb, Croatia
| | - Vladimir Stevanovic
- University of Zagreb, Faculty of Veterinary Medicine, Department of
Microbiology and Infectious Diseases with Clinic, Zagreb, Croatia
| | - Irena Tabain
- Croatian Institute of Public Health, Department of Virology, Zagreb,
Croatia
| | | | - Dario Sabadi
- Clinical Hospital Center Osijek, Department of Infectious Diseases,
Osijek, Croatia
- Josip Juraj Strossmayer University of Osijek, Medical Faculty,
Osijek, Croatia
| | - Ljiljana Peric
- Clinical Hospital Center Osijek, Department of Infectious Diseases,
Osijek, Croatia
- Josip Juraj Strossmayer University of Osijek, Medical Faculty,
Osijek, Croatia
| | - Maja Bogdanic
- Croatian Institute of Public Health, Department of Virology, Zagreb,
Croatia
| | - Maja Vilibic
- Sestre Milosrdnice University Hospital Centre, Department of
Psychiatry, Zagreb, Croatia
| | - Branko Kolaric
- Andrija Stampar Teaching Institute of Public Health, Department of
Public Health Gerontology, Zagreb, Croatia
- University of Rijeka, Faculty of Medicine, Rijeka, Croatia
| | - Boris Kudumija
- B. Braun Avitum Polyclinic for Internal Medicine and Dialysis,
Zagreb, Croatia
| | - Goranka Petrovic
- Croatian Institute of Public Health, Department of Epidemiology,
Zagreb, Croatia
| | - Anna Mrzljak
- University of Zagreb, School of Medicine, Zagreb, Croatia
- Merkur University Hospital, Department of Medicine, Zagreb,
Croatia
| | - Svjetlana Karabuva
- University Hospital Center Split, Department of Infectious
Diseases, Split, Croatia
| | - Irena Hrstic
- General Hospital Pula, Department of Medicine, Pula, Croatia
| | - Krunoslav Capak
- Croatian Institute of Public Health, Environmental Health
Department, Zagreb, Croatia
| | - Jasmina Kucinar
- Istria County Institute of Public Health, Department of Serology
and Immunology, Pula, Croatia
| | - Vladimir Savic
- Croatian Veterinary Institute, Laboratory for Virology and
Serology, Zagreb, Croatia
| | - Ljubo Barbic
- University of Zagreb, Faculty of Veterinary Medicine, Department of
Microbiology and Infectious Diseases with Clinic, Zagreb, Croatia
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12
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Konjevoda S, Dzelalija B, Canovic S, Pastar Z, Savic V, Tabain I, Barbic L, Peric L, Sabadi D, Stevanovic V, Vilibic-Cavlek T. West Nile virus retinitis in a patient with neuroinvasive disease. Rev Soc Bras Med Trop 2019; 52:e20190065. [PMID: 31166490 DOI: 10.1590/0037-8682-0065-2019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 04/16/2019] [Indexed: 11/22/2022] Open
Affiliation(s)
- Suzana Konjevoda
- Department of Ophthalmology, General Hospital Zadar, Zadar, Croatia.,Department of Health, University of Zadar, Zadar, Croatia
| | - Boris Dzelalija
- Department of Infectious Diseases, General Hospital Zadar, Zadar, Croatia
| | - Samir Canovic
- Department of Ophthalmology, General Hospital Zadar, Zadar, Croatia
| | - Zrinjka Pastar
- Department of Health, University of Zadar, Zadar, Croatia
| | - Vladimir Savic
- Poultry Center, Croatian Veterinary Institute, Zagreb, Croatia
| | - Irena Tabain
- Department of Virology, Croatian Institute of Public Health, Zagreb, Croatia
| | - Ljubo Barbic
- Department of Microbiology and Infectious Diseases with Clinic, Faculty of Veterinary Medicine, University of Zagreb, Zagreb, Croatia
| | - Ljiljana Peric
- Department of Infectious Diseases, Clinical Hospital Center Osijek, Osijek, Croatia.,Medical Faculty, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
| | - Dario Sabadi
- Department of Infectious Diseases, Clinical Hospital Center Osijek, Osijek, Croatia.,Medical Faculty, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
| | - Vladimir Stevanovic
- Department of Microbiology and Infectious Diseases with Clinic, Faculty of Veterinary Medicine, University of Zagreb, Zagreb, Croatia
| | - Tatjana Vilibic-Cavlek
- Department of Virology, Croatian Institute of Public Health, Zagreb, Croatia.,School of Medicine, University of Zagreb, Zagreb, Croatia
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13
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Vilibic-Cavlek T, Savic V, Sabadi D, Peric L, Barbic L, Klobucar A, Miklausic B, Tabain I, Santini M, Vucelja M, Dvorski E, Butigan T, Kolaric-Sviben G, Potocnik-Hunjadi T, Balenovic M, Bogdanic M, Andric Z, Stevanovic V, Capak K, Balicevic M, Listes E, Savini G. Prevalence and molecular epidemiology of West Nile and Usutu virus infections in Croatia in the 'One health' context, 2018. Transbound Emerg Dis 2019; 66:1946-1957. [PMID: 31067011 DOI: 10.1111/tbed.13225] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 04/19/2019] [Accepted: 05/03/2019] [Indexed: 12/14/2022]
Abstract
In 2018, Croatia reported the largest outbreak of West Nile virus (WNV) infections as well as the re-occurrence of human Usutu virus (USUV) infections. For the first time, fatal WNV and USUV infections were detected in wild birds. We analysed epidemiological characteristics and molecular epidemiology of WNV and USUV infections detected during 2018 transmission season. From April to November, 178 patients with neuroinvasive disease and 68 patients with febrile disease were tested for WNV and USUV. Viral RNA was detected in cerebrospinal fluid (CSF) and urine samples using a real-time RT-PCR. Positive samples were tested by nested RT-PCR and nucleotide sequencing. IgM/IgG antibodies were detected in serum/CSF samples using ELISA with confirmation of cross-reactive samples by virus neutralization test (VNT). WNV neuroinvasive disease was confirmed in 54 and WNV fever in seven patients from 10 continental Croatian counties. Areas affected in 2018 were those in which cases occurred in previous seasons, while in three areas human cases were reported for the first time. Phylogenetic analysis of six strains from patients residing in different geographic areas showed circulation of WNV lineage 2. In three patients, neuroinvasive USUV infection was confirmed by RT-PCR or VNT. Sequence analysis of one detected strain revealed USUV Europe 2 lineage. During the same period, a total of 2,574 horse and 1,069 poultry serum samples were tested for WNV antibodies using ELISA. Acute asymptomatic WNV infection (IgM antibodies) was documented in 20/0.7% horses. WNV IgG antibodies were found in 307/11.9% horses and in 125/12.7% poultry. WNV RNA was detected in two goshawks and USUV RNA was detected in one blackbird from north-western Croatia. In the Zagreb area, 3,670 female mosquitoes were collected. One Culex pipiens pool collected in July tested positive for USUV RNA. Our results highlight the importance of continuous multidisciplinary 'One health' surveillance of these emerging arboviruses.
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Affiliation(s)
- Tatjana Vilibic-Cavlek
- Croatian Institute of Public Health, Zagreb, Croatia.,School of Medicine, University of Zagreb, Zagreb, Croatia
| | | | - Dario Sabadi
- Clinical Hospital Center Osijek, Osijek, Croatia.,Medical Faculty, Josip Juraj Stossmayer University of Osijek, Osijek, Croatia
| | - Ljiljana Peric
- Clinical Hospital Center Osijek, Osijek, Croatia.,Medical Faculty, Josip Juraj Stossmayer University of Osijek, Osijek, Croatia
| | - Ljubo Barbic
- Faculty of Veterinary Medicine, University of Zagreb, Zagreb, Croatia
| | - Ana Klobucar
- Andrija Stampar Teaching Institute of Public Health, Zagreb, Croatia
| | - Bozana Miklausic
- University Hospital for Infectious Diseases "Dr Fran Mihaljevic", Zagreb, Croatia
| | - Irena Tabain
- Croatian Institute of Public Health, Zagreb, Croatia
| | - Marija Santini
- School of Medicine, University of Zagreb, Zagreb, Croatia.,University Hospital for Infectious Diseases "Dr Fran Mihaljevic", Zagreb, Croatia
| | - Marko Vucelja
- Faculty of Forestry, University of Zagreb, Zagreb, Croatia
| | | | | | | | | | | | - Maja Bogdanic
- Croatian Institute of Public Health, Zagreb, Croatia
| | | | | | | | | | - Eddy Listes
- Croatian Veterinary Institute, Regional Institute Split, Split, Croatia
| | - Giovanni Savini
- OIE Reference Center for West Nile Disease, Istituto Zooprofilattico Sperimentale "G. Caporale", Teramo, Italy
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14
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Vilibic-Cavlek T, Bogdanic M, Savic V, Tabain I, Peric L, Sabadi D, Potocnik-Hunjadi T, Miklausic B, Zember S, Santini M, Kolaric-Sviben G, Dvorski E, Butigan T, Jemersic L, Prpic J, Kolaric B, Balicevic M, Stevanovic V, Barbic L, Babic-Erceg A, Listes E, Madic J, Klobucar A, Savini G. Clinical and laboratory characteristics of neuroinvasive viral zoonoses detected in continental Croatian regions, 2017-2018. Int J Infect Dis 2019. [DOI: 10.1016/j.ijid.2018.11.301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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15
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Sabadi D, Peric L, Rubil I, Lisnjic D, Duvnjak M, Simasek D, Grubisic B, Radocaj V, Baraban V, Savic V, Tabain I, Barbic L, Kaic B, Stevanovic V, Vilibic-Cavlek T. Acute anteroseptal ST-Elevation Myocardial Infarction (STEMI) in the West Nile virus infection. Int J Infect Dis 2019. [DOI: 10.1016/j.ijid.2018.11.294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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16
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Vilibic-Cavlek T, Kristofic B, Savic V, Kolaric B, Barbic L, Tabain I, Peric L, Sabadi D, Miklausic B, Potocnik-Hunjadi T, Zember S, Stevanovic V, Listes E, Savini G. Diagnostic significance of immunoglobulin G avidity in symptomatic and asymptomatic West Nile virus infection. Rev Soc Bras Med Trop 2018; 51:591-595. [PMID: 30304263 DOI: 10.1590/0037-8682-0482-2017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 07/18/2018] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION West Nile virus (WNV) immunoglobulin M (IgM) antibodies have been shown to persist for up to 500 days in certain patients. To evaluate the usefulness of immunoglobulin G (IgG) avidity assessment in the diagnosis of WNV infection, we analyzed 54 WNV IgM- and/or IgG-positive serum samples from 39 patients with neuroinvasive disease and 15 asymptomatic cases tested during a seroprevalence investigation. METHODS Serological tests (WNV IgM/IgG antibody detection, IgG avidity) were performed using commercially available enzyme-linked immunosorbent assays. RESULTS WNV IgM antibodies were detected in 47 (87%) samples. Acute/recent WNV infection was confirmed based on low/borderline avidity index (AI) in 44 IgM-positive samples (93.6%). In three IgM-positive samples (6.4%), high IgG AIs were detected, thus indicating persisting IgM antibodies from previous infections. All IgM-negative samples showed high AIs. Patients with WNV neuroinvasive disease tested within 30 days showed low AIs. In six patients tested 34-50 days after disease onset, AI was borderline (42%-60%), suggesting earlier WNV IgG maturation. Samples with the highest IgM values were associated with the lowest AIs (Spearman's rho coefficient -0.767, p < 0.001). CONCLUSIONS Our results indicate that IgG avidity differentiates current/recent WNV infection from persistent IgM seropositivity from the previous WNV transmission season both in patients with WNV neuroinvasive disease and in asymptomatic persons. A strong negative correlation between IgM antibody levels and AI indicates that in cases with very high IgM levels, determination of IgG avidity may not be necessary. As many patients showed rapid avidity maturation, low IgG avidity is indicative of WNV infection within the previous month.
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Affiliation(s)
- Tatjana Vilibic-Cavlek
- Department of Virology, Croatian Institute of Public Health, Zagreb, Croatia.,School of Medicine University of Zagreb, Zagreb, Croatia
| | - Branimir Kristofic
- Department of Gynecology and Obstetrics, County Hospital Cakovec, Cakovec, Croatia
| | - Vladimir Savic
- Poultry Centre, Croatian Veterinary Institute, Zagreb, Croatia
| | - Branko Kolaric
- Department of Epidemiology, Andrija Stampar Teaching Institute of Public Health, Zagreb, Croatia.,School of Medicine University of Rijeka, Rijeka, Croatia
| | - Ljubo Barbic
- Department of Microbiology and Infectious Diseases with Clinic, Faculty of Veterinary Medicine, University of Zagreb, Zagreb, Croatia
| | - Irena Tabain
- Department of Virology, Croatian Institute of Public Health, Zagreb, Croatia
| | - Ljiljana Peric
- Department of Infectious Diseases, Clinical Hospital Centre Osijek, Osijek,Croatia.,Medical Faculty, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
| | - Dario Sabadi
- Department of Infectious Diseases, Clinical Hospital Centre Osijek, Osijek,Croatia.,Medical Faculty, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
| | - Bozana Miklausic
- Department of Infectious Diseases, General Hospital "Dr Josip Bencevic", Slavonski Brod, Croatia
| | | | - Sanja Zember
- Department of Infectious Diseases, General Hospital Varazdin, Varazdin, Croatia
| | - Vladimir Stevanovic
- Department of Microbiology and Infectious Diseases with Clinic, Faculty of Veterinary Medicine, University of Zagreb, Zagreb, Croatia
| | - Eddy Listes
- Croatian Veterinary Institute, Regional Institute Split, Split, Croatia
| | - Giovanni Savini
- OIE Reference Centre for West Nile Disease, Istituto Zooprofilattico Sperimentale "G. Caporale", Teramo, Italy
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Peric L, Sabadi D, Rubil I, Bogdan M, Guzvinec M, Dakovic Rode O, Kaic B, Tabain I, Vilibic-Cavlek T. Imported brucellosis and Q-fever coinfection in Croatia: a case report. J Infect Dev Ctries 2018; 12:499-503. [PMID: 31940303 DOI: 10.3855/jidc.10151] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 05/14/2018] [Indexed: 10/31/2022] Open
Abstract
The brucellosis and Q-fever coinfection is very rarely reported. To our knowledge, this is the first case report of concomitant brucellosis and Q-fever, most likely imported in Croatia. A 30-year-old male agricultural worker was hospitalized on 22 April 2017 after a ten days fever up to 40°C with chills, shivering, excessive sweating, general weakness, loss of appetite and headache. A month and a half prior to the hospitalization he lost 18 kg of body weight. Three weeks before hospitalization the patient returned from Kupres (Bosnia and Herzegovina) where he was working for the past year on a sheep farm and consumed unpasteurized dairy products of sheep origin. At admission, his condition was moderately severe due to pronounced dehydration. Routine laboratory tests showed slightly elevated erythrocyte sedimentation rate, anemia, thrombocytopenia and elevated liver transaminases. The chest X-ray showed an inhomogeneous infiltrate of the lower right lung. Three sets of blood culture were cultivated. After 48 hours incubation, bacterial growth was detected in aerobic bottles. Gram-stained smear revealed small, gram-negative coccobacilli. Specimens were subcultured on blood and chocolate agar plates. Using a Vitek GN identification card, the isolated organism was identified as Brucella melitensis. 16S rRNA gene sequencing of the isolate confirmed it as a Brucella sp. Rose-Bengal test was positive, while Wright agglutination test showed a significant increase in antibody titer from 80 to 640 in paired sera. Using indirect immunofluorescence assay (IFA), Coxiella burnetii phase II IgM/IgG titers were 50 and 1024, respectively indicating acute Q-fever. The patient was treated with doxycycline and rifampicin. So far, there has been no relapse or signs of chronic infection.
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Affiliation(s)
- Ljiljana Peric
- Josip Juraj Strossmayer University of Osijek, Osijek, Croatia.
| | - Dario Sabadi
- Josip Juraj Strossmayer University of Osijek, Osijek, Croatia.
| | - Ilija Rubil
- Josip Juraj Strossmayer University of Osijek, Osijek, Croatia.
| | - Maja Bogdan
- Josip Juraj Strossmayer University of Osijek, Osijek, Croatia.
| | - Marija Guzvinec
- University Hospital for Infectious Diseases "Dr Fran Mihaljevic", Zagreb, Croatia.
| | | | - Bernard Kaic
- Croatian Institute of Public Health, Zagreb, Croatia.
| | - Irena Tabain
- Croatian Institute of Public Health, Zagreb, Croatia.
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