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Antunes L, Mazagatos C, Martínez-Baz I, Gomez V, Borg ML, Petrović G, Duffy R, Dufrasne FE, Dürrwald R, Lazar M, Jancoriene L, Oroszi B, Husa P, Howard J, Melo A, Pozo F, Pérez-Gimeno G, Castilla J, Machado A, Džiugytė A, Karabuva S, Fitzgerald M, Fierens S, Tolksdorf K, Popovici SO, Mickienė A, Túri G, Součková L, Nicolay N, Rose AM. Effectiveness of the adapted bivalent mRNA COVID-19 vaccines against hospitalisation in individuals aged ≥ 60 years during the Omicron XBB lineage-predominant period: VEBIS SARI VE network, Europe, February to August, 2023. Euro Surveill 2024; 29:2300708. [PMID: 38240061 PMCID: PMC10797659 DOI: 10.2807/1560-7917.es.2024.29.3.2300708] [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: 12/15/2023] [Accepted: 01/18/2024] [Indexed: 01/22/2024] Open
Abstract
We conducted a multicentre hospital-based test-negative case-control study to measure the effectiveness of adapted bivalent COVID-19 mRNA vaccines against PCR-confirmed SARS-CoV-2 infection during the Omicron XBB lineage-predominant period in patients aged ≥ 60 years with severe acute respiratory infection from five countries in Europe. Bivalent vaccines provided short-term additional protection compared with those vaccinated > 6 months before the campaign: from 80% (95% CI: 50 to 94) for 14-89 days post-vaccination, 15% (95% CI: -12 to 35) at 90-179 days, and lower to no effect thereafter.
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Affiliation(s)
| | - Clara Mazagatos
- National Centre for Epidemiology, Institute of Health Carlos III, Madrid, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Iván Martínez-Baz
- Instituto de Salud Pública de Navarra - IdiSNA, Pamplona, Spain
- CIBER Epidemiología y Salud Pública, Madrid, Spain
| | - Verónica Gomez
- Epidemiology Department, National Health Institute Doutor Ricardo Jorge, Lisbon, Portugal
| | - Maria-Louise Borg
- Infectious Disease Prevention and Control Unit (IDCU), Health Promotion and Disease Prevention, Msida, Malta
| | | | - Róisín Duffy
- Health Service Executive-Health Protection Surveillance Centre (HPSC), Dublin, Ireland
| | - François E Dufrasne
- National Influenza Centre Laboratory of Viral Diseases, Sciensano, Brussels, Belgium
| | - Ralf Dürrwald
- National Reference Centre for Influenza, Robert Koch Institute, Berlin, Germany
| | - Mihaela Lazar
- Cantacuzino National Military-Medical Institute for Research and Development, Bucharest, Romania
| | - Ligita Jancoriene
- Clinic of Infectious Diseases and Dermatovenerology, Institute of Clinical Medicine, Medical Faculty, Vilnius University, Lithuania
| | - Beatrix Oroszi
- National Laboratory for Health Security, Epidemiology and Surveillance Centre, Semmelweis University, Budapest, Hungary
| | - Petr Husa
- University Hospital Brno, Masaryk University, Brno, Czechia
| | | | - Aryse Melo
- Infectious Diseases Department, National Health Institute Doutor Ricardo Jorge, Lisbon, Portugal
| | - Francisco Pozo
- National Centre for Microbiology, Institute of Health Carlos III, Madrid, Spain
| | - Gloria Pérez-Gimeno
- National Centre for Epidemiology, Institute of Health Carlos III, Madrid, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Jesús Castilla
- Instituto de Salud Pública de Navarra - IdiSNA, Pamplona, Spain
- CIBER Epidemiología y Salud Pública, Madrid, Spain
| | - Ausenda Machado
- Epidemiology Department, National Health Institute Doutor Ricardo Jorge, Lisbon, Portugal
| | - Aušra Džiugytė
- Infectious Disease Prevention and Control Unit (IDCU), Health Promotion and Disease Prevention, Msida, Malta
| | | | - Margaret Fitzgerald
- Health Service Executive-Health Protection Surveillance Centre (HPSC), Dublin, Ireland
| | - Sébastien Fierens
- Service Epidemiology of Infectious Diseases, Sciensano, Brussels, Belgium
| | - Kristin Tolksdorf
- Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Silvia-Odette Popovici
- National Institute of Public Health, National Centre for Communicable Diseases Surveillance and Control, Bucharest, Romania
| | - Auksė Mickienė
- Department of Infectious Diseases, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Gergő Túri
- National Laboratory for Health Security, Epidemiology and Surveillance Centre, Semmelweis University, Budapest, Hungary
| | - Lenka Součková
- University Hospital Brno, Masaryk University, Brno, Czechia
| | - Nathalie Nicolay
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
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Dobaja Borak M, Babić Ž, Caganova B, Grenc D, Karabuva S, Kolpach Z, Krakowiak A, Kolesnikova V, Lukšić B, Pap C, Puljiz I, Piekarska-Wijatkowska A, Radenkova-Saeva J, Vučinić S, Zacharov S, Eddleston M, Brvar M. Viper envenomation in Central and Southeastern Europe: a multicentre study. Clin Toxicol (Phila) 2023; 61:656-664. [PMID: 37988116 DOI: 10.1080/15563650.2023.2273761] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 10/17/2023] [Indexed: 11/22/2023]
Abstract
INTRODUCTION Snakebite incidence varies across Europe. However, there is limited research from Central and Southeastern Europe. These regions are notable for the presence of the common European adder (Vipera berus) and the more venomous nose-horned viper (Vipera ammodytes). No standard European antivenom protocol exists. The aim was to assess the epidemiology and treatment of viper bites in this region, focusing on a comparison of bites from Vipera berus and Vipera ammodytes. METHODS We conducted a prospective multicenter study in Central and Southeastern Europe from 2018 to 2020. This study included poison centres and toxicology-associated hospital wards in Poland, the Czech Republic, Slovakia, Hungary, Slovenia, Croatia, Serbia, and Bulgaria. The following data were collected: age, gender, Vipera species, snakebite site, clinical picture, laboratory results, Audebert's clinical severity grading score, and antivenom therapy. RESULTS The annual incidence of viper bites in Central and Southeast Europe was estimated at 2.55 bites per million population. Within their respective geographical distribution areas, the incidence of Vipera ammodytes bites (1.61 bites per million population) was higher than Vipera berus bites (1.00 bites per million population). Patients bitten by Vipera ammodytes more frequently reported local pain and developed thrombocytopenia. Antivenom treatment was more commonly administered in Vipera ammodytes bites (72%) compared to Vipera berus bites (39%). The incidence of Vipera ammodytes bites treated with antivenom within its geographical distribution area was three times higher than Vipera berus bites treated with antivenom (1.16 bites per million population versus 0.39 bites per million population). No deaths were reported. CONCLUSIONS The estimated incidence of viper bites in Central and Southeastern Europe is at least 2.55 per million population. Vipera ammodytes bites are more common and severe, characterized by higher frequencies of pain and thrombocytopenia. Antivenom is needed more often for Vipera ammodytes bites. It is vital that enough European Medicines Agency-approved Vipera ammodytes antivenom is produced and offered affordably.
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Affiliation(s)
- Mojca Dobaja Borak
- Centre for Clinical Toxicology and Pharmacology, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Centre for Clinical Physiology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Željka Babić
- Poison Centre, Institute for Medical Research and Occupational Health, Zagreb, Croatia
| | - Blažena Caganova
- National Toxicological Information Centre, University Hospital, Bratislava, Slovakia
| | - Damjan Grenc
- Centre for Clinical Toxicology and Pharmacology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Svjetlana Karabuva
- Clinical Department of Infectious Diseases, University Hospital of Split, Split, Croatia
- School of Medicine, University of Split, Split, Croatia
| | - Zuzana Kolpach
- Toxicological Information Centre, Department of Occupational Medicine, 1st Faculty of Medicine, Charles University, Prague, Czech Republic
- General University Hospital, Prague, Czech Republic
| | - Anna Krakowiak
- Nofer Institute of Occupational Medicine, Łódź, Poland
- Clinic of Anesthesiology and Intensive Care, Toxicology Unit, Central Clinical Hospital of the Medical University of Łódź, Łódź, Poland
| | - Viktoriia Kolesnikova
- Toxicological Information Centre, Department of Occupational Medicine, 1st Faculty of Medicine, Charles University, Prague, Czech Republic
- General University Hospital, Prague, Czech Republic
| | - Boris Lukšić
- Clinical Department of Infectious Diseases, University Hospital of Split, Split, Croatia
- School of Medicine, University of Split, Split, Croatia
| | - Csaba Pap
- Department of Toxicology, Péterfy Hospital, Budapest, Hungary
| | - Ivan Puljiz
- University hospital for infectious diseases "Dr. Fran Mihaljević", Zagreb, Croatia
| | | | - Julia Radenkova-Saeva
- Clinic of Toxicology, University Hospital for Emergency Medicine "N.I.Pirogov", Sofia, Bulgaria
| | - Slavica Vučinić
- National Poison Centre, Military Medical Academy, Medical Faculty University of Defense, Belgrade, Serbia
| | - Sergej Zacharov
- Toxicological Information Centre, Department of Occupational Medicine, 1st Faculty of Medicine, Charles University, Prague, Czech Republic
- General University Hospital, Prague, Czech Republic
| | - Michael Eddleston
- Department of Pharmacology, Toxicology, and Therapeutics, University/BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Miran Brvar
- Centre for Clinical Toxicology and Pharmacology, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Centre for Clinical Physiology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
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Kurtović T, Karabuva S, Grenc D, Dobaja Borak M, Križaj I, Lukšić B, Halassy B, Brvar M. Intravenous Vipera berus Venom-Specific Fab Fragments and Intramuscular Vipera ammodytes Venom-Specific F(ab') 2 Fragments in Vipera ammodytes-Envenomed Patients. Toxins (Basel) 2021; 13:toxins13040279. [PMID: 33919927 PMCID: PMC8070888 DOI: 10.3390/toxins13040279] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 04/08/2021] [Accepted: 04/12/2021] [Indexed: 11/25/2022] Open
Abstract
Vipera ammodytes (V. ammodytes) is the most venomous European viper. The aim of this study was to compare the clinical efficacy and pharmacokinetic values of intravenous Vipera berus venom-specific (paraspecific) Fab fragments (ViperaTAb) and intramuscular V. ammodytes venom-specific F(ab’)2 fragments (European viper venom antiserum, also called “Zagreb” antivenom) in V.ammodytes-envenomed patients. This was a prospective study of V.ammodytes-envenomed patients that were treated intravenously with ViperaTAb or intramuscularly with European viper venom antiserum that was feasible only due to the unique situation of an antivenom shortage. The highest venom concentration, survival, length of hospital stay and adverse reactions did not differ between the groups. Patients treated with intravenous Fab fragments were sicker, with significantly more rhabdomyolysis and neurotoxicity. The kinetics of Fab fragments after one or more intravenous applications matched better with the venom concentration in the early phase of envenomation compared to F(ab’)2 fragments that were given intramuscularly only on admission. F(ab’)2 fragments given intramuscularly had 25-fold longer apparent total body clearance and 14-fold longer elimination half-time compared to Fab fragments given intravenously (2 weeks vs. 24 h, respectively). In V.ammodytes-envenomed patients, the intramuscular use of specific F(ab’)2 fragments resulted in a slow rise of antivenom serum concentration that demanded their early administration but without the need for additional doses for complete resolution of all clinical signs of envenomation. Intravenous use of paraspecific Fab fragments resulted in the immediate rise of antivenom serum concentration that enabled their use according to the clinical progress, but multiple doses might be needed for efficient therapy of thrombocytopenia due to venom recurrence, while the progression of rhabdomyolysis and neurotoxic effects of the venom could not be prevented.
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Affiliation(s)
- Tihana Kurtović
- Centre for Research and Knowledge Transfer in Biotechnology, University of Zagreb, Rockefellerova 10, 10000 Zagreb, Croatia;
- Center of Excellence for Virus Immunology and Vaccines, CERVirVac, Rockefellerova 10, 10000 Zagreb, Croatia
| | - Svjetlana Karabuva
- Clinical Department of Infectious Diseases, University Hospital of Split, Šoltanska 1, 21000 Split, Croatia; (S.K.); (B.L.)
- School of Medicine, University of Split, Šoltanska 2, 21000 Split, Croatia
| | - Damjan Grenc
- Centre for Clinical Toxicology and Pharmacology, University Medical Centre Ljubljana, Zaloška cesta 7, 1000 Ljubljana, Slovenia; (D.G.); (M.D.B.)
| | - Mojca Dobaja Borak
- Centre for Clinical Toxicology and Pharmacology, University Medical Centre Ljubljana, Zaloška cesta 7, 1000 Ljubljana, Slovenia; (D.G.); (M.D.B.)
| | - Igor Križaj
- Department of Molecular and Biomedical Sciences, Jožef Stefan Institute, Jamova 39, 1000 Ljubljana, Slovenia;
| | - Boris Lukšić
- Clinical Department of Infectious Diseases, University Hospital of Split, Šoltanska 1, 21000 Split, Croatia; (S.K.); (B.L.)
- School of Medicine, University of Split, Šoltanska 2, 21000 Split, Croatia
| | - Beata Halassy
- Centre for Research and Knowledge Transfer in Biotechnology, University of Zagreb, Rockefellerova 10, 10000 Zagreb, Croatia;
- Center of Excellence for Virus Immunology and Vaccines, CERVirVac, Rockefellerova 10, 10000 Zagreb, Croatia
- Correspondence: (B.H.); (M.B.)
| | - Miran Brvar
- Centre for Clinical Toxicology and Pharmacology, University Medical Centre Ljubljana, Zaloška cesta 7, 1000 Ljubljana, Slovenia; (D.G.); (M.D.B.)
- Centre for Clinical Physiology, Faculty of Medicine, University of Ljubljana, Zaloška cesta 4, 1000 Ljubljana, Slovenia
- Correspondence: (B.H.); (M.B.)
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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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Lukšić B, Karabuva S, Markić J, Polić B, Kovačević T, Meštrović J, Križaj I. Thrombocytopenic purpura following envenomation by the nose-horned viper (Vipera ammodytes ammodytes): Two case reports. Medicine (Baltimore) 2018; 97:e13737. [PMID: 30593149 PMCID: PMC6314653 DOI: 10.1097/md.0000000000013737] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Two clinical cases are reported of envenomation by the nose-horned viper (Vipera ammodytes ammodytes) venom of a 9-year-old boy and of an 84-year-old woman. PATIENT CONCERNS Both patients had been bitten on their extremities by such a snake in August near Split, a town in southern Croatia. DIAGNOSES Clinical manifestation of envenomation was severe in the case of the boy, being characterized by a severe coagulopathy. This was only just apparent in the case of the elderly woman, who suffered extensive local edema and hematoma at the site of the bite, together with a neurotoxic effect-bilateral ptosis. This was the first occasion of thrombocytopenic purpura being observed in patients envenomed by nose-horned viper venom. This unexpected clinical finding was characterized by an unusually profound thrombocytopenia of 5 and 10 × 10/L platelets of the respective patients on their admission to the hospital, together with purpura, observed on the face and thorax of both individuals. In the most serious cases, such pathology can be life threatening if not promptly recognized and treated. INTERVENTIONS The patients recovered quickly on receiving the specific antivenom along with all the usual supportive treatments. OUTCOMES No serious sequels were noticed at the moment of discharge. LESSONS Our finding constitutes an important message to clinicians to consider the possibility of such complications in the case of nose-horned viper envenomation.
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Affiliation(s)
- Boris Lukšić
- Clinical Department of Infectious Diseases, University Hospital of Split
- University of Split, School of Medicine
| | - Svjetlana Karabuva
- Clinical Department of Infectious Diseases, University Hospital of Split
| | - Joško Markić
- University of Split, School of Medicine
- Department of Pediatrics, University Hospital of Split, Split
| | - Branka Polić
- Department of Pediatrics, University Hospital of Split, Split
| | - Tanja Kovačević
- Department of Pediatrics, University Hospital of Split, Split
| | - Julije Meštrović
- University of Split, School of Medicine
- Department of Pediatrics, University Hospital of Split, Split
| | - Igor Križaj
- Department of Molecular and Biomedical Sciences, Jožef Stefan Institute, Ljubljana, Slovenia
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Karabuva S, Lukšić B, Brizić I, Latinović Z, Leonardi A, Križaj I. Ammodytin L is the main cardiotoxic component of the Vipera ammodytes ammodytes venom. Toxicon 2017; 139:94-100. [PMID: 29030107 DOI: 10.1016/j.toxicon.2017.10.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [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: 07/07/2017] [Revised: 09/08/2017] [Accepted: 10/08/2017] [Indexed: 11/15/2022]
Abstract
Venom of the nose-horned viper (V. a. ammodytes) as also venoms of some related European viperids can induce also cardiotoxic effects in mammals. In this work we demonstrated that the protein in the V. a. ammodytes venom acting on heart is a myotoxic secreted phospholipase A2 analogue ammodytin L (AtnL). In the isolated perfused rat heart AtnL induced significant and irreversible cardiotoxicity characterized by atrioventricular (AV) blockade. This venom protein induced appearance of high levels of creatine kinase, lactate dehydrogenase, aspartate aminotransferase and troponin I in the sinus effluent of the isolated heart, indicative for myocardial damage, which is obviously the primary cause of its cardiotoxic action. Gel filtration chromatography subfractions C1 and C2 of the V. a. ammodytes venom harboured most of the venom cardiotoxicity. As we showed, just these two subfractions contained also AtnL. Subfraction C1 in the final CF concentration 11.3 μg/mL (containing 3.1 μg/mL AtnL) induced a complete cardiac arrest while subfraction C2 in the final CF concentration 6.0 μg/mL (containing 0.8 μg/mL AtnL) and the pure AtnL (1.0 μg/mL) did not. Contrary to AtnL, subfraction C1 at 11.3 μg/mL was not able to induce the AV blockade. This exposed the only other cardiotoxic subfractions-specific venom protein, a cysteine-rich secretory protein (CRISP), as an additional venom component potentially involved in modulation of the heart activity. Cardiotoxicity reported in some cases of the adder (V. berus) venom and the asp viper (V. aspis) venom poisonings may be assigned to AtnL in these venoms.
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Affiliation(s)
- Svjetlana Karabuva
- Clinical Department of Infectious Diseases, University Hospital of Split, Šoltanska 1, Split, Croatia.
| | - Boris Lukšić
- Clinical Department of Infectious Diseases, University Hospital of Split, Šoltanska 1, Split, Croatia; University of Split School of Medicine, Šoltanska 2, Split, Croatia.
| | - Ivica Brizić
- Department of Pharmacology, Mostar University School of Medicine, Bijeli brijeg bb, Mostar, Bosnia and Herzegovina.
| | - Zorica Latinović
- Department of Molecular and Biomedical Sciences, Jožef Stefan Institute, Jamova cesta 39, Ljubljana, Slovenia; Jožef Stefan International Postgraduate School, Jamova cesta 39, Ljubljana, Slovenia.
| | - Adrijana Leonardi
- Department of Molecular and Biomedical Sciences, Jožef Stefan Institute, Jamova cesta 39, Ljubljana, Slovenia.
| | - Igor Križaj
- Department of Molecular and Biomedical Sciences, Jožef Stefan Institute, Jamova cesta 39, Ljubljana, Slovenia.
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Luksic B, Pandak N, Drazic-Maras E, Karabuva S, Radic M, Babic-Erceg A, Barbic L, Stevanovic V, Vilibic-Cavlek T. First case of imported chikungunya infection in Croatia, 2016. Int Med Case Rep J 2017; 10:117-121. [PMID: 28435330 PMCID: PMC5388347 DOI: 10.2147/imcrj.s130210] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
In recent years, several European countries reported cases of imported chikungunya infection. We present the first imported clinically manifested chikungunya fever in Croatia. A 27-year-old woman returned to Croatia on 21 March 2016, after she stayed in Costa Rica for two months where she had noticed a mosquito bite on her left forearm. Five days after the mosquito bite she developed severe arthralgias, fever and erythematous papular rash. In next few days symptoms gradually subsided. After ten days she felt better, but arthralgias re-appeared accompanied with morning stiffness. Two weeks after the onset of the disease she visited the infectious diseases outpatient department. The physical examination revealed rash on the trunk, extremities, palms and soles. Laboratory findings showed slightly elevated liver transaminases. Serological tests performed on day 20 after disease onset showed a high titer of chikungunya virus (CHIKV) IgM and IgG antibodies which indicated CHIKV infection. CHIKV-RNA was not detected. Serology to dengue and Zika virus was negative. The patient was treated with nonsteroid anti-inflammatory drugs and paracetamol. Her symptoms ameliorated, however, three months later she still complaint of arthralgias. The presented case highlights the need for inclusion of CHIKV in the differential diagnosis of arthralgia in all travelers returning from countries with documented CHIKV transmission.
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Affiliation(s)
- Boris Luksic
- Clinical Department of Infectious Diseases, University Hospital Centre Split, Split, Croatia.,School of Medicine, University of Split, Split, Croatia
| | - Nenad Pandak
- School of Medicine, University of Split, Split, Croatia.,Department of Infectious Diseases, General Hospital "Dr Josip Bencevic", Slavonski Brod, Croatia
| | - Edita Drazic-Maras
- Clinical Department of Infectious Diseases, University Hospital Centre Split, Split, Croatia
| | - Svjetlana Karabuva
- Clinical Department of Infectious Diseases, University Hospital Centre Split, Split, Croatia
| | - Mislav Radic
- School of Medicine, University of Split, Split, Croatia.,Department of Rheumatology and Clinical Immunology, University Hospital Centre Split, Split, Croatia
| | | | - Ljubo Barbic
- Department of Microbiology and Infectious Diseases with Clinic, Faculty of Veterinary Medicine, University of Zagreb, Zagreb, Croatia
| | - Vladimir Stevanovic
- Department of Microbiology and Infectious Diseases with Clinic, Faculty of Veterinary Medicine, University of Zagreb, Zagreb, Croatia
| | - Tatjana Vilibic-Cavlek
- Croatian National Institute of Public Health, Zagreb, Croatia.,Reference Centre for Diagnosis and Surveillance of Viral Zoonoses of the Ministry of Health of the Republic of Croatia, Zagreb, Croatia.,School of Medicine, University of Zagreb, Zagreb, Croatia
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8
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Karabuva S, Brizić I, Latinović Z, Leonardi A, Križaj I, Lukšić B. Cardiotoxic effects of the Vipera ammodytes ammodytes venom fractions in the isolated perfused rat heart. Toxicon 2016; 121:98-104. [PMID: 27623431 DOI: 10.1016/j.toxicon.2016.09.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [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: 06/10/2016] [Revised: 08/31/2016] [Accepted: 09/01/2016] [Indexed: 01/16/2023]
Abstract
The nose-horned viper (Vipera ammodytes ammodytes) is the most venomous European snake. Its venom is known as haematotoxic, myotoxic and neurotoxic but it exerts also cardiotoxic effects. To further explore the cardiotoxicity of the venom we separated it into four fractions by gel filtration chromatography. Three fractions that contain polypeptides (A, B, and C) were tested for their effects on isolated rat heart. Heart rate (HR), incidence of arrhythmias (atrioventricular (AV) blocks, ventricular tachycardia, ventricular fibrillation, and asystolia), coronary flow (CF), systolic, developed and diastolic left ventricular pressure (LVP) were measured before, during, and after the application of venom fractions in three different concentrations. Fraction A, containing proteins of 60-100 kDa, displayed no effect on the rat heart. Fractions B and C disturbed heart functioning in similar way, but with different potency that was higher by the latter. This was manifested by significant decrease of HR and CF, the increase of diastolic, and the decrease of systolic and developed LVPs. All hearts treated with fraction C in the final CF concentrations 22.5 and 37.5 μg/mL suffered rapid and irreversible asystolia without AV blockade. They underwent also ventricular fibrillation and ventricular tachycardia. Fraction B affected hearts only at the highest dose inducing asystolia in all hearts, ventricular fibrillation in 80% and ventricular tachycardia in 70% of the hearts. Venom fraction C induced 71% of all recorded heart rhythm disturbances, significantly more than fraction B, which induced 29%. Most abundant proteins in fraction C were secreted phospholipases A2 among which the venom component acting on the heart is most probably to be looked for.
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Affiliation(s)
- Svjetlana Karabuva
- Clinical Department of Infectious Diseases, University Hospital Centre Split, Šoltanska 1, Split, Croatia.
| | - Ivica Brizić
- Department of Pharmacology, Mostar University School of Medicine, Bijeli brijeg bb, Mostar, Bosnia and Herzegovina.
| | - Zorica Latinović
- Department of Molecular and Biomedical Sciences, Jožef Stefan Institute, Jamova cesta 39, Ljubljana, Slovenia; Jožef Stefan International Postgraduate School, Jamova cesta 39, Ljubljana, Slovenia.
| | - Adrijana Leonardi
- Department of Molecular and Biomedical Sciences, Jožef Stefan Institute, Jamova cesta 39, Ljubljana, Slovenia.
| | - Igor Križaj
- Department of Molecular and Biomedical Sciences, Jožef Stefan Institute, Jamova cesta 39, Ljubljana, Slovenia; Department of Chemistry and Biochemistry, Faculty of Chemistry and Chemical Technology, University of Ljubljana, Aškerčeva cesta 5, Ljubljana, Slovenia.
| | - Boris Lukšić
- Clinical Department of Infectious Diseases, University Hospital Centre Split, Šoltanska 1, Split, Croatia; University of Split School of Medicine, Šoltanska 2, Split, Croatia.
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Karabuva S, Vrkić I, Brizić I, Ivić I, Lukšić B. Venomous snakebites in children in southern Croatia. Toxicon 2016; 112:8-15. [PMID: 26802624 DOI: 10.1016/j.toxicon.2016.01.057] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [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] [Received: 11/19/2015] [Revised: 01/09/2016] [Accepted: 01/19/2016] [Indexed: 11/15/2022]
Abstract
This retrospective study represents observation of 160 children and adolescents aged up to 18 years that experienced venomous snakebites in southern Croatia and were treated in the Clinical Department of Infectious Diseases in the University Hospital Centre Split from 1979 to 2013. The main purpose of this research was to determine the epidemiological characteristics, clinical presentation, local and general complications, and received treatment. Most bites occurred during warm months, from early May to late August (80%), mostly in May and June. Upper limb bites were more frequent (59%) than lower limb bites (40%). Out of the total number of poisoned children, 24% developed local, and 25% general complications. The most common local complications were haemorrhagic blisters that occurred in 20% children, followed by compartment syndrome presented in 7.5% patients. The most dominated general complication was cranial nerve paresis or paralysis, which was identified in 11.2% patients, whereas shock symptoms were registrated in 7% children. According to severity of poisoning, 9.4% children had minor, 35% mild, 30.6% moderate, and 24.4% had severe clinical manifestation of envenomation. Only one (0.6%) child passed away because of snakebite directly on the neck. All patients received antivenom produced by the Institute of Immunology in Zagreb, tetanus prophylaxis as well, and almost all of them received antibiotics, and a great majority of them also received corticosteroids and antihistamines. Neighter anaphylactic reaction nor serum disease were noticed in our patients after administrating antivenom. A total of 26% children underwent surgical interventions, and incision of haemorrhagic blister was the most common applied surgical treatment, which was preformed in 15.6% patients, while fasciotomy was done in 7.5% subjects. All of our surgically treated patients recovered successfully.
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Affiliation(s)
- Svjetlana Karabuva
- Clinical Department of Infectious Diseases, University Hospital Centre Split, Šoltanska 1, Split, Croatia.
| | - Ivana Vrkić
- Clinical Department of Infectious Diseases, University Hospital Centre Split, Šoltanska 1, Split, Croatia.
| | - Ivica Brizić
- Department of Pharmacology, Mostar University School of Medicine, Bijeli brijeg bb, Mostar, Bosnia and Herzegovina.
| | - Ivo Ivić
- Clinical Department of Infectious Diseases, University Hospital Centre Split, Šoltanska 1, Split, Croatia; University of Split School of Medicine, Šoltanska 2, Split, Croatia.
| | - Boris Lukšić
- Clinical Department of Infectious Diseases, University Hospital Centre Split, Šoltanska 1, Split, Croatia; University of Split School of Medicine, Šoltanska 2, Split, Croatia.
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Fabijanic D, Carevic V, Karabuva S, Radic M. Relation of ABO blood groups to coronary lesion complexity in patients with stable coronary artery disease. Anadolu Kardiyol Derg 2014; 14:561-562. [PMID: 25233510 DOI: 10.5152/akd.2014.5488] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Affiliation(s)
- Damir Fabijanic
- Department of Cardiology, Split University Hospital Centre; Split-Crotia.
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Karabuva S, Carević V, Radić M, Fabijanić D. The association of ABO blood groups with extent of coronary atherosclerosis in Croatian patients suffering from chronic coronary artery disease. Biochem Med (Zagreb) 2013; 23:351-9. [PMID: 24266306 PMCID: PMC3900083 DOI: 10.11613/bm.2013.043] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Aim: The aim of study was to: 1) examine the relationship between ABO blood groups and extent of coronary atherosclerosis in patients with chronic coronary artery disease (CAD), 2) compare ABO blood groups distribution in CAD patients and general population, 3) examine possible differences in traditional risk factors frequency in CAD patients with different ABO blood groups. Materials and methods: In the 646 chronic CAD patients (72.4% males) coronary angiograms were scored by quantitative assessment using multiple angiographic scoring system, Traditional risk factors were self reported or measured by standard methods. ABO blood distribution of patients was compared with group of 651 healthy blood donors (74.6% males). Results: Among all ABO blood group patients there was no significant difference between the extent of coronary atherosclerosis with regard to all the three scoring systems: number of affected coronary arteries (P = 0.857), Gensini score (P = 0.818), and number of segments narrowed > 50% (P = 0.781). There was no significant difference in ABO blood group distribution between CAD patients and healthy blood donors. Among CAD patients, men with blood group AB were significantly younger than their pairs with non-AB blood groups (P = 0.008). Among CAD patients with AB blood group, males < 50 yrs were significantly overrepresented when compared with the non-AB groups (P = 0.003). Conclusions: No association between ABO blood groups and the extent of coronary atherosclerosis in Croatian CAD patients is observed. Observation that AB blood group might possibly identify Croatian males at risk to develop the premature CAD has to be tested in larger cohort of patients.
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Affiliation(s)
- Svjetlana Karabuva
- Department of Internal Medicine, Split University Hospital, Split, Croatia
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Bozić I, Capkun V, Bozić D, Karabuva S, Caljkusić K, Trgo G, Carević V, Fabijanić D. [Anticoagulant therapy in patients with permanent atrial fibrillation - evidence based medicine and clinical practice]. Lijec Vjesn 2013; 135:129-134. [PMID: 23898692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Objective of study was to assess the concordance of the tromboprophylactic treatment in patients with permanent atrial fibrillation (pAF) with guidelines of the European Society of Cardiology. Prospective cross-sectional study consecutivelly included 674 patients (400 S59%C male) discharged from cardiology department with the diagnosis pAF. The thromboembolic risk (TE) has been established according to CHA2DS2-VASc score, whereas the bleeding risk has been assessed according to HAS-BLED score. 578 (86%) belonged to the group of high, 57 (8%) to the group of moderate, and 39 (6%) patients to the group of low TE risk. 601 (89%) patients received thromboprophylaxis: 310 (46%) warfarin, 258 (38%) acetylsalicylic acid, and 33 (5%) patients clopidogrel. Warfarin has been prescribed to 47% of patients with high, 49% of patients with moderate and to 26% of patients with low TE risk (P=0.03). Acetylsalicylic acid (ASA) has equally been prescribed to patients of all TE risk groups: low, moderate and high (39% vs. 39% vs.38%/o; P=0.998). ASA (P<0.001) and warfarin (P=0.007) have been used more frequently in the group of patients with high bleeding risk, in which the same incidence of warfarin and ASA administration has been registered (53% vs. 47%; P=0.416). Age > or =75 has been an independent predictor of non-administration (OR 1.7; 95% CI 1.2-2.4; P=0.003), whereas the history of stroke was for warfarin administration (OR 0.47; 95% CI 0.29-0.76; P-0.002). In prescribing thromboprophylaxis to patients with pAF, cardiologists do not observe the recommended clinical guidelines. Despite nonexistence of contraindications, a significant number of patients with high TE risk has not been administered warfarin. At the same time, warfarin has been administered to the patients with low TE risk, exposing them unnecessarily to the undesired effect of anticoagulant treatment.
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