Biserka Trošelj-Vukić

Modified range of alanine aminotransferase is insufficient for screening of hepatitis C virus infection in hemodialysis patients.

Objective : A moderate increase in serum alanine aminotransferase (ALT) has been reported to be a helpful, low-cost tool for predicting viremia in anti-hepatitis C virus (HCV)-positive hemodialysis (HD) patients. This study focused on evaluating the effectiveness of a lowered normal serum ALT value as a screening method for HCV infection in HD patients. Material and Methods : Serum ALT levels were compared with HCV virologic status in 125 patients on maintenance HD. Results : The prevalence of HCV antibodies was 23%. A total of 3.7% of viremic HD patients did not have a detectable antibody response. Using the conventional upper limit of normal for ALT of 37 IU, there was no significant difference in the frequency of elevated ALT levels between HCV RNA-positive and -negative patients. However, if the upper limit of normal for ALT was lowered to 27 IU, the difference was significant. Nevertheless, 60% of viremic patients still fell within the normal range. Conclusion : Although inexpensive and widely available, the monitoring of serum ALT levels is not useful as a screening method for HCV infection in HD patients.

Malaria, a Travel Health Problem in the Maritime Community

BACKGROUND Three to five hundred million cases of malaria occur annually, causing over one to two million deaths. Malaria is one of the leading causes of fever, resulting from travel in tropical or subtropical countries. That risk is very high, especially for sailors. By the nature of their job they cannot avoid malarial regions and generally suffer from the lack of medical help aboard, insufficient knowledge of preventive measures, and lack of up-to-date information about chloroquine resistant areas. METHODS Retrospective analysis embraced all cases of malaria among seafarers employed in the years 1990-1993 by the Croatian sea carrier Losinjska Plovidba, and cases treated at the Clinic for Infectious Diseases, Rijeka, in the same period. RESULTS In that period, among seafarers treated in our Port Health Office there were registered 23 cases of malaria; 19 cases among sailors and 4 among tourists, all of them aboard merchant ships. Among seafarers treated in the Clinic for Infectious Diseases from 1990-1993 there were 13 malaria patients, 12 of them sailors and 1 tourist. CONCLUSION The aim of this work is to study the morbidity of malaria on board ships owned by the Croatian shipping company Losinjska Plovidba in the 4-year period 1990-1993 and point to the lack of a health system for their health protection. It can be concluded that the severity of malaria, the number of complications, the period of disablement for work, permanent health damage in a marked number of young persons on duty abroad, all clearly demonstrate the individual and social costs of this disease in Croatia and the maritime community worldwide.

Cytomegalovirus reactivation after low-dose steroid treatment for hemolytic anemia in a patient with primary Epstein-Barr virus infection.

ZusammenfassungBei Cytomegalie-seropositiven Patienten kann eine intensive therapeutische Suprimierung der Immunabwehr zur Reaktivierung einer latenten Cytomegalovirus-Infektion führen. Viele dieser immunsuppressiven Therapie-Protokolle enthalten auch hochdosierte Kortikosteroide. Nicht bekannt ist hingegen, ob eine Behandlung mit niedrigen Dosen von Kortikosteroiden bei sonst gesunden Personen eindeutig mit einer Reaktivierung von Cytomegalovirus verbunden ist. Wir beschreiben die Reaktivierung einer Cytomegalovirus-Infektion mit bei einem 21-jährigen immunkompetenten Mann, der einen Monat lang mit niedrigen Dosen von Kortikosteroiden behandelt wurde. Die Indikation zur Steroidtherapie war eine ausgeprägte hämolytische Anämie, ausgelöst durch eine primäre Mononukleose (Epstein-Barr).SummaryCytomegalovirus reactivation is a well described event occurring after intensive therapeutic suppression of the immune function in patients with latent infection. Treatment protocols for suppression of the immune response often include high-dose steroids. However, it is not known whether even a low-dose steroid treatment can reactivate latent cytomegalovirus in otherwise healthy persons. We documented cytomegalovirus reactivation after low-dose steroid treatment for autoimmune hemolytic anemia as a complication of Epstein-Barr virus mononucleosis in an immunocompetent 21-year-old man.

Pityriasis rubra pilaris in association with laryngeal carcinoma

Pityriasis rubra pilaris (PRP) is a rare group of hyperkeratotic, papulosquamous diseases that can be acquired or inherited. Cases of PRP associated with malignancy have been rarely reported. We report a case of 46‐year‐old man who presented with rapidly progressing PRP as a possible initial cutaneous symptom of a previously undiagnosed laryngeal carcinoma. Microlaryngoscopy was performed because of the patient’s hoarseness, and this revealed leucoplakia on the left vocal cord. Histopathological examination led to the diagnosis of squamous cell carcinoma in situ. After surgical treatment, the clinical signs of PRP began to resolve, and the patient was free of skin lesions at follow‐up. This case represents a rare coexistence of PRP with malignancy, and indicates that PRP can occur as paraneoplastic dermatosis associated with laryngeal cancer.

Late Symptomatic Plasmodium malariae Relapse in the Territory of the Former Yugoslavia

Despite the achievement of endemic malaria eradication, imported malaria remains a health problem in Europe.1 In contrast, cases of autochthonous malaria described in Europe in recent decades could be taken as rarities; such cases were, in general, considered in the differential diagnosis of fever of unknown origin (FUO).1–4 Epidemiologically, these malaria infections could be explained by the introduction of the infected mosquitos by aircraft (“airport malaria”)3 or by infection of indigenous anopheline vectors with exogenous plasmodial species from infected persons returning from endemic areas.4 In the territory of the former Yugoslavia, almost one-third of the area was a well-known endemic malarial region for centuries.A national malaria eradication program was started in 1947, and the last cases of autochthonous malaria were officially reported in 1964.5 We describe here a case of autochthonous Plasmodium malariae malaria in a 61-year-old man living in Rijeka in western Croatia who presented with hypersplenism and a history of fever which lasted intermittently for over 13 years. Case Report

Efficacy of Pefloxacin in the Treatment of Patients with Acute Infectious Diarrhoea

ObjectiveTo investigate the clinical and bacteriological efficacy of 5- and 7-day pefloxacin therapy in patients with acute infectious diarrhoea.Patients and study designEighty-two adult patients with acute infectious diarrhoea were randomly divided into three groups: group 1 (n = 20) received 5 days of treatment with pefloxacin, group 2 (n = 27) was assigned to a 7-day pefloxacin protocol, and group 3 (n = 35) was treated symptomatically. The daily dose of pefloxacin was 400mg orally. Clinical and bacteriological response was analysed on the third, fifth and seventh days of treatment as well as 1 and 4 weeks after the end of treatment. The study was an open-labelled, prospective clinical trial.ResultsIn the 47 patients (100%) of both pefloxacin groups a clinical improvement was noted on the third day compared with the control group, where this occurred on day 7. Bacteriological eradication was verified on the fifth day in 18 patients (90%) from group 1 and in 25 patients (93%) from group 2; they all had negative stool cultures 1 and 4 weeks after therapy was completed. Only 22 patients (63%) in the control group had negative stool cultures on the seventh day of treatment, but 4 weeks later all of them were negative.ConclusionThere was no difference in clinical (p = 0.232) and bacteriological (p = 0.972) efficacy between the 5- and 7-day pefloxacin treatment protocols. However, both protocols differed significantly in clinical improvement (p < 0.001) and bacteriological eradication (p = 0.017) from the control group.