Dragica Terzić

Reconstruction of the evolutionary dynamics of hepatitis C virus subtypes in Montenegro and the Balkan region

More than 20 million hepatitis C virus (HCV) carriers live in the countries of the Eastern Mediterranean. We determined HCV genotype distribution among chronically infected patients in Montenegro and investigated the phylodynamics and phylogeography of the most represented HCV subtypes. The HCV-NS5b sequences of the Montenegrin patients were compared with sequences isolated in different known localities of the Mediterranean area, Europe and Asia. A Bayesian approach was used in order to allow the simultaneous estimate of the evolutionary rate, time-scaled phylogeny, demography and ancestral spatial status. The most frequent HCV subtypes among the Montenegrin patients, were 1b (34.7%) and 3a (24.7%), but there was also a significant prevalence of 1a and 4d (19.5%). Subtype 3a was significantly more frequent among younger patients and intravenous drug users (IDUs), whereas subtype 1b was more frequently associated with iatrogenic exposure and older ages. The spatio-temporal analysis of the epidemic suggested that HCV-1b penetrated Europe at the beginning of the XX century, probably through Greece and Cyprus and in the 1920s reached Montenegro, where there was an exponential increase in the effective number of infections between the 1950s and 1970s. The phylogeographic and phylodynamic analysis of HCV 3a showed that its most probable origin was in the Indian sub-continent (Pakistan in our reconstruction) about 300years ago. The evolutionary dynamics analysis showed that HCV-3a reached Montenegro more recently in the late 1970s and underwent multi-phasic growth still persisting. Our data suggest multiple introduction of HCV subtypes in the area, supported by different causes of dispersion: adverse social conditions and unsafe medical practices for HCV-1b and i.v. drug use for HCV-3a.

First diagnostic cases of human babesiosis in Montenegro

Babesiosis is a parasitic infection similar to malaria. It belongs to the group of vector-borne transmissible zoonoses.1 The primary vectors are various types of ticks.2 Dispersion of the infection is enabled by a wide range of reservoirs for parasites (domestic and wild mammals).2–4 Examinations in Europe proved that the Babesia parasite is the most frequent agent in coinfections with Borrelia burgdorferi.5 The first diagnosed cases of human babesiosis in Montenegro were registered in 2011, at the Infectious Disease Clinic in Podgorica.6 In our ten examined patients, clinical characteristics and laboratory findings were not specific. Manifest Erythema migrans (EM) was observed in six patients. In seven cases, Lyme borreliosis was diagnosed by Elisa method. The diagnosis of babesiosis was confirmed in all ten patients by analysis of the bone marrow biopsy, stained according to Romanowski, and in four patients by analysis of thick drop and peripheral blood smear, stained by Giemsa-I. Seven cases had coinfection with Borrelia burgdorferi and Babesia agents. In the clinical picture, non-specific symptoms of common infectious syndromes predominated. Changes in blood and differential blood pictures were registered for every patient. Intraerythrocytic annular forms of the parasite Babesia spp. were found in histological cultures (Fig. 1). In comparison with Plasmodium, Babesia does not cause pigment in erythrocytes, nor does it produce schizonts or gametocytes. After the diagnosis was made in all ten cases, treatment was administered: clindamycin + quinine sulphate in a course

Predisposing Factors Responsible for the Occurrence of Bacterial Purulent Meningoencephalitis

Bacterial purulent meningoencephalitis (BPME) is a life-threatening infectious disease caused by various pyogenic bacteria. The disease is defined as the inflammatory process of leptomeninges (visceral layer, pia mater and arachnoid membrane) and brain parenchyma with exudates in the subarachnoid space and surrounding brain structures. The aim of the study was to define the predisposing factors responsible for the occurrence of BPME, as well as the possible correlation between the presence of predisposing factors and patient demographic characteristics, etiology and outcome of the disease. This retrospective-prospective study included 90 patients with BPME confirmed by clinical, neuroradiological and laboratory findings. Multivariate logistic regression models were fitted to analyze the impact of the predisposing factors on the disease outcomes. Predisposing factors that were related to BPME were found in 61% of patients. Cranial trauma as the leading factor was recorded in 23.3% of patients, followed by previous neurological disease in 14.4% of patients, while 13 patients were exposed to previous chemotherapy or long-term corticosteroid therapy. Cardiovascular diseases were reported in 12.2% and diabetes in 7.8% of patients. The existence of cardiovascular diseases significantly influenced unfavorable outcome of the disease, i.e. ”deceased” in comparison to ”cured” (OR=8.418; 95% CI=1.007-76.270), independently of age and gender. None of the examined predisposing factors was significantly related to the ”recovered with sequels” outcome as compared with ”cured” outcome. Older age and presence of cardiovascular disease as a predisposing factor significantly increased the odds of the BPME unfavorable outcome ”deceased” as compared to ”cured” outcome.

Genetic diversity of the haemagglutinin (HA) of human influenza a (H1N1) virus in montenegro: Focus on its origin and evolution

In 2009 an influenza A epidemic caused by a swine origin H1N1strain, unusual in human hosts, has been described. The present research is aimed to perform the first phylogenetic investigation on the influenza virus A (H1N1) strains circulating in Montenegro, from December 1, 2009, when the first case of death due to H1N1 was confirmed, and the epidemic began causing a total of four fatalities. The phylogenetic analysis of the strains circulating showed the absence of a pure Montenegrin cluster, suggesting the occurrence of multiple re‐introductions in that population from different areas till as far as the early 2010. The time to most recent common ancestor (TMRCA) for the complete dataset has been dated in early 2008, pre‐dating the first Montenegrin identification of H1N1 infection. These data suggest that virus was spreading undetected, may be as a consequence of unidentified infections in returning travelers. Anyhow, the estimated TMRCA of Montenegrin strains is fully consistent to that found in different areas. Compatibly with the time coverage of the study period here analyzed, molecular dynamic of Montenegrin strains follows similar trend as in other countries. J. Med. Virol. 88:1905–1913, 2016.

Dijagnostika fokalnih promjena u jetri

Uvod. Patoloski procesi u jetri mogu biti difuznog karaktera (zapaljenski,metabolicke bolesti, hematoloske bolesti, toksicne bolesti) i fokalne (zapaljenske,parazitarne i tumorske). Cilj rada je prikaz fokalnih promjena u jetrinomparenhimu nakon ultrazvucne, laparaskopske i patohistoloske dijagnostike.Metode. Retrospektivno-prospektivnim ispitivanjem je obuhvaceno 147punoljetnih pacijenata oba pola. Fokalne promjene jetrinog tkiva su sagledaneultrazvucnom, laparoskopskom i patohistoloskom dijagnostikom.Rezultati. Osnovne karakteristike ispitanika: muskaraca 71 i žena 76 sanajvecim brojem pacijenata (102 - 70%) životne dobi između 40 i 70 godina,sa ravnomjernom distribucijom za svakih deset godina starosti. Međutim,neobicno je veliki broj pacijenata ženskog pola registrovan u cetvrtoj decenijiživota, cak 14 (9,5%) od ukupnog broja ispitanika, odnosno 18% odispitanika ženskog pola. Metastaze cine 104 (71%) svih fokalnih lezija jetre.U vecini slucajeva radilo se o metastazama karcinoma dojke. Iako najcesceimaju tipicnu ultrazvucnu prezentaciju, metastaze u jetri mogu da daju sirokspektar razlicitih ultrazvucnih slikaZakljucak. Najcesce fokalne promjene u jetri su metastaze adenokarcinoma.Samo 3 (2%) fokalne promjene dijagnostikovane ultrazvukom nisu potvrđenekao fokalne laparoskopskom tehnikom i patohistoloskom analizom tkiva jetre.