Elizabeta Ristanovic

Prevalence of Borrelia burgdorferi in Ixodes ricinus Ticks in Belgrade Area

OBJECTIVE Lyme borreliosis is vector-borne zoonosis. The causative agent of Lyme borreliosis is a spirochete of Borrelia burgdorferi (Bb) sensu lato complex, which is transmitted by ticks of the Ixodes ricinus complex. The aim of our paper is to estimate the prevalence of I. ricinus ticks, the level of their infectivity by Bb, and the prevalence of certain genospecies of Bb sensu lato in ixodide ticks inhabiting Belgrade. MATERIALS AND METHODS An estimate of the tick population density was expressed by the value of flag/hour. For isolation and cultivation of Borrelia, selective Barbour-Stonner-Kelly II media was used. Typization of Borrelia was made by applying the species-specific polymerase chain reaction (PCR) and polymerase chain reaction-restriction fragment length polymorphism analysis. In statistical analysis, Chi(2) test was used. RESULTS Values of flag/hour have varied in relation to year observed and type of habitat: The lowest values were recorded in the city parks (17.9). The values were higher in parks-woods (19.7 and 33.4, respectively). The highest values were detected in localities similar to wooded areas (48.0). The estimated average infestation of ticks with Bb was 21.9%, excluding statistically significant differences by years of investigation. We found the dominance of Borrelia afzelii (75%). Bb sensu stricto (22.2%) as well as Borrelia garinii (2.8%) was much less present. Statistically significant difference was established in the prevalence of the above-mentioned genospecies in relation to the examined localities. CONCLUSIONS We have established the prevalence of all three genospecies in the city of Belgrade. Bb sensu lato was found, with the dominance of B. afzelii.

Prevalence of antibodies to Rickettsiae in different regions of Serbia.

We assayed the presence of antibodies specific for Rickettsia typhi, R. akari, and R. conorii in sera of persons from several localities in Serbia with different geographic, climatic, and lifestyle characteristics. Sera from 140 patients with unclear clinical symptoms and 273 healthy persons were tested for the presence of rickettsiae-specific antibodies by indirect immunofluorescence assay. In this study, for the first time we detected the presence of rickettsiae from the spotted fever group in Serbia. We detected the presence of antibodies against R. conorii in the samples from all tested localities. The proportion of positive cases was low in the plain agricultural areas but reached up to 23% in the mountain areas. We also observed a significant number of cases positive for antibodies against R. akari. Antibodies specific for the antigens of R. typhi were detected in only 2 samples from the municipality of Pec (Kosovo region). These findings contribute to the prevalence of Rickettsia species in Southeast Europe. Our study also revealed a dramatic lack of awareness of rickettsioses among medical personnel and pointed to the need for urgent measures that would help improve the current situation in the region.

Seroprevalence of Borrelia burgdorferi in occupationally exposed persons in the Belgrade area, Serbia

Lyme disease (LD) is a natural focal zoonotic disease caused by Borrelia burgdorferi, which is mainly transmitted through infected Ixodes ricinus tick bites. The presence and abundance of ticks in various habitats, the infectivity rate, as well as prolonged human exposure to ticks are factors that may affect the infection risk as well as the incidence of LD. In recent years, 20% to 25% of ticks infected with different borrelial species, as well as about 5,300 citizens with LD, have been registered in the Belgrade area. Many of the patients reported tick bites in city’s grassy areas. The aim of this study was to assess the seroprevalence of B. burgdorferi in high-risk groups (forestry workers and soldiers) in the Belgrade area, and to compare the results with healthy blood donors. A two-step algorithm consisting of ELISA and Western blot tests was used in the study. Immunoreactivity profiles were also compared between the groups. The results obtained showed the seroprevalence to be 11.76% in the group of forestry workers, 17.14% in the group of soldiers infected by tick bites and 8.57% in the population of healthy blood donors. The highest IgM reactivity was detected against the OspC protein, while IgG antibodies showed high reactivity against VlsE, p19, p41, OspC, OspA and p17. Further investigations in this field are necessary in humans and animals in order to improve protective and preventive measures against LD.

Molecular characterization of Borrelia burgdorferi sensu lato strains isolated in the area of Belgrade, Serbia

This is the first report of the molecular characterization and identification of Borrelia burgdorferi sensu lato strains isolated in Serbia. Isolates A1, A2 and M1, from Ixodes ricinus, belong to Borrelia burgdorferi sensu stricto, while isolate K1 from Apodemus flavicollis is a mixture of Borrelia afzelii and B. burgdorferi s.s.

Smallpox as actual biothreat: lessons learned from its outbreak in ex-Yugoslavia in 1972

Variola (smallpox) virus is classified as class A of potential biological weapons, due to its microbiological, genetic, antigenic and epidemiological characteristics. The potential danger is more real because vaccination against smallpox has stopped since disease eradication in 1979. That is why we want to share our unique, rich experience and acquired knowledge in the fight against this highly contagious and deadly disease during the smallpox outbreak in ex-Yugoslavia in 1972. It was the largest postwar outbreak in Europe when there were officially registered 175 ill patients, 35 of them with lethal outcome. This outbreak was specific by the time of its occurrence, the affected territory, dimensions and some epidemiological characteristics, but also by the well-organized, synchronized and efficient reaction of the competent state services in the fight against it.

Case report: Lifesaving therapeutic plasma exchange by cell saver in an obstetric emergency

Introduction. Abnormally high levels of triglycerides (hyperlipidemia) are often the result of a number of disorders in the body, which over time can lead to conditions such as hypothyroidism, nephrotic syndrome, diabetes, obstruction of the biliary ducts, hepatic impairment et al. The topic of how to treat the extreme hyperlipidemia has been an important discussion point in medical circles. Case report. This paper presents the case of a 33-yearold pregnant women in the 34th week of the first proper pregnancy with laboratory-verified extreme hyperlipidemia, who was brought in critical condition to the Clinical Center of Kragujevac. After the emergency cesarean section was performed, due to the general poor condition of the patient and extremely high levels of triglycerides and cholesterol, lipopheresis was indicated, which in our institution was not technically possible to treat and therefore it was necessary to find an alternative solution. Conclusion. It was shown that the application of intraoperative blood salvage can be used successfully not only in heavy bleeding during surgery, but also for cleaning the blood itself, which was clearly shown in the laboratory analysis. key words: hyperlipidemia, operative blood salvage, blood transfusion, autologous. SaŽetak Uvod. Povećane vrednosti triglicerida (hiperlipidemija) obično su posledica niza poremećaja u organizmu koji vremenom mogu dovesti do stanja poput hipotireoze, nefrotskog sindroma, dijabetesa, opstrukcije žučnih puteva, oštećenja funkcije jetre i dr. Kako lečiti ekstremnu hiperlipidemiju značajna je tema za diskusiju u medicinskim krugovima. Prikaz slučaja. U ovom radu prikazan je slučaj 33godišnje trudnice u 34. nedelji prve uredne trudnoće sa laboratorijski verifikovanom ekstremnom hiperlipidemijom, koja je u kritičnom stanju dovezena u Klinički centar Kragujevac. Nakon hitno izvršenog porođaja carskim rezom zbog opšteg lošeg stanja pacijentkinje i ekstremno visokih vrednosti triglicerida i holesterola, indikovana je lipofereza, za čiji tretman u našoj ustanovi ne postoje tehničke mogućnosti, te je bilo neophodno pronaći alternativno rešenje. Zaključak. Pokazano je da aparat za intraoperativno spasavanje krvi može biti uspešno upotrebljen ne samo kod obilnog krvarenja u toku hirurške intervencije nego i za čišćenje same krvi, što jasno pokazuju laboratorijske analize. ključne reči: hiperlipidemija, operativno spašavanje krvi, transfuzija krvi, autologna. CASE REPORT: LifESAving ThERAPEuTiC PLASmA ExChAngE by CELL SAvER in An ObSTETRiC EmERgEnCy Marija Vranes1, Zvezdana Lojpur1, Milena Todorovic2, Gordana Ostojic3, Elizabeta Ristanovic3, Bela Balint3,4 1Department for Transfusion Medicine, Clinical Center of Kragujevac, Kragujevac, Serbia 2Clinic for Hematology, Clinical Center of Serbia, Belgrade, Serbia 3Military Medical Academy, Belgrade, Serbia 4Serbian Academy of Sciences and Arts, Belgrade, Serbia PRikAz SLučAjA: TERAPijSkA zAmEnA PLAzmE PuTEm AuTOLOgnE TRAnSfuzijE u AkušERSkOm uRgEnTnOm STAnju Marija Vraneš1, Zvezdana Lojpur1, Milena Todorović2, Gordana Ostojić3, Elizabeta Ristanović3, Bela Balint3,4 1Služba za transfuziju, Klinički centar Kragujevac, Kragujevac 2Klinika za hematologiju, Klinički centar Srbije, Beograd 3Vojnomedicinska akademija, Beograd 4Srpska akademija nauka i umetnosti, Beograd