Rosanda Mulić

Hepatitis B in the family

During a 3-year period (1992–1995), 239 index cases of hepatitis B virus (HBV) infection and 459 members of their households from the Osijek-Baranja county were examined. The aim of the study was to determine the spread of HBV infection in the families with a member verified as a virus carrier, and to identify the family members with the highest risk of infection according to kinship degrees. The retrospective and prospective methods were used in the study. The probable route of infection was assessed by the use of an epidemiologic questionnaire, and the serologic status of the study subjects concerning infection with HBV was determined by enzyme immunoassays (HBsAg, anti-HBs, anti-HBe and anti-HBc). The first member of a family identified as a virus carrier was considered an index case. HBV infection was demonstrated in 334 (47.85%) out of a total of 698 subjects. Only 21 (6.28%) of the 334 subjects with verified HBV infection developed the clinical picture of acute hepatitis B. The ratio of clinically manifest vs inapparent infection was 1:16. Serologic traces of infection were detected in 95 of the 459 family members of the index cases, yielding a mean rate of the infection among the virus carrier family members of 20.70%.

Risk factors for pulmonary tuberculosis in Croatia: a matched case-control study.

BackgroundMycobacterium tuberculosis is a necessary, but not sufficient, cause of tuberculosis. A number of studies have addressed the issue of risk factors for tuberculosis development. Croatia is a European country with an incidence rate of 14/100 000 which is slowly decreasing. The aim of this study is to evaluate the potential demographic, socioeconomic, behavioural and biological risk factors for tuberculosis in Croatia in comparison to other high-income, low-incidence European countries.MethodsA total of 300 tuberculosis patients were matched for age, sex and county of residence to 300 controls randomly selected from general practitioners’ registers. They were interviewed and their medical records were evaluated for variables broadly described as potential risk factors.ResultsIn multiple logistic regression, the following factors were significant: parents born in a particular neighbouring county (Bosnia and Herzegovina) (OR = 3.90, 95% CI 2.01-7.58), the lowest level of education (OR = 3.44, 95% CI 1.39-8.50), poor household equipment (OR = 4.72, 95% CI 1.51-14.76), unemployment (OR = 2.69, 95% CI 1.18-6.16), contact with tuberculosis (OR = 2.19, 95% CI 1.27-3.77), former (OR = 2.27, 95% CI 1.19-4.33) and current smoking habits (OR = 2.35, 95% CI 1.27-4.36), diabetes (OR = 2.38, 95% CI 1.05-5.38), a malignant disease (OR = 5.79, 95% CI 1.49-22.42), being underweight in the previous year (OR = 13.57, 95% CI 1.21-152.38).ConclusionIn our study, the identified risk groups for tuberculosis reflect a complex interaction between socioeconomic conditions, lifestyle and non-communicable diseases. Interventions focused on poverty will undoubtedly be useful, but not sufficient. Tuberculosis control would benefit from a combination of broad public health activities aimed at the prevention and control of risky lifestyles and non-communicable diseases, interventions outside the health sector, and efforts to constantly improve the Croatian national tuberculosis programme.

Epidemiologic and ecologic characteristics of some diseases transmitted by arthropods on the littoral of the Republic of Croatia

OBJECTIVE To show epidemiologic and ecologic characteristics of some diseases transmitted by arthropods on the littoral of the Republic of Croatia. METHODS The pattern of infectious diseases that are transmitted exclusively by vectors was monitored during the period 1985 to 1999. Data on the incidence of the diseases in the Republic of Croatia as a whole and available data on the presence of the vectors for the diseases on the littoral are presented for comparison. RESULTS Mediterranean spotted fever, murine typhus, Lyme disease, cutaneous and visceral leishmaniasis, and pappataci fever occur sporadically on the Croatian littoral. Tick-borne meningoencephalitis is endemic in the northwestern part of Croatia but is not present on the littoral. Twelve cases of malaria are imported into Croatia per year on average. CONCLUSION Diseases transmitted by arthropods are not a major public health problem in Croatia. The medically relevant entomofauna of Croatia has not yet been adequately investigated.

Occurence of Visceral and Cutaneous Leishmaniasis in Croatia

UNLABELLED The purpose of this study was to show epidemiological characteristics and clinical manifestations of visceral and cutaneous leishmaniasis in Croatia. METHODS Analysis of data on reported visceral and cutaneous leishmaniasis cases and description of the most common clinical manifestations of the disease was based on meta analysis of collected data. RESULTS A total of 124 cases of visceral and cutaneous leishmaniasis were reported from 1954 until the end of 2006. During the 1994-2006 period, 35 people became infected: 23 with visceral and 12 with the cutaneous form of the disease. The diagnosis of cutaneous leismaniasis is based on the clinical picture, epidemiological data, and light microscopic histology. The clinical picture of visceral leishmaniasis was confirmed by detection of amastigotes in bone marrow aspirate (n=22; 95.7%) and liver (n=1; 4.3%) and by serology-indirect immunofluorescent assays (n=23; 100%). Age-specific morbidity is highest in the 0 to 4 age group (0.29%). None of the infected was human immunodeficiency virus positive. CONCLUSION It is estimated that there have been some changes in epidemiological characteristics of the natural foci of leishmaniasis in Croatia.

The history of leprosy in Dubrovnik: an overview

Leprosy or lepra is an infectious skin disease caused by Mycobacterium leprae which predominantly affects the skin, peripheral nerves and the mucous membrane of the upper respiratory tract and oral cavity and which – in spite of today’s efficient treatment – represents a public health problem in some countries of the world. It is also called Hansen’s disease, named after Norwegian physician Gerhard Armauer Hansen (1841. – 1912.) who had discovered its originator in Bergen in 1871 (1-3). The disease was known as early as in classical antiquity, whereby its Greek name lepra was derived. It is characterized by a low level of contagiousness and possibility of mutilations.. The disease apparently originated in East Africa and spread by human migrations so that Europeans and North Africans brought it to West Africa and America during the past 500 years. In Croatia, the last sporadic cases in the Croatian Littoral and Dalmatia were recorded in the mid-20th century. In 1956, the last case of leprosy was recorded in Blizna, a small village near Trogir, which Stanimirovic et al established to be an endemic region in the Republic of Croatia.

Izgubljeno vrijeme u otkrivanju i početku liječenja tuberkuloze: što treba napraviti?

Ovim istraživanjem željelo se odrediti veličinu i analizirati čimbenike koji utječu na kašnjenje u otkrivanju i započinjanju liječenja tuberkuloze. Oboljeli od plućne tuberkuloze detaljno su intervjuirani o rizičnom načinu života, različitim demografskim, socioekonomskim i zdravstvenim obilježjima te je izračunano vrijeme od početka simptoma do početka liječenja. Medijan i 75. percentil navedenog vremena iznosili su 68 i 120 dana. Unutar mjesec dana od početka simptoma liječiti se počelo 16,7 % bolesnika, u drugome mjesecu 23,8 %, 23,3 % u trećem mjesecu, 12,9 % u četvrtome mjesecu, dok je 23,3 % ispitanika liječenje započelo više od četiri mjeseca nakon početka simptoma. Uporaba droga bila je povezana s vremenom dužim od medijana, što se smatralo dugim kašnjenjem (p=0,021) u otkrivanju i liječenju tuberkuloze. Najniži stupanj obrazovanja (p=0,021), minimalan (p=0,039) te minimalni do prosječni mjesečni obiteljski prihod (p=0,020), pušenje (p=0,050) i komorbiditet (p=0,048) pokazali su se značajnima kad je promatran 75. percentil izmjerenog vremena, što se smatralo ekstremnim kašnjenjem. U multiplome modelu uporaba droga ostala je značajno povezana s dugim kašnjenjem, a najniži stupanj obrazovanja (p=0,033), sadašnje (p=0,017) i bivše (p=0,045) pušačke navike s ekstremnim kašnjenjem. U uvjetima smanjivanja incidencije tuberkuloze kašnjenje u otkrivanju i liječenju tuberkuloze može se smanjiti zdravstvenim prosvjećivanjem opće populacije ne samo o tuberkulozi nego i općenito o zdravlju te stavovima i navikama glede prevencije i ranog liječenja. Istodobno se mora povećati i znanje o tuberkulozi te dijagnostičke sposobnosti zdravstvenih radnika.