Zvizdić S

Significance of Q Fever Serologic Diagnosis in Clinically Suspect Patients

Abstract: Q fever is caused by C. burnetii, an intracellular obligate bacterium. For clinical confirmation of Q fever, diagnosis of interstitial pneumonia is of significance. The acute disease varies in severity from minor to fatal, with the possibility of serious complications. Chronic endocarditis is a well‐known outcome. Symptoms of Q fever can vary; fixing diagnosis is done by serology with the phase I and the phase II antibody. We tested 44 sera of 31 clinically suspect patients. From these, 22 patients were taken to the infection clinic, 8 to the pulmonary clinic, and one to the general hospital. From the 31 patients, 21 patients had one serum, 7 patients, 2 sera, and 3 patients, 3 sera. Blood samples were collected by vein puncture, and serum samples were kept at −20°C until testing. All sera were processed by indirect imunofluorescent assay (IFA) Q fever IgM and IgG. Of 44 processed sera, 21 were seropositive. Specific IgM antibody was found in sera of 6 patients (19.4%), and specific IgG antibody in sera of 16 patients (51.2%). In sera of 15 clinically suspect patients (48.3%), no specific anticoxiella antibody was found. From these results we can confirm the importance of serology in laboratory diagnosis and clinical affirmation of suspect Q fever. Indirect imunofluorescent assay (IFA) is reliable and appropriate for daily, routine diagnosis of human Q fever.

The Connection Between Endourological Procedures and Occurrence of Urinary Infections

Introduction: Endoscopic surgery and endourological procedures imply the use of special instruments that are introduced into the urinary system through the urethra and percutaneous techniques that allow ante grade access to the urinary tract. The risk of urinary tract infection after endourological procedures and the use of antibiotic prophylaxis for these procedures is a question about which there is no unique opinion. Goal: The objective of this study was to determine the connection between endourological procedures and occurrence of urinary infections and to analyze the risk factors of urinary infection for patients who were hospitalized at the Urology Clinic of the Clinical Center University of Sarajevo (CCUS). Material and methods: The research was conducted as a prospective study on a sample of 208 patients of both genders, who were hospitalized at the Urology Clinic of the CCUS and to whom one of endourological procedures was indicated either for diagnostic or therapeutic purposes. All patients were clinically examined prior to endoscopic procedures and after the treatment attention was focused on the symptoms of urinary tract infections. Results: Analysis of the presence of postoperative bacteriuria shows that it has been more common in men or in 48 cases (28.1%) compared to women with 8 cases (21.6%) (p>0.05). Preoperative catheterization was statistically significantly more present in patients who have had a postoperative bacteriuria (16 or 28.6%) compared to those without bacteriuria (8 or 5.3%) (p<0.05). Analysis of the average duration of postoperative catheterization shows that patients with postoperative bacteriuria had longer duration of postoperative cauterization of 1.97±0.14 days (range 1-20 days) compared to those without postoperative bacteriuria with 1.4±0.4 days (range 0-5 days) and with a statistically significant difference (p<0.05). Antibiotic prophylaxis in relation to the occurrence of postoperative bacteriuria did not show a statistically significant difference (p> 0.05). Analysis of the correlation coefficient indicates that a statistically significant effect on the occurrence of postoperative bacteriuria have preoperative bacteriuria, duration of postoperative catheterization and duration of hospital stay, as well as the total duration of hospitalization before and after endourological treatment (p<0.05). Conclusion: It is important to emphasize that the endourological procedures are safe procedures in terms of urinary tract infections. This study should lay pathway to establishment of guidelines for the application of antibiotic prophylaxis in endourological procedures. This would standardize the perioperative use of antibiotics, taking into account the local prevalence of pathogens and antibiotic resistance, but keeping the individual approach to each patient, considering all risk factors for the development of urinary infection after endourological procedures..

Public Health Problem of Zoonoses with Emphasis on Q Fever

Abstract:  Zoonoses are animal and human diseases. Q fever is primarily a zoonosis—an animal disease that can be transmitted to humans under certain conditions. Recent epidemiological studies suggest that Q fever should be considered as a public health problem in many countries where it is present, but unrecognizable due to inadequate disease controls. Through specific serological diagnosis of clinically suspected human Q fever cases, we are trying to determine a level of general Coxiella burnetii (C. burnetii) exposition among populations in different regions of Bosnia and Herzegovina. This would be a contribution in controlling the present and the future disease outbreaks, as well as its prevention, which is one of the prime objectives of public health. During the period from January to June 2004, in the Laboratory of the Department for Microbiology in the Medical Faculty of the University of Sarajevo, of 58 tested sera from 48 clinically suspected individuals, we confirmed the presence of specific anti‐C. burnetii antibodies in 30 sera (51.7%), from 25 seropositive individuals (52.0%), by means of indirect immunofluorescent antibody (IFA) testing. Urgent steps must be taken in public education to help decrease the risk of C. burnetii infection among at‐risk populations in regions of Bosnia and Herzegovina.

Serotesting of Human Q Fever Distribution in Bosnia and Herzegovina

Abstract:  Q fever is a zoonotic disease with worldwide distribution. It occurs in different geographic regions and climate zones. From 1990 till the end of 1997, only three infected individuals were registered in Bosnia and Herzegovina, during the year 1991, with the incidence of 0.05% 000. From 1996 onward, there was a sudden aggravation of epizoological and epidemiological situation in particular regions of Bosnia and Herzegovina. We performed serotesting during the 4‐year period from 2000 to 2003. We tested serum samples from 708 individuals from different regions of Bosnia and Herzegovina. Q fever was serologically diagnosed in 249 individuals. The overall seroprevalence was 35.2%. The acute disease form was confirmed in 79.9% of the whole seropositive sample. Most of the Q seropositive individuals were from Kakanj (17.3%), Mostar (15.3%), Sarajevo (12.5%), Bihać (9.6%), Zenica (9.2%), Gornji Vakuf (8.9%), Tešanj (4.4%), Visoko (2.8%), and Travnik (2.4%). The number and distribution of seropositive individuals suggests that Q fever is endemic in Bosnia and Herzegovina.