Browsing by Author "Mitrović, Nikola (55110096400)"

Introduction: Chronic hepatitis C virus (HCV) infection can progress to liver cirrhosis that causes bleeding from the gastrointestinal tract, liver failure and primary hepatocellular carcinoma. Use of standard therapeutic option consists of recombinant pegylated interferon alpha 2a/b with ribavirin in order to eradicate virus and prevent complications. Objective: The aim of investigation was to evaluate efficiency of combination therapy (pegylated interferon alpha 2a/b plus ribavirin) in patients with chronic HCV infection and to estimate predictive factors for successful treatment. Methods: A total of 387 patients with confirmed diagnosis of hepatitis C were evaluated (aged 18-65 years of both genders). Patients were treated with pegylated interferon alpha 2a/b and ribavirin according to a standard regimen lasting 24 or 48 weeks, dependent on virus genotype. Results: Negative HCV RNA (PCR assay) was recorded in 79.7% of patients at the end of treatment. Six months after completed therapy, negative HCV RNA, i.e. stained virologic response (SVR) was assessed in 70.5% of patients. Statistical summary of our results concerning SVR confirmed better efficiency of combination therapy for the following parameters compared to other investigated variables: age ≤40 (843% vs. 59.1%; p<0.0005), absence of cirrhosis (75.6% vs. 58.3%; p=0.003), lack of genotype 1 (86.6% vs. 61.8%; p<0.0005), and in patients who received full doses of pegylated interferon alpha 2a (78.3% vs. 633%; p=0.002). Conclusion: Combination therapy of recombinant pegylated interferon alpha 2a with ribavirin leads to SVR in the majority of treated patients (70.5%). Successful treatment depends on a variety of host and virus factors.

Introduction: Bilateral facial nerve palsy (FNP) is a rare condition that is idiopathic in only 20%. FNP is the most common cranial neuropathy in West Nile neuroinvasive disease (WNND) but is usually unilateral and only a few cases of bilateral FNP have been reported. Case: We present a case of a 65-year-old woman with confirmed WNND and simultaneous bilateral FNP. Results: In August 2022, the patient presented with ataxia, gait instability, tremor, fever, and vomiting. Following admission, due to her cerebrospinal fluid analyses she was diagnosed with WNV encephalitis. Her initial symptoms subsided, but on the 17th day of the disease, right FNP was observed. Three days later bilateral FNP developed, predominantly on the right side, with bilateral otalgia. Further diagnostic was performed but no other aetiology that could contribute to FNP was found. The patient was treated with a 3-day metilprednisolone course, followed by 60 mg of prednisone with dose tapering for 12 days. One month later she was discharged with significant regression of the left and slight regression of the right FNP. Subsequent physical therapy was conducted. The patient’s neurological status gradually improved and 4 months after the first symptoms onset, her neurological examination was normal. Conclusions: WNND should be included in the differential diagnosis of acquired bilateral FNP. It can result in full recovery, but unfavorable course is also possible. © 2024 Nikolić et al.

Introduction: Bilateral facial nerve palsy (FNP) is a rare condition that is idiopathic in only 20%. FNP is the most common cranial neuropathy in West Nile neuroinvasive disease (WNND) but is usually unilateral and only a few cases of bilateral FNP have been reported. Case: We present a case of a 65-year-old woman with confirmed WNND and simultaneous bilateral FNP. Results: In August 2022, the patient presented with ataxia, gait instability, tremor, fever, and vomiting. Following admission, due to her cerebrospinal fluid analyses she was diagnosed with WNV encephalitis. Her initial symptoms subsided, but on the 17th day of the disease, right FNP was observed. Three days later bilateral FNP developed, predominantly on the right side, with bilateral otalgia. Further diagnostic was performed but no other aetiology that could contribute to FNP was found. The patient was treated with a 3-day metilprednisolone course, followed by 60 mg of prednisone with dose tapering for 12 days. One month later she was discharged with significant regression of the left and slight regression of the right FNP. Subsequent physical therapy was conducted. The patient’s neurological status gradually improved and 4 months after the first symptoms onset, her neurological examination was normal. Conclusions: WNND should be included in the differential diagnosis of acquired bilateral FNP. It can result in full recovery, but unfavorable course is also possible. © 2024 Nikolić et al.

Results Eighty percent of patients were male of average age 29.6±8.6 years; in 61.8% patients intravenous drug abuse was determined as risk factor. Thirty patients (54.1%) had no symptoms and 38.2% were icteric. Acute hepatitis C spontaneously resolved in 33.3% patients, while in the treated group 79.6% of patients completely recovered (p=0.006). Treatment success was 92.9% in the group of patients who started with treatment before the 45th day of disease, while in the patients who started treatment later the success rated 58.3% (p=0.037).; Methods Total of 55 patients with acute hepatitis C, hospitalized at the Clinic for Infectious Diseases in Belgrade from January 2005 to December 2012 were enrolled in this study. Forty-one patients were under follow-up over six months for evaluation of the development of the disease into a chronic infection and effectiveness of treatment with INF-α.; Conclusion Acute hepatitis C is most common in young male adults infected via injection drug abuse. The use of INF-α is effective in the treatment of the disease, and success of the treatment is more probable if treatment is started before the 45th day.; Introduction Acute hepatitis C most frequently develops after parenteral infection of hepatitis C virus. The disease often develops into chronic infection, although it can resolve spontaneously. Interferon alpha (INF-α) is used in therapy, but still without precise treatment recommendations.; Objective The aim was to present characteristics of patients with acute hepatitis C and to assess effectiveness of using re-combinant INF-α in therapy. © 2014, Srpsko Lekarsko Drutsvo. All rights reserved.

Background: The global epidemic of nosocomial diarrhea caused by Clostridioides (Clostridium) difficile started in 2000, with high mortality rates and emergence of a new hypervirulent strain NAP1/BI/027. The aim of this study was to assess the presence of ribotype 027 and other C. difficile ribotypes in a Serbian University Hospital, compare the temporal variability of ribotypes 3 years apart, as well as to compare clinical, demographic and laboratory characteristics and disease outcome among patients infected with 027 and non-027 ribotype. This was a prospective observational cohort study addressing 4-month intervals during 2014/2015 and 2017/2018. Results: Ribotyping was performed in 64 non-duplicate C. difficile strains. Ribotype 027 was the most prevalent, and was detected in 53 (82.8%) patients (43/45 and 10/19 patients in 2014-2015 and 2017/2018, respectively). Other detected ribotypes were 001/072 in 4 (6.3%), 002 in 4 (6.3%), 014/020 in 2 (3.1%) and 176 in 1 (1.5%) patient. The percentage of the patients infected with ribotype 027 significantly decreased during the 3-year period, from 95.6 to 52.6% (p < 0.001). Ribotype 027 infection was associated with fluoroquinolone treatment more frequently than infection with other ribotypes [33 (62.3%) vs. 2 (18.2%), p = 0.010)]. A severe C. difficile infection was diagnosed more often in patients with the detected ribotype 027 compared to those infected with non-027 ribotypes (p = 0.006). No significant difference in the mortality and recurrence rates was found between the patients infected with ribotype 027 and those infected with other ribotypes [10/53 (18.8%) vs. 2/11 (18.2%), p = 0.708, and 10/35 (28.6%) vs. 0/2 (0%), p = 1.000, respectively]. Conclusion: Clostridium difficile ribotype 027 was the most prevalent ribotype among patients in a large Serbian hospital, but there is a clear decreasing trend. © 2020 The Author(s).

Background: The global epidemic of nosocomial diarrhea caused by Clostridioides (Clostridium) difficile started in 2000, with high mortality rates and emergence of a new hypervirulent strain NAP1/BI/027. The aim of this study was to assess the presence of ribotype 027 and other C. difficile ribotypes in a Serbian University Hospital, compare the temporal variability of ribotypes 3 years apart, as well as to compare clinical, demographic and laboratory characteristics and disease outcome among patients infected with 027 and non-027 ribotype. This was a prospective observational cohort study addressing 4-month intervals during 2014/2015 and 2017/2018. Results: Ribotyping was performed in 64 non-duplicate C. difficile strains. Ribotype 027 was the most prevalent, and was detected in 53 (82.8%) patients (43/45 and 10/19 patients in 2014-2015 and 2017/2018, respectively). Other detected ribotypes were 001/072 in 4 (6.3%), 002 in 4 (6.3%), 014/020 in 2 (3.1%) and 176 in 1 (1.5%) patient. The percentage of the patients infected with ribotype 027 significantly decreased during the 3-year period, from 95.6 to 52.6% (p < 0.001). Ribotype 027 infection was associated with fluoroquinolone treatment more frequently than infection with other ribotypes [33 (62.3%) vs. 2 (18.2%), p = 0.010)]. A severe C. difficile infection was diagnosed more often in patients with the detected ribotype 027 compared to those infected with non-027 ribotypes (p = 0.006). No significant difference in the mortality and recurrence rates was found between the patients infected with ribotype 027 and those infected with other ribotypes [10/53 (18.8%) vs. 2/11 (18.2%), p = 0.708, and 10/35 (28.6%) vs. 0/2 (0%), p = 1.000, respectively]. Conclusion: Clostridium difficile ribotype 027 was the most prevalent ribotype among patients in a large Serbian hospital, but there is a clear decreasing trend. © 2020 The Author(s).

Background/Aim. In Serbia, pegylated interferon (PEG-IFN) alpha-2a has been registered since 2013 for the treatment of patients with chronic hepatitis B (CHB). Numerous advantages, new experiences during the past five years and lack of any published data in our specific population, have initiated this study, with the aim to examine efficacy and safety of PEG-IFN in patients in a Serbian referral center. Methods. This prospective study included 36 patients with CHB who were treated in the Hepatology Department of the Clinic for Infectious and Tropical Diseases, Clinical Center of Serbia in Belgrade, during 2012–2017. Patients had a standard 48-week treatment protocol with PEG-IFN, with measurements of liver enzymes, serology and viraemia before, during, at the end of the treatment and follow-up 6 months afterwards. Treatment outcome was determined using serology (clearance of HBeAg), biochemical [normalization of alanine aminotransferase (ALT)] and virological response [hepatitis B virus (HBV) DNA < 2,000 IU/mL]. Results. Virological success in patients with HBeAg positive CHB was achieved in 50% of patients, HBeAg clearance in 62.5%, and normalization of ALT in 37.5% of patients. In patients with HBeAg negative CHB, 38% of the patients achieved virologic success, biochemical success was obtained in 47.6% of the patients and only one (4.7%) patient had HBsAg clearance. Conclusion. PEG-IFN is important for treatment of patients with CHB in well-defined situations, and in our population success rates are similar to other published studies. Although safety and tolerability are satisfactory, there is a possibility of more serious side-effects so it is necessary to monitor patients regularly during the treatment. © 2020 Inst. Sci. inf., Univ. Defence in Belgrade. All rights reserved.

Introduction: Cryptosporidiosis is an acute infectious parasitic disease of the gastrointestinal tract, considered as zoonosis underestimated in immunocompetent population.The pathogen is primarily the cause of devastating diarrhea in AIDS patients. Solitary cases and small outbreaks in immunocompetent persons are rarely discovered. There is also a human strain of Cryptosporidium. Case Outline: In December 2010, we examined three family members among whom each successively developed acute gastroenteritis. Their stools were liquid, light brown, without mucus or blood. All of them had abdominal cramps and generalized muscle pains. The daughter had fever and vomited during the first two days.The patients were administered symptomatic therapy. Complaints resolved after 10-17 days, with general condition moderately changed. Cryptosporidium was confirmed in the stool of patients who were second and third to contract the disease. We presumed that the first person released pathogen before the time of examination, although she still had diarrhea. All of them recovered completely. By epidemiologic survey we were unable to presume with certainty the source of infection. Conclusion: This is the first description of cryptosporidiosis in immunocompetent individuals in Serbia, which proves that it is present in our country, and that search for it should be included into a routine parasitological check-up of stool. Taking into account the distance in onset time complaints, all combinations are possible; from infection among family members (shortest incubation period) to family members infected from an identical source (different incubation period). Negative finding of the sample collected on the 7th day from the beginning of symptoms does not exclude the diagnosis in this particular situation. Further epidemiologic studies of this disease are necessary as it is clear that it exists in our population. At that moment we were unable to do typization.

Introduction: Chronic Hepatitis C Virus (HCV) infection leads to progressive fibrosis making fibrosis staging necessary in the evaluation of such patients. Different fibrosis scores are emerging as possible non-invasive alternatives for liver biopsy. The Fibrosis-4 Index (FIB-4) and AST to Platelet Ratio Index (APRI) scores are the most widely used and the most extensively tested. This study aims to determine if it was possible to accurately use these to identify patients that are unlikely to have severe fibrosis. Methodology: One hundred and forty-two patients with chronic hepatitis C infection who underwent liver biopsy since January 1st 2014 until May 31st 2017 at the Hospital for Infectious and Tropical Diseases in Belgrade were analyzed. The FIB-4 and APRI scores were calculated for each patient and compared to histologically determined fibrosis stage. Results: A comprehensive statistical analysis was conducted in order to compare patients with and without severe fibrosis and to evaluate the accuracy of the fibrosis scores. Patients with non-severe fibrosis were younger, had higher platelet counts and lower transaminase levels. FIB-4 had an AUC of 0.875 and the APRI score had an AUC of 0.861. No patients with severe fibrosis or cirrhosis had a FIB-4 lower than 1.08. FIB-4 was superior to APRI in identifying patients with severe fibrosis in the study cohort. Conclusion: FIB-4 was superior to APRI in the recognition of severe fibrosis. FIB-4 may prove very useful in identifying patients without advanced liver disease, especially if other non-invasive methods are inaccessible. © 2018 Karić et al.

Introduction: Chronic Hepatitis C Virus (HCV) infection leads to progressive fibrosis making fibrosis staging necessary in the evaluation of such patients. Different fibrosis scores are emerging as possible non-invasive alternatives for liver biopsy. The Fibrosis-4 Index (FIB-4) and AST to Platelet Ratio Index (APRI) scores are the most widely used and the most extensively tested. This study aims to determine if it was possible to accurately use these to identify patients that are unlikely to have severe fibrosis. Methodology: One hundred and forty-two patients with chronic hepatitis C infection who underwent liver biopsy since January 1st 2014 until May 31st 2017 at the Hospital for Infectious and Tropical Diseases in Belgrade were analyzed. The FIB-4 and APRI scores were calculated for each patient and compared to histologically determined fibrosis stage. Results: A comprehensive statistical analysis was conducted in order to compare patients with and without severe fibrosis and to evaluate the accuracy of the fibrosis scores. Patients with non-severe fibrosis were younger, had higher platelet counts and lower transaminase levels. FIB-4 had an AUC of 0.875 and the APRI score had an AUC of 0.861. No patients with severe fibrosis or cirrhosis had a FIB-4 lower than 1.08. FIB-4 was superior to APRI in identifying patients with severe fibrosis in the study cohort. Conclusion: FIB-4 was superior to APRI in the recognition of severe fibrosis. FIB-4 may prove very useful in identifying patients without advanced liver disease, especially if other non-invasive methods are inaccessible. © 2018 Karić et al.

People who inject drugs (PWIDs) experience high rates of hepatitis C virus (HCV) infection, primarily due to needle sharing and limited healthcare access, resulting in a disproportionate disease burden within this population. This prospective study evaluated treatment outcomes in 432 adult patients with chronic hepatitis C (CHC) treated with direct-acting antivirals (DAAs) at the University Clinical Center of Serbia. Patients were categorized into two groups based on a history of drug addiction: PWIDs (163, 37.7%) and non-PWIDs (269, 62.3%). The PWID group was further categorized into subpopulations of problematic PWIDs (39, 23.9%), ex-PWIDs (124, 76.1%), and PWIDs on OST (96, 58.9%). The PWID group demonstrated significantly lower treatment adherence, with an intention-to-treat (ITT) rate of 82.8%, compared to 96.3% in the control group (p < 0.001). In contrast, no significant differences were observed in per-protocol (PP) outcomes between the two groups. Additionally, PWIDs were significantly younger (p < 0.001) and had higher rates of psychiatric disorders (p < 0.001), alcohol abuse (p < 0.001), and HCV genotype 1a (p < 0.001). Advanced fibrosis was predictor of PP treatment failure among PWIDs, while mood disorders and alcohol use disorder were associated with interruptions before the scheduled completion time. For non-PWIDs, older age and advanced fibrosis emerged as key predictors of PP treatment failure. The loss to follow-up was most commonly observed in the problematic PWID subgroup (p = 0.001). These findings highlight the importance of addressing barriers in PWIDs through integrated care strategies that concurrently manage addiction and HCV. © 2024 by the authors.

People who inject drugs (PWIDs) experience high rates of hepatitis C virus (HCV) infection, primarily due to needle sharing and limited healthcare access, resulting in a disproportionate disease burden within this population. This prospective study evaluated treatment outcomes in 432 adult patients with chronic hepatitis C (CHC) treated with direct-acting antivirals (DAAs) at the University Clinical Center of Serbia. Patients were categorized into two groups based on a history of drug addiction: PWIDs (163, 37.7%) and non-PWIDs (269, 62.3%). The PWID group was further categorized into subpopulations of problematic PWIDs (39, 23.9%), ex-PWIDs (124, 76.1%), and PWIDs on OST (96, 58.9%). The PWID group demonstrated significantly lower treatment adherence, with an intention-to-treat (ITT) rate of 82.8%, compared to 96.3% in the control group (p < 0.001). In contrast, no significant differences were observed in per-protocol (PP) outcomes between the two groups. Additionally, PWIDs were significantly younger (p < 0.001) and had higher rates of psychiatric disorders (p < 0.001), alcohol abuse (p < 0.001), and HCV genotype 1a (p < 0.001). Advanced fibrosis was predictor of PP treatment failure among PWIDs, while mood disorders and alcohol use disorder were associated with interruptions before the scheduled completion time. For non-PWIDs, older age and advanced fibrosis emerged as key predictors of PP treatment failure. The loss to follow-up was most commonly observed in the problematic PWID subgroup (p = 0.001). These findings highlight the importance of addressing barriers in PWIDs through integrated care strategies that concurrently manage addiction and HCV. © 2024 by the authors.

Background/Aim. The reactivation of the varicella zoster virus results in herpes zoster. Acyclovir is currently recommended over 7 to 10 days for herpes zoster treatment and should be started within 72 hours of rash eruption. This study analyses whether a therapy delay and/or shorter courses of treatment are associated with adverse outcomes. Methods. We identified 292 patients treated at the Clinic for Infectious and Tropical Diseases in Belgrade for herpes zoster in a five-years period. The data on these patients were analyzed using the descriptive statistics, the χ2 test, the Mann-Whitney U-test and the multiple logistic regression analysis. Results. The average time from rash eruption to the first dose of acyclovir was 4.07 ± 2.64 days. The patients received acyclovir for 6.83 ± 2.45 days. Seventy-one patients had disseminated herpes zoster, 100 had cranial nerve involvement, 86 had complications other than postherpetic neuralgia and one patient died. In cases where therapy was delayed there was no significant association with complications (χ2 = 0.031; p = 0.86). Our logistic regression model was not able to predict who was treated less than 7 days. An association between the HZ complications and abbreviated acyclovir regimens was not demonstrated (χ2 = 1.109; p = 0.326). We conducted the PubMed search on February 1st, 2017 and found no proof for the need to apply at least 7 days of acyclovir therapy for herpes zoster in the studies that have been published so far. Conclusion. We were unable to prove an association between therapy delay and unfavorable outcomes. The same was true for shorter than recommended acyclovir courses. © 2019 Inst. Sci. inf., Univ. Defence in Belgrade. All rights reserved.

Introduction: We aimed to describe neurological manifestations and functional outcome at discharge in patients with West Nile neuroinvasive disease. Methods: This retrospective study enrolled inpatients treated in the University Clinic for Infectious and Tropical Diseases in Belgrade, Serbia, from 1 June until 31 October 2022. Functional outcome at discharge was assessed using modified Rankin scale. Results: Among the 135 analyzed patients, encephalitis, meningitis and acute flaccid paralysis (AFP) were present in 114 (84.6%), 20 (14.8%), and 21 (15.6%), respectively. Quadriparesis/quadriplegia and monoparesis were the most frequent forms of AFP, present in 9 (6.7%) and 6 (4.4%) patients, respectively. Fourty-five (33.3%) patients had cerebellitis, 80 (59.3%) had rhombencephalitis, and 5 (3.7%) exhibited Parkinsonism. Ataxia and wide-based gait were present in 79 (58.5%) patients each. Fifty-one (37.8%) patients had tremor (41 (30.3%) had postural and/or kinetic tremor, 10 (7.4%) had resting tremor). Glasgow coma score (GCS) ≤ 8 and respiratory failure requiring mechanical ventilation developed in 39 (28.9%), and 33 (24.4%) patients, respectively. Quadriparesis was a risk factor for prolonged ventilator support (29.5 ± 16.8 vs. 12.4 ± 8.7 days, p = 0.001). At discharge, one patient with monoparesis recovered full muscle strength, whereas 8 patients with AFP were functionally dependent. Twenty-nine (21.5%) patients died. All of the succumbed had encephalitis, and 7 had quadriparesis. Ataxia, tremor and cognitive deficit persisted in 18 (16.9%), 15 (14.2%), and 22 (16.3%) patients at discharge, respectively. Age, malignancy, coronary disease, quadriparesis, mechanical ventilation, GCS ≤ 8 and healthcare-associated infections were risk factors for death (p = 0.001; p = 0.019; p = 0.004; p = 0.001; p < 0.001; p < 0.001, and p < 0.001, respectively). © 2023, Fondazione Società Italiana di Neurologia.

This study, conducted at two university-based infectious disease clinics, included 216 patients with chronic hepatitis C. The primary objective was to assess the positive and negative predictive values, sensitivity, and specificity of achieving a sustained virological response (SVR) at 4 weeks compared to 12 weeks post-therapy. The results demonstrated a maximum sensitivity of 100% for achieving SVR at 12 weeks after reaching SVR at 4 weeks for all analyzed genotypes, except for genotype 1b treated with EBR/GZR therapy, where the specificity was 75%. Additionally, younger age and less advanced liver fibrosis were identified as independent predictors of achieving a sustained virological response at both 4 and 12 weeks. The significant normalization of various biochemical parameters was observed after treatment, indicating an overall improvement in liver function. This study suggests that shortening the monitoring period to 4 weeks might be effective for younger patients without significant fibrosis, potentially reducing loss to follow-up, which is a critical issue in HCV treatment. These findings align with the “test and treat” approach. Further research is needed to confirm these findings and incorporate them into official guidelines, which could simplify and enhance the effectiveness of HCV treatment protocols, aiding global efforts to eliminate HCV as a public health issue by 2030. © 2024 by the authors.

This study, conducted at two university-based infectious disease clinics, included 216 patients with chronic hepatitis C. The primary objective was to assess the positive and negative predictive values, sensitivity, and specificity of achieving a sustained virological response (SVR) at 4 weeks compared to 12 weeks post-therapy. The results demonstrated a maximum sensitivity of 100% for achieving SVR at 12 weeks after reaching SVR at 4 weeks for all analyzed genotypes, except for genotype 1b treated with EBR/GZR therapy, where the specificity was 75%. Additionally, younger age and less advanced liver fibrosis were identified as independent predictors of achieving a sustained virological response at both 4 and 12 weeks. The significant normalization of various biochemical parameters was observed after treatment, indicating an overall improvement in liver function. This study suggests that shortening the monitoring period to 4 weeks might be effective for younger patients without significant fibrosis, potentially reducing loss to follow-up, which is a critical issue in HCV treatment. These findings align with the “test and treat” approach. Further research is needed to confirm these findings and incorporate them into official guidelines, which could simplify and enhance the effectiveness of HCV treatment protocols, aiding global efforts to eliminate HCV as a public health issue by 2030. © 2024 by the authors.

Legionella pneumophila is a rarely diagnosed microorganism in Serbia. It causes legionellosis, usually a mild respiratory infection. However, in some cases it can be severe and even life threatening. In June 2020, during the COVID-19 pandemic, a patient with symptoms of the aforesaid infection, namely severe pneumonia and acute respiratory distress syndrome, was admitted to the hospital. The multiplex polymerase chain reaction (PCR) test (The BioFire FilmArray Pneumonia Panel plus) detected the presence of L. pneumophila in the patient’s bronchial secretions. The specific culture for the detection of that organism, however, remained sterile. The patient’s paired sera had been sent for serology and the results in both of them came back positive for Legionella spp. 1–6, while the assays specific for each one of the 10 serogroups detected more than a fourfold increase of antibody titers in an uncommon serogroup 2 only. The patient was treated with moxifloxacin; he recovered well and was discharged after 26 days of hospitalization. Having being diagnosed with the L. pneumophila infection correctly through the multiplex PCR test, the patient was given the right therapy with moxifloxacin. The serologic assays corroborated this result and revealed the uncommon group 2, thus confirming the necessity of carrying out all the tests available to attain the exact diagnosis of legionellosis. © The Author(s) 2022.

Legionella pneumophila is a rarely diagnosed microorganism in Serbia. It causes legionellosis, usually a mild respiratory infection. However, in some cases it can be severe and even life threatening. In June 2020, during the COVID-19 pandemic, a patient with symptoms of the aforesaid infection, namely severe pneumonia and acute respiratory distress syndrome, was admitted to the hospital. The multiplex polymerase chain reaction (PCR) test (The BioFire FilmArray Pneumonia Panel plus) detected the presence of L. pneumophila in the patient’s bronchial secretions. The specific culture for the detection of that organism, however, remained sterile. The patient’s paired sera had been sent for serology and the results in both of them came back positive for Legionella spp. 1–6, while the assays specific for each one of the 10 serogroups detected more than a fourfold increase of antibody titers in an uncommon serogroup 2 only. The patient was treated with moxifloxacin; he recovered well and was discharged after 26 days of hospitalization. Having being diagnosed with the L. pneumophila infection correctly through the multiplex PCR test, the patient was given the right therapy with moxifloxacin. The serologic assays corroborated this result and revealed the uncommon group 2, thus confirming the necessity of carrying out all the tests available to attain the exact diagnosis of legionellosis. © The Author(s) 2022.

Introduction Toxic liver injury is becoming greater problem in today´s hepatology. Until today more than 900 drugs, toxins and herbs have been identified that can cause different liver injury. There was no significant research of this problem in Serbia so far. The aim of this study is to present the patient with severe form of acute hepatitis, whose etiology is exclusively toxic. Case outline A 23-year-old male, from Belgrade, previously healthy, got sick with signs and symptoms that correlated with acute hepatitis. Biochemical analyses pointed to severe form of acute hepatitis with impending hepatocellular failure. The diagnosis of toxic liver injury was set. It was caused by the use of number substances and supplements: Ecstasy, whey protein, branched-chain amino acid (BCAA), creatine, high doses of vitamin D, glutamine, and multivitamin complex. He was treated with infusion, gastroprotective, and substitution therapy. During hospitalization, the patient’s symptoms disappeared with gradual normalization of biochemical analyses of the liver. When the patient’s condition was satisfying, blind percutaneous liver biopsy was performed, with the following pathohistological findings: Lobular hepatitis, with no fibrosis, etiology correlates to toxic. After a month and a half since the disease had begun, the patient fully recovered. Conclusion Increased number of persons with toxic liver injury is being registered in developed countries worldwide. Similar trend can be noted in Serbia as well. By presenting young previously healthy man with the severe form of toxic acute hepatitis and impending liver failure, we are pointing out the significance of this problem. Multidisciplinary approach is needed to reach the most effective solutions. © 2019, Serbia Medical Society. All rights reserved.

Introduction Acute liver failure is a rare and very complex clinical syndrome, a consequence of sudden and severe liver dysfunction. There are several causes of this condition (viruses, medications, toxins, metabolic, autoimmune and malignant diseases), but etiological agent often remains undiscovered. Case outline A 40-year-old male patient had suddenly taken ill with signs and symptoms of acute hepatitis, which was confirmed through biochemical analyses. The cause of acute liver failure was not determined. Despite all therapeutic measures, the clinical course of the disease was unfavorable: severe icterus, decreased synthetic function of the liver and hepatic encephalopathy developed. In the later, subacute course of the disease, ascites and episodes of hepatic encephalopathy developed, and biochemical findings indicated chronic hepatocellular failure. After three months of treatment in hepatic coma there was lethal outcome. Histopathological findings confirmed the diagnosis of decompensated liver cirrhosis of unknown origin. Conclusion The cause of acute liver failure often remains unclear; potential causes should be looked for in infections by unknown viruses or in exposures to toxins. The disease is most commonly presented as a subacute failure with the development of liver cirrhosis. Survival rate is low. © 2018, Serbia Medical Society. All rights reserved.